the descent of the diaphragm to suck the blood from the vena cava into the heart, at the same time making firm pressure on the abdomen to prevent regurgitation and help circulation.

DR. CARSTENS: I think that DR. SHURLY stated the case correctly. I believe chloroform is given often where it is not absolutely necessary, but there are some neurotic cases in which the chloroform is of great advantage. Also when the perineum is very rigid chloroform should be administered, thus allowing it to gradually stretch and permitting the head to slowly sweep out. Only in such cases, in turning, and in instrumental delivery, is chloroform necessary. There seems no doubt that the general relaxation of all the tissues from the chloroform cause post-partum hæmorrhage.

DR. DELOS PARKER: Do you think a small amount of chloroform is not of advantage? Small doses will give very good results. Three or four inhalations are sometimes enough to very much blunt the agony of the ordeal.

DR. BECELAERE: These cases which are apparently benefitted by such small doses receive their benefit from the fact that the patient's mind is diverted. If you make up your mind to use chloroform in obstetrics give it to full surgical effect.

REPORT OF CASES.

DR. TAPPEY: The case of purpura which I reported two weeks ago made a good recovery. A man came under my observation recently who had knocked the skin off his knuckles and he took the fat from a dead cow and bound his fingers up. Swelling of the fingers followed and a purpura appeared upon the other hand. Later on it appeared upon the other hand. Then upon the ears, the nose, ankles, knees and elbows, also upon the mucous membranes of nose, mouth and throat, There was not much constitutional disturbance. Was the purpura a consequence or merely a coincidence.

DR. E. L. SHURLY: The whole morbific action was confined to the skin. I did not known that the fatty acids could produce this condition of diapedesis. This case may throw some light on the pathology of purpura hæmorrhagica. This is a very striking illustration of the cutaneous structures.

DR. CARRIER: There is no evidence that there was not an internal hæmorrhage. DR. SHURLY: If there had been any parenchymatous effusion it would have been indicated by some constitutional symptoms.

DR. CARRIER: There may have been an effusion into the muscles.

DR. SHURLY: We do not have the same perivascular spaces in the muscles as in the skin.

DR. CARRIER: It is now said that purpura hæmorrhagica is due to a microbe. There is at the present time an extremely interesting case of purpura in the hospital.

DR. SHURLY: It is a well-known fact that the hypodermic injection produces a marked fluidity of the blood and in this case some free fatty acid or fatty alcohol may have been set free in the blood producing a very similar effect.

DR. CARSTENS: The fact that the lesions are symmetrical would indicate that the trouble was central, although it had a local starting point.

DON. M. CAMPBELL, M. D., Secretary.

STATED MEETING, MAY 9, 1892.

THE VICE-PRESIDENT, B. P. BRODIE, M. D., IN THE CHAIR.

PATHOLOGICAL SPECIMENS.

DR. GEO. DUFFIELD presented an omentum of a patient who had presented the following clinical history: A good deal of pain round about the navel, chronic diarrhoea, undigested food in the stools. A great deal of ascites. The fluid was removed several times and re-accumulated. The case had been diag nosed sarcoma. Post-mortem examination-abdomen tense, three pints of fluid in the abdominal cavity. The abdominal walls were free and healthy. The omentum was hard, white, free and stiff, and the seat of the disease. Some few adhesions were found and an occasional spot of ulceration. Looked like malignant sarcoma. The abdominal cavity was filled with small nodular lumps and the intestines were infiltrated to such an extent as to almost obliterate their calibre. Microscopically the growth was found to be a carcinoma.

DISCUSSION OF PAPERS.

DR. J. NEWELL read a paper entitled "Large Doses of the Acetate of Lead in Hæmorrhage."

cases.

DR. J. A. WINTER: I am much interested in the doctor's paper and will cer tainly put his principles of administration of the drug into practice in suitable The books do not deal largely with the acetate of lead. Five grains is given in text-books as the maximum dose. It is supposed to enter the blood as an albuminate and is slowly eliminated; that thrown off by the bile is re-absorbed, then again eliminated by the mesenteric glands, and finally thrown off in the alvine dejections as a sulphide. I would think it to, be a good uterine hæmostatic. It is very slowly eliminated which perhaps is the reason its action lasts so long.

DR. DELOS PARKER: Did you ever use it in ulcer of the stomach?

DR. NEWELL: No. It might be good but perhaps would be a little irritating. DR. BRODIE: If the bowels do not move do you have any bad effects? DR. NEWALL: No. I never give a cathartic and never have had any bad results.

DR. BECELAERE: How do you account for the action of the drug?

DR. NEWELL: The action of the drug is too rapid to be accounted for through the medium of the circulation. It acts through the vaso-motor nervous system, on the capillaries and small blood-vessels.

DR. STEINBRECHER: I have given it in five grain doses to control the hæmorrhages of typhoid fever. I would like to ask the doctor if he ever employed it in that disease?

DR. NEWELL: I have never given it in typhoid fever and I am not very confident of the action of any drug in the hæmorrhages of typhoid fever.

DR. BECELAERE: Is there a specific action on the uterine muscle? DR. NEWELL: It does produce contraction in uterine hæmorrhage. DR. F. W. MANN: The physiological action of the acetate of lead is on the peripheral organs as seen in lead palsy and its hæmostatic action is from its effects upon the peripheral blood-vessels. The mineral are better than the vege

table styptics as shown by this drug, but the physiological styptic of the future may be better than any. Recently a solution of fibrin-ferment in calcium. chloride has been proved a very efficient styptic. Many physiological experiments have been made which indicate that it may have a wide field of use in hæmophilia, hæmatemesis and kindred conditions.

DON. M. CAMPBELL, M. D., Secretary.

EDITORIAL ARTICLES.

THE AMERICAN MEDICAL ASSOCIATION.

THE American medical association has held few annual meetings that can rank in point of success with the meeting recently held in Detroit. The attendance, which comprised some of the most eminent names in American medicine of to-day, was exceptionally large. For the first time in the history of the association the members found two full working-sessions in operation in the sections of the association. This gave distinct prominence to the scientific objects of the gathering and tended to purge the association of the imputation under which it has not always unjustly rested,—the imputation of frittering away its time in foolish and debilitating deliberations, in wire-pulling practices, and in fractious bickerings upon ethical or pseudo-ethical subjects.

Ethical disputes were not entirely excluded from the attention of the Detroit meeting. The question, as to whether a member of the New York state medical society, who, previous to the schism of that body from the association had been. a member of the association, could remain such, was settled perhaps, under the circumstances, in the only way it could be settled. Principles should be maintained, although, when the report of the judicial committee in the case of Dr. Potter came under consideration, the sentiment of a large number of the association would have been in favor of straining a point in favor of more liberal doctrine. However, it is anticipated that good will come out of this occurrence, and some better understanding result from the conference to be held between representatives of the American medical association and the New York state. medical society.

The preeminent success of the Detroit meeting in both its scientific and social aspects augurs well for the future of the association. A new spirit is moving over the face of the turbulent waters of the association's past. In a few years the dominion of old fogyism will be broken. The new policy of the association will not be moulded upon the estimable ideals of a past generation, but will be brought into closer relationship with the present needs and necessities of professional life. There is no good reason why the association should continue its present laissez faire existence, coming together but once a year, then separating and wielding no further influence over the profession save that exercised by its journal. The association need not pattern its existence on that of a century-plant, whose life between its infrequent inflorescences is one of passive viridity. The association should be bearing fruit all the year round. In order to do this important reforms must be effected. In addition to a well paid secretary or chief executive officer of preeminent ability who should command a

salary of five or six thousand dollars per annum, there should be a number of deputation secretaries whose duty it should be to represent the parent association at all meetings of state medical societies. These secretaries should be engaged in active missionary work; they should advocate the uses and advantages of organization as a means of advancing professional interests; they should organize state societies into effective branches of the parent association, and enlist all the members of these societies as active members of the association. With some well-considered scheme of this kind there would be no reason why the American medical association should not consist of fifty thousand members. Possessing, as such a body undoubtedly would, the best medical journal in the world, there would be no reason why the association should not wield a power for good over the professional life of the country such as no other body could ever hope to exercise.

Every visitor to Detroit departed full of admiration for the beautiful city of the straits, praising highly the hospitality of its citizens, so amply shown in the sumptuous entertainments they provided, and bearing grateful testimony to the excellence and completeness of the arrangements made by the local profession for their reception.

The local profession, in turn, thank their guests for their presence and bid them very heartily come again.

EDITORIAL BREVITIES.

THE INSANE IN EGYPT.

DR. PETERSON contributes to the Medical Record an interesting article on the insane in Egyyt. The population of the state of New York is about six millions, the same as Egypt, so that interesting comparisons can be made. New York represents the newest civilization, Egypt the oldest. New York has about sixteen thousand insane under public care, Egypt has only one asylum situated at Cairo with two hundred and fifty inmates. The Koran's prohibition of the use of alcohol, is considered to cut off one of the most fertile causes of insanity. It is curious that out of the two hundred and forty-eight patients in the asylum at Cairo, Dr. Peterson found sixty-four cases to be due to haschisch intoxication.

AMERICAN ACADEMY OF MEDICINE.

PRIOR to the meeting of the American medical association, the American academy of medicine held its annual reunion. The academy aims to leaven the profession of America with the influences born of academic training. As yet the academy has not been an influential body, the methods whereby its members are selected not securing for it, the support of the influential men of the profession. The degrees of A. M., or B. A., are like that of M. D., they may mean anything or nothing. The one may mean that its possessor cannot speak grammatically just a much as the other may mean that its possessor does not know the origin and ramifications of the pneumogastric nerve. The aim of the academy is a laudable one-to elevate the educational standard, but to be an influential body, it must have something more than good intentions, as these alone lead nowhere in particular. Let the academy fill its ranks with the emi

nent in medicine, even though they, like the greatest of poets, know "little of Latin and less of Greek," and it will soon become a body, from which will emanate all that gives tone and influence to the profession.

AMERICAN MEDICAL EDITORS.

ONE of the pleasantest events of the late meeting of the American medical association, was the princely banquet given by Mr. Geo. S. Davis to the medical editors of America. The medical editors are a bright body of men, and the after-dinner orations were singularly full of wit and pleasantry. Mr. Davis has added another obligation to the citizens of Detroit, in thus giving to these scribblers from remote parts, so pleasant an impression of the city of the straits.

BLOOD DISTRIBUTION IN THE SEXES.

ONE of the strongest morphological arguments, made by Sir James CrichtonBrown, in his oration on sex in education, in establishing the physiological basis of distinctive differences in the emotional and intellectual constitution of the sexes, was that drawn from a comparison of the relative sizes of the arteries governing the cerebral circulation. The distribution of the blood to the brain, in the two sexes, differs considerably. The internal carotid arteries with their branches, the anterior and middle cerebral arteries, supplying the supra-orbital convolutions, the island of Reil, the gyrus fornicatus, the Rolandic area, the angular gyrus, and the first temporo-sphenoidal lobule were much larger in the male than in the female brain. In the female, however, the vertebral arteries and the basilar were much larger. The region of the brain best supplied with blood in the male, were the anterior lobes, while the region best supplied in women were those presiding over the sensory functions.

THE VALUE OF MEDICAL SERVICES.

A LAWSUIT recently tried in New York City to some extent gives the law's opinion on the value of professional services. Dr. W. M. Polk brought suit for services rendered by his business associate, Dr. Barrows. He was consulted in a case of fever and was absent ten days, having to travel to Atlanta. A bill was presented for two thousand five hundred dollars, virtually valuing the services rendered at two hundred and fifty dollars per day. New York physicians testified that the charges were not excessive. The Atlanta physicians deposed that fifty dollars a day would be a suitable recompense. A verdict was reached only after much debate, and this awarded one thousand five hundred dollars to the plaintiff, which is equivalent to saying that a physician's full time is worth one hundred and fifty dollars a day or six dollars an hour.

MEDICAL NEWS.

ARIZONA has now a state medical association.

DR. W. G. HENRY, of Detroit, was married June 1.

THE British medical association meets in Nottingham, July 26, 27, 28, and 29. ABUSE OF CHARITY.-It is stated that two-thirds of the people who go to the Vanderbilt clinic in New York, give fictitious names and addresses.