abortion and those who violated the poison laws, and was in favor of such legislation as would prevent the sale of proprietary medicines containing morphine, chloral, and other injurious drugs.

Karl T. Webber said that one of the chief difficulties in securing convictions, especially under the criminal practice act, was the conflicting testimony of physicians themselves; as it often occurred that the testimony of one set of witnesses would be contradicted by that of others, and that he had noticed that the physicians of one school of practice would often testify against those of another. He thought an important step would be gained in the enforcement of such laws if physicians themselves would be more united. He thought the officers stood ready to enforce all legislation pertaining to matters of public health.

Horace Ankeney said that the laboratories of the Dairy and Food Commissioner ought always to be available for the purpose of determining the composition of drugs and the adulteration of foods; and that he believed that there should be stringent laws regulating the sale of proprietary medicines containing morphine, chloral, and other injurious drugs, and preventing the sale of impure foods. In the administration of his office he has tried to enforce the present laws, but knew them to be very defective.

Dr. Brown said that the dental profession would, so far as it could, co-operate with the medical in securing needed legislation in behalf of public health.

Dr. Hunt said that the Homeopathic physicians of the State could be counted on to assist in securing better legislation.

Regular Meeting, October 15, 1906.

Members present 37. Pathologic specimen of an Acephalus Monstrosity presented by Dr. J. F. Baldwin.

Dr. A. M. Steinfeld read a paper cn "Congenital Dislocation of the Hip."

Dr. W. J. Means reported a case of traumatic stricture of the esophagus following the drinking of nitric acid with suicidal intent.

OBSTETRICS FOR NURSES. By Joseph B. DeLee, M. D., Professor of Obstetrics in the Northwestern University Medical School, Chicago. Second Revised Edition. 12mo of 510 pages, fully illustrated. Philadelphia and London: W. B. Saunders Company, 1906. Cloth, $2.50 net.

In this new book Dr. DeLee presents a work of the greatest value, not only to the nurse, but also to the practitioner, upon whom the duties of a nurse often devolve in the earlier years of his practice. It is almost a text-book of itself on this important subject. In fact, if a criticism were offered, it would be that it is too elaborate. When it is taken into consideration, however, that the book will go into the hands of the nurse as well as the practitioner, no objection to the completeness of the text can be made.

THE AMERICAN ILLUSTRATED DICTIONARY. All the terms used in Medicine, Surgery, Dentistry, Pharmacy, Chemistry and kindred branches; with over 100 new tables. By W. A. Newman Dorland, M. D. Fourth Revised Edition. Octavo of 836 pages, with 293 illustrations, 119 of them in colors. Philadelphia and London: W. B. Saunders Company, 1906. Flexible Morocco, $4.50 net; thumb indexed, $5.00 net.

This popular dictionary needs no introduction to the profession. The present volume brings up the vocabulary of medical science to the present date. Over 2,000 new words have been defined and numerous improvements made throughout the text. Nearly every table has been considerably amplified. The pictorial features have been enhanced by the addition of colored plates. The volume is convenient in size, and having flexible leather binding, it makes a most attractive and useful desk dictionary.

DIET IN HEALTH AND DISEASE. By Julius Friedenwald, M. D.. Clinical Professor of Diseases of the Stomach in the College of Physicians and Surgeons, Baltimore; and John Ruhrah, M. D., Clinical Professor of Diseases of Children in the College of Physicians and Surgeons, Baltimore. Second Revised Edition. Octavo of 728 pages. Philadelphia. and London: W. B. Saunders Company, 1906. Cloth, $1.00 net; Half Morocco, $5.00 net.

The general practitioner and nurse will appreciate this book. Its aim is entirely practical. A concise account of the different kinds of food, their composition and use, is given, and also the principles of diet, both in health and disease, set forth. The greater part of the work is devoted to the sick, and an effort is made to tell the doctor how to feed his patient.

Clinical Lecturer on Diseases of Women and Abdominal Surgery, Lawrence Hospital.

Were it not for post-operative complications surgical mortality would be represented by a very small fraction of one per cent.

One of the greatest works we can do, therefore, is to study carefully and eliminate so far as practicable these complications from our work. Our efforts along this line can not be crowned with success unless we constantly ask ourselves why and frankly and thoroughly accept the lessons taught by our failure. That many of the complications might be averted by rigid scrutiny of our cases before operating and careful preparation for the same is doubtless true. The complications after operation, for convenience of study, may be grouped as immediate and remote. Some of these are liable to follow any surgical effort, while others can only follow operations in special regions. It will be impossible in a short paper to discuss thoroughly all the varied complications which may occur.

The immediate: Broncho-pneumonia; nephritis; peritonitis; sepsis; acute mania; secondary hemorrhage.

The remote: Stitch abscess; nonfebrile suppression of urine; intestinal obstruction; hematocele; sub-acute mania; hysteria; fecal fistula; hernia.

If we ask ourselves why we have a broncho-pneumonia following an operation we have at once suggested these factors in its production:

First. Direct irritation of bronchial glands and mucosa by the inhaled ether.

Second. Secondary irritation produced by excess of carbonic acid gas in large quantity of "residual air," the result of faulty methods of anesthetization.

Third. Irritation of sympathetic, causing contraction of small arteries and arterioles, favoring venous stasis by removal of vis a tergo.

Fourth. Shock of prolonged operations, lowering power of resistance to exposure.

Fifth. Improper care subsequent to operation during the period of reaction.

Sixth. Improper circulation due to faulty position during operation, as in the so-called Trendelenberg position.

It will be seen that of these causes practically all are almost, if not quite, preventable.

The method of administering anæsthetic and the judg ment of a skilled anæsthetist will do more than any one thing to prevent the direct injurious effects of the anæsthetic. There is one thought occurs to me in this connection which has probably not been given enough consideration, viz.: There is increased work placed upon the lungs and bronchial mucosa as a result of the blood being surcharged with carbonic acid gas during anæsthesia, and the call for increased elimination of urates because of diminished elimination through kidneys and bowels.

This increased eliminative effort may be of great import. This thought emphasizes the fact that pre-operative preparation of patient should never be omitted except in emergencies.

The same cause may be operative in the production of nephritis. I believe that the generally accepted theory of this condition is that it is due to direct irritation of epithelium lining uriniferous tubules. Against this is the fact, that in nearly all cases the Sp. Gr. of the urine is high while the quantity is small, showing that the excretion of solids is not so much interfered with as is the watery secretion. This would seem to point to the vascular portion of the kidney as the seat of primary trouble. The albumen being due to serum transudation. If this be the true state of affairs we have several things to learn anew about the treatment of those cases, not the least of which will be to keep in mind the part played by the sympathetic

in control of blood vessels. It may possibly be a just query, "Are we doing much to help eliminate these two complications by accepting without question the theory that they are entirely due to the anaesthetic?"

Is it not more than probable that faulty preparation and some error in after care may be equally responsible with the anaesthetic? These are complications which may occur after any operation, hence are of vital importance to all of us.

There is another form of suppression of renal function which, for want of a better description, I have called a febrile suppression of urine, i. e., without any evidence of inflammation. This condition is not of the immediate complications, but of those classed as remote. It comes on from five to ten days after operation, after a period of apparently normal excretion of urine which has been free from albumen. The patient has had normal temperature and pulse for several days and they remain normal until within a few hours of death, after patient is decidedly uræmic. One observation is that those patients are decidedly anæmic.

In one case, after a smooth progress for ten days, with pulse 68 to 72, temperature 98 to 98.6, there was sudden and complete suppression. Pulse remained full and good, at 70 to 76. Temperature below 99 for five days, during which time a total of 31 oz. of urine was secured by catheter. Her temperature then went to 103, she became comatose, and in less than four hours had a few slight twitches, but not decided convulsion, and died. A post mortem showed lobulated and cirrhotic kidneys. In this case a large number of examinations of the urine before and for a week following operation failed to show albumen. The microscope showed no casts until after the suppression, when in a small specimen by catheter a few hyaline casts were found.

Another case, patient 30, voided 53 oz. of urine in 24 hours preceding operation. No albumen, no casts. Five days succeeding operation urine averaged 27 oz. for each 24 hours. No albumen, no casts. Temperature ranging from 97.2 immediately after operation to 99.4 first 24 hours. From then to beginning of fifth day from 97.4 to 98.7, pulse 68 to 74. Complete suppression. The 24 hours preceding death pulse 66 to