perfectly safe for the children to return to school after the disease is over; that must be decided somewhat from the severity of the attack. If the disease has been at all a malignant one it will be safe to say that three weeks should pass, after the child that has been sick, has completely recovered, before any other children of the household should be allowed to attend school.

This gives ample time for the possibility of the disease to manifest itself in any other member of the family.

It would be most unwise to allow children to attend school before we have had sufficient opportunity, and time, to discover whether the disease is in their systems, even if they have not come down with it themselves.

There is a difference of opinion as to the communicability of whooping-cough, by children carrying it to school.

While I do not think the disease can be carried in the clothing like small-pox, yet from some cases that have recently come under my notice, I am inclined to think that one child may carry the disease to another previous to the cough being recognized in the one who has been the means of spreading it.

Many parents need to be informed of the great necessity for strictly carrying out these rules for the prevention of contagious diseases; and circulars should be issued, by all school boards, and distributed free every season, stating the reasons for these rules, as a matter of self-protection. One of the most desirable advances is the appointment, in all our large cities, of a medical inspector.

A lady should be appointed to examine into all cases where the female pupils are not able to attend school, also to see whether there are any girls in a condition unfit to attend to their school duties, and if there are, have them sent home until sufficiently recovered for them to return. to their studies without any danger to health.

Such a plan as this is now in operation in some of the eastern states, and also in Paris, where a young woman, having a medical education, has been appointed medical inspector. Her duties are to see that the girls are not overworked, and that they perform their tasks under the

best sanitary conditions possible. This is a good step forward in the direction of practical school sanitation. In most localities attendance upon school is inforced at certain periods when the girls should be privileged to remain at home; and to accomplish this most desirable end I would earnestly recommend that each Board of Education should appoint a suitable lady medical officer, with specific duties for the district under her supervision.

What we are aiming at is to have the girls grow up into strong, healthy, educated women, and many suggestions can be given to the mothers by the visiting medical officer, that will materially help to bring about this desirable end.

Woman's sphere should yet be enlarged, her occupation in many departments ought to be better remunerated, and her education ought still to be further perfected in her special lines of duty; but education that tends to injure her should be avoided, since instead of rendering her strong, capable and more self-reliant, it is calculated by misdirection to make her weak, incapable and helpless, during the years of her life when she most needs strength.

In some districts, also, a physician might advantageously be appointed as medical examiner to look after the boys, and decide all doubtful cases of contagious diseases. As already stated boys need special instruction particularly adapted to their future mode of life.

Educated mechanics is the present and future need of the country, and while it may be beyond our power to improve the education of those men already in the labor field, it should be the aim of all school boards so to direct the course of studies that all boys leaving our public schools may grow up into intelligent healthy manhood. Then may end all strikes.

There is great need that all boys, particularly, be carefully and thoroughly instructed as to the physiological effects of alcohol upon the human organism. With proper and careful instruction as to the scientific use of alcoholic liquors much of the abuse that now prevails may be prevented. The only sure and certain remedy is a more general diffusion of hygienic knowledge.

SURGERY.

SURGICAL NOTES.

J. G. GILCHRIST, M. D., Iowa City, Ia., EDITOR.

ORIFICIAL SURGERY.-E. H. Pratt, M. D., Chicago. W. T. Keener, pp. 141, $1.00. This little manual is one of the most original in its subject-matter that has appeared in many a day. There can be no question that the writer has developed a great fact, one that has hitherto had very insufficient attention given it: at the same time is this not a little "strong," to put it mildly? "In all pathological conditions, surgical or medical, which linger persistently in spite of all efforts at removal, from the delicate derangements of brain substance that induce insanity, and the various forms of neurasthenia, to the great variety of morbid changes repeatedly found in the coarser structures of the body, there will invariably be found more or less irritation of the rectum, or the orifices of the sexual system, or both. In other words, I believe that all forms of chronic diseases have one common predisposing cause, and that cause is a nerve-waste occasioned by orificial irritation at the lower openings of the body." No one who has witnessed the acute local suffering and reflex disturbances occasioned by rectal fissures, urethral caruncle, and the like, can question the fact that serious disturbances of health can originate in these intrinsically trivial lesions, but at the same time, there are few, I think, who would be willing to accept the Doctor's exceedingly broad statement without essential modification. The clinical reports appended are of interest and value, and will scarcely fail to direct the attention of all practitioners to this sadly neglected field; nevertheless, it is equally certain, that the Doctor's methods and theories will undergo considerable change in course of time, leaving enough to entitle him to the thanks of the fraternity. Of course radicalism and enthusiasm are necessary, in all departments of human thought and action, but it is not that qual

ity which survives; it is the conservatism growing out of these that remains. The Doctor, moreover, should strive to find some terms to take the place of "force of the circulation" and the like, which are not pleasant to professional ears. There can be no question that the practitioner who fails to avail himself of Dr. Pratt's work, will rob his patients, very often, of a restoration of health and comfort; those who are wise enough to buy his book, and practice his methods, will surely have occasion often to make humble acknowledgments to him for a truly invaluable assist

ance.

PENETRATING GUN-SHOT WOUNDS OF THE ABDOMEN.One of the most concise and yet eminently classical papers on this subject, was read by Dr. Nancrede of Philadelphia, at the annual meeting of the American Surgical Association, May, 1887 (Ann. Surg. June, 1887). The writer is eminently qualified to speak with authority, as apart from his high standing as a surgeon, he was the first in this country, probably, to propose laparotomy in the treatment of such injuries. It seems but yesterday when a perforating gun-shot of the abdomen, or indeed any of the great cavities, was considered to be an accident from which recovery was not to be expected, more particularly if one or more of the viscera was injured. Now quite a different significance attaches to such accidents, at the same time those who are not fully informed are quite prone to give a far too favorable prognosis. Unquestionably a perforating wound of the abdomen, involving the viscera, is quite certain to result in death if treatment is purely expectant; but the fatal result may be precipitated by a laparotomy, if cases are not selected, and the operator is not fully competent. Death may be caused by shock, hæmorrhage, both combined, or peritonitis. Dr. Nancrede thinks hæmorrhage and shock, in many cases, may be considered cause and effect. At all events, those who have had much to do with surgery, know how difficult it is, at times, to differentiate hæmorrhage from shock, and more particularly when both are co-existent, to determine which assume greater

prominence: certainly when hæmorrhage is evidently active, laparotomy and ligature of the source of the bleeding are primary and imperative indications, so much so that any surgeon, even if of moderate attainments and experience, would scarcely be justified in pursuing a merely expectant policy. Our writer says, however: "When a skilled operator cannot be secured, in exceptionally favorable cases the attempt may be made and succeed, but most cases will do better left to nature, than operated on by a bungling surgeon.' This is true in every word, from an old school point of view, and to some extent from a homoeopathic. But the success of an operation by old school practitioners very largely depends upon the skill of the operator, and the consequent care and thoroughness with which all details are carried out, with little if any attention to medicinal treatment, not, however, from a depreciation of its value, but from want of therapeutic knowledge. How different from our standpoint! We do not by any means ignore operative skill, and careful manipulation, but our resources are so extensive in therapeutics, that often inferior surgeons secure surprising results, under circumstances where the old school practitioners would expect certain failure. I know this sounds "quackish," and perhaps is not in good taste, but a somewhat extensive experience in abdominal surgery enables me to state with the utmost positiveness that good after-treatment will often more than atone for poor or indifferent operative work. Arnica should always be given after such operations as we are now considering, and Arsenic takes its place when the first symptoms of septicæmia are observed. With these two agents alone results will be obtained far more brilliant than the best of those who have not, or will not have-such potent agencies at hand. Good surgery is of course to be desired, but good therapeutics will often give a result that the best surgery could not hope for or expect.

THIN-WALLED CYSTS.-Dr. R. F. Weir (Ann. Surg., June, 1887) in speaking of operations on bursal cysts, relates the following: "Extirpatian of a sub-hyoid bursa. The tumor