with the instrument. The ease with which delivery was accomplished made me think very seriously in regard to the procedure so strongly advocated by some of always resorting to version when a face presentation with posterior chin is recognized before much or any descent has been accomplished, and I am inclined to the opinion that if I had a similar case to deal with I would act on that principle.

CASE VII. Case in the out-patient department of the free Lying-in-Hospital in charge of Drs. Utley and Arthur. Colored primipara, aged about 20. Lateral plane presentation, arm in vagina. Dr. Arthur called by students in charge of the case. Dr. Arthur turned without difficulty and brought down the arms. The head, however, caught at the brim. The uterus was not tetanic. but the head was large. Dr. Arthur having failed to deliver called Dr. Utley from the Hospital and the latter, after repeated efforts to deliver manually or by forceps to after-coming head,

THE EVILS OF NIGHT WORK FOR CHILDREN.-Sir James Crichton Brown, speaking on the subject of pursuing young children with lessons into their home life, says: "It seems to me high time for a declaration of rights on behalf of hepless clildren, and on behalf of future generations also, whom, if we are not careful, we shall load with a burden more grievous than the national debt a burden of degeneration and disease. I trust that some one of my medical brethren will bring this subject to the front and obtain an emphatic condemnation of home work' in the case of children under twelve years of age. I have encountered many lamentable instances of derangement of health, disease of the brain, and even death, resulting from enforced evening study in the case of young children, with the nervous excitement and loss of sleep which it so often induces, and I am fully persuaded that even when it does no perceptible injury to health, it is inimical to true progress. To pursue young children with lessons into their home

called me and my chief of clinic, Dr. K. B. Batchelor. The child was dead long before our arrival. The head was firmly impacted in the pelvis, occiput at symphisis, and chin in the hollow of the sacrum, brow impinging on posterior margin of brim. Wishing to avoid craniotomy, although the child was dead, we determined to try delivery by traction, rotation and the Veit-Smellie plan, supplemented by supra-pubic pressure. At first both Dr. Batchelor and myself could make no impression and we began to think craniotomy would be necessary. Finally, however, I making traction by the legs and jaw of the child and Dr. Batchelor making very vigorous pressure over the hypogastrium, the head passed the brim and was easily delivered at the inferior strait. Notwithstanding filthy surroundings and much manipulation the case resulted most successfully for the patient. The carefully kept chart showed no temperature above 99° F. and recovery was prompt and complete.

STERILIZATION OF CATHETERS.- Dr. Kutner (Druggist's Circular) advises exposing catheters to the action of hot steam as an efficient means of sterilization. Before one is introduced into the bladder an irrigation of the urethra must be made. For this purpose a four per cent. solution of boric acid is to be recommended. As a lubricant a borated glycerine he has found most serviceable. This is prepared by adding 146 grammes of anhydrous glycerine to 150 grammes of a four per cent. solution of boric acid; boric acid is then added to saturation.

THE green goods man who meets the unsophisticated granger at Jersy City, and adroitly manages by showing him a pile of paper with one good bill on top, and in return for this worthless trashs gets his little pile of hard earned cash, is not more subtle and designing than the medical sharp, generally a third rate graduate of some fourth class medical college, who hesitates on the brink of legitimate practice with its hard work and tiresome wait for a living, and prefers the more exciting life of the traveling man.

With his little knowledge of medicine brightened up on his specialties, he is able in a short time by practicing his little speech to so impress us country doctors with the idea that we are completely obsolete, and we wonder how in the world we ever managed to get along at all without the articles which this our benefactor brings right to our office, and is willing to sell to us so cheap

or on such reasonable terms that we cannot well afford not to have them.

He will even take our note, which flatters us, as no one about home cares to do that, promising to accommodate us with an extension when due if not suitable to pay, but we speedily receive notice from the bank that it has been left for collection with costs.

He

Beware of him, youn gman, or ere you have arrived at years of discretion, he will have your back office littered so full of useless trash that you will be compelled to do as a friend of mine has done. has built a large case covering one side of his office, in which he has stored the accumulation of a quarter of a century and calls it his green goods case.

With much self satisfaction he pilots each new green goods agent into this room and shows him his hoard. Then politely explaining to the astonished

agent that it is impossible for him to build greater cases and thus store more goods, he bows him out.

It took my friend twenty-five years and hundreds of dollars to arrive at this happy climax. That you may be able to circumvent this fiend is my object in reading this paper, but I fear I shall fail, for he is as cunning as the serpent, and we well, human nature is so weak.

He always flatters us about our splendid prospects or our being the leading man in the town, and of course we cannot be behind Dr. So-and-So, who did not hesitate to buy one on sight.

And then he always comes around with testimonials and copies of orders from the noted physicians and professors from the great medical centers. That settles it. We give our order and can hardly wait for an opportunity to try our wonderful acquisition. A case finally comes and the blamed thing don't work at all, or not as it did for the skillful agent. Then we swear off on all agents until the next time.

As to the above mentioned professors, I often wonder where they find room to store their accumulations of green goods, for of course they buy them. Does not the agent say so? And of course they do not get them for nothing in return for the testimonials by which we are hoo-dooed.

The twenty-five year green goods case to which I refer contains an array that helps to dazzle the eye of the rustic and impress him with the wonderful knowledge of his doctor, but the game is not worth the ammunition.

I am not able from memory to give you a full inventory of this miraculous case, but will attempt it and if I mistake not each one of you as I read will find duplicates of many articles men

tioned, and I also predict that all will not be found in the offices of the country doctor, but our more polished and astute brother of the city will be found to be particeps-criminis.

First it contains a set of patent splints alleged to be suitable for every possible fracture of the human frame, but never known to suit any case. You always

throw them aside and make one. Next comes that expensive fad in medicine about which none of us knows any too much, and we reaort to after exhausting the U. S. Pharmacopea — electricity. Batteries until you cannot resist. Batteries with wet cells, batteries with dry cells and batteries with no cells, but all of them sure to be out of order when your best paying nervous patient puts in an appearance for treatment.

Electricity is like woman in many respects, subtle, and just when you think you have her, it is gone and you cannot tell what's the matter.

But I must hasten on. Atomizers that cease to atomize after one or two usings, and vaporizers that never did vaporize, occupy an entire shelf; rubber goods long since dead and brittle from age, among which is found the ten dollar obstetrical bed-pan, that after two or three cases smells to Heaven, and calls up the ghost of old Anti-septis himself. These are on the list.

Combined surgical engines intended to aspirate any cavity in the human anatomy or wash out and irrigate stomach, bladder, uterus or frontal sinus, are found but long ere this have ceased to be able to pump water out of a bucket.

Obstetrical forceps made in shapes and forms that surely it would be no sin to worship. These in half dozen

EXCISION OF THE KNEE-JOINT.-Jonathan Hutchinson (University Medical Magazine), in writing on excision of the knee, makes use of these words: "Excision of the knee-joint has, I believe, with many surgeons fallen into almost complete disuse." He had four cases in private practice. Of these one died. of tetanus, but the other three recovered with firm anchylosis. He states that this is the complete record of his private

lots intermixed with gleaming speculums intended to view the interior regions, make a formidable array.

Abdominal supporters, ankle braces, bandage rollers, breast pumps, catheters, club-foot shoes, cupping glasses, dilators, douches, gags, inhalers, knot tiers, knock-knee apparatus, lancets, microscopes, milliampèremeters, nozzles, ophthalmoscopes, otoscopes, percussion hammers, pessaries, pile pipes, pocket batteries, repirators, scarificators, snares, stethoscopes, stomach pumps, stop cocks, stricture cutters, spinal braces, syringes, trumpets, trusses, water bags, wire cutters and wry neck apparatus, ad infinitum.

I never admired anyone so much as the green goods man, who in less than five minutes sold me a set of throat speculums. I have been looking for him ever since. When in his mouth I could see everything plainly from the orbicularis oris almost to the umbilicus, but every single patient I ever tried it on from that day to this ended in retching to such an alarming extent that I was glad if the anus retained its normal location.

But my time and your patience forbid that I should pursue this painful subject further, and I have but touched on a list that might contain many semipatent appliances and remedies that are literally forced on us unsophisticated medical men.

In conclusion, young man, be patient. After many years you will gain wisdom, also a large stock of medical green goods, which your administrators will sell to the junk shop.

But one other solution occurs to my mind at present-buy a gun.

cases; and he offers it as a valedictory contribution, for it is thirteen years since his last case, and he states that it is not likely he will ever do another; nor, perhaps, is it probable that complete excisions of this joint will ever again come into professional favor. It may serve, at any rate, to counteract any future tendency to speak depreciatingly of the final results of complete excision of the knee.

SOCIETY REPORTS.

THE CLINICO-PATHOLOGICAL SOCIETY OF WASHINGTON, D. C.

MEETING HELD APRIL 6, 1895.

Dr. D. O. Leech reported a CASE OF DIPHTHERIA TREATED SUCCESSFULLY WITH ANTITOXINE. The patient was a female, 2 years old. Schering's solution, 5 c.c., was given, followed by improvement. In twenty-four hours the injection was repeated, and was followed by a slight rise of temperature, but next day the temperature reached almost normal point again. A bacteriological examination was made between the first and second injections. Iron and potassium chlorate were used locally and constitutionally. Recovery at this date seems to be certain. The Klebs-Loeffler bacilli are still to be found in the cultures, four weeks after the beginning of the attack.

Dr. Dillenback saw two cases in his own practice treated with antitoxine. Six hours after the first injection of 10 c.c. improvement followed. This one injection was all that was used in each

case.

Dr. Bowen read his paper, PUERPERAL ECLAMPSIA WITH PLACENTA PREVIA.

Dr. D. O. Leech opened the discussion; he said that such cases were so rare that he had found no such complication recorded. He had seen but one case of placenta previa in his own practice. In this case tamponing of the vagina was followed by high forceps operation. The child was born dead but the mother

made a good recovery. He doubted if Dr. Bowen's case was one of puerperal eclampsia from uremia. Can placenta previa be diagnosed before the finger can be inserted into the os uteri? He thinks this would be difficult. Were there sufficient indications of placenta previa prior to the dilatation of the os? He thinks there were, although the positive point is the recognition by the finger. He thought the expectant plan of treatment in such cases was proper. The occurrence of puerperal eclampsia without any urinary derangement is rather doubtful.

Pla

Dr. Beatty saw no reason why the expectant plan in such cases should not be advocated, as it must be the popular idea among most of us. He had the misfortune to meet with two cases in his own practice, used the expectant plan of treatment with good results to mother, but both children died. centa previa occurs among our dispensary patients as a rule, and midwives often deliver such patients without the assistance of a physician. They do not seem to be frightened by hemorrhage occurring during labor. He thinks that Dr. Bowen might possibly have saved the child. The occurrence of convulsions with placenta is hard to explain in Dr. Bowen's case, as he found no kidney derrangement, and of course it could not have been uremic.

Dr. Mackall cited a case of puerpural convulsions in which the child was delivered after six or seven convulsions ; no albumen was found in the urine.

Dr. Dillenback read a paper entitled ATRESIA OF CERVIX UTERI IN A PREGNANT WOMAN.

In the absence of Dr. Glazebrook, Dr. Snyder was requested by the chair to open the discussion. He said he could scarcely understand how such a condition could be caused. The treatment by incision of the cervical portion of the uterus was good, but he would have been tempted to make an abdominal section.

Dr. Dillenback said in regard to Dr. Snyder's query as to the amount of ulceration about the cervix, and its subsequent condition, he found no difference from an ordinary lacerated cervix uteri. He thought that if he had diagnosed the case at his second visit he might have delivered a living child.

He does not agree with Dr. Snyder in regard to the abdominal section; incising the cervix seems to be both rational and easy, while it is much safer than section. In his case the cervix seemed to be obliterated from pressure, as the patient had been in labor fifteen hours. When the incision was made he did not know whether or not he was making the incision at the seat of the os uteri.

Dr. Snyder remarked that he was surprised that the cervix returned to its normal condition after the os had been so completely obliterated.

Dr. Dillenback thought they were lucky enough to make the incision in the line of the cervix uteri, because it did not tear, but seemed to dilate in the natural way. Subsequent treatment was used and the uterus washed out and applications made, showing that the opening was made at the natural site.

R. T. HOLDEN, M. D., Secretary.

MEDICAL PROGRESS.

INFLAMMATION OF THE UTERINE APPENDAGES.-Dr. Augustin H. Goelet of New York read a paper on this subject at the recent meeting of the American Medical Association at Baltimore, in which he stated that the contention was not that these inflammations of the tubes and ovaries can always be cured but that it is frequently possible and, unless immediate operative interference is absolutely demanded, the patient should be given the chance and the attempt should be made before submitting her to a radical operation. This he thought particularly important since treatment directed toward attaining this end did not militate against a subsequent operation for their removal should it become necessary, but, on the contrary, improved the chances of an ultimate successful result. He called attention to the fact that when once removed these organs cannot be replaced, and asked the question if it was not a serious error, in the light of recent developments in the etiology and pathology of the inflammations of the appendages, to remove these organs without previous attempt at a cure or removal of the cause which may be operating to maintain such condition. It may be denied that diseased tubes and ovaries are removed unnecessarily, but it must be admitted that they are too often removed for disease which is amenable to patient and persistent treatment, or which may be cured by a minor surgical operation, involving no risk, such as currettage or

repair of a lacerated cervix. If these cases are submitted to careful treatment instituted for the purpose of clearing up the surrounding exudation and favoring drainage through the natural channel (the uterus) in many instances the necessity for a radical operation would be removed and the woman restored to a life of usefulness and happiness. In corroboration of these views he reported twelve selected cases which had come to him from the gynecologists who believed that removal of the diseased organs was the only method to be adopted for restoration of their health, yet these patients recovered completely without the loss of these organs. The writer stated that these were not the only cases with such an unfavorable outlook which he had been able to cure in this manner, but they had been selected from among a number of others because they had consulted other gynecologists before they came under his observation.

* * *

ON THYROID TUMORS. Dr. Alfred Square Cooke has reported in the British Medical Journal notes on three cases of operation on the thyroid gland, in which he says:

As the result of my experience in these cases I would suggest that the observation of the following seven rules would greatly facilitate the successful completion of an operation :

1. Give chloroform as ether engorges the already enlarged veins. 2. Observe scrupulous cleanliness, have plenty of assistance, and many forceps and ligatures handy.

3. Take plenty of time.

4. After exposure of the cyst use only directors and fingers for dissecting, and keep close to the cyst wall.

5. Keep the fingers and wound moist with an antiseptic solution sufficiently weak not to irritate the sensitive and important nerves sometimes exposed, and, as far as possible, keep the parts in their normal position.

6. Partially evacuate a large cyst before removal to assist the later stages of the operation.

7. Insert a small drainage tube before sewing up for fear a collection of serum