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should press upon and occlude the trachea.

The possible dangers which must be kept in mind and guarded against are three in number; they are :

1. Wounding of large distended vessels.
2. The wounding of large nerves.
3. Cellulitis after operation.

The after-treatment is quite as important as the operation. It also might be summed up under three heads :

1. Dust the wound with antiseptic powders and apply gentle but firm pressure with a pad of antiseptic wool over the cavity left.

tion of more than 5500 since 1892. In France the overcrowding of the medical schools is also excessive, but in this connection we cannot do better than quote the remarks delivered by Professor Brouardel at a recent meeting of the Association des Médecins du Département de la Seine: "Two years ago I drew your attention to the fact that the number of medical students was increasing rapidly. The augmentation still continues unabated. In all the French faculties our future confrères are now twice as numerous as they were ten years ago. The same kind of thing is going on in Germany and likewise in England. Various causes have been invoked in explanation of this state of affairs; many people thought that the law regulating military service was to blame in the matter. There is no reason whatever for this supposition. The laws have not been altered in Germany or in England, and yet the rate of pro

2. Keep the head and neck absolutely at rest for some days by pillows, sand bags or splints.

3. Keep a careful watch that no retained serum causes pressure upon the trachea.

I consider that the following are the indications that the tumor needs removal.

1. If the tumor be steadily increasing gression remains the same. In France in size. the female midwifery candidates, who have nothing to do with military service, have doubled their numbers in the last

2. If there be troublesome pressure upon the trachea, esophagus or nerves.

3. If the tumor be so placed as to render impossible a possible necessary tracheotomy.

4. If the patient strongly urge its removal because of its unsightly appearance, or its interference with the movements of the head.

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BROUARDEL ON THE MEDICAL PROFESSION.-One of the great questions of the day undoubtedly is, What shall we do with our sons? In the profession with which we are more immediately concerned there are at the present moment close on 33,000 gentlemen with British qualifications practicing the science and art of medicine in all parts of the world, but chiefly within the narrow limits of our own small island. The plethora of alumni in our schools is truly alarming, and yet we have cause to congratulate ourselves that matters in this respect are not so bad with us as they are elsewhere. In the United States, for instance, the medical student roster last year was said to contain no fewer than 38,850 names, being an augmenta

five years. For my part I am convinced that it is the publicity accorded to the achievements of science which is responsible for the illusoryideas entertained by heads of families. Day by day in their newspapers they see the great importance that on all sides is attached to public health, civil and military, and logically enough imagine that the persons charged with the solution of the great problems involved receive a proportionate compensation. They conclude that their offspring will derive both honor and profit while pursuing this grand career. They would be much astonished if anyone were to point out how the efforts we make to render houses wholesome, to root out epidemics, to improve medical charities, all have the effect of narrowing more and more the field wherein the medical man was formerly wont to garner a meagre harvest. Now, in ten years' time the number of reapers will have doubled. If the number of medical men has doubled, the number of unsuccessfal practitioners will have increased threefold."

MARYLAND

their welfare. More than this it would have been wise to have put on this board some one

Medical Journal. who possessed a knowledge of asylum con

struction and an experience in asylum management.

The board lacking this important element, delayed long before it organized, and has delayed longer since. This board certainly cannot be conversant with the deplorable condiof the insane in this State. The county almshouses have hundreds of insane that should be under State control, and the regular asylums are crowded to overflowing. This last statement is literally true, for at Bay View Asylum there are a number of insane in the almshouse department that should be in the asylum. Of course it is important that the farm purchased for the use of the new asylum shall be a good one, and it has been rumored that our Farmer Governor was waiting until the crops would show what the land was. We trust he is not waiting to see the bloom upon the aloe, or for a rise in the price of wheat.

PUBLISHED WEEKLY.

TERMS OF SUBSCRIPTION, $3.00 a year, payable in advance, including postage for the United States, Canada and Mexico. Subscriptions may begin with any date.

DATE OF PAYMENT.-The date following the subscriber's name on the label shows the time to which payment has been made. Subscribers are earnestly requested to avoid arrearages. CHANGES OF ADDRESS.-When a change of address is ordered, both the old and new address must be given. Notice should be sent a week in advance of the change desired.

TO CORRESPONDENTS.-Original articles are solicited from members of the profession throughout the world. Reprints will be furnished in payment of accepted articles if the author's wish is so stated at the time.

CORRESPONDENCE upon subjects of general or special interest, prompt intelligence of local matters of interest to the profession, items of news, etc., are respectfully solicited. Marked copies of other publications sent us should bear the notice "marked copy on wrapper.

Address: MARYLAND MEDICAL JOURNAL,
209 Park Ave., Baltimore, Md.

WASHINGTON OFFICE:
Room 22 Washington Loan and Trust Co. Building.

BALTIMORE, JULY 13, 1895.

MORE than a year has elapsed since the legislature of Maryland granted an appropriation for the purpose of esThe New tablishing a new asylum for Insane Asylum. the insane of this State. The importance of increasing the accommodation for the insane had been represented to previous legislatures, but to no avail. At a meeting of the State Medical Society held at Annapolis a year ago last November, the subject was brought up and discussed, and a committee appointed to urge the legislature to make better provision for our insane.

The medical profession throughout the State became interested in the question and it was largely due to this influence, backed by the intelligent interest of the Governor, that a bill was passed granting an appropriation. After a long interval a board was appointed, and the first mistake was made here in not putting on that board some physician who was conversant with the needs of the insane in this State, and who was interested in

The conThe delay has been inexcusable. struction should have been begun by this time, and then the profession could have gone before the next legislature for an additional apIf the propriation to complete the work. gentlemen composing the board of the New Asylum only realized the condition of our unfortunate insane they would hasten, by every means in their power, the purchase of the farm and the construction of the buildings.

***

THIS is the season of the year when summer diarrhea and digestive troubles are frequent, especially among children, Summer Diarrhea. and prompt and effective must be the treatment to be of benefit. The strongest adult may be suddenly stricken down with the usual symptoms of pain, vomiting and diarrhea, which reacting on a weak or a diseased vascular system may bring on the fatal end speedily.

If there is an offending substance in the gastro-intestinal canal the sooner the canal is emptied the better. Purgatives should be prompt and emetics quick and powerful. Warm water, mustard and water in an adult, will promptly expel most of the stomach's contents while a large enema will empty the lower bowel and make room for such food as has passed into the intestinal canal from the

stomach. As soon as the stomach can stand it, castor oil, with a little laudanum to prevent griping, should be given in capsules to hasten on the peristaltic action and sweep out the intestines.

After this, rest is indicated and nothing should be put into the stomach. Water will be demanded but it should be positively prohibited, for it will induce vomiting and cause great gastric pain which a strong mustard plaster will hardly counteract. Bits of cracked ice may be allowed to melt in the mouth and if there is much heart weakness a little brandy may be poured over a teaspoonful of cracked ice. At this stage nature will usually do her part and little or no medicines are indicated.

There is a great inclination to give opiates, especially hypodermic. This is usually bad practice unless the pain is so severe that nothing else will control it and then a very small dose should be administered. Anything that tends to lock up the secretions before the offending substances have been removed from the body should not be given. Whatever medicine may be given internally should be in the form of very small powders on the tongue or in drop doses of some of the more powerful tinctures.

No fixed rules can be laid down for the treatment of these disorders in adults or in children and the many friends and relatives who love to collect around the bed and offer their abundant sympathy will confuse any but the firmest physician and such persons should be firmly but politely asked to leave and the case should be put into the hands of one good nurse or a member of the family who will faithfully carry out the directions of the physician without interference on the part of meddlesome friends and relatives.

These indefinite directions should be of assistance in the many cases of indigestion and cholera morbus that are so frequent at this season of the year.

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adults do not suffer from it as a rule. The greater control of the sphincter of the bladder in older persons cannot altogether explain this, nor can the greater acidity of the urine, or the size the bladder in the young, satisfy those seeking the cause of this trouble.

Stumpf, who has an article in the Munchener Medicinische Wochenschrift as quoted in the Boston Medical and Surgical Journal, gives an account of a simple and apparently rational expedient which he has successfully adopted in the treatment of bed-wetting in children. He believes that the passage of even a few drops urine through the sphincter vesicae excites the action of the detrusor to such an extent that the desire to pass water becomes almost imperative. Every one knows how difficult it is to restrain the flow after the first few drops have passed out. His theory is that during the sleep of children the sphincter becomes relaxed and in the horizontal position a little urine enters the urethra. The irritation from these few drops causes the sphincter to let go and the urine is voided in a good stream.

The fact that the urine passes in sleep in a full stream and not gradually helps to support this theory. To prevent this accident the author advocates elevating the position of the pelvis so that the accumulation of urine in the bladder will gravitate back to the fundus and not press against the sphincter and try to pass it. This may not be an altogether comfortable position for the child and it may not be a position which can be held by all children, but he has found it successful in several cases and in two inveterate cases which had resisted all other treatment.

In twelve cases he found it uniformly successful. It had to be continued for three weeks or more, when the cure was complete. The amount of fluids taken at bedtime need not be limited nor need the children be awakened during the night to pass water. The difficulty of keeping the more restless ones in this position is the principal point. This method has the merit of being very simple and recommends itself to those persons who have tried all other means without any amelioration.

This position is called in abdominal operations the Trendelenburg position and may have its field of usefulness extended to children.

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journal which was started many years ago to the leading medical journal of the world.

At the meeting of bacteriologists held in New York last month the following committee was appointed: Professor W. H. Welch, M. D., chairman; Professor W. Sedgwick, Ph.D.; Professor Theobald Smith, M. D.; Professor T. M. Prudden, M. D.; Professor J. G. Adami, M. D.; George W. Fuller, S. B.; Professor A. C. Abbott, M. D.; Professor V. A. Moore, B. A., M. D.

At the meeting of the Medical Society of the State of Pennsylvania held at Chambersburg, the following officers were elected for the ensuing year: President, Dr. W. S. Foster, Allegheny county; Vice-Presidents, Dr. John Montgomery, Franklin; A. P. Hull, Lycoming; T. H. Shapnack, Green; A. B. Brumbaugh, Huntingdon; Secretary, W. B. Atkinson, Philadelphia; Assistant Secretary, A. L. Stevens, Bradford.

At the quarterly meeting of the State Board of Health of Maryland held this week, Secretary James A. Steuart reported that six deaths occurred out of the 37 cases of smallpox in Middleburg in April; 28 cases were colored and 9 white. The deaths all occurred among the colored cases. Of those treated but one had been vaccinated. The expense to the county will be about $3000 and to the State about $4000. Dr. Steuart urges the organization of a Board of Health for Charles county.

It is with great regret that the death of Dr. James Brown of Baltimore is recorded. Dr. Brown was graduated from the University of Maryland in 1875 and had a wide reputation as a genito-urinary surgeon, which was his department at the Johns Hopkins Hospital. Dr. Brown had been unwell for some time and became accidentally infected in performing a surgical operation which, together with a pulmonary affection, brought on an unexpected end. By a curious coincidence his elder brother, Dr. Thomas R. Brown, also died from a wound infection received during an operation. Many years ago Dr. James Brown lost his eye from gonorrheal ophthalmia from an accidental infection during a faithful attendance on a case of gonorrhea. He was one of the most skillful manipulators in his branch and the ease with which he could catheterize the ureters in the male was simply marvelHis death is a great loss to the profession and to the Johns Hopkins Hospital.

ous.

PUBLIC SERVICE.

OFFICIAL LIST OF CHANGES IN THE STATIONS AND DUTIES OF MEDICAL OFFICERS.

UNITED STATES ARMY.

Week ending July 8, 1895.

Leave of absence for two months, to take effect upon his relief from duty at Fort Yellowstone, Wyoming, is granted Captain C. M. Gandy, Assistant Surgeon.

Leave of absence for one month, to take effect upon his relief from duty in the Department of the Colorado, is granted Lieutenant Colonel David L. Huntington, Deputy Surgeon General.

Leave of absence for two months is granted Captain Charles B. Ewing, Assistant Surgeon.

UNITED STATES MArine service.

Fifteen days ending June 30, 1895.

George Purviance, Surgeon, to proceed to Delaware Breakwater Quarantine as Inspector, June 19, 1895.

John Godfrey, Surgeon, detailed as Chairman Board for physical examination candidates Revenue Cutter Service, June 17, 1895.

Fairfax Irwin, Surgeon, detailed as Chairman Board to consider necropsy reports, June 15, 1895.

H. R. Carter, Surgeon, granted leave of absence for fifteen days, June 24, 1895.

C. E. Banks, Passed Assistant Surgeon, detailed as member Board to consider necropsy reports, June 15, 1895. Detailed Chairman Board for physical examination candidates Revenue Cutter Service, June 19, 1895. Detailed Chairman Board for physical examination of officers, Revenue Cutter Service, June 27, 1895.

J. J. Kinyoun, Passed Assistant Surgeon, detailed as member Board to consider necropsy reports, June 15, 1895.

G. B. Young, Passed Assistant Surgeon, granted leave of absence for thirty days, June 19, 1895.

B. W. Brown, Passed Assistant Surgeon, detailed as Recorder Board for physical examination officers, Revenue Cutter Service, June 27, 1895.

M. J. Roseman, Passed Assistant Surgeon, detailed as Recorder Board to consider necropsy reports, June 19, 1895.

J. A. Nydegger, Assistant Surgeon, granted leave of absence for five days, June 19, 1895.

W. J. S. Stewart, Assistant Surgeon, detailed as Recorder Board physical examination candidates, Revenue Cutter Service, June 19, 1895.

didates, Revenue Cutter Service, June 17, 1895. Emil Rochazka, Assistant Surgeon, granted leave of absence for twenty-six days, June 27, 1895.

Rupert Blue, Assistant Surgeon, detailed as Recorder Board physical examination of can

BOOK REVIEWS.

System of SURGERY. Edited by Frederick S. Dennis, M. D., Professor of the Principles and Practice of Surgery, Bellevue Hospital Medical College; President of the American Surgical Association, Member of the German Congress of Surgeons, etc. Assisted by John S. Billings, M. D., LL. D., D. C. L.; Deputy Surgeon-General, U. S. A. Volume I., pp. 880. Philadelphia: Lea Bros. & Co., 1895.

One would almost think that in this age of hurry and skimming that systems of medicine and surgery would find few readers, but when such magnificent and ambitious works as this one are offered to the profession, written by the masters in the profession, there are few who would not be arrested by one part at least. To the first volume of this work twelve writers have contributed, and each one is a professor or teacher at the head of his department. In view of the ordinary ignorance of the history of medicine and surgery the opening chapter by Dr. Billings is especially interesting and timely. Drs. Councilman, Dennis, Gerster, Stephen Smith, Warren, Welch and Horatio Wood, all contribute to this volume. It is no easy task to give in a few words the scope of this work nor can the results of a critical examination of its contents be given, but when one sees the names and the subjects, the value of the book will be appreciated. The book maker has done his work exceptionally well and the illustrations, which number over four hundred, are very liberally distributed through the text.

THE BULLEtin of the AMERICAN MEDICAL PUBLISHERS' ASSOCIATION.

This is the opening number of the little journal which the medical publishers decided to issue monthly in their interests and in the interests of their advertisers. With the exception of a few unimportant typographical errors, it is a very creditable paper and will doubtless serve the purpose for which it is intended.

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