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tricle, the second was due to clots in right lateral and third ventricles, and the third attack was due to the clots on the medulla and occlusion of the basilar artery, and that she did not have hysteria in any sense of the term, and that this mental condition was due to the structural changes that would necessarily take place from the presence of these clots.

9. The chilling of the blood-stream may be responsible for the nephritis that occasionally follows etherization.

10. Prolonged anesthesia profoundly deteriorates the blood and strongly militates against recovery; hence rapidity of operation is most desirable.



THE MANAGEMENT OF GIRLS at the PERIOD OF PUBERTY.- Dr. Playfair of London (Medical Record, August 31) read a paper entitled Remarks on the Education and Training of Girls at and about the Period of Puberty." Up to puberty there was no necessity to treat boys and girls differently. At puberty well-defined changes occur in the girl and there was an especial development of the nervous and emotional system. With limitations essential to sex, he considered that the advent of the higher education of women was an advantage. The fault of nearly all who managed high-schools was that they ignored the sexual functions of the girls and that they contend that there was no real difference between the adolescent male and female. If that were so, how is it that we see so many cases of anemia in the adolescent girl, and the disease is almost unknown in boys? One reason is that in boys' schools physical sports are compulsory, while that is not so in girls' schools, and the tendency is for them. not to take nearly sufficient exercise. Exercise should be compulsory in girls' schools and another regulation he would like to see would be one to interdict corsets. He would insist on the importance of at once stopping all school work when symptoms of illness begin to show themselves.



The Tri-State Medical Association met in the City Hall, Cumberland, Md., Thursday, September 5, 1895, at 1.30 o'clock P. M., and was called to order by Dr. S. S. Good, the President.

Dr. J. J. Wilson of Cumberland delivered the address of welcome and the President responded in an appropriate manner, giving a brief summary of the work of the Association for the year.

Dr. J. B. Murdock of Pittsburg, Pa., was then introduced and addressed the Association upon THE ADVANTAGES OF TORSION AS A MEANS OF ARRESTING HEMORRHAGE. He said, in substance, he regarded nothing so important as arresting hemorrhage during surgical operations. Surgeons have been endeavoring to find out the best means of obtaining this result throughout the ages. First, the tourniquet was used, causing in some cases gangrene by too much pressure being exerted. The actual cautery came next, and with the fillet continued until Ambrose Parê demonstrated the great value of the ligature. For more than two hundred years after the cautery continued to be used. Torsion has had advocates all down the ages, nearly as long as the ligature. Thomas Bryant brought it into prominence in England. It is largely employed in Pittsburg now, through the influence of Dr. Murdock, who has been using it successfully in his surgical work in the Mercy and West Pennsylvania Hospitals for a number of years. Used in one thousand amputations in these hospitals with excellent results. Two methods of torsion are employed, the free and limited. One pair of forceps used in free torsion, two in limited. Dr. Murdock has modified the limited form by employing the thumb and finger of left hand instead of second pair of forceps. The advantages claimed for torsion are that it favors coagulation of the blood in the artery better than ligature; that it is less likely to be followed by secondary hemorrhage; that no foreign substance (as ligature) is introduced

into wound; that wound heals by first intention.

After the conclusion of the address, discussion followed, participated in by Drs. C. S. Hoffman, R. L. Randolph, J. M. Spear and J. D. Skilling.

Dr. Murdock was tendered a vote of thanks and elected an honorary member of the Association.

The following officers were elected for the ensuing year: Dr. C. S. Hoffman, Keyser, W. Va., President; Dr. J. M. Spear, Cumberland, Md., Vice-President; Dr. J. W. Johnston, Davis, W. Va., Vice-President; Dr. S. H. Gump, Bedford, Pa., Vice-President; Dr. Percival Lantz, Alaska, W. Va., Recording Secretary; Dr. F. W. Fochtman, Cumberland, Corresponding Secretary; Dr. H. W. Hodgson, Cumberland, Treasurer.

A letter was read from Dr. Rohé of Baltimore, regretting his inability to be present at the meeting.

Dr. Percival Lantz read a paper entitled MALINGERING, which was discussed at some length by Drs. Randolph, Good, Wilson and others, each physician citing one or more cases which had come under his observation. (See page 413.)

Dr. R. L. Randolph of Baltimore reported a very rare case of sympathetic ophthalmia where vision was preserved in the injured eye. As a rule, sympathetic ophthalmia never shows itself in those cases where vision is still present in the injured eye. This case was seen at the Johns Hopkins Hospital. A stone cutter by occupation who had received a penetrating wound of the ciliary region seven iary region seven weeks previously. The anterior chamber was full of pus. This was evacuated and the vision in the eye rapidly improved and finally reached a point where he could discern large objects in the room and could readily count fingers. This was about five weeks after the injury. At this time he complained of dimness of vision in his good eye and an examination of this eye revealed a typical plastic_irido-cyclitis of sympathetic origin. The problem was what to do. Had the injured eye been blind, enucleation would have been resorted to at once, but it should be re

membered that there is a case on record where a patient in just such a plight was seen by a surgeon and the latter wisely concluded not to enucleate and when he saw his patient one year later the injured eye was the eye which alone possessed vision, the sympathetically affected eye having become blind. The injured eye in vision in Dr. Randolph's case sunk rapidly for some unknown reason and the necessity for not enucleating it no longer existed, so it was enucleated. The whole interest of this case is centered in the fact that the sympathetic inflammation broke out while vision was still present in the injured eye.

At 8 P. M., the Association again met and opened with a good attendance. Dr. Hoffman, the newly elected President, presiding.

Dr. J. W. Johnston of Davis, W. Va., read a paper entitled A CASE OF APOPLEXY (see page 421), which was discussed by Drs. Spear, Brotemarkle and Doyle.

Dr. Percival Lantz presented a patient with the diagnosis of lupus. The patient was examined by the members and discussion as to methods of treatment followed, participated in by Drs. Good, Doyle and Spear. Dr. Lantz closed the discussion.

Dr. J. A. Twigg read his paper on SHOCK AND ITS TREATMENT. In the discussion that followed, Dr. Good said he thought it impossible to make a general rule for the treatment of shock, each case being a law unto itself.

Dr. A. B. Price thought ether the best anesthetic to be used in shock.

Dr. Duke related a recovery from severe shock following operation, with use of heat, and strychnine hypodermically.

Dr. Spear said he did not believe much in use of stimulation, or hypodermic medication in severe shock. He He advised waiting for reaction.

Dr. Brotemarkle reported a case of a man cut by chain-saw, both limbs having been cut off, followed by severe shock and death.

Dr. B. M. Cromwell reported a case of profound shock following abortion, resulting in recovery.

After the close of the discussion it was decided to hold the next meeting in Cumberland during the month of December. Adjourned to meet at that time.

E. T. DUKE, M. D., Secretary.


CHOLERA AND COMMA BACILLI. In the scientific memoirs by medical officers of India (Homeopathic Recorder) appears a paper on The Results of Continued Study of Various Forms of the Comma Bacilli Occurring in Calcutta, by Brigade Surgeon Lieutenant Colonel D. D. Cunningham, F. R. S., C. I. E. It will be remembered that Dr. Cunningham is one of those cited as giving evidence in favor of the comma bacilli — a citation which is far from correct, since an imperfect report of his was accepted as positive evidence when such was only intended to be preliminary. In this paper Dr. Cunningham emphatically declares that cholera in Calcutta is not invariably characterized by the presence of any cultivable comma bacilli in the intestinal contents, and that even in cases where such organisms are present they by no means invariably give characteristics described by Koch and ordinarily accepted as belonging to true cholera bacilli, but differ greatly in different instances both as regards their morphological and physiological proper



DOES ETHERIZATION EVER CAUSE ACUTE LOBAR PNEUMONIA?-Dr. W. H. Prescott (Boston Medical and Surgical Journal, 1895, CXXXII, page 304) has not found any reference to ether as the exciting cause of acute lobar pneumonia in literature. It is generally agreed that the pneumococcus is the cause. There are many cases of broncho-pneumonia and inhalation-pneumonia and others with pulmonary symptoms, but none of true lobar pneumonia. Upon examining hospital records covering more than forty thousand cases of ether

ization, three cases of acute lobar pneumonia were found.

The first case was that of a widow of 40, with an abdominal tumor, which was examined under ether. The next day she had a severe chill, cough, bloody expectoration, pain in right lower back, considerable dyspnea and some cyanosis. Dulness below angle of right scapula; bronchial breathing. Autopsy six days later showed the right lung, except the apex, completely solidified.

The second case was also that of a widow, aged 53. She was etherized for a perineorrhaphy. Four days later complained of pain in right lower chest. On examination was found to have a pneumonia.

The third case was in a patient 60 years old. He had a slight chill during exposure two days before etherization. Three days after operation temperature rose to 105 degrees F. and an attack of acute lobar pneumonia began. In view of the very large number of etherizations and the small number of pneumonias reported, it may be said that ether rarely acts as the exciting cause of pneumonia, and that the three cases above mentioned may have only been coincidences.

GALL-STONE EXTRUDED THROUGH ABDOMINAL WALL.--Dr. Pilcher (Brooklyn Medical Journal) presented a gallstone, one inch in diameter, from a lady 65 years old. Last June she presented symptoms of inflamed gall-bladder, a tender and painful tumor extending from margin of liver toward umbilicus. There had been painful seizures, evidently from gall-stones. There was a distinct phlegmon connected with the tumor involving the abdominal wall. Operation was done under the belief that it was a suppurating gall-bladder adhering to the abdominal parietes. The phlegmon was incised and much pus evacuated. No communication could be found with the gall-bladder. The cavity was curetted and irrigated and contracted very much. Patient was so much relieved that she declined further treatment, although a tumor still ex

isted in the region of the gall-bladder. A discharging sinus remained, discharging viscid fluid until recently.. General health greatly improved. Recently, induration and obstruction to the sinus showed itself and after poulticing there was spontaneous opening and discharge of the immense gall-stone.

* *


1. Thyroidectomy, when total, brings on, in from two to four days, rarely later, certain dystrophic and serious nervous phenomena that almost inevitably cause the death of the animal.

2. The cases in which these effects fail to be produced are very exceptional, and the true reason for them is not yet surely known. We may admit a vicarious development of succenturiate thyroids, but it cannot be denied that there may be other modes of compensation as yet unknown to us, and this seems absolutely so suggested by certain results of the experiments.

3. The morbid condition to which thyroidectomy gives rise is due to a direct autointoxication, which affects principally the central nervous system. The thyroid seems to have the function of neutralizing certain toxic products that are continually circulating in the blood and which gradually accumulate in the system, producing serious and fatal effects without the intervention of the thyroid secretion.

4. There is absolutely no connection between the function of the thyroid and that of the spleen.

5. The implantation of the thyroid in another part of the body, if successfully done, never fails to prevent the fearful and fatal effects of thyroidectomy.

This is very different to what happens when a successful attempt is made to transplant the pancreas.

THE Illinois State Board of Health has ordered examination of matriculates of all medical colleges by the faculty of the State University.

care, show a singular want of diversity of employment and will afford much disappointment to the advocates of the woman movement.

Medical Journal. They do not afford much encouragement to our

young women to enter upon this expensive and laborious training requiring so many of the best years of their lives. And further the low percentage of marriages shows that there is something in the surroundings of these women which prevents the realization of the natural and highest destiny of man or woman, a state for which nature has formed them and upon which the continuance of the species depends.

But few of the "friends of woman" in this country will be willing to accept the above statistics as representing the state of affairs existing here, however faithfully they may represent those of England. England is a country, they will say, of precedent and it is hard to eradicate the prejudices and alter the customs of that most conservative nation. With us it is different; the field is open to all, of either sex, who will go in and occupy it. We believe this to be true and is problem must find its solution, if at all, in this republic. But of one thing we are equally assured and that is that woman's occupation must be limited and altogether insignificant compared with that of man. It requires no argument to show that her peculiarities of structure and function and the demands of maternity will always handicap her in the race with men, therefore that the advantages of the "higher education" must be reserved for comparatively few - the chosen few, let us hope of her sex.



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WHAT has woman accomplished since the opportunities of higher education were vouchsafed to her? Is it too soon to form an intelligent opinion on the subject, and if not, have the results justified the means? Some English statistics have recently been brought forward by a Mrs. Gordon, in the Nineteenth Century, for July, which enable us to at least form some idea upon the subject regarding English women. The careers of the graduates of some seven or more of the institutions for the higher education of woman in England during the past fifteen to twenty years have been followed, and the sum of the results is stated to be that of 1486 of these exstudents 680 are engaged in teaching, 208 have married, II are pursuing medicine, 2 are nurses, 8 or 9 are in government employment, I is a bookbinder, I is a market gardener and I is a lawyer. These figures, if reliable, and they seem to have been collected with great

Educated Woman.


THE city physician, surrounded by the conveniences and luxuries of city life, can scarcely appreciate the disRemote Country Practice. comforts and even hardships to which his country brethren are habitually subjected. Only those who have actually experienced or witnessed it can realize the life of the country doctor. The writer has known such a physician in a wealthy rural community embracing a large village, the county seat, to say that he had rather see his sons breaking stone on the common pike than following in his footsteps. This was doubtless an exaggeration and only illustrates the tendency men have to magnify those evils which are nearest, and to depreciate or be blind to

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