In the very nature of things, however, the prophylaxis in these cranial affections of otitic origin must be the work of the general practitioner. True it is that the acute otorrheas of the acute infections as measles, diphtheria, scarlet fever, and others seldom, comparatively lead to fatal complications on the part of the brain-though as experience ripens we are learning that a greater number of cases of meningitis in children have their origin here than we were at first willing to believe-but these acute otorrheas by reason of neglect do in many cases go on to subacute or chronic suppuration, the most dangerous form of aural dis

To prevent this transition it is neither possible at all times. nor necessary to call upon a specialist for his services; but it is not only desirable, but imperative, that the family physician should acquaint himself with the proper method of treating these cases, and should comprehend to what consequences of immense importance to the future welfare and happiness of his patient they may lead. Howsoever much we may be believers in luck we have no right to carry our belief into our practice in the treatment of these cases. The following is apropos and was told me quite recently:

A family physician was accompanied by a friend to see a little patient convalescing from one of the acute infectious diseases. On raising the child's head the pillow was found saturated with the purulent discharge from the ear. On being asked what treatment he had prescribed for the ear complication, the physician calmly replied, "Oh, nothing; that will dry up all right."

This was almost criminal negligence, or ignorance, or both, and can find no justification in any plea. It is here, in just such cases as the above that prophylaxis should begin. They come, as a rule, to the family physician and trust him to properly care for them. If he has any comprehension of real danger that threatens them he will labor vigorously and persistently until his patients are discharged cured and all likelihood of any secondary trouble eliminated. Regarding the prophylaxis of these diseases Professor Macewen of Glascow has the following to say:

"As chronic otitis media and the extension of inflammatory processes to the mastoid antrum and cells is the primary focus which leads most often to intracranial inflammatory lesions, the eradication of the otitis media must be regarded as the most potent factor in the prophylaxis of inflammatory lesions."

Regarding the neglect of these cases he says: "The treatment of middle ear disease is too frequently neglected. When the tympanic cavity has become the seat of chronic suppuration, with ulceration of the mastoid antrum and cells, it becomes a standing menace to the safety of the patient. The disease progresses insidiously, and one cannot be certain as to where and when it may end. A person might as well have a charge of dynamite in the mastoid antrum and cells, as one cannot know the moment when accidental circumstances may arise which may cause the infective material to become widely disseminated all over the cerebrospinal system. It is no part of the plan of this work to enter into the general treatment of aural disease which is fully discussed in the many excellent treatises on diseases of the ear to which the reader as referred. Chronic otorrhea is, however, much too lightly regarded and is frequently considered as a mere inconvenience instead of a menace to life."

Third and Broad Streets.

Hospital and Clinical Reports.

ANNUAL REPORT OF ST. FRANCIS HOSPITAL.

The thirty-first annual report of St. Francis Hospital of Columbus, Ohio, for the year ending January 1, 1897, shows the following general summary: The number in the hospital January I, 1896, was 80. The number of patients received each month during the year was as follows: January, 87: February, 62; March, 74; April, 61; May, 68; June, 74: July, 82; August, 81; September, 69; October, 85; November, 75; December, 104: total, 1.013.

Discharged during the year, 893; died in hospital, 36; remaining in hospital January 1, 1897, 84; number of diseases or injuries treated, 1,013; number of deaths, 36; percentage of mortality, 3.4; number of cases in medical wards, 519; surgical wards, 301; eye and ear wards, 139; gynecological wards, 32; dermatological wards, 22; total, 1,013; number of deaths in medical wards, 25; surgical wards, 10; in gynecological wards, 1; total, 36.

Of the patients 408 were Catholic and 605 non-Catholic. Their ages were: Number between 1 and 10 years, 18; 10 and 20

years, 130; 20 and 30 years, 338; 30 and 40 years, 209; 40 and 50 years, 137; 50 and 60 years, 108; 60 and 70 years, 52; 70 and 80 years, 18; 80 and 90 years, 3. The countries from which they came were: Arabia, 3; Austria, 9; Belgium, 1; Bohemia, 1; Canada, 6; Denmark, 3; England, 21; France, 3; Germany, 108; Hungary, 3; Ireland, 130; Italy, 10; Newfoundland, 2; Norway, 1; Poland, 2; Russia, 6; Scotland, 7: Sweden, 1; Switzerland, I; United States, 693; Wales, 3.

Among the occupations given were: Actor 1, blacksmith 12, bricklayer 6, carpenter 11, clerk 14, cook 18, domestic 78, engineer 8, farmer 50, fireman 2, housekeeper 164, journalist 2, laborer 295, machinist 14, miner 43, painter 14, policeman 1, printer 9, professor I, railroader 19, sailor 2, school teacher 7, seamstress 10, soldier 2, student 43. tailor 13. Twenty-one had no occupation.

Society and Association Proceedings.

ABSTRACT OF THE PROCEEDINGS OF THE COLUMBUS ACADEMY OF MEDICINE.

The regular meeting of the Academy of Medicine was held in the Public School Library on Monday evening, June 21st, Dr. Dickson L. Moore, President, in the chair. The Secretary, Dr. H. M. Platter, read the minutes of the previous meeting, which were approved. A case of tuberculosis of the hip, which involved the greater trochanter and head of the femur, was exhibited by Dr. M. T. Dixon. The doctor reported that the patient had suffered from this disease for three years and was admitted to the Protestant Hospital and placed under the care of Dr. R. Harvey Reed, who operated upon him in October, 1896, at which time the boy, aged 16, was very much emaciated, and the prognosis in the case rather unfavorable. Dr. Reed stated that at the time he entered the hospital there was three inches of shortening, due in all probability to the disease affecting the epiphysis. He stated that on making the operation, not only the head of the femur, but the greater trochanter, together with a portion of the ilium and ischium, were all involved. The head of the femur, together with the great trochanter, were removed and the diseased portion of

the ilium and ischium thoroughly curetted. The limb was immobilized and a Buck's extension placed on it, and kept on for several weeks. The wound was packed with iodoform gauze dipped in iodoform emulsion; the wound dressed daily and allowed to heal by granulation. As much as possible of the periosteum was preserved, which favored the restoration of a large portion of the excised bone, so that when the patient was dismissed there was but three and a half inches shortening, notwithstanding he entered the hospital with three inches shortening. Since leaving the hospital the boy has been walking everywhere with the aid of a crutch and a brace which fits snugly over the outer side of the thigh, including a portion of the ilium. It was also demonstrated to the members of the Academy that he could walk without either a brace, cane or crutch, which, in the opinion of the doctor, indicated the advantage of a complete removal of the diseased parts in a case of this kind with the preservation when possible of the periosteum.

Dr. W. S. Phillips reported a very interesting case which he had diagnosed as pulmonary hemorrhagic infarct of the lung which followed a severe hemorrhage occurring in the puerperal state. This report was discussed by Dr. Wirth, as was also a case which was shown to the Society by Dr. Kerr, which was examined by Dr. Dumm, Baldwin, et al., and diagnosed as a case of liver disease accompanied with gastric catarrh.

The regular paper of the evening on "Anchoring the Kidney," was read by Dr. R. Harvey Reed, in which he advocated the abdominal method of anchoring the kidney by the use of a long needle with which he pierced the parenchyma of the kidney, carrying the needle directly through the back and tying the sutures over a piece of gauze on the integument. He advocated this method as being much more simple and more easily performed than the old method of opening the capsule in the lumbar region. The paper was discussed by Dr. Baldwin, who admitted the simplicity of the operation, but who doubted its utility and thought there was some danger of puncturing the pelvis of the kidney and allowing the escape of urine; also danger of hemorrhage. Dr. Baldwin advocated the Johnson method of making a lumbar incision, dividing the capsule, having a flap on each side which was attached to the lumbar muscles and thus allowing the kidney to be anchored by granulation.

Dr. W. D. Hamilton discussed the paper and in doing so exhibited a patient on whom he had performed a lumbar nephrorrhaphy, and dwelt particularly on the danger of anchoring the kidney that was diseased, and thought that a kidney ought to be examined carefully before operating for fear of anchoring one which was undergoing tubercular degeneration or some organic disease which might prove fatal. The doctor preferred the lumbar method, as he doubted the efficiency of that advised by the author, in this class of cases, notwithstanding its simplicity and the ease of performance.

Dr. Reed closed the discussion by saying that he did not contemplate the anchoring of a discased kindney; that where such was the case he believed in, at least, making a nephrotomy and if the indications warranted it a nephrectomy; that it was only in case of a displacement which was giving pain and annoyance to the patient and where the kidney had not undergone organic changes that he advised anchoring, although he believed that surgeons were warranted in anchoring any kidney that was loose, whether it was giving annoyance or not, just as much as they were in making a radical cure for hernia, or the removal of the vermiform appendix, which at the time of operation was giving no particular trouble; that each and everyone were liable to give trouble without a moment's warning.

Dr. N. R. Coleman reported the Philadelphia meeting of the A. M. A., and after reviewing many of the details, remarked that he thought Columbus could obtain the meeting for 1899 if she so desired it. He thought they could be entertained at an expense not to exceed $15,000. He scored the Philadelphia hotels, restaurants and hacks for exorbitant prices and poor service, and thought Columbus was able to give better service and more reasonable rates than were charged at Philadelphia. A motion was made by Dr. Lawrence that a committee be appointed to take measures to obtain the meeting of the American Medical Association for 1899. This motion was substituted by Dr. R. Harvey Reed that the report of the committee, as given by Dr. Coleman, be placed on record and that the same committee, consisting of Drs. Starling Loving, N. R. Coleman, F. F. Lawrence, C. F. Clark and George M. Waters, for obtaining the meeting of the American Medical Association for 1898, be continued for 1899, and that they take proper steps in regard to the matter. Dr. Baldwin dis