rules and regulations of the American Medical Association and the code of ethics, and such by-laws as may be deemed necessary to govern the members of your society.

The boys at Paducah are going to put their shoulders to the wheel and do all that is in their power to make our visit pleasant and profitable. It should not be forgotten that while Paducah is in "the pennyroyal" district that they grow mint down there, and that they send up to Nelson and Bourbon to get the other ingredient that is so essential to the make of that drink which is so delicious and dear to the heart of every Kentuckian. That the inner man will be cared for there can be no doubt, and the social features will be all that the most exacting could expect. It is hoped that the scientific features of the meeting will be equal or better than those of the past, and in order to be sure that you will be ready with your paper begin it now and let it have time to mellow, and when revised you will like it better, and so will your auditors.

Editors American Practitioner and News:

Please announce that the forty-seventh annual meeting of the Kentucky State Medical Society will be held in the city of Paducah, beginning on Wednesday, May 7th, and continuing through Thursday and Friday.

The Committee of Arrangements, of which Dr. Frank Boyd is Chairman, is determined that this session shall be the one to make "The Purchase" famous; the banner meeting in registrations, in scientific interest, in social solace, and in the addition of new members.

The Committee on Topics has completed its work by selecting subjects for special discussion which are of the highest practical importance, and the agreed writers, gentlemen of wide reputation, will discuss the various papers to which they have been assigned in the most pleasing and scientific way.

The Secretary is now waiting and willing to receive titles of voluntary papers. Members contemplating contributing to the programme should make the fact known at once, remembering that those who first come are first served, all things being equal.

The railroads will extend the usual courtesy-one and one third fare for the round trip. Paducah is now well supplied with good hotels, which promise most excellent creature comforts at a moderate cost. Now let us all pull together hard and strong, and success is bound to attend the Fortyseventh Annual. I am, as I shall ever be, yours truly,

STEELE BAILEY,

Secretary Kentucky State Medical Society.

Current Surgical and Medical Selections.

MOSQUITOES AND DISEASE.-The search for the pathogenic mosquito still goes on. Having fastened the responsibility for malaria upon this insect, the scientists seem bent upon fixing the blame for yellow fever upon it too. We trust we shall hear something more definite on that point at the coming Pan-American congress in Havana. The role of the anopheles in malaria seems to be well established, but we still need more definite information about the completion of the life-cycle of the malarial parasite. Is the mosquito the intermediary host, or is the essential link-" the means by which its existence is assured from year to year "-the individual known in the Lancet as "malarial man"? During the past year a few facts of importance-confirmatory rather than truly original-have been added to our knowledge of the propagation of malaria. Thus, Manson's experiment on himself was confirmatory. He submitted himself to be bitten by some imported anopheles mosquitoes, and promptly developed an attack of tertian fever. This was a disease that he could not readily have picked up in England, and the plain inference is that the imported insects gave it to him. Again, Drs. Sambon and Low, with Signor Terzi, betook themselves to the most infected spot on the Roman Campagna, and by protecting themselves from the bites of mosquitoes entirely avoided the disease. Other persons around them, who took no precautions, as promptly took it. The desideratum now is to find something that will kill the mosquito, and then having found it to apply it. It seems to us at present writing to be a bigger problem to exterminate the mosquito than it is to control malaria with quinine. We can kill the parasite in the blood of man more readily than in the system of the mosquito-or even than we can kill the mosquito itself. In other words, from an economic standpoint it may be a question whether it is not as easy to take malaria and cure it with quinine as it is to go on a still hunt after mosquitoes. This is a question in prophylaxis that has not much more than got itself stated. A solution of it is not yet in sight.-Philadelphia Medical Journal.

THE SURGICAL TREATMENT OF EPILEPSY.-The most interesting contribution to the surgical treatment of epilepsy has recently been made. by Professor J. William White (Philadelphia Medical Journal). Although the new method described by him has been employed in only two cases, and he is not himself convinced of its value, the results have been so encouraging as to be worthy of the attention of every progressive surgeon. Professor White's new treatment is intended only for those cases in which a distinct motor center is involved, and its advantages are lessened risk of life and the possibility of a cure or amelioration without paralysis of important muscular groups. The description, as given by the author, is as follows: The affected center is, of course, determined in advance by the most care

ful study and observation of the case. Its relation to the cranium is indicated by a silver or iodine mark upon the shaven scalp two days before the operation. The scalp is sterilized and resterilized three times at intervals of twelve hours, not only before the trephining, but also before each subsequent application of the treatment. A horse-shoe shaped flap is raised and a half-inch button of bone removed with a small trephine. The dura is left intact. Thirty minims of a sterile two-per-cent solution of eucaine is then injected into the brain substance at the center of the trephine opening, the point of the needle being introduced about three quarters of an inch. The needle is gradually withdrawn as the last ten minims of the solution are injected. The flap is replaced. The patient is returned to bed, and on the day of operation and the following day should receive full doses of bromides. At intervals, the proper length of which can only be determined by experience, the injection is repeated. The patient should be kept in bed at least four hours after each injection, and should take bromides for from one to two days.

SPREAD OF Yellow Fever.-Previous to the discovery of the fact that the mosquito is the means of conveying the virus of yellow fever, H. R. Carter collected considerable valuable evidence to show that several days must elapse after a house has been infected before another person will be able to contract the disease. In a number of instances it was distinctly proven that at least ten days must pass after a case of yellow fever has entered a house before the virus will become sufficiently developed to infect a second person, and a subsequent period of from three to six days will elapse before symptoms of the disease are manifested. The first period he calls "extrinsic incubation," and in the light of recent discoveries becomes easily explainable, for it is the time which must elapse from the infection of the mosquito by biting a yellow-fever patient to the time the mosquito becomes capable of communicating the disease to man. From this it follows that when a case of yellow fever develops in a clean house the inmates of this house who leave within a few days may be permitted to go without quarantine detention, for they will not develop yellow fever.-Medical Record.

THREE DANGEROUS OPERATIONS.-John B. Deaver (Philadelphia Medical Journal), refers to the repair of lacerated cervices, the rapid dilatation or divulsion of the cervical canal, and curettement of the uterus. While these are excellent and beneficial procedures when performed intelligently, they are capable of much harm when done indiscriminately and without proper precautions.

Lacerated cervix is so common that without special indications it is better to let it alone. The indications for repair are: (1) Gaping of the edges of the tear and consequent exposure of the cervical mucous membrane; (2) ulceration; (3) a large amount of hard scar tissue; (4) subinvolution; (5) hereditary tendency to malignant growths. It is contraindicated in cases where salpingitis, pyosalpinx, or adhesions exist. The

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breaking up of peri-uterine adhesions by bringing the uterus down to the vulvar orifice often liberates septic foci, giving rise to peritonitis.

The indications for curettement are retained foreign matter, usually post-puerperal, acute and chronic endometritis. The possibility of lighting up a latent salpingitis or sepsis must be borne in mind. Gonorrheal infection positively prohibits curettement. The amount of information to be gained from an examination of specimens obtained by curettement is not satisfactory, as the specimens are small and fragmentary. In advanced carcinoma, where radical operation is impossible, curettement followed by cauterization will lessen the patient's discomfort.

Dilatation of the cervical canal is ordinarily both inefficient and dangerous, and offers no advantages over divulsion. Where there is dysmenorrhea due to cervical stenosis and displacement of a non-adherent uterus, dilatation is indicated as a preliminary step to curettement. But this operation, as well as the two others, requires thorough antiseptic preparation; too often they are regarded as comparatively trivial and carelessness is permitted. Where these operations are demanded in the presence of adhesions or inflammatory conditions the operator must be prepared to correct such conditions by abdominal operation.

Scarlet FevER.—In mild cases the treatment consists of rest in bed, liquid diet, plenty of water to allay thirst and promote elimination of the poison, and a mild cathartic, such as calomel. The free use of milk, buttermilk, water, and mineral waters lessens the danger of post-scarlatinal nephritis. For a mild diuretic, potassium acetate answers well and may be aided by the citrate or bicarbonate of potash or sweet spirits of nitre. The nose and throat should be cleaned by spray or syringe with a mild antiseptic, such as hydrogen peroxide. A gargle may lessen the danger of ear complications, and in addition the sore throat is improved by a teaspoonful every three hours of the following:

The temperature may be controlled by lukewarm or cold sponging, or, if the patient is nervous and restless, by acetanilid, phenacetin, or sodium salicylate. A weak heart may require strychnine, digitalis, or alcohol. If the kidneys become involved, give warm baths, saline cathartics, milk diet, and water with liquor potass. citrat. Keep up counter-irritation over kidneys with poultices and mustard, and promote diaphoresis by hot pack or vapor bath. Convulsions may be controlled by morphine, atropine, chloral hydrate, potassium bromide or chloroform. Urgent symptoms may demand hot mustard baths, with cold affusions or ice to the head, or even venesection. Morphine is the best remedy to control the pain of scarlatinal rheumatism, but sodium salicylate should be given, and the joint wrapped in a glycerin ointment.-F. D. Millard, in Pediatrics.

INTESTINAL OBSTRUCTION.-W. J. Walsham (British Medical Journal), in discussing intestinal obstruction, calls especial attention to a cause usually overlooked by most authors. It is the reduction of an old hernia, usually by the patient, occasionally by the physician, en masse, that is, sac with contents and all complete through the canal of exit into the body cavity. If the hernia is already strangulated of course the process goes on, to the surprise and discouragement of the attending doctor. If the hernia be simply incarcerated, strangulation will sooner or later appear, depending upon the usual accidental circumstances. The history going with this condition is a very painful, rather forcible, at first slow then very sudden reduction, beginning and continuing with the pain and ending with "a pop," but usually without cessation of the symptoms of strangulation. As a rule, just within the ring of the canal a tumor can be palpated and percussed which represents the hernial mass. The treatment consists of laparotomy and whatever management its findings indicate.-Medical News.

The Treatment of Burns in INFANCY AND CHILDHOOD.—In a paper in Pediatrics for March, Charles Warren Allen says that when more than one third of the cutaneous covering is involved in a severe burn the outlook is unfavorable. Aromatic spirits of ammonia is highly recommended to meet the indications of vital depression. Unless the child is too young for the drug to be used at all, opium in doses proportionate to the age may be employed until a quieting effect upon the system has been secured. Picric acid as a local application, in a one-per-cent watery solution, has the effect of giving almost immediate relief from pain, and healing takes place rapidly under its use. It is best not to remove the dressing next to the skin, but simply wet this with picric acid and apply your absorbent cotton over this. By not changing the inner layer of dressing the pain is greatly diminished and the danger of outside infection is greatly reduced. Iodoform is objectionable, both from its odor and the danger of iodoform dermatitis. A permanent bath offers one of the best means of securing comfort in the deeper and more extensive burns. For soothing purposes the old carron oil is the best known and the most extensively used. The most important point in the treatment of these conditions is to refrain from the removal of the dressing. The Charlotte Medical Journal.

THE SALINE TREATMENT OF DYSENTERY.-(W. J. Buchanan, British Medical Journal). The author published, in a previous issue, a note on the results of the treatment of dysentery by salines in 555 cases, with ouly six deaths; 300 more cases have since come under his observation in the Central Prison, Bhagalpur, Bengal, making a total of 855 cases, with nine deaths. The results are better than those of the previous year. The average stay in the hospital was about eleven days, though many might have been discharged earlier if it had been thought best. There is little to add to his remarks previously made. He used, throughout the year, the following mixture: Sulphate of sodium, 1 drachm; aquæ fœniculi, ad. I