stimulating (and in large doses of paralyzing) sympathetic ganglia.

Many attempts have been made to establish a connection between certain conditions of high blood pressure and an overactivity of the adrenals; both nicotin and epinephrin are suspected by some of being factors in the causation of arteriosclerosis. The question naturally arises if tobacco may have not only a direct action on the blood vessels, but also an indirect one exerted through its effects on the suprarenal glands; this question cannot be answered at present.

These experiments of Cannon and his co-workers are also of interest as another illustration of how drugs may affect the activities of some of the organs of internal secretion-organs which until recently were supposed to be rather independent of the action both of drugs and of the nervous system. We may recall in this connection the experiments which show the effect of emotions on the activity of the adrenals, and others which show that some of the physiologic effects of iodin and probably some of those of diet are exerted through another organ of internal secretion (the thyroid).

The activities of the organs of internal secretion are thus becoming of increasing interest not only in physiology and pathology, but also in pharmacology and practical medicine.-J. A. M. A.

Endogenous Infection in Midwifery.

Not long ago Aschoff, in the interest of accuracy, proposed that the term "auto infection" be dropped from obstetrical terminology and that in its place we speak of endogenous and exogenous infection; meaning by the former, infection caused by germs from the patient's own vulvo-uterine canal, by exogenous, those in which the germs are brought to the canal from elsewhere. According to Pankow and Kroenig (Deutsche Med. Woch. Vereinsvericht, March 14th, 1912), there can be no doubt that when modern precautions are taken practically all puerperal infections are endogenous. The question is are they spontaneously endogenous or are they artificial endogenous infec

tions in which the germs have been pushed by the finger of physician or midwife, from the more external into the deeper parts of the canal. According to Pankow, the statistics of the clinic at Freiburg shows that 4-5 per cent of primiparae and 3 per cent of multiparae suffer from spontaneous endogenous infections; while a comparison of primiparae on whom vaginal examinations (with rubber gloves) had been made, with those in which the parturition was controlled by rectal examinations alone, showed nearly twice as many infections in the former class; and a slightly greater difference where no examination was made. In other words, where vaginal examinations were made, about 4 per cent of all the patients were infected by germs carried by the finger from the outer parts of the canal into the deeper parts; the artificial endogenous infection of Aschoff. With multiparae 4.6 per cent of those examined by the vagina were infected; while of the others only 2.9 per cent were infected.

In invstigating the numbers of the bacteria of the vulva, introitus and fundus of the vagina, respectively, Pankow found a steady decrease of the pathogenic bacteria from the surface inward. He concludes that while pathogenic germs constantly tend to spread into the vagina, they are, under normal conditions, steadily killed off by the acid vaginal secretions.

In discussing Pankow's paper Kroenig stated that a long series of experiments at the University clinic had shown not only the impossibility of completely disinfecting the vulva, but that all such attempts resulted in a marked increase in the germs, with the further danger that in the slight erosions which antiseptic measures are likely to produce, germs which have been maintaining a saprophytic existence may take on pathogenic characters. Kroenig has consequently given up all attempts at disinfecting the vulva (and, from the context, the vagina also). He maintains that improvement in the matter of puerperal infection, aside from the restriction of vaginal examinations, is mainly to be looked for in the direction of decreasing the general and local disposition to infection. He regards the systemic practice of getting the patients up at a very early period as one of the most important means to this end. GIFFORD (Omaha).

Please Remember

That the mailing list of the Western Medical Review, insofar as it concerns members of the N. S. M. A., will in future be controlled by the Secretary of the Association, Dr. J. M. Aikin of Omaha. In the past the Review management has frequently been unjustly censured for not putting various parties on the mailing list when their names had not been reported to the State Secretary as in good standing. The Review has no way of knowing how you stand with your local society and must depend on the State Secretary for information as to who are or who are not members. In future report all failures to receive the Review to Secretary Aikin and if you are a member in good standing he will so report, if not you must find out from your local secretary what is the reason. All changes of address and withdrawals from membership should also be reported promptly to Secretary Aikin and he will report to the Review. In this way much misunderstanding and unnecessary correspondence can be avoided.

Treatment of Tetanus.

Simon J. Young (Journal of the American Medical Association, February 24, 1912) believes it possible that in the antitoxine treatment of tetanus we have erred in the matter of dose -that too small doses have been given. A boy ten years of age, having convulsions every few minutes, and in a serious condition, received 5,000 units of tetanus antitoxine at once, and a like dose daily during the next few days, with smaller doses when temperature and pulse became normal, which occurred about the tenth day. In all he received 46,000 units. Recovery followed. In two other cases much larger doses were used. In a boy, 150,000 units were injected, and in a man 220,000 units. These cases all seemed hopeless, but all ended in recovery.

The Boston Transcript makes the very pertinent remark that man is a funny proposition because, when he reads a medical book, he fancies he has every disease described; but when he reads the works of a moralist, all the faults that are pointed out he sees, not in himself, but in his neighbor.

The Forty-fourth Annual Meeting of the Nebraska State Medical Association.

Nebraska State Medical Association met in forty-fourth annual convention at the Lindell hotel, Lincoln, Nebraska, May 7, 1912.

Called to order at 1:30 o'clock p. m. by President A. D. Nesbit.

Address of welcome delivered by Dr. A. R. Mitchell of Lincoln, as follows:

Mr. Chairman, Ladies and Gentlemen: Forty-four years ago the first address of welcome was made to a small group of earnest men, who gathered to form the nucleus of the Nebraska Medical Society. This meeting was held in the office of Dr. James H. Peabody, in the city of Omaha, May, 1868. Who spoke the first words of welcome we do not know. Each succeeding year words of greeting have welcomed the earnest men who have gathered for mutual helpfulness and for the broader purpose of extending to others, to the community and to the world, the benefits of our work. It is fitting, therefore, at this time to acknowledge with grateful hearts the honor you confer by accepting the invitation of our local society.

The world is beginning to realize that those best fitted to direct its people wisely are the men who study man. The physician is the one man of science who touches humanity at every point. From the cradle to the grave he is the one man best fitted to direct and advise. The world now admits its tremendous debt to medical science, although its acknowledgment has been tardy.

In Bethlehem, nearly 2,000 years ago, there emerged from the darkness and confusion of the then civilization the spirit of divine truth in human form, but it is only now that the civilizations of all the earth begin to acknowledge the force of the influence there begun; many still walk in darkness. The human mind cannot accept the facts of nature until it has reached the point of understanding. Nature has no secrets-all is open, all is free when our mentality has reached far enough for us to know. Day by day, month by month, year by year, the widening mind of science is building mountains of facts. From the summits the world receives the illumination, the enlightenment, the new development. A few there are who remain in the shadow, held back by tradition, by prejudice, by mental atony, but the world moves on and they will soon be forgotten. These are they who

oppose the interests, which enlightened progress proposes for the good of all. These are they who do not realize that an endorsement of the Owen bill is a step in the direction for improving the whole world and only indirectly the profession, which, with the exception of these misguided people and those interested in exploiting the public for private and selfish gain, is in accord with the progressive movement.

Our profession has a mission. That mission is to safeguard the health and lives of the people. We must not falter. We must select for our officers and for our representatives men whose ambition subordinates all personal advantage to the honor of the profession. The profession must stand for the interests of the people, not the people for the profession. The doctor must have his patients, not the patients their doctor.

Like the divine force which has lifted the world into the moral and spiritual light of truth, so you, who know man and his needs, must lift him out of the shadow into the light of science, as it is revealed by you.

The profession of Lincoln welcome you as men who represent that science.

lows:

Response was made by Dr. A. D. Dunn of Omaha, as fol

Mr. President, Fellow Physicians: We take great pleasure in coming to Lincoln. We are glad of the welcome that has been extended to us by Dr. Mitchell and by the members of the Lincoln profession. We always have a good time when we come to Lincoln. If there are dissensions in the Lincoln profession they lay them aside long enough to extend us a welcome and to make our stay pleasant. The physician is naturally somewhat of a recluse. It has only been of recent years that he has been getting together thus frequently, in his county, in his state, in his national society, for the purpose of exchanging ideas that may help humanity and for the sake of getting a better acquaintance with his fellows and for the sake of better apreciating his fellow and his work. Man is naturally a social animal. The social things that go to make up his life are oftenest the things that are emphasized. We only have to cast our eyes back over the popular songs of the past twenty or thirty years to find that the ones which are sticking and still remain popular are those that have to do with the social side of man. Years ago we heard of the "Bicycle Built for Two" and we heard of "Sweet Marie" and of "Annie Rooney" and of "The Quilting Party," and of "Casey" and the "Strawberry Blonde." All