In discussing these two cases Pick called attention to the fact that if he found two cases in one week, other pathologists must be finding them also. He admitted that all recognized treatments of syphilis possessed an element of danger. from. Mercury could cause degeneration in heart and kidneys. Salvarsan may be a useful but it is a dangerous drug. Medical College Graduates. In 1880 there were graduated 3,241 physicians from all schools. In 1904 the number graduated was 5,747-perhaps the high water mark. Ever since, possibly because of more stringent supervision of standards, the number has decreased, till last fall it reached 4,273. In 1880 there were for every 100 graduates, 82 regulars, 12 homeopaths and 6 eclectics. In 1911 there were for every 100 graduates, 94 regulars, 31⁄2 homeopaths and 212 eclectics. The homeopathic colleges graduated 380 in 1880 and only 152 in 1910. The reduction in the eclectic graduates has been from 188 to 110. The physiomedical has ceased to exist. This shows the trend of medical education. Dollinger's Operation In Graves' Disease. The problem of preserving the sight in the cases where Graves disease produces an extreme exophthalmos has only been partially solved. In moderate cases, bandaging the lids or sewing them together is a sufficient protection, but in some cases the pressure from behind is so great that the stitches tear out and the cornea ulcerates and sloughs in spite of everything. Sattler in his monograph cites 63 such cases, 12 of which ended fatally. To meet this danger, Dollinger proposes (Deutsche Med. Woch. 41, 1911), taking out a large wedge from the outer wall of the orbit, so as to allow the contents of the latter to bulge laterally instead of straight forward. In one case he has performed this operation with complete success. A diagonal incision was made back of the malar ridge, and the greater part of the thin portion of the outer orbital wall removed. A corresponding part of the orbital periosteum was then extirpated, whereupon the orbital contents bulged freely into the opening. The fibres of the temporal muscle were not reunited, but the skin wound was carefully sewed. The result was perfect. The pain disappeared and on the lids being closed with sutures the corneal ulcer healed promptly. To the reviewer the idea seems a most valuable one, and he would suggest that, in place of the somewhat difficult chiseling through the outer orbital wall in the depths of the temporal fossa, equally good therapeutic and cosmetic results could be obtained by exposing the outer margin of the orbit through the drawn back sides of a horizontal incision, and simply biting off with a bone forceps as much of the wall as is desired. The only object of preserving the margin of the orbit is for cosmetic purposes, and from experience with a modification of Krönlein's operation, I am convinced that practically as good cosmetic results are obtained, where the bone is simply thrown away, as when it is replaced. Gifford (Omaha). Summary of the Treatment of Post-Partum Hemorrhage. If very urgent either compress the aorta or plunge the hand into the uterus, remove the afterbirth or remnants of afterbirth, if any, knead the uterus between the intra-uterine and abdominal hands until it contracts, and then give hot intrauterine douche and ergotinin gr. 1-50, ergotinin 1 c. c. or infundibulin 1 c. c. If not so urgent proceed in the following order if the bleeding fails to stop: 1. Rub up the uterus and make it contract, thus deciding whether the hemorrhage is traumatic or atonic in character. 2. Pass a catheter and express the placenta. 3. Hot vaginal douche. 4. Hot intra-uterine douche. 5. Manual exploration of the uterus, with removal of any remnants of afterbirth or blood clot, followed by 6. Intra-uterine kneading of uterus. 7. Plugging the uterus with iodoform gauze. 8. Ergotinin citrate (gr. 1-50) or infundibulin 1 c. c. into the buttocks. 9. The treatment for the restoration of the patient from collapse. 10. Long watching by the bedside for fear of further hemorrhage or recurrence of symptoms of shock.-E. Hastings Tweedy, Rotunda Hospital, Dublin. Somers (Omaha). Statistics of Insanity. Dr. C. W. Pilgrim, in his presidential address at the sixtyseventh annual meeting of the American Medico Psychological Association in June, deals largely with the history of the state institutions for the insane in New York, and discusses at considerable length the care and treatment of their wards. The first institution, Bloomingdale, a private one originally, is now a state institution, and received its first mental cases in 1797. In 1843 the Utica asylum was opened and in 1845 there were in all institutions in New York 763 insane patients out of a total population of 2,604,495, or one committed insane individual to 3,413; a marked contrast to the present ratio of one to 278. In his historical account of the different institutions he pays honor to the pioneer officers in their work and suggests the perusal of their essays and reports. This analysis of the statistics for twenty years, ending with 1910, shows 52 per cent gain in the general population, and 104 per cent in the insane population in the state of New York. As causes for the increase, he mentions "unfit aliens," also "the pace that kills," due to the conditions of American life, with alcoholic and other excesses, and he says alcoholic excesses, syphilis, sexual excesses, and the abuse of drugs comprise practically one-third of all the cases. He argues that the state should assume the expense and proper care of these unfortunates. This care comprises special medical attention, comfortable housing, intelligent nursing, substantial and nourishing food and suitable clothing. In New York state the civil service laws, which are impartially administered, assure skilled and experienced medical attention. The care with which cases are studied and the records kept are worthy of the highest commendation. Contrary to the usual opinion as to the incurability of insanity, careful and conscientious examination of the statistics shows nearly 25 per cent are either permanently cured or improved to such an extent as to be able again to take up their former position in society, 15 to 20 per cent more are returned to their homes in a condition to live without violating the ordinary rules of conduct, and 70 per cent of those who are oblged to spend their lives under institutional care are taught some useful work and live contented lives. In order to improve the condition under which the hospital staff must live, he recommends a service similar to the army. Promotions to depend on the length of service and competency and also a retirement age with a pension. There should also be suitable quarters and allowances for married men. He makes these recommendations to make the work more attractive to ambitious young men. An important change in the laws in New York, in regard to the admission of patients, places them in charge of the health officer rather than the sheriff, prior to their committment to the hospital. Patients are also admitted on their own initiative, which plan has done much to favor early treatment. He recommends relief for the overcrowded condition of the existing state institutions by added state institutions where pay patients can be received and properly treated. He lays particular stress on the "penny wise and pound foolish" method of making appropriation for state institutions and compares the conditions in this country with those in Europe, where much more money is spent for the care of the insane. Joseph M. Aikin (Omaha). The Prevention of Gangrene by Arterio-Venous Anastomosis. Although the formation of a connection of an artery with a vein had been practiced for various reasons by several men, Wieting, in 1908, was the first to report a case of gangrene of the lower extremity arrested by this procedure and in Germany the operation has gone by his name. Serious theoretical and experimental objections have been raised against the procedure. More particularly, Coenen, at the last meeting of the German Surgical Society (Abst. in Centralblatt f. Chirurgie 29, p. 106) reports a number of experiments, some of which indicate that the procedure may not only be useless, but dangerous. For instance, he found that dogs stood without harm a double sided ligation of the carotid and the external jugular vein; but that when the central ends of the arteries and the peripheral ends of the veins were united, the animals died with cyanosis of the head. Wieting (Ibid. No. 37) responds that Coenen's experiments on the dog are no criterion of the possibilities of surgery in man and, furthermore, that no matter what Coenen found and what theorizing would lead us to expect, the fact remains that the operation has saved limbs that otherwise would certainly have been amputated. Additional proof of the at least occasional value of Wieting's operation is given by a recent case of Heymann (Deutsche Med. Woch. 34, 1911), in which a beginning angio-spastic (from tobacco, twenty strong cigars a day) gangrene of the left hand was checked at once by an end to end union of the brachial artery with the peripheral end of the brachial vein. Following the operation the pain, which had been intense, ceased almost at once and by the next day the color of the hand was much improved and the necrotic end of the little finger, which, when cut on the day before, had not bled at all, but had merely exuded a discolored fluid, bled freely. Some swelling and oedema of various joints and muscles occurred after the operation, but this disappeared and the hand gradually regained much of its usefulness; the conditions continuing good up to the time of writing the report, or nearly a year. GIFFORD (Omaha). Vaginal Cesarean Section in the Treatment of Eclampsia. Eclampsia has been well defined as "A Disease of Theories." This expression applies more particularly to the etiology of the disease, though it may be said that there is no statement made in reference to the many phases of the disease that is not open to argument. No one has determined the cause of the disease further than to establish the fact that it is dependent upon pregnancy. That it is an auto-intoxication which emanates from maternal or foetal tissues essentially all will agree, but no one has as yet produced the proof of the exact origin of the toxines. It is encouraging that there is little difference of opinion as to pathological changes found in the organs of the mother as the result of eclampsia, but when we come to the management of eclampsia we are confronted with many sided views. We are told by Peterson that the treatment is as yet empirical and it is for this reason that we look to the results of the various methods of treatment. We, therefore, welcome the contribution of Dr. Rueben Peterson of the University of Michigan, who has collected the reports of 530 cases of eclampsia which were operated by vaginal Cesarean section. These cases have been collected from all over the medical world and the conclusions which the author has reached should serve to clarify many of the problems relative to the treatment of eclampsia by vaginal Cesarean section. Vaginal Cesarean section was introduced by Duehrssen in 1896. It has rapidly gained an abiding place in obstetric surgery. Nowhere is it more popular than in its application to anti-partum eclampsia, where it is imperative to deliver the mother in the shortest possible time and with the least amount of injury to the mother and child. As with all new operations, vaginal Cesarean section has been extolled and condemned by many. It has been given undue prominence and unjust criti |