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from pressure of the tube, the position of which must be changed daily, so that it will come in contact with different areas of the lung. Hemorrhage demands withdrawal of the tube and packing the cavity with gauze, and an opiate given to allay the cough, which the presence of the packing induces.

SWEDEN'S last census records the lowest death-rate yet attained by a civilized nation. During the last ten years it averaged only 16.49 per 1000.

GERM OF HYDROPHOBIA.-Professor Sormani of the University of Pavia, Rome, is reported in the daily papers to have discovered the hydrophobia microbe, which has so long eluded absolute demonstration.

IN FRANCE medicine appears to have charms for the old as well as for the young and energetic mind. It is said that a Frenchman lately became a qualified practitioner at the age of fifty; that another scientifically inclined man at seventy-two began preparing for the degree of Bachelor of Science with a view of thereafter taking up medicine; while a French navy surgeon was still faithfully performing his duties on board ship at the ripe age of eighty-one.

SPREAD OF THE SLEEPING SICKNESS.-According to press cable despatches the London School of Tropical Medicine has issued a report on the sleeping sickness which is now devastating Uganda, Africa. Although discovered only a few years since it is stated that 20,000 or 30,000 people have died from the disease, and that it is spreading to new areas with increased virulence. The only step which seems to have any effect in preventing the spread of the disease is the isolation of new cases.

METHOD OF GIVING MERCURY IN SYPHILIS.-Fournier (in Sem. Med.) rejects fumigation, baths, mercurial plasters and other such methods as being scientifically obsolete, and gives the three possible methods of today as: I, internally (by the mouth); 2, inunction; 3, hypodermic injections, with the following advantages: Advantages of ingestion are: 1, ease of administration; 2, well tolerated; 3, proved activity. Disadvantages of ingestion are: 1. May upset digestion; 2, can only use moderate doses, heroic ones causing intestinal irritation; 3, hence not suited when quick action is necessary. Advantages of inunction: 1. Very active; 2, only occasionally disturbs digestion; 3, does not interfere with administration of other medicines. Disadvantages of inunction: 1. The trouble of applying; 2. secrecy difficult; 3, likely to occasion stomatitis; 4, curative effects variable according to thoroughness of administration. Advantages. of injection: 1. Active and easily regulated; 2. does not disturb digestion; 3, stomach free for other agents; 4, if occasional large injection, remarkably active. Disadvantages of injection: 1. Dangers of local complications; 2, pain (sometimes very intense); 3, trouble of regular administration.

Society Proceedings.

WESTERN SURGICAL AND GYNECOLOGICAL ASSOCIATION. Proceedings of the Twelfth Annual Meeting, held at St. Joseph, Mo., December 29 and 30, 1902.

[CONTINUED FROM PAGE 82.]

TREATMENT OF INJURIES OF THE PELVIC FLOOR OCCURRING DURING PARTURITION.

Dr. William E. Groud, of West Superior, Wis., read a paper with this title. His conclusions were that almost every woman during her confinement suffered injuries from which she did not recover unless she was subjected to a secondary operation for repair of lacerations of the pelvic floor; that immediate suture of apparent lacerations did not restore pelvic support in the vast majority of cases; that from one to two months after labor the woman should be subjected to a thorough examination and any relaxation corrected, before it had time to impair her health.

LUNG SURGERY; HISTORICAL AND EXPERIMENTAL.

Dr. B. Merrill Ricketts, of Cincinnati, Ohio, presented an elaborate contribution on this subject, which was illustrated by lantern slides. We give the author's conclusions in his own words:

Conclusions.-1.

Severing one or more of the larger pulmonary

blood vessels results in instant death.

2. If death does not result in a few minutes, bleeding will be slow and gradual.

3. If bleeding is slow and gradual, it may require hours or days to cause fatal exhaustion.

4. If death does not occur until after the end of the second day following severe bleeding, infection is the cause.

5. All, or part of the escaped blood, may pass through the opening in the chest into the bronchus or alimentary tract.

6. The blood may escape into the pleural cavity or cavities, pericardial or peritoneal cavity, or all, and thereby become concealed.

7. Pneumonotomy. More definite knowledge of conditions and symptomatology is necessary that surgery of the lung may be perfected and made more aggressive in general.

8. Abnormalities, congenital or acquired, must always be considered in dealing surgically with the lungs.

9. Atalectasis and apneumatosis should be cared for by relieving the compression by removing the cause.

10. The same surgical principles can be applied to the lung as to other organs of the living body.

11. The bony chest may be opened for exploration of the lung with as little danger as opening the abdomen, cranium, articulating capsule, kidney, liver, pancreas, spleen, stomach, gut, or hepatic duct.

12. Hermetically closing the chest is irrational, unscientific and dangerous.

13. Closing the chest wound by any means does not prevent the escape of blood from injured pulmonary vessels into the pleural cavity. 14. All wounds of the chest wall, whether penetrating or non-penetrating, should be treated aseptically, and with reference to drainage.

15. No instrument or needle should be made to enter the lung tissue for exploration, or the removal of fluid, unless the bony chest has previously been opened.

16. Foreign bodies in the bronchia or parenchyma of the lung may be detected with a fine exploratory needle through an open chest with the lung contracted.

17. Foreign bodies in the lung and bronchia, when causing serious symptoms, should be removed.

18. Some small foreign bodies becomes encysted and remain harmless.

19. The position of a foreign body in the lung changes with expansion and contraction of the lung.

20. Hemorrhage, when due to pulmonary tuberculosis, should not be allowed to become fatal without opening the bony chest, and the application of pressure by forceps, gauze or otherwise.

21. Bleeding of the lung from any cause will, in many cases, cease when the lung is allowed to contract upon itself, with an open chest. 22. Blood clots within the pleural cavity should be removed at the time they are discovered, whether infected or not.

23. Blood clots in the pleural cavity may become organized with or without adhesions of the parietal and visceral pleura, or they may become infected and cause more serious consequences.

24. Hemoptysis may be absent in the most severe lacerations of the lung.

25. If bleeding from larger pulmonary vessels results, forceps should be applied; if not, gauze should be securely packed in the cavity.

26. Drainage of pulmonary cysts of any character can be effected with the same success as in any other organ.

27. Incision for drainage should be done with or without the presence of adhesions. If without adhesions, the opening in the chest should be at the lowest point of the pleural cavity for drainage by gravity.

28. Many incisions of the lung may and should be made with and without even local anesthesia.

29. It is probable that but a few will necessitate the use of general anesthesia.

30. Abscess of any character and of any location in the lung should be found and opened.

31. Gangrene of the lung demands most radical surgical measures, such as opening the chest, drainage, and the removal of all necrotic tissue.

32. Polypi of bronchia seldom necessitate removal, but they may cause conditions which may require surgical intervention.

Pneumonorrhaphy, -1. Silk, silkworm gut and animal tendons are the most desirable materials for lung surgery.

2. Absorbable sutures and ligatures, as a rule, are not to be relied rpon as to strength and durability.

3. Silk and silkworm gut may become encysted in the lung and remain harmless.

4. The tug, and a combination of the tug and tobacco pouch sutures constitute the most desirable ones for use in the lung.

5. Ligatures and sutures may be dislodged by sudden expansion of the lung due to sudden closure of the opening in the chest wall.

6. The blood vessels, bronchia and lung tissue should be ligated separately, great care being used not to include too much tissue of any kind in one ligature.

7. Needles to be employed in lung tissue should be round, with a rounded point. They should never have a sharp point, or sharp edges.

8. Not all ruptures, punctures or lacerations of the lung require sutures, or any surgical intervention whatever.

9. Many lacerations of the lung without fracture of the bony chest can and should be treated by suture, compression with guaze or forceps. 10. Puncture of the lung from any cause, such as stab and gunshot, resulting in hemorrhage, should be treated by opening the chest and applying ligature or compression.

11.

Rupture of the lung should be treated as a laceration.

Pneumonectomy.-1. A portion or all of one lobe, or the entire right or left lung, may be removed without causing death.

2. For complete or partial lacerated portions of the lung, when severe, pneumonectomy is necessary and should be done.

3. Gangrene of the lung requires in many cases the removal of all necrotic tissue.

4. Hernia of the lung, when sudden and of but few hours' duration, should, as a rule, be amputated, and the stump fixed in the chest wall, as there is no sac.

5. Hernia of the lung coming on gradually has a sac, and should be returned to the pleural cavity, if possible, without amputation.

Pneumonopexy.-1. This is the safest and most rapid way of dealing with the stump of lung tissue in the majority of cases, necessitating excision for any cause.

2. Adhesions of the parietal and visceral pleura have without exception taken place, whether there have been lacerated or incised wounds, with or without suture.

3. The degree of adhesion corresponds with the degree of injury.

4. Cysts of the lung of any character can best be drained through viscero-parietal adhesions. In the absence of adhesions the wall of the cyst may be sutured to the edges of the opening in the chest wall, drainage to be at once accomplished or at some subsequent time.

TO BE CONTINUED.

MEDICAL SOCIETY NEWS.

THE ILLINOIS SOCIETY.-The sister society across the river has placed its meeting very fortunately for physicians of Missouri who wish attend both the Missouri and Illinois meetings. The Illinois Society will meet at Chicago on April 29-30 and May 1-2. The advantage of having these two societies meet at times not simultaneous will be appreciated by a considerable number of physicians in both States.

ENTERTAINMENT DURING THE MISSOURI STATE MEETING.-The Committee of Arrangements of the Missouri State Medical Association having but one member resident of Excelsior Springs, we, the undersigned, members of the profession at Excelsior Springs, in order to relieve him of as much work as possible, and to provide for the accommodation of visiting physicians and wives at the April meeting will cheerfully make all arrangements for board and accommodations for visiting members who will send us their names. E. LOWREY, A. C. O'KELL, J. J. GAINES, W. S. WALLACE.

THE STATE SOCIETY MEETING.-The early meeting of the American Medical Association has occasioned a change in the time of meeting of our State Society. The meeting this year will be held at Excelsior Springs on April 21, 22, 23. Arrangements are being made with the expectation that this will be a meeting of more than usual interest. We are pleased to publish the following from the Committee on Scientific Communications:

"The officers have determined to make the coming meeting of the Missouri State Medical Association the most interesting one in the history of the association, and to this end it is proposed to have a series of symposiums on subjects which will be interesting and instructive. The Committee on Scientific Communication would be greatly obliged for any suggestions which you might make in the matter, looking towards the accomplishment of the purpose alraedy stated. If you desire to read a paper before the association, kindly send the title at once. In view of the unusually early date of the meeting it is essential that there should be no delay "Yours very truly, "H. W. LOEB, Chairman."

SOUTHWESTERN IOWA MEDICAL ASSOCIATION.-The annual meeting of this society will be held in Creston, Iowa, February 19. Headquarters at the Summit House; place of meeting, Potter Post hall. Following is the program: President's address, Enos Mitchell, Weldon; Presentation of Cases; Report of a case, H. R. Layton, Leon; Catarrhal Pneumonia, J. P. Standley, Bedford; Some Problems in Obstetrics, W. K. Keith, Fontanelle; Puerperal Eclampsia, J. E. Howe; Greenfield; The use of Cocaine in Major and Minor Surgery, I. S. Buzard, Russell; Injuries of the Shoulder Joint, C. B. Powell, Albia; Notes on Colles Fracture, B. N. Torrey, Creston; Stones in the Common Duct, complicating Ulcers of the Stomach-Autopsy and Its Teachings, D. Macrae, Jr., Council Bluffs; An Improved Cleft Palate Operation, B. F. Gillmor, Creston; Operations on Infants, B. B. Davis, Omaha; Therapeutics of Bright's Disease, J. P. Claybaugh, Creston; Report of Cases of Cancer cured by X-ray, W. L.

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