patient is in the dorsal position and the anesthetist maintains a complete anesthesia. This, however, may not be practical, except with sufficient assistance. In private work Dudley's (Brooklyn) plan, to tie the child into a chair, does very well. The anesthetist can be of some assistance to the operator, especially if he will use the simple device for feeding the ether mask, which I will describe later. If now only a talking anesthesia is maintained, the fauces can be easily kept clear of blood and mucus. To the importance of protecting the lower air way, Bennet (New York) calls particular attention in a paper in the April, 1904, Laryngoscope. He cites in this connection the method devised by Crile (Chicago), who introduces heavy-walled rubber tubes through the nostrils to a point in the pharynx opposite the top of the larynx, respiration taking place through the tubes, and the anesthetic applied in this manner. The mouth is kept open and the tongue pulled well forward, while the space thus formed at the back of the pharynx is packed tightly with gauze. Not many of the major operations are performed on children. Of more than 400 operations done during one year at the St. Mary' Free Hospital for Children (New York), out of a total of 1,000 cases less than 10 per cent. were of any magnitude. The operation itself, then, need have no further particular mention in this paper. It is interesting, however, to notice that many of the operations in this report, which is probably a typical one, deal with conditions which reveal some impoverished state of the blood or a lowered vitality. The anesthetist must always carefully note the general condition of his patient, and be on his guard that anesthetic plus operation plus lowered vitality be not greater than the resisting power of the organism. Of the general conditions which predispose to danger, first and foremost is the status lymphaticus. I found an editorial in the Medical News in the spring of 1902 which quoted a report from the Children's Clinic at Gratz that all the deaths occurring there during the past twenty years, were in patients in whom this condition was proved at the autopsy. I do not know that I ought to do more than just mention this matter, for a most excellent article on the subject appeared in the January, 1904, number of PEDIATRICS. Suffice it to say that the status lymphaticus may be suspected in a child whose superficial lymph glands generally are involved-those in the neck and the axilla, the tonsils, the pharyngeal lymphatics, the circumvallate papillæ of the tongue. The spleen may be palpable. The child appears to be in perfect health, may be a trifle too fat, and perhaps the skin is thin and pale; the complexion pasty. If one encounters such a child it is undoubtedly best to avoid chloroform. Concerning rachitis and scrofula, one can say only what might be said of all depraved conditions. Conserve the strength, hurry as much as possible, use the least possible quantity of the anesthetic. Let the child have nourishment as late as possible before the operation, according to its condition and the nature of the meal. The same rules are operative in these cases in children just the same as in adults. Concerning the induction of anesthesia while the child is sleeping, I have only to say that it can be done and is a good practice. The difficulties are that one is likely to give too strong a vapor, and to attempt it during a light sleep. Dr. Satterthwaite. has had some excellent results at the Hospital for Ruptured and Crippled (New York). It frequently happens that the children fall asleep while waiting for the operation, and on a number of occasions he has been able to effect a narcosis without the child's knowledge. Such cases have been reported here, too. It has been the pleasure of my own experience as well. Only this morning I succeeded in continuing the natural sleep of a baby boy into the anesthetic sleep. It was specially desirable in this instance, for it was thought to be objectionable to let him become aware of the slight operation which had to be done about the prepuce. It is a procedure which deserves wider practice. I fear I have left many important matters unsaid, but I hope I have touched the salient points of the subject. In conclusion, permit me to show you the only new appliances which I have been able to find. This tubular spring is to slip over the ordinary Allis rubber cover so as to make the face opening fit any size face. One or more may be used for a child's face. By its means the regular adult size inhaler can readily be made small enough to fit even an infant's face. This other, a bulb ether container, is fitted, as you see, with a sharp-pointed metal nozzle, so that it can be stuck into a towel cone and enable the anesthetist to manipulate the cone and control the ether supply with one hand. Tieman has made both of these for me. I have found them very handy. Dr Tucker, of the Eye and Ear Hospital (Brooklyn), taught me a trick the other day which I have used with good results. It is to fold several thicknesses of gauze over one end of the Allis instead of threading it. I like that, because I can place one of these 5 grm. tubes of ethyl-chloride in my modified Allis inhaler, put on the cover and obtain a quick and pleasant anesthesia while completing the anesthesia by introducing ether through the side opening. DEFECTS OF EYES, EARS, NOSES AND THROATS IN SCHOOL CHILDREN.* BY A. W. HAWLEY, M.D., OF SEATTLE. WASH. The object of this paper is to awaken an interest in this important subject, and to enlist your support and co-operation in establishing, throughout this State some systematic plan for the detection and correction of these defects in school children. Systematic examinations of school children are now made, annually, in Connecticut under a state law, and in New York, Illinois and Texas under the directions of the State Boards of Health and the Boards of Education. Statistics from the work of many individual investigators clearly show the necessity of such examinations. It is unnecessary to give a detailed report of these investigations. It is sufficient to say that in general from 30 to 40 per cent. of all school children have some refractive error, and that from 15 to 25 per cent. suffer from defects of the ears, nose or throat. To determine in a measure the condition of the school children, the writer examined over 400 pupils in three of the largest schools of this city. The results of this work demonstrate that the children of this city are no better off than those of other cities, and that there is need of action on the part of this Association and its individual members. In the examination of the 400 pupils of the city schools, the vision of each was tested by the ordinary chart of Snellen's test letters place in good light, 20 ft. (6 meters) distant. An ophthalmoscopic examination could not be made because of the lack of proper facilities as to light or room. However, this was not essential to the value of the work. The nose and the naso-pharynx were examined, whether any complaint had been made or not, which resulted in the detection of a number of cases of adenoids and hypertrophied tonsils. The hearing was tested by tuning fork and by the whispered and spoken voice whenever suspicion pointed to ear trouble. *Read before the Washington State Medical Association, Seattle, Wash., July 12-14, 1904. Acknowledging that this examination was by no means complete or perfect, nor all that could be desired, yet its results are sufficiently accurate to be of value in this discussion. At the B. F. Day School over 165 scholars were examined, with the following results: Ninety-seven, or 58 per cent., had some refractive error, vision being reduced to 6-9 or less. Seventy-eight, or 47 per cent., had adenoids and hypertrophied tonsils, or both. Twelve, or 7 per cent., had defective hearing or chronic suppurative otitis media, or both. At the Central School over 160 scholars were examined, of whom Seventy-eight, or 48 per cent., had some refractive error, vision being reduced to 6-9 or less. Eighty-two, or 51 per cent., had adenoids or hypertrophied tonsils, or both. Twelve, or 7 per cent., had defective hearing or chronic suppurative otitis media, or both. At the Rainier School over 95 pupils were examined, of whom Forty-one, or 43 per cent., had some refractive error, vision being reduced to 6-9 or less. Fifty, or 52 per cent., had adenoids or hypertrophied tonsils, or both. Six, or 6 per cent., had defective hearing or chronic suppurative otitis media, or both. The percentages just given, of the defectives in our city schools, are considerably higher than those obtained from similar examinations in other cities. This is explained, however, by the fact that the children examined were selected by the principals because they were deficient in school work, or were supposed to be defective in some way. In testing the vision of these children it was impossible to make a differential diagnosis between myopia and hyperopia, or astigmatism in all cases, on account of the lack of facilities for a proper examination. This would have been desirable and instructive, as the records of other investigations show that myopia is found with increasing frequency as the higher |