segment, another forceps can be pushed to include the remainder of the ligament, which in turn can be divided. When the finger cannot reach the superior margin of the ligament, the lower section of each ligament can be seized and divided, when the whole organ can be made to descend, and thus the entire ligament upon each side be divided. When this procedure is necessary, the difficulty of proceeding is greatly increased because of the narrowing of the vaginal space.

After removing the uterus, the parts should be allowed to retract, in order to allow vessels, prevented from it by their traction, to bleed. By this means arterial twigs are often discovered which otherwise escape detection. All further arrest of hæmorrhage can be accomplished easily with forceps. This step is of vast importance, since hæmorrhage may not only result fatally, but even become the unsuspected cause of fatal peritonitis.

The last step of the operation concerns the management of the wound. The most elaborate sewing and draining of the vaginal cavity have been done. Stitching the peritoneum to the vaginal wall is regarded necessary by some operators. One operator recently stitched the two tissues together in front of the uterus before opening the Douglas pouch. Stitching the anterior vaginal border of the rent to the posterior border, drawing the ends of the ligatures out through their centre, has been very commonly done. Running a purse-string suture around the top of the vagina with a piece of rubber drainage tube, and the ligatures, passing through the middle of the puckering, has been used.

Sewing up of the vagina is unnecessary in most cases. These various vagina closings have been regarded as essential to keep back the bowels and to prevent septicæmia through the vagina. Of the former, there is a minimum danger. When the operation is completed, the superior vaginal opening collapses as thoroughly and completely as the ostium vaginæ closes. The oozing apposed surfaces at once interdigitate and inaugurate the preliminary processes of union. At the end of forty-eight hours the top of the vagina is all closed to fluids except that portion occupied by the means of drainage.

Iodoform gauze in the vagina is of the utmost importance, and, when wrongly used, is a source of danger. The vagina must be absolutely aseptic, and herein the iodoform gauze is of such great service. Stuffing the vagina too full of this agent keeps apart the walls of the top of the vagina and prevents their union. Care should be taken to avoid separating the top of the vaginal walls, The danger of this separation must be patent to any observer. Ribollet attributes the death of one of his patients to crowding too much gauze into the upper vagina.

ACCORDING to Lori (“Jahrb. f. Kinderh.") the most frequent of air-passage complications of typhoid fever is an acute catarrh of the larynx, pharynx and trachea. Vocal-cord-œdema sometimes occurs, from which result functional vocal troubles of various kinds. Diphtheritis and laryngeal œdema rarely occur, and somewhat less frequently larynx, pharynx, and trachea paralysis, therefrom. These are most frequent in the second stage of the fever, as also are åphonia, hoarseness, and dyspnoea. The most frequent serious complication is laryngeal perichondritis, which usually occurs in the sixth to eighth week of the fever. The cricoid, arytenoid cartilages and epiglottis are most frequently affected. The treatment is locally astringents, and internally wine and iron, especially when paralysis is present.

THE "Western Medical Reporter" looms up as a great authority on therapeutics as witness the scientific certificates appended to "Duffy's Malt Whiskey" advertisements in the daily press by the eminent editor of the "W. M. R." These therapeutic achievements, however, hardly prepare the medical mind for the pathological triumph shown by the discovery of a post-mortem tumor presented by Dr. Belfield at a late meeting of the Chicago Medical Society("Western Medical Reporter," Dec. 1887, p. 293.) In future the world must remember that Chicago has a pathologist before whom Virchow can but hide his diminished head; whose profundity is only equaled by the Nebraska genius who discovered enlarged prostate in the female.

THE "Medical World" in a late issue proposes to inaugurate, during the coming year, a decidedly desirable innovation; the substitution of for the misleading 3. The numberless mistakes which have resulted from the mistakes between 3 and certainly render some such substitute desirable. The one urged by the "World," has some striking advantages; it is readily associated with the word it is intended to symbolize, being the initial (Greek) letter of that word. It is readily made and not easily mistaken for any other symbol in a prescription.

A MONTROSE, Dakota, correspondent writes that he likes the MEDICAL STANDARD, but would be pleased "to know if it has a parent, the editor's name being absent." We are frequently in receipt of similar curiosity queries, to all of which we now reply that the MEDICAL STANDARD has a number of editors, but its editorials are its own, and its parent is the medical profession. By the verdict of its readers and its evident prosperity, it enjoys the advantages of sufficient talent, though this obviously would furnish but a flimsy pretext for hoisting the editorial staff to the masthead of the journal as a means of personal advertisement of the editors. The STANDARD thinks and speaks for itself, upon its own responsibility, and not as the organ of an individual, a clique or society. For medical editors always to stick their personal labels over the columns of their publications is a species of cheap tradesmen's advertising, inconsistent with the dignity and individuality of the journal, and with the established principles of the profession. Let the policy of the journal stand or fall on its intrinsic merits. To prop it up with a carefully listed "staff" or "corps," or coterie of "collaborators," is usually a confession of weakness in the journal itself to counteract which each of the eminent editorial gentlemen is supposed to bestow his services in return for the honor of being heralded as an editor on the staff of the renowned “Medical Reconstructor" of Heapbigtown. This practice, if confined to ordinary journalistic limits, might be less farcical, but it runs riot in medical journalism to an extent which will eventually reduce the mighty editor to the rank of the latter-day college "professor." Such a catastrophe may the gods avert!

AN epoch-making decision in forensic psychiatry has recently been given by Judge H. M. Somerville of the Alabama Supreme Court. In principle it is an extension of the right and wrong test modified by the influence of modern psychiatry. It is essentially the same as the European continental code that there can be no crime where, by mental disease, free determination of the will is impaired. The New Hampshire decision, making insanity a matter of fact for the jury to determine, not a matter of law, and the corroboratory Illinois decisions, were great scientific advances on the mob-law right and wrong test promulgated, through the outery of sensational newspapers, by the English judges at the bidding of the House of Lords, which, as Judge Somerville shows, was an innovation on the English law as laid down in Oxford's case. A Sergeant Ballantyne says that these judges, instead of saying what the law was, made law at the bidding of a mob. Their "law" was forced by newspaper sensationalists into dominance in Anglo-Saxon countries. New Hampshire, Illinois and a few other states adopted the scientific principle that the responsibility of a lunatic was a matter of fact and not of law, and that it was incumbent on the State to prove responsibility beyond a reasonable doubt. With the latter principle Somerville's decision does not agree, although it gives the first clearness and scope. As the Judge was for twelve years a trustee of the Alabama Insane-Hospital, superintended by one of the ablest American alienists, Dr. Bryce, this decision is obviously the result both of a knowledge of the law and of the actual clinical aspects of insanity. Judge Somerville, after a voluminous citation of authorities, decides that the inquiries to be submitted to the jury in every case where insanity is pleaded as a defense are: Was the defendant at the time of the commission of the alleged crime afflicted with a disease of the mind, so as to be either idiotic or otherwise insane? If such be the case, did he know right from wrong as applied to the particular act in question? If he did not have such knowledge he is not legally responsible if by reason of the duress of such mental disease he had so far lost the power to choose between right and wrong and to avoid doing the act in question, as that his free agency was at the time destroyed, nor if at the same time his alleged crime was so connected with such mental disease in the relation of cause and effect as to have been the product of it solely."

ONE of the foremost figures in the medical profession of the Northwest has passed away. Alonzo B. Palmer, M. D. LL. D., Dean of the Medical Department, and Professor of Pathology in the University of Michigan, died Dec. 23, 1887, in his 73rd year. Dr. Palmer was well known in Chicago, having been city physician during the 1852 cholera epidemic. He had occupied chairs in Berkshire Medical College and the Medical Department of Bowdoin College. He had held his position in the Michigan University since 1853. He was devoted to the duties of his professorship

and very frequently lectured four hours a day. He was prominent in the councils of the American Medical Association. During the war between the states he served as surgeon in the Second Michigan Infantry. He was a man of imposing presence.

PROFESSIONAL courtesy in medical societies has in some cases become somewhat excessive. Courtesy to the extent of "claque" has usurped the place of criticism. A distinguished professor of some joint-stock diploma-mill reads a paper before a medical society carefully packed with his adherents. The president, a member of the same clique, dictates the discussion by calling only on members of the clique. As a result a seemingly official endorsement is given to a worthless production. This condition of things has obtained for a number of months in the Chicago Medical Society. Through the influence of the MEDICAL STANDARD this practice was dropped and a little wholesome, albeit somewhat acrid criticism resulted, whereupon, in the columns of a local contemporary, appears the wail of an ex-“boodler" member of the clique which most infests the Chicago Gynæcological, Medical and Pathological Societies. The members of this coterie formerly read the same paper and discussion before the three societies. The MEDICAL STANDARD (October) commented on the fact that a venerable practitioner was summarily cut short by the president, when criticising a paper, while certain germ-specialists were allowed to talk by the yard. This expression had an almost literal significance since discussion by these worthies consisted in reading their remarks from the proof-sheets of the Chicago Gynæcological Transactions.

THE Chicago Medical Society is undeniably in a decadent state. The greatly diminished attendance on its meetings is sufficient evidence of this. The reasons are self-evident. The packing of the discussion by the president, the inexcusable indictment of a conscientious investigating committee at the dictation of the "boodlers" whom they exposed, the servility displayed toward rascally county officials by the chief official, the toadying to local diploma-mills, have all played their part. The Society needs to redeem itself from its present decadence by encouraging more critical discussions, by an impartial enforcement of the five-minute discussion rule, and by tolerating less dictation by members of unsavory political and diploma-mill affiliations. The Society should take a more active part in enforcing the medical practice act, the abortifacient act, and in securing medical control of the county institutions. These topics are better worth attention than the lucubrations of germ-crammed men using their recent voyages to Europe as a personal advertisement.

THE resuscitation of medical jokes is at present a thriving industry. "Puck" resuscitates in a modified form the following from the "Pickwick Papers" now about half a century old: "Reporter (to eminent surgeon)—Anything new this morning, doctor?" "Eminent surgeon-O-um—ah, yes—an operation at the Cheek and Chin Hospital, one of the most wonderful known to science. I took out a man's pericardium, put three stitches in it, and restored it. Patient lived twenty minutes. A most rare and successful case!"

The "Cincinnati Lancet-Clinic,” not to be outdone by the lay press, goes half a century better and resuscitates the following joke of Beau Nash given in Oliver Goldsmith's biography of that personage which appeared about a century ago: "Doctor (to patient)—'Did you follow my prescription?' Patient-No, sir, or I should have broken my neck.' Doctor-'How broken your neck?' Patient-'I threw the medicine out of the window.' Doctor-Blankety Blank Blank.'"' The last clause is a beautiful specimen of the "Lancet-Clinic's" humor, as the original is destitute of this pithy addendum. It is to be hoped the "Lancet-Clinic” and “Puck" will continue their labors in medical joke archæology until all those of the pre-Adamite period are resuscitated.

THE organ of the American Medical Association has lately discussed medical practice laws in the spirit of the Maine man who was in favor of the enactment of a prohibiton law but opposed to its enforcement. It hints that medical colleges which have enforced preliminary requirements have suffered and have seen persons, refused admission by them, go to other more accommodating colleges. The truth is that the colleges which have most stringently enforced their preliminary requirements and have maintained a good teaching faculty (not a collection of old fogies of the phil

istine era of American medicine, and young snobs of the present era, like the faculties of some socalled high-grade colleges), have the largest classes. A good teaching faculty and a reputable diploma are good attractions to the mass of preceptors. To use a high-grade college simply as a means of advertisement to its faculty is to degrade the school.

The "Journal" does not seem to be very well acquainted with the results of the preliminary requirements of Boards of Health. Reference is made to Dr. Gerrish's statistics about preliminary requirements (MEDICAL STANDARD, Vol. II). To an analytical mind these furnish decisive evidence that a large proportion of the colleges adhere to the requirements forced on them by medical practice acts. Since such beneficial results have been thus produced, consistency would demand an extension of the scope and an elimination of the defects of these acts. Legislation, to achieve its best results must be a matter of evolution rather than of the cataclysmic character proposed by the "Journal." If our esteemed contemporary be really in favor of proper medical education, it should see that the professors of the orthodox, old code Eastern medical colleges who joined with Ray V. Pierce and other patent medicine men to defeat a medical practice act, are properly disciplined. As things are, it would seem that its cross-roads-college medico-journalistic allies, who denounce medical practice acts in one column and laud the great “organ" in another, have been the chief inspiration of its utopian editorials on medical legislation. These betray strong evidence of the spirit which is denounced in the French proverb that the "better is the sure enemy of the well."

DR. G. FRANK LYDSTON in a recent lecture ("Medical and Surgical Reporter.") discussing masturbation, states that "Marriage is a cure for most of the sexual defects and complaints of young men, and once your patient is happily married, you will hear no more complaints until the babies commence to demonstrate the success of your prescription." These opinions would express bad morality and worse sociology even were they therapeutically well based. That they are not, every neurologist and surgeon who has followed up his cases can bear witness. Every insane hospital contains dozens of masturbatory lunatics for whom marriage has been prescribed as a remedy resulting in complete failure and the prolonged unhappiness of two human beings.

The error of Dr. Lydston lies in mistaking the desire for sexual intercourse for an entity, furnishing an indication for treatment. Desire of sexual intercourse is merely a symptom and can be treated only by the removal of its causes. This is the true treatment, not the satisfaction of the desire nor its repression. In the great majority of cases sexual desire, which cannot be healthily controlled by the will, is due either to constipation, improper food, improper clothing, improper literature, ascarides or leucorrhoea or analagous causes. Satisfaction of sexual desire will not remove these causes. Until they are removed the satisfaction of it in any way is but adding fuel to the flame. The results of so-called "sexual starvation" are due to partial sexual gratification in an abnormal, albeit unconscious, way, not to abstinence from sexual intercourse and are never cured by it. Cold sponging, proper diet, proper clothing, proper literature and proper attention to the rectum will cure all cases of "sexual starvation" except such as are reversions to the savage type of unrestrained debauchery or depend on cerebral or spinal disease or malformation. In the first case training is indicated, and in the last hospital treatment, not marriage nor sexual intercourse. Christianity teaches restraint of the “old man Adam.” Evolutionary ethics teach that the higher the organism the better developed and the greater the .checks on the primitive instincts of the race. Where theology, the dominant philosophy, and clinical experience join in condemning a procedure of doubtful morality intended to benefit one individual at the possible expense of another, the physician incurs a great responsibility who prescribes it.

JUDGING from the tone pervading the contributious to the columns of the STANDARD on the subject, the view that pneumonia is an inflammatory affection still holds its own and in the main directs the treatment. There is a strong support given to this view of the nature of pneumonia by the treatment recommended by the majority of contributors not only to our own columns but to those of contemporaries.

Calomel in the earlier stages of the disease seems to be a general favorite. There is no element of locality biasing its use, for practitioners in New York, Indiana, Illinois, Missouri, Pennsylvania and Wisconsin recommend it. There is a strong feeling, not confined to any locality, in favor of venesection in certain selected cases. On all hands the supporting treatment in the majority of cases

and in the later stages finds favor. Quinine does not retain the favor it once enjoyed. Its untoward effects are better recognized and it is looked upon chiefly as a symptom remedy. The general discussion of the subject exhibits much more unanimity than might have been expected when it is remembered that under the term of pneumonia are comprised so many diverse secondary conditions whose treatment În many cases involves that of the primary condition.

A RECENT discussion in the Kansas City Medical Society illustrates very markedly that the view which regards Peyerian patch ulcerations as pathognomonic of typhoid fever, is by no means universally accepted. That other diseases beside typhoid fever can produce these ulcerations, is shown by the case reported by Dr. F. W. Chapin (MEDICAL STANDARD, Vol. I) in which scarlet fever produced similar lesions.

OPERATIONS during pregnancy have of late been much discussed. Cases of successful operations during this condition are far from infrequent. Dr. P. F. Munde ("Amer. Jour. of Obstet., Oct. 1882) removed by means of the actual cautery the epitheliomatous cervix of a multipara four months pregnant. The pregnancy was unknown at the time of the operation but progressed favorably. Verneuil has shown that operations and accidents during pregnancy are by no means so generally followed by abortion as would be thought at first sight. Lawson Tait has ovariotomized six pregnant women of whom five recovered without abortion; the sixth after aborting.

THE Cook County Board in choosing the members of the homoeopathic county hospital staff set a good precedent which they did not follow in the case of the regular staff. They deemed the local homœopathic society intelligent enough to select good representatives but thought that the ex-saloon keepers and livery-stable men on the Board better fitted to select representatives of the regular profession than the Chicago Medical Society. The reason was plain-the Society had exposed “boodle” methods before any other members of the community. This insult to the regular profession should be resented by Illinois physicians. No objection can be raised to most of the physicians selected.

DR. FRANK H. DONALDSON, of Baltimore, declares that many Germans do not consider that medicine exists in America, their impression being derived from the braggadocio concerning everything American indulged in by uneducated American physicians when abroad. Dr. Donaldson cites as an illustration of this braggadocio the statement made in a German company by an American that a friend of his in Springfield, Ohio, "had performed over eight hundred ovariotomies." It is obvious from this statement that one American physician, uneducated in the surgical history of his own country, went to Europe in Dr. Donaldson's person and that he visited some very badly educated German surgeons, for every German surgeon of prominence knows that at Springfield, Ohio, lives the veteran ovariotomist, Dr. A. Dunlap, one of the first followers and pupils of McDowell.

THE carelessness with which "expert" testimony is given in certain cases is something remarka-. ble. Dr. A. C. Simonton of Des Moines reports a case in which a woman died suddenly with symptoms of thermic fever. Poisoning was suspected and the suspected person, a hitherto reputable pharmacist, insisted on an investigation. A local chemist, after examining some soup, which the woman had eaten, and her stomach, reported finding coniine therein, whereupon an indictment was found. This same chemist, although he failed to preserve either the coniine found or the material from which it was taken, testified to its existence. On cross-examination it was shown that his "coniine" was an unstable ptomaine and that he had used a process abandoned twenty years ago by most chemists because of its dangerously misleading nature. The chemical knowledge of this "expert" was so limited that he never found out that bromo-chloralum had been used to preserve the stomach given him for examination. Twelve out of thirteen physicians called by both sides testified that the woman died of thermic fever. She had all the symptoms of thermic fever and none of coniine poisoning. Notwithstanding all this testimony the jury disagreed, and stood nine for conviction of murder and three for acquittal. The majority laid more stress on the local chemist's evidence than on all the other testimony.