and firm approximation. A couple of deep temporary sutures were applied through the deep rent in the tissues. Our man was in splendid condition for two days without either pain or fever. His bowels opened naturally, and he had an appetite; but on the third day, peritonitis developed and he died shortly after its onset. After death it was found that half an inch below the mesenteric border of the bowel, the sutures had ulcerated through, and permitted of leakage of intestinal contents into the peritoneal cavity.

Such then are the results of active surgical interference in cases of hernia. The above is an epitome of just eleven months' experience in dealing with hernia, especially strangulated hernia, with a view of securing a permanent cure. My first operation being on January 29, 1889, and my latest, December 10th, 1889.

As a result of the experience obtained in the personal management of these cases, and what I can learn by watching the practice of others, along with a thorough and searching study of the modern and recent varied, miscellaneous and abundant literature on the subject of the surgery of hernia, domestic and foreign, I have come to the following conclusions:

FIRST. That the original and predisposing cause of hernia is almost invaribly a congenital defect of development, especially with the male sex.

SECOND. That a permanent, enduring cure by the aid of a truss, is seldom if ever obtained; on the other hand, that though by its presence, it may occasionally excite adhesive inflammation, which will interfere with the bowels' descent, yet in the majority of cases, when strangulation follows after this delusive cure, the pathological condition present very much enhances the dangers attending this, and it adds proportionately to the difficulties of an operation, for radical cure. THIRD. No one operation will do for all cases, but each must be treated according to indications encountered.

FOURTH.-No medical attendant should allow a recent hernia to remain down more than twelve hours if symptoms of strangulation are present, and should of all things avoid severe or protracted pressure, in making taxis.

FIFTH.-Conceding that hernia usually dates from birth, an infant should be examined as soon after birth as possible, and if a condition of the testes is observed, which will later in life, favor hernia, it is imperative that it should be treated as any other congenital deformity, which may lead to years of misery, by immediate surgical measures.

THE BROOKLYN MEDICAL JOURNAL.

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EDITORIAL.

THE TRAINING OF THE NURSE.

The training-schools for nurses have gotten into the journals, and the indications are that they are likely to stay there for a time. The trained nurse fills an important place. The conditions under which she is trained are vexing the trainers. The critics are rubbing their eyes over the revelations of a training system that seems vicious. Some things have to grow; they cannot be created. The enthusiasm which inspired the lady patronesses and managers in behalf of their sex was a good starter, but now that there are a good many trained nurses and the training-schools are an educational fact, business principles in their conduct are in order.

The "charity" cry, however urgent at first as an appeal, is now a little on the hysterical order. A young woman, whose skill and acquirements can command twenty dollars a week, is hardly an object of charity, and to be educated in a "charitable" institution is not likely to command the approval of a young woman who is independent enough to seek a school where such remunerative skill can be acquired; she, when the facts are fully known, is not likely to seek admission to a training-school, where she is to be held as a "charity" student, where the contract is held to be all on one side and from which she can be arbitrarily and summarily expelled, without a hearing. Certainly a young woman, who would knowingly place herself under such a régime, might well be treated by her managers as a serf and undeserving of a hearing.

A training-school must be in immediate connection with a hospital, and those training-schools have proved most useful to the hospital and to the nurse where the conduct of the school has been under the immediate and exclusive control of the hospital authorities. Friction must result under a bicipital management. The education of the nurse and the control of the hospital should have one responsible head. All, who have to do with hospital control, know how great the revolution the trained nurse in the hospital has effected; the contrast with the old experience with orderlies and paid nurses is delightfully apparent.

The theory of her training is, perhaps, not familiar to many outside of those connected with hospital service. The matriculant is of immediate and effective service from the day she enters the hospital. She performs duties under the eye and direction of the second-year nurse in charge of the ward. She receives from the superintendent of the school personal and daily instruction and direction in all the details of nursing as defined in the curriculum of the school. The important duties and grave responsibilities of night service are not allotted to her till the second half of the first year, and in the second year she is sent out to private nursing, where she acquires the experience of undivided responsibility of her relations to the family and the home. In service to the hospital and at private nursing, she is, from the beginning to the end of her relations to the training-school, a source of income to the school. The hospital pays for her service and the private patient pays. In each case she gives a quid pro quo. She is never, for one moment, a pauper, a dependent or a "charity" student. The school is her educator and her protector, and the school receives just as much money from the hospital for the services of the nurse, who has just entered the school, as for the services of the headnurse in the ward, and just as much money for the services of the nurse who is sent to her first private case as for the services of the nurse who is just completing her two years' relation to the school. This is unique. There is nothing comparable to this relation of pupil and school in any other educational institution. She is not a pauper nor a "charity" scholar.

MEDICAL JURISPRUDENCE.

It gives us pleasure to announce that Sidney V. Lowell, Esq., has kindly consented to prepare for the JOURNAL, from time to time, a summary of the decisions of the Court of Appeals and other courts, which have an interest for the medical profession. Mr. Lowell's posi

tion in the legal profession insures the thorough reliability of the interpretation which he will place upon these decisions, and at once establishes confidence in the comments which he will make upon them.

OBITUARY.

WALES LEWIS CARY, M.D.

Dr. Wales L. Cary was born in Boston on the 13th of February, 1861. His father was a cabinet-maker, and shortly after his son's birth moved to the town of East Machias, Maine, where the family were together until the Doctor's sixteenth year, when he went back to Boston to obtain an education. He attended with credit the Boston High School for three years, and then came to Brooklyn, matriculating at once in the Long Island College Hospital, where he pursued his medical studies for the better part of four years. After graduating with honor at the Long Island College Hospital, he served a year's term on its House Staff and then went into general practice, locating on Lafayette Avenue, one door from Sumner, and making there a comfortable home for his mother and two sisters, and his wife. Here he remained until his death, on the 16th of May, 1890.

Dr. Cary was unquestionably one of the brightest, best-posted, and most promising young physicians in Brooklyn. He was a self-made man in the truest sense of the word. He educated himself and supported himself from his sixteenth birthday, often suffering extreme privation and being obliged to practice a most rigorous economy in order to obtain the knowledge he sought. His highest ambition was to be a "thoroughly competent physician." As a man he was a consistent Christian, kind-hearted, generous to a fault, and gentle. As a physician he possessed most of those rare qualities which render the true doctor's entrée into the sick-room sunshine and an inspiration to the sick, while a really keen power of observation and great practical ability in the application of means to ends made his treatments both skilful and successful.

Dr. Cary leaves many friends in all stations of life the poor will mourn his loss equally with not a few prominent citizens of Brooklyn; and it can be truly said, that he had scarcely an enemy amongst his professional brethren. It seems indeed strange that one so young and promising should be taken in the midst of a successful activity; still

those who mourn his loss may yet be comforted by the bright example he has set to all young men who may come to know of his history, and further by the honorable position he had won amongst the profession of Brooklyn.

Dr. Cary died of leptomeningitis and acute cerebral softening. He leaves a widow and two children, and a mother and two sisters.

RESOLUTIONS.

At a meeting of the Board of Managers of the Alumni Association of the Long Island College Hospital, held May 18th, the following minute in relation to the death of Dr. Wales L. Cary was made:

The Officers and Council of the Alumni of the Long Island College Hospital have heard with great sorrow of the death of Dr. Wales L. Cary, Corresponding Secretary and Treasurer of the Association.

Personally, he has endeared himself to them by his qualities of sterling character, while in the discharge of official duty he has always commanded their uniform confidence and esteem. In the wider field of professional work and achievement he had already by fidelity, zeal and assiduous industry won an enviable record which gave promise of greater eminence as the years should go on. That one so earnest in spirit and so well equipped for usefulness could not longer live to be useful is at once a misfortune and a mystery.

Resolved, That this minute be placed on the records of the Association, and that a copy, signed by the President and Secretary, be sent to the widow of Dr. Cary.

PROCEEDINGS OF SOCIETIES.

BROOKLYN PATHOLOGICAL SOCIETY.

The 313th regular meeting of the Brooklyn Pathological Society was held January 16, 1890, at the Society Rooms. President Dr. John C. Shaw in the chair, twenty being present.

Dr. Louis F. Criado presented a paper entitled, "An Interesting Case of Pyelonephritis Following Displacement of the Right Kidney.” [Brooklyn Medical Journal, 1890.]

DISCUSSION.

I made

Dr. J. P. THOMAS.-The kidney certainly presents a different appearance than when I opened the specimen at the autopsy. the post-mortem for Dr. Buchaca, late in the afternoon, in a poorlylighted room. The tumor was very large, had pushed up the liver,