medical and nursing staff of these hospitals, while the expense of this work is defrayed from the funds of the Department of Health of the city, the head of which should retain a general supervision of the whole.

This must conclude what I may now say about the hospital work of my own city. I have drawn a faithful picture of our hospital conditions. The defects which they present are very great; they are very far short of measuring up to the present needs of our population, but nevertheless the work that is being done is a vast and a creditable one. There is behind none of the hospitals of Brooklyn a long history and venerable traditions; none of them possess large endowments or wealthy patrons. A steady and assured income is the great need of every one of them. In so far as they do public work and bear public burdens they are rightful claimants for public money. In so far as they are the agents of organized beneficence they appeal to the charity of the community. In so far as they return to the community better medical knowledge and skill, and training in the nursing of the sick, they appeal to that most powerful of all instincts in the human heart, that of self-preservation, for adequate support and larger opportunities.

The apathy of any community toward its hospitals must spring only from lack of information or from misapprehension. To supply the one and correct the other has been the object of this communication.

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EDITORIAL.

REFORM IN THE BURIAL OF THE DEAD.

We are glad to see that the subject of funeral reform is engaging the attention of the clergy. A society of clergymen in Topeka, Kansas, has passed resolutions opposing the custom, on the part of pall-bearers and friends, of uncovering the head at the commitment of the body to the grave. The local medical society has unanimously endorsed these resolutions. It would be well if all similar associations would pass resolutions to the same effect.

ASYLUM FOR THE INSANE IN CHINA.

It seems somewhat singular, in view of all that has been done of a missionary nature for the Chinese, that no provision has been made for the care of the insane, and yet such is the fact. To Dr. E. P. Thwing, of Brooklyn, is the credit due of having called the attention of the civilized world to this oversight. The Medical Missionary Society has now taken the matter in hand, and expresses the hope that the establishment of the first asylum for the insane in China will be an international work, as was the founding of the first hospital at Canton half a century ago. In the promotion of this object it respectfully and earnestly solicits the aid and support of the press, foreign and native, and of officials, business men, and missionaries, who in their several positions come in contact with and influence various classes of the people.

THE POPULAR USE OF HARMFUL DRUGS.

In a very instructive paper, published in the Journal of the American Medical Association, Dr. I. N. Love discusses the merits of some of the recent antipyretics, and concludes with the following remarks, which we commend to our readers:

"Acetanilide, while of great value and surely safer than antipyrin, is no exception to the rule that obtain with all drugs. It should be handled carefully, administered judiciously, and under no circumstances should the public be educated in its use.

"The time has come for the profession to call a halt and endeavor to check the reckless use of medicines upon the part of the people. The secular press, in disseminating information regarding the action of drugs, gleaned from medical sources, is to a large degree responsible for the drugging habits of the people; but the medical profession is not blameless in the matter, in that many physicians verbally advise the purchase of many drugs by their patients, and carelessly and thoughtlessly impress them with their harmlessness.

"Medicines, which are nothing more than the tools by which the physician hopes to accomplish certain ends, should no more be left in the hands of an uninformed lay public, to use at their pleasure, than should the equipments of a surgeon's office or the accoutrements of a standing army (all intended, if properly used, as a protection to the lives of the citizens) be recklessly placed in the hands of children, or those unskilled in their use.

"If the members of our sister profession of pharmacy do not become imbued with the above thought, and act upon it, physicians may be forced to supply themselves with a part, at least, of the medicines needful to cope with disease, feeling that the attending inconvenience will be more than compensated by a knowledge of the fact that they will have a more definite control over the drugs administered to their patients."

ANTI-VACCINATION IN ENGLAND.

Dr. Charles N. Hewitt, Secretary of the State Board of Health of Minnesota, has just returned from Europe, where he has been investigating the methods of vaccination and the preparation of vaccine virus, in addition to a thorough examination of the preventive treatment for rabies, and the bacteriological methods of the prominent bacteriologists. He informs us that the fight against vaccination is very bitter and formidable, and that it is more than probable that in the near future the battleground will be extended to America.

PROGRESS IN MEDICINE.

SURGERY.

BY GEORGE R. FOWLER, M. D.,

Surgeon to St. Mary's Hospital, and to the Methodist Episcopal Hospital, Brooklyn.

UPON EXTIRPATION OF THE RECTUM, WITH PRELIMINARY OR SIMULTANEOUS

COLOTOMY.

N. A. Weljaminow (Centralblatt f. Chirurgie, No. 10, 1890). After carefully studying the entire literature of the subject of resection of the rectum for carcinoma, W. draws the following conclusions:

1. Low amputations and resections of the rectum only are to be considered as slightly dangerous operative procedures, furnishing certain and palpable results, not only as regards radical cure, but functionally considered as well.

2. High amputations and resections are to be considered as very dangerous operations, giving, without exception, unfavorable functional. results, as well as uncertainty regarding the radical cure.

3. By the combination of the last named with the performance of preliminary colotomy (Schinzinger) good functional results may be obtained (two cases reported by the author), as well as greater certainty of reaching and removing the growth assurred.

4. Preliminary or simultaneous colotomy after Schinzinger-Madelung is indicated: a, in all amputations above the third sphincter (8 to 9 cm. above the anus, or when the latter itself is involved in the disease, together with more than 7 cm. of the rectum); b, in all cases in which the sphincters may possibly be preserved, but in which it would be impossible, dangerous or useless to suture the bowel after removal of the diseased portion; c, when the occurrence of a urinary fistula is to be anticipated, or when the removal of the recto-vaginal septum and the accumulation of cloaca seems unavoidable; d, finally, when, as a result, considerable narrowing of the rectum is to be found, or a satisfactory emptying and disinfection of the colon is not possible.

UPON THE RESULTS OF TREATMENT OF HYDROCELE.

E. VonWinkel (Beit. zur Chir. von Bruns, Czerney, Kroenlein u. Socin., Bd. 5, Hft. 2). The author reports 90 cases, together with abstracts from the histories of the same; 48 cases were treated by

puncture and the injection of iodine; cure followed on average in from seven to eight days. Of these, 6 cases relapsed, 25 cases were treated by radical operation, the period of recovery averaging twenty-three days; of these but one relapsed. The radical operation, with various modifications, gave equally satisfactory results.

OBSTETRICS.

BY CHARLES JEWETT, M.D.,

Professor of Obstetrics and Diseases of Children and Visiting Obstetrician, Long Island College Hospital; Physician-in-Chief of the Department of Diseases of Children, St. Mary's Hospital, Brooklyn.

ANTISEPTIC CURETTING OF THE UTERUS IN PUERPERAL ENDOMETRITIS.

Dr. E. Braun (Arch. f. Gyn., B. xxxvii., H. 3). The author reviews some of the prevailing opinions with reference to the bacteriology of puerperal fever. He believes with Kehrer that three groups of germs are concerned in the etiology of child-bed fever, viz.: pyogenic, septogenic and saprogenic micro-organisms. In other words, he holds that puerperal fever may be pyæmic, septic or sapræmic. The latter or putrid form he thinks the most common.

Charpentier regards septic endometritis as the principal initial form of child-bed fever. After curetting and douching the uterine cavity he mops it with creosote and glycerine.

Of 7,600 puerperal cases at Vienna 101 were curetted, 96 recovering. Of the 5 fatal cases three were considered septic rather than sapræmic.

The Vienna method is as follows: The patient is placed in the Sims position, the external genitals cleansed and the vagina and uterus irrigated with a thymol solution, before and after curetting. A finger thick iodoform pencil is dipped in tincture of iodine and left in the uterus. Vaginal tears and abrasions are touched with tinct. iodin. The cervix and vagina are lightly tamponed with iodoform gauze. The patient is given a dose of cognac and an ice bladder is applied' over the abdomen. A vaginal douche of thymol solution is used once daily. The fever subsides in from one to six days. Parametric inflammation had not been observed as a result of the curetting.

Curetting is indicated when a septic condition of the endometrium is announced by fever, faulty involution and fetid lochia. It is useless after the infection has become general.

USE OF CHLOROFORM IN NORMAL LABOR.

Porak (Arch. d'obstet. et de gyn., April, 1890) considers chloroform safe if given with care in small and intermittent doses. Accidents are due to carelessness. Too long-continued use of chloroform and