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chronic cystitis, which would otherwise undoubtedly have been mentioned, such as the importance of drainage by artificial fistula, or otherwise.

Chapter XVIII., on Effects of Labor and Lactation on the Uterus, is a most interesting one. In fact, it is difficult to select one or another chapter as specially instructive, for each is so complete that we cannot speak too highly of it.

We are a little surprised, after treating so clearly of a lax and half-open state of the anus, dependent upon a rupture of the fibres of the sphincter muscle during labor, without rupture of either the mucous or cutaneous investment, that the author makes no reference to a similar condition of the orifice of the vagina from a sundering of the perineal body, without the mucous membrane or integ. ument being torn. We have been forced to consider this class of cases quite as important as cases of laceration of the perinæum.

The book is rich in thought and clinical experience, and the opinions of other high authorities are so interestingly interwoven that it is by far the most readable work on the subject with which we are familiar.

We commend it most heartily, not only to the specialist, but to the general practitioner, assured that it will prove one of the most instructive and interesting in his library.


THE AMERICAN OTOLOGICAL SOCIETY.1 The Transactions form a well-printed volume of one hundred and seventyeight pages, of which one hundred and twelve are devoted to reports upon the progress of otology and fifty-five to original papers. The reports are of the usual excellence, although it would have been rather more in accordance with general views upon the subject to have treated the development of the ear as pertaining to physiology rather than to anatomy. Dr. Green furnishes, among the original papers, a very interesting contribution to the study of brain mur



The twelfth annual report of this excellent organization, which has recently been published and submitted to the legislature of the State, contains much of interest, and shows that the good work undertaken by it, years ago, in a systematic manner as well as a philanthropic spirit, is still progressing as satisfactorily as could be expected.

According to the returns of the respective officers of the various classes of institutions for the care of the poor, the number of inmates during the past year was as follows: In the state insane asylums, 2314; in the institutions for the blind, 361 ; in the institutions for deaf-mutes, 1142; in the State Asylum for Idiots, 252; in the State Inebriate Asylum, 52; in the county poorhouses, 6840; in the city almshouses, 9651; in the orphan asylums and reformatories, 16,612; in the homes for the aged, 3910; in the hospitals, 2268. The average number of all classes under care in the State the past year, it thus appears, was 43,712. The receipts for the past fiscal year, in

1 Transactions of the American Otological Society. Vol. ii., Part II.


cluding the cash balance at the commencement of the year, and the amounts received from voluntary donations ($793,337), the state treasury, municipal. ities, and other sources, were $7,909,791.22 ; and the disbursements during the year were, for buildings and improvements $820,778.67, for supervision and maintenance $6,587,975.04,- total, $7,408,753.71.

Since its organization the board has directed its attention mainly to reforms in the administration of the public charities, as regards their humanitarian influences and the removal of the causes of pauperism: First, by an effort to improve the condition of the poorhouses throughout the State, both as to accommodations and management. Second, by the removal of children from the poorhouses and almshouses. Third, by the removal of the acute insane from poorhouses. Fourth, by urging the speedy transfer of the chronic insane from the poorhouses to the Willard Asylum, and by effecting improvements in the asylums exempted from the operation of the “ Willard Asylum Act.” Fifth, by securing to the sick in poorhouses proper medical treatment and care in separate apartments. Sixth, by endeavoring to obtain a uniform system of records of the ivmates of poorhouses and almshouses. Seventh, by endeavoring to establish a custodial institution for unteachable idiots and feeble-minded persons. Eighth, by a careful and extended examination of the system of outdoor relief for the poor, and by the diffusion of information to officials and the public upon the subject calculated to secure proper discrimination and greater economy in its administration. Ninth, by devising and recommending systems of useful and, whenever practicable, profitable labor for the inmates of poorhouses, insane asylums, reformatories, and other institutions. Tenth, by providing for the unsettled poor, temporarily in the State, proper treatment and care, and providing for their removal to places of legal settlement, or to the custody of friends in other States or countries.

The influx of insane, idiotic, feeble-minded, and other infirm, helpless, or distressed individuals into the State from other quarters, especially from Canada, has hitherto been a fruitful source of pauperism and a large and steadily increasing charitable burden. By an act passed in 1873, however, these classes are now committed, by the county superintendents and other officers, direct to certain poorhouses and almshouses designated by the board, where they are maintained as the wards of the State until disposed of as their several conditions and circumstances, after a thorough investigation of the case, may seem to demand. Since the act has been in force, this work, including the board, clothing, and medical attendance of such persons, and the disbursements for forwarding them to their respective destinations, where this was practicable, has been carried on at an annual cost not exceeding $23,000, or about $30 for each individual thus brought under care.

In regard to the condition of the poorhouses throughout the State, the board report a marked improvement, both in the buildings and their internal management, and they consider this largely due to the work of intelligent and benevolent persons who make frequent visits to these institutions and examine into their administration. A part of these visitors act under the authority of the board, while the visits of many others are altogether voluntary. It is to be deeply regretted, however, that in some of the counties no action in the matter has been taken, their buildings remaining in the same wretched condition in which they were found when first examined.

Another excellent work has been the removal, during the last few months, of all children over two years of age from the poorhouses to asylums and other institutions, and, wherever practicable, to private families. This is in accordance with the law of 1878, and the board is of the opinion that the various asylums are thus doing a valuable service by affording temporary shelter and relief to such children until they can be taken into families living in comfortable circumstances. In no way, it is believed, can public officials, the managers of asylums, and others charged with the care of dependent children more effectually lessen the social evils and burdens of pauperism than by constant and well-directed efforts to secure situations for them in good homes.

The removal of the acute insane from the poorhouses to proper asylums and the speedy transfer of the chronic insane to the Willard Asylum are measures which have engaged the earnest attention of the board; but the latter work has been hampered by the want of sufficient room at that institution to accommodate all that should be sent there. In a few counties little or no improvement is noticeable in the care of the insane, and the old dilapidated asylum buildings, with their loathsome and unsightly surroundings, still remains blight upon the management of the public charities, and a standing reproach to the counties in which they are situated. The report shows that the total increase of insane in the custody of institutions in the State during the past year was 767. The increase of the chronic insane at the Willard Asylum was 130, and in the various county poorhouses and asylums 179. Of the insane in the latter institutions, 1084 are in counties exempt from the operation of the Willard Asylum act, and this leaves 818 chronic insane in the poorhouses still to be provided for. These insane are generally held in counties which thus far have failed to make adequate provision for their care, anticipating that the State would extend its accommodations in accordance with the act establishing the Willard Asylum, and in some of these counties the condition of the chronic insane is so distressing as to demand immediate relief. These facts and considerations have already been submitted to the governor, at his request, and a presentation of them has been made in his annual message. The board be lieve that this pressing demand might be, in some measure, complied with if the legislature would convert the present State Inebriate Asylum at Bing. hamton to the same purposes as the Willard Asylum ; since it is claimed that, as at present conducted, the benefits of this institution accrue almost wholly to those who are in no sense the objects of state beneficence.

In regard to the condition of unteachable idiots and feeble-minded persons, the board report that, under an act passed in 1878, which appropriated $18,000 to the New York Asylum for Idiots for the establishment of a proper institution for the care of this class of unfortunates, the trustees of the asylum have effected the temporary lease of an unfinished school building at Newark, Wayne County, which is capable of accommodating about 140 inmates. The board has also accomplished, in connection with the State Charities Aid Association, many needed reforms in the administration of the public hospitals and other charitable institutions of New York city, and is now devoting special at

tention to the important subject of tenement-house reform there; so that it will be seen that its work is of an exceedingly wide scope, aiming to embrace, as it does, the whole field of public charity in the State. While many obstacles to the carrying out of its ends have already been overcome, a vast deal of labor still remains to be accomplished; but the measure of success which has thus far crowned its efforts is quite sufficient to encourage it to continue them perseveringly in the future.

One of the latest projects of the board is the establishment of a State Reformatory for Women, similar in many respects to the Massachusetts one at Sherborn, and the matter was recently brought before the committee of ways and means of the Assembly at Albany, when eloquent pleas in favor of the measure were made by Mr. William P. Letchworth, president of the board, and the well-known philanthropist, Mrs. Josephine S. Lowell, who is chairman of the State Charities Aid Association.

REGISTRATION REPORT OF RHODE ISLAND. The twenty-fifth registration report of Rhode Island, for the year 1877, we are sorry to see, is the last to be published under Dr. Snow's able editorship, as it is hereafter to be prepared by the State Board of Health. With a population of 258,239 by the census of 1875, there were, in 1877, 4450 deaths, 6235 births, and 2282 marriages reported. The mortality was greater than usual among children, owing largely to the fact that diphtheria prevailed so extensively among them, 92.07 per cent of the decedents from that cause having been under ten years of age. Six hundred and sixty-one deaths were reported from consumption ; 492 from diphtheria ; 259 from cholera infantum; 226 from pneumonia aud congestion of the lungs; 213 from old age ; 182 from diseases of the heart; 181 from apoplexy and paralysis ; 135 from cancer; 134 from fevers ; 132 from accidents ; 95 from croup; 83 from convulsions and fits; 62 from scarlatina. In 1876 diphtheria was seventh on the list, and scarlatina not among the first thirteen causes of death; in 1875 not among the first thirteen, and scarlet fever sixth ; in 1874 it was last and scarlet fever second. At the present time, while the mortality of the colored people in our Southern cities is double that of the whites, Dr. Snow's analysis of their record in Rhode Island is especially interesting. His conclusions are that " though the colored population in Rhode Island has been perhaps more favorably situated for prosperity and elevation than in the other Northern States, the statistics show what we have had occasion to remark at other times, that the colored population is not self-sustaining in this State, and that its number (6271) is kept up only by immigration.”

MEDICAL NOTES. - A number of physicians of this city, among them the editor of the JOURNAL, having consented to sign an invitation to Dr. E. P. Banning, of New York, to deliver lectures upon the Human Voice and the Physical Education of Children, we wish to repudiate altogether any indorsement of the course as it is now advertised in the daily papers. We find in the list of lectures one on The Male and Female System, “ before gentlemen only,” and one on Female Weaknesses, “ before ladies only." We do not believe that subjects of this character are suitable for public audiences, and we have had occasion more than once to condemn popular instruction of this character, which is becoming more frequent, and of the unfitness of which we have had one or two striking examples lately.

– The value of dextro-quinine as an antiperiodic has been tested by Dr. Dunlap, of Chillicothe, Ohio, who reports favorably on its action in the Ohio Recorder. About two grams given during the night will ward off the chill, without causing deafness or tinnitus aurium. It is well tolerated by weak stomachs. The price is said to be about one third that of quinine.

- The Lancet reports this manner of diagnosticating thoracic aneurism: “ Place the patient in an erect position, and direct him to close his mouth and raise his chin to the fullest extent; then grasp the cricoid cartilage between finger and thumb, using gentle pressure upward ; if dilatation or aneurism exist, aortic pulsation will be distinctly felt by transmission through the trachea.” The plan seems to have been suggested by Surgeon-Major Oliver.

- In a recent lecture Forbes Winslow spoke at length on the Psychology of Hamlet, and in conclusion said his opinion was that “there is no evidence to prove that Hamlet feigned madness, and that, tracing the delineations of his disposition carefully, there are conclusive facts of the existence of mental aberration followed by complete restoration to health previous to the termination of the play." An interesting synopsis may be found in the Medical Press and Circular for February 12th.

- Professor Jaderholm, of Berlin, earnestly warns smokers against the use of paper cigar holders. He has discovered that they contain dangerous quantities of arsenic. This refers especially to holders which are colored green, red, etc.

PHILADELPHIA. The distinguished surgeon Professor S. D. Gross having completed the fiftieth year of his professional career, a complimentary dinner is to be given to him by his colleagues at the St. George's Hotel, on Thursday, April 10th. A large number of invitations have been issued, and the profession in different parts of the country will be represented. We beg to tender our congratulations to this eminent man on the brilliant record of his half century's work, and our acknowledgment of the debt which American surgery owes to him.

– Prof. Roberts Bartholow, of the Medical College of Ohio, has been elected to the vacant chair of materia medica and therapeutics in the faculty of the Jefferson Medical College of Philadelphia. It is understood that he will accept the position. The friends of the school consider this an important addition to its strength.

— At the request of the trustees, Professor Stillé has withdrawn his resig. nation, and will continue as professor of the theory and practice of medicine and of clinical medicine in the University of Pennsylvania. The loss of Professor Stillé would be deeply regretted, and it is with pleasure that we learn that he has consented to reconsider his determination.

- The college commencements took place this year in much the same

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