isted among the intestines. The inguinal ring was large enough to admit several fingers, and no adhesions were found within a couple of inches of the ring, this being lined, as was the entire sac where adhesions did not exist, with the glistening peritoneal membrane. A small quantity of peritoneal fluid was found in the sac, this latter containing a large amount of small intestine, and probably ten inches of the large bowel. Having broken up the adhesions near the centre of the mass of intestines, imbedded in adhesions was found an elongated, thickened appendix. As the operation was performed between attacks of pain, no acute inflammation was present, but the numerous adhesions, the burying of the appendix, and its thickened walls, all pointed to the fact that the patient had suffered from numerous attacks of appendicitis. The appendix was removed by the usual method, the bleeding points where large adhesions had necessitated cutting, were tied, and the intestines with much difficulty replaced in the abdominal cavity. The opening was then closed layer for layer. The foregoing record briefly outlines the history of a case of appendicitis which the writer believes to be unique, and which should impress upon us the lesson that acute attacks of pain, located among the abdominal viscera, may point to appendicitis, although the proverbial tenderness at McBurney's point may be lacking. REPORT OF THE SECTION OF PÆDOLOGY. The Demands of Pædology in the Progresss of Medicine, by Anna D. Varner, M. D. My Paralyzed Baby; a Unique Case, by Mary Brewer, M. D. Convalescence, by Edward Steel Haines, M. D. The Observation of Symptoms in Children, by Julia C. Loos, M. D. Marasums, by F. L. Muth, M. D. THE DEMANDS OF PEDOLOGY IN THE PROGRESS OF MEDICINE. ANNA D. VARNER, M. D., WILKINSBURG. There is no other field of medicine that requires the attention alike of general practitioner and specialist, be he gynecologist, surgeon, oculist or aurist, as the diseases of children. No other part of the work is more important. To promote health in a child is like laying a firm, strong foundation for a large building. The whole superstructure depends upon the strength of the foundation. The health of an adult depends a great deal upon his physical condition in early childhood. Another reason why pædology is such an important study is because of the exceedingly high mortality in children. In our large cities one-tenth of all infants born die during the first year, onethird of all deaths are in children under two years of age, and 45 per cent. under fifteen years. The diseases to which these children succumb are of such a nature that in the present state of our knowledge prevention is possible. According to Holt, who made 726 consecutive autopsies in children under three years of age in the New York Infant Asylum, 322 deaths were due to pneumonia, 56 to pulmonary tuberculosis, 189 to diseases of the digestive tract, 35 to diseases of the brain, 36 to marasmus, and the remaininng 88 to various other causes. We find very much the same proportion in private practice, either in the city or country, so that in any locality under any conditions, if the diseases of the respiratory tract, and those due to digestive disturbances and faulty nutrition were deducted from the sum total of all diseases, less than one-third would remain. five Remember, I am referring now to the mortality of infants. After years of age the acute contagious diseases are the most fatal. It is interesting to note the chief etiological factors concerned in these diseases. Omitting malformations and accidents connected. with birth, diseases in infancy are due largely to these four causes: Inheritance, infection, exposure to cold, and conditions interfering with nutrition. The last mentioned includes improper food, unhygienic surroundings and neglect. Over against those appallinng figures which prove that more than one-third of the human race die before reaching maturity place such causes as improper food, impure air, infection, neglect, etc., and tell me, is not prophylaxis the chief requirement in the advancement of pædology? True, in acute infectious disease great progress has been made in prophylaxis. The sanitary conditions have been improved and quarantine laws enforced. Scientists are wrestling with the problems of germ life, serum therapy, and the purifying of our water supply. Some effort has been made to control the spread of tuberculosis, very little to prevent syphilis. Surely the chronic infectious diseases. demand more effort of the profession to suppress them than even the acute diseases, because they are more disastrous to humanity. Tuberculosis is widespread and usually fatal. Syphilis is more frequently transmitted from parent to child than any other disease. They are both practically incurable. The best way to control them is to prevent them; the best time is childhood; the best means is to educate the people how to live so as to avoid contracting them. But the prevention of the so-called germ diseases is not all that is to be considered by the profession in the future. Germs do not multiply on good soil. They are making some very interesting tests at the Homoeopathic Hospital at Pittsburg. They are taking cultures from the hands of the operator, the assistants, the nurses, and the field of operation just at the beginning of an operation after the most rigid antiseptic preparation, and they are proving over and over again that it is the patient's resisting power and not the absolute absence of germs that prevents many a fatality there. Suppose ten people are exposed to infection and only one infected, then it is obvious that the most important way after all to prevent disease is to increase the resisting power of the body. This brings us to the chief fundamental cause of disease-poor nutrition. If, as we are told, protoplasm is the basis of all life, then this protoplasm contains the secret of the power to resist disease. Each cell is composed of nutrient matter, living matter, and formed matter. In health there is a sort of fixed proportion between these component parts. In old age the formed matter exceeds the nutrient. From maturity to old age they are equal, but mark you, in childhood the nutrient far exceeds the formed matter. It must, if a child's body is to be kept in a healthy condition and grow at the same time. I believe that the secret of vitality and the power of resistance lies in this ratio of proportion between the nutrient and formed matter. So you can readily see that anything that changes the quality and quantity of the nutrient matter, will not only decrease the resisting power of the body against germ diseases, and increase the predisposition to hereditary diseases, but will prove the starting point to digestive troubles and various other maladies which may follow the victim through life. Nutrition, then, is certainly the most important study in pædology, and the high death rate in childhood will not be materially decreased until this subject receives more attention from the profession. No young woman's education should be considered complete until she has a wholesome practical knowledge of the duties required of her as a wife and mother. No one would entrust his horse to the care of a man entirely ignorant of horses. A man could not be expected to run an engine who never was on one in his life. Yet this most delicate bit of human mechanism-a new-born babe-is oftimes at the mercy of an ignorant, indifferent woman. If the child be delicate no wonder it meets with disaster before the end of the first year. I wish especially to call your attention to the need of reform in our present common school system. From six until sixteen years of age the majority of children spend half their waking hours during the winter months in the school room. Many a child owes his ill health to poor ventilation, long hours of confinement, night work, and the worry and excitement over examinations. Many nervous disorders and diseases of the generative organs in women are due to over taxing themselves in school at the time when the menses are being established. Side by side and of equal importance with development of the mind in our public schools should be the development of a strong physical body. To this end the following suggestions are offered: A physician who is especially interested in children on every school board throughout the State. Each teacher required to have a thorough practical knowledge of hygiene, the laws of health and prophylaxis. Each child upon entering school to present a certificate from his physician at home stating condition of health, hereditary predisposition, etc. Physical instruction by competent teachers in each school. Physical exercises and class work regulated to suit the condition of each child, so that nervous, delicate children may not be required to do so much work as the more vigorous. No night work until after twelve years of age. No examinations at stated intervals which so many children anticipate with nervous dread. School duties lightened for girls at puberty. A course of practical lectures delivered separately to the boys and girls in the high schools, embracing the laws of health, nutrition, prevention of tuberculosis, syphilis, etc. Modifications might be made to render the scheme more practical, but it will not be long until some course must be adopted to prevent children breaking down during the public school course. True, a beginning has been made. Physiology has been taught in an imperfect manner for some years. In Philadelphia a physician has her office in the Girls' High School building, and spends her entire time looking after temporary ills of those 2,800 girls. In New York City one of the teachers in the high school is a physician, and gives practical lectures on physiology and the laws of health. In both cities the school children are examined by physicians at stated intervals for incipient contagious diseases. Even the infants in our large cities are faring better than in former years, with the fresh air fund, pure milk and free ice for the poor. These reforms must be encouraged, insisted upon until the children in all our towns and cities enjoy the same privileges. You will notice that the greatest progress in prophylaxis has been made in the prevention of contagious diseases. In the laboratory |