habits of the race during reproduction. So dubious one. In Illinois it would be sufficient long as these longings were of trifling char- to make the claim that the mental condition acter their morbid nature would not be disput- of the puerperal woman was unsound, and the ed, nor considered worthy of thought; but let burden of the proof would immediately fall on a pregnant woman kill and eat her husband, the State, in obedience to that old legal preor newly-delivered woman, in that peculiar sumption of innocence in every man. In Infrenzy for blood that arises from perturbed diana and New Hampshire the same just sexual states, kill her child, and these ludicrous doctrine is held. Mental states are matters of longings furnish a psychological key to such fact, not ideal creations of law. It is sad to actions of great forensic importance. Every say that in the majority of our States the burwoman during the pregnant state is, it will be den of proof falls on the prisoner in all cases obvious, subject to influences that weaken in which insanity is a defense, and what insanher will, engender emotional mobility, render ity is, is determined by legal tests set up deapathetic natural affection, and give rise to cades ago under pressure from English ideas of suspicion as well as to perverted precedents. Barbarous as these legal doctrines sensations and propensities. are, they are held in California, Delaware, Legally these mental states predispose to Kansas, Georgia, Maine, Massachusetts, Mismurder, infanticide, nymphomania, arson, souri, Minnesota, New York, Ohio, Pennsylsanguinary cruelty, dipsomania and klepto- via, Texas, Michigan, Mississippi, Nebraska, mania, either pure or resulting from a desire New Jersey, North Carolina, Tennessee, Kenfor possession dominating a weak will. The tucky, and the Federal Courts. literature is full of illustrative instances. These cruel absurdities have their natural When a well-to-do puerperal woman steals the results. Judges unable to rid themselves of public authorities willingly admit the plea of legal superstitions, resort to subterfuges to kleptomania; but when the poor, hunted, avoid enforcing the alleged law in cases in seduced woman steals she is too often treated which crime was the offspring of insanity not as a criminal. If a married woman kill her covered by the legal definitions. In the innew-born child, no jury will convict her. Let fanticide case of "The People vs. Kate Harvey" a seduced and abandoned girl do the same, (Alienist and Neurologist, 1885,) expert tesand a public example is demanded (pour en timony was not introduced until after the jury courager les autres.) Yet in this last case the had convicted the prisoner; but the judge alpower of self-control is much more weakened, lowed the mental condition produced by the not only from the puerperal state but from puerperal state to mitigate the sentence. The other moral effects engendered by seduction, absurdity of such procedures is well summed desertion and dread of exposure. This is ar- up by Judge Doe, of New Hampshire. "If rant injustice, that can only be defended on tests of insanity are matters of law, the practhe tyrant's plea of necessity for the protec- tice of allowing experts to testify what they tion of society, a plea, as history shows, based are should be discontinued. If they are maton ignorant prejudice. Severe penalties never ters of fact the judge should no longer testify decreased infanticide, since the seduced infant- without being sworn as a witness and showing icide never could apppreciate the bearing of himself qualified to testify as an expert." these penalties. This was well illustrated by In dealing with any forensic question the Goethe, who never drew a truer or more physician's first duty is to determine whether pathetic picture than that of Margaret, about such a thing is a fact, not whether it might to be executed for an infanticide springing under certain supposable conditions have a from the perturbed mental state clearly evi- bad effect in society. Once ascertained to be dent from her last interview with Faust. a fact, it is his duty to declare it such. In In conditions of doubt, justice leans to the this spirit I have striven to prove that in presumption of innocence. From what has crimes committed during the puerperal state already been said it must be evident that the the burden of the proof lies on the State, mental state of the puerperal woman is a since the alleged criminal suffers from a path ological state predisposing to violations of by means of the close relation of the capsule major and minor morality. The law, in its assumption that every one is innocent, regards crime as an unusual state, and this presumption of innocence is strengthened if the state of the alleged criminal predisposes to unwilling violations of morality.-The Alienist and Neurologist. Remarks on Steven's Operation. Read before the Topeka Academy of Medicine and Surgery, April 1, 1890. BY G. A. WALL, M. D. Mr. President and Gentlemen :-The subject of this paper is one which is creating considerable favorable and much unfavorable comment from the profession, especially in the east. to the outer fibers a considerable relaxation may be obtained, while the muscle is not allowed to fall back as in operations for strabismus. The relative position of the muscle to the eye is very little if any changed, in reality the muscle is only weakened. Relaxation to the desired extent is always obtained, but the relief to the insufficiency is not always per manent, for the healing process is sometimes attended with a degree of contraction nearly equal to the advantage gained by the operation, in which cases a renewal of the operation upon the same or opposite sides may be made. The operation is nothing more nor less than a partial tenotomy, but instead of commencing at the border of the tendon, we commence at its center. It might be well to say here, that should any high or even moderate error of refraction be found it should first be corrected before concluding to operate. The object of to deviation of the visual lines which is not visible but which can easily be found, should it exist, by producing diplopia by means of prisms. It is in those tendencies that this operation seeks its results. It will probably not be amiss to give the this operation is to reduce the slight tendency details of his operation. It is one which demands careful judgment and delicacy of manipulation on the part of the surgeon, for it is an easy matter to produce diplopia, and our cure would certainly be much worse than the disease. The operation is performed in the We all know that these slight deviating tenfollowing manner: Having placed the eye dencies would cause more trouble than the under the effect of cocaine, the conjunctiva is greater ones, because then our patient soon divided immediately over the insertion of the learns to suppress the image of the squinting tendon, and at its center, about 4 inch in ex- eye, and therefore has no desire for binocular tent. The tendon is then picked up with a vision; but in these slight tendencies, there is small, fine-toothed forceps and small opening a constant desire to retain binocular vision, and made in it, the point of a small, blunt hook, since the muscles do not act in harmony, there similar to a strabismus hook, only much must be a constant strain on some muscle, smaller, is then introduced into the opening and sooner or later it will begin to feel that in the tendon, and with a fine, blunt pointed strain, and as a result headaches, pain in the scissors the tendon is divided towards each eyes and various nervous phenomena will border between the hook and sclera, preserv- arise. By this operation he claims to be able ing the capsular attachment at the borders of to relieve headaches, spinal pains, neuralgia, the tendon. and even chorea and epilepsy when not due to The insertion of the tendon is somewhat organic lesions. That there are beneficial refan-shaped, and by dividing all but the ex-sults to be obtained by this operation in some treme fibers at the borders of the tendon, it of those nervous phenomena I have no doubt, lengthens slightly, while division of the ex- but before we operate we should carefully ternal fibers leaving a central band, results in weigh every statement made by our patient, very little if any extension of the tendon. not at one examination but at several. I have The advantage of this operation is, that by seen many cases benefitted by it, and call to means of the extreme outer fibers of the ten-memory the following case which, I think, ildon, or where greater relaxation is required, lustrates its effect. A lady from Wisconsin 66 eyes for which in the past were assigned to the records as cause unknown." Perhaps many poor unfortunates who, without this operation, would end their days as inmates of insane and imbecile asylums, will be cured! was brought to the Woman's Hospital in Chicago for some supposed ovarian trouble, I know not what. A double ovariotomy was recommended, I think. She complained of occipital headache, pain down the spine at the angles of the scapula, and vertigo when compelled to sit or stand long. She said she had not been able to sleep on her back for six months, and in any position was much troubled with insomnia. In the meantime she was sent to Dr. Hotz for some eye trouble, and upon examination only a slight error of re-efitted at all. fraction was found, but he found a tendency That some assertions contained in this artiof the eyes to upward deviation, and suggest-cle are true, I hope to be able to demonstrate ed an operation to the patient, stating that to this society at some future day. some of her symptoms might be relieved by Especially does this apply to cases of chronic chorea and epilepsy in which no organic lesion of the brain or spinal cord exists. In Steven's work he cites many cases of chorea and epilepsy which were permanently cured, and many which were only improved or not ben Preparation for Motherhood. Read before the Eastern Kansas District Medical Society, at Topeka, Ks., April 8, 1890. BY DR. M. R. MITCHELL, OF TOPEKA, KS. The most important epoch of womanhood is the incipiency of motherhood. Much of its importance is the attending suffering it brings. Glancing over the field of our subject the following question arises, viz.: What can be done to prevent, or at least to help bear these sufferings? Such questions should concern us as physicians, and awaken the deepest sympathies of a common humanity. The question as to causes suggests a wrong somewhere that may be righted. During the whole process of gestation and parturition, we observe Nature's admirable adaptation of means to end. The formation of the enveloping membranes, the uterus gradually enlarging to accommodate the continuously growing contents. The generative passage has been increasing in size, and becoming soft and distensible, so that the parturient process, which was seemingly impossible, can be accomplished without physical harm. Yet possibly not without some suffering. No doubt but what Dr. Stevens in his ambition overreaches the bounds of benefit derived from this operation. There is, of course, great antagonism to it among the physicians of New York city, but one can plainly see Lusk says, "The pains of labor are mainly why that is. Notwithstanding that opposition, through the compression of the uterine nerves it is progressing, and will surely succeed in by the contraction of the muscular fibers." saving many sufferers from the torments of The severity of the pains may be regarded as headaches, neuralgia, and constantly aching in proportion to the resistance to be overcome. The agony becomes greatest, in the mechan-themselves at the menstrual period is truly ical distension of the cervix by the presenting appalling. It is no part, and the passage of the same along the vaginal canal and through the vulva. uncommon thing for young ladies at the menstrual period, to so expose themselves at balls, skating rinks, and This pain can be scientifically explained as like places, in such manner as is most calcuthe result of a physiological action. lated to do them the most harm. Such recklessness is really criminal, and the sad consequences are sooner or later realized. It is, however, a gratifying fact that the practice of certain modes of life, and medical science may do much to mitigate even the There is no want of obstetrical literature physiologically contingent pains of childbirth. giving instructions as to the best procedures It is undeniably the case, that the larger and appliances to be used in assisting and amount of suffering attendant upon the preg-carrying the woman through the trying ordeal nant state, and childbirth, is owing to prevent-immediately incidental to the parturient effort. able causes and pathological conditions. Gynecological teaching is abreast with the demands for methods of treatment and repair of diseased conditions as we find them incidental to childbearing. But it may be that more detailed and specific teaching in refer Although in consequence of Mother Eve's first and great transgression, the sentence, "In sorrow thou shalt bring forth children," was pronounced upon herself and her feminine descendants, yet it must be conceded that ence to prevention of woman's sufferings much the greater amount of sorrow and suffering, attending the childbearing process among the daughters of Eve, are attributable to the perverting and degenerating influences of customs indulged in, and especially under the rule of modern civilization. It would, therefore, be decidedly unjust, unscientific' and, we think, untheological for the becoming mothers of this age to still farther tarnish the memory of their maternal ancestor by attributing more than at least a small part of their woes to her original sin. Evidence of this fact is sustained by history of barbarian nations, where it is said the women are generally less perverted physically than civilized women. Childbirth is regarded with very little apprehension, since it occasions little pain or inconvenience. The same is true with many women among the lower laboring classes. would be in line with a progressive civilization, and the genius of practical christianity. Preventive medicine does hold a prominent place on the programme of duties of the industrious and conscientious general practitioner. No less possible and imperative is the use of proper preparatory means in the prevention of many of the long list of ills connected with childbearing. When we look down the vista of many maternal lives, we see a series of periodical tortures, each covering almost the whole time from gestation to months after confinement. Is it any wonder that some such in their desperation will resort to criminal methods to gain relief? Look at the home training of girls as we find it, in the so-called fashionable and higher grades of civilized and christianized countries. Many of the ills referred to are clearly trace"The ease with which the Indian women able to physical defects in early development. perform the parturient act is proverbial. They How many of these girls pass into womansuffer scarcely at all with the pains of child- hood mere dwarfs, chlorotic, pale, sickly, birth, and, without doubt, one reason is, the nervous, hysterical, stooped, hollow-chested, preservation of their sexual health by rest imperfectly developed bone and muscle, imduring the menstrual period." It is said, at paired digestion, headache, backache, imperthose seasons they invariably absent them- fect menstrual function; in a word, ere they selves from the lodge and enjoy absolute rest. arrive at the threshold of the connubial state, If the hardy women of the forest are benefit- they are miserable physical wrecks. All the ted by rest, certainly our more delicate fe- result of causes, such as a want of proper males may be thus benefitted. The reckless nutrition, proper clothing, proper physical exmanner in which some young women treat ercise, proper primary instruction and guid of little value to success in any great undertaking without physical vitality. Too many of the so-called educated and cultured ladies, when they enter the domain of pregnancy and parturition, appear as intellectual fizzles. A worthy enthusiasm is now abroad in this age, striving to afford the young woman at least equal advantages with the young man, to mental culture and accomplishments in the fine arts. But abreast with these should be physical culture, which is absolutely essential to the proper enjoyment of the intellectual and æsthetical attainments. So, also, should the training and education of females include the development of strong, vigorous muscular and ance as to physical functions. A mother's The profoundest learning, the most charmcare, influence and teaching can accomplish ing talents and the best accomplishments are much. In fact, a woman who is a true mother, possesses a prowess unequalled. She is af forded a sphere of good to the race scarcely surpassed by any other human agency. Especially is it so in regard to the physical development of her daughters. The application of dietary rules should be her constant care, also proper and timely exercise, at work, or play, which will develop strong muscular power. Clothing should be provided such as will secure comfort, protection, ease and freedom of muscular action. Thus, the girl's feet should not be crowded into little shoes, hands pinched by little kids, the body as tightly bound as a whipstock, or as thinly clad as a Fegee Islander. No person has a better opportunity, nor is nervous systems, because these qualities are more capable than the mother of instructing the girl as to a practical knowledge of her own peculiar functions. This should be given If the judicious use of air, sunshine and early and timely, that she may grow into muscular exercise, should occupy prominent womanhood intelligent as to the importance places in the curriculum of schools and colof her mission as a possible mother. False leges for the education of girls, childbearing modesty, and an equally false fear of degi ad- would be shorn of many of its terrors, and a ing or corrupting the young mind, should healthier, longer lived race would ere long never deter from this important duty. On the other hand, neglected early teaching and ignorance in these matters often record the story of suffering in connection with the pregnant state and parturition. "Youth is the time to serve the Lord, The time to secure the great reward." Not only in the home, under the tutelage of the mother, has the essential physical culture of the girl been neglected or perverted, but also has our system of education in this rcgard been a failure. The spirit of the ages in relation to education, from the time of the Christian Era, has been to despise and neglect the body, as if the body were a clog or an impediment to the acquisition of knowledge. The Manichæans put the climax to this idea by teaching that "God was the author of the soul, but the devil was the maker of the body." As well might we expect a house to stand when the foundation is taken from under it, as to demand intellectual vigor from one whose physical strength has been dwarfed or wrecked. the sine qua non to the physiological process of childbearing. inhabit our globe. Some little attention has been given, of late years, to the introduction of gymnastics into our schools, though in a crude and unsystematic mode, yet we have reason to feel that this indicates the dawning of better days for the physical culture of women. A more thorough development and practical execution of this idea afford a fine field for laudable effort on the part of philanthropic societies, and the race-loving medical profes sion. The immediate preparatory attention of the physician is important in carrying the woman He should be consulted early in every pregsafely through pregnancy and confinement. nancy. He should use all proper and available means to acquaint himself with the general state of health, the predisposition of the woman, the formation, structure and condition of the pelvic organs, and to correct, as far as possible, any abnormal condition. Perhaps the most important therapeutic data in a case, is the condition of the blood. A capital fact in |