the regulations of midwifery are practically the same as when the State first began to exercise control over the practice and are utterly absurd and inadequate when compared with the requirements of obstetric practice by doctors of medicine. No preliminary education or obstetric experience is required; the woman's ingenuity in passing the examination is all that is necessary. And yet a woman who cannot read or write in any language can pass a written examination. The committee believes that the time is ripe for a readjustment of midwifery requirements, and that there should be adequate regulations commensurate with the demands of modern obstetric practice. The report to the committee by Miss F. Elizabeth Crowell, who superintended the investigation, makes up the bulk of the article. The information regarding their personal, social and professional status was obtained from the midwives by Mrs. M. J. Rogers of the Visiting Nurse Association, and later a special detective with New York experience in this line of work visited the same midwives to gain information as to criminal practices. In Chicago 47 per cent, of the births are reported by midwives, chiefly among the Italians, Slavs and Germans. It is impossible to make any accurate estimate of the number of midwives practicing in the city; the registry is absolutely valueless for all practical purposes. Speaking roughly, there are between 500 and 600. This estimate is based on the numbers registered at the county clerk's office (1634), and in the last City Directory (466). Allowing for changes by death, removal, etc., 500 may be a conservative estimate of the present number. Of the 466 in the City Directory but 346 could be identified in the register, and in a majority of cases they were incorrectly recorded. Over onehalf of the 223 visited were incorrectly registered. There was very little illiteracy, only one being unable to read or write. Sixty-seven (30 per cent.) presented foreign diplomas, which may be considered as evidence of proper training; III (about 50 per cent.) had certificates from local midwifery schools, so called, which are prima facie evidence of but one thing-that the holder had money to pay for it. Many of these local schools could not be traced, but seven were found and investigated. and investigated. The same strictures. made on the New York schools apply to those of Chicago; they are diploma mills. In two cases no text-books were used, instruction being solely by word of mouth. When possible, opportunities are given for practical experience, but this is not considered essential. One "school," seemingly well patronized, judging from the number of certificates, offered private instruction in the modus operandi of successful abortion as a lucrative specialty. In this particular instance the school of midwifery seems to have been also a school of crime. The standard of cleanliness was found to be much higher than in New York, one explanation being that nearly all the midwives lived in separate homes instead of crowded tenements, as in New York. Coming to the criminal aspect of the practice of these women, they were found to be on a par with those of New York. Forty-nine midwives agreed to perform an abortion on the special agent who visited them, and four of fered to sell drugs that would act as abortifacients. abortifacients. Twenty-two were put down as suspicious because of information given by others or because of their possession of instruments for which they had no legitimate use. Of these women 19 offered to receive patients in their homes, in direct violation of the law. In fact, there is very little, if any, obstetrical work done in these unlicensed lying-in establishments; they are simply abortion shops, and the same epithet would apply to some licensed lying-in institutions, socalled. It is probably true that the crime. of abortion is increasing in Chicago, and it is generally conceded that the midwives are chiefly responsible. The committee, in conclusion, recommends changes in the law, giving the State Board of Health authority to inspect or control midwives, and suggests the issuing of short-term licenses without additional fees after issuance; the appointment of a local official with sufficient assistants, who should be responsible for the conditions of midwifery practice in the city, acting in conjunction with the local health authorities; the promulgation of rules restricting and regulating the practice of midwives by the State Board, whose local representatives should be charged with their enforcement. Provision should also be made for the assumption of the control of midwife education by the State Board of Health, and in instituting a plan of midwife education, the board should also provide for repetition courses of from two to four weeks every two to four years, such as are favored by the German and Austrian schools and the Ger the first group of the new buildings of the Allgemeines Krankenhaus. They have begun the rebuilding with the departments for women, and two of the three clinics, for midwifery and gynecology, are completed, one for Professor Schauta and the other for Professor Rosthorn, recently called from Heidelberg. About 10,000 deliveries a year take place in the three clinics, one of which is for midwives. The new clinics are exact duplicates of each other, and each has accommodation for about 200 patients. The buildings are of four stories, a central building with wings, built of brick and stucco, with spacious corridors, large windows, tile floors and white oil-finished walls. Inside and out they form the most attractive hospital buildings that I have ever seen. But it is not so much this aspect that gives one that sinking of the heart of which the Queen of Sheba complained when Solomon showed his treasures-it is the organization and the completeness of the arrangements for teaching and for the scientific study of disease. One large floor is assigned to students, who live in the building while attending the midwifery cases. Each clinic has its own laboratory, a special museum for man Society for Midwife Reform. De- teaching purposes, a library and a fully tailed tabulated statements of the results Modern Hospital Prof. William Osler "If anyone interested in hospitals-in every possible detail, construction, situation, general arrangements for the comfort of the patients, for the convenience of the students, for the advancement of science-if such an one wishes to have a Queen-of-Sheba sensation, let him visit equipped small laboratory adjoining the gynæcologic operating-room, so that an opinion may be given immediately as to the nature of a growth. Down to the smallest detail every care has been taken to make these two clinics the most perfect of their kind, and if the hospital is completed on this elaborate plan it will, indeed, be worthy of the fame of the Vienna school, and there will be nothing like it in Europe or America. The Government foots the bills, and the total cost of the two buildings has been 9,000,000 kronen ($1,800,000).” MATERIA MEDICA AND THERAPEUTICS. UNDER THE CHARGE OF ALFRED C. PRENTICE, A.M., M.D., Assistant in Surgery. College of Physicians and Surgeons; Attending Physician, New York Home for Destitute and Crippled Children. action. Non-Fatal Serum Re- A. P. Ohlmacher, Detroit (Journal A. M. A., March 14), reports two cases of severe reaction to therapeutic serum injections. In both cases the contingency of hypersusceptibility had been considered and attempted to be met by administering several “immunizing” injections during the first eight or ten days of what is shown by animal experimentation to by sensitizing interval. In both cases the more common "accelerated reaction" of the serum disease, as defined by von Pirquet and Schick, i. e., urticaria, joint pains and fever, failed to appear. It seemed as if these more usual manifestations accumulated and took the form of one grand explosion. The first case was that of a woman, expecting confinement. in a short time, who was suffering from a chronic polyarticular rheumatism. For this she was given injections of antistreptococcic serum, 10 c.c. daily for three days, and then at longer intervals. There were no evidences of serum reaction until the seventh injection, on the fifteenth day of the treatment, when there was a sudden attack of very pronounced oedema, cyanosis, feeble rapid pulse, severe apnœa and unconsciousness. After what seemed several minutes, but, of course, was less, gasping inspiration occurred, followed by a rapid recession of the oedema and cyanosis, with spasmodic breathing, moaning and gradual return of consciousness. As soon as the patient was able to talk she complained of chilliness, and severe rigors occurred, with vomiting, which together lasted about 15 minutes. Following the chills the cutaneous sur face took on a bright red hue, and fever gradually developed, reaching a maximum of 103° F. in about three hours. All had subsided by the next morning; the woman expressed herself as feeling perfectly well, and for a week or two the rheumatic joints were much more comfortable. Ohlmacher here parenthetically expresses his belief that the good results. following the injection of horse serum in chronic rheumatism are due to the periodic hyperæmia in the affected joints by the "accelerated serum reaction." Some fears were felt for the child in utero, but all went well. In the second case, that of an adult man, the cumulative reaction was not so severe, principally differing in that the apnoea was less prolonged and consciousness entirely lost. There was also a longer interval (three minutes) between the injection and the appearance of the symptoms, but in other respects the cases were similar, even to the relief of the rheumatic symptoms. The Use and Abuse of TheNew York MedSalt Solution. ical Journal (April 25, 1908) has the following abstract from American Journal of Obstetrics: Balloch reaches the following conclusions: 1. Physiological salt solution is a fluid which is isotonic with the plasma of the blood. 2. Its field of therapeutic usefulness is in conditions which cause alterations in the quantity of the plasma. 3. The quantitative alterations are chiefly those which are caused by hæmorrhage and obstruction of the upper bowel. The qualitative alterations are caused by the various toxæmias. 4. The exact per centage of salt in the solution is important, and extemporaneous solutions are to be condemned, owing to the danger of hæmolysis. 5. The subcutaneous tissue forms the most useful avenue for the introduction of the fluid. The intravenous route may be used in emergencies, and for post-operative purposes the rectum is most serviceable. 6. Its use for irrigating purposes in abdominal surgery will not prevent the formation of adhesions, and it is probable that its use for washing away pus blood and debris is not more effective than dry sponging. The Therapeutic Value Walko (Wiener of Oil and Bone Marrow in Diseases of the Stomach. Klin. Wchschrft., No. 47, 1907). The author's observa tions concerning the mode of action of the fats, especially the oils, were made upon the majority of those gastric affections which are associated with the increased production of hydrochloric acid, including hyperacidity, hypersecretion, the alimentary and nervous type of either; gastric ulcer, erosions of the gastric mucosa, acidity, hyperæsthesia; also pyloric stenosis of a benign and cancerous character. In the hyperacidity cases bone marrow (freshly boiled) was found to have a well-marked inhibitory influence upon the secretion of acid. It is fully assimilated by the bowel. In gastric ulcer the author prescribes during the first days, repeatedly, a tablespoonful of a mixture of 100 g. olive oil, 5 g. bismuth and 3 g. magnesia usta. Cold milk is not permitted until the third day. Rest in bed is insisted upon in all these cases. F. R. tion of Flies and Mos quitoes. Solution of Formalde- In the Archives de hyde for the Destruc- médicine et de pharmacie militaires for April, 1908 (New York Medical Journal), M. Delamare, chief of the military wards of the hospital of Saint-Denis, describes a method of destroying flies and mosquitoes in apartments by the use of a 10 per cent. solution of commercial formaldehyde. Saucers containing the solution are placed on the window sills and on tables in proximity to the places infested by the flies. The solution is said to be very effective, flies and mosquitoes being arrested and killed in their flight as they pass over the vessel containing it. Saucerfuls of the solution placed at the heads of the beds in the hospital wards protect patients from attacks. The author had the curiosity to count the number of insects killed, and found that during the period from August I to August 7 the daily average was 4000 flies. The saucers should be emptied of dead flies and replenished with fresh solution once a day. ORIGINAL COMMUNICATIONS. THE USE OF SALICYLATE OF SODA IN ACCIDENTAL AND SURGICAL TRAUMA.* By MOZART MONAE-LESSER, M.D., Surgeon, New York Red Cross Hospital, New York. The object of this paper is not to bring before you facts with which you are all well acquainted, but rather to speak of the action of a drug as an adjunct to surgical cases, its effect being positive, if not startling. It may be proper to follow the usual routine and dwell somewhat on the principal so-called physiological action of the drug, and a brief incursion may not be out of place. The diffusibility of salicylate is well known. When injected into the veins of a cat salicylate of soda appeared in the urine in 10 minutes; in the bile, 15 to 20 minutes; in the saliva in 10 minutes. When taken into the stomach it appears in the saliva in 20 minutes; in the urine in 45 minutes. (On examining the urine of patients taking salicylate it must be borne in mind that a reaction occurs similar to that of sugar, which must not mislead.) The normal elimination of salicylates is by the skin and kidney, but almost wholly by the latter, and in nursing woman also through the mammæ. Bernard and Liron are responsible for the statement that salicylate, whether taken by mouth or injected into a vein, will appear in two hours in all secretions, including cerebro-spinal fluid. It will also be found in inflammatory exudates. Large doses, as attested by Reiss, Ewald, Senator and others, reduce tem *Read at the clinical meeting of the New York Red Cross Clinical Society, May 16, 1908. perature from 1 to 3 degrees in febrile cases. However, if it is given in doses not larger than 0.6 (10 gr.) and repeated every three or four hours, very little, if any, antipyretic action can be observed. When the temperature does fall with the administration of these doses, it is due to the lessening of the inflammatory processes and diminution of pressure. It is of importance to note that ordinary doses of this drug have no perceptible effect whatever upon the temperature. Ringer concurs in this view. Aside from the diseases which are generally known to be benefited by salicylate of soda, we find an action not noted by many authors, but well explained by clinical facts. An exhaustive research and strict observation has led me to the belief that this remedy is of extroardinary value as a sedative in traumata and the inflammations connected with them. This is principally due to its rapid diffusive power, for the drug is not only carried to the inflamed parts through the circulation, but also by direct osmosis. An experiment at which the author assisted was made as follows: A bladder containing healthy urine was cystoscoped and the catheter inserted into each ureter; this was followed by an injection of salicylate of soda into the rectum. As a result the urine subsequently taken from the bladder contained the drug long before the ureteral catheters |