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taining on an average over one thousand patients, re- quires qualifications of Buy Eskalith a special and high order. If any of the State hospitals has a superintendent unfitted for his duties, the specific statement should be made and measures should be instituted to secure a change. This would certainly seem preferable to placing all the asylums practically under the control of non-resident officials, who deem it important to interfere in such matters as the use of tobacco, as has been done by the Buy Lithium Carbonate State commissioners. The State hospitals are not penal institutions, and it is apparent that such questions as the use or disuse of to- bacco is a matter properly belonging to the local medical officers, and should not be settled by a disallowance of an estimate for that article. It is to be hoped that the public does not approve of such measures of economy, nor do we believe that the commissioners can justify their act on the plea that it is injurious to health ; for the allowed list of articles includes such stimulants as tea and coffee. The use and the abuse of an article are dis- tinct ideas. The present position of the resident medi- cal officers of our State hospitals seems little better than that of clerks appointed to enforce the ideas of an auto- cratic board. Generic Lithium Carbonate Favorable Eskalith Cr opportunity for the exercise of individual Purchase Lithium Carbonate talent by the eight superintendents in the State in the solution of problems in psychiatry is re- moved. So far as can be judged by public acts, no true reform has been instituted br the State Commission in Lunacy. The effort to utilize the labor of the patients, as an eco- nomic factor in asylum management, is only new in the apparent purpose to render it compulsory, as in the pri- sons. " Sew and make your garments, or you shall not be clothed," would seem to be the edict. For a long time systematic work by a portion of the patients has been regarded as a curative and otherwise useful means of treatment, and doubtless it has been used as fully as was practicable for proper purposes. The time has hardly come — rather, is past — for using forcible measures to se- cure work from the inmates of our asylums which may yet be justified in our penal institutions. Having no interest in this question aside from that 798 MEDICAL RECORD. [December i6, 1893 which belongs to every citizen of the State, except a pride in the noble professional and humanitarian work done in our State asylums by the medical officers, I can speak without bias from a partisan standpoint, and it is my sincere conviction that the present plan of State supervision is unwise. Though the present Commission may give a safe and even useful application of the law, enough has already been done by them to show that the plan is dangerous, in that it is susceptible of development into an autocratic control of persons who should be free to act, until it is shown that they are unfitted for their posts ; when they should be removed instead of being re- strained and controlled by the rules of the Board. If the plea for honor through a useful lessening of ex- penditures is to be made, then by all means let us have the items by which the saving is secured, and let these items be criticised by the aid of the statements of those who made the estimates, after giving the reasons for ask- ing the allowance. Further, it does not seem that the moral influence of the Commission will be enhanced by such general state- ments as that a number of persons have been maintained at State expense by being improperly included in the "families" of asylum officers. If there has been fraud on the State it should be dealt with in a proper way, and not condoned by decreeing that it shall not continue. The interests are too important and delicate for such coarse methods. Each citizen of the State must feel that this subject may have a personal importance, for there is always the liability to the occurrence of insanity in some friend or relative. Shall the care of that person be under hospital or prison methods? My letter is written solely in what I deem to be the interests of truth and right, for I have neither a personal cause to defend nor an enemy to punish. E. D. Ferguson, M.D. Trov, X. Y., December g, 1893. SHOULD WE TREAT IMPOTENCE? To THE Editor op the Medical Recokd. Sir : It seems to me that such sophistry as that contained in Dr. Waugh's answer to the question : " Should Impo- tence be Treated?" (Medical Record, December 2d, p. 736) ought not to go unchallenged. The fear that our patients may not use their various organs to the best ad- vantage morally is no reason why we should decline to heal their bodily infirmities. When a patient comes to me suffering with chronic gastritis, brought on by wor- shipping too ardently at the shrine of Bacchus, I do my best to restore his physical ailment, with' a gratuitous lecture on Temperance, if I think it worth while. It is not the physician's business to felicitate his patient upon the loss of a physiological function, or a priori pass sen- tence upon his dejected, spirit-broken, and unsexed client for crimes yet to be committed. The physician should be a physician first, and a moralist afterward. I recall a case of vaginismus which came under the care of the late Professor J. Ford Prioleau, during my service in the Charleston City Hospital. The woman was a prostitute by profession, but Dr. Prioleau in speaking to the class of undergraduates before him said, that although the wom- an would probably resume her immoral mode of life if cured, that was no reason why he should decline to re- store her, so far as he was able, to her normal condition. No one who knew Dr. Prioleau ever questioned his purity of mind or character. I think the views expressed by Dr. Waugh at variance with the objects of the medical profession, and .should be repudiated. Yours truly, J. M. Hays, M.D. Greensboro, N. C- Pertussis. — The severity of the paroxysms may be often relieved by using a drachm of hydrogen peroxide in a lit- t le glycerine and water four or five times daily. A CASE SHOWING HOW A LO.ST INTUBA- TION TUBE WAS POSITIVELY LOCATED BY MEANS OF AN ELECTRICAL SEARCHER. Ilv J. MOUNT BLEYER, M.D , NEW YORK. LARYNGOLOGIST TO THE WEST SIDE GERMAN CLINIC, liTC, In describing the electrical searcher devised by me for the location of intubation tubes that may have acciden- tally slipped down into the larynx or the air passages I desire also to give a brief report of Eskalith Er a case in which such an accident happened, and in which I successfully lo- cated the lost tube with my electrical searcher after all other known means to do so had been ineffectually tried. It was the first time I lost control over a tube, in some five hundred and forty cases of intubation of the larynx, which I have had the good fortune to do within the pe- riod of six years. Nevertheless, such an accident may happen to me again, in fact it may happen to anybody who practices the operation of intubation. Not long ago my colleague Dr. Derleth called me to see one of his patients, a little girl three years old, who was suffering from a severe case of stenosis of the larynx due to acute laryngitis, which had resisted the most vig- orous treatment and had become very alarming. Nothing that had been tried relieved the symptoms of gradually increasing dyspnoea, and we decided upon tub- ing the larynx. The tube ordinarily suitable for a child of that age was found upon introduction to be two sizes too small, perhaps on account of the distention of the larynx. Another, to all indications of the proper calibre, was introduced and immediately the dyspncea became relieved. This tube was left in place four days, and as the child had made such a good recovery I decided to remove it. To my surprise on searching for the head of the tube with my finger I could discover no trace of it, although I readily mapped out the space of the larynx and could feel the vocal bands. There was but one infer- ence to draw and that was that the tube had slipped down and was lodged somewhere Eskalith 450 Mg below the vocal bands. The respiration was undisturbed and for a long time I was puzzled as to what had become of the tube, but from the Lithium Eskalith tubular character of the insjjiration I was led to be- lieve that the tube was still in the vault of the larynx. But there was nothing that the examination recalled to substantiate my suspicion until I probed with a metallic staff bent to a shape to accommodate its passage belovi- the vocal bands. To make doubly certain I next searched the bed-clothes and deferred further exploration until a large dose of castor-oil had been administered and its effect observed, so as to exclude the possibility of the tube having been swallowed and lodged in the intestinal canal. A free examination of the bowels revealed nothing of the tube. Dr. F. S. Dennis was summoned, and the advisability of making an exploratory opening in the windpipe was' discussed. Dr. Dennis advised against such an operation unless a positive diagnosis of the location Order Lithium Carbonate Online of the tube was arrived at. At his direction the patient was removed to St. Vincent's Hospital, where the facilities for operation were better. All through the consultation I insisted upon the tubular breathing as being diagnostic of the position of the tube in the vault Eskalith Cr 450 of the larynx under the vocal bands, ^\■hile Dr. Dennis was inclined to agree with me he nevertheless refused to resort to operative measures until that point had been settled beyond per- adventure, and it was then, taking thought of the metal- lic character of the obstruction, that the idea of the elec- trical searcher occurred to me, and I hurriedly proceeded to rig up the instrument which located the tube as I had insisted after the bullet probe searcher had been used, and which I shall now describe. On the opposite page I append a rough sketch of my in- strument, which will give you some ocular idea of its shape December i6, 1893] MEDICAL RECORD. 799 The apparatus consists of three parts, i , the battery ; 2, the alarm and bell : 3, the searcher, together with their accessories. Perhaps it would be best to describe the parts in de- tail, by themselves. The battery was an ordinary vulcanite cell, with zinc and Lithium Carbonate Online carbon Buy Lithium Carbonate Online plate in a solution of sulphate of mercury, both plates being invested in separate compartments in the anterior portion of the cell, where they impinge upon platinum springs which are riveted to conductors on the outside of the cell from both positive and negative poles. The zinc and carbon are interchangeable, it being im- material which way the current travels through the ap- paratus. The poles of the battery come into contact with the conductor of the bell at Lithium Carbonate Buy the top of the partition, and it is necessary that the metallic surfaces should be clean, as any film of dirt or oxide would impede the pas- sage of the current.

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