country physician is not up to date in this class of cases. We should be informed on the subject and be able to give them a satisfactory answer to such questions, according to the light of true scientific research. If we can not conscientiously give them the benefit of "twilight sleep" treatment we should be able to give them satisfactory reasons why we can not do so.

The old H. M. C. tablet (hyoscine, morphine and cactin) out of which has grown the scopolamin-morphin combination, combination, was first used in this country about twelve years ago. After careful observation by our leading obstetricians it was abandoned in both their elinical and private practice because of its deletarious effects. especially upon the newborn: a number of babes being fatally narcotized at birth.

So long as the placenta remained attached after birth the children could be induced to

breathe, although the heart and respiratory

acts were slower than normal. As soon as areation from the mother was interrupted (placenta detached) asphyxiation became established; prolonged efforts at resuscitation proving ineffective in a certain per cent. of cases. This, together with the other well recognized effect of the drugs (scopolamin and morphine) slowing up and prolonging labor, and predisposing to serious sequellae, are the particular factors that have led the profession to look with askance upon "twilight sleep" and the reports that have come from certain sources, and to hesitate in making use of the drugs, until further experimentation develops a safer rule for governing their use and method of administration.

Novocain, chloral hydrate, gelsemim canlophylun, lobelia. nitrous oxid gas have all been tried and found wanting. Nerve blocking and spinal anaesthesia have been tried and abandoned.

Scopolamin and morphin or morphine are dangerous remedies in obstetrics and when used require experience and proper faculties for their administration. It is a special form of anaesthetic and the patient should be given the attention of a special anaesthetist, just as one would do in any surgical case, where consciousness of the patient is to be held in abeyance.

Under such circumstances, i.e., a special trained assistant to assume responsibility and administer the drugs, and in a hospital with all necessary accoutrements, "twilight sleep" may be used in selected cases to advantage. Even then through the idiosyncrasy of certain patients failure will occur, and an occasional patient or the baby will be lost.

The criticism from more conservative minds in medicine is just and timely, for many prac

titioners will allow themselves to be forced into the use of "twilight sleep" through jealousy and fear of losing their patients. The method will undoubtedly be well tried and some form of near painless labor will come out of it, but until the certainty of its administration has been determined, let us hold safety the first principle in our armamentarium.

THE LAW OF HEREDITY.*

By MAURICE BELL, JR., Eminence.

One of the most familiar facts in Nature is that like produces like. Human beings produce human beings, and nothing else produces them or can be produced by them. This fact establishes the law of heredity. In its stricter sense the law means the transmission of special qualities. In this application it does not mean alone that black parents will white parents produce black children, or white children. It means in the more restricted sense, that special qualities in the parents will be represented in the children. by the tendencies to the development of those qualities. It is very difficult to draw the line between broad and restricted tendencies thus transmissible and transmitted.

But the fact that broad characteristics, both physical and mental, are transmitted to our knowledge creates the presumption that a child will be born with a tendency to develop any strength or weakness that one or both its parents possess.

This tendency appears in the most unexpected and curious forms. Thus, one, two or more generations may be skipped, when a child will be born with a characteristic handed down to it, has existed but lain dormant in its parents or other intervening progenitors.

Again, a child may be born with a characteristic that was really foreign to the blood of its ancestors, but was instilled in it by their occupation. For illustration, it was discovered in the case of Jesse Pomeroy, the boy murderer, that although his parents were excellent people, his father was a butcher and his mother was in the habit of visiting the shambles for several months before the child was born. Neither parent had ever developed a homicidal tendency, and yet they were so inured to the taking of lower lives and the shedding of blood that it is conceivable that this habit was transmitted in the child into a homicidal tendency.

It is certainly a fact that an ailing, peevish mother will produce a child of a similar disposition, we may expect nothing else.

A farmer in selecting plants from which to save seed for the next year's planting, never *Read before the Henry County Medical Society.

makes the mistake of choosing indiscriminately, nor does he select the weakest on the theory that it makes no difference. He will select the finest, largest plants to furnish seed. It is by pursuing this method that improved varieties are constantly being brought out. Hence we are compelled to believe that the strongest parents will produce the strongest children.

Take the mothers of great men and they have been great women. The maternal influence is greater than the paternal. The reason for this is, the child is a part of the mother's body during the nine months of gestation, and as such part it receives the nourishment she chooses for herself, has the same blood in its veins that fill hers, and is subject to all the nervous conditions that effect her. birth the physical relation is maintained to a slight degree in the fact that it receives its nourishment from the breast.

After

The mother is the natural and constant custodian of the child, and as imitation is an essential part of our nature, its character will be moulded in a large measure by hers. This being a fact that heredity plays a vital part in the character of the child, let us inquire what its manifestations may be. The first and most evident truth is that physical qualities are transmitted. Thus blond parents have fair children, as a rule, large parents have large children, or children who grow to be large.

Parents descended from a line of hard manual workers usually have well developed offspring. People who live natural, intelligent lives, are likey to be healthy, no matter what weakness they may have inherited, for the reason that Nature's efforts are always bent to correct errors.

A good deal of bad living is required to overcome this natural tendency, but most people live a great deal worse than they think. These remarks are deemed timely for the reason that if people come to rely too much on heredity they will rely too little on themselves. Some exhibit the weakness of assuming that as they are the product of their ancestors way of living, it is useless for them to try to he anything else.

And as our ancestors have handed down certain tendencies to us, and we realize those tendencies are bad, we are placed under the strongest obligation to live in a manner to overcome as much as possible.

It is evident that no matter from what point of view we regard this subject, living is an essential part of it.

While size is an element of no value in the ordinary struggles of life, strength is. By strength is meant not only good bone and -muscle, but that deeper strength which is found in the ability to resist the evil influence

of conditions which militate against strength. If one takes cold easily he is not strong. Men of apparently splendid physical development are seen to succumb under conditions which seemingly much weaker men resist.

Hence, by strength is meant vital energy. It is clear that abundance of vital energy is one of the most useful qualities it is possible for us to possess. By living right we can inculcate within ourselves the natural power to resist disease, and by cultivating ourselves, we can transmit the tendency to others. If we violate natural laws, knowing our acts to be violations, we transmit to our children a tendency to do likewise.

Abortion is the deliberate taking of human life and its practice leads to a disregard for the sacredness of life. A sound mind usually goes with a sound body, so it is essential we cultivate sound bodies if we desire to bear children with sound, competent minds.

There is still another phrase, that is the transmission of moral qualities. It must be evident to-all thinking people that immoral habits of thought and conduct produce a like tendency in the offspring. It is much easier to go wrong if the body and mind are weakened by disease.

There are deformities of mind as well as body, and they are much more easily transmitted. If we try to do right, our children will inherit the tendency to strive for the same end.

Each one stands between two eternities, the past and the future. In each of us is implanted the natural tendency to be better than our ancestors. It is our duty to recognize this tendency, to cultivate it, to make the most of it. In ourselves in the short time allotted us, we can begin a tendency which will turn aside evil tendencies we have inherited, and in so doing we can begin a new line of good, stretching throughout the eternity before us. Our lives are not for a day, not for the few poor years allowed us, the influence of each goes forward forever.

A perfectly satisfactory accounting for this abnormal implantation of the placenta over the internal os has not been determined, but clinical observation shows, that it occurs more frequently in multiparae than in primiparae, and that it is more common aomng the working classes.

That abdominal Cesarean section for the relief of placenta previa, is becoming more favorably and more frequently considered, can readily be seen in perusing any of the new text books of obstetrics or in any of the articles upon this subject, appearing in the journals.

Mrs. A. K., white, age 36. Married at 23. Eleven pregnancies. Eight living children. Family and personal history negative, save the three abortions. The first occurred March, 1911. The second December, 1912, for which no cause for either could be determined, and the last, at three and one-half months, October 24, 1913. This was caused by a placenta previa, as was found when delivering her and of which I told her and her husband at that time.

Menstruation returned returned November 28th, 1913, and did not recur again. During

March she had a continuous lead of blood which she took for a prolonged menstruation, but for which she did not consult me, but informed me in April of it. July first I received a call to see her at once, but it was an hour or more before I could do so and I found she had had a severe hemorrhage, but that all flow of blood had ceased and an examination with speculum revealed no bleeding. I was told at this time that she had had some bloody discharge quite frequently. A threatened miscarriage was diagnosed, and the patient put to bed. No further symptoms occurred and after ten days she was allowed to get out of bed and the next day she took up her household chores. August 11th I was again hur riedly called on account of hemorrhage and again the bleeding had ceased before I arrived. Examination revealed no pathology whatsoever nor could the placenta be felt through her thin abdominal wall. The case was watched again until August 19th, and no

*Read before the Jefferson County Medical Society.

I

protest she got out of bed again to take up the duties of her home. The night of the twenty-second I was again called but this time on account of some abdominal discomfort. was told that at 5 o'clock in the afternoon there was considerable hemorrhage, but that there had been none since. Again nothing could be discovered on examination. And the

patient was given one-half grain of morphine and 1-150 grain of atropine hypodermically. I saw her the next morning and found the cervix patulous. On introducing the index finger the placenta could be felt. The abdomen was palpated and an oblique presentation with head on left side could be made out. Dr. Gossett was at once called in and the husband told that a Cesarean section was the safest procedure for the mother and the child. Patient was at once sent to the Jewish hospital. No discomfort was occasioned by the move to the hospital. And no vaginal discharge was noticed until seven o'clock that evening. Again at eight o'clock when the urine was voided there was some blood discharged. At 11:15 there was evidence of considerable bleeding and it was then decided to interfere, and orders were given for the patient to be taken to the operating room.

Assisted by Doctors Lee Kahn and E. E. Owen and Dr. E. L. Henderson as anaesthetist, an abdominal Cesarean section was performed and a five and three-quarter pound boy was delivered. There was severe hemorrhage from the placental site just as soon as the baby was lifted from the uterus but it was immediately stopped as soon as the placenta was detached and the site of the attachment heavily wiped with gauze. Five hundred c.c. of normal saline solution and twentyfive minims of pituitrin were introduced under the skin at this time.

By the time the closure was completed the patent's condition was very satisfactory, meteroism coming on after the first thirtyfour hours and continuing for eighteen hours was the only unpleasant feature of convalescence. This was relieved best by pituitrin twenty-five minims hypodermically, and magnesium sulphate half ounce, glycerine two ounces. turpentine two drachms, in quart of hot water per rectum. Mother and baby were permitted to go home September 9th.

Hemorrhage, the only symptom, was very graphically portrayed in this case, beginning early in pregnancy, recuring in increasing intervals as pregnancy advanced.

If the abnormal situation of the placenta is detected during pregnancy, send your patient to a hospital and terminate gestation as soon as the symptoms demand.

COUNTY SOCIETY REPORTS

Barren The Barren County Medical Society met in Dr. Bott's office, Glasgow, August 18, 1915, with the following members present: Ferguson, Miller, Porter, Turner, Jordan, Biggers, Howard, Smock, Acton, Botts, and Taylor.

The society was called to order by Dr. Miller. The reading of the minutes was deferred to next meeting.

case:

There being no papers, reports of clinical cases were called for, when the following cases were reported, and kindly noted by Dr. Porter. J. C. Jordan reported the following Young man, 19 years old, has had for some time, persistent elevation of temperature, with evening remission, and night sweats, the morning tempcrature being 103, pulse 60, headache, coated tongue. lassitude, no cough, and bowel action normal. He was operated on some time since for appendicitis, but about the scar there is dullness, some enlargement, and at times considerable pain. The case was discussed by Drs. Biggers, Howard, Turner, Botts and Miller, the belief prevailing that there is local trouble which should be looked after by the surgeon.

W. F. Biggers described a case of "Otitis Media' which has been under his care since December, 1914. The patient is a girl four years old. well nourished, and intelligent. Two or three times a week, she falls and remains unconscious for about ten minutes. Otherwise, her condition differs but little from the average child of her age. She has had the treatment commonly given in such cases, but the spells" don't improve. He asked for suggestions as to treatment, and prognosis. Drs. Miller and Ferguson believe the case is one of regular Epilepsy, and as such we can hardly hope for any treatment to be successful.

S. J. Smock suggests that a successful treatment of the ear trouble might mitigate-possibly cure the condition.

T. F. Miller submitted for consideration a plan to organize an inter-county medical society composed of the members of the county societies of Barren, Metcalf and Hart counties, on plans hereafter to be devised. Motion carried, that we favor the movement, and that Dr. Howard be appointed to correspond with the Secretaries and others interested, making such arrangements as may seem proper, and report results at our September meeting.

After arranging a program for our next meeting, the society adjourned to meet in Glasgow, September 15, 1915.

J. MORGAN TAYLOR, Secretary.

Barren The Barien County Medical Society net in the office of Dr. A. T. Botts, July 21, 1915 wit hthe following members in attendance: Jor

dan, Siddens, Turner, Ferguson, Acton. Miller, Botts, Britt, Smock, Porter, Howard, Taylor, Carroll, Palmore, and Depp. Dr. Henry Childress of Paducah, was a welcome visitor.

The meeting was called to order by President Ferguson.

The minutes of last meeting were read and approved.

In response to a call for clinical reports, a number of cases were reported and discussed. Nearly every member present participated in the discussion, and all felt that the time was well spent.

C. C. Turner, whose report I send under separate cover, described a very interesting case.

Motion carried that a committee be appointed to prepare resolutions expressive of the feeling and sentiment of the society on the death of Dr. Joseph Sherrell Leech, which sad event occurred July 10, 1915. C. C. Turner, A. T. Botts, and R. H. Forter compose said committee.

Following is the program for our next meeting:
E. L. Palmore, "Puerperal Eclampsia."
J. B. White: Report of Cases.

T. F. Miller: Other Complications of Labor."
J. G. Siddons: Report of Cases.

June 5th issue of the Journal of the A. M. A., on Tanlac. After quite a lengthy discussion a committee composed of Drs. Bell, Sandbach and Stites, was appointed, to act for the society in publishing extracts from this article in our two local newspapers.

A committee composed of Drs. Bassett, Sandbach and Keith was appointed to publish the movement of bringing the State meeting to Hopkinsville in 1916.

G. W. Lovan reported several cases of "Pellagra" with an enormous death rate.

B. A. Caudle presented a clinical case and the chair appointed Drs. Bell, Williams and Watts to make examination and diagnosis. Report: Woman, colored, age 25, three children, anaemic, no fever, pulse 95, tongue sore and coated, diarrhoea, vaginitis, eruption on hands and complains of weakness and pain i nthe abdomen. Diagnosis, pellagra.

J. G. Gaither read a paper on "Inguinal Hernia." Diagnosis very important. Operative interference lessens the mortality. Inguinal the most frequent of all hernias. Eighty-six per cent. of cases occur in the male and most often on the right side. The doctor had several of operation.

1915.

J. MORGAN TAYLOR, Secretary. Boyle-The August meeting of the Boyle County Medical Society was held at the Calvert Hotel, Perryville on August 17th, with the following members present: Geo. Cowan, J. R. Cowan, J. E. Caldwell, J. R. Steele, D. M. Godbey, W. H. Sparrow, T. R. Griffin and H. M. Pitt

man.

The application for membership of Vance Rawson and Will Hunn, were reported favorably by the Board of Censors. Vance Rawson received the votes of all members present and was elected to membership.

The secretary was instructed to notify the applicants of the action of the society.

H. W. Watts, in discussing the paper said: "I enjoyed the paper. The essayist has covered the grounds. Diagnosis most important from the Hence look general practitioner's standpoint. very carefully for the diagnosis.

F. H. Bassett: Why do you use this operation does not in preference to the Ferguson that bother the cord?

J. G. Gaither, (Closing): Necessary to bother the cord to reach the floor hence raise it from the force of the oncoming intestines.

in some cases.

J. R. Cowan read a paper entitled, "The Differential Diagnosis of Fevers," which elicited much discussion and favorable comment, and was ordered printed in the State Journal.

The society adjourned to meet September 14th, at the Elks Club.

T. R. GRIFFIN, Secretary.

Christian The Christian County Medical Society met in regular session Tuesday, July 20th, in the Avalon, Hopkinsville, President Gates was in the chair and the following members preseat. Gates, Erkiletian, Lovan, Lacy, Keith, Williams, Wright, Lackey. Stites, F. M. Bassett. Caudle Harned, Watts, Bell, Stroube. Reynolds, Dade, Stites, Frank, Rice, Gaither and Sandbach.

After the reading of the minutes of the previons meeting the Sceretary read an article from the

W. E. Reynolds, in discussion said he was much pleased with the paper. Often used blister. Now prefer the ice bag. Use digatiline.

J. Paul Keith: Thanks to Dr. Stroube. My efforts are not a perfect success. Often loose most favorable cases. Prefer warm comfortable room well ventilated.

J. G. Gaither: Do not believe in blisters. May use counter irritation. Pneumonia does not often kill negroes while tuberculosis kilis at once. Very peculiar. Always look for pus after thirteen days.