E

MEDICAL COLLEGE GOVERNMENT. VERY other industrial enterprise of the world has moved up out of the rut of ages, and taken on modern ways. The medical college, however, seems to be the one glaring instance, among others not quite so conspicuous, of adhering with tenacity to the old forms of organization and government which were ripe and ready for sepulture several generations ago. What is a medical college but an industrial enterprise in which the ways of business are attempted in the hope of earning expenses and wiping out of bad debts? Medical men are proverbially poor business men. That is our commercial rating. And we cling to that Bradstreet hall-mark with all the wealth of affection of the other old Aunty to the saving tenets of Original Sin. We are not to be disturbed in our more than ripvanwinkle slumber. Nothing can bring us to a sense of our has-been methods-not even palpable mismanagement, indifferent teaching, execrable business, the loss of desirable students, and the constant biting of thumbs at each other among rival Professors; nay, not even the steady increase in the burden of debt; nothing can in any appreciable degree affect those who are hell-bent upon running things even to the very dickens.

S

**

pretense and guise of being under the surveillance and dictation of a bold, bad board of directors or trustees-just so long will there be wishy-washy teaching, despicable bossism, professional and professorial jealousies, underhanded and dirty ways of ousting a rival, and the turning down and out of students for causes other than lapses in matters medical.

**

**

S there no help for this pitiable state of affairs? Dare we assume that the world at large is not fully cognizant of our poor business tact, our wretched teaching, our bickerings and jealousies, our augmenting debt, and our political fights to keep desirable teachers out, and wire-pulling, social, and financial pets in, the faculty? Do not the students-those now coming to us under the rigorous selective rules of the State Boards-do not these quickly pierce the flimsy phylacteries of the carpet-knight professors, and of those few elder wall-flowers retained in reverence of age and in order to lend a passing local color to the title over the front door of the school? Of course they do; and so doing they send the news back to the preceptor and the profession and the world, and we are pilloried because of our narrowness and our selfishness. Have we not frequent mutinies because of insufficient and inefficient teaching in the school? Do we not have from time to time complaints of the insufferable high-handedness of gosling Professors with the class, from which latter belike they graduated but the semester preceding?

THE

**

ness methods; of adapting itself to the exigencies of the times in which we live. Medicine is an exact science; as much so as either of the other professions or vocations. True, it is circumscribed in its sphere of usefulness; it has its metes and bounds; but so have the other professions. Therefore put it upon a business basis-such an one as will appeal to the commercial spirit of the hour, and cause men of means to take it up and make it successful, just as they engage in gasmachines, or ax-helves, or electrical appliances, or in any other purely business venture which promises a fair return for money invested. Sentiment has no place in a medical school outside the lecture room; and it is a large question whether it has much room in that room. Every man in every chair should be as trusted and skilled an employee of that college-corporation as he would need to be were he employed in a large manufacturing establishment turning out delicate watches, instead of instructing medical men and women. Each teacher should be selected because, and only because, of his special skill and ability for the place for which he is billed; and not because of his influence in filling the private business of the surgical chairs, or because of his grateful throwing of an undiscriminating ballot on supreme occasions.

L

*

* *

ET the medical part of the medical college be directed by the medical people; but the business part, the appointing of teachers, the keeping them in office from year to year, the purchase of necessary apparatus, the payment of bills and interest on a bad debt, the securing of students-all these should be matters of business attended to by business people. Why not view this matter sensibly and away from the business methods of a halfcentury ago? Look over the list of eminent men who would adorn a college chair bringing both honor and value to that chair in a modern commercial-medical college, and how many of these men (whose names have graced full many a page in current literature and whose white plume is always found in the forefront of battle against disease and death)— how many of these would think seriously for

even a moment of accepting place in a medical school one hundred miles away, which would entail the pulling up of home ties and a living practice? Not one! There isn't a medical man in Cleveland to-day making a fair living who would remove to Chicago to take to professoring in any one of its colleges. And there isn't one there who would come to Cleveland under the same conditions. every wide-awake medical man knows how these colleges are organized and governed, and that his lease of life in many of them is worth nothing beyond the immediate semester in which he may arrive.

*

* *

the several

For

IF [F the alumni of the several colleges could be roused from the pleasant contemplation of annual dinners at Delmonico's or Frascatti's, and the other equally agreeable exercises following thereupon, they could accomplish much to save their respective alma-maters from annihilation-for to this pass must it come at last. But the alumni of most of our homeopathic colleges is a pleasant fiction; or it is merely a well-leaded list at the back of the Annual Announcement of persons existing and extinct, to conjure with for future students; inclined and necessarily successful graduates, or it is composed of a body of convivially who gather once a year around a three-dollar plate to eat and drink and listen to choice chaste little rose-leaf stories, and, later on, to those a wee bit heavier in the girth and ensemble, the same while burning incense at the shrine of Nicotia; presently they are addressed by some glib-tongued, languorousmiened Professor with gold spectacles and a mustache reaching upward and backward and onward behind his ears, the address deftly interwoven with wonderful operations performed in that college; then the election of a college official to the presidency; after this more stories of the heavier sort (to fit the different mood now upon the celebrants to the accompaniment of apollinaris, plus-),and the mighty work for which this august body had been summoned out of the four winds of homeopathy is done. It disbands; and so it all ends in smoke! And yet this is that mighty engine which, put in working trim and rationally directed, could rescue its almamater from the hands of the vandals who are using it more for personal aggrandizement than for the good of the school or of our system of medicine. Will not the alumni arouse them and take hold? Or don't they care?

Materia Medica Miscellany.

Conducted by J. WILFORD ALLEN, M. D., 110 West 12th Street, New York.

Extraordinary Toxic Effect of Quinine.

Dr. Franklin W. Bock 39 records the case of a major in the army, recently returned from the Philippines, to whom quinine was prescribed in five one-grain pills, one to be taken every hour, in spite of the patient's assertion "that he couldn't stand quinine at all." In three hours quinism was marked. Grippal pains subsequently set in, and facial erythema of erysipelatous character, signs of physical collapse, and mental delirium followed. The effects of this small dose appear to have lasted about four weeks. On several occasions previously toxic symptoms had followed the attempt to administer quinine to this patient.

Diagnostic Value of Koch's Tuberculin.

Albert Fraenkel 38 says that the reaction against

McClelland.

Peck.

Custis.

the use of this agent, which was the natural result when it was found that not only was it useless as a therapeutic agent, but also that even as a means of diagnosis its employment was not free from danger, has gone too far, and that properly and carefully administered it gives valuable information with very little risk. A large portion of the undesirable by-effects and sequelæ attributed to the reagent are due solely to the unnecessarily large doses which it has been customary to give.

Diphtheria, Therapeutics of.

to the following few: Belladonna, phytolacca, apis, kali chloricum, mercury, and possibly lachesis.

If asked which of these few drugs I prescribe most frequently, I think the order would be as follows: Phytolacca, kali chloricum, belladonna; then would come one of the mercuries, or apis, or possibly lachesis. As to detailed indications, the following may be usually confidently considered: Belladonna.-When the circulation is actively disturbed, and the usual febrile symptoms with the characteristic throat appearance and modalities, belladonna may be prescribed. The right side need not always govern the selection of the drug. In the febrile sphere gelsemium will sometimes also do good service; but the dull, stupid expression, flushed face, and tremulous weakness must be present.

Kali Chloricum.-This drug I generally give for its oxidizing action, besides its strong influence upon the mucous membrane. If the stomach shows signs of derangement it is so much the better indicated. In my opinion it is useless to give kali chloricum in infinitesimal doses in diphtheria; two grains every hour or two for a day or two will produce good results without endangering the kidneys. Of course it must not be continued too long; its usefulness is over when the patches have disappeared. Chlorate of potash is an excellent second to the permanganate, and it will do satisfactory work in conjunction with belladonna or phytolacca.

Phytolacca Decandra.-When phytolacca is indicated the general aching so frequent in diphtheria will exist, the fibrous tissues being involved. The throat will be dark, with a sensation of hot lumps therein. This is doubtless due to the swollen tonsils, which are full of hot blood. There is a tendency to glandular enlargement. This glandular involvement further suggests ailanthus glandulosa, which sometimes proves useful in malignant cases, especially when a good local germicide has not been used. Phytolacca has, with the general aching, a soreness which seems to be deep enough to arise from the periosteum, but not the broken-bone feeling so common in grippe and so usually characteristic of eupatorium perfoliatum. The throat pains of phytolacca tend upwards into the ears, as though following the course of the eustachian tubes. With all this miserable condition the breath is very offensive.

Mercury. Of the mercuries the biniodide probably has the preference over any other preparation; probably because of its rapidity of actionand in diphtheria we certainly desire rapid effects. The red iodide of mercury acts strongly on the left tonsil, while the yellow iodide acts upon the right. The yellow iodide tongue is thickly coated yellow, especially toward the base, with red

tip and edges; while the red iodide tongue feels very sensitive, as though scalded. Mercurius cyanatus is frequently recommended by practitioners, but I confess to having been disappointed in its effects. It has produced "a white opalescent coating, resembling the superficial mucous patches of syphilis, on the pillars of the velum palati, and on the tonsils," but for all that I have failed to secure curative results in its use in diphtheria.

Apis Mellifica.-Apis is indicated when the patient is very weak, and has the characteristic appearance of the throat which is very sore on attempted deglutition. The late Dr. H. N. Martin

professor of practice in the Hahnemann College of Philadelphia-declared that he would rather depend upon apis for throat troubles than any other one drug, if he were limited to a single selection. While apis is a good throat drug, it is, however, by no means a panacea.

Lachesis Trigonocephalus.-Among the snake poisons the one I have found most effective in diphtheria has been lachesis. Its indications are so well known that I will not take your time by repeating them. by repeating them. Suffice it to say that when prescribed according to these same well-known indications it will rarely fail. Unlike the drugs already named I do not use lachesis in low dilution; the thirtieth dilution is the preparation I

use.

For the after-effects of diphtheria such drugs as china for strengthening the mucous membrane, and gelsemium for nerve weakness, may be needed; but my experience is that when a good germicide, such as permanganate of potash, is used, together with the general treatment herein outlined, there are few sequelæ from diphtheria.

PELVIC INFLAMMATIONS COMPLICATING THE

PUERPERIUM.*

By GEO. S. COON, M. D., Louisville, Ky. This communication, while necessarily touching puerperal sepsis in general, is intended especially to deal with pelvic peritonitis, pelvic cellulitis, salpingitis, and oöphoritis. In the majority of cases two or more of these pelvic inflammations are associated and are septic in character. Occasionally they are traumatic or irritative.

Few conditions are more trying to the obstetrician than puerperal fever, for not only is it a most dangerous complication, but one for which, in the majority of cases, he must hold himself responsible, through lack of cleanliness. I cannot

*Read before the Southern Homeopathic Medical Association.

agree, however, with those ultra gentlemen who would hold their attendants responsible in every case, for, in spite of the most rigid asepsis and antisepsis, occasional cases will occur. Never theless these cases are so rare that in every case of puerperal sepsis the presumptive and circumstantial evidence is against the attendants, and their only escape from self-conviction is the consciousness of having observed the well-known aseptic rules. Failure to do less is criminal negligence, and will result, sooner or later, in some unnecessary death. Statistics show that under modern prophylaxis and treatment the death rate from sepsis, in lying-in hospitals, has been reduced from ten per cent. to less than one-half per cent. Yet, in spite of this fact, there is still much slovenly work done about the parturient woman.

The general symptoms of puerperal sepsis are much the same, irrespective of the local part involved. These are: an elevated temperature following perhaps a chill; a rapid pulse; physical depression; a foul tongue, with anorexia; and in the worst cases a septic diarrhea. The local symptoms are more or less tenderness and pain, with a foul discharge, or the lochia may be arrested. The physical signs vary with the part involved. Although, unquestionably, pelvic cellulitis may occur almost independently of peritonitis, the two are frequently associated, and a differentiation at the bedside is often impossible. Peritonitis

is usually accompanied by tubo-ovarian inflammation, while cellulitis may leave these organs uninvolved. The infection of the cellular tissue is usually through the lymphatics, and comes most frequently from a lacerated cervix. If the disease be confined chiefly to the cellular tissue, there will appear locally, in one or both lateral vaginal culs-de-sac, a fullness which has a boggy œdematous feel. In a few days or a week later the culs-de-sac may be tense and full. The temperature in the meantime has been 102° to 104°, and the pulse proportionately increased. If there has been no involvement of the peritoneum pain will not be a marked symptom, and tympanites will usually be absent. The exudate which has taken place may be absorbed or become seropurulent, forming an abscess; the latter result occurring in about one-fifth of the cases. These abscesses may be opened above Poupart's ligament or through the vagina, without entering the peritoneal cavity; or, if left to themselves, may rupture into the rectum, bladder, vagina, or abdominal cavity. Occasionally they burrow to distant points; I having seen one that reached the diaphragm, while cases have been reported that perforated the lung and pleura.

Pelvic peritonitis may be induced by a leakage of the lochia through the fallopian tubes, an extension of an endometritis or a cellulitis, or absorption through the lymphatics. In any case

the tubes and ovaries are apt to be involved. Pain and tympanites, often accompanied with nausea and vomiting, with a wiry, tense pull, are usually marked symptoms. The peritonitis is usually localized by an extensive exudate, which glues the surrounding organs together and offers a barrier to the offending material. Frequently this exudate fills the entire pelvis and extends into the abdominal cavity. The abdominal muscles are hard and tense, the uterus becomes fixed and immovable, and the pelvis is filled with a boggy or firm, unyielding mass. Should the exudate become infected a pelvic abscess results; otherwise absorption takes place, as in cellulitis. As already intimated, the diagnosis between pelvic peritonitis and cellulitis, while clear in a small percentage, is obscure and impossible in the vast majority of cases. The difficulty is greatly increased by our inability to make more than a superficial physical examination.

Cellulitis existing alone is more often onesided, the pain less severe, tympanites less marked, the pulse less wiry, the stomach less irritable, and the exudate less extensive. Nor is a differentiation in the early stages important, since the general treatment is the same in both. Far more important is it to differentiate a localized from a general septic peritonitis, since the latter demands immediate surgical intervention. The task is at times a most difficult or impossible one, since, not infrequently, a localized peritonitis gives rise to as high a grade of symptoms as the general. Extreme distention, high fever, intense pain, and persistent vomiting are by no means constant symptoms in general septic peritonitis. I recall two cases in which none of these symptoms were prominent, and the only marked signs present were the rapid thready pulse and the peculiar facial expression.

As it is impossible to tell, at first, whether puerperal pelvic inflammation will end in suppuration or resolution, and since the latter takes place in the majority of cases, it is wise to begin the treatment on the expectant plan. In every case of puerperal fever the genital tract. should receive the most careful inspection, and the source of infection be removed, if possible. The uterus should be cleansed, and in the majority of cases the dull curette is advantageous. Only rarely, if properly used, does it result in harm. Intra-uterine douches are frequently of service, and in some cases a gauze drain. Large hot vaginal douches, of a saline solution, should be frequently repeated.

A most important, but too often neglected, adiuvant, is the clearing of the intestinal tract, which should be evacuated daily by an enema or a mild saline cathartic. Hot compresses or ice bags should be used over the lower abdomen; they control the pain and, to a certain extent, the in