ounces of placental debris, stinking (putrefying) was removed from the uterus, under chloroform, and iodoform-gauze pack inserted.

She did fairly for some days, but gradually sank with chronic sepsis. I saw her again in consultation January 29, 1903, at which time she was suffering chiefly from cystitis, but there was subinvolution and the vaginal slough was not granulating well.

About February 6, 1903, she was "curetted" by Dr. McCosh. Suddenly on the evening of February 10 she was seized with severe pain in the right parotid, and in four hours the face was as badly swollen as in well-developed mumps. I saw her February 18, when the swelling was enormous and the suffering intense, but advised waiting until suppuration should be positively determined.

February 21, with patient under chloroform, I opened a huge abscess of the right parotid, curetted away most of the gland and applied a carbolic pack. She died February 24.

This was undoubtedly of septic origin; but there was no trace of pus-infection of any part of the body except the one parotid.

Case II. Mrs. O. D., patient of Dr. G. S. Dodds of Brookport, Ill., age 38, never pregnant, history of probable infection with Neiser's coccus six years ago. Examination March 23, 1906, showed whole pelvis filled with tumor and inflammatory material. She was admitted to St. Mary's Infirmary May 5, 1906, and prepared for operation.

Combined vaginal and abdominal section was made (under hyoscine-morphine anesthesia) on the morning of May 8. The trouble was a large fibroid tumor of the right ovary and cystic tumor of left; both ovaries were removed; also the uterus on account of adhesions and an obliterative salpingitis.

There was little nausea and patient slept most of the night following operation. Morning temperature May 9 was 99 and evening 100. May 10 temperature was 99 all day and patient was comfortable; bowels moved from enema. At 4 p. m. patient complained of sore throat and temperature was found to be 1014. Purge was ordered and at 7 a. m., May 11, her temperature was 99 and general condition excellent. At

1 p. m. (end of third day following operation) swelling, with pain, was noted on the right side of the face just below the ear; at 5:30 this had increased to the size of a goose egg, with intense pain and temperature of 101. At 7 the swelling over the parotid was very great, pain worse, temperature 103. Vaginal packing was removed and douche given, though no evidence of infection existed and abdomen was flat and painless. Morphine as needed to quiet pain of "surgical mumps" was ordered and ice-bag applied. May 12, the morning temperature was 102, evening 104, and face swelled to the limit of skin-stretching; pain was very great; abdomen free from symptoms. May 13, pain was less, morning fever 101, evening 103, with rigor at 4 p. m.; no abdominal symptoms. May 14, morning temperature was 100, pain not so great and swelling a little less marked with tendency to "point" behind jaw; evening temperature 102, with slight delirium. May 15, morning temperature was 1001, evening 1021. May 16, patient seemed better, but pulse was intermittent, and pain in neck and face so severe as to require morphine; highest temperature 102. May 17, morning temperature was 101. At 6 p. m. 103; pus was escaping from external meatus all afternoon; abscess under ear was lanced at 6 p. m., about one dram of pus escaping. May 18 the stitches were removed from the abdominal wound and healing found to be complete; temperature was 101, but face still swollen badly with no discharge from either wound or ear; hot carbolized flax-seed poultice was applied. On May 20 her temperature was 100; abscess on side of face was opened, evacuating about one ounce of very thick pus. Next day a deep abscess ruptured into the cut, discharging a large amount of pus. After this recovery was slow, but perfect; with temporary salivary fistula.

In this case there was never at any time any symptom which pointed to abdominal or pelvic infection; yet the patient became profoundly septic from the parotid suppuration. If there had been no pus formation, but merely pain and swelling, the "nervous" or "sympathetic" theory of causation might be maintained. That it was not due to infection from chloroform or ether administration (one of the suggestions as to the cause heretofore) is apparent from the fact that the

patient had nothing but the hypodermic anesthetic: the hyoscine-morphine-cactin tablet. That there is some as yet unknown bond of union between ovary and parotid is claimed by Dorland, who cites the fact that certain tumors of the ovary are accompanied by scantiness of parotid secretion. Dyball advances the theory that in certain tumors of the ovary there is a peculiar toxic material akin to that which produces mumps; and that during manipulation some of this is forced into the blood, infecting the parotid gland, through which it may be eliminated. It is presumed that the parotiditis is not primarily a true pus-infection-only 44 per cent of the cases reported ended in detectable abscess-formation; the toxins having poisoned the parotid to such an extent that it becomes a locus minoris resistentiae, it is very easy for secondary infection to occur from the mouth which is always rich in staphyllococci. In those cases in which pus did not form it has been claimed that infection through Stenson's duct failed to take place; and these uniformly ran an afebrile course. Paget collected reports of 101 cases of parotiditis following trivial causes like introduction of pessaries and slight blows upon the genitals.

The trouble usually appears upon the fourth or fifth day after injury or operation.

Of the cases collected by Dorland the following were the operations:

That more than 50 per cent occurred after operation in which the ovaries were not touched disproves the theory that the trouble is due to some ovarian or other toxine liberated by manipulation. In my opinion most of the cases are caused by a mild pus-infection due to some error in technic or to the

liberation of pyogenic matter from the field of operation, and that the parotid becomes the site of local secondary infection only by mere accident, just as thrombosis of the left femoral vein sometimes follows operation for appendicitis. Those attended by huge swelling and much pain in the parotid without fever and without suppuration are possibly not due to infection by staphyllococcus or streptococcus, but to one of the minor pyogenic micro-organisms-notably the bacillus coli communis, which often produces, elsewhere, most distressing inflammatory conditions, even vast quantities of pus, without any decided rise in temperature. Bacteriologic investigation of fluid withdrawn from the infected gland ought to settle this. In both of my cases staphylococci were present; but unfortunately both had gone on to suppuration before the microscopic examination was made.

A CHRISTMAS STORY.

BY E. S. M'KEE, M. D., CINCINNATI.

About eighteen years ago I was called to see a patient, a recent arrival from Russia, whom we will call Mrs. Blankstein. She was very ill indeed, and I found it necessary to see her every day for a month, commencing December 15. She recovered and in due time I sent my bill. In somewhat overdue time her husband came to my office to pay it. The following was his plea: "Mr. Doktor, dat bill you zendt mein vife, he's all dright, but vone dem visits you makes mein vife you makes him ond a Ghristmas day, and, I vandts you make me a bresent dat visit you makes mein vife ond a Ghristmas day." The request was so original, coming from the source it did, so different from the usual demand for a per cent off, that I threw off the visit, made him a "bresent" of it, instead of charging him double, as I felt like doing, for being taken away from my Christmas turkey.

I have had many times the worth of the presented visit telling it to my friends. Almost every Christmas since this occurred I have been called to some sufferer, poor in this world's goods, and before leaving I have told the story of the Christmas present of a visit and made the patient a present of the Christmas visit I was then making. The happy smile, the brightened eye of the pale patient has been my reward for working while the rest of Christianity was feasting. Journal American Medical Association, Dec. 23, 1905.

IS MATERIA MEDICA A PROPER SUBJECT FOR FIRST YEAR STUDENTS?*

BY A. J. GIRARDOT, M. D.,

Professor of Materia Medica of Toledo Medical College, Toledo, Ohio. - Is materia medica a proper subject to be taught to students of the Freshman year in our colleges?

In answer to this question I will give a few of several reasons to substantiate my position in the affirmative. To fully appreciate the therapeutic actions of drugs, one must be versed in its Pharmacology, which in itself embraces the whole of materia medica and therapeutics relating to drugs.

The study of medicine, or rather the knowledge of medicine is growing to be more and more a science; and science being classified knowledge, one must of necessity be acquainted with the origin, composition, physical characteristics and chemical properties of any substance that he may chance to administer.

If he thoroughly understands these attributes it goes without contradiction that he will be better prepared to obtain the results he desires. As the student is to burden himself with the different and diverse subjects of the science of medicine, he will in no way overtax his energies in gaining this classified information, which he will find of such great benefit and assistance to himself in the subsequent study and application of therapeutics. Again, the Freshman begins on an entirely new study of a science, of which he may have very little, if any, knowledge; and as the mind of the new student has to be moulded and made familiar with the many different branches of less actual importance than that of materia medica, why should we not be justified in teaching as early as possible this branch, which treats of the composition, uses and laws governing their uses, of those substances which he must. of necessity be called upon to daily employ in his life's work?

To my mind there has been and still is a tendency in our colleges to underestimate the full value of this important subject and to consider it as a secondary branch. Gentlemen, the evil and pernicious results of this attitude towards materia *Read before the Ohio Association of Medical Teachers, December 26, 1906, Columbus, Ohio.