head of his bed, on which the diagnosis of his malady is supposed to be written, is correct, or as full as it might be.

Then there is another point which has struck me much during the past ten years, and especially so whenever demonstrations are being given, either at the bedside or in the laboratory, namely, the far greater interest and earnestness which characterize the student of today as compared with his predecessor. Much of this is, I think, due to the indulgence of a larger hope. Hidden, as still are, the great mysteries of life, there yet are definite facts to be grasped by the mind, to be seen and handled, not only imagined or asserted; and the place of these facts in the economy of Nature, their bearing upon others, and their relation to work yet to follow, give a precision and confidence to study that is, comparatively speaking, of modern growth. There was plenty of assertion and show of knowledge in the past; but even the teachers did not believe the half of what they taught, nor comprehend the half of their sage pronouncings. Nature has, as it were, taken man more into her confidence, and daily reveals so much, even while concealing more, that the learner stands firmly on the ground he has gained, instead of trembling on a quagmire, the length and breadth and depth of which he I could not see and did not care much to imagine or investigate. He felt sure of little then but of his own and his teacher's ignorance, but now he grasps much that is ascertained truth and such as can be seen, shown, measured and recorded with perfect accuracy.

*

*

THE DIAGNOSIS OF INTESTINAL RUPTURE. Dr. Berndt, in the Medical Record, discusses the question of intestinal rupture from the diagnostic point of view, emphasizing not only the difficulty of establishing the certainty of a lesion of the gut wall, but also the importance of so doing in order to enable the surgeon to undertake an early laparotomy. The effects of a severe contusion are very similar to those produced by rupture, but the author points out that while vomiting is present in both

cases, its nature varies so much as to constitute it an important element in diagnosis. In simple cases of shock the vomiting is reflex in character, and, although repeated two or three times, is never very serious. On the other hand, where the intestine is ruptured, it is due to the extravasation of the gaseous and fluid contents of the bowel into the peritoneal cavity, and is then always of a persistent and intractable character. Sundry recent investigations are added in which this opinion has been strikingly confirmed.

*

SUCCESSFUL LIGATURE OF THE INNOMINATE ARTERY.- Mr. Coppinger's patient, whose innominate and carotid arteries were simultaneously ligatured in 1893, and whose progress towards recovery was noted in this journal (British Medical Journal) during many weeks, is now about being presented for inspection in London. The operation was performed at the Mater Misericordiae Hospital in January, 1893. The patient was shown six weeks later at a meeting of the Royal Academy of Medicine in Dublin as a case of successful ligature of the innominate artery, and was exhibited six months afterwards at the meeting of the British Medical Association at Newcastle-on-Tyne, as an instance of cure of subclavian aneurism by simultaneous ligature of the innominate and common carotid arteries. The patient, a man, aged 55, is now in good health two years and a-half after operation and is the only living example as yet exhibited in Europe of cure of subclavian aneurism by innominate ligature.

A SERVICEABLE RULE.- Dr. Goodell, says the Medical World, never passes a sound into the uterus without first demanding a full history of menstruations. Attention to this rule will often prevent your tendering the designing patient a cheap abortion. Even with a clear history, he repeats the rule of the elder Dr. Goodell : "Cervix hard as the tip of your nose, no pregnancy exists; cervix soft as your lips, pregnancy almost certain to exist."

MARYLAND

digestion and many more, whilst close by are the centers for the ocular muscles. It is

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BALTIMORE, SEPTEMBER 7, 1895.

IN an interesting paper published in the Boston Medical and Surgical Journal of

Exophthalmic Goiter.

August 8, Dr. J. J. Putnam of Boston discusses the various theories advanced with reference to the nature and origin of exophthalmic goiter. Although the subject is in a state of uncertainty from which it is impossible as yet to free it, it has an intrinsic interest which is enhanced by the able manner in which Dr. P. handles it. There are three theories prevailing: 1. That it is due to localized lesions of the medulla. 2. That it is a neurosis. 3. That it is of toxic origin, and related to disease of the thyroid.

He suggests in advance that each of these views may contain some part of the truth, and only needs the genius of some one to unite them into one generalizing conception.

With reference to the first, we can scarcely omit the medulla from a participation because in it lie the principal centers of cardiac activity and regulation of the vaso-motor system, of the sympathetic nerves, of sugar

the typical symptoms of the disease have been excited by operations upon the medulla and its nerves. But this theory cannot be maintained in the absence of constant and uniform lesions, and against it is also the fact that no known lesion of the medulla gives rise to such varied and numerous symptoms.

Of the toxic theory we must still say non constat. The strongest argument in favor of a thyroidal toxic influence is that drawn from the benefits of thyroidectomy. This operation, but recently introduced, has multiplied of late with great rapidity. Kocher of Berne has had over 50 cases in 2000 goiter operations of all sorts. The result has been very satisfactory, particularly from ligature of the thyroid vessels (three of the four only should be tied). But this satisfaction is marred by occasional unaccountable death. Improvement in these cases is sometimes rapid, sometimes very slow. Other methods acting on the gland with occasional favorable results, are the internal use of iodine, revived in the clinics at Berne, and electricity. Putnam has found the latter of real service, powerful and prolonged Faradic currents being applied, so as literally to squeeze out the contents of the gland. On the other hand, occasionally diminution in the goiter and improvement in the symptoms follows the use of the thyroid extract. Absence of thyroid swelling or other evidence of disease of the gland in many cases is also against this theory. And so is the absence of temporary aggravation of symptoms after the electrical squeezing process above referred to.

The discussion of the neurosis theory is conducted in a masterly manner. Dr. Putnam, however, does not favor the view so strongly advocated by Gowers, of location of the neurosis (if that be the explanation) in the medulla; he considers it certain that when lesions be found, possibly nutritional, they will be found not only there but also in the higher and related lesion centers and probably in the peripheral nervous system as well. In short, he regards Graves's disease as a "degenerative neurosis;" as one of the ways in which the nervous system suffers "dissolution;" as marking one of the many lines of cleavage at which the nervous functions break when exposed to strain.

The Preliminary Examination.

IT has always been considered a good and a wise rule to look well to the beginnings of what we undertake and to make sure that we get a good start. In respect to medical education, we have long ignored this salutary regulation. Young men were admitted to the study of a most difficult and abstruse science, replete with a technical nomenclature, and requiring for its mastery an extensive knowledge of physics, mathematics and chemistry without any preparation whatever. It was no uncommon thing in those days for a lad to leave his plough to attend medical lectures, and in some cases at any rate a youth might have passed through his entire medical career without knowing how to write. The writer has heard it assigned as a reason why written examinations were not held, that the students were not sufficiently educated to write their answers. Ignorance was rife and it was a wonder to many how students managed to get through. It is no exaggeration therefore to say that in respect to the attainments of the student of today as compared with his predecessors of a few years back, there has been a vast improvement. We are in the transitional stage and we have n't gotten much as yet it is true, but let us be thankful for the little we have gotten and above all for the hope of better things which the future offers to us.

The regulations at present in force with regard to the preliminary examination are uniform throughout the United States, and embrace a certain amount of algebra, arithmetic, physics, Latin and composition. This schedule is sufficiently comprehensive provided it is impartially enforced. But is it so enforced? We have good grounds for thinking that it is not. There is the same difficulty here as in the finals, that a partial jury of the Faculty sits as judge of the applicant's attainments. The finals fortunately are now supplemented by the State examinations, and these can be relied on generally to correct the defects of the graduation examinations. There is no such corrective as yet in the case of the preliminaries and it is in connection with them that we would urge that a similar corrective be applied. Let the State Board be empowered to hold the preliminaries and let all students desiring to matriculate appear before it and obtain its sanction and permission as a prerequisite to admission to the

colleges. If the State Board be unable by reason of present demands upon its time to undertake this additional duty let a new board, consisting of members of the profession at large, possessing the requisite qualifications, be appointed. In New York this plan has been adopted and is working well. The examinations there we understand are rigidly enforced and with the result of raising very materially the standard of qualifications of students and discouraging unworthy applicants. Lastly, let a suitable person or persons be authorized to conduct courses of study for the benefit of intending students that they be trained with as little delay as possible to pass these preliminary examinations. We understand that such a course will be inaugurated in this city during the month of September and we hope that it will receive liberal encouragement from both students and colleges.

The Apothecary in the Navy.

***

C. MARION DODSON, M. D., of this city, in a paper read before the Maryland Pharmaceutical Association, points out that the apothecary in the Navy still, as 30 years ago, stands with the crew before the mast. True, his pay has somewhat increased and he has a certain consideration on sea and land due to his education, social position and attainments, but he has not yet even the official standing accorded the captain's or paymaster's clerk. He points out further that the requirements of education have been steadily advancing and only graduates of pharmacy can now obtain such positions. The medical officer, on the other hand, has had his position advanced and now receives from $1500 to $5000 per year, whereas less than a century ago he received only from $300 to $500. His official standing has been greatly improved and new honors and titles have been bestowed on him. Dr. Dodson thinks that the relations between surgeon and apothecary are identical with those on shore. While he does not suggest in detail what the title or rank should be, he thinks that a proper grade and fairer compensation should be given and he urges that the pharmaceutical profession should unite in having a suitable bill framed and presented to Congress. We trust Dr. Dodson's suggestions will bear rich fruit and that our sister profession, to which we are so much indebted in every way, may, like the medical, obtain its just deserts.

Professor Franz von Ried, the oldest of the German surgeons, died recently at Jena, aged 85 years.

Mr. Christopher Heath has been re-elected President of the Royal College of Surgeons, England.

Professor Lister was presented with a portrait of himself on his retirement from King's College, London, July 31.

The woman's medical school in St. Petersburg, which was closed for political reasons in 1887, is soon to be reopened.

The Woman's Medical College of Cincinnati has united with the Laura (Presbyterian) Memorial Medical College there under the latter name.

The present Board of Health of Chicago is said to be composed of a dealer in flour, an

other in axle-grease, and another in the real estate business.

Professors Guyon and Lannelongue have been elected respectively President and VicePresident of the French Academy of Surgery.

The $10,000 Hodgkins Prize of the Smithsonian Institution was awarded to Lord Rayleigh and Professor Ramsey, of London, for their discovery of argon.

The College of Physicians and Surgeons of Baltimore intends to establish a department for the demonstration of Materia Medica and we learn that Dr. S. J. Fort of Ellicott City is to be the demonstrator.

The Fort Wayne College of Medicine has adopted the four year course but it is understood that only those who intend to graduate in 1899 must have attended a four years' graded course of study.

Bacteriologic examination of drinking waters are now made in North Carolina under the auspices of the State Board of Health, Drs. Albert Anderson of Wilson and W. T Pate of Gibson's Station being the examiners.

St. Luke's Hospital, New York, has received a bequest of $200,000 from the late Rufus Waterhouse, the money to be applied to the establishment of a ward for consumptive sewing women, in memory of his wife, who was a victim to that disease.

According to Mr. Ernest Hart, in the French army where local water supplies are often bad and where typhoid till lately raged severely, its occurrence has been almost wholly destroyed and the army kept free from it by the use of the Pasteur filters.

The William F. Jenks memorial prize of five hundred dollars, under the deed of trust of Mrs. William F. Jenks, has been awarded to A. Brothers, M. D., 162 Madison Street, New York, for the best essay on "Infant Mortality During Labor, and its Prevention."

The eighteenth annual reunion of the Pennsylvania and Maryland Union Medical Association was held August 29 at Chickie's Park, Columbia, Pa. Dr. George H. Rohé of Baltimore presided. The following were elected officers for the ensuing year: President, T. M. Livingston, Columbia, Pa.; Vice-Presidents, Chas. G. Hill, Baltimore, Henry Landis, Reading; Secretary and Treasurer, J. K. Lineweaver, Columbia.

PUBLIC SERVICE.

OFFICIAL LIST OF CHANGES IN THE STATIONS AND DUTIES OF MEDICAL OFFICERS.

UNITED STATES ARMY.

Week ending August 31, 1895.

Captain Julian M. Cabell, Assistant Surgeon, upon the expiration of his present sick leave, will be relieved from duty at Washington Barracks, D. C., and ordered to report to the Surgeon General.

First Lieutenant Frank T. Meriwether, upon the expiration of his present sick leave, will be relieved from duty at San Diego Barracks, California.

First Lieutenant Charles E. B. Flagg, Assistant Surgeon, upon his return from duty in the field, will be relieved from duty at Angel Island, California, and ordered to Fort Hancock, Texas, to relieve First Lieutenant Francis A. Winter, Assistant Surgeon.

First Lieutenant Winter, on being thus relieved, is ordered to Fort Grant, Arizona, for duty, relieving First Lieutenant George M. Wells, Assistant Surgeon. Lieutenant Wells, on being thus relieved, is ordered to Fort Mason, California, for duty, relieving Captain William L. Kneedler, Assistant Surgeon. Captain Kneedler, on being thus relieved, is ordered to San Diego Barracks, California, for duty.

Captain Walter D. McCaw, Assistant Surgeon, is relieved from duty at the Presidio of San Francisco, California, and ordered to Fort Ringgold, Texas, for duty, relieving First Lieutenant Champe C. McCulloch, Jr., Assistant Surgeon. Lieutenant McCulloch, on being thus relieved, will report in person to the Commanding Officer, Army and Navy General Hospital, Hot Springs Arkansas, for duty at the hospital.

First Lieutenant George M. Wells, Assistant Surgeon, granted leave of absence for two months, to take effect on his relief from duty at Fort Grant, Arizona.

First Lieutenant William W. Quinton, Assistant Surgeon, is relieved from duty at Fort Riley, Kansas, and ordered to Fort Logan, Colorado, for temporary duty at Fort Logan, Colorado, relieving Captain Louis A. LaGarde, Assistant Surgeon. Captain LaGarde, on being thus relieved, will proceed to Boston, Mass., and report for duty as Attending Surgeon and Examiner of Recruits.

Leave of absence to date from August 21, and to include September 30, 1895, is granted Lieutenant-Colonel John S. Billings, Deputy Surgen General, United States Army.

UNITED STATES NAVY.

For one Week ending August 31, 1895. Surgeon J. E. -Gardner, and Passed Assistant Surgeon F. J. B. Cordeiro, to temporary duty as members of the medical board at the Naval Academy, September 5.

CURRENT EDITORIAL COMMENT.

RECIPROCITY.

Virginia Medical Monthly.

WE believe the day is at hand when it is safe to advocate the laws of reciprocity between States having boards of examiners who adopt the same standard of requirements. This is a matter which, from the very nature of affairs, must very soon engage the serious attention of the profession.

MENTAL THERAPEUTICS.

Philadelphia Polyclinic.

It is our duty as physicians to study the many questions involved in the subject of mental therapeutics more carefully than we have done, to rescue this important remedial agency from the hands of ignorant or designing charlatans, to establish scientifically its uses, and thus to prevent its manifold abuses.

SANITARY LEGISLATION.
Cincinnati Lancet-Clinic.

IT is reasonable to believe that the mean death rate of the people of the great Central States can be reduced 25 per cent. within the next ten years. In order that this may be accomplished, with a corresponding reduction in the total amount of sickness, it is necessảry that judicious sanitary laws shall be enacted. The advisors of the legislatures must be found in the ranks of the medical profession. For this reason medical men should be found on legislative tickets.

MENACE TO THE COUNTRY'S HEALTH. Medical Record.

EVERY summer the eastern seaboard of this country, from New Orleans to New York, is threatened with an invasion of yellow fever by vessels hailing from Cuban ports, especially Havana and Santiago. Our only defence against this invasion lies in a quarantine service which varies in efficiency at different points and which may fail at any time in one of a dozen ports through a single error in judgment of the executive officer. This is a very weak defence, as the country learns to its cost every few years; yet as long as Cuba belongs to a foreign power and that one which ranks low in the scale of practical sanitation, so long shall we be menaced with every returning summer. The only way to escape the danger is to stamp out the plague in its home.