The College and Clinical Record

A MONTHLY MEDICAL JOURNAL, Conducted especially in the interest of the GRADUATES AND STUDENTS of JEFFERSON MEDICAL COLLEGE

RICHARD J. DUNGLISON, A.M., M.D., Editor. VOL. V. NO. 11.

PHILADELPHIA, NOVEMBER 1, 1884.

PREPARATION FOR THE STUDY OF MEDICINE.

The ninth annual session of the American Academy of Medicine was held in Baltimore on the 28th and 29th of October. Since the policy, introduced at the session in Philadelphia two years ago, of having scientific papers presented, has been adopted, the sessions have increased in interest and importance. The Academy, as most of our readers are aware, is an association of physicians requiring for fellowship the possession of a degree in arts as well as that in medicine, asserting that the preparatory training of a classical education is the proper entrance into the study of medicine. Is their standard a just one? If it is asserted that a collegiate degree is essential to becoming a physician of renown, the statement cannot be substantiated, because many an instance can be given of famous men without the A. B., or of A. B.'s without fame. But if we look at the magnitude of subjects embraced in the study of medicine, to the comparatively short period of time given for their mastery, and the amount that constitutes the minimum attainments to be able conscientiously to practice on the one hand, and secure the respect of the great mass of the community on the other, we are forced to conclude that a preparatory mental training is essential to the acquirement of the necessary knowledge of medicine in the time allotted. While a college training may not be the only course that will accomplish this, it is the most convenient evidence of such training available.

This is no discovery of the past decade; the discussion of the mental and social plane of the doctor is neither new nor rare; and

ments of the average possessor of an M. D. degree in the United States are less than those of any other profession, and the time required to master the art less than that of most trades, has been made with hardly a protest since the founding of the American Medical Association. So that if silence is to be construed into assent, the medical men of the country have accepted the assertion as true, and have vainly theorized for an improvement. These theories have failed in practice, chiefly because they have attempted to raise the profession as a mass; on the other hand the Academy, while endeavoring not to assert any excellence in their individual members, has clearly defined a line, on the one side of which are to be found the probabilities of educated physicians and safe practitioners :on the other, only a possibility of such a result. They have called attention to the former class by admitting only such to fellowship, and thus virtually offering a higher degree in medicine. In so doing they have placed themselves in opposition to the faint-hearted and conservative, as well as those the amount of whose attainments help to decrease the average standing of the profession. It was a bold thing to do! for a handful in the face of thousands to make such a step; but we all admire pluck whereever and however shown; and while that handful of men, who gathered together for a few years, were subject to more or less ridicule, as visionaries and enthusiasts, they held fast, and by the single note of their song have called attention to the accepted condition more emphatically than ever before. We admire a determined spirit, but we admire success more, and since the Academy is steadily growing in numbers, and the great reforms in medical education are at least cotemporaneous with its life, this element is also present and of itself would warrant the prominent notice given it here.

What, then, does the Academy propose for its mission? It wants in no uncertain voice to warn those entering upon the study of medicine against the error of an imperfect preparatory training. It wants to bring together in

good fellowship physicians who have spent their four years in college halls, and have acquired a taste for letters and art. It aims at mutual improvement by carefully prepared papers at its annual meetings. Such earnest and courageous efforts command our admiration; the successful fruition of the labors of the Academy invokes our sincere congratulations. We wish it God speed in its noble and unselfish work.

AN ARTICLE NOT FOUND IN THE
CODE.

"ON THE DUTIES OF PHYSICIANS TO EACH OTHER AND TO THE PROFESSION AT LARGE."

Man is a social animal; hermits and anchorites are monstrosities. "It is not good for man to be alone," the words of man's Creator, fully states the need of man for companionship, that the development through the intermediate cycles has not changed; and what is true of man as man is equally true of him in his professional relations. And yet the fact is patent that too many of our physicians are professional hermits. They seem to be, to borrow a chemical simile, a saturated molecule, with no disengaged affection for any one else, and so they revolve in their limited sphere, repelling

all around them.

Now, while the framers of the Code gave nothing upon the duty of physicians associating for mutual intercourse, both social and intellectual, the duty still remains, and the necessity for so doing should be urged upon all, especially upon the young practitioner, that he make no mistake in this direction.

But where is the benefit? Much every way. Let any one who has had five years' practice fully and freely meditate upon his work; is there not, at least, a tendency (a much more positive word would probably be nearer the truth) to fall into mere routine practice? Is the diagnosis as carefully made as at first? In the desire not to treat a name, but the patient, is not some combination of drugs given because some previous patient, complaining of about the same ills, recovers while using it, and not because, from the symptoms and knowledge of the action of medicines, the combination is

indicated in the particular case in hand? Take the last ten cases and try to give satisfactory reasons why the disease was called what it was, and why the treatment was made as it was, and see if it is not a difficult task. If it is not, then it is because the knowledge acquired in prac tice has been used to instruct others, either in lecturing or in writing papers. But, the objection is urged, joining a medical society does not improve one in this respect; certainly not Neither will a most carefully prepared mixture benefit the patient, no matter how long he has it in his possession, if he does not use it. A proper use of societies keeps one polished, and out of ruts. Membership should be had in a medical society for the aid it gives to one's self.

Lord Bacon said: "I hold every man a debtor to his profession; by the which, as men, of course, do seek to receive countenance and profit, so ought they, of duty, to endeavor themselves, by way of amends, to be a help and ornament thereunto." And herein lies another great reason: The profession, as a profession, needs the help of the humblest of its members. A meeting and comparing of ideas, a friendly criticism and seeking for the reasons of things, all help to strengthen the individual powers of each.

Again, there is the enthusiasm of numbers, the unification of distinct interests by mingling on a common platform. It has become the fashion in some quarters to ridicule the meetings of the American Medical Association, dubbing them pic-nics, etc. But the fact that there is a power to draw together a thousand physicians, even if it is only an excursion, has an effect of creating and maintaining a feeling of fraternal relation and common pride in the profession of our country that cannot be brought about in any other way. scientific results of this Association and our State societies are not always what one might wish, their mission is for good, nevertheless.

While the

How to utilize's one's membership in a medical society cannot be spoken of now. A study of its constitution, and an earnest effort to aid in bringing about the object for which the society was organized, will help settle this

question. The fact to be emphasized here is that every physician owes it to himself, his patients, the profession, and the public, to be actively engaged in the sessions of at least one medical society.

THE TREATMENT OF INEBRIATES.

In a recent issue we published an interesting article on this subject from the pen of one who had made it a special study. The tendency The tendency seems to be, at the present time, to consider the inebriate as a patient, rather than as a sinner merely, in his departure from the path of rectitude, as viewed from a purely temperance standpoint. It is contended that until the inebriate can seek relief in a home or an asylum, which he cannot get outside, at his own house, in as open a manner as one can who is suffering from injury or fever, and without the fear of being made an object of execration, little can be done to cure and reclaim this class of patients. To bring about this state of affairs only one way seems feasible to those who entertain such views, and that is for the whole community to consider the habit of inebriety a disease and to treat it as such. Judicial legislation upon the whole subject will then be changed, and in place of sending the inebriate to a jail or House of Correction for thirty days or a few weeks, to be afterwards turned loose unreformed, and, after having had no proper medical care, in a worse condition than when he entered, he will be sent to a home or asylum (not an insane asylum) and be put under proper treatment and restraint, and kept there until his condition has become normal, or as near normal as it is possible to make it. These views of a perennial social evil seem based on rational premises; it would be well worth comparing statistically the results of this and other treatment, could the after history of all such patients be carefully followed up.

THE NEW LOCAL ANÆSTHETIC. The ophthalmic surgeons seem to have had almost a monopoly of the study of the anæsthetic effects of cocaine hydrochlorate, the recently discovered merits of which, as an obtunder of sensibility, have excited so much enthusiasm within a brief interval of a few

weeks. If it is to be the coming local anæsthetic, applicable to all mucous surfaces—and if to the conjunctiva, why not to other membranes of the class-what a future may be opened to it! Fortunately for these gentlemen, it is found, at a time when its costliness may be an obstacle to its general use, that only a few drops are required for instillation upon the sensitive conjunctiva to produce local anesthesia. It remains to be seen how wide a range its application may take, even in ophthalmology, if stronger solutions should be resorted to; but when we think of the various channels lined with mucous membrane and accessible to the medication and manipulation of the general surgeon and the surgical specialist, and of the various operations upon cavities and outlets which are complicated in their performance by the over-sensitiveness of the nervous system distributed to these regions, we cannot but think that if all the wondrous results that are claimed for this salt in this early stage of its history should be established by further experiments and observations, the benefit to mankind from its introduction may be incalculable. We must not be too sanguine at the outstart, or too enthusiastic in the expression of any view as to the possibilities which may be associated with its more general introduction. We will only say that at present cocaine hydrochlorate is the sensation of the hour, as a glance at the leading medical journals of the country for weeks to come will abundantly prove.

Class-Room Notes.

-Prof. Parvin teaches that chorea which cannot be controlled justifies the induction of abortion or premature labor.

-Prof. Bartholow attributes the increase of tapeworms to the increase in the amount of raw and very rare beef eaten.

-Prof. Parvin says, when a woman frequently aborts, and no cause can be found, give her anti-syphilitic treatment.

-At the clinic, Prof. Bartholow gave convallaria infusion (a tablespoonful twice a day) for mitral lesion, as better than digitalis.

-For relaxation of the pelvic symphyses Prof. Parvin suggests plaster-of-Paris bandage. It has never been used, to his knowledge.

-At the clinic, Prof. Bartholow prescribed glycerine, and said it has decided power to prevent fermentation in the stomach, as has lately been shown.

-Prof. Parvin says milk for babies should always be diluted with barley water or mucilag. acaciæ. The best substitute for mother's milk can only be told by experiment in each case.

-Prof. Bartholow says the suggestion to apply oleum gaultheria locally in rheumatism is to be much commended. If the skin will not bear it, it may be diluted in soap liniment. -Prof. Da Costa says that pruritus vulvæ is a symptom of diabetes mellitus often occurring and not enough recognized. In this disease defective nutrition causes neuralgia, which fact is perhaps not generally known. Pulmonary disease often occurs from the same cause, but the death rate from consumption in this disease is not so large in America as in Germany, where it reaches thirty to thirty-five per cent.

-Prof. Gross reported at the clinic that all of thirteen partial removals of the breast for cancer, at the Jefferson College Hospital, had resulted in a recurrence of the tumor within eight months. Of twenty-two operations by removing the whole breast, which he has done, five have lived three years without a recurrence of the trouble. He believes three years' nonrecurrence to indicate that danger is past. He teaches that the whole breast and its covering is to be removed and the axilla opened, for it is impossible to tell from the outside whether glands are infiltrated.

-Prof. Da Costa finds sulphate of copper, gr. -, four times a day, combined with opium, to be very effective in chronic dysentery. Other remedies he finds useful are bismuth (gr. x, the adult dose being three or four times

a day), especially in children, nitro-hydrochloric acid, zinc sulphate, argentic nitrate, iron sulphate or Monsell's solution (gtt. iij-v), or solution of the nitrate (gtt. xx-xxx). All except iron should be combined with opium. When other things fail, small blisters over the spot of greatest soreness sometimes do good. The diet should contain no starches, fruits or vegetables.

-Prof. Parvin, in post-partum hemorrhage, grasps the placenta firmly between the handsone inside and one cutside of the womb-detaching the placenta, and stimulating by friction. If the bleeding does not stop, he takes out the placenta, and putting his hand in again, presses on the posterior part of the neck of the womb, bringing the hands as near together as possible. Hypoderms of ergot, quinine, or opium, he says, are vain to trust to, though

excellent when they do act. If the womb swells up and gets soft again use direct hæmostatics: I, hot water; 2, iodine or chloride of iron on a sponge probang; vinegar on a sponge probang.

College News and Miscellany.

PRELIMINARY EDUCATION.-It is a noteworthy sign of the progress of the times to find a newly organized medical institution-the Medico-Chirurgical College of Philadelphiainsisting upon the following requirements for admission to its junior or senior class:-A degree in arts, philosophy or science; or, a certificate of examination and graduation from an academy, high or normal school which does not confer degrees; or, the certificate of the Auxiliary Literary Term as established by this school; or, a certificate of having passed a preliminary examination of a duly organized county medical society, such as ordered by the action of the Pennsylvania State Medical Society at Pittsburgh, in 1878; or, finally, a successful examination before the Faculty in orthography, English composition (written as ordered at the time and place of examination), arithmetic, geography, English grammar, elementary physics, Latin grammar and translation.

THE S. D. GROSS PROFESSORSHIP OF PATHOLOGIGAL ANATOMY.-Dr. R. J. Dunglison, Treasurer of this Fund, reports the following additional contributions: Dr. D. Hayes Ag. new, of Philadelphia, $100.00; Mrs. Elizabeth Casey, of Ballston Spa, New York, $50.00; Dr. Laurence Turnbull, of Philadelphia, $50.00; David H. Lane, Esq., of Philadelphia, $25.00; Dr. W. L. Kneedler, U. S. Army, $25.00; Dr. H. Fritsch, of Philada., $20.00; Territory, $10.00; Dr. J. L. Swett, Newport, Dr. J. H. Day, Walla Walla, Washington N. H., $10.00; Dr. Thomas Lyon, Williamsport, Pa., $5.00; Dr. W. W. Dale, Carlisle, Pa., $2.00.

MEDICAL WIT AND HUMOR.-Dr. Julius Wise, 806 Olive street, St. Louis, Mo., proposes to publish during the coming year a large volume under the title of "The Encyclopædia of Medical Wit, Humor and Curiosities of Medicine." In this undertaking he solicits the kindly aid of the profession. Witticisms, and anecdotes of a humorous or curious nature are solicited. There are numberless unpublished experiences that would prove a source of amusement and instruction, and all physicians, druggists, dentists, and others supplying original contributions will receive due credit in the work.

CORN SILK.-Parke, Davis & Co. announce, for the information of the medical profession, that they are now in condition to supply the demand for their preparations of corn silk, which of late they have been unable to meet, on account of the shortness of the fresh drug in the market. Corn-silk may be regarded as a new remedy, from the fact of the comparatively recent discovery of its properties as an emollient, antiseptic and diuretic in vesical catarrh and other forms of vesical irritation.

Toronto, Canada, September 6, 1884, the principal physicians of the city being present.

-Dr. D. N. Rankin (Class of 1854) has returned, after an absence of three months in Europe. He was a delegate from the American Medical Association to the British Medical Association at Belfast, and to the International Medical Congress at Copenhagen.

The

-Professor Mallet, of Jefferson Medical College, met with an unfortunate loss, immediately upon his arrival in Philadelphia to assume the duties of his Chair, by the burning of his household furniture in a storage warehouse. Philadelphia Medical Times indulges the hope thas this may prove a good omen, as it recalls the fact that the late Professor Gross met with a similar loss shortly after his arrival, and he subsequently remained here for life.

CONTRIBUTIONS TO MEDICAL LITERATURE.

-Dr. H. V. Sweringen (Class of 1876) reports an interesting case of Puerperal Convulsions in the Obstetric Gazette for September, 1884.

-At a meeting of the College of Physicians of Philadelphia, held October 1st, Dr. A. Hewson (Class of 1850) read a paper on "Some Uses of the Electric Light in Diagnosis."

-Dr. L. Webster Fox (Class of 1878), of Philadelphia, publishes in the Medical News, October 4th, 1884, a paper entitled "Clinical Observations in the Ophthalmic Hospitals of

London."

-An interesting clinical lecture, by Dr. Louis Elsberg (Class of 1857), of New York, on "The Classification of Laryngeal Neuroses,' is published in the Philadelphia Medical Times, October 18th, 1884.

-Dr. John B. Roberts (Class of 1874), read a paper on "Legal Control of Medical Practice by State Examination," before the Medical Jurisprudence Society, of Philadelphia, October 14th, 1884.

-The Journal of the American Medical Association, for September 27, 1884, publishes in full the paper written by the late Professor Gross on 66 Lacerations of the Female Sexual Organs Consequent upon Parturition." As the last contribution to medical literature of this great and beloved surgeon, it possesses to the whole profession a melancholy interest.

-Dr. John L. Dickey (Class of 1883), of Wheeling, West Virginia, reports, in the American Journal of the Medical Sciences, for October, 1884. the history of a case of glioma retina. He appends a summary of the literature of this subject, which shows that most gliomatous tumors originate during foetal life, and that permanent recovery is extremely rare.