fluctuation. Several ridges can be felt on the skull and in the posterior part of the mastoid process there is distinct bony elevation with rough, thickened edges. The walls of the external auditory canal are collapsed so that inspection of the middle ear is impossible. Ear disease of any kind is denied. The swelling decreases a little on massaging from behind toward the ear, and increases when the patient inflates his cheeks while closing his nose and lips. It is a case of pneumatocele of the head, there being a communication between the swelling and the external air through the mastoid process and the eustachian tube.

Emphysema about the head is not at all infrequent; injuries or congenital defects, especially in the frontal region, furnishing a communication between one of the air cavities and the subcutaneous tissue. This condition, however, usually lasts but a few days, disappearing spontaneously. Both in general surgical and in otological literature there are but twenty seven cases reported, eighteen occipital and seven syncipital. In most cases the small communication can be closed by encouraging the growth of granulation. In one case where two operations proved unsuccessful, Kromer resorted to an osteoplastic flap. If in our case paracentesis and pressure bandage are of no avail it will be indicated to make free incision and a careful examination. If the breaking down of a neoplasm is the cause of the pneumatocele an extensive operation may be necessary.

36 WASHINGTON STREET.

THE

CHICAGO MEDICAL RECORDER.

Journal of the Chicago Medical Society.

Drs. Arthur R. EDWARDS, FRANK BILLINGS, WILLIAM E. Quine, Committee on Publication.

CHICAGO MEDICAL SOCIETY.

A regular meeting of the Chicago Medical Society was held in Schiller Hall, Schiller Building, Wednesday evening, June 4. PRESIDENT DR. A. H. FERGUSON in the chair.

The minutes of the previous meeting were read and approved. The Membership Committee reported favorably on the following applications: J. G. Bemis, L. F. Holland and I. S. Louis. The Secretary was instructed to cast the ballot of the Society for their election.

The Board of Trustees recommended to the Society that the following be made Emeritus Members: Drs. John C. Webster, William T. Belfield, John Bartlett and Z. P. Hanson, and that the following be made Honorary Members: Drs. Henry M. Lyman and F. W. Reilly.

The following resolution was introduced by Dr. Campbell and adopted by the Society:

Resolved, It is the sense of this meeting, as a matter of protection to the public generally, and to children in particular, that all dogs on streets or public places of the city of Chicago, whether accompanied by an attendant or not, should be muzzled at all times. throughout the year.

Resolved, That a copy of this resolution be sent to His Honor, the Mayor of Chicago, with the earnest request that he give the matter his serious consideration.

DR. R. PREBLE moved that an honorarium of $250 be given to the Secretary and an honorarium of $150 to the Treasurer. Seconded and carried.

DR. W. A. EVANS moved that the Chicago Medical Society extend an invitation to the American Medical Association to hold the next meeting of the Association in Chicago. Carried.

It was moved and carried that a committee of five be appointed to present the invitation to the American Medical Association, consisting of Drs. A. E. Baldwin, H. N. Moyer, A. C. Cotton, W. A. Evans and A. H. Ferguson.

PROGRAM.

DR. MORGENTHAU presented a patient with

OCCIPITAL PNEUMATOCELE.

DR. E. FRIEND: I operated on that case two years ago and removed a tumor as described by the essayist. Two months ago he again visited my clinic at Rush, and I referred him to Dr. Senn, who concluded that it was pneumatocele. The microscopic appearance of this growth impressed me as a sarcoma. It was firmly adherent to the fascia, and it was impossible to say where its starting point was. Dr. Greensfelder saw the case at the time. Dr. Senn thought that possibly there was a recurrence of this growth, which involved the mastoid, and gave rise to the entrance of air in this locality.

DR. M. J. SEIFERT read a paper on

MEDICAL INSTRUCTION.

DR. W. T. ECKLEY: On the whole, I agree with everything the doctor has said. Teachers certainly ought to be perfection, the student ought to be perfection, and the medical colleges ought to be the product of the millionaire's liberal purse. The essayist has pointed out that the teachers and students are not perfection. would like to ask him how many professors there would be tomorrow morning in the colleges, if the anatomist, physiologist and pathologist were expected to present to their students material other than that found in the text books? I wonder how much anatomy there would be tomorrow morning that cannot be found in the text books? The same thing is true of pathology, physiology, etc. I regret that I have not more time to follow the gentleman up, and show him that while his argument is good, the condition of the times is not such as to warrant the conclusions he has drawn.

DR. A. C. COTTON: Although I did not hear all of the paper, I must confess that I am in sympathy with Dr. Eckley. If the teacher must be depended upon for absolute originality, I fear there would be very few chairs occupied tomorrow. There are fundamental facts in every department of medicine that must be taught the under

graduate, and the field for originality must be necessarily limited. I agree with the essayist that the teacher ought to be able to present his subject in an attractive manner, so as to make a permanent and lasting impression upon the student's mind. That is one of the rare essentials of a teacher. But, that he must be absolutely original and able to cut loose from all authority, is going a little bit farther than we are prepared to go at this time.

DR. HAROLD N. MOYER: It would be unwise to achieve perfection all at once in medical education. The strides medical education has made in the last twenty years in this city are simply amazing. Teachers are born, not made. The knack of imparting knowledge is inherent in the man. It is a quality he cannot acquire, be he never so great a master of his subject. It is a question of evolution. Of course, the surgeon must have a large ampitheater, and so far as the good is concerned, the student would as well be outside. Individual instruction, development of competition in the faculty, that is what is needed, and it is coming rapidly. The professorial chair should be filled by the best teacher. The manner of selecting instructors, and allowing the students to have considerable choice as to whom they shall receive instruction from, will do more to stimulate both the teacher and the student than anything which can be devised.

With regard to text book instruction, I do not suppose that the essayist means that something should be taught that is not in the text books, but that the man occupying the professorial chair sits down in his office the evening before his lecture and reads up a chapter, and the next day recites what he has learned. That is not a lecture, it is a recitation. A man who must read up on his subject before delivering a lecture ought not to stand before the class. He should be so saturated with knowledge of his subject that he need not read up. The matter of medical education is a development. We cannot cut loose from the past all at once. Better methods will be instituted gradually. We must get the advice and assistance of men who have made a practical study of education, and apply their principles to the teaching of the medical sciences. The other things must be a matter of growth.

DR. J. F. BURKHOLDER: There are one or two points in the paper that ought to be discussed a little further. One of them is the lengthening of the course. It is absolutely impossible to do the work we have to do in four years, and do it well. If you want to carry on the work you are now doing, you must make it five years. Do not compel men to have a college degree, but give them another year in the medical course. I have seen men come into college with a B. A. degree that were no better prepared to take up the work of the medical course than any undergraduate. I have also seen students who were hardly able to meet the entrance requirements, and they have done excellent work in the college. A great deal depends upon the student, the receptive faculty of his mind. The preparatory education of the student cannot be too great in some directions, but

the idea of requiring a B. A. and then a four years' medical course is absurd, unless that preparatory course has a great deal of biology in it. It has been my experience that men who come in with good biological training are better than the men who come in with a simple B. A. degree in arts-a man, perhaps, chucked up to the chin with Latin and Greek. The poorly prepared student comes in with little Latin and no Greek. The man with the B. A. degree in arts does no better work than the man who has no degree. But take the same man, and give him a B. S. degree, with a sprinkling of biology, and he will do much better work. I think it wise to give a man a two years' course in biology first, and then five years in a medical school.

Pick up any of the curricula of the medical colleges, and expect a student to do justice to the work laid out in four years of nine months each. It is absurd. The human mind cannot stand it. Preparatory work ought to be more thorough than at present. Five years of nine months each in medical college is none too long, but do not make him take a four years' course at the university, and fill him up with classics. What he wants is biology. It is the foundation of all our work.

DR. F. S. CHURCHILL: Dr. Seifert has set a very high standard for us, one I would like to see carried out, but I do not see how it is to be done. Practicing physicians cannot be expected to be trained in pedagogy. For practice alone they should have an excellent preparatory training, four or five years in medicine, one or two years in the hospital, and I cannot see where the pedagogic training is coming in. Therefore, it seems to me we shall always have poor teachers in our medical schools, and the majority of men teaching medicine, as a rule, are exceedingly poor teachers.

With regard to remuneration, some of the departments should be very highly paid. The anatomist, pathologist, chemist and bacteriologist should be paid large salaries; clinicians smaller salaries, because they ought to be men in active practice to be good teachers. The best teachers in medicine are men who have been successful in private practice. They learn much from the study of their private cases, and are able to give the student a great deal of knowledge which they derive from this experience.

As to the quiz, the successful quiz depends largely on the personality of the teacher, and the most successful quiz is the one that is conducted on the lines of the case system. Do not ask the student to describe the symptoms of "scarlet fever," but distribute reports of actual cases, and then make the student discuss the case and reason out the symptoms, thus arriving at a diagnosis. This will train them to do the work they will be called on to do in practice. It is absurd to cram their minds with facts; they must be taught to reason. I know, from personal experience, that they like this work. My teaching at Rush is purely clinical, but when there are no patients, e. g., on stormy days, I use printed reports of cases, as I have indicated. Section teaching is also an important matter, and in such teaching I would