nent English surgeon, who not long ago visited this country and inspected many of our operating-rooms while in active use for the purposes for which they were designed, upon his return home, expressed his unqualified admiration for the superior detail manifested by American surgeons in their antiseptic precautions, and suggested that his fellow-countrymen imitate our care in this regard. It seems to us that the lesson from all this is, that when the most thorough antisepsis cannot be observed in the surgery of the battlefield, the injured soldier has a better chance with Nature as his surgeon than if he relies upon one of our profession under what would be an extremely hazardous disadvantage. Otherwise we will always favor prompt opening of the abdominal cavity with a view to placing the injured structures in the best possible condition for repair.

A New Explanation of Surgical

Shock.

Dr. Eugene Boise, of Grand Rapids, Mich., presents an extremely interesting article upon this subject in the New York Medical Journal of April 12, 1902. He opposes the generally-accepted idea that surgical shock consists in a profound general relaxation. He maintains that the entire condition is due to heart-spasm, with consequent lowering of the arterial tension, because of the supply of blood to the arterial system. This being due to the failure of the heart to relax sufficiently for the inflow of the usual quantity of blood to be passed on to the aorta. He quotes from Agnew's system of surgery in reference to death from shock, "when a fatal termination is to follow, death may be sudden, produced by heart-spasm, the ventricles forcibly contracting and then ceasing to beat.”

On the same subject he quotes from the American Text-book of Surgery, that "the heart has been found contracted and empty." Also from the Medical and Surgical Reporter of October 12, 1895, in the case of a woman who, on being suddenly told of her son's death, fell to the floor and expired; the autopsy showed rupture of the left ventricle of the heart. He very properly suggests that these cases show that death could not have resulted from paresis of the heart and arteries.

He refers to Landois and Sterling's Manual of Physiology, page 106, as showing experimentally that severe stimulation of the sympathetic causes heartspasm and low arterial tension. Also, that other laboratory experiments have shown that electric stimulation of the vaso-motor system causes conditions similar to what we find in shock. He gets another argument for his position by the cold sweaty skin of shock, which he says can only be explained by his theory, that is, stimulation of the sympathetic nerves distributed to the sweat glands. He quotes Howell's Text-book of Physiology, in which reference is made to Goltz's description of the sweat-gland nerves in 1875, and mentions the fact that stimulation of the periferal end of a divided sciatic nerve will cause sweating, even after the limb is amputated. Also, that if the leg is exposed to a higher temperature after division of the nerve, it becomes suffused with blood, but remains dry, the nervous mechanism governing the sweat glands having been severed. This again is changed by electric stimulation to the periferal end of the divided nerve, resulting in profuse perspiration. Thus he shows that the sweating in shock is due to nerve-irritation rather than vascular conditions.

Contrariwise, the excretion of urine is dependent upon vascular conditions re

quiring a certain blood-pressure, below which it is difficult or impossible for the kidneys to functionate, and thus we find, as we would expect from Boise's theory, that the production of urine is diminished or entirely suppressed in shock.

Relaxation of the sphincters, which are under the control of the voluntary nervous system, is what would be expected, though the active susceptibility of the sympathetic nervous system is increased, such as the peristaltic movements of the bowel. The inhibition of cerebral spinal activity is due to anemia.

The practical lesson to be drawn from this view of shock is its application to treatment. The author, therefore, suggests the use of nitrate of amyl and glonoin for their important relaxing effect, and of opium, strychnine, intravenous saline solution, and extraneous heat for their more enduring effects. This treatment is immediately followed by a restoration to normal conditions, or nearly so. The strychnine must be given in large doses, for, as he says, quoting from H. C. Wood's Therapeutics, edition · of 1892, page 436, "it has been shown by experiments of Klapp that the primary stimulation of the vaso-motor centers (by moderate doses of strychnine) is followed by fall of arterial pressure and vaso-motor palsy. Also, that very large doses produce immediate suppression of the vasomotor centers and fall of blood-pressure." According to Bartholow, "a large toxic dose of strychnine will paralyze, instead of stimulate, the vaso-motor centers in the medulla and thus prevent any rise of blood-pressure." According to Dr. Carl Heinaman, "large doses cause diminished frequency of cardiac movements with dyastolic pauses." La Hausse has shown that "large doses slow the movement of the heart by a paralyzing influence on the intra-cardiac ganglia."

Concerning the efficacy of the intravenous injection of saline solution, he maintains that it is not explainable on the ground of its filling the blood vessels, but because it has a sedative relaxing effect upon the spasmodically contracted heart-muscle by means of its warmth. In evidence of this, he refers to the now well-established fact that these injections are most effective in this condition when the solution is used at a temperature of 115° Fahr.

We have been thus explicit in recapitulating this valuable article because we deem its author's views to be correct, and, necessarily, the treatment he advocates to be the only one proper in this condition. We should be glad to hear from our readers on this point whenever they have occasion to put his suggestions into practice.

Cure of Malignancy by
Oophorectomy.

Dr. Wm. H. Simmons, of Bangor, Me., in the Medical Record of March 15, 1902, relates the case of a married woman between 40 and 45 years of age, who had never been pregnant, and had always suffered from dysmenorrhea; who had an undoubtedly malignant ulcer of the breast of more than three and one-half years' duration, and measuring about 42x3% inches, and occupying the site of the left breast, which had been destroyed. Both of her ovaries were removed and were found small, prolapsed, very fragile, and densely adherent, with a troublesome adhesion of the left ovary to the sigmoid flexure, necessitating considerable deep suturing to control bleeding. Recovery was quite uneventful, the dressing being removed on the tenth day. The ulcer was completely healed in just eleven weeks after operation, being covered

with a firm, smooth, dry scar that still exists, operation having been done on September 30, 1901. The ulcer dressing before and after operation consisted of carbolized vaselin. Granulation was first noticed about four weeks after operation.

This is merely an additional instance of the inexplicable efficacy of oöphorectomy for the cure of malignant conditions. It does not always suoceed, but does in so large a proportion of instances, that it seems more promising of success even than the removal of the growth

itself.

The Osborn Treatment of

Small-Pox.

Elsewhere we publish a report by Dr. S. S. Bogle, upon this subject. His experience, and that of many others, tend to show that the bathing of the surface twice daily with a strong bichloride-ofmercury solution is a very, if not the most, efficient treatment of small pox with which we are acquainted, but we must qualify this by adding, in those sections of the country from which these uniformly successful reports emanate. We have found that the bulk of this evidence is from the southern portions of the country, largely west of the Mississippi. Experience with it in our section has not, thus far, yielded nearly as good results. It would appear from this, that climatic conditions so modify the disease that it yields better to the local antiseptic treatment, especially with the bichloride, in the southwestern quadrant of the United States than it does in the northern and more densely populous sections. That the treatment is efficient in the territory mentioned has been certified to in so many instances, and by so many observers thousands of miles apart, that the

possible coincidence of mistaken diagnoses, or of mild attacks or other modifying causes that would result in successes which might be credited to this particular treatment, that coincidence can no longer be considered a factor in opposition to accepting this treatment as of demonstrated efficacy. It requires more experience to determine why it has not been as successful in the north and east ; whether due to climatic modifications of the disease, or to the improper application It is of the remedy, or any other cause. in order that our friends in the northeastern quadrant of the country, who have tried this treatment, should report their experiences.

The case reported by Dr. G. W. Bolkcom, of Tower, Minn., is one of bichloride poisoning during the use of this treatment. It may, as he says, be one of the ten thousand cases in which this may occur. We suggest, however, that mercury, being used with greater safety when elimination is most active, which certainly is true of cutaneous elimination in warmer sections, that the explanation may be based upon differences in climate. If we are correct in this surmise, the treatment will be found more effective and safer in the south than in the north.

Night Medical Schools.

An editorial in one of the leading medical journals takes us to task for some of the views we expressed in the February number of THE MEDICAL COUNCIL in reference to night medical schools. The criticism is due to a misapprehension. We spoke in favor of giving every man a chance who was specially qualified by nature to take advantage of it in a way that would not be possible by attending the courses of lectures in the ordinary. medical school, particularly with a re

quirement of a degree in the arts before entering upon the study of medicine. We made no objection to students being instructed in the use of instruments of precision, and all that the latest develop ments in medical science have shown to be necessary to the proper practice of medicine, but we do object to useless waste of time in repeatedly doing unnecessary things, such as the cutting and mounting of sections, and many hours of uselessly-repeated work in the chemical laboratory. We also objected to the enforced memorizing of minutiæ, a knowledge of which is absolutely useless in the practice of medicine, such as the exact dimensions of a blood corpuscle or the diameter of a capillary. Men who will make the sacrifice, we then stated, requisite in attendance upon a nightschool of medicine, after the daily labor for bread and butter, are made of the material that the profession can hardly afford to lose. Such men are bound to rapidly make good whatever deficiency may result from their possibly deficient mode of education, after they begin the practice of medicine, and can afford the time to pursue the requisite additional studies.

of which respiratory movements of the chest-walls continue, as if the patient were breathing, the real condition not being suspected until the patient, already as good as dead, stops these movements, after which it is too late to effect resuscitation. He insists that the anesthetizer should not only observe the movements of the chest, and feel the pulse, but that he should listen to the laryngeal souffle of the air passing in and out of the larynx. The moment this ceases, ΟΙ even diminishes, chloroform should be withdrawn until normal respiration is reestablished. He believes that chloroform will not kill if these precautions are observed. Nor does he think that heart disease is a contra-indication to the use of chloroform, but is of the opinion that the great danger is in individuals having sensitive nervous reflexes apt to continue for a long time after they are once excited. The extensive experience of this observer compels attention to his views, and the additional care he suggests can do no harm, is in line with the duty of the anesthetizer, and will insure greater safety to the patient as well as ease to the operator, if carefully observed.

Disease.

Panas, in the Bulletin de L'Acad. de. Med. of Paris, March 4 and 11, 1902, states that he has performed 15,000 operations under chloroform anesthesia without a single mishap. He attributes this good fortune to the care exercised by the anesthetizer, according to his (Panas') theory of the mode of death from chloroform inhalation. This he This he believes to be due to a spasm of the glottis preventing the passage of air either in or out of the lungs, but in spite

F. Wenzel, in the Munchener Med. Wochenschrift, February 18, 1902, calls attention to the cure of phimosis by dilatation instead of cutting. This is being quoted in the medical journals without any comment that would disabuse the reader's mind of the impression that the suggestion is a new one. It is, however, quite an old remedy, and an article upon which subject appeared in the MEDICAL COUNCIL of April, 1896, by Dr. Wm. Shaw Stewart, in which a number of cases, all cured by this method, were cited.

Process in Education.

A letter some time ago by Dr. Charles E. Woodruff, of the regular army, in American Medicine, relative to the mode of education at West Point, has attracted considerable attention, particularly on the part of those interested in educational matters. He shows that the mental pressure exerted upon our military cadets is extraordinary, and far beyond the capabilities of even an exceptional mind to endure without disabling effects. West Point probably holds the record for mental cramming. It has justly been remarked that the quickness of mind and memorizing required for entrance to, and continuance at, West Point are characteristic of many degenerate minds.

And it

is a well-known fact among those who have given the subject attention, that forced memorizing and quickness of response to questions relative to new things learned are damaging to some of the best qualities of the mind. But even a naturally superior mind, in both quality and energy, is bound to be seriously deteriorated, if not utterly wrecked, by a fouryears' course at West Point. The same is true of the systematic courses of instruction in our educational institutions, high and low. The doctor favors fewer hours of study, a larger number of vacations, and a lessened strain upon the memory; and in all these we concur.

We have, more than once, called attention to the effects of mental cramming, claiming that it developed some of the least important qualities of the mind, to the inevitable, and often permanent, detriment of those which are its most valuable paris. The only hope of a really good mind at West Point and in all of our other high-pressure institutions is to keep as low in class-standing as is consistent

if we could, abolish the entire system of examinations. They are, after all, ineffective in determining the knowledge of the student. Questions are not properly framed to elicit an answer that is even a little measure of the student's knowledge. It is far better to have classes so small that the teacher has a pretty thorough concept of the capabilities of each of its members, whereby a true judgment could be passed as to their fitness for advancement, or the merit of a degree. We consider marking and percentages absolutely ridiculous, and would much rather prefer the impression made upon the mind of the examiner at the conclusion of an examination, should one be held, that ought to be both written and oral, as well as practical, if the subject admits of this.

Such

At no time in life is a proper system of education so important as in early childhood. The little child should be as free as the air, full of enjoyment, getting plenty of rest, and being abundantly fed in response to a normal appetite. children should be good-natured, cheerful, rosy-cheeked, full of life, happy, and contented. Whatever interferes with these requirements is positively injurious, as is the present method of taking a child. out of bed, feeding to it a breakfast, often in a hurry, then sending it to school, where it remains for three long, weary hours, not in the pleasurable acquirement of desired knowledge, which it can take delight in using, but in the performance of irksome tasks, or in the maintenance of a cramped, rigid position within a confined space and atmosphere, until it has lost its freshness, and becomes irritable, perverse, mischievous, and otherwise unnatural. This is followed by a lunch or dinner, with a child not nearly as fit to receive it as nature intended and provided that it should be, after which, the grind