of weight or constriction about the pelvis, especially in males; spasmodic or periodic dysuria, without apparent genito-urinary cause; a tendency to diarrhoea, especially in the morning; the presence of blood, pus, shreds or mucous in the stools; irregular menstruation or dysmenorrhæ in young women, when no other cause can be found; all these and many other symptoms call for anal, rectal, and sigmoid examinations. In fact, I would suggest that in all chronic cases, where other treatments and diagnoses have proven unsatisfactory, in which the symptoms may be reflex in origin, that an investigation be made of these parts in order to determine if irritation or disease there may not be the cause of the disturbance.

The general disturbance present is not always in proportion to the changes found. Very slight changes may produce very marked symptoms and very serious changes may produce very insignificant general symptoms. It is no easy task to determine whether rectal irritation is causing symptoms in some cases, and the only thing to do when one feels that irritation may be present, is to relieve all possible sources of such irritation.

Realizing, as we all must. the important bearing pelvic irritation and disease has on the general system, we should keep in mind that the anus, rectum and sigmoid are important organs in that region, and capable of producing disturbances elsewhere, when the seat of irritation or disease.

TUBERCULAR MENINGITIS.

By J. W. Kelly, M. D., Bellville, Ohio.

On January 1st, 1903, Mr. N., of a neighboring town, requested me to go to his home at once and see his baby boy, fourteen months of age; he said the "family doctor"-Dr. E., a Regular, had done all he could and was willing any one else should try his hand in the case. I found the child at death's door, had been having spasms for twentyfour hours, bulging of anterior fontanelle to the size of a hen's egg, and unconscious. Diagnosis of attending physician, "Tubercular Meningitis." There seemed to be nothing to do and acted accordingly. Child died a few hours later.

In May, 1897, the family doctor informed me that Mr. and Mrs. N. had recently buried a second child, a boy sixteen months of age, having the same run of symptoms as in the preceding case. Monday morning, December 30th, 1900, was called by telephone to hurry to the N. home, as the baby was sick.

Family History.-Father's good. Mother's mother and other

near relatives died of Tuberculosis. Brother, a strong, lusty lad of seventeen years, had pneumonia when one year of age, otherwise healthy. Sister, twelve years of age, never sick. The two fatal cases mentioned above.

On Saturday preceding my visit, baby had shown symptoms of "cold." Sunday some fever, slight cough, vomiting; during the night was restless, and at 4:00 A. M. gave a scream which, as the parents said, "made their blood run cold." They then noticed the scalp bulging and called me at once. I found a big, hearty-looking boy of five months, slightly feverish, rolling his head, pupils contracted, bulging of fontanelle, cough. Remedy, Gelsemium 2x every half-hour. Apis 3x every two hours.

Wednesday morning.-Child slept well during preceding night, effusion slightly diminished, no fever. Remedy, Apis 3x, Helleborus 3x. Alternate every two hours.

Friday morning.-Father met me at the gate with a broad smile and a huge hand-shake, declared Harold was better and Homeopathy the treatment for babies. The child made an uneventful recovery.

In August, 1902, the family horse broke Harold's left femur at junction of upper and middle thirds. The parents, fearing any irritation might bring on "head symptoms," called me, with Dr. E. We put him in a plaster cast embracing the limb and pelvis. Extension removed as soon as cast became dry. Result perfect. Three weeks after removing cast he re-fractured (green stick) the bone at about the same point. Treated as before with like result. He walks and runs without a limp. There was no apparent weakness of the bones, as any other child's ought to have broken under like conditions. Does the complete recovery from the accidents, as recorded above, have any bearing in deciding the presence or absence of tubercles as cause of his attack of Meningitis? Authorities tell us that recurrences happen till a fatal issue results. The magnitude of the injury and the restraint necessary to proper treatment gave them abundant opportunity, but they are not in evidence as yet, for Harold is as rugged a three-year-old, both mentally and physically, as could be desired.

The outward manifestations of the disease were identical in the three cases, except that the first two children vomited frequently for two weeks before the family realized that they were seriously ill. Harold did not have spasms, but that stage was rapidly approaching at the time of my first visit.

The first child was nursing when the attack came. The second was weaned at about the tenth month. Harold was taken from the

breast during the first month and cow's milk substituted. Cow's milk was given in each case to supplement the mother's, which was scanty. Milk was not sterilized in either case.

In the spring of 1900 a second girl baby came. Has never been sick. On the 4th inst. the parents came to my office with another baby boy, seven months old. Had shown symptoms of "cold" the day before. Has slight fever, cough pupils normal in size and reaction; no vomiting; bowel action normal; protrudes tongue, tightly compressing it between the lips. When I called the mother's attention to it she said her daughter had noticed it several days before. Will the symptoms be in evidence later on? Remedy-Ferrum Phos.

Report by 'phone to-day is that the child is better, and no new symptoms. During this examination learned that mother suffered with sore nipples the entire period of lactation with each child. Although I could find no indications of tubercles, advised immediate weaning of child. Had I known it was "going to happen again" would have warned her before the child was born.

Were the three cases tubercular, and Harold's one of those cases that get well in spite of the doctor? Or was it simple meningitis, and if so, what about the other two cases? Would like to hear from some older and wiser head.

My previous experience was limited to two cases. The father of a baby boy asked me for medicine in the absence of the family doctor. I did not see the case. He said the child was feverish, rolling his head and gave such a peculiar scream while asleep. Remedy, Apis and Gelsemium. This proved a fatal case during the following week.

One of my neighbors requested me to see his grandchild, a boy twenty months of age. Found the child moving about the room in a listless manner, pupils normal in size but insensible to light; slight fever, no appetite, bulging of anterior fontanelle. Grandparents had not noticed anything wrong the day before. The child made a quick and complete recovery on Gelsemium and Hellebore. This was the fifth of a family of seven children, two boys and five girls. No other cases in the family. History of tuberculosis in families of both parents. It will be noticed that there was an absence of prodromal stage in the two cases that survived, also that the oldest son in each family escaped an attack, and all of the girls.

In 1903 the Rochester Homeopathic Hospital cared for 1,975 patients, the number of visits to the free dispensary were 3,310, and two visiting nurses connected with the Hospital made 2,332 calls.

t

MEDICAL EDUCATION.*

By H. E. Beebe, M. D., Sidney, Ohio.

It was Dryden who said: "Make choice of a subject beautiful and noble which shall afford ample field of matter wherein to expatiate." Certainly this topic meets that requirement.

A medical education to-day means more than it did a decade ago, and decidedly more than when some of us, who are on the downward hill of life, entered the professional arena. Then, the standard of requirement was low, very low in comparison with the present standard. Note the transition. We attended two courses of lectures, four months each, and the second course was almost, or a greater part of it was, a repetition of the former year. The student's paramount desire was to secure a diploma whether he knew anything or not. To-day, the prospective M. D. attends four courses of lectures, of 7 to 9 months each, in four separate years, and laboriously endeavors to know something, and he does know it if he completes his college course in a reputable, first-class college. He must know something more than the three R's to enter a medical college. At least Ohio's preliminary educational requirements are such that all who wish to enter do not succeed in doing so.

These advanced steps are bound to elevate the professional standing of the coming graduate. It has done so already, and it is a satis faction to know that the degree of M. D. is looked upon with much more respect than ever before in this country. Not until quite recently has the old world given any special credit to our medical institutions. In proof of this, they lately are sending representatives over here to investigate our educational methods. This is certainly most encouraging.

Not until now has the philanthropist possessed sufficient confidence in our medical colleges to endow them.

The public is just opening its eyes to the fact that it is to the medical profession it must look for guidance in hygienic and sanitary matters and the preservation of the human race. What a laborious effort it was to educate the great State of Ohio to the importance of establishing a State Board of Health. To-day public sentiment is so strong that a board of health possesses more legal authority than any other organization in the community. Through our educational efforts this has been brought about.

There has long been a strong prejudice against all legislation with the least smattering of anything medical in it, believing that it was altogether for the profession. We have been obliged to educate the

* Read before the Marion County, Ohio, Medical Society.

public to see necessities, until now they are crowding us on to greater efforts by endowing our medical colleges and aiding in placing medical departments in our great State universities, where money is furnished to thoroughly equip for teaching. The weaker colleges must succumb for want of necessary financial support. This is all right, for equipment is most essential to carry out good work.

"Dr. Billings, President of the American Medical Association, at the New Orleans meeting, estimated that in order to give a medical student the proper advantages in the laboratory courses it would cost between $400.00 and $500.00 annually per student. If he is correct in his estimate, the only hope of the average medical student receiving these advantages is in an endowed institution or a State university, for he is not able to pay such fabulous fees, and not to receive these advantages is lowering the standard of the profession and may result in the sacrifice of life."

After all, when the new M. D. is legalized to practice he is but just prepared to begin to teach himself the realities of the profession, and to unlearn many things that he thought were established facts. The successful physician is born, not made. He must early learn to teach himself as well as others. It is not always the technical knowledge that wins in the professional race. It has been well said: "Practice is a field in which tact is the fertilizer."

In all lines of thought it is always difficult for the veteran to keep up with the procession. This is markedly true with the old physician. Human lives are constantly being entrusted to our care by confiding patients or friends, thus making our responsibilities second to none other in any walk or profession of life. Therefore ignorance is not accepted for a valid excuse for error.

There are many valuable things taught now of which the old doctor is not as well informed as the young physician ought to be. He has not had the time nor opportunity to fit himself in many of the later ideas. But an excuse for this is not accepted, for here is a duty he owes to his clientele, to fit himself so far as he can, by keeping in touch with new ideas, through journals, books, post-graduate work, and not the least, the medical societies. In no other way can he do it successfully, and unless he makes extra endeavors along these lines he is bound to fall behind in the professional race.

Books and journals are invaluable to the busy practitioner. We should follow Lord Bacon's maxim, "Some books are to be tasted, others swallowed, and some few to be chewed and digested." Our literature is so plentiful that there is little excuse for neglecting it.

At this time of a revival of medical organization such live socie