zation there is found an incorporation of a surgeon and two assistant surgeons. At the head of this corps it is a pleasure to find the name of Dr. T. C. Minor, who is well and favorably known as a colaborer in the editorial department of the LANCET-CLINIC. There is one other part

of the municipal administration which is hoped will come in line in the way of professional services. Reference is made to the Board of Education, which should have identified with it a corps of physicians who should at frequent intervals visit the schools for the purpose of reporting to the Board upon their sanitary condition and have an inspection of the physical welfare of the pupils. This child-study idea is very much more important than usually considered. Where carried out to a natural result, there is a constant saving of pupils from sickness. and epidemics.

THE HEALTH DEPARTMENT.

So far as is known at the period of this writing, there has been no change of a material character developed in the Health Department of Cincinnati.

OHIO STATE MEDICAL SOCIETY. This organization will convene at the city of Dayton, June 3 and 5, inclusive. Dr. W. B. Chapman is the President. There are many matters of much business importance to come before the society, which makes it very desirable that there should be a large attendance of members. There has been a good deal of activity, more than usual, in the organization of county societies. These county societies. are the units of all medical organizations. When they are active their membership is represented in the State organization. In the county societies the working force for the good of the profession is to be found. Dr. Chapman is well known throughout the State, and has been for some time

President of the Ohio State Board of Health. He is a model presiding officer for any association, and never fails to reflect credit upon himself and the society with which he is identified. Assurance has been given that the local profession of Dayton are fully alive to the occasion, and will honor themselves in honoring the State Society.

SWAMPED BY PHYSICIANS' BILLS.

"The United States Medical Association, with offices at 41 Carew Building, made an assignment in the Insolvency Court yesterday to Attorney John C. Rogers. The association was conducted by Alfred S. Wood and Walter C. Collins, and it insured its members against any expenses occasioned by sickness or disease. For the payment of a small sum every week or annually the association undertook to pay all the physician's and drug bills of the insured, so that on regaining health, or even in the event of death, there would be no bills to pay. According to Assignee Rogers the association has been in business about one year, and it had a number of clients. Recently several members were sick and were waited on by physicians. Assignee Rogers says that the physicians and their patients were in collusion and exorbitant bills were rendered, which the association was unable to or would not pay. On being pressed the association was compelled to assign, and yesterday the assets were placed at $50, consisting of office. fixtures, and the liabilities were given as $700, mostly claims of physicians for medical services."

The above clipping from a Cincinnati daily newspaper of May 20 is significant, and tells a little story which it would be wise on the part of the people and of some doctors to take notice.

Attention has been directed on several occasions recently to so-called lodge or benevolent society practice in Cincinnati. This practice yields an infinitesimal reve. nue to those who engage in it. At first the young man thinks it a good way to obtain an introduction to business, and

forthwith enters upon a contract which he will be glad to relinquish and cancel at the earliest possible day. The laborer is worthy of his hire. This applies to physicians, mechanics and laborers alike. The above notice of an assignment made by one of the so-called benevolent associations is a normal result of all such work. As may be seen, the doctor concerned will get nothing in the way of fees. It is a profit and loss account from beginning to end, and should never have been entered upon.

As to the charge that there was collusion between patients and doctor, it is believed to be untrue. The practice of medicine is not a trade, but a profession. Physicians' bills cannot be made out justly at an invariable rate per visit. This must of necessity change according to the circumstances and other conditions of the patient.

One of the most prominent evils of the day in connection with the practice of medicine is a tendency upon the part of the people, largely encouraged by many physicians, to carry all possible patients to a hospital for treatment, no matter what their circumstances may be. This is particularly the case in regard to surgical maladies. When a patient is taken to the hospital with an expectation of payment of professional fees for professional services, a hospital is one of the greatest blessings that can come to such persons. It is known to be very difficult in everyday practice to draw correct lines of demarcation between those who are fit subjects for hospital treatment and those who are not, and also between those who are deserving of charity services and those who are not.

The physician who does a family practice and visits his patients from day to day knows better than any other person their circumstances and their ability to compensate for services rendered, and it may be said he invariably makes out his

bills accordingly, taking into consideration ability to pay. These benevolent societies, so-called, lodge practice and insurance organizations such as the one just assigned should receive the frowns and discouragement of every man who regards himself as a reputable practitioner of medicine. The writer is well aware of the trend of the times in the way of consolidations and combines and everything pertaining to the world's business. Combines such as the one above indicated are the result of this trend.

EDITORIAL NOTES.

LITERARY COURSES FOR HOSPITAL NURSES.-Dr. Edwin Walker, of Evansville, has put a course of lectures in operation with the nurses under his care. The movement commends itself as being in the line of ordinary practical sense. Many otherwise good and efficient nurses lack a training of this nature. The opportunity is given by Dr. Walker for such as have not had all of the educational facilities that is naturally desired and craved. There is no danger of either doctors or nurses having too much culture and refinement. Dr. Walker is doing a good work.

Calomel in Pediatrics.

In administering a laxative Ladbiewski (Jahrbücher f. Minderhielkunde, No. vi) prefers castor oil to calomel and enlarges on its almost marvelous action in flatulent colic, dyspepsia, febrile gastrointestinal catarrh, convulsions from indigestion, icterus, hydrops and syphilitic and scrofulous eye affections. He gives ten to twelve doses of calomel ophthalmicus in .005 to .02 gm. quantities, according to age, preferring this form of the drug as the finest pulverized. This preparation he advises made up fresh, as traces of sublimate develop in the mixture of calomel and sugar also in time. Calomel decomposes on exposure to sunlight; and salt, salted foods and cherry laurel water, iodine and ammonium chloride have a tendency to transform part of the calomel into sublimate.-Pediatrics.

Correspondence.

INTERNATIONAL CONGRESS OF MEDICINE AT MADRID.

MADRID, April 26, 1903.

Editor LANCET-CLINIC:

Following my letter on our voyage to the meeting, on the 20th, as soon as we reached Gibralter we found that the time was very short, and in consequence it was necessary to give up the idea of a visit to Tangiers. We proceeded by ferry-boat to Algesiras, a true small Spanish city, where we dined, and from there we took the train for Ronda. It was necessary to stop over for the night and take the train in the morning. It is a small city of some 19,000 inhabitants, built on the top of a mountain, and surrounded by others, giving the appearance of an amphitheatre. The Sierra de Ronda, the Sierra de Tolox are more attractive, measuring over 6,000 feet in height. From the park can be seen the Sierra de Ronda descending perpendicularly in a precipice, where the Tajo is descending as a foaming river.

At ten promptly the train left for Bobadilla, where the company was divided, some going to Sevilla, the others proceeding to Cordoba. It was my intention to stop over in Cordoba to have an idea of the city, which was the capital of the Moorish kingdom, but on account of the poor accommodations of the railroad I deemed it much wiser to continue the voyage to Madrid.

66

I reached Madrid on the morning of the 22nd, and I was met by a gentleman with a red strap around his arm on which was written Congress." He took me to the bureau for the lodgings, and in a moment I received the tickets for ten days' board and lodging in a private family. Bus, etc., all was included in the price paid for the ticket.

After having been installed in a dwelling place we proceeded to the Museum and Biblotegm where the headquarters had been established. The confusion was remarkable; nobody knew anything; every one of the employés was green and unable to handle an immense crowd. Chronic kickers found reasons for complaining, and I remember a German doctor who wanted to re-enter the building by another

side, was hollowing, "es um barbaridad.” But with the exception of the kickers I believe that there is no reason to complain too much. The Congress was formally opened on the afternoon of the 23rd, in the Royal Theatre, in the presence of His Majesty the King of Spain. The theatre was crowded to the utmost by one of the best crowds, only doctors and their wives being admitted, all in evening dress. The officers wore their uniforms, contributing to the ceremony. Among the uniforms. those of the United States were very conspicuous, worn by our Surgeon-General, Assistant Surgeon-General and others.

Promptly at 3 o'clock, under the strains. of the Spanish national hymn, the King entered his lodge, accompanied by his mother, the Queen Regent, and the Infanta Isabella and other ladies and dignitaries. He was cheered and applauded by the enormous crowd, and he, standing up, saluted, and replied to the cheers with a contented smile. The stage was occupied by the official delegates from the different governments, and in the centre was the President of the Ministers, Silvela, with the officers of the Congress.

After the opening of the Congress Julian Calleja, President of the International Congress, read an address in the Spanish language, welcoming the royal family and the members of the Congress. He spoke of the present condition of medical science, and on the scientific importance of the Congresses.

The Secretary-General, Dr. Fernandez Caro, read a brief address, giving the number of the members of the Congress who had been registered as follows: Germany 776, Australia 7, Argentina 45, Austria 258, Belgium 98, Bosnia 3, Brazil 25, Bulgaria 4, Columbia 2, Cuba 13, Denmark 35, Egypt 12, United States 195, France 826, England 238, Greece 6, Haiti 1, Italy 235, Japan 4, Luxemburg 4, Mexico 25, Portugal 33, Roumania 21, Norway 51, Holland 16, Peru 4, Russia 297, San Domingo 2, Servia 9, Sweden. 21, Switzerland 35, Paraguay 11, Uraguay 3, Venezuela 18. Total members present, 6,961, of which 3,431 were foreigners and 3,530 were Spaniards. Papers to be read, 1,681.

After the address of the Secretary the delegates, representatives of the different governments, spoke a few words, saluting Spain and the officers of the Congress.

ACUTE ARTICULAR RHEUMATISM, WITH SERIOUS COMPLICATIONS.-On June 1, 1902, I was called to see Mrs. , aged twenty-three, family history and previous health excellent. She complained of pain in calf muscles of left leg and exquisite tenderness over the external saphenous vein and left knee joint; whole left leg and thigh were immovable and edematous; temperature 104°, pulse 120, respiration 30; great restlessness, tongue red and fissured; no appetite, bowels constipated, stomach irritable and urine scanty and albuminous.

The illness, which began May 31, was attributed to exposure to cold and rain while menstruating. Menstruation ceased four hours after exposure, though due to continue several days longer.

On account of the irritability of the stomach, the diet was peptonized milk and lime water.

On June 12, as the stomach rebelled against the administration of the salicylates in the usual way, I gave Tongaline in teaspoonful doses well diluted with water every hour while awake. All other internal medication was discontinued.

Until June 16 no appreciable effect waa noticeable except that the medicine was retained, the pain was lessened and the fever was two degrees lower.

On the morning of June 16, I was surprised to find temperature 100° and the patient able to move her limbs, which had become very edematous; June 17, delirium lessening, heart's action more steady and pain in serous membranes lessening.

The isolation of such children as might be sources of contagion was formerly left entirely to the judgment of the teacher. Some of these were not very observant; others, depending solely on their own. diagnostic skill, neglected to send cases which were really contagious to the medical school inspector. This was the weak point in the system. In order to obviate this defect, the inspector now visits the class room himself once a week, and examines each pupil. This examination is not a thorough one, but, as almost all of the acute exanthemata and the contagious affections of the eyes and the skin have typical manifestations on the head, face, or hands, or in the mouth and throat, the examination is sufficient to detect any such disease. The visit to the class room also gives the inspector an opportunity to instruct the teacher and demonstrate to her those symptoms which are to be especially noted, in order that she may be able to select the cases which are to be sent to the physician for examination. The teachers are aware that it is possible for them to contract a contagious disease from their pupils, and that the more thorough the inspector's examination, the less this danger is. For these various reasons the teachers observe their pupils more carefully and more intelligently.

There are at present eighty medical school inspectors in the borough of Manhattan, each having three or four schools, with a total of 4,000 to 5,000 children to inspect. The schools are situated in one neighborhood, so that as little time as possible is lost in going from one school to another. The inspector visits his schools before 10 A.M. every morning, and examines, in a room set aside for that purpose, all pupils who have been isolated by

or

the teachers as being possible sources of contagion. Children presenting any symptoms of measles, scarlet fever, diphtheria, mumps, whooping cough, chickenpox are sent home immediately; those affected with contagious diseases of the skin or eyes leave at the next recess. Each of these children is given a card on which are stated the reason for exclusion and the date on which the child should return for re-examination, with the advice to the parents that the patient should be promptly treated.

When cases of measles or scarlet fever are found, tae department of health is notified by telephone; and the pupils are visited by an expert of the department, for the purpose of confirming the diagnosis. In all cases excluded on account of throat affections, a culture is taken and sent to the bacteriological laboratory of the department for examination. The next day the school inspector receives the result of this examination. The patient is visited by the district medical inspector, who decides when the child may return to school. No pupils excluded on account of measles, scarlet fever, diphtheria, chickenpox, or smallpox are readmitted until they have received a certificate from the department stating that the premises are free from contagion.

After the day's work is finished a report is sent to the department stating, on a separate blank for each school, the number of pupils examined, and the name, age, and address, with the reason, in each case excluded.

Once a week the inspector visits the class rooms and examines each pupil. As he is seated at the window, the children pass in line before him. Special attention is paid to examination of the head, face, eyes, mouth, and throat. For the inspection of the mucous membrane of the lower lids (trachoma) the children draw them down themselves. For the examination of the mouth and throat, the mouth is opened as wide as possible and the tongue protruded. In this way, in almost all cases, the tonsils, uvula and pharynx may be seen, sometimes even the upper portion of the epiglottis. When the tongue obstructs the view of the tonsils and pharynx if the child phonates "ah!" the soft palate rises and these parts may be seen. In those cases in which these methods do not give a satisfactory view, the wooden

tongue depressors are used, a separate one for each child. Those pupils who require a more careful examination than is possible in the class room are sent to the inspector's room. The children, even the youngest, soon learn what they are expected to do, so that the examination of a large number requires but a comparatively short time. Those who examine systematically the throats of all sick children know that this is sometimes difficult on account of the fear and struggling of the patient. In the class room they see a number of others do the same thing before them, and offer no resistance. As almost all children between the ages of five and fifteen attend public school, in the future physicians ought to have very little trouble in examining the throats of children over five years old.

While in the class room the inspector

may ask if any cases of contagious disease have been reported from that class. If there are any, or if he himself has found such, special attention is paid in the examination to the possibility of other cases of the same disease. Each inspector is provided with a note book. By keeping a record of each class on a separate page the work is very much facilitated. Inquiry if any pupil has a sick brother or sister at home will sometimes reveal the existence of a case of contagious disease not reported.

At the end of each week a list of those pupils who have been absent for three or more days on account of sickness is obtained from the school. These are visited and the character of the disease is determined. If cases of contagious disease are found, the name, address, disease, and its duration are sent to the department. The inspectors report every Saturday morning at the central office to receive instructions.

In order to prevent, as far as possible, the spread of diphtheria, each pupil is provided with an envelope in which his pencils and penholders are placed. When a case of diphtheria occurs in a class room cultures are taken, not only from the suspected throats, but also from the children sitting around the patient. The importance of this is at once apparent when we remember that it has been repeatedly demonstrated that the presence of the Klebs-Loeffler bacilli in the throats of seemingly healthy individuals may be a source of danger to others.