MEDICAL RECORD: A Weekly Journal of Medicine and Surgery. GEORGE F. SHRADY, A.M., M.D., EDITOR. THOMAS L STEDMAN, A.M., M.D., ASSOCIATE EDITOR. PUBLISHERS WM. WOOD & CO., 51, FIFTH AVENUE. New York, July 2, 1904. COLLEGIATE TRAINING OF WOMEN. THERE has arisen among civilized women within the past few years a great desire to compete with men in whatever callings of life are open to both sexes. This new departure on the part of women has been especially noticeable in the United States. In order to qualify themselves to meet men on anything like equal terms in the battle of life, women have recognized the fact that they must, as far as is possible, be well equipped for the fray. Consequently female colleges have sprung up like mushrooms in all parts of this country. To a lesser extent this statement is true also of Great Britain. As to the wisdom of this course opinions are greatly divided, but the weight of evidence would seem to show that women in encroaching upon fields which have hitherto been occupied solely by men, on the whole, have been illadvised. Of course, it is well understood that some women must go out of their own groove of work and earn their livings outside their homes. It is, however, a grave question as to whether this tendency has not been carried to excess, and whether the race has not suffered, at any rate in America, through women deserting their domestic duties for a life which is contrary at least to the traditions of their sex. The Is a collegiate training harmful to women? majority of medical men are of the opinion that such is generally the case-at all events, that co-education is harmful to women-and hold the view that women are not fitted physically for the strain put upon them by strenuous professional or business careers. In the Edinburgh Medical Journal for May, 1904, Dr. T. Claye Shaw deals with this matter from his own point of view, which it may be asserted is probably the point of view of nine-tenths of the medical profession. The writer points out that those best able to judge of the evils of college training for women are medical men attached to such institutions, and their experience is to the effect that stress of competition. presses in too indiscriminate a way upon the young women who are brought together and educated in very large numbers. In the opinion of Dr. Shaw, the forcing system in vogue in colleges both for men and women at the present time is good neither for the quick-witted nor for the moderate or dull girls. The former, indeed, perhaps suffer the most, for their readiness at work and the pressure that is put upon them to accomplish an end at all risk, though at times compassed with impunity, often ends in disaster and evil after-consequences. The writer also thinks that the results of these distressing efforts to compete with man on his own ground are de If women desire a university education they should be separated from men in their work, as in addition to the competition in intellectual pursuits the entire trend of co-education is toward the elevation of the purely intellectual, and the disregard of the emotional side of the character, thereby unfitting the woman for her natural vocation, that of motherhood and of caring for her children and home. While a few women succeed in competing with men on the same plane of mental endeavor the majority are more or less failures, their training on the lines of co-education, not having benefited them a jot, indeed rather the reverse. Dr. G. Stanley Hall, the eminent American psychologist, has recently published a work on "Adolescence," a part of which treats of its relations to education. In a consideration of adolescent. girls, and their education from a medical standpoint, the author quotes largely the opinions of medical men on the subject, some of which will be noticed here. Dr. Storer urged that girls should be educated far more in body and less in mind, and thought delicate girls frequently ruined in both body and mind by school. Dr. Clarke, in 1873, wrote a book in which he pleaded that woman's periods must be more respected. This work appeared at the height of the movement to secure collegiate opportunities for girls, and was suspected of being unofficially inspired by the unwillingness of Harvard University to receive them. It reached a seventeenth edition in a short time, but the views expressed therein were warmly combated by a number of ladies distinguished in the movement for the higher education of women. Clouston has, in various articles and books, expressed himself in very trenchant terms. In the United States, Clouston thinks that most families have more or less nervous taint or disease; that heredity is weak because woman has lost her cue, although nature is benign and always tends to a cure if we have not gone too far astray, but, he adds, "There is no time or place of organic repentance provided by nature for sins of the school master. A man can work if he is one-sided or defective, but not so a woman. "If she be not more or less finished and happy at twenty-five, she will never be." Parents want children to work in order to tone down their animal spirits, and it almost seems to Clouston as if the devil invented school for spite. Dr. S. Weir Mitchell has so often given out his views on the question, that they are well-known. Woman, he holds, is physiologically other than man and no education can change her. Grant Allen said: "In any ideal community the greatest possible number of women must be devoted to maternity and marriage, and support by men must be assumed and not female celibacy. The accidental and exceptional must not be the rule or goal. This is only a pis aller. It is not so much the unmarried minority that need attention as the mothers. We must not abet woman as a sex in rebelling against ma ternity, quarrelling with the moon, or sacrificing wifehood to maidenhood." Le Bon pleaded that the education we now give to girls consists of instruction that fits brains otherwise constructed, prevents womanly instincts, falsifies the spirit and judgment, enfeebles the constitution, confuses their moods concerning their duties and their happiness, and generally disequilibriates them. Sir James Crichton Browne holds that differences between sexes are involved in every organ and tissue, and deprecates the present relentless zeal of intersexual competition, concerning the results of which it is apalling to speculate from a medical point of view. When the University of St. Andrews opened its theological department to women, it was not a retrograde movement, because our ancestors did no such thing, but a downhill step fraught with confusion and disaster. He quotes with approval Huxley's phrase that "what has been decided among prehistoric protozoa cannot be annulled by act of Parliament." Prof. A. W. Small thinks that to train women to compete with men is like poison administered as a medicine, the evils being quite as bad as the disease. So far as co-education is concerned, Dr. Stanley Hall thinks that while the system is not so harmful in college and still less harmful in university grades after the maturity which comes at eighteen or twenty has been achieved, it is high time to ask ourselves whether the theory and practice of identical co-education, especially in the high school, which has lately been carried to a greater extreme in this country than the rest of the world recognizes, has not brought certain grave dangers, and whether it does not interfere with the natural differentiations seen everywhere else. The consensus of expert opinion is against the higher education of women carried to extremes, and particularly adverse to co-education. The weightiest argument against too much mental stimulus for women, is the fact that educated women, and especially highly educated women, are less fecund than their more ignorant sisters. Herbert Spencer was authority for the statement that "absolute or relative infertility is generally produced in women by mental labor carried to excess." According to Dr. Hall, this has probably been nowhere better illustrated than by college graduates. He says "Excessive intellectualism insidiously instils the same aversion to 'brute maternity' as does luxury, overindulgence, or excessive devotion to society. Just as a man must fight the battles of competition, and be ready to lay down his life for his country, so woman needs a heroism of her own to face the pain, danger, and work of bearing and rearing children, and whatever lowers the tone of her body, nerves, or morale so that she seeks to escape this function, merits the same kind of opprobrium which society metes out to the exempts who cannot or who will not fight to save their country in time of need." The ordinary woman's true place is her home, and by far her most important duty to the race and to the State is the bearing and bringing up of children. Her educational training should at least not unfit her for the proper performance of this essential service. It is claimed, and undoubtedly with much truth, that the modern system of education does tend in this direction. Consequently, the system should be altered. If by a continuance of the present methods of educating women, the birth rate of those countries in which such methods are practised will inevitably decrease, it can be clearly understood that the game is not worth the candle. DIAGNOSIS OF TOPHI IN THE EAR. THE differential diagnostic characters of tophi in the ears is discussed by Dr. Wilhelm Ebstein in a recent number of the Deutsches Archiv für klinische Medizin. Strangely enough, there seems, the author tells us, to be no very accurate description of tophi in the books. The question is then under what circumstances one is justified in considering a nodule in the ear as referable to the group of tophi, and therefore proof of the existence of gout. The best description is that given by Garrod, who says tophi are sometimes single, sometimes numerous, sometimes smaller than a pin head, sometimes larger than a split pea. They generally have the appearance of pearls, and usually lie on the borders of the helix. As regards consistency they are sometimes hard and sandy, but frequently soft and yield a milky juice on puncture. Since Garrod's time little in the way of description of them seems to have been attempted. As to their significance, they are regarded as the exclusive property of the gouty. Thus Duckworth has found them in one-third of his cases (forty-nine out of 150), and as their appearance frequently precedes the arthritic manifestations of gout, their presence has acquired a diagnostic value that can hardly be over estimated. In the course of the preceding year Ebstein has seen, in three cases, formations in the ears which resemble in many ways, and therefore require differentiation from the true gouty tophi, from which they are separated by the following characters: First, their seat is neither in the cuticle, nor in the subcutaneous connective tissue, but in the cartilaginous tissue itself; and, secondly, no uratic contents can be obtained from them. The first of the cases was that of a man, with gradually increasing joint pains, and old tuberculous lesions at the apices, who presented on the antihelix sharply bounded, hemispherical elevations, 4 mm. in diameter, with a hard feel, which yielded on puncture no fluid, the tumor being solid. The left knee-joint was 3 centimeters larger in circumference than the right, and the patellar bursa contained fluid which was drawn three times but never contained uric acid or urates. second case, a man of thirty-two, developed the tophi-like bodies while under intermittent obervations extending over years. The helix and antihelix, tragus and antitragus, exhibited a series of prominences which, on puncture, yielded fluid not containing uric acid or urates. The mother was under treatment for chronic gouty arthritis. The third case was one of typical uratic gout, without typical tophi anywhere; prominences of cartilaginous consistence were present in the ear cartilage itself. The These observations, though few in number, nevertheless yielded a viewpoint that deserves attention. Grouped, the observations yield the result that rheumatic, and goutily-burdened individuals, tophilike nodules may be present in the ears which do not correspond to the gouty deposits frequently occurring there, not being like the ordinary tophi, seated in the subcutaneous tissue, but lying in the cartilageş MEMORIAL TO THE LATE MAYOR WALTER REED. It is proposed to erect in the city of Washington, a suitable memorial to Walter Reed, Surgeon U. S. Army. For this purpose the Walter Reed Memorial Association has been formed and has further been incorporated under the general laws of the District of Columbia, to give unity to the various proposals which have been made for the securing of a Memorial Fund. The officers of the association are: Presi- dent, D. C. Gilman, LL.D., Vice-President, General G. M. Sternberg, LL.D; Treasurer, Mr. Charles I. Bell; Secretary, General C. De Will, U. S. A. The executive committee is composed of the following: Major I. R. Kean, Surgeon, U. S. A.; Major W. D. McCaw, Surgeon, U. S. A.; and Dr. A. F. U. There are many and obvious reasons why the late Major Reed's memory should be perpetuated by the building of an appropriate monument. One reason is that physicians, whose benefits to the human race have been, perhaps, greater than those of any other profession, have been less often honored during life or after death than members of any other pro- fession. Again, medical men of the United States have not been greatly distinguished in original scientific research, so that when an American surgeon has made a discovery such inestimable importance as the cause of yellow fever, it is fitting that the discoverer should receive every possible Although Dr. Carlos Finlay of Havana, several years ago, had advanced the theory that a mosquito conveyed the yellow fever to man, he did not suc- ceed in demonstrating the truth of his theory. It remained for Major Reed to prove fully by laboratory and practical experiments that such was indeed the case. The principal conclusions of the board of investigators, of which Reed was the leading spirit, were: (1) The specific agent in the causation of yellow fever exists in the blood of a patient for the first three days of his attack, after which time he ceased to be a menace to the health of others. (2) A mosquito of a single species, stegomyia fasciata, ingesting the blood of a patient during this in- fective period is powerless to convey the disease to another person by its bite until about twelve days have elapsed, but can do so thereafter for an in- definite period, probably during the remainder of its life. (3) The disease cannot in nature be spread in any other way than by the bite of the previously infected stegomyia articles used and soiled by patients who do not carry infection. The application of methods suggested by these conclusions resulted in the virtual extirpation of the yellow fever in Havana, and like means may be relied upon to have correspondingly efficacious effects in localities in which yellow fever is rife. It may be anticipated that it is but a matter of time when yellow fever will be known no more. That the discovery made by Reed is one of the first importance, must be clear to all. He was assuredly a benefactor to mankind at large, and as WORK OF THE PUBLIC HEALTH AND MARINE-HOS- The annual report of the Surgeon-General, re- cently issued, gives the doings of the Marine-hospital Service for the fiscal year 1903. A part of the report is devoted to the sanatorium for consump- tives established by the service at Fort Stanton, New Mex. Two hundred and seventy-four pa- tients have been treated at the sanatorium during the year, an excess of 62 over the previous year. There were 12 discharged, recovered; 54 discharged, improved; 10 discharged, not improved; 150 re- mained under treatment during the year. treatment has been, on the whole, attended with Regarding the plague, the report states that cases During the fiscal year 857,046 immigrants were At the close of the fiscal year the commissioned Among the contributed articles in the report is an excellent one by Passed Assistant Surgeon J. C. Perry on the epidemic of cholera in the Philippine Islands during 1902. THE LOCALIZATION OF TABETIC LESIONS. In the Paris letter of the Albany Medical Annals, for May, 1904, reference is made to Pierre Marie's article in the Revue Neurologique on this subject. Marie's article is probably the best exposition of the matter that has ever been given. The Paris school of neurology has made immense studies of late, and our knowledge of nervous pathology has been greatly increased by the laboratory work of men like Brissaud, Marie, Babinski, and others. The meeting of the "Société' Neurologique" on the first Thursday of every month is an event in scientific circles, for no meeting passes by without papers of the highest interest being read and earnestly discussed. Marie, in his paper on "The Localization of Tabetic Lesions," proposed to explain this localization, by bringing into play the lymphatic distribution of the spinal meninges. He has noticed that in early tabes, the topography of the patches of sclerosis does not always coincide with the intramedullary course of the posterior nerve-roots, and therefore thought that this relationship was more apparent than real. For him the sclerosis of the posterior columns is not the extension of the process observed in the posterior nerve-roots, but is dependent upon, and limited by, the lymphatic supply. From the investigations of several observers and by laboratory experiments made by Marie himself and others, it is evident that the posterior columns, their meninges, and the posterior nerve-roots have a special lymphatic system, the "posterior lymphatic system," constituting in itself an anatomic entity, Marie consequently believes that the lesions of locomotor ataxia can be best explained by admitting that the morbid process is one of lymphatic origin and distribution. Marie ends his paper by saying that "The initial lesion of locomotor ataxia is a syphilitic lesion of the posterior spinal lymphatic system." The primary cause of tabetic lesions has ever been of the greatest interest to the neurologist. Recently a certain amount of doubt has been cast upon the widely held belief that to syphilis must be attributed the origin of locomotor ataxia. The conclusions therefore of so eminent a student of nervous pathology as Marie cannot much weight. but carry MILITARY SANITATION IN THE JAPANESE ARMY. The Japanese have afforded to a somewhat wonderf ing world an excellent object lesson on the value o. military organization and preparation for So well have they imitated and assimilated Western methods and ideas, that probably no European army is superior while more than one is inferior to that of Japan as regards equipment and organization. This is the case, too, with sanitary and medical affairs. The first evidence of the State of high efficiency to which the Japanese had brought their military medical organization was in the war with China in 1894. In the Journal of the Association of Military Surgeons of the United States for June, Lieutenant-Colonel John Van Rensselaer Hoff, Deputy Surgeon-General, U. S. A., calls attention to this almost forgotten fact. The writer quoted from writings of the present Director General of the British Royal Army Medical Corps, who was at the time of the Chino-Japanese war at the scene of conflict. The then Colonel Taylor says in part: "At Port Arthur there were opportunities of seeing how every part of the medical machine worked. Lives were saved on the spot where the men fell, by the prompt application of tourniquet and even large arteries were ligatured under heavy fire. . . . The wounded were removed from the field without any delay just as quickly and quietly as they always were on the bi-weekly parades of the bearer columns in time of peace. If regiments were engaged far ahead, the regimental bearers did the work until the bearer companies came up, when they again took their places in the ranks. There was no loss of time, the medical men were everywhere." So little news of the war has been allowed to leak out by the Japanese authorities that only the main facts are known. However, it may be taken for granted that the Japanese Military Medical Department has upheld the reputation it gained for itself in the war with China, and has successfully vied with the army in fulfilling its duties. There is no doubt that if the war with Russia is long protracted that there will be an immense amount of disease with which to deal. When the rainy season sets in, considering the insanitary state of the towns in Manchuria, typhoid fever will become rife, and it is not unlikely that plague and beriberi may attack the troops. Beriberi is a disease to which the Japanese are susceptible, and plague is a malady more prevalent in China than in any other country. The work before the medical organizations of both Russian and Japanese armies bids fair to tax their respective capabilities to the utmost, but, judging from the accounts of the Japanese Military medical service, it should, at least, be relied upon to cope with any situation presenting itself with credit. News of the Week. Medical Congress at St. Louis.-The plan and purpose of the Medical Department of the Congress of Arts and Science at St. Louis deviate so far from traditional lines that some explanation may be necessary to show how it should interest the medica! profession. It is primarily a congress of scholars. rather than of specialists. It is divided into twenty-four departments, one of the strongest of which is medicine. The Department of Medicine is divided into twelve sections, embracing the principal fields covered by the subject. These do not include Embryology, Anatomy, Physiology, or Bacteriology, as these subjects are embraced in in the Department of Biology. The Department of Medicine will be opened on Tuesday, September 20, under the chairmanship of Dr. William Osler, with two general addresses by Dr. W. T. Councilman of the Harvard Medical College and Dr. Frank Billings of the Rush Medical College. One of these speakers will review the progress of medicine during the past century, and the other will treat its fundamental conceptions. On Wednesday morning, September 21, a section of Public Health will meet under the presidency of Dr. Walter Wyman, Surgeon-General of the U. S. Public Health and Marine-Hospital Service. It will be addressed by Prof. W. T. Sedgwick of the Massachusetts Institute of Technology and Dr. Ernst J. Lederle, formerly Commissioner of Health of New York City. Communications relating to the subject are also expected from several eminent members of the profession. A section of Otology and Laryngology will meet at the same time: Chairman, Dr. Glasgow of St. Louis; Principal Speakers, Sir Felix Semon of London and Dr. J. Solis-Cohen of Philadelphia. In the afternoon a section of Preventive Medicine will meet, under the chairmanship of Dr. Mathews, President of the Kentucky Board of Health. It will be addressed by Professors Ronald Ross of Liverpool and Celli of Rome. Some question has been raised against the advisability of separating the sections of Preventive Medicine and Public Health. This separation is, however, of no practical importance, as all interested may equally well attend both. On the same afternoon a section of Pediatrics will meet under the chairmanship of Dr. Rotch, and will be addressed by Escherich of Vienna, Jacobi of New York, and others. On Thursday morning, September 22, there will be meetings of sections of Pathology and Psychiatry. The chairmen of these sections are Drs. Simon Flexner and Edward Cowles respectively. Marchand of Leipzig and Orth of Berlin have accepted invitations to address the section of Pathology, but it is not certain whether both will be able to attend. Psychiatry will be treated by Ziehen of Berlin and Dana of New York. In the afternoon a section of Neurology will meet, under the chairmanship of Prof. L. F. Barker of Chicago, and will be addressed by Kitasato of Tokio and Putnam of Boston. The sections which will meet on Friday and Saturday, September 23 and 24, are as follows: Therapeutics and and Pharmacology. Chairman: Dr. Hobart A. Hare of Jefferson Medical College. Speakers: Sir Lauder Brunton, F.R.S., of London and Prof. Mathias E. O. Leibreich of the University of Berlin. Internal Medicine, Friday afternoon. Chairman: Prof. F. C. Shattuck of Harvard University. Speakers: Prof. Clifford Allbutt, F.R.S., of the University of Cambridge and Prof. William S. Thayer of Johns Hopkins University. Surgery, Friday morning. Chairman: Prof. Carl Gynecology, Saturday morning. Chairman: Prof. One of the two principal speakers in each section will treat of the relation of the subject to other departments of knowledge; and the other of its present problems. Besides the principal speakers it is expected that each section will receive several brief communications from leading members of the profession in attendance at the meeting. It will be seen that the division into sections is one of subjects rather than of men. The chairmen and speakers will be different in different sections, but the attendance, it is expected, will be the same, except in the sections holding their meetings at the same time The California Medical Practice Law.-The Supreme Court of California has recently rendered a decision in a test case upholding the constitutionality of the law establishing the State Board of Medical Examiners. The decision not only declares the law constitutional in every respect, but approves of its object and affirms the need of such regulation of the practice of medicine in terms so emphatic as to effectually discourage all future attempts to evade the law. University of Southern California.-The graduation exercises at the Medical Department of the University of Southern California, Los Angeles, were held on June 14. The degree was conferred upon twenty-four members of the class. A most enjoyable banquet was participated in by the faculty, graduating class and alumni, at the Angelus hotel in the evening. On the following Thursday the corner-stone of a new clinical laboratory building was laid. This is to be one of the best equipped jaboratories in the West and will cost $200,000. The Annual Sacrifice.-The New York Times says that the State Board of Health of Pennsylvania has communicated to the Mayors and Burgesses of every city and township in the State a memorandum calling attention to the need of a better enforcement of the law relative to the sale of toy-pistols and high explosives. It makes the assertion that the recorded casualties last year from the use of toypistols, giant firecrackers, and explosive toys during the Fourth of July celebration were 4,349 injuries and 466 deaths, or more than the Russian casualties in killed and wounded during the recent two days' fighting at Hai-Cheng._ Its tabulated record of injuries and deaths last Fourth of July makes the following showing of totals: Died of tetanus caused by injuries. Died of other injuries. Totally blinded. Number who lost one eye. Number who lost fingers. 406 60 ΙΟ 75 54 174 3,983 Total number of casualties in the United States.. 4,349 Warning against Yellow Fever.-Dr. Taber, the Commissioner of Health of Texas, has sent an official communication to the Governor requesting the latter to issue a proclamation warning the people of the State of the imminent danger of a yellow-fever epidemic if they neglect the first. principles of cleanliness and sanitation in their houses and communities. On account of the open winter of 1903-4 in southern Texas and the prevalence of yellow fever in Mexico at present, he says he greatly fears that should a case be introduced into the State with the present very bad sanitary condition of a large number of the cities and towns and the presence of the yellow-fever mosquito, which also exists in large numbers throughout the State, there will be the most extensive epidemic of yellow fever ever known. He therefore urges the Governor "to issue a communication calling upon the county judges, mayors, and health officers of Texas to inaugurate sanitary campaigns in every community in the State without delay, especially for the destruction of the mosquitos." The Manhattan Eye and Ear Hospital, which has been located for many years at Forty-first Street and Park Avenue, is to have a new home next door to the Baron Hirsch Trades School in East Sixtythird Street. The capacity of the present hospital is fifty ward patients, with eight rooms for private. patients. It is proposed to construct eventually on the new plot buildings which will accommodate about four hundred ward patients and fifty private patients. Exhibit of Johns Hopkins Hospital at the World's Fair. The Johns Hopkins Hospital has placed a display in the Educational Building at the St. Louis Exposition. It is unique as being the only demonstration of nursing work among the exhibits. The exhibit consists of a series of photographs showing the hospital' exterior, views of the interior, groups of student nurses at work in the laboratories, class-rooms, and wards. Models of nursing appliances in operation, with specimens of charts," |