Hahnemann, later was employed by Jenner in vaccination and in modern practice, exemplified by Pasteur in the treatment of hydrophobia. We have no excuse to offer for our editorial and assure our readers that it embodies the best that is known to medical knowledge today, regarding the prophylactic and curative treatment of tetanus, and according to Prof. Behring, it is homeopathic.

THE HOSPITAL AS A FACTOR IN MEDICAL EDUCATION.

It is safe to say that many of the laity who hold official positions connected with the management of hospitals do not fully realize the mission of a hospital. To them, a hospital fulfills its purpose when it provides care and comfort for the sick. Aside from the usefulness in providing accommodations for pay patients who may desire its services, the only basis upon which a hospital trustee seeks support towards maintenance from the public is the amount of charity dispensed by the hospital in caring for those in the community who are unable to secure for themselves, proper and skilled medical treatment.

No one of course would deny that this should be one of the purposes of a hospital, but should it almost invariably be the only one that is made prominent before the public? Rather, should not the fact be emphasized that the hospital affords ideal conditions and surroundings for the study of disease and that its chief purpose is to make such study in order that physicians may better understand and treat disease.

Should not hospital trustees give more attention to the educational work of the hospital, giving every opportunity to the medical man to study the variations of diseased conditions as they appear in the hospital and should they not require that these opportunities be fully utilized by the visiting staff?

Dr. W. T. Councilman, of the Harvard Medical School, in a report made to the Council on Medical Education, Chicago, April 20, 1905 (Journ. A. M. A., May 6, 1905), thus defines the object of medical education and the means of securing it:

"The object of medical education is to train individuals so that they may be of service in combating disease. Some of the individuals so trained will deal with the great questions of disease as it affects the general public; some will seek by the experimental study of disease to increase knowledge; but by far the greatest number will deal with disease in the individual. The same methods of education are applicable to all.

"The student may acquire in the medical school knowledge of disease and proficiency in the use of methods by means of which knowl

edge is acquired. Knowledge in medicine, as in any other branch of science which deals with things, is derived from the study by the senses of objects and the phenomena exhibited by them. The study is aided by various methods, by the use of which the territory covered by sense impressions is extended. From the interpretation of sense impressions and by analogy, hypotheses may be formed which are to be tested by experiment and future observations. The experiment is also of great value in enabling observations under known conditions to be made. Every case of disease presents some variations from the type, and general knowledge of a peculiar disease gives little assistance in ascertaining the conditions produced in the individual affected. Knowledge of the conditions produced in the individual by diseases is essential, and can only be obtained by the methods of science.

"In medical education it must be recognized that the student can acquire knowledge of the things he is studying only by means of the senses. Lectures in medical education play a very subordinate role. The lecture has its place, but it has to be given in connection with the student's work, and it is for the purpose of amplifying and co-ordinating the knowledge he has obtained from the study of objects by means of his senses.

It is self-evident that the only place in which such a study of disease can be made is in a hospital and not to utilize the opportunities offered for such study in every hospital is a serious failure of duty on ́ the part of those directing its management.

A little thought will show what the inauguration of the fullest. utilization of the education opportunities of a hospital would entail upon both the hospital trustee and the physician.

To the trustee it would mean that the hospital equipment should contain everything that would contribute to the study of disease; the hospital would be a vast laboratory in which workers would be provided to observe and study diseases. It would mean that every case in the hospital whose relation to the hospital is that of debtor. i. e., every part pay and free case should be utilized for purposes of study and instruction. It would mean that every hospital should have a connection with a medical college in order that this instruction could be available to those desiring to learn of disease. It would mean that the hospital staff should be composed of the teachers in the affiliated college in order that the greatest utilization of the clinical facilities of the hospital would be made.

To the physician it would mean that his work in the hospital would have to be of a high order on account of the fact that he would be subject to the observation and criticism of those who are eager to learn of disease. His work in the hospital would be that of original investigation and research and the imparting of the knowledge thus gained to medical students. It would mean that the medical staff of

the hospital would have to consist of active men who would hold their positions by virtue of the work they were capable of doing, rather than by virtue of their influence with the hospital trustees. In short, it would mean that every public hospital would become in truth a "laboratory for the study of disease," and that every professional and lay worker in this laboratory would have uppermost in his mind the question, "How can I add to the sum total of the knowledge of disease?"

Selections.

TREATMENT OF APOPLEXY.

Perhaps an apology should first be made for presenting even a short paper on so well-worn a subject, but from my experience with certain cases I feel that there are some points that have been overlooked by many who have been called to treat this difficulty. Of course we can do nothing in a typical case of apoplexy, as its advent is usually unexpected and the attack swift in its working, with death. terminating the scene.

There are other cases, however, which we are pleased to term "apoplectiform seizures," which closely resemble the true apoplexy, the symptoms of motor disturbance varying in degree with the extent of territory involved, and for these considerable may be done by pursuing a careful and conservative course of treatment. Whenever these symptoms of motor disturbance, either slight or pronounced in their character, are recognized we must insist upon absolute rest as a matter of the first and most supreme importance. Not only physical rest. but everything having a tendency to induce anxiety of mind in any phase must be carefully avoided, and an atmosphere of quiet and freedom from all excitement be maintained.

When we consider the causes which lead to the attack we can readily understand the necessity for keeping the blood current in a quiescent state in order that nature may repair the damage done. The patient should not be raised to an upright position, nor carried from room to room, and the clothing should be removed or changed with the least possible amount of motion. The recumbent position should be maintained for a week or ten days at least, and no exertion on the part of the patient be permitted. The extremities should be kept warm by heat, or better still by massage thoroughly given, and the heart's action carefully watched and supported. The functions must be regulated with care, as a little neglect in this direction creates

a danger from autointoxication, which in itself predisposes to seizures of apoplexy. Every channel of elimination should be kept as free as possible, and after three days have passed and there have been no further seizures and no increase in the paralytic symptoms, I know of no better course to pursue than the intelligent use of colonic flushing for the bowels, using sterilized water at a temperature of 110 to 120 degrees. If this results in an evacuation then give a sterilized saline enema as high up as possible, with the intention of having it retained. This should be done every third day, or every other day at a stated time, and will bring about much comfort to the patient; also by its thorough irrigation of the kidneys and bladder it allows a greater susceptibility to any homeopathic medicine that is administered, for at condition inviting autointoxication we cannot consider as anything else than a detriment to any drug we wish to employ.

Alcoholic stimulants should not be given, as they only increase the difficulty. Three days or more may safely elapse without effort being made to give the patient nourishment, as frequently the stomach is in so irritable a state that no food can be retained or assimilated, and there is the added danger of needlessly exhausting the patient by nausea and vomiting. When water can be swallowed it should be given in moderate quantities at frequent intervals, a teaspoonful at a time, care being taken not to raise the head.

When it seems absolutely necessary to give nourishment and there is difficulty in swallowing, rectal alimentation should be resorted to after the bowels have been evacuated by a sterilized enema. Bovinine, two teaspoonfuls, Mellin's food, four teaspoonfuls, and a pint of sterilized milk may be injected twice daily, this being sufficient under ordinary circumstances. Do not underestimate the danger of allowing the patient to get up too soon, to be seen by friends, to talk business, or in any way be annoyed.

When it comes to the administration of medicine, arnica is probably employed as freely as any drug with which I am familiar, Belladonna comes next, but I have found that opium given in appreciable doses is worthy of the utmost confidence. Another remedy in which I have great confidence is echinacea, and this is especially indicated where there is a tendency to degenerative changes, the best results having come from twenty drops of the tincture in half a glass of water, given every half hour or with less frequency, as the symptoms in the case may determine.

One has to constantly bear in mind that every channel of elimination be kept free, and that mental and physical rest, that is, absolute, be maintained, in which emotional strains are to be avoided as wholly

pernicious to this class of sufferers.-G. Spencer Kinney, in The Medical Student.

SOME REMEDIES TO BE REMEMBERED IN THE
TREATMENT OF MISCARRIAGES.

My object is to bring to your notice a few remedies that are but seldom used by the majority of our profession, but which, nevertheless, are often useful in the treatment and prevention of miscarriage.

Aletris. This remedy is very useful when there is a condition of uterine weakness, with a sensation of weight in the uterine region, and tendency to prolapse of the uterus. Probably its most efficient action is in those cases where the woman has aborted before, and the condition is become habitual. In these cases the remedy should be commenced three or four weeks before the period at which the patient usually aborts, and given three or four times a day, and continued for a like period beyond the expected miscarriage. If any threatening symptoms arise afterwards, the remedy should be again used. After quite an experience with the different potencies, I have come to rely mainly upon the Ix dilution.

Baptisia. This valuable remedy has proven helpful to me in many instances in threatened miscarriage from mental depression, shock of bad news, watching and fasting, or from low forms of fever.

Caulophyllum.-A very useful remedy for the prevention of premature labor and of miscarriage, when the pains are of a spasmodic character, are feeble, and there is but little loss of blood. It is indicated in the early stages. In deficient labor pains caulophyllum acts well when the pains do not appear with sufficient vigor and regularity, or when the pains have ceased from exhaustion. In these cases I find the best preparation to be 1x or 2x trit. of caulophyllin. When the pains are too severe and too painful, or are spasmodic, my choice is for a higher potency. I have found caulophyllin useful in "spasmodic pains" whether during labor or after-pains, or during menstruation. The active principle is less irritating to the fauces than the tincture.

Helonias. Here we have a very valuable drug. Its usefulness in abortion is limited, but for the proper conditions no drug is more worthy of trial. We frequently find women who are anxious to have children, and who become pregnant, but as the menstrual cycle rolls around, they are unable to hold on to the product of conception, owing to uterine atony; or, even if they pass over the period without loss of the ovum, by remaining quietly in bed during the week, on the slightest over-exertion, or even from getting angry or unduly excited,