room, in whose sacred precincts scenes unrolled themselves you had not even dreamed of before; he taught you to open the hearts of sick people to you, in the folds of which you discovered weaknesses and fortitudes, arousing your pity and your admiration and a resolution to be like him, the seeds of your future success. As Dr. Murphy says, "Medicine is not an art and it is not a science, but it is an art to which science is applied. The purpose of medical education is to prepare men to treat patients. The patient is the unit around which the medical universe revolves. These are basic principles that have been lost sight of in our modern trend of education. Why? Just look over the division of the students' time. As a student he devotes a certain number of hours to laboratory work, to experimental work, to dissections and clinical work, then ask yourselves: How are the best practical men produced? The writer has been through the mill himself, he has also taught more or less successfully some of these things to many students; he certainly values these things highly and thinks them necessary; but he has nevertheless pitied these students with all his heart, because all these things failed to teach them that the testtube, however much of the chemical composition of normal and, abnormal fluids it may reveal, never taught how quickly to assuage the agony caused by an inflamed bladder or of a passing gallstone! The microscope may reveal the germs in the excretions of the lung of tuberculosis or of pneumonia, but it does not tell how to stop the air hunger and the distressing aches of a chest, convulsed by a racking cough. And has it not happened that before the testtube revealed the abnormality of the secretions of the kidneys and the microscope the nature of the germs in the excretions from the lung, that pain and exhaustion have snapped the life thread? And who can prevent it? Surely only one, the clinical teacher, who has imbibed the essence of medicine, the application of scientific deductions to the rescue of the sick and the dying at the bedside of the hospital ward-his grave responsibility, willed to him by his great prototype, his preceptor of long ago, must become the keynote of his endeavors-he must teach the student at the bedside without loss of time to inspire hope, to convert apparent failure into success, to convert the darkness of despair into the sunshine of victory; of the victory of scientific medicine, artfully and promptly applied. Then and only then will the fifth year, the intern hospital year, become of great value to the young physician and the hospital itself, the good hospital, which is a crying need of the times, both for the students and patients. A. S. v. M. The Industrial Education of the Crippled and Deformed. There is a growing tendency on the part of those who are engaged in public as well as private philanthropy to direct their efforts toward the prevention of dependency rather than simply to provide care for those who become dependent. This tendency finds expression in many ways which are comparatively new. To some of us, at least, none of the newer ways of providing against dependency is more interesting or more profitable than the correction of deformity in children or the proper care of those prospective cripples suffering from chronic disease. A surprisingly large number of such patients, especially if cared for during childhood, may be converted from helplessness to a state of complete or comparative independence. Those of us who have been engaged for some years in the hospital care of these children, however, are having it forced upon us that hospital care alone is not sufficient to establish the permanent independence of such individuals. A considerable number of our orthopedic patients are, by reason of the nature of their disabilities, unable to avail themselves of the ordinary opportunities for acquiring an education. It is not uncommon, therefore, for such patients at the completion of their hospital care to find themselves several years behind normal children of the same age in the matter of their school work. Not only this, but many of these patients even at the completion of hospital care and when all has been done for them that can be done, find themselves physically unequal to the perform ance of all the duties of any given trade or occupation. The mere statement of the problem suggests the answer, which is that such children during their hospital care and afterwards should be carried along by means of special methods of instruction, so that when the hospital care has been completed they may, as rapidly as possible, be provided with such an education as will enable them, no matter what their condition, to perform some duties by which they can earn a livelihood. A number of industrial training schools have already been established, but a very small percentage indeed of such patients can now be cared for with the educational facilities that are available. For example, the Widener Memorial School at Philadelphia, which is one of the finest examples in the world of the form of philanthropy which I have suggested, has a million dollar plant, with an endowment of three millions more, but limits itself to the care of less than two hundred children. All of these children in the Widener School, however crippled or deformed, are being given the best of hospital care and provided with such instruction as will render them absolutely independent. This agency is, therefore, doing a tremendous amount of good and doing it in as nearly an ideal manner as possible. It can readily be seen, however, that many more such agencies, even if they must be carried on at less expense of money, must be provided for such individuals. The Nebraska Orthopedic Hospital has made a beginning in this direction, but only a beginning. All of our children, both those who are up and the bed patients who are able to do so, recite daily to competent teachers in lessons which correspond as nearly as possible to those which children of the same age are having in the grade, schools. Cooking, sewing and bookbinding are also being taught to those who are able to do those kinds of work. Other courses of instruction contemplated at the present time are horticulture, picture framing and photography. Two of the older girls, formerly patients in our hospital, are already independent; one is a seamstress and the other a telephone operator. It is quite important for the institution which provides hospital care to supervise the launching of these patients in occupations which will make them independent. There is a great danger that such patients if returned to their homes, either because of lack of means or because of over sympathy on the part of parents or friends, even though much improved as to their physical condition, will relapse into a state of dependency. Constant stimulation and intelligent supervision are necessary with these children as with others to have them use such energy and ability as they have toward proper ends. Teachers and equipment must be provided in increasing measure to supplement our hospital work if a full realization is to be obtained of the plan to make these patients independent. The State of Nebraska has been making rapid progress along the lines of caring for its orthopedic patients and by doing just a little more our institution will stand in the very forefront of those which are being devoted to work of this particular kind. H. WINNETT ORR (Lincoln, Neb.) The Tramp Problem. The tramp problem seems to be in process of solution if we may judge by the enthusiasm with which everyone approves the plan for a colony where these sick people can be segregated, studied and cured. The old theory that they were perfectly healthy men too lazy or vicious to work has been definitely and permanently abandoned as untrue. To be sure we all feel the grind of work and long for periods of rest and recuperation, but this does not alter the other fact that a healthy man takes to work like a duck to water. Any one who elects to endure the frightful sufferings of vagabondage when by a little industry he can make himself comfortable, is by the very act proved to be abnormal. He simply cannot work-and that's the end of it. The old plan of forcing him, in his enfeebled state, to do nard labor for which he has to go to the limit of his physique, being given neither the muscles nor energy, is as brutal as compelling an old bank clerk to work as a stevedore. Besides, it merely increases the basic neurathenia. The modern way is correct be cause it has succeeded in every place in Europe where it has been tried. Each case is taken to the colony, fed, clother and rested so that he can build up and do such work as will not exhaust, but strengthen him. Meantime he is studied by experts to find out what broke him down, and whether he is such a congenital weakling that severe strains are wholly out of the question. Curiously enough some of these sufferers are men of considerable intelligence with powers of concentration which tempted them to work beyond their limit of daily recuperation. They used up their capital instead of living within the vital income. Some have exhausted themselves in sedentary work involving nerve strain, which we now know is a very serious matter. Hobo printers and barbers must be advised to abandon their old trades and taught new one involving no strain which cannot be recovered from by the night's rest and sleep.-American Medicine. The following, sent us by a country physician, illustrates one of the diagnostic difficulties met with in country practice: "Dear Sir Mr. Doctor: My Mother she is sick on Liver and stomach Trouble. she got Belleache all Day. Some times she is offle Bad. So that she can't do Her Work. I wish you could Give Her the Best Medicine you got for That stomach and Liver is Her trouble, and she got to trow up all the time and Her Bowels Won't Move very Good. Send the Medicine along With Mr. L. B. She is 50 years old, and she got Pain in the Back to. She come Herself, But the Roads are to Bad, and to far. she can't Make the Trip. she trows up Gall. So that's all. "Much oblige if you send Medicine out. "Respectfully yours, "B. B Little Nelly told Anita what she termed a "little fib." Anita-"Yes, it is, because my father said so, and my father is a professor at the university." Nelly "I don't care if he is. My father is a real estate man and he knows more about lying than your father does."U Presbyterian. |