The Teaching of Surgery.

Certain faults in the present method of teaching are pointed out by M. D. Tinker, Ithaca, N. Y. (Journal A. M. A., October 22), who also makes certain recommendations for its betterment. One great fault is the ignoring of the relative value of what is taught. In practically all medical colleges surgery is taught as if all the graduates were to become surgeons. Relatively few graduates will actually practice major surgery, but the things they will have to handle are comparatively neglected. These are the "common surgical diseases and injuries, the giving of anesthetics, the use of antisepsis, arrest of hemorrhage, more thorough training in surgical diagnosis, symptomatology and prognosis, as well as the treatment of the common forms of surgical disease and injury. As a result many of our present day graduates are better posted on the latest brain surgery or blood vessel anastomosis than on the diagnosis of appendicitis or gall stones, or the treatment of leg ulcer. Tinker criticises also the method of written examinations as a test of the fitness of a student; these should be replaced largely by clinical and laboratory examinations. The need of laboratory methods in teaching antisepsis is also emphasized and the method used in Cornell University is described. Practical experience in anesthesia should also be a requisite. Tinker also makes a point of the parallel use of current literature in his studies of the student, instead of depending exclusively on the text books, as is now commonly the case. Far more important, however, than methods of teaching is the quality and previous preparation of the students who are to be taught, and the qualifications and ability of the teacher and the facilities for work. In regard to the student he thinks that few, if any, teachers in universities requiring a college degree as a preliminary to medical study would be satisfied to go back to teaching high school students. It is true that the higher entrance requirements shut out some worthy men, but there will always be plenty of schools, he says, that will offer these men as good facilities for work as they can profit by. He believes that arrangements could be made rendering it possible for a student at twenty-one to take his preliminary scientific degree before beginning his medical course.

Simpler Requirements for the Education of Nurses.

In the exhaustive discussion of nursing problems at a recent meeting of the Medical Association of the Greater City of New

York, there was one phase of the subject which was apparently not touched upon by any of the speakers. This is the growing tendency in the larger training schools, in the selection of candidates, to choose young women of such education and social status that after having received their training, in many cases, they are disinclined to serve, and are therefore after their graduation of very little further value in a nursing way to the medical profession or the public. This is very much as if graduates of West Point should decline their commissions in the army and resign the duties for which they are prepared by a costly government education, free of all expense to themselves.

These very superior and attractive young women not infrequently marry, and doubtless they make excellent wives for their fortunate husbands, who are sometimes physicians, or their economic independence enables them to escape the laborious tasks of private nursing, which they soon find uncongenial. In either case, however, physicians and their patients receive no equivalent for their education in the hospital and training school. There is a real need for plain, commonsense nurses, not overtrained, who are imbued with the idea of loyal personal service and who expect to continue in the actual work of nursing the sick-people in moderate circumstances as well as the rich. In the opinion of many practicing physicians, this need can be adequately met only by training women of humbler social station, to whom the opportunity afforded by a nursing career will be welcome as a means of modest livelihood.-New York Medical Journal.

Atropine and Eserine in Determining the Time of Death.

At the last meeting of the Ophtalmological Society at Heidelberg, Groenow pointed out that after death the normal changes in the size of the pupil make it difficult to determine, with one agent alone, whether the pupil reacts to it or not, but by using atropin in one eye of a number of corpses, and eserine in the other he found that after one-half to 1 hour a decided difference in the size of the pupil could be observed, which lasted for a period of several hours. Since the reaction occurs if the drugs are used within 3-4 hours after death, but not later than that, the method may be of use in deciding how long a time has elapsed after death.

GIFFORD (Omaha.

Pseudo-Rabies.

At the last meeting of the Society of Microbiology in Berlin, Zwick make a report on a disease which was first described by Aujeszky, an Hungarian veterinary, in 1902, but about which singularly little has appeared in bacteriological literature. The disease, which hitherto has been observed only in cattle, dogs, cats and rats, gets its name from the striking similarity of some of the symptoms to those of rabies. The most marked symptom of the disease is uninterrupted restlessness with a continuous rubbing, biting, scratching or gnawing at some particular portion of the body (in laboratory cases generally at the point at which the virus was injected). To this is added paralysis of the apparatus of locomotion and of swallowing. It generally runs an acute course, the incubation lasting from 36-96 hours, but exceptionally 5-8 days or more. The virus is found in the central nervous system, in the blood and blood-containing organs. Although pseudo-rabies can be readily conveyed to rabbits, guineapigs, mice, sheep and goats, the germ has hitherto remained undiscovered, unless certain bodies, which have been found in the brain prove to be it. Culture experiments have failed entirely. The germ will not pass the Berkefeld filter. Pseudo-rabies can be distinguished from the real thing by its rapid course, the lack of aggressiveness on the part of its victims, the infectiousness of the blood and other organs than the brain and spinal cord; also by the fact, that it can readily be conveyed by subcutaneous injections, which by the way, produce marked local reaction. The disease appears not to have been noted outside of Hungary, but if we may judge from the history of other apparently sharply localized diseases, it will be found before long in other parts of the world. It may well be that some Nebraska man will be the first to observe it in America. GIFFORD (Omaha).

At a meeting of a state medical society, the secretary read a letter from the Consul of one of our far-away possessions urging the need of a resident physician in his district. In the moment of silence that followed the reading, a young man in the hall arose and said modestly: "I wish you would put me down for that place, sir. It sounds good to me. My practice here died last night."-Success Magazine.

"You may pay me $100 down and $25 a week," said the physician. "Sounds as if I were buying an automobile," replied the patient. "No," said the doctor, "but I am.

A Brief Report of Four Cases of Syphilis Treated By Ehrlich's "606.'

By DRS. H. C. SUMNEY AND J. W. HELLWIG, Omaha, Neb.

It has been our good fortune to have a supply of "606” placed at our disposal by the courtesy of Dr. Simon Flexner, of the Rockefeller Institute, who has requested us to use it in our hospital charity work. In carrying out this work we have had occasion to use this remedy in a number of specially selected cases and in this brief report desire to give our experience with the first four cases injected which we have had under observation since November 3, 1910. We only hope to give a brief outline as to the action of "606" in the first five weeks as we have observed them. Dr. Leo DeLanney, house physician at the Douglas County Hospital assisted us materially in carefully following out the results in these cases. Lesser's method of making the solution was followed out in these cases and the injection was given intra-muscularly in the gluteal region. We have only mentioned the salient points which might be of interest in drawing conclusions.

Case I-Age Thirty-six-Male-Single. Weight 150 pounds, with a history of having contracted the initial lesion in the early spring of 1910, followed by an eruption. Was treated by internal medication of Hg. Eruption cleared up but mucous patches in the mouth persisted five months after infection. Syphilitic-onychia appeared which did not readily respond to treatment but had considerably improved. November 3, 1910, an injection of 0.6 grams was given, 10 c. c. of the solution into each buttock. Immediately after the injection considerable pain supervened. The acute pain rapidly subsided in about one-half hour but a dull pain continued radiating down the leg and to the back; swelling and induration became quite marked and a soreness remained which lasted about ten days. The infiltration disappeared in about two weeks. Within the first four hours the pulse dropped to 60 and temperature to 97 1-5°. Extreme lassitude manifested itself with a feeling of chilliness; later in the day temperature rose to 99 1-5° with subnormal pulse rate, appetite poor and patient passed a restless night. On the morning of the second day temperature rose to 101°, pulse 64 with practically the same symptoms continuing. On the evening of the same day temperature became normal. The mucous patches in the mouth disappeared about the fourth day, leaving behind a slightly congested area which disappeared a few days later. At the present writing the patient has gained weight, he feels well

and has no noticeable symptoms of syphilis. We were unfortunate in not obtaining a satisfactory photograph of the case.

Case II-Age Twenty-one-Male-Single. Weight 140 pounds; occupation tinner, with the following history: Infection six months ago, probably a mixed chancre. Had prodromal symptoms, but eruptions that followed were not pronounced. Mucous patches appeared in the mouth and throat. Was given internal treatment about two weeks, several months ago. Several ulcers appeared over different parts of the body about the latter part of the third month which gradually grew larger. He came under our observation November 4, 1910, and we found on examination large ulcerating syphilides on the lower extremities, abdomen and back; precocious in type, the largest lesions appearing in the popliteal space of both legs and the calf of the left leg as well as the right arm. (See Fig. I, Case II.) Smaller ulcerated lesions were scattered over different portions of the body. An injection of 0.6 grams of "606" was given November 4, 1910. As in the previous case similar local symptoms followed the injection, pain radiating down the leg, along the sciatic nerve and up the back. It subsided after twenty-four hours and subsequently only noticed the swelling and induration and some soreness on pressure. These symptoms disappeared completely after ten days. Shortly after injection temperature rose to 99 3-5 with pulse rate of 100, which gradually became subnormal and for five days showed an irregular increase and decrease during the day with a marked tendency to subnormal. It will be quite apparent, (Fig. II, Case II) that a rapid change had taken place in the first five days and can only be attributed to the action of "606" as no other treatment had been given for several months and the lesions were rapidly increasing in size. On November 9, (Fig. II, Case II), when second photograph was taken the crust on the more superficial lesions had fallen off and the larger ulcers showed a decided improvement, taking on the appearance of a healthy granulating ulcer. The ulcers had entirely healed five weeks after the injection, results which we have not seen in this class of cases even under the most rapid action of any of the usual forms of treatment. He gained ten pounds in weight within four weeks, has returned to work and feels perfectly well.

Case III-Age Twenty-nine-Weight 160 pounds-Male. Five months ago a chancre appeared on the sulcus-coronaria; six weeks later an eruption appeared over the entire body, probably large papular-syphilides; had mucous patches in the mouth and throat. He came under our care at the County Hospital, No