age. Encourage every young man who seeks advise regarding medical education to first grasp the true spirit-the ideal spirit of success, and then let the university ideals of President Hadley be presented to him, that he may then realize the full value of his opportunities in medicine should he choose it as a profession.

In this day of competition and hurry the young man who chooses medicine as his life's work is too apt to want the short cuts to entrance into the profession. He loses sight of the ideal in the actual hurry. Too frequently he has entered medicine simply because there is a good living in it-he has no greater ideal-consequently when in practice he never rises, perhaps, even as high as wishing to have the reputation of wanting a good bank account-the spirit of service has "never touched him," and professional success is not measured to him, he is a stranger to it; he has no use for the intellectual-to him medical societies are a bore where selfish men exploit their experinces to advertise themselves. His ideals are so dwarfed that he regards "the pull' as the means "great men" use to promote their ascension in the world. He lives and dies a selfish, sordid, disgruntled man. How transformed would have been such a life if early he had encountered the university ideal grown up with it around him, and before him saw all of the rich possibilities of an intellectual life broadened by the spirit of service and hallowed by memories of professional earnestness. F. P. N.

WE have just quoted from the address of President Hadley on the university ideals, and now we turn to the inaugural address of President Wil

From Another
View.

son of Princeton, wherein we and more of the same order of thought, reiterating the university ideal as paramount to professional success. Prof. Wilson says: "Though the university may dispense with professional schools, professional schools may not dispense with the university. Professional schools have nowhere their right atmosphere and association, except where they are parts of a university and share its spirit and method. They must love learning as well as professional success in order to have their perfect usefulness. Whatever our calling, our thoughts must often be afield among men of many kinds, amidst interests as various as the phases of modern life. The managing minds of the world, even the efficient working minds of the world, must be equipped for a mastery whose chief characteristic is adaptability, play and initiative which transcends the bounds of mere technical training. Technical schools whose training is not built upon the foundations of a broad and general discipline cannot impart this. The stuff they work upon must be prepared for them by processes which produce fiber and elasticity, and their own methods must be shot through with the impulse of the university.

From the view point of these two great educators-men who create ideals, foster and promote the university spirit, we see that the future success of American medicine must be founded upon the broad training

which is to be had in a university training. American medicine has reached a place in the world's educational progess which bids fair to rival that of the older nations of the earth, and this because the men who are at the helm, the men who are shaping the course of progress, are universitytrained men.

Let every physician receive enthusiasm from this source and determine to do his part toward encouraging students to recognize the university ideal as the true ideal in medicine.

The ideal which will give professional success, and thereby perfect usefulness, which after all is the ideal of the profession of medicine.

F. P. N.

IN a discussion on the use of antitoxin before the American Pediatric Society at its Boston meeting (Archives Pediatrics, Qctober, 1902), Dr.

The Use of
Antitoxin.

Charles D. Kerley, of New York, in a very able and practical paper, discussed "Diphtheria, With and Without Antitoxin in 150 Cases." In speaking of the indications for and use of antitoxin Dr. Kerley said "In suspicious cases I do not wait for the culture. By suspicious cases I mean visible membrane. I inject and then take a culture. I have injected a few cases which did not develop diphtheria later. To the best of my knowledge the recovery cases are all living at the present time, and have never shown any untoward results from the use of the antitoxin. In addition to bringing the antitoxin into use at the earliest possible moment it is necessary to be able to know when more is required; this is a point not generally appreciated. According to my observation the beneficial effects are not evident until ten or twelve hours have elapsed. If after twelve hours no improvement at all is evident, I reinject. After improvement is noticed by a fall in the temperature, and by the membrane taking on a ragged granular appearance, I wait twelve hours more to observe the further changes. If at this time the character of the membrane remains unchanged, or shows fresh deposit with perhaps a rise in temperature and increased prostration, the antitoxin is repeated.

"A chart was presented which demonstrates well the effect of antitoxin upon the disease as indicated by the temperature. Improvement was noticed after each injection, but was not sufficient to control the disease until 9000 units had been given, this being the amount of the antidote which the little child required to combat the poison in her system.

"The death rate in diphtheria may be reduced to a very small percentage by the early use of full doses of antitoxin, not less than 3000 units, which should be given during the first twenty-four hours if possible. This amount is to be repeated without hesitancy if improvement is not promptly observed. When in doubt intubate; so when in doubt, inject. This I practice and teach. About 20 per cent of the cases develop urticaria, which is annoying for a few days. I have noticed no other unpleasant results from the use of the serum.

"I would establish the following principles:

"With visible membrane inject at once, and take a culture.

"In croup, inject if there is inspiratory and expiratory obstruction. "The patients should be seen at twelve hour intervals.

"Reinject in twelve hours if the patient is not improved, or if improvement is not marked.

"If continued improvement does not follow reinject at twelve hour intervals until the membrane disappears.

"Dosage, 2000 units for a child under one year of age, the amount to be repeated if necessary.

"Three thousand units for a child over one year of age, the amount to be repeated if necessary.'

Monographs on Nervous Diseases

With Especial Reference to Hygiene, Nursing and Therapeutics.

Myxedema.

BY F. SAVARY PEARCE, M. D.,

PHILADELPHIA,

Professor of Nervous and Mental Diseases in the Medico-Chirurgical College of Philadelphia; Neurologist to the Philadelphia Hospital.

Ist

S a disease characterized by myxematous degeneration of the subcutaneous tissues occurring in adult life. The affection is due to disease of the thyroid gland in which there is defect of internal secretion of this organ. When the disease occurs in early life, the name sporadic cretinism is applied; and when it occurs as the result of extirpation of the thyroid gland, it is designated cachexia strumipriva. Myxedema occurs more frequently about the thirtieth up to the fortieth year of age.

Symptoms are of mental obtundity with the physical signs of enlargement of the body through increase and deposit of myxematous degenerative material in the subcutaneous tissues. The patient seems fleshy, but the skin is harsh, dry and sallow looking rather than normal in color. There is no true edema. The expression becomes blank, the patient complains of great feebleness, the lips and lobules of the ear and eyelids thicken. The intestinal tract is torpid, the secretion of the kidneys is but little. This condition exists for some years without much change from month to month. The face is round in contra-distinction to the face in Paget's disease or in acromegly.

Prognosis of myxedema is good; wonderful results being gotten by means of the use of the thyroid gland internally, this making up for the deficiency in the diseased body. The extract of the gland may be given in grain doses, three times a day, gradually increased until palpitation of the heart may be produced.