This array of symptoms is caused by the meningitis of the convexity, producing irritation in the underlying gray matter of the convolutions wherein resides the mental functions. Both the mental condition and the epileptic attacks are thus accounted for. Sometimes in these instances there is destruction of limited areas of the cortex, and as a result, depending on location and extent of lesions, there may be paralysis of an arm, a leg, one side of the face, or the three together, termed hemiplegia, or the loss of some other cerebral function.

The descriptions which have been given apply to many or most of the cases of meningitis, but often many of the symptoms, especially those of local significance are not manifested, and a diagnosis may be difficult or impossible. In some instances, where the most prominent symptoms are the constitutional ones, fever, etc., the disease very nearly simulates typhoid fever.

Another thing must be mentioned lest you should be misled by what has already been said. The local symptoms described are doubtless due to local lesions, and such are usually found on the post mortem table. But sometimes corresponding lesions are not found. In the latter instances the changes may have been transitory and disappeared, or they may have been so slight as to e detection by the ordinary means of observation.

escape

The great

The prognosis of the disease is very unfavorable. majority of cases terminate fatally. But in the epidemic form of the disease, near the end of an epidemic, when it usually assumes a milder form, a fair proportion of cases recover; and even in the most fatal form of the disease, tubercular meningitis, recovery sometimes occurs, the possibility of which has been proven by changes found on the post-mortem table.

But, unfortunately, in these cases the restoration is often not complete. There may remain changes in the meninges, chronic thickening, etc., which might be termed chronic meningitis. There may be changes in the eyes or ears, causing blindness or deafness. Or, more frequently, and of most serious consequence, there may remain changes in the central nervous substance, causing various paralysis or even complete imbecility.

We will be very brief on the subject of treatment. Mercurials and iodide of potash internally, leeches or cold douches to the head, have been extensively employed and recommended. But the chief treatment will always be symptomatic. Aperients to relieve constipation, chloral for convulsions and restlessness, opium to relieve

pain, if necessary, but especially an attempted sustenance of the vital powers with proper food and stimulants, and guarding the patient, so far as possible, from all external sources of irritation, are the means upon which most reliance must be placed.

MEDICAL EDUCATION FOR THE DENTIST.

BY W. R. ALEXANDER, M.D., Cincinnati.

While this subject may appear small in its bearings, it is greater in its dependencies, as in the history of the world there is no age which demands more thoroughness and comprehensiveness in all its professions, especially those dealing with human life, than does this. A few years ago, and even to-day in small country places, physicians did and are doing all the dental work necessary for the community. The demands of to-day are more knowledge and thoroughness, and he who would not be merely a mechanic in the dental profession must heed the call or else stand aside for the more enlightend ones who will in time take his place, leaving him to seek less cultivated fields where the name alone is the only necessity to successful practice.

The best illustration of the truth of this is to be seen in our large centers of population where men are becoming more and more engaged in practice of specialities that they may become the better acquainted with the more minute details of their own work. Every day as science advances and a better acquaintance with the human system is becoming more general we are shown to a greater degree the wonderful connection of the human sytem with all the internal organs. The great necessity of a more thorough knowledge of the whole is shown. What would those acquainted with the wonderful and intricate anatomy of our human system think of a man who would undertake to make a specialty of the lungs, the heart, the throat or the stomach, that would restrict his studies to those particular organs alone?

Now the teeth are no less a part of the human system than the lungs, heart, throat, or stomach. Each one does its own peculiar work in its own way, but each is a necessity to the other, contributing to the health, beauty and strength of the system as a whole. Hence, virtually speaking, there is no organ of the system that is entirely independent of the other, and the hand cannot say to the

feet, "I have no need of thee," or the stomach to the teeth, "I have no need of thee," because each is a necessity to the other, having direct communication by that grand and most wonderful system of electric wires called the nerves, which makes the body a unit in its great work. Therefore, a person to be a competent dentist in this age, in all that the term implies, should have such an acquaintance with the anatomy and physiological action of the human system as to be able not only to understand the relations of one organ to another, its office, etc. but to be able to prescribe in any emergency for a patient who is for the time being temporarily under his care. This knowledge can only be acquired by a successful study of the Science of Medicine. There are other considerations which almost make it a necessity that the dentist should be a competent physician. Say, for example that a pregnant woman should apply to have an aching tooth extracted; as a dentist, much harm might be done by extracting the tooth, possibly inducing through the pain or nervous shock incident to the extraction, a miscarriage, involving the loss of two lives, or, at least, taking out a healthy tooth which was merely aching from nervous pressure incident to the pregnant condition. As a physician a

nervine could have been administered which would have saved all the trouble. Or a patient with a hemorrhagic diathesis, who would soon bleed to death were their teeth or tooth extracted. In the case of the administration of anaesthetics, how is the mere knowledge of dentistry to enable one to know that his patient's nervous system is so run down that he will die from nervous shock should he attempt to anaesthetize him, or that he has aortic obstruction or mitral regurgitation, a knowledge of which can only be obtained by a very close familiarity with the physical sounds of the heart, taught only in schools of medicine? A consumptive patient with a hemorrhagic diathesis, would soon succumb to an anæsthetic. The author has seen instances of all the above cases and every physician and dentist of ordinary intelligence in his profession knows such cases have existed and have met their deaths in the dental chair, which could have been prevented had the dentist been a competent M. D., and can only be prevented in the future by the medical education of the dentist.

Knowing full well, greatly to the credit of the dental profession, that the dentists have done and are doing a great and good work in this land of ours, enabling, by their wonderful mechanical knowledge and skill, not only beauty to hold its reign with those

whose beauty has been so marred by the loss of their teeth, but have actually perpetuated and preserved human life by enabling the aged to masticate food. Therefore looking upon their profession not only as a very honorable and skilful one, but as one of great benefit and comfort to the human family generally, I would seek to still further elevate and ennoble it by insisting upon the rising generation at least so qualifying themselves as to be fully prepared for the labor of every department connected with it, and as a safeguard to human life. In every profession the work of reform and perfectness is to-day the watchword, and none can or should expect to reach the topmost round on the ladder of professional fame without fully qualifying himself, as the opportunity at the present time is so very ample. The best of medical and dental schools present themselves on every hand, and is not as it was in the younger days of my honored and reputed father, who had to ride many hundred miles horseback, over a long, and for a great part, mountainous road, where human habitations were few and far between, which entailed great discomfort and suffering—from East Tennessee to New York city-to take his first course in medical lectures. In those days, however, men "thirsted for knowledge," and were willing to travel a long ways in search of it. I feel that all the older dentists at least, who, during a long and successful practice, have felt the need of a medical education, will agree with me as to the necessities of it in their profession. fact, the writing of this article was at the suggestion of a dentist prominent and successful in his profession, who desires to see it move along with the age, and thus retain its high position before an intelligent public.

In

In concluding this subject, I would say I have attempted in a brief way to call attention to a few only of the many cases that may come before the dentist, showing the necessity for a medical knowledge far in excess of present requirements for a doctor in dental surgery. No man in any honorable profession should be satisfied with its mere financial emoluments, but should labor for that eminence which should light the way for the great and constantly increasing horde of civilization coming after them.

REMOVAL OF THE TONGUE AND FLOOR OF THE

MOUTH FOR EXTENSIVE EPITHELIOMA.

BY MAYO COLLIER, M.S., LONDON, F.R.C.S., ENG.,

Senior Assistant Surgeon to the Northwest London Hospital, Assistant Demonstrator of Anatomy to the London Hospital Medical College.

Three weeks ago I was consulted by a patient aged sixty-nine, suffering from an affection of the tongue and floor of the mouth. He had first noticed a sore three months ago near the right border of the tongue, about its middle. The disease had quickly spread, and involved the anterior two-thirds of the tongue and floor of the mouth symmetrically, rendering the organ immovable, and completely filling the floor of the mouth. The patient had been a great smoker, was possessed, apparently, of good teeth, but suffered considerable pain in the right side of the jaw and face. He stated that he was getting weak and losing flesh. There was no family history of cancer. There was no doubt that this was a case of extensive epithelioma, and the only points in reserve were the advisability and practicability of its removal.

Having consulted with Sir W. MacCormac, I determined to remove the whole growth from below, feeling sure it could be done. The case was sent into St. Thomas Home, and on Friday, the 19th, I performed the following operation, being kindly assisted by Mr. Battle, Mr. Jenning and Mr. Sanderson :

The two lingual arteries were first secured by ligatures at the apices of the great cornua of the hyoid bone, so as to prevent subsequent bleeding from the dorsalis, lingual, sub-lingual and ranine arteries. The ordinary curved skin incisions from the angle of the jaw to the chin were adopted, the centre of the curve just reaching the attachment of the tendon of the digastric muscle of the hyoid bone. The sub-maxillary glands were next turned outwards and the free edges of the mylo-hyoid muscle exposed. These were notched as far as the outer borders of the genio-hyoid muscle, thus preserving the central attachments. The under aspect of the floor of the mouth was now perfectly free, and one finger being pass ed between the genio-hyo-glossi and genio-hyoid muscles as a guide, the tongue and floor of the mouth were completely and easily separated from the lower jaw. A further separation was effected as far down as the hyoid bone, and the whole structures— tongue, sublingual glands, and the floor of the mouth, removed en masse by the écraseur. Not the slightest hemorrhage followed