munities can perform a duty in keeping with the consistent function of the medical profession, by spreading the gospel of school hygiene, and thereby overcome the apathy so characteristic of the people on vital questions.

MEDICAL REVIEW

A WEEKLY JOURNAL OF MEDICINE AND SURGERY

CONDUCTED AND EDITED BY

H. W. LOEB, M. D., 3559 OLIVE ST., ST. Louis, Mo

AND A CORPS OF ACTIVE COLLABORATORS

YEARLY SUBSCRIPTION, $1 00

Entered at the St. Louis Postoffice as Second-Class Matter.

ANNOUNCEMENT.

In assuming the editorial management and the publication of the MEDICAL REVIEW We do not desire to indulge in pyrotechnics nor do we offer a superabundance of promises. In fact, the superlative has, in our aims, a far less important place than the usual, the common place, the ordinary and the necessary. We have ambitions, surely, but we prefer to let them lie dormant and unexpressed until your commendations have given to them an actual re

alization.

Many changes are in contemplation; some appear in this number; others will be added week by week until perfection is attained, which, of course, will carry us out of the land of the present into the domain of the never.

We have reduced the price of the journal to $1 per year, and we hope, by giving a large amount of good, classified and condensed matter, to provide a medium for the dissemination of medical knowledge which will be of service to the practitioners of medicine whom we may have the good fortune to interest in our enterprise.

SANITARY INSPECTION OF SCHOOLS.

Much of our space in this issue is devoted to the papers read before the MEDICAL SOCIETY OF THE CITY HOSPITAL ALUMNI upon this highly interesting and important subject. The value to the health of the community cannot be estimated, while the cost of properly conducting the work as outlined and contemplated sinks into insignificance compared with the loss to the city and people entailed by the spread of disease and the early neglect or inattention to the ills of school children. It provides a lesson not only for the city, but likewise for the country and smaller towns, where less attention is paid to public regulations as to health than in the cities. Physicians who live in all com

CONSOLIDATION OF MEDICAL. COLLEGES.

room.

The demand of modern medical education tends toward the consolidation of medical instruction into a few large and well-conducted institutions. It is but a few years since a few men could present a medical curriculum in a comparatively short time, equipped with only a couple of lecture rooms, perhaps a modest chemical laboratory, and a dissecting Instruction was then almost wholly of a didactic character, in which practical demonstration played a very insignificant rôle. In fact, medical science, as then taught, consisted largely of the "principles" of medicine and surgery. Within a short time all of this has changed. The modern medical school requires a hospital, laboratories, recitation rooms and an equipment for scientific pursuits that requires an enormus outlay of capital. The very large increase in the medical curriculum. necessitates a much larger staff of teachers, so that from the mere standpoint of numbers, the old-time faculty would not be able to present a third of the subjects required in the highly technical modern

medical education.

These changed conditions increase competition, and in the struggle for supremacy those schools which have the best equipment necessarily attract the greater number and better class of students. A continuation of such conditions must of necessity result in some schools giving up the struggle for existence, or affiliating with other schools. This latter we believe to be the better policy, and one which will save the capital now invested in medical education and will materially improve the teaching capacity of the schools, not only by increasing the number of students, enlarging the capital, but also by doubling the number of instructors.

CONSOLIDATION OF MEDICAL JOURNALS.

Much that has been said above, regarding the consolidation of medical colleges, would apply with even greater force to medical journalism. The energy that is now expended in keeping alive a considerable number of medical journals could be conserved, providing only that there could be an extended consolidation. Not only would the cause of medical journalism be materially advanced, but the burden of the profession would be materially lessened, and the profession benefited by having fewer, but stronger journals.

We note that the two most influential medical journals of Kansas City--the Kansas City Medical Index and the Kansas City Lancet-have been consolidated under one management. Dr. John Punton will act as editor-in-chief, and associated with him will be twelve well-known physicians and surgeons of Kansas City.

Two old and well-known Chicago journals-the Standard and Practitioner-have recently amalgamated. This is due to the retirement of Dr. John H. Hollister from active editorial duties.

CAN CONNECTIVE TISSUE ARISE FROM

EPITHELIUM?

Each stride that science makes in advance impresses more favorably on us the limitness of all our differentiations and classifications. Where our Philistine sentiment to-day is happy in the repose of a well-assured and fortified basis for argumentation, to-morrow we see a battle waged for principles hitherto believed indisputable. Boundaries and limits crumble away, and, as our knowledge becomes more vast and extensive, the number of fixed notions and conceptions grows less. That these remarks, in a significant way, pertain to the realm of histologic anatomy is shown by a very remarkable investigation of L. LOEB, of Chicago. In a series of very careful experiments he does not attempt more or less than to tear down the boundary line between connective tissue and epithelium. While, it is true, the idea itself has offered itself repeatedly, and in a very conspicuous way before, to our knowledge, it has never before been put to the test in this impressive way. Embryologic evidence has been accumulating slowly during the last decade to the effect that the terms of epi-, meso- and endoblast have at last lost their meaning, and the designation of tissue of epi-, meso- or endoblastic origin has been forced more and more to the background. Numberless other differentiations have taken their place, and at present it may be boldly asserted that histogenesis of the different tissues appears more complex than ever before. This only is certain, that a simple and easily applicable scheme certainly will not cover the so-called nature of things.

Even pathologic histology has been so deeply permeated by these revolutionizing ideas, that, for instance, the possibility of carcinomatous proliferations arising from sources other than epithelial is at present earnestly and with strong arguments discussed by a number of our leading scientists. In the experiments referred to, epithelial lamellæ were transplanted on superficial wounds or directly

inserted into the deeper connective tissue layers. The author claims that in successive stages he could trace the deeper epithelial cells changing into connective tissue cells and that their nuclei especially assumed the typic structure of those of the latter; in other words, he was able to demonstrate in several instances, gradual transitions between epithelial cells and connective tissue. From the appearance of the papillæ, in the transplanted pieces of tissue he thinks he can admit evidence to show that the papillæ are formed by the gradual breaking down of the epithelium.

If

Everyone conversant with the difficulties surrounding observations like these, must confess to the many sources of error intrinsic to the interpretation of the pictures studied by the author. On the other hand, Loeb knew of these possible fallacies himself, enough to guard against them. nevertheless he is positive in his statements, we may take this as a proof that his specimens show conditions of extraordinary interest. It would be very desirable for another observer to take up these investigations and carry them to a degree of conclusiveness so as to eliminate the last trace of uncertainty that as yet, we must admit, remains. We wish, however, to emphasize the fact that, a priori, there is no reason why the assertions of

Loeb should not be correct.

INTRODUCTION OF NITROGEN GAS INTO THE
PLEURAL CAVITY FOR THE CURE
OF CONSUMPTION.

This method of treating phthisis, which was described by Dr. Murphy at the last meeting of the American Medical Association, has been employed to a considerable extent and several unfortunate results have been observed, but so far none have been published. Recently, at a public clinic in Chicago, a man was exhibited who was suffering from severe hemiplegia caused by the injection of gas into the pleural cavity. Paralysis was on the left side of the body and was marked by extreme spasticity. There was a suggestion of diplegia in the history of the case, as it was stated that there had been some disturbance of speech and impairment of motion upon the right side of the body but this disappeared within a few weeks. The paralytic stroke supervened immediately, before the injection was finished. Inquiry among patients who have been subjected to the treatment shows that transient paralyses are by no means uncommon. The evidence so far accumulated shows that the procedure is by no means devoid of danger, and a certain percentage of mortality for the operation can be confidently predicted.

SOCIETY PROCEEDINGS

this without being guilty of vanity, for he knew quite well that his effort at best was no more than an average sample of what the society produces at every meeting. It was, he said, the energetic

ALUMNI.

MEETING MARCH 9, 1899, DR. GEO. HOMAN,

PRESIDENT.

The Medical Inspection of School Children and the Hygiene of Schools.

DISCUSSION.

DR. J. B. SHAPLEIGH said the report to the school board ought to show what, in the opinion of this society, would be the very best and most efficient scheme of school inspection for this city, but it ought also to indicate in what way modifications might be made with the least impairment of efficiency. It should include also the simplest and least expensive scheme compatible with a fair degree of efficiency, since the financial the financial side will necessarily be considered by the board. The report should give fully the details of the inspection as far as they can be drawn up. The committee ought to be one familiar with the inspection and competent to inform the school board upon small matters. The question of money, of course, would be one for the school board to deal with, the society being able to only outline the workings of such a plan. For this purpose he moved that a committee be appointed to consider the matter and draw up a plan to present to the school board and, if necessary, to consult with the board.

DR. ELSWORTH SMITH, JR., was unexpectedly asked to make the formal presentation of the prizes. In doing this he said he thought he voiced the sentiments of the committee when he said that all the papers submitted were excellent and commendable efforts, and after a perusal of them anyone would be of the firm conviction that the effort being made in this matter was certainly most important and most worthy. Aside from Aside from the intrinsic value of the papers, as literary productions, they would certainly serve a useful purpose in furthering the object the society had in view when taking up the subject, and in the name of the society he congratulated both the gentle

men.

DR. CHARLES SHATTINGER, in accepting the prize, said it would be casting a reflection upon the judgment and impartiality of the advisory council were he to say he did not deserve the prize. If he were to express no satisfaction at the distinction, it would be ascribed to hypocrisy. Therefore, he accepted the honor thankfully, gladly and proudly. He thought he could say

DR. M. H. POST asked if these papers were to be submitted to the board of education.

THE PRESIDENT said the papers would be made. a part of the scientific transactions of the society, and in that way brought to the notice of the board of education.

DR. POST said there was a great deal of information contained in the papers which was startling, and which would be a surprise to the outside public and would be a great stimulus to public hygiene. He thought it very desirable that the board of education should be furnished with the facts contained in the papers.

THE PRESIDENT said reprints of the essays would be furnished the board of education and others, and could be distributed by them.

DR. L. T. RIESMEYER Considered the medical inspection of school children, as well as the inspection of the schools and their proper equipment of the greatest usefulness and importance. He desired to ask Dr. Schattinger for information in regard to the real value of bacteriologic examination by the culture method alone, in so far as the length of the period of isolation after reconvalescence from diphtheria was concerned. He said that in exceptional cases diphtheria bacilli were found in healthy throats, and he wished to be informed whether hygienists considered it necessary to keep patients at home as long as bacilli were found, irrespective of their virulence, after clinical convalescense had been completely established, say for a number of months.

DR. C. C. CRANDALL recalled experience he had in London some years ago in connection with Dal

ton.

Dalton had, since 1875-77, been conducting investigations systematically in his laboratory; children go to the laboratory about the time they enter the schools and are carefully examined. These examinations cover the sight, hearing and general physical condition of the individual, and also, in a measure, a mental test of their capacity. *See pages 319 and 324, this number.

In certain cases, where defects were discovered, the children were requested to return for observation, and in some instances they were taken from school because of defects. It should be the duty of those in charge of the children in schools to watch and care for the physical as well as the mental condition of the children, and, where defects are found, to report the fact to the parents. Ultimately, he said, the capacity of the children will be advanced by this work. The work undertaken by the society as shown by the essays, was just the beginning of what would ultimately obtain here as it already exists in other cities. Dalton had for years been endeavoring to obtain such a condition in the schools in London, but on account of the expense and the lack of appreciation, up to the last four years he had not been able to do anything in a public way. The speaker said he had with him a report such as was given to each individual by Dr. Dalton, and he thought it might be of value to the committee; the report, he said, would show the nature of the physical and mental examination.

DR. PHIL. HOFFMANN said he thought the medical supervision of the schools should not be confined alone to the physical condition of the children, but might be extended to include the school houses and furniture. He was led to this by the paper read by Dr. Shattinger. It was undoubtedly It was undoubtedly true that the furniture, desks and benches, of the ordinary school house were altogether inadequate for the proper comfort of the children. Most of Most of us could probably remember the old desks and benches in use in the schools, and possibly a great many of these were still in use. It is probable that many of the cases of spinal curvature originated in the school rooms. He believed the habit of making the children stand during recitations was a pernicious one in many cases. Desks, etc., should correspond in some degree to the increased size of the children as they passed from the lower to the higher rooms, yet it should not be forgotten that in a class or room containing a number of children there would be all sizes and conditions represented.

THE PRESIDENT said he thought the whole subject had been well covered by the papers presented. His own experience was confined to the work done last fall in one school, and that for colored pupils. The mortality of the colored population was, as all who had looked into the matter probably knew, about double that of white population. It was true, too, that the fecundity rate was, perhaps, nearly double; the birth rate is large and the mortality rate large. The particular school under his observation would possibly represent a fair type of the school of the older kind in construction and arrangement. The average attendance was about 1000 children of all ages, except the more ad

not.

vance grades. In the course of the service there were two things which had attracted his attention casually, because, under the rules, no sanitary inspection was permitted. The system of heating in this school was noticed because the flue from the furnace opened directly into the center of the main hallway; if there was any contrivance by which germs could be more effectually disseminated he said he did not know it. The inclination among children and sometimes adults was to use the opening of the register as a place for expectoration. In cold weather the children stand over it and warm themselves, and mud from their shoes is turned into dust and carried throughout the building. There could be no better means, he thought, of disseminating germs through a building, unless it were a power fan in operation, throwing out dried sputum. That was one of the objections found. Whether the same arrangement was existent in many of the schools he did not know, but hoped Another thing bearing on the sanitary management of the building was that in this same school house on Saturdays the blinds were drawn down and the windows tightly closed; Monday the windows were opened, it was presumed, and the furnace started up. The speaker said he thought it should be the invariable rule that on Saturdays every window should be opened and the shade, thrown up and the school flooded with light and airs even in the cloudiest weather; he thought this was necessary to a wholesome condition. He said he had mentioned the matter to one of the members of the board of education, but whether it had been remedied he did not know. It was such a simple thing in the sanitary care of such a building that he wondered if it had been carried out. It was probably convenient for the janitor to thus close up the building, but it ought to be an inflexible rule that on Saturdays the windows should be opened, so that all sunlight and fresh air possible might enter the rooms.

DR. B. M. HYPES said he had been interested in the papers as well as in the work of the inspection. He thought it was an admirable undertaking, and believed it was appreciated, not only by those interested in the work, but by many of the citizens both among the profession and the laity; but he was afraid much of the benefit to be derived from the work would be lost unless the society took some action for the dissemination of the knowledge contained in the papers read. The speaker was not aware that this plan had been adopted anywhere else. He made this statement, he said, because he believed the profession was ignorant of the work done, and therefore thought the society should take some means of distributing these papers.

[TO BE CONTINUED.]