lent letters you have published during the past year, dealing with the medical history, life and customs of the cities on the continent, and the medical and surgical technique now in vogue there. But one is induced to give his impressions of a "home" city for many reasons which may or may not be potent excuses. Some of the stolid institutions of our medical centers are not recent growths, and while they do not date back to the fifteenth or sixteenth centuries, they do go well into the eighteenth and have played a very important part in the development of our educational life. Our customs, technique and ideas are now receiving the merited recognition and commendation of the foreign masters and their followers. Our methods of work and progress in the art of teaching are rapidly making it unnecessary for a student to go abroad to receive advanced instruction. This fact alone is sufficient justification for dwelling upon the life in one of our great centers of technical learning.

Philadelphia ranks very high as a focus of medical work, observation and study. The atmosphere is wonderfully free from the wearing activity and nervous tension so common to large cities. The clinics are packed with available material and yet the methods employed in handling it are totally devoid of hurry or confusion and every feature of each individual case is placed vividly before the student. This is, of course, of unlimited value to the student and a feature which furnishes superior advantages for post-graduate work.

There are many old institutions; those of particular interest to the physician are the Pennsylvania Hospital, Wills' Eye Hospital, the Medical Department of the University of Pennsylvania and the College of Physicians.

The Charter of the Pennsylvania Hospital was granted by the Provincial Assembly May 11, 1751, and the corner stone laid in 1752. It was founded for the treatment of the sick and insane poor and the honor of being the originator is ascribed to Benjamin Franklin, though he himself gave the credit to Dr. Thomas Bond. In 1895, the managers printed a history of the Hospital from 1751 to 1895, which is fascinating to one who cares to dip into historic lore. One of the incentives for its foundation is shown by a brief quotation from the text of the history: "The opening of the

Pennsylvania Hospital inaugurated a new epoch in the treatment of lunatics in this country as it began by receiving them as patients suffering with mental disease, to be subjected to such treatment as their cases required, with a view to their ultimate restoration to reason, instead of simply confining them as malefactors." It also contains the text of the original charter, a fine photogravure of West's painting, "Christ Healing the Sick," numerous vignettes from photographic views of the hospital, letters from Dr. Fothergill of London, Richard Penn and Benjamin Franklin, who was the first clerk of the Board of Managers. From the day of its foundation, nearly one hundred and fifty years ago, it has kept pace with the progress of science, and to-day is a veritable nest of buildings showing the steps of advance in hospital construction and hygiene. In 1840, the Department for the treatment of the insane was transferred to West Philadelphia, where it occupies an extensive area. The hospital buildings proper are in the busiest part of the city, but a sense of restfulness controls the visitor from the time he raises the old bar latch at the gate to enter till he hears it fall behind him as he leaves. The ancient and worn stone steps leading to the entrance of the main building are alone enough to start a retrospective train of thought. One's feelings are best described by a verse from a poem by Francis Scott Key, "On Visiting the Pennsylvania Hospital:"

"Whose fair abode is this? Whose happy lot
Has drawn them in these peaceful shades to rest,
And hear the distant hum of busy life?
The city's noise, its clouds of smoke and dust,
Vainly invade these leafy walls that wave

On high around it, sheltering all within,
And wooing the scared bird to stay its flight

And add its note of joy to bless the scene:
The city's toils, and cares, and strifes are, sure,
Alike excluded here-Content here smiles
And reigns, and leads her vo’tries through the maze
Of flower-embroidered walks to bowers of bliss:

O! tis a sight to warm the heart of him

Who feels for men, and shares the joys he sees.

It has been stated here that this hospital is the oldest in the United States.

Wills' Eye Hospital, founded in 1832, is the oldest in the United States for the treatment of diseases of the eye exclusively. In 1898, 13,203 patients were treated there and about as many in 1899. The Department of Medicine of the University of Pennsylvania was established in 1765, and the College of Physicians, which is similar to the Academy of Medicine in New York, in 1787. So, we see that some of the institutions have grown from roots deeply imbedded in the past.

The undergraduate in medicine will find here many good schools and an atmosphere conducive to study. The postgraduate student will find a wealth of material in the clinics and wherever he goes will be received with courtesy and attention by the professors and instructors. In the clinics of the Philadelphia Polyclinic Hospital, which was organized in 1882, there are about 23,000 new cases annually and the matriculant has access to nearly all the important clinics in the city, viz.: Blockley, the Pennsylvania Hospital, Jefferson Medical College Hospital, Episcopal Hospital, Wills' Eye Hospital and others. He is enabled to study the work and methods of some of the best operators, clinicans and writers in the country and no day need pass without eight hours' work and as much of it can be practical as he chooses to make it.

The work of the men in Philadelphia in special lines has made a deep impression in this country and abroad and is no small factor in moulding the medical thought and practice of the period. Here can be found undoubtedly the best work on the eye and especially the most scientific and accurate methods of refraction in this country, if not in the world. Here also is the home of Retinoscopy in America and through the work of Jackson, de Schweinitz and Thorington that method has become the most exact for the detection and estimation of errors of refraction, especially astigmatism. Morris, Risley, Gould, de Schweinitz, Pyle, Oliver and Hansell have contributed extensively to the literature of ocular diseases. It has been noted by some of these oculists that the number of operations for cataract in Philadelphia is decreasing year by year and this is attributed to the fact of the careful work in refraction that has been done here for years.

Students and physicians are to be congratulated that there are such excellent facilities for good work so near home and that the time is rapidly approaching when they can get advanced work in any special line and at their very doors. The clinics and laboratories of Philadelphia, New York and Baltimore will supply every reasonable demand for working knowledge.

HARRY S. PEARSE.

A School

for Tropical Diseases

Editorial

Among the responsibilities forced upon us by our present national policy of colonial expansion, none is more important than the care of the well-being of the various nations under our sway. "The white man's burden" is not alone military and administrative, but is in the highest degree medical. The diseases of the tropics with the pests and plague which devastates entire countries must be met and conquered. Great Britain has recently awakened to her responsibilities in this matter and has established two schools for the study of tropical diseases, one near London and the other at Liverpool. Germany, with her rapidly increasing colonial possessions, has formed plans for such a school at Hamburg, and France has one already in operation in Algiers. The United States too must face the responsibilities and meet this need. The medical officers in the United States service must be trained to combat all the different tropical diseases in which heretofore we have needed only to take a scientific interest. This skill must not be left to chance or individual industry but should be the result of a training instituted by the government to this end.

One of the first duties of this country is the establishment of a post-graduate school for the study of tropical diseases where medical officers of the United States should receive both scientific and practical training in the maladies which they will be compelled to treat. The appropriation for such a school should be liberal and the best medical men of the country should be invited to co-operate in making successful

this work which will be potential in determining our capacity for governing semi-civilized races.

The Elective Diagnosis of

Piorkoski, a well-known bacteriologist of Berlin, has devised a method by which colonies of the typhoid bacillus can be distinguished Typhoid Fever from those of the colon bacillus. It consists of a so-called elective medium, one on which the typhoid bacillus will easily grow while other bacteria do not. This medium is composed of urine, which has undergone ammoniacal fermentation, with the addition of peptone and gelatine. Tubes containing this medium filtered and sterilized are inoculated with the suspected fæces. The contents are poured in Petri dishes and kept at a temperature of 22°C. for twenty-four hours. The typhoid colonies then appear as transparent filamentous bodies while the colon colonies are rounded with well defined edges. Piorkoski claims that the typhoid colonies can be recognized three days after the beginning of the disease and that in the twenty-six cases tested, his results were confirmed by the subsequent course of the disease. Although many of these elective methods have heretofore proved failures it is to be hoped that this present method which can also be used for the examination of water and milk may accomplish all that its author claims. The subject is now being rigidly investigated at the institute for infectious diseases in the Charité, Berlin, and it will not be long before its absolute scientific value is determined.

Scientific Review

The Antitoxin Treatment of Tetanus. It is to-day generally agreed that tetanus, in its different forms, is a single disease caused by the spore forming bacillus discovered by Nicolaier in 1885. Kitasato was the first to cultivate the bacillus of tetanus in pure culture. Most of the animals used in ordinary laboratory experimentation are susceptible to tetanus infection, and thus it follows that the tetanus bacillus and its products have been made the subject of very careful study.