complications. These thirteen patients died during the third and fourth weeks of their sickness from the effects

of these complications Five of these thirteen had intes-, tinal hemorrhages, and all showed besides the usual ulcerations of the glands of Peyer, lesions in the mesenteric and solitary glands, the stomach and the spleen; and one case showed enlargement of the bronchial glands, and laryngeal ulcerations. The "stadium eruptionis et florescientiæ" manifested itself in two of the thirteen cases during the second week, and all had diarrhoea from the beginning of the attack. The remaining twenty-six cases died during the second and beginning of the third weeks, and post-mortem examinations disclosed that the glands of Peyer, the solitary glands, the stomach, and other organs were in a state of intense congestion, and we have reason to believe that had these patients survived a week or ten days longer that the glands of Peyer and others would have also undergone molecular death. The majority of these patients suffered from constipation throughout their illness, and the temperature curves ran higher than it did in those patients who showed moderate diarrhoea, which doubtless must be regarded as an effort on the part of nature to relieve the intense congestion to which we referred.

That this disease is not dependent upon, but simply associated with, an inflamed or ulcerated condition of the follicles or glands of Peyer, there can be no question. The tendency of this disease is to produce venous congestion in certain organs. It causes the headache in the beginning by producing congestion of the superior longitudinal sinus about the foramen cæcum; and this is a very close analogy between the repeated epistaxis that occurs in the first stages of this affection, and the diarrhoea and subsequent intestinal hemorrhages. It also causes the bronchial catarrh and ultimately the laryngeal ulcer in the same manner and on the same principle as it causes the gastric

and intestinal catarrh, and ultimately intestinal ulcerations. That during the course of this disease the blood undergoes great and decided changes all must admit; that it becomes unfit for nutrition the non-healing of wounds. would indicate; and thus during the course of a typical case of this disease the whole system becomes invalid, and the weakest parts give way first, and thus closes a long series of changes incident upon, as it has often been expressed, the organism and its environment. That this disease is infectious; that its tendency is to run a determinate course; that it belongs exclusively to man, who can only communicate it to his own species, all must confess; but as regards the physical, chemical or natural history of its cause the scientist himself cannot tell. But by the incessant dissolution of limit, as it were, we arrive at a more or less adequate idea of the minuteness of the cause, and though all experimental evidence is here shut out, we are not entirely left without guidance; for beyond. the length of a wave of blue light the microscope has never ventured hitherto. The sources of disease are being rapidly illuminated by hygenic light, and without an intention on our part of appearing uncharitable, we would simply transport the conception of the origin of all epidemic, contagious diseases, regardless of climate and other circumstances, to certain combined conditions over which man could exercise unqualified control. Disease must be propitiated by means different from those usually resorted to. The first requisite towards such propitiation is knowledge as regards its origin; the second is action, shaped and illuminated by that knowledge. In a very noble address before you last year, our retiring President made this remark: "I should insult your intelligence did I not claim that a prouder record for medicine is to be found in the preventive side of its work." J. C. ROSSER, M.D.,

Chairman.

COMMITTEE ON MEDICAL EDUCATION.

C. N. HEWITT, CHAIRMAN.

I will not inflict upon the Society a report on medical education after the customary and stereotyped sort-a mixture of old theories and personal ideas, winding up with the lament that after all it makes little difference, as the profession are not united; the way is not open for any reasonable reform, etc.; on the contrary, I am able to report that a step in medical education has been taken by the Regents of the University of Minnesota which pnts our State in this regard far in advance of any other State in this country, and has placed in the hands of the medical profession of Minnesota the opportunity for the elevation of the standard of requirements for degrees in medicine to the highest grade proposed by the best of our American colleges.

It will be the pleasant duty of your Committee, therefore, to review this important movement and to make a brief study of its bearing upon the future of medicine in our own State, and indirectly throughout the country.

But before entering upon this review and discussion, permit me to call to your minds what are the essentials of medical education to-day.

There are two clean-cut standards put before our students and they are becoming better defined every day. One is the popular criterion and the other the professional one. The first requires no elaborate treatment here. There are none who hear me who do not know what it is, and the dangers and professional shipwreck it has wrought for so many, young and old, who have surrendered to it.

Its boasted test, evidence of value, and "bait for gudgeons," is popularity, as proven by much business and large pecuniary returns. Its standard is a commercial one, assimilating business and professional aims and methods till the last is swallowed up by the first. Its demands are such as no faithful, educated physician can concede. Yet the "solid results" (for its advocates use the language and methods of the Boomer) are so seductively presented that in these times successfully to resist the temptation is a capital test of the metal a man is made of.

The other standard, the professional, has two degrees: the conventional and the higher and more difficult one, which is the practical accomplishment of the very best among us. This last is the one we all aim at, but the conventional standard is the average of our success. Fortunately the conventional standard is a rising one, and a little thought will do away with the necessity for any argument to satisfy us that in its gradual and steady advance rest our surest hopes for the future of medicine, so far as that future depends upon the members of the profession itself. The leading difficulties in our way today are:

1st. The practical absence of any compulsory standard of preliminary education before professional study can begin.

2d. The variable character of the actual instruction and requirements for degrees in medicine in even the best existing colleges.

3d. The specialization of instruction and study and of clinical work in medical colleges.

4th. As one result, the development of "specialties" in practice, and so the frequent absence of all practical knowledge of "general practice" on the part of young men taking up such specialties from the date of graduation.

5th. The concentration of such special practitioners in large centers of population.

6th. The competition for students which, as a prominent recent example shows, compels a reduction of requirement for degrees to a low and debased standard-an average, in fact, of all colleges at all respectable who teach and confer degrees.

7th. The absence of thorough instruction in hygiene, public and private, which must underlie all proper preparation for the practice of medicine now and hereafter.

8th. The permitting teaching faculties to sit in judgment on their own work and to confer degrees on their own students.

This last is admitted by the best of our medical college professors to be the one evil whose removal must precede any true reform in existing schools of medicine.

Add to this fatal mistake in college organization which comes at the expiration of medical study, the other as bad, which precedes it, the absence of any proper preliminary education as an invariable requirement, and the result, as we see it in the condition of the profession to-day, is not difficult of explanation.

To remedy these evils the general practitioners who constitute the body of the profession have hitherto failed, and for evident reasons. The control of the professional organization in this country is largely in the hands of the faculties of colleges and of the specialists, as witness the proceedings of the last two meetings of the American Medical Association at St. Paul and Cleveland.

The lessons of such control and the recognized evils of our position has resulted in many attempts at a change and with varying success in different States. In Minnesota the organization of any medical college as a part of our university system was wisely deferred by the regents, though application has more than once been made to them to that end within the last dozen years. In 1882, after a careful study of the subject, a member of this Society addressed a communication to the regents urging