66 their cherished alma mater. We are "a fast people," more rapid than wise, since we are impatient to intrude ourselves into positions of great responsibility and importance without due qualifications. The first annual report to the Governor, of the Illinois State Board of Health furnishes material for thought and candid reflection. The Board was created by a special enactment of the State Legislature. It is composed of representative men of the various modes of practice in Illinois. Our own branch of the profession is ably represented in that body in the person of Prof. A. L. Clark, A. M., M. D., who is made its secretary, and who, it is presumed, was the writer of said report. The law became operative, and the Board was organized in July, 1877. I have the first annual report, of 1878, before me, and the statistics it furnishes are of great public interest. During the first year, that Board examined 336 applicants for license, who before had none to practice medicine, of whom 221, or more than two-thirds of the candidates were rejected for incompetence. Within the brief period of about two years, this Board has sat down upon and quashed 1,200 unqualified practitioners within the State, and necessitated their immediate emigration outside of it, where wholesome protective laws of this nature do not prevail. The diplomas of eight medical colleges have been ignored for holding two graduating courses within one year. Six certificates have been annulled for gross unprofessional conduct. The report ventilates what was a singular condition of medical practice, that an army of incompetents, with and without diplomas or licenses of any kind, were preying upon the people. It gives emphasis to an unpleasant fact, well known before, that very few of the numerous quickly and cheaply made candidates for graduation have ever been rejected by average medical colleges of any school of practice, rendering it apparent that the chief aim in running these colleges has been to catch students and get all the money they could, to elongate the list of matriculants and graduates without any proper regard to a judicious curriculum. There are honorable exceptions to this general practice, it is consoling to know; yet these form exceptions more than the rule, it would seem. Much has been said and is being written about "respect to private rights," and "men's right to control their own business, personal or incorporated," etc. What moral or legal right has any man or an associated body of men, to pursue a business which is prolific of general evil? Liberty, which we justly venerate, does not, in its broadest sense, include license to do any wrong. Our medical educators have a vast influence for the good or evil of the thousands they annually instruct; they have it in their power to elevate or lower the standard of our great profession. "Students, like softened wax, with ease will take Those images which first impressions make: If these are fair, their lives will all be right; If dark, they'll cloud them all with shades of night." Never was reform more needed than in the defects of our system of medical education, and I am glad to be able to know that this is already inaugurated. About one-fourth of the allopathic and homoeopathic colleges have recently extended their college terms with a longer course of study, and a very few have adopted a graded course of instruction. Our own branch of the profession has done even better in some essential respects on an average. The "Bennett College of Medicine and Surgery," Chicago, Ill., gives one term annually of six months; the "American Medical College, St. Louis, Mo.,' and the "Eclectic Medical College, Cincinnati, Ohio,” hold two terms, of five months annually; the "Eclectic Medical College" and the "United States Medical College," in New York City, and the "California Eclectic Medical College," in the vicinity of San Francisco, Cal., hold one term of five months each year. All our colleges require three years' study, two terms of attendance in college and successful examination as to merit before graduation. This is a sound and sensible reform in the right direction, and it is believed that our appreciative practitioners will most heartily second and sustain our institutions in this commendable work of thus elevating the standard of medical education so as to make it in all respects equal the best. There is a real demand for thoroughly educated eclectic medical practitioners, and will be an increasing demand for such a long time to come. Armed with our own numerous discoveries and improvements in therapeutics, with our views of the treatment of disease, with a cultured and able fraternity, and our liberal and just code of medical ethics, an enlightened and ever appreciative public opinion will sustain us with all needed patronage. Let each member of our branch of the profession write out and post up the following, or a similar motto: "A generous ardor boils within my breast, This urges me to fight, and fires my mind (To be continued.) [XXXIX.] CASE IN PRACTICE. BY J. P. MARSH, M. D. Miss H., aged seventeen, robust in appearance, of nervosanguine temperament, was taken with severe pain in the left ovarian region, July 17, 1879. I was called about 9 o'clock P. M., found patient suffering great pain, and of periodical character, which resembled labor-pain. After making strict inquiry and learning that her menses had been very regular, but rather profuse in quantity, I made an examination per vagina, and found a mass was protruded through the os the size of a pullet's egg. I then formed the opinion I had uterine polypus to contend with. I administered fluid extract ergot (Squibb's) 31, and repeated in one hour, and soon after giving last dose the polypus was expelled, followed in about five hours by three more nearly the same size, all connected together by connective tissue, and the group suspended by a pedicle the size of a quill. On exploration of the uterus, I found the attachment just within the cavity, at the right marginal border of cervix. Passing the growths through the loop of the ecraseur, I carried it up to the base, and severed the pedicle and brought it away entire. The hemorrhage was not profuse. I swept the cavity with carbolated oil, and ordered vaginal injections of warm water and table-salt. I saw no indications for drugging, and gave nothing but a little Dover's powder, to induce quietude. Will some brother practitioner give his opinion why those growths were grouped, and the cause of formation. KIRKWOOD, Ill. [XL.] VICARIOUS EXPENDITURE OF NERVE-FORCE. BY J. T. KENT, M. D., ST. LOUIS, MO. The occult changes from rheumatic irritations from one locality to another-for example, from one knee-joint to the other have long been very unsatisfactorily described by the application of the familiar term metastasis. The profession has been quite satisfied by simply being able to name a phenomenon without taking trouble to think of the busy causes underlying such peculiar manifestations. If a female bleeds from the nose, lungs or bladder, at regular intervals, and fails to menstruate, the term vicarious menstruation is quite satisfactory, and the patient is well satisfied with the profound wisdom of the doctor. Is it possible that retained excreta may produce a temporary neurasthenia of the vaso-moter centers of nerves supplying certain joint-cartilages, and that the simple movement of such neurasthenia to an opposite or adjacent center or cell, could change from the joint of one extremity to the same joint in the opposite extremity? It would seem quite astonishing should such a condition finally prove to be a cause of the obscure, so-called, rheumatic irritation. Any depressing influence may act as a cause of local neurasthenia of any nerve-center, centers ganglia or cells, and change a natural excretion, and establish an exit at a different locality by the vicarious expenditure of nerve-force. Certain crises are innate and appear periodically and are governed by natural forces; but, if such forces are deflected, they may expend themselves on other tissues not always to afford exit to morbid or natural excretions, but to bring about the necessary expenditure of nerve-force which is evolved normally as to quantity, but deflected, and produces abnormal phenomena. Habit, so-called, frequently creates a vicarious expenditure of nerve-force. Tobacco-chewers emit saliva amounting to excessive abnormity from the peripheral irritation of the chorda tympani by the quid coming in contact with the parotid duct and its sensitive nerves. The masturbator induces an undue expenditure of nerve-force, not only in venereal organism but from the vegetative center which presides over the testicle during the manufacture of semén. In such cases, semen is created to abnormally by peripheral friction, causing excitation of certain centers to the expense of others. Such peripheral irritations are not so striking as many that work internally. An "over-loaded" stomach demands the expenditure of more nerve-force during the digestive process than other centers can afford to lose, hence the phenomena of indigestion. In this vicarious expenditure of nerve-force, we see a great variety of unaccountable phenomena. The same kind of force is not always deflected, but a change from motor to sensory, or from vegetative to sensory is often observed. The deficiency of expenditure of nerve-force so necessary to mobility may be manifested in hyperesthesias; or the lack of nervous energy manifested in anesthesia may be caused by a vicarious expenditure often observed in spasms, and other exaggerated phenomena of moter centers. Lesions of conductivity are not unfrequently observed. The inability of axes-cylinders to conduct properly; or the feeble insulativity of medullary tubes may change the current of nerve-force to vicarious channels. Constipation has often produced, indirectly, eruptions upon the skin, turgescence of brain, cord and liver. Retained integumentary excretions have often suspended the evolution of vegetative nerve-force and heat-producing processes become exaggerated, resulting in fevers, diarrhoeas, effusions and hemorrhages. Urea retained by diminution of the nerve-force necessary to perpetuate normal function, is soon followed by excitation of |