action for the Convention when it meets, not with any presumptuous views of prescribing to its members, but for the purpose of inaugurating that conference which we desire to see conducted through the press the absence of sufficient time for viva voce discussion, when the council shall have been assembled.

in

And before we consider what should be prescribed, it will be well to estimate what will be the Convention's powers of prescription, how far they will be entitled to prescribe, how far they should confine themselves to advice. It is to be remembered that the colleges as yet have established no Convention, they have only been invited to do so by the Convention. Now we hope to see every Medical College in the United States represented in the proposed Convention. Any thing short of an overwhelming majority of them will render nugatory any attempt to prescribe authoritatively to the rest, and reduce the council to mere advisory prerogatives; for what is prescription, legislation, without penalties attached to non-compliance? Now the proposed Convention has no penalties to inflict, except what consist in withholding academic recognition from the recusants; in refusing to receive their tickets and diplomas as evidences of academic standing. If the Convention includes delegates from all, or very nearly all of the educational institutions recognized by the profession, as we earnestly hope it will, then the power of giving or withholding such recognition will be an irresistible means of enforcing their prescriptions; and should the American Medical Association back this with their power of recognition also, as doubtless they will, refusing to receive delegates from any institutions except such as accept the rules established by the Convention, then these rules, fortified by such double recognition, must have a force superior to all resistBut, on the other hand, should we be disappointed; should many of the great colleges refuse to take part in the council, then an attempt. at enforcing their decrees might lead to schism rather than success, and evils beyond all estimate result from the ill-judged effort; though, even in this case, much good influence might be exercised in the way of advice, which would bear a weight exactly proportioned to the character and qualifications of those who might constitute the council.

ance.

We shall, in the following propositions, proceed upon the presumption first contemplated, viz. that the Convention when assembled shall find itself in a position to speak as with the united voice of all the recognized institutions for medical education throughout the United States. Even then, in our opinion they will do well to draw a careful line of distinction between what they prescribe and what they advise.

Too much stress has been laid, we think, upon a uniformity of proce

dure throughout the United States. If it be true, as we have elsewhere endeavored to show,* that the amount of time, money, preliminary instruction, etc., which a student can bring as material for his medical education, depends upon the social, economic, and political advancement of the community in which he lives, or in which he is to practice, upon circumstances, that is to say, over which neither Medical Colleges nor conventions of them, nor Medical Societies, nor Associations formed from them, have any control; then it seems to follow that an attempt at making the standard exactly and rigidly uniform throughout the United States, prescribing exactly the same for Massachusetts and Pennsylvania as for Arkansas and Iowa, must result in one of the following evils : Either those regions in which a more advanced civilization enables a higher standard to be established must be kept down to the lower grade of qualification which alone is found practicable in newer and less developed States, or, the higher standard being adopted, these latter, being reduced to the acceptance of this or none, must fall out of the range of provisions thus made, and supply themselves as best they may with medical practitioners, always ready to fill the vacuum, trained in some of the various forms of empiricism so rife in the Western country. In short, if absolute uniformity is demanded, either Pennsylvania must be reduced to the standard of Arkansas, or Arkansas be left out of our system altogether; and surely neither of these is a "consummation devoutly to be wished."

To avoid either of these results, we think that the council should prescribe a minimum standard, below which they will not recognize a system of medical qualification anywhere, and advise improvements and ameliorations as they may be believed practicable for immediate or gradual adoption; the prescribed minimum being that mode of procedure which is at present recognized and practiced by reputable institutions; the improvements such as the wisdom of the members may devise as capable of elevating the present standard wherever and whenever they may be found practicable.

In a future number some suggestions will be made, both of articles to be prescribed and improvements to be suggested; but, meantime, do not these very distinctions to be observed between things prescribed and things advised show the necessity of making this Educational Convention as permanent an institution in the profession as the Medical Association itself?

We feel assured of this, that the very same considerations which have demanded so imperatively the summoning this Convention are conclu

* Memphis Medical Recorder, May, 1856.

sive for rendering it permanent. The circumstances which circumscribe at present the possibilities of general advancement are transient in their nature, and a higher standard will gradually be rendered feasible, as population increases, and the adjuncts of civilization are multiplied among us, so as to supersede the present provisional state under which our social arrangements are conducted here in the West by a more permanent system. If, then, the community for which we are legislating is in a transition state, and the circumstances under which we legislate are undergoing a perpetual change, it necessarily follows that the legislative body must be permanent in its constitution, or else how can its legislation be adapted to the ever-changing possibilities and requirements amid which its enactments have to take effect? Once determine that it shall sit year by year, as the Medical Association does, and then we may anticipate a progressive character in its legislation, so that what it advises this year may be prescribed the next, and what it doubtfully suggests at one meeting may be seriously entertained the next, and adopted as a positive enactment at some future period. This would allow, also, of correcting those portions of previous legislation which were not found to work as well in practice as was anticipated.

An attempt to do all the work in one sitting will certainly result in a scheme either defective or far beyond the mark, or possibly both at once, especially if that sitting is limited to a single day; but if it is known that this Convention is to be followed by another every year, then both moderation in what is immediately done, and expansive views of what is to be attempted to be done in future, may be regarded at the same time, and every improvement contemplated as preparatory to subsequent further advances.

But for other reasons we deem it important that the Educational Convention should be a permanent institution. For a long while the necessity has been growing upon us for some body which shall bear to the colleges the same ethical relation as the Medical Association does to individual physicians. Undignified squabbles are perpetually taking place between rival colleges as to matters affecting their official intercourse with one another, which are endless simply because there is no recognized tribunal to decide them. WE WANT A CODE OF ETHICS FOR OUR COLLEGES, and a Society for its administration. And the very matter for the discussion of which this Convention was called could be included in such a code. For once set about determining the conditions upon which the colleges will receive students from one another, and mutually recognize each other's tickets, diplomas, etc., and you will find yourself at once engaged in prescribing what shall be recognized as the prin

ciples of a general system of education. Such an educational eode could be established with just the same sanctions and penalties as at present give efficiency to our code of ethics: if a physician offends against this, he is expelled the Society, and physicians no longer recognize him or consult with him. So, should a college infringe upon the Educational Code, it would be excluded from the communion of the other colleges; they would not receive its tickets or recognize its diplomas; and, supposing, as we have all along, that such a Society acted in concert with the Medical Association, then all holding the diplomas of a college so excommunicated would be treated by physicians who were members of the Association, as not in the profession: consultation with them, and other acts of recognition, would be declined. Two such Societies, wisely coördinated in their functions, like two chambers in a Legislature; acting in concert, yet independently of one another; each engaged in its own department, but uniting upon those measures which could be most efficiently and beneficently carried with the united sanction of both, might with wisdom, moderation, and conscientious rectitude, in both, bring into harmony and union of action the teaching and practicing members of the profession, which recent attempts at reformation, devised with more zeal than judgment, have gone far to bring into a temporary position of mutual antagonism.

II. A CASE OF SPONTANEOUS MORTIFICATION.

BY THOMAS L. MADDIN, M.D.,

PROFESSOR OF ANATOMY IN SHELBY MEDICAL COLLEGE, NASHVILLE, TENN.

A NEGRO Woman, Easter, about 35 years of age, had enjoyed good health all her life, with the exception of difficulty at her menstrual periods, which had been deranged from the time of puberty, always at these times suffering great pain, with the flow often protracted and amounting to menorrhagia. In the intervals, however, her health was good. Her temperament a mixture of phlegmatic and bilious. When first called to see her, she was suffering with one of her usual menstrual periods, which was treated with anodynes, warm hip-baths, and hop fomentations, etc. So soon as the discharge was established, she seemed relieved, and I discontinued my visits. In about a week I was sent for again, and found her laboring under an apparent attack of acute rheumatism, considerable heat of surface, furred tongue, constipated bowels, and pulse about 100 to the minute; but the most distressing feature of

the case was quite a swollen condition of both hands and arms as high as the elbow, and of both feet above the ankles, with intense pain, especially around the roots of the nails of all the fingers and toes. The pain originated in the wrists and ankles, but had spread to all the joints involved in the swelling.

I gave five grains of blue pill and five grains of Dover's powders, to be repeated at an interval of four hours, until three portions were taken. Relieved the bowels with castor oil. Next day prescribed

Mix, and make solution. Dose: One tablespoonful every four hours.

This treatment, with an anodyne at night, was continued three days, with partial relief of all the symptoms. The pulse became natural, the pain subsided, and the tongue improved; the swelling, however, continued. But with some general directions I dismissed the patient. The next day I was summoned in great haste to see her again. I found her sitting upon the side of the bed, looking very well; but her fingers and toes had become shrivelled, dry, and cold, as high as the metacarpo-phalangial articulation of all the toes and fingers, and without a particle of sensation; there were also scattered upon her arms and legs, but principally her arms, black, dry, and crisped-looking surfaces, varying in size from a mere point to three inches in diameter. These places had the appearance of being burned very deep with dry heat. The only constitutional symptom which attended this acute mortification was a flagging state of the circulation. No sensation, whatever, could be elicited, by any kind of torture, from the fingers or toes; the skin seemed to be contracted close around the bones; but the patient complained all the while of intense burning sensations wherever the black crisped surfaces existed. Upon inquiry, I found that she had done only some light domestic work from the time I had first dismissed her. Her appetite was good, and general health seemed undisturbed, the pulse only a little languid.

I prescribed four grains of quinine every four hours, the bowels to be opened with rhubarb, and a nourishing diet allowed; and, as a local