Editorial Department.

TOPOGRAPHICAL NOSOGRAPHY.

In our last two numbers we have set on foot a series of papers which we hope to render very copious before we have done with them. We allude to the articles by Drs. Haggard and Mentlow, in our present number, and that of Dr. Lipscombe, in the December issue.

We can conceive of nothing so interesting in the study of disease as the observation of the changing phases of epidemic and endemic pathology which accompany the progress of society from the pioneer encampment to the elaborate and scientific agriculture, and the eager clashing of interests and opinions, the studied luxury and restless activity which characterize the city life of modern civilization.

Under our Government, and sometimes within a few hours' travel, we are able to contemplate the natural history of the human race from the savage state to that of the excess of civilization, the examples of which have in older countries to be sought for in the historical records of centuries; and if in social, political, moral, and intellectual features we thus find types of character placed side by side which otherwise would have to be sought by travel through distant climes, and by study through the records of distant ages, it would naturally be expected that what is true of the mental characteristics should not fail in regard to the bodily constitution. Nor do the facts disappoint this expectation. The diseases of savage life are not those of civilization; the diseases of town and country are not identical; the diseases of pioneer culture are different from those of a region where the wild luxuriance of spontaneous vegetation has been subjugated and rendered subservient to the exigencies of a thronging population. In short, all the various circumstances of climate not only, but moral, physical, and social relation under which the human constitution can be placed, have their influence upon those organic and functional aberrations which constitute disease. Since, then, the various phases of life succeed one another in this country so rapidly

that the corresponding phases of epidemic and endemic disease are as transient as they are interesting, does not the necessity seem pressing that they should be promptly and faithfully recorded before they have passed away with the circumstances which have occasioned them?

This is what we are trying to do with regard to our own State, by inducing intelligent physicians in all parts of it to supply such information as the field of their labors may have furnished them with; hence the papers in question. But this ought not to be limited to any one State: it ought to be done in all. Types of disease in countless variety are appearing, and passing away again with the circumstances in which they originated; and the period for recording them, unless seized on the instant, is lost, never to be recalled. Let, then, our brethren of the periodical medical press exert themselves to procure, in such quantity as they are able, and of the best quality possible, records which shall hereafter furnish the indispensable materials for a nosographical history of the United States.

PRIVATE MEDICAL INSTRUCTION.

WE desire the attention of medical students, and of those interested in them, to our advertisement under this caption. The step we are taking has been the result of serious reflection upon the defects of existing provisions for the extra academical education of medical students. According to existing arrangements, three years is understood to be the whole period devoted to preparation for the medical profession, of which eight months are spent within the walls of a medical college, and the other twenty-eight, we fear, but seldom employed in a manner calculated to advance the student's proficiency.

Being convinced that, at least for a long time, the whole period of study cannot be extended, we are desirous of promoting the most efficient and economical use of that period at present agreed upon; and as, through the total inefficiency of office instruction, now that it is generally offered gratuitously, two-thirds of the course is to a great extent wasted, we have concluded to attempt something in the way of a substitute. For the details of our plan we must refer to our advertisement. We have a few words to say here about our terms, in which we think we shall have to deal with two classes of objectors: First, instruction of this sort has been offered gratuitously, or, what comes to the same thing, the fees paid for it have been credited in the subsequent purchase of

tickets in more than one medical college; and a similar liberality, it is suggested, ought to be extended by us. Now, our proposed school is grounded upon the very fact that extra academical education, from having become gratuitous, has become inefficient. Believing this to be a great evil, we have attempted a remedy. By making our course gratuitous we believe we should increase the evil; for medical education, like every thing else, is regulated on the principles of demand and supply: the supply will soon follow the demand; plenty of young and well-educated physicians are ready and willing to offer the supply, but the demand has been swamped through students being taken for nothing, and taught nothing for it. We are more desirous of exciting competition, and so eliciting a healthy supply, than of swamping the market by underbidding. Therefore we offer our instruction for a fair remuneration, believing that it is fully worth what is asked for it; believing, also, that gratuitous instruction may generally be estimated on the same terms, being generally worth exactly what is paid for it.

An opposite class of objectors is, to our mind, much more difficult to dispose of those, namely, who will think that we have placed our terms too low. Now here our trouble is, that we entirely agree with the objectors, the terms being exactly one half of what is paid for the same amount of instruction in Philadelphia. We admit that by putting the terms too low, we approximate to the great evil now so prevalent of gratuitous instruction, which we see to have resulted in nominal instruction. But we believe that, under all the circumstances surrounding them, what we ask is all that students in this part of the country can be expected to pay. If we believed that any one else could get more for private instruction, we should be the last to underbid them. The market, we have before said, has been depressed by the gratuitous system, and it is only gradually that it can be raised to a healthy standard.

ON Monday, the 27th of December, I was called to see a child at a hotel in Nashville, and who had been brought that day from Marshall county, a distance of eighty miles, for the purpose of having a grain of corn removed from the trachea. I first saw the child, at the date mentioned, at about eleven o'clock at night. The parents gave me the following history of the case. Their little boy, two years and ten months of age, had been feeding poultry in the yard with corn, on Tuesday, the 21st of December, when he was suddenly seized with a most violent and spasmodic cough. So severe was the paroxysm, that the father thought the child at one time dead, as he told me he could not perceive that he breathed. An interval of repose followed, and he vomited and ejected a grain of corn from the stomach, proving that he had introduced one or more grains into the mouth. The spasmodic cough returned again the next day, and was repeated at intervals for several days in

succession, with such severity that the parents thought he would on several occasions suffocate. The sleep was very disturbed, and there was great restlessness from the difficult respiration. From this account, and from the effort in breathing, the croupy cough, and the great mucous ronchus in the trachea and lungs, I was at once satisfied the foreign body was still in the windpipe, and I advised tracheotomy for its removal. The parents were reluctant to have any cutting operation performed, as they informed me they had been told that it could be removed with forceps without opening the trachea. I tried to explain to them the impossibility of this, but had finally to leave them undecided in regard to an operation. The next morning, (Tuesday,) the father called on me, and told me he had decided to place the child in my hands, to do with him as I thought proper to save his life, for he was satisfied he would soon die unless he was relieved.

I accordingly, at about twelve o'clock on Tuesday, just one week from the time of the introduction of the foreign body, assisted by Professor Maddin, and in presence of Dr. Kelly and several medical students, performed tracheotomy. The respiration was very much embarrassed before I commenced the operation. An incision of about an inch and a half in length was made in the median line. The hemorrhage was very free indeed on dividing the deep cervical fascia. In fact, the neck was very short and fat, and the trachea at a greater depth than usual from the surface; and the bleeding was much greater than I have ever before seen it in the same operation, on account of the excessive venous engorgement from the pulmonary obstruction. The venous bleeding was restrained by pressure, but I found it necessary to tie a branch of the thyroid artery. After doing this, and while applying pressure on the venous orifices, and waiting for the oozing to cease before opening the trachea, the child began to sink so rapidly, although the anaesthetic had been removed from the face, that I feared to delay a moment in completing the operation. I therefore at once plunged the point of the bistoury, well guarded with my finger, through several of the tracheal rings, but no relief was given by it to the respiration, which in a few moments entirely ceased. The pallor of death was on the face, the limbs and jaw perfectly relaxed, and the eyes fixed and glassy as in death: in fact, the little patient to every one present seemed to have expired. I promptly closed the wound I had made with the fingers of one hand and the nostrils with the other, and, applying my mouth to the child's, I inflated the lungs, requesting Professor Maddin to compress the thorax alternately as I inflated it. By thus blowing with considerable force through the mouth, I learned from him that the air freely entered the lungs and