DR. FRANK H. BARNES (Stamford): I would say this, Dr. Donaldson, in reply to your question: because so many of the smaller towns in the state do not have a physician. They say that if they have medical inspection, they will have to get a doctor from the outside to examine their children. They feel it to be a great burden to be put to this expense. It seems as if there should be a limit on the proposition. I should say that a town of over five thousand inhabitants should have medical inspection of schools. For that reason, a committee should investigate this matter. I move, Mr. President, that the Chairman appoint a committee of five to investigate this matter and report at the next annual meeting.

DR. SAMUEL MIDDLETON GARLICK (Bridgeport): I do not wish to remark definitely on the motion. I wish to speak, however, of a somewhat different method of educating the public than by the method mentioned; referring the matter back to the parent educates the parent, and the child itself. I think it is much more desirable to educate the individual than it is to educate the public.

In the second place, that idea carries with it another principle, that it educates the parent and the child to trust their own physician; while to dismiss the matter without reference to the family physician, tends to reduce the confidence in him that they should have. In any bill to be presented to the legislature, or any report of a committee, that principle should be held in mind.

DR. GEORGE HERMAN WRIGHT (New Milford): I would refer to what Dr. Garlick has just spoken of, that the parents can be perfectly educated in almost every case, not only to submit to the inspection, but to carry out the recommendations made by the inspector; and the way to educate them is to get results. I mean that if the inspector's recommendations are carefully made and carried out, the news of the good results obtained will spread among all classes of society. It will spread as fast among the poor and ignorant as among any other class of people. With us in New Milford, this has been the case. I have had quite a number of children come to me whose vision had been tested by means of a card. That is a crude method; because children who have keen vision may need glasses worse than those with bad vision. If the child is fitted with glasses and good results are obtained, more children will come from among the children of that parent's friends; and, for that matter, more adults will come. That has happened so many times, over and over again, that the educational effects of simply making good appears wonderful. Or perhaps a child comes in and has the interior turbinate and its adenoids attended to. The good results in this case bring in others. That is the way to make progress in this direction, by education, rather than by compulsion.

DR. THOMAS G. SLOAN (South Manchester): One other thing should be taken into account, and that is that it is as necessary to have the coöperation of the physicians in the town as it is to have that of the people. If the school physician and the school nurse and some operator do the work, they are likely to lose the coöperation of the family physicians. For that reason, it is necessary to have the cases referred back to the family physician.

DR. FRANK K. HALLOCK (Cromwell): All in favor of having a committee of five to investigate the subject of medical inspection of schools appointed by the Chair will say "aye"; those opposed, "no". The motion is carried, and the committee will be appointed later.

DR. EDWARD W. GOODENOUGH (Waterbury), closing the discussion on his paper: The question was asked by Dr. Meade whether the teachers examine the children's eyes. In some schools, they do; and in some, the principals only do this. Once in three years, there are sent home reports of the results in those cases in which is found defective vision. These cases have been called to my attention, and sometimes I have had glasses found for these children. I have had some children who have gone up as high as the eighth and ninth grades, and who have been told over and over again that their eyes were defective without any attempt at relief.

There is no free clinic for dental work in Waterbury. With the interest that the Dental Association takes in examining the children's teeth this year, however, I think that they now see need of a dental clinic and that eventually one will be established.

One thing very remarkable to me was that in some ways Waterbury was pretty healthy. I have found only two cases of ringworm of the scalp, two cases of favus, no case of trachoma, and few cases of scabies; yet the more I go around among the children, the more I feel the need of medical inspection—not simply the kind of inspection that has been spoken of in the discussion, the examination for contagious disease, but the inspection of other cases, of mouth-breathing, for instance, cases that are so extreme that, after discussion with their teacher, you feel the absolute need that something must be done. I think that Dr. Root will agree with me that these children are danger-breeders for other children, are infection carriers; because the slightest exposure to infection is bound to light up in them and become a serious menace to the others. The germs are more apt to be virulent, also, in these cases.

I took up this school inspection over a year ago, because I thought it a pity that it should be dropped. We had four inspectors, who inspected simply for infection. Then the appropriation for this was cut out, and the work was dropped. The Board of Health appointed me, and the Board of Finance paid me as much as the other men had received, and

also paid a nurse to help me, because they saw the effect of the work. It was not that I was more proficient than the other men, but because they had not taken advantage of their opportunities. They were capable men. If we are going to get school inspection, we must do work that will appeal to the parents and evidence itself in such a way as to impress them. The nurse is a great help. All the towns should have school inspection. We shall continue it in Waterbury, and we shall have more than twelve towns in Connecticut to furnish medical supervision of schools.

Secondary Parotitis.

FRITZ C. HYDE, M.D., GREENWICH.

Stephen Paget's letters in the London Lancet in 1886, and later his report of 101 collected cases of secondary parotitis, gave impetus to the modern interest in this relatively uncommon condition. It is only in the last decade that anything like a general discussion of the subject has been recorded in the foreign and American literature. Interest has centered about post-operative parotitis, and because of the classical reference to the connection between the parotid gland and the generative organs opinion has run the gamut between a pathology based purely upon a sympathetic or reflex nervous etiology and that of the present which is usually based upon infection solely.

In the past five years I have had five cases of secondary parotitis under observation. A review of these cases is the basis of this paper. Study of the reported cases, and of my own, has convinced me that in secondary parotitis, whether it be called post-operative, symptomatic, spontaneous, cœliac, terminal, or what not, we have clearly to do with infection of the gland via the efferent duct. There are conditions which obviously predispose to infection.

Case I.

PERSONAL CASES.

Acute dysentery. Septic parotitis. Death. The patient entered the Greenwich Hospital September 13, 1906.

She was a servant girl aged 30. She had acquired acute dysentery in a New Hampshire hotel, where there was a small local epidemic of the disease. When she entered the hospital she had been ill one week. On admission she complained of severe abdominal pain, nausea and diarrhoea. She was exhausted by her journey. From the first the dysentery assumed a virulent type.

The temperature ranged from 99.6° F. rectal to 106°, the pulse 100 to 144, respiration 20 to 40. She had from 10 to 22 stools daily, consisting chiefly of mucus and blood, and at the last a continuous involuntary discharge from the rectum. Treatment consisted of various rectal irrigations, hypodermoclysis when the fluid intake was reduced to practically nil, and bismuth, tannic acid preparations, and morphine internally. Constant stimulation was necessary. I wish to call attention especially to the fact that morphine had to be used continuously and that the fluid intake was very small, the latter never exceeding 50 ounces in twenty-four hours. These facts, with the constant loss of fluid in the stools, resulted in dehydration of the body and a very dry mouth. Treatment of all kinds was singularly ineffective. On September 21st, nine days after admission, the patient complained of pain in the region of the right ear and a swelling of the parotid gland was discovered. The swelling rapidly involved the entire gland, but no fluctuation or local abscess could be made out. Dr. R. C. Myles and Dr. R. H. M. Dawbarn saw the case in consultation and both advised against incision. The duct up to the margin of the gland was patent and a few drops of a purulent fluid could be expressed by milking the gland. There were no other gland enlargements. From the onset of the parotitis the patient grew steadily worse, dying fourteen days after admission and six after the beginning of the parotitis. Case 2. Traumatic parotitis. Recovery.

The patient, a woman aged 50, entered the Greenwich Hospital May 13, 1907, with a history of a blow on the side of the head. There was diffuse swelling of the ear and adjacent structures, which soon became localized, definitely, to the entire left parotid gland. This was treated by external applications until May 21st, when fluctuation in the lower part of the gland could be made out, and I incised and drained. Recovery was uneventful, the patient leaving the hospital June 3d, with the wound nearly healed. The origin of this infection is, I think, clearly from the mouth. It is probable that the blow, received during a family quarrel, occurred at a time when psychological influences might well have produced a dry mouth. The swelling of adja