somely. It will do it for the medical school if the society will only use its individual and united efforts in that direction. I would earnestly recommend, therefore, that this society appoint a standing committee, no member of which shall be a member of the faculty, to confer with that body as to ways and means in which and by which the society may be of practical assistance to the medical school.

Finally I wish to speak somewhat of the relation of the members to society and the work of the society as a whole.

The attitude of each and every member should be one of loyal and enthusiastic support, with a cheerful willingness to work. It has been my experience in the past on more than one occasion to have heard a member say, "O, yes, I belong to the State Society, but I don't get much out of it. I pay my fee every year and get a dinner and hear a few papers read, but I can't say I get much out of it." Such a spirit is unworthy of the age in which we live. Not what do I get out of it, but what can I put into it for the benefit and help of my fellow members, should be the motto of every man and woman worthy to meet in this body. A more recent criticism, and one not entirely without reason, is that too many of the papers are presented by the specialists, and so are not of a character to be most helpful to the general body of general practitioners. The best answer to this criticism. is, that the critics themselves should do more work.

The specialists more frequently prepare papers because they are undoubtedly more frequently urged by the committees of the various bureaus, they are more frequently invited no doubt, because giving as they do all their time and study to the perfection of a single department, they are the more conversant with the most recent advance along their particular line, because they have more time for literary work and because they are oftentimes more accustomed to express the results of their investigations and experiences on the written page. Nevertheless there is always the danger strive against it as one may, of the specialist studying the case too much

from his particular point of view, and therefore it is, that there is no paper more valuable and more acceptable than that carefully prepared from the rich store of clinical experience, which is the possession of every conscientious general practitioner. The more they write, the less will the specialists be called upon.

To one who has watched the general character of the work of the society for the past fifteen or twenty years, the improvement is marked and gratifying. The papers cover a wider range of subjects, show evidence of more study, and extended research and conclusions are more frequently drawn from the consideration of a collection of recorded clinical cases than from the single case as formerly. But in one respect the society has not made satisfactory advance, that is along the line of the study and development of our materia medica, a department vital to our existence as a distinctive school. I do not know that the society should be blamed, indeed I do not feel that the society should be criticised for this. There are many good and sufficient reasons for it, but I do believe the time is ripe for work on this most important subject. It is very gratifying to know that in some direction this work has been begun along satisfactory lines.

At the last meeting of the O. O. & L. Society, the President, Dr. Bellows, of Boston, presented a definite plan for the revision of the materia medica. The provers should be hired, they should be examined by a general practitioner, and by the various specialists, to note their normal condition. During the proving, under the care of a director of provings, the prover from day to day is to undergo physical examination and any deviation from normal noted. Such in brief are the gross outlines of the plan. The committee on presidential address reported that the suggestion contained therein should be put to the practical test and committees should be appointed in the various cities to prove a single drug. The committee consists of a director, two general practitioners, and one practitioner in each branch of special work.

In Brooklyn, New York, the necessary money has been. raised, the committee appointed, and the work begun. Here in our own city the committee has been appointed with Dr. E. P. Colby as director. Dr. Bellows is general director over all committees. This is the right and scientific way which to prove a drug, where the narrative of the prover is supported by the physical, chemical and pathological examination.

I sincerely trust that this society will see its way to do something to encourage persistent, steadfast work in materia medica, and with this end in view would recommend that the society offer annually or biennially a prize for the best paper on materia medica, and that the contest be open to the members of the senior class of the Boston University Medical School.

The danger in the present attitude of the old school toward us, which may be summed up as one of tolerant indifference, the apparent tendency of some few of the newer members of our faith to long after the flesh-pots of allopathy, the possibility of the official recognition of our school in the army and navy, are all themes worthy of our consideration at this time, but I fear I have already taxed your patience far beyond the bounds of courtesy.

Tonight upon the threshold of a new century, gaze as far as we may, there is to be seen only encouragement. We have an established medical faith. It has been accepted by many and that many increasing every day. It has been established by one hundred years of indomitable perservering work by noble men and women who had that greatest of all courage, the courage of their convictions. It is for us who know that their convictions were true and to it that their labors have not been in vain. yet a minority in the medical world, but in all great reforms that ever have been or ever will be, it is necessarily the minority that is right. Whenever I meditate on minorities, I am always reminded of a story of the late Dr. Bartol. The

right to see True, are we

reverend doctor had invited a young friend to assist him in a service in the old church at the west end. The two reverend gentlemen sat in the pulpit while the congregation assembled. There were not many, and as the time approached for the service to begin, the young man remarked upon the few people present. The elder divine peeked around the desk, surveyed the congregation, and then quietly remarked, "Yes, yes, there are but few such people."

WHAT IS PERITONITIS?

BY HORACE PACKARD, M.D.

[Read before Boston Hom. Med. Society.]

The subject, which I have selected tonight, is perhaps couched in somewhat peculiar terms. Modern bacteriological research has materially changed former theories regardiug inflammation, and has established beyond any question what is peritonitis. All who have given heed to facts, which have been evolved of the relation which microbic life bears to the human body, can be but profoundly impressed with the importance of the subject. Much light has been thrown upon many hitherto obscure pathological problems.

Inflammations of the peritoneum have been, and are now, among the most perplexing affections which menace human life. Without premonitory symptoms, pain arises in the abdomen, quickly followed by local or general tenderness, reflex nausea and vomiting, gradually increasing distension, loose movements, collapse and death may be, within four or five days from the beginning of the attack, and without any inkling whatever on the part of the family or physician of what the cause has been of such a calamitous illness.

Since it has become known that the appendix vermiformis figures so largely in inflammatory abdominal affections, it is natural that in cases of persistent pain and tenderness, sus

picion should be aroused of its complicity. Excluding these, however, as well as cases of peritonitis, which are a sequela to tubal disease in the female, there are still a not inconsiderable number which are obscure in their origin, fatal in their effects, and exhibit on exploratory incision, or autopsy, no physical explanation of their cause.

What I have to say to you is based largely upon matters which have come to my notice in the course of examination of cases of abdominal infection. The cases quoted are some out of the ordinary run which have come to my knowledge.

Case 1. Mrs. C., age 62, was seen in consultation with her family physician late in the evening of Dec. 10, 1898. She had for two years or more been troubled with intestinal indigestion. The day prior to my visit she had vomited at noon, which was accompanied by pain in the abdomen of indefinite character. Saturday, the day of my visit, the pain had become very severe, with recurrence of vomiting and loose stools. Her temperature was 101.8°, pulse 112. Palpation disclosed great tenderness in right hypochondrium, occupying the whole space between the costal cartilage and crest of ileum. No tumor demonstrable. My notes, written at the time, read "Obscure case, may be appendicitis, possibly gall stones. Exploratory incision advised."

The patient was immediately taken to the hospital and the abdomen opened. The appendix was sought first and found normal. The gall bladder was next explored and found also normal. The pelvic organs were also without pathological change. The intestines were then inspected, and, after going carefully over their whole length, the upper part of the ileum, at about its junction with the duodenum, was found, for a distance of about fifteen inches, dark livid red, infected, but not nodular, thick and inflexible as compared with normal intestine. There was no plastic deposit on the peritoneum, no pus, no feculent fluid, no perforation. The wound. was closed without drainage, and ice bags applied to the abdomen. But little pain was suffered thereafter. The