The recent epidemic of influenza seems to have increased the condition mentioned in the paper. I wish to call attention to that part of the paper in which he mentions suppuration of the orbit in connection with suppuration of the sinuses. It has been my misfortune in the last three years to have three bad cases of suppuration of the orbit in connection with the ethmoid and sphenoid sinuses. The first case was a case of suppuration in both the ethmoid and sphenoid sinuses, and illustrates what the essayist speaks of in a case of facial erysipelas. In a couple of days the eyeball on one side began to bulge, and I began to mistrust that there was suppuration of the orbit, and at the same time pus began to discharge from the nose. The other two cases were apparently suppuration in the ethmoid cells. There are a couple of little sinuses between the ethmoid cells and orbit. I do not know whether there is any name for them or not, but there is a channel from the ethmoid cells to the eye. The question of drainage comes up in these cases. Of course, an incision above the eye, in the hair, gives a smaller scar, and affords better drainage, than an incision below the eye, but, on the other hand, the pus running down over the eye causes irritation. In my first case I made an incision over the eye for. cosmetic reasons. It was a little girl, and in order to hide the scar I made the incision in the eyebrow above, and then worked through over behind the eyeball with a blunt dissection to the pus. I got good drainage. Had a dacryocystitis. The next time I made an incision below the eyeball, but did not get a good result. I had to make an incision above the eye, and had to put in through-and-through drainage. In the third case an incision below the eyeball was all that was necessary. I got good drainage, and the case was entirely cured. Our recent epidemics of influenza and acute choryza in connection therewith have increased these nasal suppurations, but the literature on the subject is scant. I am therefore glad to have heard this paper on the subject.

DR. J. A. WATSON (Minneapolis): The subject of the doctor's paper is very timely. I remember that when in general practice I was worried, more than once or twice, by my inability to confirm a suspicion of suppuration in the nasal sinuses, and puzzled, in the few cases where I was able to make a positive diagnosis, as to the proper treatment to adopt. Dr. Farker has drawn a very close distinction between the pathological changes found in the acute and chronic forms, respectively, and I am sorry that time did not allow him to discuss more fully the varying treatment to be adopted under these varying conditions. In acute cases, where there is little or no thickening of the mucous membrane or production of new tissue, it is usually possible to cure aural suppuration quickly and easily by the extraction of an offending tooth with drainage through its socket or through the canine fossa. The good results claimed by

dentists are due to the fact that the cases they treat are nearly always caused by diseased teeth, and are almost invariably acute in their clinical history. It is very necessary, before adopting any procedure having as its object the cure of the disease, to determine the chronicity of the disease, and the exact pathological condition present. In all old chronic cases, particularly where the mucous membrane is much thickened, nothing short of a very radical operation should be considered. The Luc-Caldwell operation is undoubtedly the most satisfactory in the great majority of cases. Dr. Parker assisted me in a case upon which I operated about Christmas of last year. The young man had suffered from pain and profuse foul discharge from the antrum for seven or eight years. I removed almost the whole anterior wall, and through the opening thus made cut away a large part of the partition between the antrum and nasal cavity, including the anterior portion of the inferior turbinate. Recovery was rapid and complete. In less than three months the man was absolutely well, there being no sign of either pain or discharge.

THE MODERN TEACHING OF MATERIA MEDICA AND THERAPEUTICS

R. O. BEARD, M. D.

Minneapolis

In the practice of medicine, as in human life at large, the currents of action or re-action are usually traceable to an educational source. When the stream sets forward it is evidence of a power behind, as of an open way ahead. When the tide sets back it is evidence that it has been driven into a blind pocket from which there is no exit but in retreat. At the end of the pocket there is always an apparent stasis. Into such a cul-de-sac modern medicine has drifted under the influence of the therapeutic teaching of the past. Progressive as it is in its main movement, scientific as it is in its method of advance, it has been compelled to halt at the head of this cul-de-sac, and to turn back in search of other outlets of progress. Its stasis is observed in the dominant therapeutic nihilism of the present day, in a prevailing and gathering scepticism of the drug treatment of disease. Its search for other avenues of exit is to be noted in the opening up of new and varied methods of healing. In the end, as in the whole process of evolution, there is advance. If the empiric teaching of the past has led the physician of to-day into paths which his scientific faith and practice cannot follow; if, in actual use, his pharmacopeia has been narrowed to the recognition of but a few remedies; if, in his modern warfare with disease, he has been compelled to abandon many of the crude weapons with which his professional forefathers ineffectively fought, his capacity for harm has been materially diminished, and his range of usefulness has widened itself out into the pursuit of other agencies of cure. Modern medicine, through these new

side channels, is working back into the main current of scientific progress.

Nevertheless, there is danger in stasis too complete or too prolonged in any one direction. Therapeutic nihilism has become a menace to the immediate movement of medicine in a direction in which its course should be no longer impeded, and this stasis continues because the channel of this therapeutic cul-de-sac continues to be choked by the worthless mass of materia medica which medical educators of the text-books and the colleges alike persist in pouring into it. It is time that the medical profession called a halt upon its teachers. There is need for relief, in which the whole body of the profession may engage.

It is the purpose of this paper to point out briefly the measures by which this relief may be attained.

I. It is time for the medical profession, through its national body, to authorize and edit, by a commission of therapeutic experts, an index expurgatorius of the useless and discarded drugs with which the pharmacopeia is still burdened. It is to be regretted that the last commission appointed to revise the national standard failed to use the opportunity which lay in its hand.

2. Scientific teachers of materia medica and therapeutics should exercise the courage of their convictions, and repudiate the teaching of much which remains, unfortunately, in the text-books as the mere debris of the materia medica of an earlier day.

3. The medical colleges must speedily follow the lead of three or four representative schools in America in placing the subject of materia medica among the essentially laboratory branches; in providing for the adequate equipment of laboratories, and for the employment of instructors who are fitted to conduct laboratory methods of instruction. Students should individually study the raw materials, the preparations and the physiologic effects of remedies which, later, they are to learn to prescribe.

4. The profession should abandon and teach the abandonment of the use of every drug, the employment of which

does not rest upon an intelligent understanding of its physiologic action, clearly demonstrated and accepted. Empiricism has no longer a place in the practice of medicine. Its effect on functional activity, and possibly through that functional influence, upon structural change, is the only rational basis for the application of any therapeutic measure.

5. In order to the determination of the classical physiologic effects, the profession should demand the standardization of all drugs. It should secure the enactment of laws which make a working distinction between proprietary preparations and patent medicines. These laws should forbid the sale of any remedy for human disease without the publication of its actual formula. They should require that its ingredients be of standard strength and purity, and of substantial uniformity.

As a step in this direction, the organization of a national bureau for the analysis and certification of pharmaceutical products, which has been jointly proposed by the American Medical Association and the American Pharmacal Association, is worthy of the united support of the profession. The most reliable of large manufacturing chemists and pharmaceutists are friendly to the enterprise. Those who are not, have reason to fear the searchlight of laboratory investigation. An obstacle to the legislative control of patent medicine has always been the self-interest of a commercialized newspaper press, and the medical profession of the state should therefore take heart of hope from the fact that a higher sense of public duty is growing up in the profession of journalism, and it should applaud the announcement that, among the more representative newspapers, the Minneapolis Evening Journal has purged its columns of objectionable medical advertising.

6. Most vital of the needs of the present hour, for the advancement of scientific medicine, is the cultivation and exercise of a therapeutic conscience in the practice of the profession, a conscience which shall disdain the use of drugs which are not clearly indicated, which shall hesitate before the clear infliction of therapeutic harm,