server, that apparently nine out of ten family physicians wait until a child breaks down or develops disease before interfering. The teacher has seen the logic of this position, and has stepped into the opening in his imperfect way, to cure the mischief before it arrives. It is certain that our sense of self-respect, if not our interests, will not much longer permit us to sit in our offices, waiting for some harm, made operative by our inaction, to send us the little patient.

We have in like manner an attitude on the treatment of our syphilitic patients, but we have no attitude on the treatment of the greater problem of the social evil and the conditions bordering upon it, though we know that syphilis has for a long time been on the increase, that it is one of the most productive causes of degeneration, and that carnality with barely covering to hide downright lewdness is everywhere apparent. In the present general corruption, devotion to sensuality, the beastliness of open impurity, and every shameless form of iniquity, and absolute indifference to all woe its own, surely, our profession has a duty to perform besides that of mere repair of the physical evils entailed by these causes. We have too long, for our own good, been the beneficiaries of the public's ignorance. Let us now tell the people the truth. The truth can not be contrary to the real interests of humanity. The eternal years of God are hers!

Another problem which we have not fertilized is that of food requirements. The people are still without a physiological rudder to steer through the enlarging sea of foods. It is no blasphemy to ask, what has the profession done for the people's knowledge of food? The answer is, nothing. We have done no more for the growth, training, food, and clothing of the child, and but little to abate the crimes committed against children in the matter of food. It is a biting truth that there is nothing like uniformity among mothers in the feeding and care-taking of children, and the consequent ex

cessive infant mortality is a reproach to the profession. "We often wonder at the ignorance of the general public in regard to matters of health, but our pity never extends to the point of affording them reasonable instruction."

Another problem concerning which the medical profession does not appear to realize its position and responsibility is that of intemperance; most appalling in great cities. In the year past this nation drank 19.48 gallons of alcoholic stimulants per capita, nearly doubling the quantity in twenty years. The people of the United States spend annually the enormous sum of $1,074,000,000 for malt and alcoholic liquors. These figures challenge the attention of the medical profession. But astonishing as these figures are, they are as nothing compared with the extent of pathological territory covered by alcoholism. The medical profession has done nothing to stem the strong current of popular favor for liquor as a beverage. In fact, we have never gotten beyond the therapeutic consideration of alcohol, alcohol as a food and stimulant. With drunkenness and its satellites, poverty and misery, everywhere in evidence, to urge the claims of alcohol as a food, has no more force or dignity than a mere quibble. It may be sublime to the experimenter, but it is ridiculous to the rest of the world. Men are not going to answer the painful earth by pointing to this affront to civilization as a food. One need not be a prohibitionist to perceive that in this problem we have not shown the highest level of life-comprehension. No viler evil than the drink habit calls itself custom. Civilization in this problem of intemperance has progressed from the ape to the devil. The medical profession has already done and said more than is good for its intersets in palliation of alcohol, and has reaped the consequences in popular distrust.

Let these few examples, taken from the many, suffice to illustrate the sad picture of professional limitations. We have shown a rare devotion to clinical medi

cine, something of the crusader's fervor; now let us show something of the same fervor, perchance in a broader, if not a holier, cause, the medical instruction of the people. This democracy of education in medicine is the only route to the complete sanitation of the world. With the diffusion of this information, the medical profession will enter upon that broader education, higher intelligence, and greater destiny foreshadowed by its leaders.

DISCUSSION

DR. C. F. DIGHT (Minneapolis): The only hope of the world is in education, and it must be an education of all the people, as well as of the children. This is being accomplished in some of our eastern cities by simply throwing open the doors of public school buildings for free public lectures, and a former superintendent of the public schools of New York wrote me about a year ago that there had been an attendance of about 1,000,000 people at these lectures, which dealt with practical matters-sanitation, sociology, biology, history, etc. I should like to see this Association put itself on record as favoring such a use of the public school buildings of our large cities throughout the state, where public lectures could be given, and the people instructed along various practical lines. It would not cost very much, and the buildings might as well be put to that use when school is not in session. The chief expense would be to heat and light them for a few hours. In many of our towns we can find local talent, at but little cost, to render this useful service.

DR. MARY McCoy (Duluth): I wish to say a word as to the standing of the medical profession as compared with those of the law and the ministry. If you ask a lawyer whether justice is being done I think he will tell you it is not. Not only that, but it has come to be so bad that the great journals and magazines are devoting large space to the discussion of these crimes and shortcomings. The ministers will tell you the world is worse than ever. On the other hand, the medical profession has eradicated many diseases, such as yellow fever, smallpox, etc., and has made steady advancement along other lines, so I think we compare very favorably with the legal and the ministerial professions. I think we have cause to congratulate ourselves upon that fact, and no physician need feel that we occupy an inferior position among the professions.

GANGRENE OF THE THROAT

J. A. WATSON, M. D.

Minneapolis

Gangrene of the throat cannot be considered as in any sense a disease specifically distinct from other septic manifestations of the same region. It is indeed but the most severe and violent, while fortunately the most rare, of a series of septic manifestations characterized above everything by their violence and severity. The other members of the series, following Watson Williams' classification, are (a) Superficial septic inflammation, e. g., so-called hospital sorethroat; (b) Membranous septic inflammation, e. g., some cases of pseudodiphtheria, scarlatinal diphtheria, etc.; (c) Edematous inflammation, e. g., acute edematous tonsillitis, pharyngitis, epiglottiditis, arytenoiditis, cellulitis of the tissues of the neck, etc.; (d) Phlegmonous or suppurative cellulitis.

The condition under discussion occupies the last place in the series. Felix Simon, as long ago as 1895, endeavored to establish the pathological identity of these various conditions, and to show that they were but varying degrees of virulency, manifested under varying conditions by one and the same disease. Certain it is indeed that so far no etiological distinction has been established. The trend of bacteriological investigation on the contrary seems rather in the opposite direction, since it has now been proven that the same microorganism may produce pathological conditions anatomically distinct in different cases, and, further, that in some instances anatomically indentical lesions may be of variant bacteriological origin.

It is the purpose of this paper, however, to discuss the condition under consideration from a clinical, rather than

from a pathological standpoint, and with this object in view it will make for definity and clearness of classification to distinctly except from our category all those superficial necrotic processes which are a comparatively common and, as it were, an accidental accompaniment of various inflammatory throat affections, but more particularly of diphtheritic conditions. We include, in short, only those processes in which the gangrenous tendency of the inflammation is its most striking and characteristic feature, a feature becoming manifest at a very early stage in the course of the disease and at once throwing into comparative insignificance all accompanying local phenomena. The writer is prompted to make this distinction by the result of correspondence on the subject with certain eminent laryngologists who repeatedly used such expressions as "necrotic ulceration" in reply to his queries, a term which comes very far short of describing the condition he has in mind.

This most virulent septic manifestation then, gangrene of the throat, in the properly limited sense defined above, attacks quite indiscriminately the young and the aged, the robust and the debilitated. It may occur quite independently of any pre-existing disease, or in the course of septicemia, rheumatism, tuberculosis, syphilis, and diabetes. It is occasionally the result of severe traumatism, such as that produced by corrosive poisons. There are probably other predisposing conditions, but the cases reported are as yet too few in number to serve as a basis for very wide generalizations. The clinical history of the disease can perhaps be best described by the presentation of the records of a few typical cases, two of which, occurring in the practice of the writer, have not been hitherto reported.

CASE I. J. N., male, aged 32. This man came to my office June 20, 1901, complaining of loss of voice and pain in the throat, particularly on swallowing. He had been in this condition for about two months, and was becoming steadily worse. His throat had been "cauterized” about two weeks before by a physician in the country, since when the symptoms appeared to be greatly aggravated.