drift of medical colleges-mostly of the stock company order-towards suspension of business or to a unity with a well-endowed or state university. That these changes are for the best and honorable. interests of medicine the student or observer will, at once, admit as stubborn facts.

We, who are readers of medical journals, admire such articles as Drs. Hunter and Powell present, and not least the classical writings of Dr. Fischer, who tells us of the glorious deeds of the Fathers in Medicine-a subject much neglected in our medical

course.

Harvard, during very many years, has required of candidates for matriculation in medicine the Bachelor's degree in Arts or Philosophy, and Cornell recently has announced similar requirements for its M.D. degree. This announcement recalls the words "History repeats itself," for the student in Medicine will remember that several centuries ago Oxford and Cambridge required of medical students similar qualifications. That our Canadian universities and Provincial Medical Councils do not exact, and have not exacted, such matriculation requirements is not only lamentable, but disastrous to the respectability of medicine. Such is to me an established belief, proven by my careful study and inspection of more than 1,200 undergraduates and graduates, who were passing our Council's examinations and those of the University of Trinity College. The fact is this, and very evident to all interested in the progress and respectable standing of medicine, that there has been, and now is, unpardonable velleity on the part of our legislators and faculties in medical studies in reference to such preliminary requirements. Although to many, like myself, whose studies in Arts were totally distinct from association with medical subjects, the lately-arranged and combined courses, wherein either the B.A. or B.S. and Medicine are sought, although not ideal, are commendable, it would appear, to use a simile, like the present of the silver spoon for each one pound of baking powder. Another fact is, those who were not privileged to acquire either B.A. or B.S. or Ph.B., disassociated from medical studies, deserve the profession's highest esteem in the struggle for the acquirement of two degrees, and, too, well worthy that cum honoribus should appear on their parchments. Yes, honor graduates they are, and ever will be in our estimation, but we feel very weak, especially so when we notice in every country newspaper that nearly every dentist is an "Honor Graduate of Toronto University," and they, or each one of them, is a doctor. Another fact is, I do not think so much respect is contained in

doctor as when, in 1869, I received M.D., for our universities of late, to catch popularity and pennies, are multiplying faculties, and the doctorate is the bubble, beautifully colored and equally as empty, for the unwashed and inane aspirants. In time we will assume the plain Mr. and follow the example of Cameron. Not least, it has been my belief for many years that any university in catering to the whims of visionaries for faculties is dishonoring itself and the three learned professions and is doomed to dishonor. Are such "pipe dreams"?

To have had an hour's pleasurable conversation with one of my professors and an ex-M. H. O. of Toronto, a writer of a medical text-book, a biographer of the earliest settlers of the Bay of Quinte district, an ex-surgeon of more than ordinary distinction of the U. S. army, etc., in a House of Refuge is not cheering to my thoughts or to those who may read this acroamatical gallimaufry. Such has been a recent event and proof that intemperance debases; however, in this instance, the inmate of the county's Refuge is self-suporting, although invalidated. Yes, brother, he is an exPresident of the Canadian Medical Association and author of the classical work, "The Biographies of Canadian Medical Men." Magni nominis umbra.

It is, in a sense, somewhat lamentable that we, who are prevented by various fates from attendance at our Provincial and Dominion Medical Associations, are benefited only by an occasional publication of an address, and as such able addresses appear at diverse times and in the authors' favorite journals the halo of glory of these annual gatherings is not apparent to absentees, but is fully enjoyed, personally exalting, encouraging, and honoring to not only city but the "four corners" licentiates in our ranks. One fact is this, that by yearly or more frequent associations with each other to compare experiences, to confirm old views or to abandon them, to have our egoism appear or to be silenced, or by association have moments for self-introspection and the renewal of old acquaintances not only frees "our minds from many silly notions," but makes us better citizens, and, most decidedly, better doctors. The benefits are innumerable and within the power of obtainment by all who hold progressive views and feel the responsibility of the doctorate.

Very few professors, I learn, have had experience in what is ordinarily termed "country practice," and when we consider the fact that nine-tenths of the number of students are from the country, and no doubt will engage in rural practice, it is to be regretted that said professors cannot and do not give lessons from experience as regards aretology, the ethics of practice, and other instruction in

which and by which their students would be benefited, for thus forewarned and instructed many more years of more efficient service to the community, financial results more encouraging, in fact, every benefit we pray for, would result from heart-to-heart talks about their future labors.

The so-called ethical medicine concerns, whose goods by every device, assisted by medical journals, are most disgustingly and too often introduced to us, have been and are our greatest enemies in every respect, especially so in the cleavage they have caused in our relationship to our next best friends-the honest druggists. However, reaction is setting in, and we are learning that the local druggist has enough on his shelves to meet our practical work-and also learning that the price lists are eclipsed by ethical and legitimate publications more deserving of our study and adoption-learning, too, that it is not professional to act as salesmen for non-ethical goods, even if, in our verdancy, we hang on our office walls their alluring and charming, yet disgraceful, picture cards. We, of all professional men, most assuredly are the most easily victimized, and an ordinary survey of our own daily life will most clearly, yet sorrowfully, prove this fact. Yes, the allowance by us of the work of the patent medicine concern or company to break up an ancient and honorable friendship existing between us and druggists, is dishonorable and disastrous, and those of us who take brief yet clear observations of the movements and designs of men can easily see the maelstrom to which we are drifting. To preserve our professional standing we must preserve our friendship with honest druggists-our best friends.

A TREATMENT FOR SPRAINED ANKLE.*

BY J. SHEAHAN, M.D., ST. CATHARINES.

When we speak of sprained ankle we understand an injury suddenly produced in that joint when its movements are carried beyond their normal physiological limits, or when the bones entering into its formation are deflected in some unnatural direction, without, however, producing actual dislocation. Then we find a stretching, or a partial rupture, or a complete rupture, of some of

* Read at the annual meeting of Ontario Medical Association at Hamilton.

the ligamentous fibres surrounding the joint, with injury to the synovial membrane and the tendons and tendon sheaths about it.

There are sprains by eversion, and sprains by inversion, the latter being more common. In sprains by eversion the foot is usually rotated outward at the tip, and flexed corresponding to the physiological movements. The ligaments on the plantar and inner surface of the foot are very strong, so that forced eversion or outward rotation is more apt to fracture the malleolus than to tear the ligaments, and possibly also to fracture the fibula, producing a Potts' fracture; however, less degrees of force do produce sprains of this character, with injury to the internal lateral or deltoid ligament. In sprains by inversion the foot is rotated inwards and extended (plantar flexion). If this happens without much inward rotation of the tip of the foot (adduction) the calcaneo-astragaloid ligaments and those below and in front of the external malleolus, and on the dorsal outer surface of the astragalo-scaphoid joint, are torn. The most frequent site of tenderness and ecchymosis is, therefore, below and in front of the external malleolus. On the other hand, if inward rotation (adduction) of the foot predominates, the joints between the calcaneum and cuboid and between the scaphoid and cuneiforms are more often contused, producing a sprain of the tarsus; the ecchymosis and tenderness is then farther forward.

Symptoms.

The injury is accompanied as a rule by pain, often of an intense throbbing character, and followed by more or less disability, swelling, heat and discoloration of the surrounding parts, even over the foot and leg. Peri-articular swelling is a marked and early symptom, because of the fact that the soft parts next the joint are not hidden under thick layers of muscle and fat.

Causes.

Injuries of this character may be caused by a variety of acci

dents.

The commonest are, falls, which either carry flexion or extension too far, or force the bones forming the joint in a wrong direction; or twists, such as occur when the patient suddenly turns about with the foot fixed.

Various conditions act as predisposing agents to sprains; amongst the most common are a previous injury of a similar nature, which leaves a weak joint behind; or a deformity or mal-union of a fractured tibia, which places the joint at a mechanical disadvantage and alters the normal line of transmission of the body-weight.

Lesions.

The actual lesion which occurs when the ankle joint is sprained varies considerably in different cases and is often difficult to determine accurately. The chief effect of the injury always falls on the ligaments, and they are damaged to a greater extent than any other structures of the joint; in fact, the degree of sprain is determined by the extent of injury to the ligaments.

In the mild forms the ligaments are merely overstretched; in others they may be torn from a small amount in the medium to an extensive degree in the severe injuries.

In the severe injuries the ligaments are torn across, or detached from the bone, opening the joint capsule; or portions of the bone, usually the tip of one or other malleolus, may be detached along with the ligaments.

Results.

The results of these injuries will vary with the severity of the lesions. The immediate effect is the occurrence of pain. Then swelling of the joint rapidly follows.

In the milder cases, when the ligaments are simply overstretched, there is comparatively slight swelling immediately after the accident, but a synovitis may subsequently occur and give rise to much trouble. In the more severe cases there is usually considerable effusion of blood at the time of the injury, and this will produce a certain amount of immediate swelling of the joint. This swelling is later increased by the occurrence of synovitis.

The remote effects of sprained ankle result partly from the synovitis and partly from the imperfect union that not uncommonly occurs in the torn fibres of the ligaments. The latter condition is especially troublesome later in the course of the case, and gives rise to that feeling of weakness which is so common a result of neglected sprains.

Unless the synovitis be actively treated it may lead to a permanent weakness of the joint from over-distension or from adhesions between various parts of the synovial surfaces, which, although fibrinous at first, may organize into fibrous tissue, and thus interfere with the proper movements of the joint.

It is also well to bear in mind that when there is considerable hemorrhage the blood is very slowly absorbed from the articular cavity, in which it remains fluid for a considerable time.

All sprained ankles, when the foot has been thrown out or everted, are liable to be followed by a weakened arch or the development of a valgus, so these sprains should be treated with the foot well thrown in, inversion, and later a proper lace shoe with an arch support should be worn.