tensive powers which might be wisely used. Many sonianism. Expectancy was considered preferable to influential members neglected to join their county heroic treatment by some of the most astute physimedical societies merely because the legal penalties cians, and homœopathy seemed to some a medium for not so doing were removed. The law remained, between doing too much and nothing at all. It was and men of high public spirit should have obeyed it, a very seductive and delusive system to many poetic penalty or no penalty. In fact, they should have re- and imaginative souls, and it finally threw great light doubled their efforts to fill up their ranks and increase upon the natural history of disease, which no one but their influence. enthusiasts would have dared to seek. It is true that the position was a rather peculiar and difficult one, viz., that of restraining the Brobdingnagian grossness of Thompsonianism on the one hand, and the Liliputian absurdities of homoeopaths on the other. Numbers, science, and abstract reason, without the aid of broad common-sense and prudence, were and still seem destined to fail for a long time. In 1846 and 1847 the American Medical Association and the New York Academy of Medicine perpetrated these errors of policy. It is true that, in 1823, the medical societies of the State and counties of New York had declared that the medical profession should be exercised with fidelity to its scientific principles and approved doctrines, and that a departure from these constituted quackery. But in old times every homœopathic physician had been educated in the regular way, and almost all of them fell back, as they now do, upon approved methods in every great emergency, and some of them could have been led back into the regular ranks. It is a wise saying that "all prejudices, however inveterate and apparently unreasonable, have, in some obscure way, an honest origin, and are most generally just inferences from narrow premises, which pride, passion, or interest prevent their adherents from at once acknowledging; and when ignorance comes in aid of any or all of these causes, it opens a wider scope to their influence." All epidemics in the moral and scientific worlds must have a certain course or run, and require the wisest and most Christian or politic treatment. If prejudice is met with prejudice, passion with passion, pride with pride, and class interest by class interest, an endless war ensues, during which the public and the profession suffer. It is not right to regard every one who differs from us in law, politics, religion, and medicine, as wholly a scoundrel. There were always in the homoeopathic, and even in the eclectic ranks, men with a reasonable amount of knowledge of medicine, and of passable morality, who were honestly but blindly pursuing what they conceived to be new and useful light. The wonders of magnetism and electricity had excited a belief in the marvellous, and many have a pitiful but honest craving after miracles and marvels. Medicine was more imperfect forty years ago than now, and part of the usual practice with antimony, mercury, and bloodletting was as injudicious and perhaps as terrible, both in seeming and in results, as Thomp The best educated, most honest, and practical of the homœopaths would, perhaps, long ago have been in the regular ranks, if treated wisely and tolerantly. In the first burst of their enthusiasm, they, like Dr. Paine, spoke disrespectfully of the medical profession, and published severe and even slanderous newspaper and other articles against it. The larger mass of medical men thought they could easily crush a small band of unreasonable and unreasoning enthusiasts. But as long as the regular profession could not cure all diseases certainly, quickly, and pleasantly, a large number of the laity sided with those who believed they could and promised they would; and others saw no great choice in being severely vomited by tartar emetic or lobelia. It is also true that the regular profession of this city devoted itself most earnestly to the study and diagnosis of disease, and founded the Pathological Society in 1844, while the exclusives, viz., the eclectics and homœopaths turned their whole attention to deluding themselves and the public that they had made and were constantly making the most wonderful advances in the treatment of all diseases, especially incurable ones. The studies of the regular profession seemed to carry it away from the sympathy of the public, while those of irregulars appealed directly to it. Of course, the one became unpopular, while the others grew in public admiration. This continued until the great discoveries by aid of the microscope, ophthalmoscope, laryngoscope, stethoscope, etc., etc., carried the regular profession so far in advance that specialties in medicine had to be established, followed by specialties in therapeutics, leading to the grand discoveries of the bromides, chloral, carbolic acid, nitrite of amyl, salicylic acid, the hypodermic syringe, and hosts of remedies for formidable diseases, which paled all the petty appliances of the homoeopaths and eclectics, and commenced to convince the public and most of the irregulars that the regular profession was more than their peer, both in the study and cure of disease. Finally, the imperfect law of 1874 became the entering wedge for restoring the regular profession to its lost rights and influence. The majority of the homeopaths use the new discoveries of the regular school more than they do their old remedies; the so-called new school of homœopaths has become the old school of medicine, and the Thompsonians and eclectics were always in their doses and remedies merely an ill-cultivated branch of regular medicine. RURAL HYGIENE. Reviews and Notices of Books. CYCLOPEDIA OF THE PRACTICE OF MEDICINE. Edited THE present season naturally suggests the feasibility by DR. H. VON ZIEMSSEN. Vol. xiv. Diseases of the Nervous System and Disturbances of Speech. By Prof. of a temporary absence from the city and its possible A. EULENBURG, Prof. H. NOTHNAGEL, Prof. H. VON advantages. Although the practice of ruralizing is ZIEMSSEN, Prof. H. JOLLY, Prof. A. KUSSMAUL and becoming more and more extensive, the evils which Dr. J. BAUER. Translated by E. Buchanan Baxter, have become associated with it have been proportionM.D., and Alexander Morison, M.B., Edin., of London; David F. Lincoln, M.D., George B. Shattuck, M.D., ally magnified. In consequence of the demand for Samuel G. Webber, M.D., of Boston; and J. Haven country board, a large number of farmers have thrown Emerson, M.D., and John A. McCreery, M.D., of New York. ALBERT H. BUCK, M.D., Editor of American open their doors for customers, and vie with the counEdition. New York: Wm. Wood & Co., 1877. try hotel-keepers in the general unsanitary condition of their premises. Even in the so-called model farm-erai practitioner meets in his daily routine to which THERE is probably no class of diseases which the genhouses, the first-class country hotels, and in the larger he brings less positive knowledge and less definite establishments of the more fashionable resorts, we ideas, and the care of which he therefore undertakes often find the foul and reeking privy vaults in close with less comfort to himself and less good to his paproximity to a well; the rooms, if not small and close, tient, than diseases of the nervous system. at least unventilated; while the dietary is stamped with the most objectionable features of boarding-sel may be invoked by the physician in charge. But house management. Under the circumstances, except for the out-door life which the season invites, many of the guests would suffer from serious attacks of ill-lytic or the aphasic, must be undertaken by the genness. The religious camp-grounds, in many instances, need much more sanitary supervision to make their continued occupation from year to year free from danger. All these are certainly drawbacks; but there is no doubt that the benefits of ruralizing are sufficient to warrant every hard-worked, nervous, overstrained Metropolitan in being temporarily absent from his home-free for a time from business cares, and free to enjoy a change of scene and condition, which, at this season of the year particularly, he so much demands. In large cities a certain number of such cases may be turned over to the care of specialists, or their coun throughout the vastly greater portion of the land even victim of neuralgia, chorea, or epilepsy, for the parathis aid is not available, and whatever is done for the eral practitioner. It is with pleasure, therefore, that we note the amount of space in this Cyclopædia devoted to Diseases of the Nervous System. It is one of the greatest merits of a work like this that it not merely contains valuable treatises on the diseases we are most familiar with, like pneumonia and dysentery, but that it supplies its thousands of readers with equally exhaustive and practical papers on subjects with which they are but little familiar, and which are very briefly and unsatisfactorily handled in our general works on practice. The volume now before us begins with an article on Vaso-Motor and Trophic Neuroses, from the pen of the well-known Prof. A. Eulenburg, of Greifswald. A few pages are first devoted to the subject of Hemicrania, with regard to the etiology and pathology of which the author confesses his ignorance in a way that is truly refreshing. When speaking of treatment he scouts the guarana humbug, finds quinia and ergotine of use sometimes, nitrite of amyl temporarily valuable, both in treating the paroxysm and the intervals, to the but dangerous, and attaches the greatest importance, constant galvanic current, for the employment of which he gives special directions. Let the numerous victims of migraine in the medical profession try it on their abundant evidence for or against the remedy. own aching heads, and they ought soon to accumulate Angina pectoris, which next claims attention, is discussed in an able and instructive manner, being divided into the following types: 1. Excito-motor cardiac or cardio-centric, ganglionic angina pectoris, from direct lesion of the automatic excito-motor ganglia of the heart. 2. Regulator angina pectoris, from lesion of the cardiac nerves of arrest. 3. Excito-motor sympathetic angina pectoris. 4. Vaso-motor angina pectoris. The symptoms of these various forms are given, and the treatment, though confessedly unsatisfactory, at least makes an attempt at being rational. After a brief discussion of unilateral progressive atrophy of the face-one of the curiosities in medicine -thirty pages are devoted to Basedow's disease, also called exophthalmic goitre. We regard it as a mistake in the translator or editor not to give this name as a synonym in the text, nor allude to it in the index, inasmuch as, right or wrong, it is the name by which the disease is best known in America. The constant employment of the word "struma" for "goitre" is open to the same objection. Prof. Eulenburg differs from von Graefe in not regarding the loss of power to move the lid in harmony with the eyeball, in looking up or down, as pathognomonic of Basedow's disease. Nothing new or definite is given on the pathology of the affection, while in the way of treatment the greatest good is claimed from galvanization of the sympathetic. Among the trophic neuroses, progressive muscular atrophy, pseudohypertrophy of the muscles, and true muscular hypertrophy each claim a section. In speaking of progressive muscular atrophy the author cautions against the "do-nothing" treatment, and claims that early cases are improved or arrested by the use of electricity and "medical gymnastics." In a later portion of the book, Eulenburg again appears with chapters on catalepsy, tremor, and paralysis agitans, and a few words on Hammond's disease or athetosis. Prof. H. Nothnagel, of Jena, occupies but a comparatively small space in an excellent discussion of the questions of epilepsy and eclampsia. He disagrees with Russell Reynolds in his rejection of "reflex epilepsy." The question as to the causes of epilepsy is divided into: "1. What influences produce the epileptic change? and, "2. What produce the outbreak of the symptoms? It is taken for granted that the change is brought about gradually, that it may depend on "lesions of a definite anatomical kind," or on "factors not appreciable anatomically," and again later (p. 210) we are told that "epilepsy may be developed altogether spontaneously, without any inducing influences whatever at present known." But if anatomical changes are to be found, we are not left in doubt as to where to look for them. "The pons and medulla oblongata are the seat of epilepsy; if any anatomical changes exist they are to be sought for in these parts" (p. 262). And yet the author admits that "probably no uniform, constantly recurring histological change generally forms the basis of epilepsy." The entire discussion on the pathology of the disease will bear study. In the treatment of epilepsy, Nothnagel puts more confidence in bromide of potassium than anything else, though by no means lauding it as infallible. He begins treatment with 75 grains (5 grammes) a day. and increases it to 10 or 15 or even 20 grammes (150 to 300 grains). The section on Tetanus is contributed by Dr. J. Bauer, of Munich. It is rather more surgical in its character than most of the articles in the Cyclopædia. The author does not believe in the inflammatory character of tetanus, nor does he altogether accept the theory of simple increased reflex irritability. Under the head of treatment he has a good deal to say about the treatment of the wound, and relies for the tranquillization of his patients upon chloral and bromide of potassium. The subject of Chorea is handled by Dr. von Ziemssen himself in his usual interesting and instructive manner. The distinction is first clearly drawn between what should be included under this name and the so-called Chorea magna sive Germanorum, the dancing manias and simulated spasms formerly confounded therewith. Due credit is given to English observers as having furnished the most valuable contributions to the study of this subject. The cerebral nature of chorea is maintained, though it is not claimed that the brain is the exclusive seat of anatomical change. The prognosis is declared to be gener ally good. The pages on treatment give quite a long list of remedies bearing some reputation in this line, among which arsenic seems to be most favorably noticed, while strychnia and bromide of potassium are declared to be useless. Prof. F. Jolly, of Strasbourg, furnishes a thorough little treatise, covering one hundred pages, on Hyste ria. He carefully goes over the whole ground of the relations of this affection-which he designates as a general functional neurosis-to various physical and psychical conditions. While, so far as we have observed, nothing new is advanced, the reader is furnished with a summary of what is at present known on this interesting subject. But probably that portion of this volume most worthy of notice is the one which we shall be obliged to dispose of hurriedly in the limited space still left us. We refer to the three hundred pages occupied by Prof. A. Kussmaul, of Strasbourg, in a discussion of the Disturbances of Speech, which he himself mod estly characterizes as "An Attempt in the Pathology of Speech." Notwithstanding the many uncertainties and obscurities in which this subject is involved, no thinking man can begin the perusal of these pages without being lured on from chapter to chapter by the fascination which belongs to this border-land between the material and what we have been wont to regard as the immaterial. The mere mention of some of the sub-headings of chapters will be sufficient to indicate the general range of the discussion: “Speech as a Movement of Expression and an Acquired Reflex; The Principle of Sound-Metaphor; Sensory or Instinctive in Contrast to Intelligent Judgment; The Three Stages of Language; The Centre of Speech a Great Central Organic Mechanism; Speech and Consciousness; Sensory Channels of Language; The Localization of Speech; Aphasia; Word-Deafness; Word-Blindness; Syllable-Stumbling; Deaf-mutism, and the Education of Deaf-Mutes," etc., etc. Passing to and fro from the physical to the metaphysical. from physiology to psychology, Prof. Kussmaul interests his reader equally in the known and the unknown, and stimulates the keenest desire to penetrate still further into this mysterious realm of thoughtmechanism and the philosophy of speech. The subjects here discussed are too novel and unfamiliar to the general reader to be satisfactorily represented by a few quotations, or any attempt at a brief abstract of the same. We must, therefore, content ourselves with the above general reference to Prof. Kussmaul's admirable work, which, in our opinion, constitutes the great charm of this volume. One thing which is quite noticeable in the later numbers of the Cyclopædia is the increasing number of references to the other volumes, thus giving a unity in diversity to the work as a whole, and show ing the high esteem in which it is held by the best thinkers in Germany. Reports of Societies. THE NEW YORK NEUROLOGICAL Anniversary Meeting, May 6, 1878. THE meeting was called to order by DR. E. C. SEGUIN, the retiring President, who gave a brief review of the work done by the Society during the year. He then introduced DR. J. C. SHAW, of Brooklyn, the President-elect, who thanked the Society for the honor it had conferred upon him in making him its presiding officer. In lieu of an inaugural address, he presented a contribution to the discussion of the paper for the evening, which was then read by DR. E. C. SEGUIN, and entitled ing to Charcot, in the early stages of ataxia. It was a mixed type. The microscope showed the lesion to be sclerosis, and not secondary degeneration. The remainder of the cord was normal, with the exception of the part about the central canal, which showed a multiplication of nuclei, an enlargement of the peri-vascular spaces, and an obliteration of the central canal; probably peri-ependymal sclerosis. THE PRESIDENT, Dr. Shaw, reported three cases in which there were almost no pains, yet well-marked ataxia was present in two cases at post-mortem, though sclerosis of the posterior columns existed. The third case was yet living. His patients were two (living), 36, and 62 years. males and one female, and aged respectively 43 He was of the opinion that the electric-like pains were by no means uniformly present as an early symptom of locomotor ataxia. DR. HAMMOND doubted whether Dr. Seguin's case should be called one of locomotor ataxia. He thought that examination of the specimens with the low power showed that it was one in which there was simply A CONTRIBUTION TO THE PATHOLOGICAL ANATOMY OF sclerosis of the columns of Goll, and was like Pier SCLEROSIS OF THE POSTERIOR COLUMNS OF THE The essential symptoms in the case which was made the basis of the contribution were as follows: A male patient, æt. 58 years, was first seen by Dr. Seguin, Dec. 7, 1876. At that time the following record was made: for four or five years he had had burning numbness in the feet and legs, and recently as high as the umbilicus. Within the last three months he had had the same sensation in the fingers of both hands. In the February following the same symptoms were present, with the addition of distinct constriction bands about the lower part of the abdo men. Patient lost sight of. ret's case. DR. SEGUIN regarded it as a case in which the sclerosis involved more than the posterior median columns or the columns of Goll, and stated that examination with a higher magnifying power showed marked sclerosis in certain parts of the columns of Burdach. In that view he was sustained by Dr. Spitzka. DR. SPITZKA suggested that the peripheral numbness was due to causes of which at present we had but little knowledge, and in that opinion Dr. Seguin coincided. DR. HAMMOND referred to two cases which bad lately come under his observation, in which the ataxic symptoms were well marked, yet in neither instance had the patients suffered from any pain whatever. He agreed with Dr. Shaw in the opinion that electriclike pains were not such early symptoms as had usually been supposed. He had come to regard inequality or marked contraction of the pupils as one of the earliest symptoms. In some cases the gastric symptoms were prominent very early, and might exist twelve or fourteen months before ataxia was developed. He was seen again, October 14, 1877, when the leading symptoms were extreme anæmia and general debility. Diagnosis, agreed to by Dr. E. D. Hudson, Jr., pernicious anæmia. Numbness still present in legs and fingers. At that time, an attack of sharp pain, localized in the left heel, occurred, lasting several days. His daughter stated that he had similar pain in the left thigh, in the month of August. Those were the only pains the patient had ever had. Repeated testing of co-ordination of hands and feet had DR. MCBRIDE referred to a case in which he had failed to show any ataxia. When first observed the observed numbness of the fingers of both hands, viopatient could stand and walk with the eyes closed. lent pains of the sticking variety, inequality of the At no time was there vesical paresis or spinal epi-pupils, very slight anesthesia, absence of the "knee lepsy, or atrophy of muscles, or anesthesia. There were no symptoms in the head or the eyes. Death by asthenia. phenomena," and yet there was no history of crises or ataxia. He further referred to observations made recently by Westphal, who maintained that the absence of Autopsy, thirty-six hours after death, showed, be- the knee phenomena" was a diagnostic point of great sides a number of non-nervous lesions, slight opa- value. [The term knee phenomena relates to the folcity of the central arachnoid, an enormous accumula-lowing facts: "If the ligamentum patellæ be struck tion of calcareous plates in the spinal arachnoid, over in a healthy man while the knee is flexed at a the posterior part of the cord, low down. The cord right angle, or nearly so, a sudden contraction of low down. The cord appeared normal to the naked the extensor muscles on the front of the thigh may eye. After immersion in bichromate of potash solu- always be felt."-London Med. Record, March 15, tion, the spinal cord showed to the naked eye well- 1878. marked sclerosis of the posterior columns. It was most marked in the upper lumbar enlargement, and extending to the uppermost part of the cord. It involved nearly the entire posterior median columns and more or less of the adjacent white matter. There existed, however, a band of normal white matter between the posterior horns and the sclerosed portion; consequently the distribution of the sclerosis was not strictly that of ascending degeneration or of the sclerosis of the columns of Burdach present, accord The question of interest was whether the knee phenomena was not already present before the characteristic symptoms of posterior spinal sclerosis were developed; and also whether its absence might not, therefore, in some cases, afford material aid in forming an otherwise difficult or impossible diagnosis. Discussion was continued at some length by Drs. NEW YORK ACADEMY OF MEDICINE. SURGICAL SECTION. Stated Meeting, May 14, 1878. PLASTIC APPARATUS IN TREATMENT OF FRACTURES. DR. S. B. ST. JOHN read a vigorous and exhaustive paper upon the above subject, in which he advocated the use of the plaster-of-Paris apparatus. The interest in the paper centred in the review and criticism offered upon the lecture given in Bellevue Hospital by Dr. Frank H. Hamilton upon the Treatment of Fractures of the Shaft of the Femur in the Adult, and published in THE MEDICAL RECORD for Dec. 1, 1877. By the term "plastic" was meant any form of dressing, which, when first adjusted, was soft and yielding, and subsequently became firm and unyielding. Dr. St. John, however, confined his remarks to the plaster-of-Paris dressing, inasmuch as in the clinical lecture referred to it had been condemned with out reservation. VALUE OF STATISTICS. roller bandage was contraindicated, and most certainly such cases were not proper for the application of gypsum or any form of plastic splints. TEST OF VALUE FOR ANY APPARATUS IN THE TREATMENT OF FRACTURES. It was believed that the test of value for any dressing applicable to the treatment of fractures, was its ability to prevent shortening or to reduce shortening, if it must occur, to the minimum degree. QUOTATION FROM THE CLINICAL LECTURE. Dr. St. John then quoted from the clinical lecture to the effect that Dr. Hamilton had stated that the introduction of the plaster-of-Paris dressing was several steps backwards; that he had seen more shortening and crooked limbs since its adoption than ever before; that it afforded no means whatever for maintaining extension and counter-extension; that he had seen two or three deaths occasioned by its use; that he was happy to say it was almost abolished, and was sure that it would not be employed more than once or twice in country practice (see MEDICAL RECORD, 1877, p. 754). Certainly no condemnation could be more complete, and Dr. St. John maintained that if those opinions were not endorsed by Dr. Hamilton's profes sional brethren, he (Dr. H.) had done the medical The value of statistics was first considered, and it was believed to be a fair and legitimate inference that such as came from large and well-regulated hospitals could be relied upon as a basis for scientific deduc-profession a great wrong. tions. The qualification of, the competition among, and the honest emulation which stimulated the internes was regarded as a guaranty of the excellence and reliability of the clinical facts which they recorded and the statistics which they collated. DISLIKE FOR PLASTIC APPARATUS. With reference to plastic dressings, they were disliked by three classes of surgeons: 1. Those who were fond of fussing and pottering. of tying and untying strings, of loosening and tightening straps, and of shifting pads and cushions. 2. Those who had invented splints to fulfil certain indications; and 3. Those who based their convictions, with reference to the value of any given plan of treatment, upon careful trial, accurately noted results, and a comparison of the results obtained with those derived by other methods in similar cases. It was the latter class Dr. St. John hoped to reach. INDICATION FOR THE USE OF SPLINTS. The indication in the use of splints in the treatment of fractures was, to hold the fragments of bone in position, and to accomplish that most successfully they should be equably fitted to the shape and contour of the limb. ADVANTAGES CLAIMED FOR THE PLASTIC APPARATUS. The advantages claimed for the plastic apparatus were: 1. Little tendency to displacement of the splint; 2. Freedom to the patient to go about (in case of simple and uncomplicated fractures); 3. Less irritation, less pain, and less extravasation of blood; 4. Less liability to excoriation; and 5. Uniform compression. In order to realize those advantages the gypsum splint must be judiciously applied. It was not difficult to apply a plaster-of-Paris splint so that it would present a very neat-looking appearance, but such a splint might be very far from a judicious dressing for the fracture. There were several conditions in which a limb might be placed that would decidedly contraindicate the use of any form of dressing which did not permit of its prompt inspection at any time. There were cases in which even the application of a simple If those opinions were coupled with a preceding sentence in the same lecture-"The fracture is so oblique, that unless the fragments are maintained in position by extension and counter-extension, they always (a general law) overlap each other"-a most promising text was presented to lawyers, from which they could prove that some of the most eminent surgeons in the world were ignoramuses and unworthy to be trusted in the application of their art. THE QUESTION FOR DISCUSSION. The question for discussion was not whether the plaster splint was the best that could be employed, but whether it was, under any circumstances, a justifiable method of treatment. TEST OF VALUE FOR ANY SURGICAL PROCEDURE. Theoretical; 2. The endorsement it received by reThe test of value for any surgical procedure was: 1. presentative men; and 3. Comparative results, as shown by careful and accurate statistics. With reference to fracture of the femur, one of the main elements in deciding as to the value of any method of treatment was its ability to prevent shortening, and upon that point Dr. St. John made the unqualified assertion that the plaster of-Paris dressing could prevent shortening. When the fragments had been placed in proper position, the plaster could be so applied as to prevent any tendency to shortening. It was a passive apparatus when the muscles did not try to produce shortening, and became resistant only when the muscles became active. CONSIDERATION OF THEORETICAL OBJECTIONS. The plaster-of-Paris splint had been objected to theoretically because when applied sufficiently tight to maintain extension, it became a source of constant irritation unless the greatest care and nicety was exercised in its application, and that such constant irritation was inevitably followed by damaging effects upon the perineal tissues. It had been maintained in the clinical lecture referred to, that if the plaster was put on so that extension was maintained, the pressure would cause ulceration, and the author of the lecture had referred to one case in which extensive ul |