"The opinion of a medical man is competent as to matters which he has not made a specialty in his study or practice.

"A medical man is not disqualified to give an opinion because he is not a graduate of a college and does not possess a license to practice; or is not at the time in practice; or because a case exactly like the one in question has never been seen or read of by him before.

"A medical man is an expert on the value of medical services, but not as to the measure of damages. "The jury are not bound by the opinions of medical experts.

66

Books of science and art are not admissible in evidence to prove the opinions contained therein; but books of exact science are admissible. An expert may testify to an opiniou of his own derived from books; and when a witness has referred to a book as an authority for an opinion, the book is admissible to test his knowledge or to contradict him.

"A witness testifying to matters of opinion may be impeached by proof that upon a former occasion he had expressed a different opinion.

The qualifications of persons offering themselves as experts may be tested by the opinions of others in the same calling.

The qualification of a witness to testify as an expert is a question for the trial court, whose decision is not generally reviewable on appeal.

"The opinion of a witness as to his own qualifications is irrelevant.

"One not an expert may give an opinion, founded upon observation, that a certain person is sane insaue."

66

or

Such are some of the dogmas which are based on decisions of the highest courts in the various States of this country. Illustrative cases fully adjudicated, of which a great number are cited by Mr. Lawson, appear on every page of his book, and relieve it of the dryness which is said to characterize the literature of the law. The following quotation from a decision by Judge Temple, of the Supreme Court of California, will be an appropriate conclusion to this section of the Report: Expert witnesses ought to be selected by the court, and should be impartial as well as learned and skillful. A contrary practice, however, is now, probably, too well established to allow the more salutary rule to be enforced; but it must be painfully evident to every practitioner that these witnesses are generally but adroit advocates of the theory upon which the party calling them relies, rather than impartial experts upon whose superior judgment and learning the jury can safely rely. Even men of the highest character and integrity are apt to be prejudiced in favor of the party by whom they are employed; and, as a matter of course, no expert is called until the party calling him is assured that his opinion will be favorable. Such evidence should be received with great caution by the jury, and never allowed, except upon subjects which require unusual scientific attainments or peculiar

skill." 1

The two latest baronetcies conferred on medical men in England were bestowed on Sir Joseph Lister and Sir William Bowman. The latter is an honorary member of the Massachusetts Medical Society, having

been made so in 1881.

1 Ibid., page 243.

Heports of Societies.

BOSTON SOCIETY FOR MEDICAL OBSERVATION.

CHARLES H. WILLIAMS, M. D., SECRETARY.

DECEMBER 3, 1883.

DR. GEORGE T. TUTTLE read a paper on CASES OF MELANCHOLIA,

which is printed in full on page 77.

He

DR. WEBBER said he saw these cases generally in the early stages. His experience with opium had been favorable, but he had not used it in many cases. generally preferred valerianate of zinc and hyoscyamus, in one case he had added bromide of potassium. The prevailing tendency is to give chloral and bromide of potassium, but they may do harm when long continued. A combination of bromide of potassium and hyoscyamus often seems to be of service in melancholia.

In answer to a question as to the formation of an opium habit, the reader said that the patients do not know what they are taking, and the dose is usually reduced to a very small quantity before they leave the hospital. He had not known any bad effects from the drug.

DR. STEDMAN spoke of a case of melancholia lasting three months. The patient was twenty years old, and the attack had been caused by over study. Chloral and bromide of potassium in large doses had been tried without benefit. Opium given three times a day and a generous diet proved to be the best thing.

DR. FISHER said that he used narcotics less than

twenty years ago, when opium was the standard treatment. In many cases the relief is very great at first, but often they seem to be injured by the morphia, and may sink into a condition of dementia. In one case where no sleep could be obtained without morphia suicide had followed; in another case the opium habit was formed. It is always necessary to keep the patient under hospital control until the morphia is discontinued. Sometimes a solution of quinine may be substituted for it, the same quantity of liquid being taken at each dose. He thought that often more harm might result from omitting than from using the morphia, and he was inclined to think that since the treatment with chloral and bromide had been in vogue the reaction against opium might have gone too far.

DR. COWLES said that the cases cited by the reader included all the cases of agitated melancholia that had been seen at the hospital for the past four years. The main reliance has been a general supporting treatment. The authorities disagree on the advisability of using opium. Many German and French writers advise it, other French and English authorities condemn the use of sedatives. In agitated cases that go on badly after five or six months, it is well to use morphia or other sedatives vigorously. In some cases where cannabis and bromide are used early, and the insomnia is controlled, the patient is better able to get the benefit of the general treatment.

DR. FOLSOM said that there was still some difference of opinion in regard to the opium treatment of melancholia. From his experience he is inclined to think that opium has but little effect on the disease, but for a sedative to relieve the symptoms it is better than anything else. Many cases get well in two or three months if no harmful treatment is used. Business

men often work off an attack by giving up their occupation for one or two months, or by diminishing their amount of work; others, where the attack is more severe with specific delusions, may get well in from half a year to two years; but here the opium cannot be used continuously without doing harm. In epileptics opium is hurtful when used continuously, but may be safely given for periods of a few days. Many cases of melancholia that he sees have been taking bromides, bromidia, etc. The first step is to omit these, give ol. morrhuæ, malt, open air exercise, and many hours in bed; the amount of exercise must be adapted to each individual case, and must not be overdone, as too much is as bad as too little; sleep may also be encouraged by taking food during the night. In exceptional cases, where the delusions are severe and distressing, less harm will often result from opium than from allowing the patient to go without it. At Danvers he has seen a number of cases treated without opium with good results; it is not unusual to have two cases in eight recover. He mentioned the case of a young lady who had severe melancholia, with the delusion that she and all the family were to be killed by persons waiting outside the house. She had been taking bromide and chloral. These were discontinued, and Vichy, malt, and out-of-door exercise were prescribed. At the end of four months she was well. No sedatives were used, and the recovery seemed more complete and rapid than it might have been without these remedies. In answer to Dr. Bowditch, he said that he had known cases where the opium habit was acquired, but they were less frequent now than formerly.

opposite, and fully accounts for the left-sided paralysis. The fracture was slightly over five inches in length. It extended from a point in the left occipito-parietal suture one and a half inches behind the temporal bone, and traversed the suture, passing through the petrous portion of the temporal bone, the auditory canal, close to the inner side of the foramen ovale towards the foramen rotundum, where it terminated.

NECROSIS OF THE TEMPORAL BONE AND BRAIN ABSCESS.

Exhibited by DR. GUY HINSdale.

This specimen was removed from the body of M. P., aged forty-six, who died in the Episcopal Hospital September 21, 1883, after long-standing aural disease.

In early childhood she had scarlet fever; this was followed by aural catarrh, and the discharge from the

ear continued until her death. She stated that when twenty-two years of age a polypus could be seen in her ear. Fifteen years ago this was removed; again masses were removed thirteen years, two years, and one year, ago.

In May, 1883, four months before her death, the patient consulted Dr. Burnett, who has very kindly furnished me with notes of that date. The patient presented at that time a most wretched appearance. Extreme weakness, pallor, and emaciation betrayed the intense suffering of this unfortunate woman. Paralysis of the right side of the face had occurred during the previous winter without the supervention of additional ear symptoms. At the time of examination she presented great sensitiveness of the auriculo-temporal nerve, and complained of intense pain over the right temporal bone. To control this pain she was accustomed to use morphia suppositories. An examination

C. B. NANCREDE, M. D., RECORDER.

THURSDAY evening, December 27, 1883. The President, DR. TYSON, in the chair.

FRACTURE OF THE BASE OF THE SKULL.

Exhibited by DR. GUY HINSDale.

J. H. W., aged fifty, fell on the ice December 8, 1882, striking upon the stone pavement. The blow was received on the posterior and left side of the skull, and the skin was not broken. He was shortly afterward admitted to the Episcopal Hospital, and was totally unconscious. Blood was found flowing from his mouth and left ear, and his nose contained clots. His pupils afforded no evidence of his condition, because of an iridectomy which had been performed on both eyes some years previous. He talked incoherently; breathing was labored and at times stertorous. Paralysis of the left leg was noted.

Blood continued to issue from the left ear, and on the second day the discharge became thin, and continued serous until his death, which occurred on the eleventh day. The urine was examined several times, and found to contain sugar in moderate amount, but no albumen. Urine was passed freely. The patient never regained consciousness; he became more stupid, and paralysis of the left leg remained.

At the autopsy a superficial clot was found over the brain beneath the seat of injury. A very large clot was found over the right frontal region beneath the membranes, and filling the sulci between the convolutions. This was the result of the counter-stroke, the force having been first received at a point diametrically

entire lumen of the auditory canal, half an inch from the entrance. Late in May a large polypoid mass was extracted; bare bone was then discovered on the posterior portion of the canal, the channel narrowed and blocked with granulations. About two fluid ounces of blood escaped after removing this mass.

When I saw the woman at the hospital in September she was in a very low state, and evidently near her end. Her mind was seriously affected, conversation was impossible, and she groaned with the pain, which large doses of morphia would not altogether control. There was a moderate but constant purulent discharge from the ear and from a sinus which was found above the meatus. The whole temporal region was boggy. The probe passed in freely over an inch, and loose particles of dead bone could be everywhere felt. The disease had long been beyond the reach of any remedy, and there was nothing to be done but relieve pain and await her death.

The specimen removed embraces portions of the right temporal, parietal, and occipital bones. Almost all the temporal bone has been destroyed. Only the mastoid process and the upper border of the squamous portion remain. An area of bone one and a half by two inches has entirely disappeared. Adjacent to this region, and lying next the middle fossa of the skull, was a brain abscess, the walls of which were greatly thickened. On opening this cavity about an ounce of thick yellowish pus was found. A probe easily reached this cavity through the auditory canal and the sinus above it, and many loose fragments of bone were found at the outlet. The styloid process was found loose, but held

DR. SHAKESPEARE said that specimen was a good instance of miliary tuberculosis. The small collection in the spleen might be tuberculous, he thought, and should have been examined for tubercle bacilli. He adverted to the successful employment of very weak solutions of corrosive sublimate in washing out suppurating serous cavities.

ATHEROMA, DILATATION, AND ANEURISM OF THE AORTA; ATHEROMA OF SOME OF ITS BRANCHES ; DEATH FROM RUPTURE OF THE ANEURISM INTO

FORMITY OF THE STOMACH; MALPOSITION OF THE

TRANSVERSE COLON AND RIGHT KIDNEY; IRREGULAR SHAPE OF THE KIDNEY; ANOMALOUS ORIGIN

OF THE RENAL ARTERIES AND OF THE URETERS.

By J. H. MUSSER, M. D.

This remarkable series of specimens illustrates how serious a disease can be in progress within the body without any manifestations. The patient had been under the care of Dr. Ludlow in the Presbyterian Hospital, complaining of, and being treated for, nasal catarrh. He complained, also, of a slight bronchitis, but, it not being very decided, the nasal trouble alone was treated. A white man, aged sixty-three, well nourished, of temperate habits, and by occupation a wheelwright. He was under observation ten weeks. No previous illness. He slept well the night before his death until five A. M. He then told the night nurse he was very cold. Being covered, he went to sleep apparently; an hour afterwards he was found dead. The writer made the autopsy about twelve hours after death.

Inspection. Rigor mortis well marked; body well nourished; no scars or bruises; no ecchymoses; abdomen moderately distended; in the right lower quarter a decided swelling was noticed, almost filling that area and resonant on percussion.

Section. Abdominal cavity first examined. The above-described swelling was due to the cæcum and transverse colon. The ascending colon extended about half way the usual distance and then turned at a sharp acute angle into the transverse colon. The latter descended parallel to the former into the right iliac fossa, and from thence diagonally upwards across the abdomen to the usual place of junction with the descending colon. The omentum contained a considerable amount of fat. The right lobe of the liver could not be seen until removal of the ribs, when it was found two inches above their margin and to be only two and one half inches in length in the nipple line. In the median line this same perpendicular length was three and one half inches. More of the left lobe was visible than the right. Along the edge of the left lobe, from the median line, four and one half inches in length, extended the stomach. It appeared to be small in size. When removed it was found to be divided by a constriction five inches from the fundus; from this constriction to the pylorus the length was four and one half inches. The first or cardiac end was much smaller than normal, the walls and mucous membranes healthy. The second portion was a mere tube with thick walls. The thickening was due to the hypertrophy of the longitudinal muscular layers, and to the folds that the mucous membrane was thrown into. These folds were very marked, longitudinal, and, on their crests, congested. The peritoneum was opaque and thickened. The liver was smaller than usual also. The

It was

the pelvis at the right sacro-iliac articulation. small in size, irregular in shape, parallel to the sacrum. The portion dipping downwards tapered to a point, being one half inch in width; the upper portion was two inches wide. The pelvis of the kidney was filled with fat. Towards the small end of the kidney the bilus divided, one part extending upwards one inch along one side of the organ, the other the same length on the other side; or it might be said, a portion of the kidney dipped into the pelvis, separating it for an inch. The renal artery arose from the normal origin of the middle sacral. One inch from the point of origin it divided, one branch, one inch long, entered one lateral hilus, if it may be so termed, the other divided two and one half inches from the main trunk, one subdivision entering the remaining lateral hilus, the other running across the floor of the pelvis to the normal end of the kidney. The ureter arose in three branches - two from the upper end, one from one of the smaller pelves.

Thoracic cavity. Left pleural cavity almost filled with blood, the lung floating on the fluid. The lateral surface was adherent to the aneurism. In its removal the collapsed sac was seen on the left side of the vertebral column. The heart and aorta were removed entire. Heart enlarged, left side especially; measurements of left ventricle: round base, one and one eighth inches thick, in the middle, seven eighths inch thick, at apex, one half inch thick; mitral valves a little thickened; aortic healthy. Atheromatous processes were present in the aorta from its beginning to the cœliac axis, and extended into the latter vessel and also the innominate and carotid arteries. One calcareous plate was found in the coeliac axis. From its origin to the middle of the transverse aorta the vessel was dilated, and the characteristic fatty changes of the proliferated cells of the intima, lemon-yellow colored, smooth, soft elevations, were marked. Opposite the trachea the calibre of the aorta diminished to almost normal size, and here the sclerotic changes were most marked as well as around the mouths of the vessels. At the junction of the transverse and descending aorta the lumen was again closed. Here the aneurism originated. It was five and one half inches long, and, where distended, twelve inches in circumference. It was of the true variety, but from it sprung four false aneurisms, varying in size from a filbert to a small egg. Organized clots covered the surface of portions of the wall. Rupture of the sac took place behind and in pleural adhesions, and leaked into the cavity, finding its way through the adhesions. The vertebra were not eroded, and although the sac was in contact with the left bronchus there were no evidences of decided pressure upon it, while the relations to nerves, other vessels, and the oesophagus were such that the usual pressure symptoms could not arise.