pas fidèlement le cours de Farrington, cet admirable professeur?" *

We are not so sure about it, Dr. Arnulphy. When you pass your eagle eye over the list of textbooks recommended for use in our homeopathic colleges, in how many of these institutions américain do you find any serious mention of Hering, Hempel, and Dunham? These men, to be sure, are dead; but their works do live after them. We take no second place as lover and recommender of these homeopathic Grand Masters; and we go farther and say that if the homeopathic colleges would put these books into the hands of the class and stand by what is taught in them, very soon a better knowledge of Homeopathy would become apparent in student and practitioner. How many of the long list of professors in our homeopathic colleges, Dr. Arnulphy, do you suppose have read Dunham's unrivaled books, or possess them in fee-simple? How many of them know aught about Hempel save as a mere matter of memory or hearsay from some old-fashioned preceptor, mayhap? How many of them make use of or recommend Hering's materia medica?

Indeed, we question the advisability of recalling these three masters into the flesh, lest the modern students and practitioners of Homeopathy, not having known Joseph, turn upon and stone them, as was the fate of the olden prophets and teachers. For, think of it, just one calm mo ment-neither of these illuminati knew a single blessed thing about bugteriology, the microscope, gynecology, serum-therapy, and combination tablets. Of what avail, then, to return them to life, unless to show how utterly ignorant they were of the real secret of medicine. These men knew nothing except the curing of the curable sick. And even if the princely Farringtonpeace to his ashes, and honor to his memory! -were to be billeted for an hour's lecture on rhus tox., and permission were given the class, if they chose, to attend, during that hour, a surgical or gynecological clinic, how many vacant seats would be counted in the materia medica amphitheater? But why call on the dead? Why call on Farrington when we have his lineal descendant, and in his very chair, teaching as Farrington taught, with equal vim and vigor, and objecting to the materialistic and surgical trend of this generation, just as Farrington would have objected

The eloquence of neither of these great four would have availed in holding the class, so long as

other chairs taught, or pretended to teach, "short-cuts" to the alleged cure of all ills, from dandruff to chilblains, by means of the knife, and combination tablets, and antitoxin, and pix creosole. No single man, however enthusiastic or eloquent, could hope to hold a present-day class against the other thirty-five or forty teachers who belittled and bedeviled the one chair which alone gave the college its title to existence. The correction lies in changing the trend of the whole faculty, as did one of the foremost of Eastern homeopathic colleges.

And again we say, Dr. Arnulphy, that things homeopathically have gone most radically wrong since your departure from Chicago, America.

REMINISCENT.

-Under "Odds and Ends," in Clarke's Homeopathic World (London), we find a paper by R. H. Bellairs, on Psorinum, which moves us to ponder and wonder. We remember quite distinctly how a distinguished English homeopathic author and speaker, while visiting Atlantic City during the sitting there of the International Homeopathic Congress, insisted that Millie Chapman's recorded experiences with psorinum were, in fact, wholly imaginary, since psorinum was naught but an itch-pustule, and that, in the potency alleged to have been given by Dr. Chapman, no possible curative effect could have been experienced. And we further remember how our dear sister Millie "warped" it to the eminent gent., to the amusement of the American contingent and the somewhat discomfiture of the Englishman. Now comes an English writer admitting the value of this formerly tabooed remedy! In Bellairs' paper we find a valuable line or two credited to Experto Crede-whom we do not recognize, unless related to the other Crede who discovered his expressive method-which says that "Psorinum is the constitutional remedy par excellence for hay-fever. I believe that few cases can resist its influence-Crede." That, we also recall, has been Hahnemann C. Allen's contention for many years, and we remember how he gave it in that condition and produced wonderful re

sults.

*Which, being freely translated by our French assistant, is something like this: As to the study of materia medica in the American colleges; if it was not made interesting, it was the fault of the professors and their manner of teaching. Can anyone believe that Hering, Hempel, or Dunham, when teach

Could we believe this same conduct possible on the part of the class, if the admirable Farrington was teaching?"

tical, homeopathic remedies!

Cancer

of the Stomach.

The new work which Dr. Osler has prepared with the help of Dr. Thomas McCrae, contains a careful study of all the cases of cancer of the stomach which have been treated in the Johns Hopkins Hospital since its opening on May 5th, 1889, until March 31st, 1898. They number, in all, 150 cases, out of which the proportion of males to females has been as 5 to 1, while 57 per cent. occurred between the ages of forty and sixty years. The white and colored populations contributed in proportion to their relative numbers, but among the white patients it was noticeable that most were of foreign birth, and especially of British origin. Comparatively few gave a family history of cancer or of old gastric trouble, nor could the cases be referred in any special degree to alcohol, mental influences, local irritation, or injury. There were no cases under twenty years of age, but 6 occurred between the ages of twenty and thirty, and in these young persons the disease ran a rather rapid course, and terminated as a rule somewhat suddenly. A surprisingly large number had a history of an acute onset, and on admission the symptom most generally complained of was pain; next to this came vomiting, dyspepsia, and loss of weight and strength. The pain was generally aggravated by taking food; but in others, where neither the position of the growth nor the absence of ulceration afforded any explanation, the ingestion of food was followed by relief of pain. Vomiting was especially related to growths situated at one or the other opening of the stomach, these symptoms being less marked when the growth was upon the walls. In one case, in which the vomited matter was foul and fecal, so that communication with the colon was suspected, the odor was apparently due to sloughing of the growth, as no such communication existed at the post-mortem examination. The appetite was practically normal in a rather surprising number of these cases, though in about half there was decided anorexia. Loss of weight was a much more common symptom, and occurred even when there were no marked diagnostic features.

The authors properly lay great stress upon the value of the examination of the stomach contents by the stomach tube. They consider the presence of blood to be always suggestive of cancer. Free hydrochloric acid was permanently absent in most cases but was present in some.

Lactic acid was generally but not constantly found. In several cases the authors were able to detect masses of malignant tissue by microscopical examination of the stomach washings. A tumor could be recognized during life in 115 trium. Inflation of the stomach usually dragged cases, of which 48 were situated in the epigasthe tumor downwards and to the right, and contrary to the opinion of Broadbent, the authors assert that in their experience a much larger number of cases of dilatation are due to malignant disease than to any other single cause. They remark upon the occasional absence of both anæmia and cachexia, and attribute comparatively little importance to the evidence to be obtained from the examination of the blood as an aid to diagnosis, although in the differentiation of cases of cancer of the stomach from pernicious anæmia they consider that a blood count below one million red blood corpuscles is strongly in favor of the latter.

An interesting point to which attention is drawn is the fact that although as a rule cases of cancer of the stomach tend to get steadily worse, in certain exceptional instances there may be arrest of the downward course or even temporary improvement with increase of weight. In one of their examples this followed an exploratory incision, though nothing further was done on account of the extensive nature of the disease; in another a very positively reassuring opinion was expressed by a consultant. The authors' very careful consideration of all the elements of diagnosis leads them to the conclusion that the early recognition of cancer of the stomach cannot be made with certainty, and as they fully accept the opinion that the presence of a positively diagnosed tumor is a contraindication to radical surgical operation, they urge that exploratory incisions should be more frequently undertaken.

Where the growth is at the cardiac opening they are of opinion that gastrostomy should be done as soon as the obstruction is recognized, and before it constitutes any real hindrance to the taking of food, as to wait until the patient has become feeble, emaciated, and anæmic is to court disaster. They recognize the value, when pyloric stenosis has occurred, of making an artificial communication between the stomach and some part of the small intestine by which means life is prolonged, nutrition is improved, and discomfort lessened. Their views on the medical treatment of these cases are, as might be expected, not very encouraging but thoroughly sound. The best general tonic is in their opinion arsenic, and the

most valuable means for allaying symptoms and alleviating discomfort is the regular use of the stomach tube.

Kriegschirurgische Erfahrungen aus dem Sudafrikanischen Krieg.

The author of this small book, Dr. Küttner, was the chief of the German Red Cross Hospital with the Boers during the military operations of 1899-1900. The experiences here summarized were obtained mainly at the Modder River and the various engagements in the southwest of the Orange Free State until the taking of Jacobsdal.

The earlier pages are devoted to an account of the Roentgen ray equipment with the hospital; it seems to have been very complete, and in the hands of a special operator yielded excellent results. The author dwells on the difficulties experienced in this work, owing to the lack of clean water and the excessive prevalence of dust.

An interesting chapter is on the varying nervous shock following wounds by the small-bore rifles, and the remarkable attitudes assumed by the dead on the battlefield. The author is unable to explain these curious postures. Speaking of primary hemorrhage, the author remarks that it was rare to see much external evidence of bleeding, owing to the smallness of the apertures, but that internal hemorrhage was usually severe. The large arteries appear seldom to have been entirely divided, but the wounds inflicted on them was usually a clean cut through all the coats leading to severe, and in most cases fatal, hemorrhage. In wounds of the soft parts only by our Lee-Metfod bullet, the skin wound was found to be exceedingly simple and very small. These wounds. were often overlooked and primary healing almost invariable; no cases of clothing being carried into the wound were noted.

The author's observations on the effects of injuries to the nerve trunks are most interesting. In most of these cases the track of the bullet healed readily, but the subsequent symptoms indicated partial or complete paralysis corresponding to the distribution of one or more nerve trunks. These cases presented many anomalies. Though the symptoms suggested complete division of a nerve this was not always found to be the case; in many the division was complete, while in others it seemed as though the nerve merely grazed. This latter injury not only damages the nerve seriously, but leads to very rapid secondary degeneration. The pain in all these cases is acute, and often quite out of proportion to the apparent damage done. It is difficult under

was

these circumstances to resist some operation for amelioration of the acute symptoms, but the re

sults following explorations do not seem encouraging. It would seem as if absolute section or perforation of a nerve trunk was a less damaging injury than bruising by the passage of a bullet close to it.

Dr. Küttner is fully convinced that few cases in modern military surgery promise better results from surgical interference than injuries to the skull. The prevalence of gutter fractures is noteworthy, and these all justify trephining.

There is little to be learned from these experiences concerning the management of thoracic wounds, except it be that loose bone splinters should be removed, and that penetrating wounds seldom require any operative treatment. Hemothorax was very common, but the author does not advise aspiration unless the blood and clot can be thoroughly evacuated; this opinion is likely to

be correct.

One turns with interest to see what Dr. Küttner has to say regarding abdominal injuries in war, for among the many lessons learned during the campaign, few are of greater value than those having reference to the surgical management of gunshot wounds of the abdomen. Our German confrère holds the view that operative interference is rarely needed. He further dwells on the fact that rest and quiet are powerful factors toward recovery. Those left untended and unremoved from where they fell for some hours did much better than those who were carried off more or less at once.

Shell wounds and those from shrapnel, taken as a class, were not only terrible in their character, but extremely unsatisfactory to treat. Sepsis was difficult to prevent, the best results followed free irrigation combined with superficial and deep suturing of the soft parts when possible.

La Diphterie, depuis

Aretee le Cappadocien jusqu'en 1894.

Anyone who is skeptical as to the value of the antitoxin treatment of diphtheria receives strong re-enforcement here. The historical extracts which the author, Dr. Raoul Bayeux, has selected with excellent judgment from many old writers, ought to convince all that in its clinical aspects the disease has not altered one whit during the eighteen centuries that have elapsed since it was first described by Aretæus the Cappadocian. It has been more prevalent or more severe at one time than another; but even in its least deadly epidemics it still was fatal enough to be greatly dreaded. Dr. Bayeux's historical account further emphasizes the fact that during the ages intervening between Aretæus at the end of the first and Bretonneau at the beginning of the nineteenth century no improvement worthy of men

To Bretonneau and his immediate successor, Trousseau, we owe the systematic adoption of tracheotomy in laryngeal diphtheria; and it is difficult at the present time to realize the opposition that was roused against the frequent performance of this very necessary operation. Since Trousseau's day little advance was made in treatment until the year 1894. True, intubation, originally proposed by Loiseau and Bouchut, was revived by O'Dwyer; but it cannot be said that before the antitoxin era its results were more satisfactory than those furnished by tracheotomy. In 1894 the antitoxin treatment, the result of many patient researches into the question of immunity, was clearly and widely proclaimed to the medical world; and 1894 is the great date in the history of diphtheria. Dr. Bayeux has collected from every quarter of the globe well-authenticated statistics which clearly demonstrate the value of the treatment. To anyone wishing to study the question from the statistical standpoint, this portion of the book will prove a mine of information.

The rest of the work is occupied chiefly with an account of the treatment of laryngeal diphtheria by intubation. On this subject Dr. Bayeux is exceptionally well qualified to write. Not only has he an immense experience of this measure, but to him are due two notable improvements in connection with it, namely, the shortening and slight but important alteration in shape of the tubes, and the very simple method by which they can be removed from the larynx by external manipulation without the aid of any instrument whatsoever. It has, however, always seemed to us a pity that a less clumsy word than "enucleation" could not be employed to denote this operation.

In an able discussion of the indications for surgical intervention in laryngeal diphtheria the author draws attention to a symptom which he states to be of value, the contraction of the sternomastoid muscles during the act of inspiration. When this occurs there must be no further delay.

The Autobiography of a Quack and the Case of George Dedlow.

There is a story current that at a ladies' college situated in the medical quarter of London the teacher of English literature one day asked the pupils what was the old English word for a doctor, to which a fair lady replied, "I know please, quack." Though the damsel's knowledge was inaccurate, yet there can be no doubt that quacks form an interesting object of study, and Dr. Weir Mitchell has dissected his specimen with

Sandcraft and he had as a Christian name Ezra, of which he was of the same opinion as was Dr. Johnson with regard to Presbyterianism. "I was called Ezra, which is not a name for a gentleman."

Mr. Sandcraft would have been a delightful person to meet. We occasionally come across quacks, not necessarily medical, somewhat like him now. His views on conduct were simple. "A fellow has got himself to think about and that is quite enough. I was told pretty often that I was the most selfish boy alive. But then I am an unusual person and there are several names for things... A man must have an audience or make-believe to have one, even if it is only himself." Mr. Sandcraft, having started in "practice," supported himself at first by robbing his aunt. His "practice" led him into unsavory by-ways, and having been indiscreet enough to be mixed up in the case of one "Lou Wilson—the woman that died last year," he was blackmailed by a gentleman who knew the circumstances into posing as a coroner and giving a certificate for the death of a man who had been poisoned. Later he took up spiritualism, but having deceived an aged and trusted client, was severely beaten by the client's son. Mr. Sandcraft's remarks concerning men like himself are so apposite that we quote them in full: "Whenever a person has been fool enough to resort to folks like myself he is always glad to be able to defend his conduct by bringing forward every possible proof of skill of the men he has consulted." We take leave of Mr. Sandcraft dying in a hospital from Addison's disease and are really sorry to part with him. The Case of George Dedlow is a story of quite a different character and in some of its details reminds us of the immortal adventures of Captain Castagnette, but for a scientific piece of fooling it is excellent

De l'Anchylostome Duodenal
en General et de sa Propagation.

This is written by Dr. Hyac. Kuborn, who has had exceptional opportunities for studying the diseases of miners over a long period, and the record of his observations on ankylostomiasis amongst these workers in Belgium must be regarded as authoritative. The writer brings out very clearly the fact that the anæmia which was so frequently met with in miners thirty or forty years ago was not due to ankylostomiasis, but was brought about by bad hygienic conditions. The miners in those days worked excessively long hours in a vitiated and often poisonous atmosphere. They were badly fed, and their work was more exhausting than it is at the present

time when so many labor-saving appliances are employed. The symptoms of this form of anæmia were quite different from those of ankylostomiasis. The anæmia was of the chronic and chlorotic type, with pallor, dyspnoea, palpitations, œdema, etc., and with marked fall in the hemoglobin value of the red corpuscles. The anæmia The anæmia most frequently met with amongst miners in Belgium to-day, which is undoubtedly due to ankylostomiasis, is quite different. The symptoms are more acute, with pronounced and early gastrointestinal troubles. The stools are occasionally sanguinolent. The red corpuscles diminish in number rather than in hemoglobin value. It does not respond to iron, as was the case with the old anæmia of miners. The first appearance of ankylostomiasis in Belgium seems to have been in 1884; that is, about five years after it was recognized as existing amongst the workers in the St. Gothard Tunnel. It is assumed that the laborers, on the completion of the work, traveled to various parts of Europe, carrying their parasites with them. It is interesting to observe that the ankylostoma duodenale has been able to thrive at a temperature so low as that met with in Belgium. It is generally believed that the parasite requires a much higher temperature (70° to 80° F.) for its development.

Diabetes Mellitus and Glycosuria.

Dr. Emil Kleen's experience as a physician in Carlsbad has given him exceptional opportunities to study the occurrence, symptoms, pathology, and treatment of diabetes, and the present volume is the result.

We note particularly the stress which he lays on glycosuria as a condition apart from true diabetes mellitus. Under the latter condition are usually included different pathological conditions which are imperfectly understood, but which are characterized by a faulty metabolism as a result of which, under ordinary diet, there takes place the excretion in the urine of an abnormally large amount of sugar. Thus diabetes mellitus is not a clinical unit, but a syndrome, the chief and most constant symptom of which is glycosuria, which is represented by very varying clinical types. As Dr. Kleen points out, there are numerous cases attended with the excretion in the urine of minute, yet distinctly pathological, amounts of sugar, which cases differ widely in clinical aspect and in prognosis from the diabetic type, and which should not be included in the designation "diabetes mellitus," and it is more particularly from the point of view of prognosis that the practitioner will do well

to carefully observe and classify all cases which yield proofs of the presence of sugar in the urine. When the power of consuming the ingested and digested carbohydrates is but little, or momentarily, impaired, and when the pathological excretion of sugar under ordinary mixed diet only slightly exceeds the traces of sugar found in normal urine, or is but transitory, the condition must not be considered one of diabetes mellitus, but of simple glycosuria. When, however, the excretion of sugar becomes considerable and more persistent, but disappears when the carbohydrates are decreased or withdrawn from the food, the condition then prevailing, and which generally is accompaned by other more or less well-defined symptoms, Dr. Kleen suggests should be known as the "mild stage of diabetes," while he considers that the severe stage of diabetes is characterized by the occurrence of glycosuria, even when the carbohydrates are withdrawn from the food. We quite indorse this classification, although the limits thus fixed are far more distinct on paper than in the reality of clinical experience.

Of all races, the Hindoo is most susceptible to diabetes. Next the Jews are highest in the scale of diabetic frequency. Dr. Kleen has come to the conclusion that there is a trace of glucose in normal urine and that the amount in 24 hours scarcely exceeds one-thousandth of 1 per cent. Some slight or occasional increase beyond this may often occur without noteworthy significance, but as soon as hundredths or tenths per cent. are reached the condition must be considered pathological.

Dr. Kleen further points out that, although simple glycosuria often shows a decided tendency to remain unaltered for decades in spite of all sorts of pernicious influences, yet mild diabetes certainly not infrequently develops gradually from simple glycosuria, but it usually remains of the mild form.

Some useful hints are given, the first and most important rule being never to use for a test a specimen of urine passed when the patient's stomach is empty before the first meal of the day. This is a point which is frequently forgotten, with the result that a false impression of the case is received.

In the treatment of diabetes mellitus a rational diet must be followed, rather than an absolute one. By the latter term the author means a diet of meat and fat, with the strictest possible exclusion of carbohydrates. The difficulty is to decide in which cases of diabetes and at what periods carbohydrates must be entirely excluded, or where in moderate and strictly measured quantities they may be allowed. Herein lies the skill of the physician in the successful treatment of diabetes.