tution to be established for the treatment of eye diseases was the New York Eye Infirmary in 1820, by two brilliant young physicians of this city, Drs. Edward Delafield and J. Kearney Rodgers. This institution developed later into the New York Eye and Ear Infirmary. The interest taken in Ophthalmology by some of the noted general surgeons of the early part of the 19th century is well exemplified by the case of Dr. Samuel D. Gross. His graduation thesis was on "The Nature and Treatment of Cataract," and he became so prominent in ocular surgery, that he was sent as one of the delegates of the United States to the first International Ophthalmological Congress held in Paris in 1857. He was one of the first surgeons in the United States to operate for strabismus. Dr. D. Hayes Agnew was another noted surgeon who contributed largely to the progress of Ophthalmology. A bit of interesting history brought out in the sketches is the early distrust of the opthalmoscope, which was invented by Helmholtz in 1851. Clinicians feared that the reflection of such concentrated rays of light directly upon the retina might seriously affect the retina or the optic nerve. It is worth while to possess and read a work of this sort if only to gather inspiration from the lives of the pioneer masters of our art. J. B. THOMAS.

DISEASES OF THE NOSE, THROAT AND EAR, Medical and Surgical. By WILLIAM LINCOLN BALLENGER, M.D. Philadelphia and New York, 1908. viii, 905 pp., 14 pl., 8 vo. Price: Cloth, $5.50 net.

It is a pleasure to review this well-balanced work, which, from its clear exposition of the work being accomplished in this field, in this country, at the present time is deserving of warm praise. That it is the product of an American pen may, indeed, be a source of no little pride.

The

The first chapter is devoted to a brief description of the nose; the second, deserving of a reading by both specialists and practitioners, is devoted to the relationship of the nose to general medicine; the third, to office equipment, gives scant courtesy to spraying-apparatuses, but moderately defends the use of the cautery. author, whose work is so well known in this line, then proceeds with the clearest and best exposition of deflections and deformities of the septum nasi which the reviewer has met in any text-book. Two chapters of well-illustrated text complete the subject. In the latter the author defends his septum swivel-knife with fairness. In a later chapter, by the way, the same instrument is recommended for the removal of the middle turbinate, in properly selected cases. Under "treatment of inflammations" the author well says: "The grand purpose of treatment should be to promote the inflammatory reaction," and again, "inadequate reaction is usually present in most cases of acute inflammation." The old methods of increasing hyperemia and leucocytic migration, as poultices, counter-irritation, constriction by ligation, heat, incisions are noticed and the newer ones-leukodescent light, irrigations, etc.—are considered at greater length. Bier's treatment, as applied to nose, ear and throat, is given two pages. The opsonic index and the vaccine treatment of infectious diseases is briefly expounded.

Treatment of diseases of the accessory sinuses, for the past few years so ably developed by a multitude of surgeons, is admirably handled by the author. The uses of skiagraphy are emphasized. Many test figures are wisely employed here to aid the written description. An important chapter is given to "the tonsils as portals of infection" while the chapter on surgical treatment of the tonsils is very clearly presented. Chapters on "the singing voice" and "defects of speech" are not only well-written but likewise emphasizes the earnest aim of the writea to present a broad, true picture of the large field falling within the horizon of the present-day specialist. An adequate description of laryngeal diseases is given. Oesophogoscopy and laryngoscopy are presented briefly.

The portion of the work devoted to the ear contains

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much of value, in the method ia which it is offered, aod in excellent illustrations of operative procedures, but this part is perhaps less strongly presented. For instance we think the clauses on chronic suppuration otitis should be lengthened and inclute certain tubercular and syphilitic conditions, both of which may cause it, and obscurely so. The subject matter is excellent, the operations are described carefully and succinctly, but it might be extended. Perhaps a trifle less of the fine enthusiasm noticed in previous portions is noticeable. As a whole it is a notable book, in that it gives the latest thoughts as well as the solid body of well-settled essentials, in a wide field of medical work.

WILLIAM C. BRAISLIN.

THE TREATMENT OF DISEASE IN CHILDREN. By G. A. SUTHERLAND, M.D., F.R.C.P. Second Impression. London, H. Frowde, 1907. viii, 311 pp., 12mo. Cloth, $2.00, net.

This is a splendid little volume. What the author treats, he treats well. But there is a rather disappointing lack of the subjects and diseases which should be mentioned. The style of the author is clear, concise. It is a book that will prove of considerable value for hasty reference. LEGRAND KERR.

ROTUNDA MIDWIFERY FOR NURSES AND MIDWIVES. By G. T. WRENCH, M.D. With Introduction by The Master of the Rotunda Hospital. London, H. Frowde, 1908. xiv, 324 pp., 12v0. Cloth, $2.00 net. This book is intended for the instruction of nurses and midwives. It aims to present the information they need in a clearer and more practical manner than has been done in the manuals hitherto provided, and with the avoidance, so far as possible, of technical language. The author has succeeded well in his purpose. Obstetric nurses will find the book a safe and satisfactory guide. I.

PRACTICAL LIFE INSURANCE EXAMINATIONS. With a Chapter on the Insurance of Substandard Lives. By MURRAY ELLIOTT RAMSEY, M.D. Philadelphia and London, J. B. Lippincott Co., 1908. 231 pp., 12vo. Price: Cloth, $1.25 net.

This work on life insurance is a contribution which should prove useful to examiners. A great deal of the information in it should also interest practitioners in general. There is a chapter on substandard lives and a useful index. Diagnostics and prognostics are adequately presented. The book is fairly well written. A. C. J.

DEATHS.

H. A. C. ANDERSON, M.D., of New York City, died January 4, 1909.

CHARLES M. BRASTED, M.D., of Hornell, N. Y., died January 1, 1909.

EDWIN R. CHADBOURNE, M.D., of Pasadena, Cal., died January 10, 1909.

THOMAS B. DWYER, of Syracuse, died January 1, 1909. DAVID C. EISBEIN, M.D., of Buffalo, N. Y., died December 23, 1908.

JOSEPH FOWLER, of Buffalo, died December 17, 1908. ANDREW H. GETTY, M.D., of Athens, N. Y., died January 14, 1909.

HENRY LOUIS GOODMAN, M.D., of New York City, died January 14, 1909.

B. RUSH HOLCOMB, of Whitehall, died December 28, 1908.

WILLIAM MADDREN, M.D., of Brooklyn, N. Y., died

January 7, 1909.

JOHN J. QUIGLEY, M.D., of New York City, died January, 8, 1909.

HENRY D. SILL, M.D., of Cooperstown, N. Y., died January 14, 1909.

Vol. IX.

THE SOCIOLOGICAL SIDE OF THE TUBERCULOSIS PROBLEM.

A

T the present time the medical profession and the philanthropically inclined are paying a vast amount of attention to the prevention and cure of tuberculosis. The various exhibits which have been going the

rounds of the cities of the state have attracted large crowds of interested spectators, and to the poor the gospel of cleanliness and right living has certainly been preached. The people have been told that the contagion of consumption is in the sputum, that it is a germ disease and can only be conveyed to others by the sputum. The dweller in the tenement has also been told that there is no medicine which is a cure for the disease, that this, however, lies in hygienic methods of life, proper and sufficient food and ventilation. He has been shown examples of unsanitary dwellings and maps of the over-crowded east-side with its plague spots thickly disseminated through its closely populated area, have been graphically displayed. He has also been introduced to delightful little miniatures of model tenements with small and attractive suites of rooms and ample central court-yard, with grassplots and a fountain. This is to be his ideal, he is taught.

This instruction is all, no doubt, very useful. We have no wish to deride so fine and promising an exhibit. If a man can find tenements like those displayed, if he has the price, he will doubtless leave his close and illy-ventilated and expensive rooms in a tenement house which

No. 3

barely escapes the law, and exchange them for better quarters. If he is, unfortunately, the subject of tuberculosis, he will perhaps realize the dangers of carelessness, and if he loves his neighbor he will spit in the street no longer, if he can help it. His children and other members of his family will no doubt be relieved of a certain amount of peril and the public also. If he happens to live in a tenement where he can open the windows in winter weather without freezing the other members of his family, he will doubtless strive to obey the mandate which dictates that so far as possible he should sleep in the open air. He will get as liberal a supply of good food, including milk and eggs, as his means will permit. How much milk he will take at 8 cents per quart and how many eggs he will eat when eggs are 50 cents a dozen need not be left to the imagination.

A poor man who is also tubercular is not as a rule a prolific wage-earner. Disease forbids. He has lost his immunity to tuberculosis because of insufficient feeding, and the necessity which has compelled him to live in a dog-kennel, and eat meat perhaps once a week, if he is lucky. When our sanitarians tell these poor victims that the cure of consumption consists in a change of their method of life they really offer them a stone instead of bread. Of what use are all these instructions to the man who is trying to bring up a family on $10 per week, and who lives in a tenement, the landlord of which wrings from him a rental which represents 10 per cent. on the investment, perhaps more. Moreover, he

pays for everything else in proportion. Coal by the bucket means coal at the rate of $25 per ton. Many of these families scarcely see meat from one week's end to the other. W. A. Russell who did the computation for the congestion exhibit states that there are 12,000 women in New York City who are unable to nurse their babies because of semi-starvation and overwork. What these people need, if we are really to solve the problem, is an economic change and the sanitary change will not lag far behind. To preach the doctrines of hygienic living and the value of proper nutriment to people who have not the wherewithal to carry the instructions of the sanitarian and dietitian into effect is little short of mockery. "We asked for bread and have received stones." Stones for bread! Stones for bread! That is what society has been giving these poor victims of its own malpractices and congratulated itself on its virtuous and abundant charity.

The problem of tuberculosis is really only in part medical and sanitary. It is primarily an economic, a sociological question. It is but the simulacrum of charity, and a measure of hypocrisy for society, first to destroy the immunity of the individual by exploiting him as a wage earner, pitting him in competition against his fellow sufferer, buying its labor at the cheapest possible rate, a starvation wage, and then to congratulate itself on its tuberculosis exhibit. The tubercular poor lose their immunity, because of the dreadful conditions in which they live. They live in these conditions, not from choice, but because they are compelled to by a harsh and selfish civilization, which is willing to fatten on the bodies of men, women and little children.

This is the real problem of tuberculosis. What our cities need most of all, from the stand-point of the tuberculosis problem, is not the libraries, which a generous millionaire scatters with liberal hand, nor even vast hospitals, which have been planned lavishly, nor great and richly endowed universities. It is not mere theory nor the fancy of an idle dreamer to say that a dozen millionaires of New York could do more to solve the tuberculosis problem by providing proper and sanitary tenement house construction for the wage earner, than can be accomplished in twenty years of exhibits. It is much more scientific, much easier and less expensive to prevent tuberculosis by preserving the immunity of the individual and the race than to continue our

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present methods. Proper tenement house construction will yield 3 per cent. on the investment, so that a proposition of this sort by no means involves the giving away of large sums of money, but rather a reasonable investment and an intelligent use of funds, which would remove a great peril from the community, enable the poor to live in decent and sanitary homes and yet provide an income for the investor. This is not a dream but a possibility. This is a land of huge fortunes, and our millionaires are generously inclined. Is it not possible to show them how great a benefaction they can confer on their cities, not by sacrificing their fortunes or giving them to uses in the future whose destiny they cannot foresee, but by transforming the so-called tenement house district into abodes of light and heat and fresh air and cleanliness? The deeper and sadder and more far-reaching problem of a living wage for a day's work which shall mean not a wage sufficient merely to keep soul and body together is a problem of the future. It will be solved, though not in our day, but it is part and parcel of the same problem. The profession of medicine is doing what can be done under present conditions, as it always has done, to save men from the consequences of their own selfishness and folly. Teachers indeed are we, often prophets crying aloud in the wilderness. Sometimes the people listen. Sometimes alas they turn a deaf ear to our exhortations and jeer and laugh us to scorn. Still we can only be faithful to our trust now and ever.

The tuberculosis exhibit is the plaster which medicine offers to society to cover a sore. Until however, the economic and social conditions which have brought about the grievous wound. be changed, it will not heal but will continually fester, a reproach not to medicine but to government, to the national conscience and to society.

In a recent copy of the New York Times an announcement is made that four great tenements are to be built at Seventy-seventh and Seventy-eighth Streets, between Avenues A and B, designed to carry out the ideas of Dr. H. L. Shively.

"These tenements have been planned to make cleanliness easy and to secure for the tenants an abundance of light and air. These are things which are not really more necessary for the victims of tuberculosis than they are for everybody."

Thus the Times. Still more can be accomplished by invading the crowded purlieus of the ies which are to-day hot beds of tuberculosis and east side and tearing down the miserable rookerreplacing them by modern tenements.

A. T. B.

March, 1909

The attitude of the companies in this matter, which involves the prosperity of an entire community and the preservation of a great mineral spa at our very doors, is only an illustration of a national tendency.

As a nation we are absolutely reckless of our natural resources.

It has taken the most strenuous efforts of a strenuous president to check this tendency even in slight degree. The wood pulp people cut down in ruthless fashion timber which has been maturing for twenty and thirty years, and turn it into a product which is used for a few hours and then becomes utter waste, beyond the hope of any salvage.

There is no product of our civilization which is so much the creation of an hour as paper, and our legislatures look on complacently at the deforestation of our mountain slopes because the day of reckoning comes not for us, but for our children and our children's children. It tarries, but the steps of fate are not more remorseless.

The remedy of state reservations has been proposed for this particular evil and promises well.

At present we cannot expect private owners to respect the rights of the future. The proThe proprietors of forest lands are like an eminent citizen of renown, working for their own pockets all the time. If the state is to conserve its own resources, it must control them.

Why should our citizens go to distant Carlsbad when we have a spa of our own, situated among scenes of great natural beauty?

If Germany has found it necessary and of advantage to exercise state control over certain of her natural springs of healing, why should we in America, in view of our natural tendencies, not take similar measures to secure for all time to the people not alone of this state, but of neighboring states, the advantages which are known to accrue from such resorts? The United States exercises a certain control over the Hot Springs of Arkansas to prevent their exploitation at private hands and to render it possible for people of moderate means, or even no means at all, to avail themselves of the curative properties of these springs.

The State of New York may well consider whether it would not be of advantage to its people if it exercised control over the waters of Saratoga by making the region a state reservation.

A. T. B.

T

SENSE AND SENSIBILITY.

HIS alliterative title of one of the most famous of Jane Austen's delightful stories of a century that has passed away well describes the difference between the attitude of the two parties to the present controversy concrning animal experimentation.

Both parties are sincere, but sense governs the disputants on one side, sensibility on the other. It is Elinor and Marianne translated from the pages of Miss Austen to the legislative chamber of unromantic and utilitarian Albany.

Sensibility, however, too often becomes impressionability, and causes the heart strings to jangle in faint discords like the Japanese æolian harps we hang in our doorways which reverberate in the slightest breeze or to the feeblest contact. The good, the amiable, but impulsive folk who are crowding the lobbies and committee rooms at Albany have sensibilities which are as easily stirred. A zephyr is to them a tempest.

They shut their eyes to the woes of their fellow creatures, but grow pathetic over the poor guinea pigs. With happy inconsistency they weep over the dire fate of the prisoners of the laboratory, but wear hats with waving plumes. which tell of despoiled nests and starved birdlings. They weep over the rats and mice, but keep dry eyes for the children who perished of diphtheria and cerebro-spinal meningitis before the days of Behring and Flexner. Their heart strings jangle to the slightest breath of a mouse's squeak, but their ears are deaf to the cry of the children and the exceeding bitter cry of Rachel mourning for her children which are not. What is the empty cradle to them, the little broken toys stowed tenderly away in some carefully guarded nook soon to be wept over and again put out of sight? Thousands of people to-day are perishing of cancer. Our great captain lingered in agony for months, fighting his last enemy, and at Mt. McGregor met with his only defeat, in the sight of all men. Two of our great surgeons, men who had devoted their lives to the amelioration of human suffering, died within the year of the same terrible and mortal disease, for which there is no remedy. These people of delicate sensibility would put a ball and chain round the feet of that science which is now in steadfast pursuit of the rider on the pale horse seeking to wrest from him his sharpest dart. What matter is it to them that this form of death involves suffering, physical and mental, the most terrible which the sons and daughters of Eve are ever called upon to bear? One poor woman who dies of cancer of the uterus, or a recurrent cancer of the spinal canal, suffers more agony than the animals in a hundred laboratories. Let us, however, weep for the mice and the rats and cats consigned to untimely graves and turn a dry eye to the men and women of our own race who go down to their graves in darkness, misery and despair. Let Rachael weep for her children, but spare the poor animals even the needle's prick. A. T. B.

THE BROUGH-MURRAY BILL. N our February issue we gave reason for opposing the passage of the Davis-Lee antivivisection bill now before the Legislature. Strangely enough, this bill is also strongly opposed by one group of antivivisectionists. These have themselves caused to be introduced a measure constituting Senate bill No. 369 and Assembly bill No. 578, and now designated as the "Brough-Murray bill, an act to prevent cruelty by conferring upon the Board of Regents of the University of the State of New York the power of supervision of experiments on living animals." An endeavor has been made on the part of its friends to secure favor for it by spreading abroad the insidious claims that it is a compromise measure, and that it does not interfere with legitimate scientific or medical progress. These claims are not true, and the bill is altogether bad. Some of its provisions are as follows:

Experiments on animals shall be performed "only by a regularly licensed physician." This would exclude that great body of medical men who are not practitioners but devote themselves to scientific work; as well as the large and growing body of pharmacologists, physiologists, physiological chemists, and biologists, many of them professors in universities who have not had a medical training. It would be a calamity to exclude these from such.

The bill provides that "no experiment shall be made for the purpose of demonstrating facts heretofore established and proved." This would abolish in two lines of print the sciences of physiology, physiological chemistry, pharmacology, bacteriology, and much of pathology and surgery, for it would prevent the proper training not only of medical practitioners but of future teachers and investigators in universities, and of the members of the staffs of boards of health and independent institutes for medical research. Excepting the total abolition of animal experimentation, no more fatal blow to scientific and medical progress could be given than this proposed one of prohibiting demonstrations.

The bill gives to the Board of Regents of the University of the State of New York the power to issue all licenses to perform experiments upon living animals. It also gives them a semblance of authority in the matter of inspection, by requiring them to appoint annually representatives "for the proper supervision of animal experimentation within this State." But the bill also requires the Regents to appoint such representatives from a list of persons supplied by "any corporation formed under the laws of this State, one of the objects of which is to prevent cruelty

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in animal experimentation"! Such representatives are empowered to enter any place where animal experiments are conducted, at all times. Here we have a provision even more injurious, if possible, than the inspection provided for by the Davis-Lee bill. Experience has shown that supervision by untrained persons would result in the evils of inspection in their worst form. Representatives of humane societies who might serve as inspectors of laboratories would be persons in whom prejudice would be reinforced by ignorance of the matter which they are set to supervise, and by ignorance of what constitutes pain in animals and of the proper conditions and procedure in experimentation.

The Brough-Murray bill contains other objectionable features which it is here not necessary to specify. It should be opposed in every legitimate way not only by members of the medical profession but by all persons who are interested in the legitimate advance of scientific medicine. It cannot be too strongly insisted upon that every such measure, no matter what its advocates may publicly claim, will result, if enacted into law, in its becoming merely an entering wedge, bound to be followed by proposals for more drastic interference with scientific methods. Abolition of animal experimentation is the goal which antivivisectionists hope sometime to reach. It cannot be too often repeated that the present law against cruelty to animals comprising Sections 655 and 669 of the Penal Code and Section IO of Chapter 375 of the Laws of 1867, and now together re-enacted by the present Legislature to constitute Section 185 of Article 16 of the Penal Law, that this present law is wholly sufficient to deal with cases of abuse in animal experimentation. This contention has received support not only by the conviction of two young men in the City of New York under Section 655 for unjustifiable vivisection, but by an opinion given by ex-Judge Charles Andrews, for many years Chief Judge of the Court of Appeals of this State. This opinion is as follows:

"The section [655] does not prohibit vivisection. It subjects, however, every act of vivisection to the test whether it inflicted an unjustifiable injury. This is made clear by reading Section 655 and Section 669 in connection. In an indictment under Section 655 for vivisection, the question for the jury would be, was the physical pain and suffering caused unjustifiable under the circumstances disclosed?

"Into the determination of this question, the motive of the accused, the object sought to be attained, and the competency of the investigator would be relevant subjects of inquiry."

Opposition to both the Davis-Lee and the Brough-Murray antivivisection bills should be unanimous on the part of the members of the medical profession in this State.

FREDERIC S. Lee.