observation, which were raised against them. One by one they were disproved, and almost the only one that kept its position. was this: that the soft chancre, or the more correctly termed chancroid, is inoculable upon the bearer, while the indurated chancre is not

Now the next step of progress was to accept the theory of two kinds of poison in regard to chancre. In 1852, Basserau 24 published a work on syphilis : and in this, as the result of numerous experiments, on account of the impossibility of finding an explanation of the most common symptoms of syphilis according to the theory of unity, and from many other reasons, he drew the conclusion that the soft and hard chancres were entirely different affections; that the one did not substitute or change into the other; and that they were due to special kinds of poisons, the one of which gave rise to a local ulcer and nothing more, while the other was the precursor of constitutional syphilis with all its miseries.

These are the principal points of the doctrine which has been termed duality, as it was presented by Basserau, and later adopted and advocated by Le Clerc 25 It was at first opposed by many, among them Ricord; but in 1858 he adopted it: 26 and when this great syphilodologist, with all the power of eloquence and authority at his service, advocated the theory, it made so great a progress that F. von Niemeyer 27 says, "The doctrine of duality was adopted with a surprising rapidity by almost every distinguished syphilodologist, even by those who at first were its most zealous opposers, a fact almost without counterpart in the history of medicine."

A SLIGHT GYNÆCOLOGICAL MISTAKE.

BY J. HEDENBERG, M. D., MEDFORD, MASS.

ON reading a London letter to the Louisville "Medical News," copied into the "Boston Medical and Surgical Journal" for Dec. 23, 1880, I was reminded of a bit of experience in the "lacerated cervix" business, which recently came under my observation, and which strongly impressed me at that time that the business of repairing lacerations might at times be overdone.

The part of the letter referring to the treatment of the cervix

24 Leon Basserau, a pupil of Ricord. Traité des Affections de la Peau, Symptomatiques de le Syphilis. Paris, 1852.

20 F. L. Le Clerc: Du Chancroide Syphilitique. Paris, 1854.

26 P. Ricord: Letters sur la Syphilis. Paris, 1858.

27 Felix von Niemeyer: Lehrbuch der Speciellen Pathologie und Therapie. Berlin 1871.

uteri is so good that I propose to give first an extract from the letter, and then the experience alluded to.

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'Subsequently, Dr. Montrose Pallen, of New York, read a paper on the Etiology and Treatment of Lacerations of the Cervix Uteri, from which it seemed to follow that about twentyfive patients out of every hundred (two hundred out of nine hundred gynecological patients seen in six years in a New York clinic) suffered from laceration of the cervix uteri, which either interfered with the generative functions or produced more or less disease. These lacerations required to be sewn up, sometimes to be pared; but the right thing was to look for them after labor, and within a few days after labor to take the poor woman and sew up these unhappy lacerations. Dr. Marion Sims quite approved of this, but seemed rather doubtful whether it might not be possible to have too much of a good thing, and whether some 'unnecessary" sewing up were not practised at this moment in New York. He intimated, indeed, that he thought it was. This episode has created some alarm in the minds of the uninitiated who are not gynaecologists. When Dr. Sims was first here he demonstrated, to the satisfaction of a great many people, and indeed seemed almost to have established it as a canon in practice, that a great number of women are suffering from complaints which require that the cervix uteri shall be lacerated to the extent of complete division; and we were under the impression that according to the well-established experience of Marion Sims and his school, about twenty to twenty-five per cent of the gynæcological patients are required to have the cervix uteri divided in order to be restored to health. But if now we find that at least as many are suffering from complaints which require that cracks, cuts, and fissures of the cervix shall be shut up, it seems as if the greater part of the energies of that most fearfully numerous, highly intelligent, and active class of practitioners who, either as specialists or as family doctors, have a claim to the title of gynecologists, will in future be divided between splitting up the cervices of those women who yet possess them entire, or uniting with horsehair or silver wire those which are by nature cracked or fissured. The general moral would then be open to deduction that in respect to the uterus whatever is is wrong, and whatever is not ought to be brought about. Between the mechanists, the vitalists, the incisors, and the sutors of the womb, that long-suffering organ is likely to have anything but a quiet time; and it is perhaps hardly surprising that men like Henry Bennett, who are largely responsible for the introduction of this alarming instrument of precision, should, at the close of a long and honorable career, adopt a conservative attitude, urging some of his enthusiastic young friends to display less zeal and try a little more cool observation."

Mrs. having a very difficult first labor, the attending physician, Dr. Libby, of Arlington, sent for me in consultation. The forceps was applied, and a living child delivered, the mother making a rapid recovery. Ten months subsequently she felt ill, and acting under the advice of her nurse, consulted a practitioner in Cambridge, whose specialty is gynecology. He heard her story of a first pregnancy, a severe labor, and instrumental delivery, and thought, of course, of a laceration of the cervix, which on examination he found. Here was the trouble, he was certain: "She must have had a fearful labor, but if she had hopes of a further increase in her family she would undoubtedly be disappointed, as it was almost if not quite impossible that she should again become pregnant with the then existing state of the cervix. He proposed to restore it to its normal condition, made some topical application, and appointed a time to etherize her and put in a few sutures.

After this visit to the specialist she called upon her family physician (Dr. Libby), and told him of what she had done and what was being done to her. He asked her a few questions, and gave it as his opinion that she was then some three months pregnant. "Oh, no! this could not be: would not Dr. have found it

out when he had examined her so carefully?" The family physician advised delay and against any treatment, as in his opinion likely to produce a miscarriage, and she finally consented to follow his advice. In a few weeks she called again to say she had quickened, which proved his opinion as to the date of pregnancy correct. To cut it short, she was again delivered at full term (just sixteen months after her first labor), with forceps, of a living child, and was truly thankful she had not been made to abort by the operative procedures of the gynecologist. As I see in my copy of the new edition of " Venereal Diseases, by Bumstead and Taylor," that the author gives at page 447 an account of a mistake in the diagnosis of syphilis, (I wonder if this was the only one he ever saw?) which he informs his readers was made by a "homoeopath," I suppose I should add that the gynæcologist is an "allopath," whose card appears regularly in the "Boston Medical and Surgical Journal."

THE DEMAND FOR A HOMEOPATHIC HOSPITAL FOR THE INSANE IN MASSACHUSETTS.

BY SAMUEL WORCESTER, M. D., SALEM, MASS.

DURING the past few years the various questions concerning the management of the insane and their needs have gradually ceased to be considered the exclusive property of the close cor

poration styled the Association of Superintendents of American Hospitals for the Insane, and are receiving much and increasing attention from the profession at large and the general public. More and more it is the case that insanity is regarded — not as some mysterious disease, a knowledge of the proper treatment of which has been intrusted to a favored few, and transmitted by a kind of apostolic succession, but as a disease of the nervous system, a disease of the brain, and only a disease of the mind in the sense that the mental manifestations are disturbed or destroyed as a result of the diseased condition of its instrument, the human brain.

In June, 1873, at the time that the Danvers Hospital was decided upon, I endeavored to show in the pages of THE NEW ENGLAND MEDICAL GAZETTE the need there was for a hospital for the insane to be under homoeopathic management. Again in April, 1874, at the annual meeting of the Massachusetts Homoopathic Medical Society, an appeal for the establishment of a homoeopathic insane asylum was read by the secretary and referred to a special committee, who reported later that the time had not yet come for such an effort to be successful. The appeal was again renewed in a paper upon the "Care of the Insane," read before the Medical Society in April, 1879, and at the close of that paper the following words were used: "There has been such a discussion of the subject that the public are ready to overthrow the existing system, if any one will show or promise anything better. We can do this: a change must come, and the insane will be cared for in a more humane and rational way than ever before. Shall we lead on the movement and at the same time offer our better way of healing, or shall we sit idly by and see the golden opportunity pass from us?"

Two evidences of this increased popular interest will now be spoken of. The first is that of the establishment of a national association for the protection of the insane and the prevention of insanity. This association had its immediate origin in the general discussion concerning the management of hospitals, and the hearing before the legislative committee in the winter of 1878-79, allusion to which was made above; and it has among its members many prominent physicians and laymen. Its whole animus is opposed to the present system of asylum management, and consequently it meets with but little favor among asylum superintendents. The association at present is endeavoring to induce medical colleges, professional journals, and asylum authorities to diffuse among physicians a better knowledge of psychiatry, and also to secure in the great hospitals better facilities for physicians desirous of studying insanity; to obtain facts and statistics relating to the methods and use of restraint; and the use of labor in the hospitals for the insane in this country.

The fruits of this movement, and the influence of the association, may be very clearly seen in the inaugural message of his Excellency Gov. John D. Long, delivered at the opening of the Legislature on Jan. 6, 1881; and I shall quote fully from that portion of the message which is devoted to the insane, for my views accord fully with his, and are what I have advocated for years. He says: The increase in the number of the insane in the asylums is not believed to be due to an increase of insanity among our people, but rather to an accumulation of persons mentally affected, resulting in part from the very abundance of accommodation for them More room for them must soon be made. I trust that both as a matter of treatment and economy, some other plan will be adopted than that of erecting another costly hospital like the last. It is desirable that there should be a more intelligent classification of the insane, instead of herding them all together." After making suggestions as to this classification, he advises at a suitable time making separate provision. for insane criminals in some one of the county buildings, and also providing specially for insane epileptics, whose presence constantly serves as a source of annoyance and injury to other patients. “Contrary to what was the prevailing opinion twentyfive years ago, it is now coming to be agreed by the best experts that the recent and presumably curable insane should not be crowded together with the chronic and incurable in great hospitals, where the very air seems charged with the hopelessness of a madhouse. Connected with this change of opinion is the suggestion lately made to me, that if it shall come to the erection of new buildings, these should be small hospitals, where the curable should have every available appliance for their recovery; while, for the incurables, buildings such as I have already referred to, constructed at no great expense, would be found sufficient to meet any exigency for some years to come."

It seems probable, from the above words of the governor, that it will be the policy of the State, first to relieve the crowded condition of the hospitals by making separate provision for the insane epileptics and insane criminals; but only a few years at the most can elapse before the asylums will again be full. When that time comes, smaller hospitals will be built, and so located in the different parts of the State that they can be reached without much expense to the patients or their friends.

The present system of asylum management and the treatment. of the insane is erroneous, and within the next ten years will undergo an entire revolution. Our large asylums are manufactories of chronic and incurable insanity; and the laws of humanity and of love to the neighbor are by no means constantly kept in mind in dealing with the inmates. From a somewhat extensive