Dr. J. W. S. Gouley, who has recently passed the fiftieth anniversary of his connection with Bellevue Hospital, has, at the invitation of the Board of Trustees of Bellevue and Allied Hospitals, been delivering this winter a course of ten lectures on the Principles of Conduct Adapted to Medical Students and Physicians, to the House Staff and their medical friends at Bellevue.

Of the five lectures already given, special mention may be made of those on "The Cultivation of the Tactile, Olfactive and Gustative Senses," and on "The Early Cultivation of the Senses Essential to the Proper Conduct of the Study and the Practice of Medicine;" subjects not only of great scientific interest to physicians, but of decided practical value to the younger members of the profession.

We congratulate the doctor most heartily, both on the subject and on his manner of delivering these lectures, and anticipate with much pleasure the last half of the series, feeling sure that the interest already shown by those privileged to hear them will insure a large attendance at the ones yet to come.

"MEDICAL DIRECTORY" CORRECTIONS.

Dr. J. R. Sturtevant, of Theresa, N. Y., in a letter to the Publication Committee, offers some good suggestions in the methods of securing corrections in the Medical Directory. "Let each (member) paste onto the inside of front cover of his 1903 Directory a sheet of blank paper, and during the year, until August 1st (we prefer June 1st), record thereon any needed corrections which come under his observation, record the death or removal of any physician or the advent of any new one in his town or any town near him where there is not a resident member of the Association. If each member will send in the list which he has thus recorded I am very sure that the value of the Directory will be thereby greatly enhanced."

NOVEMBER 27, 1903. DR. C. E. DENISON, The New York State Medical Association, 64 Madison Avenue, New York. Dear Doctor-I mail you to-day exchange copy of our "Register of Physicians," and I trust it may reach you safely. Your Register reached me some two or three days ago, and I must compliment you, not only upon its appearance, but upon the general make-up of the book as well. Very truly yours,

"LA UNION MEDICA.”

The secretary of The New York State Medical Association believes that it will be of interest to the members of the Association to be acquainted with the fact that there is published in San Salvador a medical paper, entitled La Union Medica, which is the official organ of the Society of Medicine of Salvador.

This paper has since its primary issue been forwarded to the State Association. It is a journal which reflects credit upon its publication committee, and renders evident the progressive attitude which prevails in medical circles throughout the world.

It is issued monthly and is now in its seventh number. The reading matter occupies about twelve pages, advertisements about four pages. The contributions are, many of them, original, and some copied from the better contemporary literature. There is also a regular department of prescriptions, which are calculated to be of service, particularly to those physicians who have to contend with tropical conditions.

Its advertising prices do not seem exorbitant compared with those in the States, the charge for an entire page being $8, half page, $5.

The profession at large is to be congratulated upon the fact of the issuance of a regular monthly paper, which represents and is the official organ of a medical society.

A LEGAL DEFINITION OF THE TERM, THE PRACTICE OF MEDICINE.

All who have had experience in the courts with illegal practitioners have learned that the entire question of uprooting quackery depends upon the acceptance by juries, judges and the public, of a proper definition of the expression, the practice of medicine. The Eddyites, osteopaths, and the rest, have secured their vogue solely on the ground that they have no drugs, and hence did not. practice medicine. Such a definition is, of course, rank absurdity to us, and it behooves us now to avoid this misconception in the future, and to agree upon definitions which will be accepted by legislators, jurists and the public generally. The National Confederation of State Medical Examining Boards appointed a committee to formulate such definitions, and after careful consideration presents its report, which is published in the latest issue of the Pennsylvania Medical Journal. The State controls the regulation of the practice of medicine, and decides whether the graduates of reputable medical colleges shall be licensed or not to practice medicine. The committee says practicing medicine is treating diseases, deformities and injuries. Nothing could be more concise and indisputable. Establish this simple and incontrovertible position, and there can be no quibble or doubt. A legal practicer of medicine, therefore, is any one licensed to assume, directly or indirectly, the responsibilities, by offering or granting services, for the treatment of diseases, deformities and injuries.-Amer. Med.

AN OLD FRIEND IN NEW ROLES.

with whose use every medical practitioner was familiar at least in his obstetrical work. In recent years, however, the efficacy of the drug has been proven in a number of conditions and it would seem that it may be considered by the next generation of physicians as one of the most important substances in our therapeutic armamentarium.

At the recent meeting of the New York State Medical Association the employment of ergot was once more discussed in regard to its effect in alcoholism and in drug addictions of various kinds. A number of conservative observers have used ergot by hypodermic injection especially in alcoholic cases and have found it to give very satisfactory results. Surgeons especially did not hesitate to say that in surgical cases complicated by alcoholism no drug was equal to ergot in quieting the patient, preventing delirious complications, and restoring the individual to a restful

condition.

The report of the experiences at Bellevue Hospital in New York seems to prove that ergot is of benefit even in the most advanced alcoholic conditions and under circumstances in which ordinarily there would appear to be very little hope of a favorable issue in the case. Dr. Alexander Lambert has found that in the so-called wet brain

of alcoholics, an almost inevitably fatal condition, ergot given hypodermically proves life saving in a great many cases. Where formerly he was

satisfied to save two or three out of thirty or forty patients, using all of the ordinarily recommended remedies, he now has but two or three deaths from this condition during his term of service.

This is, however, not the only purely medical field in which ergot has attracted attention in recent years. In cases of chronic malarial poisoning ergot has been found more satisfactory than even quinine for the prevention of the more serious symptoms. It has been found that when surgical operations are performed upon those who have previously suffered from severe malaria it is not unusual to have symptoms of malarial fever occur a few days after the operation. The disturbance of circulation incident to the operation seems to allow the escape of malarial parasites from the spleen where they had been stored. In these patients it has been found that the use of ergot for some time before an operation and shortly after it, inhibits and often prevents the development of malarial symptoms. In other cases of chronic malaria an end can be put to the recurrence of so-called attacks of dumb ague by means of ergot.

In chronic diarrhea ergot has also been found a very useful drug. Its special field appears to be the serous or seromucous diarrheas of adults in which nervous conditions are the most important etiological factors. The vasomotor paresis which develops in these cases and permits the free outflow of serum from the dilated blood vessels of the intestinal wall is prevented by the toning up

protective effort on nature's part to assist in the throwing off of the offending micro-organisms and this protective mechanism must not be interfered with. After a time the diarrhea seems to continue as the result of the formation of a bad habit of relaxation on the part of the intestinal vessels and then ergot has a distinct field of usefulness.

It is not unlikely that in the serous conditions incident to other diseases ergot may prove to be a most important agent. Edema of the lungs still continues to be an extremely fatal disease, in spite of all therapeutic efforts. Since ergot has proved so beneficial for edema of the brain, its use here would seem to be especially indicated and, as a matter of fact, some cases have been reported in which recovery has taken place in what would otherwise have proved to be fatal pulmonary edema. In dysentery, at times, the outflow of serum from the blood vessels proves a culture medium for the rapid multiplication of the micro-organisms present in the intestine. Under these circumstances the use of ergot would seem to be indicated.

In all these cases the drug should be used up to its full physiological effect. With regard to alcoholism especially subcutaneous injections of half a dram of a fluid extract of ergot containing 12 per cent. of the drug should be employed. This should be repeated as often as is necessary, or until there is a definite improvement in the patient's condition. As was very well said by patient's condition. several of the participants in the discussion at the New York State Medical Association meeting to have due success in the use of ergot the ordinary ideas with regard to the dosage of the drug must be revolutionized. To give small amounts is to invite failure, while so far the use of larger doses have produced no serious effects and it would seem that none need be feared. Further

investigation of the uses of ergot in these and allied conditions may make the drug one of the most useful in the Pharmacopoeia.-Medical News.

A resolution which was at once a signal of danger and a protection to the profession was put before the American Medical Association by James M. Keller at St. Paul. It was as follows: "Resolved, That in all fractures of the femur there necessarily results more or less deformity."-Kentucky Med. Bulletin.

HEALTH COMMISSIONER.

Dr. Thomas Darlington has been appointed President of the Board of Health of New York City. We congratulate the new Commissioner and wish him a successful administration.

Association News.

COUNTY ASSOCIATION MEETINGS FOR JANUARY.

Rensselaer County, Tuesday, January 5th. Cortland County, Wednesday, January 6th. Allegany County, Tuesday, January 12th. Kings County, Tuesday, January 12th. Niagara County, Tuesday, January 12th. Wyoming County, Tuesday, January 12th. Warren County, Wednesday, January 13th. New York County, Monday, January 18th. Chautauqua County, Tuesday, January 19th. Orange County, Wednesday, January 20th. Rockland County, Wednesday, January 20th. Columbia County, Tuesday, January 26th. Lewis County, Tuesday, January 26th. Monroe County, Tuesday, January 26th. Westchester County, Thursday, January 28th.

Kings County Association. The regular monthly meeting of this Association was held at 315 Washington street, Brooklyn, on Tuesday, December 8th. An interesting paper was read by Dr. Jonathan Wright, on "The Shifting Aspects of the Tuberculosis Question," a discussion upon which followed by Dr. Hubert Arrowsmith. Dr. L. Grant Baldwin showed a multiple fibroid of the uterus removed from a patient 53 years old. The following nominations were made for the ensuing year: For president, Dr. George H. Treadwell; for vice-president, Dr. Arthur C. Brush; for recording secretary, Dr. Frank C. Raynor; for corresponding secretary, Dr. George F. Maddock; for treasurer, Dr. Edward H. Squibb. FRANK C. RAYNOR, Recording Secretary.

Monroe County Association.-The regular meeting of this Association was held at 74 South Fitzhugh street, Rochester, on Thursday, November 24th. In the absence of the president, the vice-president, Dr. E. Mott Moore, called the meeting to order. Interesting papers were read by Dr. C. V. C. Comfort on "Diagnosis of Pneumonia," and by Dr. Frederick H. Goddard, on "The Treatment of Pneumonia." Both papers were freely discussed by all the members present.

The Committee reported favorably on the Genesee Valley Club as the meeting place of the Fourth District Branch, next June. The next meeting will be the last Tuesday in January.

J. CLEMENT DAVIS, Secretary.

removed by operation from a girl 18 years of age, who had, previous to coming under the writer's notice, been operated upon for pyosapinx, following childbirth, the bladder probably having been infected at this time. The patient complained of pain in the right upper quadrant of the abdomen and in the lumbar region. The ureters were catheterized, and urine containing pus was obtained from both kidneys, by far the largest amount, however, coming from the right one. In order to further determine the functional capacities of the kidneys, methylene blue was administered hypodermatically. This coloring agent was excreted in two hours and five minutes by the left, but not at all in that time by the right kidney. The leucocytes rose from 9,000 to 25,000, and a diagnosis of pyelonephritis was made, but at this time the patient refused operation. The patient continued for over one month to run a very high temperature, accompanied by constant pain. When she finally gave her consent the right kidney was removed. For the first twenty-four hours following the operation the patient required most constant attention, her pulse running from 120-150, respirations 25-40, and her temperature was 102 F. During the first twenty-four hours she passed 13 ounces of urine, during the second 23, and during the third 30 ounces, after which time her temperature, pulse and respirations gradually approached normal, and on the tenth day after the operation were as follows: Temperature, 98.2; respirations, 20; pulse, 84. The wound healed by primary union.

The next specimen was that of a cecum removed from a girl 15 years of age, who had been suffering from an attack of appendicitis, which had lasted nine days prior to her coming under the writer's observation. This attack had manifested itself by symptoms of great severity, which had later partially subsided. The course of the symptoms had made the family physician doubtful as to the necessity of an operation, until an intra-abdominal tumor in the cecal region could When the abdomen was be distinctly felt.

opened, an abscess was found in the cecal region, the walls of which were not attached to the parietal peritoneum. This abscess, when opened, was found to contain about ten ounces of most offensive pus. As the cecum, as well as the appendix, half of which had sluffed off, was found in a gangrenous condition, the cecum was resected, and an end to end anastomosis was made between the ileum and the ascending colon. The patient was reported to have done well for about fifteen hours, when intestinal paresis manifested itself, and she died about eight hours later. Unfortunately no autopsy was allowed. The third specimen was that of an appendix, showing an acute inflammatory process in its tip, which was long, and turned upward, and had given. rise to inflammation of the mesentery. The infection had extended to the pyloric end of the stomach, which accounted for the unusual location of the pain, which was localized over

the gall-bladder. To make the diagnosis still more difficult, the patient, while still under observation, had an attack of jaundice which lasted three days. Operation revealed a healthy gallbladder and an inflamed appendix.

The fourth specimen was that of a larynx, which had been removed for an epithelioma. As the man was a foreigner, few details of the case could be obtained beyond the fact that he was 52 years of age, that the diseased condition had lasted about eight months, and that he had previously had a tracheotomy performed. As the patient was unable to take any nourishment on account of the tumor, which was pressing on the esophagus, an operation was undertaken. With the patient in the Trendelenburg posture, the operation presented few technical difficulties. For a time after the operation all went reasonably well, but the kidneys, failing to perform their functions, the patient died forty-eight hours later. The autopsy showed tubercular ulceration and peribronchitis of both upper lobes, recent miliary tuberculosis of the lower left lobe, enormous emphysema of the whole right lung, brown atrophy of the heart, fatty liver and chronic diffuse nephritis.

"A Review of Some Statistics of Insanity."— Dr. William Mabon presented a paper with this title.

Dr. Joseph Collins, in discussing it, pointed out that, in all probability, the supposed differences in the frequency and type of mania and melancholia were apparent rather than real, being due to differences in classification. Continuing, the speaker declared that we had no cause to congratulate ourselves on our progress in the care of the insane, for the statistics just presented showed that, at the present time there was one insane person for every three hundred of the population. There was not an asylum for the insane in this whole country which possessed facilities for any proper treatment of the acutely insane, except the Shepard Asylum in Baltimore. Yet this was the crying need, and not fine buildings and good laboratories only.

He

At the request of the president, Dr. Collins touched briefly on the differentiation between insanity and delirium due to other causes. said the subject was a difficult and broad one so long as one recognized the existence of delirium grave. Personally, he had never seen a pure example of this kind of delirium, and this experience was by no means exceptional. It was well known that certain forms of delirium occurred with many of the acute infectious diseases. The general treatment of delirium should be stimulating; nourishing and stimulating enemata should be given, and, if need be, also saline infusions. Sleep must be secured, and hyperpyrexia would demand interference.

Dr. Alexander Lambert said that Dr. Collins was evidently not aware that there was a psychopathic ward in operation in the New York Infirmary for Women and Children.

The scientific study of insanity had received a severe check when the Legislature had refused to give adequate maintenance to the State Pathological Institute, an institution which was doing true scientific work at a cost, including the maintenance of the New York City offices of the Commission in Lunacy, of $32,000. Worst of all, the death-blow to this enterprise had been given by three members of our own profession, gentlemen from other States. He could not agree with Dr. Collins that our State had not made great advances in the care of the insane, but it certainly had not in the proper treatment of the acute stage of insanity.

Dr. Mabon, in closing, said that the insane were scientifically treated in the MacLean Hospital, and in a number of the State hospitals in our own State. An effort was made to separate the acute from the chronic insane, and scientifically treat the former in a separate department. OGDEN C. LUDLOW, Secretary.

at

Orange County Association. The regular monthly meeting of this Association was held Middletown, Wednesday, December 16. 1903, at 2 P.M. The membership was fairly well represented from various parts of the county.

Dr. Purdy, of this city, presided and opened the meeting with a report of cases. Dr. M. C. Conner gave a very interesting history of a case of syphilitic osteomyelitis of the tibia, operated upon with excellent result. The members present discussed syphilitic cases in general and attention was especially called to the fact that such cases were altogether too prevalent. It was the opinion of all present that the general public ought to be educated as to the dangers of infection in this particular. Many other cases of the same disease were given by those present. Gonorrhea, an allied and by far too frequent disease, was then discussed, and likewise measures for its prevention and cure were talked over.

The time was so fully occupied by the subject above stated that the general discussion on "Fractures and Dislocations of the Upper Extremities" was laid over until the next meeting.

At the business session following the scientific meeting the minutes of the previous meeting were approved as read, and communications from several of the State officials were read by the secretary. Among them was one from Dr. E. H. Wiggin, of New York, urging the members to solicit new members and explaining in detail the many advantages to be found as a member of the New York State Medical Association. Dr. David H. Sprague, of Central Valley, applied for membership through Dr. H. E. Wise, of Turner. He was elected by a unanimous vote. There being no further business before the meeting, adjournment was made until the third Wednesday in January, at which time the annual meeting and election of officers for the ensuing year will occur.

CHARLES IRA REDFIELD, Secretary.