with the anatomical state of the lung and to "see" the lesion is nothing; one must ascertain the functional value of the organ. It is only thus that one can know its power of resistance.

Radioscopy of precision, that is, orthodiagraphy, enables one to study pulmonary elasticity, the verifying of which is such an important point. One assumes that the lung possesses its normal elasticity, when on examining the pulmonary image during forced inspiration and expiration there is a great divergence between the observed dimensions, principally in the vertical diameter, that is by the descent of the diaphragm. Thus the amplitude of the motions of the diaphragm becomes the indirect measure of the elasticity of the lung, and one has only to note the position of the diaphragm during inspiration and expiration on the fluorescent screen, to measure the difference between the two limits, and to compare it with the normal figures. It is necessary to compare the figures for both lungs, as the pulmonary elasticity may be wholly or only partially diminished.

In a paper sent last year to the "Académie des Sciences," Dr. Guilleminot and I gave the result of our examination of 22 diaphragms; and we reached the following conclusions:

1. The normal height of the diaphragm in man is different according to the side examined. The right side is higher than the left by 1.9 c.m. on an average. Given a horizontal line passing through the upper border of the interclavicular notch, on the right side the diaphragm is distant 15.5 c.m. from that line; on the left side 18.4 c.m.

2. The distance the diaphragm traveled, measured on twelve healthy individuals, was the same on both sides, and measured 1.63 c.m.

Any appreciable difference from that average figure would denote a notable alteration in the pulmonary elasticity. A diminution of movement on one side of the diaphragm during inspiration is a sign of the greatest value, which may precede all the others, even the appearance of an opaque zone at the apex; at the end of inspiration, especially voluntary deep inspiration, the diaphragm descends less on the sick side than on the healthy side, whereas at the end of expiration it goes up as high on both sides. This very important sign shows that one-half of the diaphragm, during inspiration, meets more resistance than the other half in attempting to lengthen the corresponding vertical diameter of the lung, and would indirectly make us think that a certain amount of induration was preventing the normal extension of its parenchyma. In all the cases of consumption that we have examined, the movements of the diaphragm were most considerably diminished, the figures being 0.8 c.m. to 1 c.m.

Not only is it possible in many cases to affirm the presence of

commencing pulmonary tuberculosis by means of the movements of the diaphragm, but by the same means one can get hints as to its evolution. In two cases where we had diagnosed commencing tubercular lesions, we were able to control the disappearance of the pathological modifications of the respiration by the re-establishment of the normal movements of the diaphragm, and thus foresee a definitive cure.

In tuberculous cases in order to be able to give a right prognosis, one must necessarily know the state of the heart, and it is again by orthodiagraphy that one can most easily reach this knowledge. My friend, Dr. Chiron, in a recent article on the mensuration of the heart-area by means of the Radioscope, confirms the hypotheses set forward by Bouchard and Balthazard in 1902, and shows that with regard to tubercular cases one may consider two groups.

1. Small heart in those predisposed to tuberculosis.

2. Large heart in advanced tuberculosis (cavity stage) with cardiac dilatation, resulting from pulmonary sclerosis and from the extension of the caseous lesions.

The normal average heart-area, says Chiron, is 79 sq. c. m. The finding of a normal heart-area, and especially of a larger heart-area than normal, must have great value for prognostic purposes in commencing pulmonary tuberculosis. In three cases which I had occasion to see with him, three cases of cured pulmonary tuberculosis, we were able to verify the perfect play of the ribs and diaphragm and the increased size of the heart

area.

The systematic observation, by means of orthodiągraphy, of the pulmonary and pleural transparency, of the play of the ribs and diaphragm, of the heart-area, thus showing the anatomical state of the respiratory elasticity, should, combined with notes as to the height, weight, and breadth of a subject, give what Dr. Pignet has called "the numerical equivalent of man;' that is, the test, or standard, of health. The diagrammatic reproductions of these observations enable one to follow the forward or backward evolution of the disease, by comparing tracings taken at different times. The discovery of some abnormal development during these comparisons arrests the attention of the medical attendant, and enables him, not only to account for some lesion, till then ignored or hidden, but more than that, it allows him to foresee the evolution of the disease; and as Professor Crancher has so well said, "To foresee is to cure."

PRESIDENTIAL ADDRESS.*

BY JOHN K. WARREN, M.D., WORCESTER, MASS.

Ladies and Gentlemen, Members of the Massachusetts Homœopathic Medical Society:

To-day, for the second time, I have the privilege of addressing you, and I wish first to express my high appreciation of the honor which you have conferred on me in electing me to preside over this honorable body.

Twelve years ago, I was appointed by the president and executive committee as orator, and on that occasion took for my theme, "Uncertainties in Medicine," and I might well continue the same subject to-day, for although there has been greater general advancement along all the medical and surgical lines in the past twelve years than during any like period of time in the history of medicine, still there are unsolved problems and many subjects upon which we desire a more perfect knowledge and deeper insight; while much has been learned, more still remains to be acquired.

But, as I do not wish to go on record or descend into history as a pessimist, I have chosen to-day to turn the search light toward the future and see what we can there discover for our encouragement and inspiration, and so say what of the

morrow?

It is often said that medicine is not an exact science, This is either true or false according to what you include under the term "science of medicine."

Exact science is knowledge gained and verified by correct observation and accurate thinking. It is knowledge reduced to law and embodied in system. Exact science has to do with what can be seen, handled and demonstrated by the human mind, but when science attempts to explore the deeper mysteries, to explain what lies beyond the easily visible and tangible, it is no longer certain or science, but enters upon the vague and uncertain.

Many theories which have been considered as well established scientific truth, have been obliged to give way under the stronger light of more perfect knowledge. The great changes in the hypothesis of the astronomers, the undermining of the atomic. theory in chemistry by the recent experiments with Radium and the remarkable statement made by one of the Professors at Cambridge, a son of the great Darwin "That the evolution theory must be materially modified, that the scientists who have been looking for a continuous transformation of species, are making a mistake, that a closer study of the world's progress, reveals the fact of sudden and great transformation, after long lapses of time." These changes of view regarding *Before the Homœopathic Medical Society April 11, 1906.

what have been considered the fundamental theories of science are sufficient to show that they are far less certain than had been claimed.

It is more than probable that very few, if any, of the present theories will be standing by the end of the present century, and if they are, they will be so changed as to be practically something else.

When the scientist pushes off into the unknown, guided only by his own imagination, he is too far from home to justify positive declarations, and what he puts forward as sure explanations are too often only his own mental creations which may look well and read well and make it easier to explain other things, but they are not a revelation of the actual and the real, they are not facts or science. But truth is eternal and changeless and the thousands of earnest seekers after knowledge during the past hundred years have proven that the grand old law of "Similia similibus curantur," is just as true to-day as it was in the days of Samuel Hahnemann. We are homoeopaths today not from choice only, but from necessity as well, for the clinical experience of thousands of earnest men and women during the past century has proven that although the law of homoeopathy may not be the only law of cure, it certainly is the best law known to medical science to-day, and so long as it continues to be the best, let us follow it, ever seeking for a more perfect knowledge of the human organism, both in its physiological and pathological conditions, that we may steadily advance toward a better understanding of that subtle law which controls the vital spark we call life, and should the wisdom of the future find out a better law we will be as willing to adopt and follow it as we were to choose the one by which we are now guided.

Our brethren of the old school thought at first to wither us with their scorn, or annihilate us with their contempt, but the fierceness of their visage only served to reveal to us our weakness and stimulate independent thought. Failing in their first attempt to destroy, they now would feign remove our identity by taking us inside with one grand gulp, including even the long talked of exclusive dogma, so that no more mention might be made of us among men or maidens forever.

There is so much that needs to be accomplished for suffering humanity I sincerely hope the day is past when we shall expend our energies in denouncing other schools or methods of medical practice, but rather with a broad charity and spirit of progression be ready to receive the truth wherever found, proving all things, holding fast that which is true.

The physician is no longer a mere prescriber of medicines, but like the policeman he is expected to prevent trouble, as well as to restore peace and order, after the enemy has invaded

his domain. The work of the best physicians to-day is largely preventive and will continue to be more and more so as the general public becomes educated along sanitary and hygienic lines. The true physician stands for all that is highest, purest and best, not only in medical skill but in moral character and pure thought, and no scientific attainment can compensate for the want of correct moral principle. He, or she, should be the foremost teacher to whom the public should look for instruction and help in everything that tends to uplift and purify life, for who knows so well as the physician the influence exerted by the mental and moral upon the physical condition, and it is the mental and spiritual looking out through the physical, rather than the physical which constitutes the true man, yet they are so intimately related, that one cannot suffer, without injury to the other. In the healthy body only, can there exist the highest mental condition.

Dr Holmes has said that, in order to thoroughly educate the man, you must commence with his grandfather. This is equally true of the physical condition; and what better time than the present to commence the education of the grandfathers of the future, and who are more competent for this task than the men and women who are devoting their lives to this same work?

Dr. Stanley Hall, President of Clark University, says that almost every person by the time he has reached the age of twenty-five has the seeds of death planted in him. If this is true, then there is something radically wrong in the care and training of children. What this care and instruction have been up to the age of puberty determine largely their future health. That ignorance is the great producing factor in vice and disease, there can be no question.

What physician is there that does not know from his own experience that most of the evils arising from youthful indiscretions are the result of ignorance, and would have been avoided had the child been properly instructed in early life; and how shall our children receive proper education in this most important department of knowledge except it be made a part of the regular curriculum of the schools?-for the parents are neither willing nor competent to teach.

I would suggest that this society appoint a committee to prepare a proper course in hygiene, said course to be approved by this society, and upon its approval by this society to be presented to the various school boards throughout this commonwealth for their adoption.

To this same, or to another committee I would suggest that the subjects of stimulants and narcotics be referred, who shall outline a proper course of study on that subject.

I would also suggest for your consideration the advisability of creating a board of seniors, similar to the "Senate of