Four decades have passed, however, since that date, and now we find that which was then orthodox in the way of brutality to the sick, to be repellent not only to the people, but to the thinking members of the medical profession, regardless of schools.

No longer does a physician blister the back of a strong man to heal an inward ailment. No longer does a physician torture the consumptive girl with croton oil spread over the breast, or supplement his treatment with a heroic tartar emetic plaster. Nor do we find the compound tar plaster used until the flesh suppurates, and the patient cries in agony for relief. The lancet lies, a curious relic of days gone by; rusty is the metal of the spring, rusty also the edge of the blade. In those days the ten grains of "blue mass," or the ten grains of calomel, or the heroic dose of podophyllin began the treatment that was immediately followed by an ounce of castor oil or two compound cathartic pills as an assistant. In those days the patient was tertured by the cruelties of those who believed in heroic medication. The gentle ray of the sun was a thing unheeded. The kindly touch of a supporting remedy that would conserve vital force and not sap the patient's strength was, by "authority," resisted with all the energy of those who had the power to say what should be employed, and who believed that anything else than cruelty was quackery. Men who believed that kindness to the sick was more effective than distressing pain caused by outward applications and inward heroics, were classed as charlatans who knew not the needs of those who needed medication. Seemingly the beautiful allegory of the sun and the wind, and the earthquake and the fire, contrasted with the power of the still small voice, had no modern application. The so-called "fable" of Æsop, in which the wind was conquered by the kindness of the sun, fell unheeded upon the ears of those who heard the words of the text.

Listen! Let us think backward. Let us apply the lesson of it all. "The still small voice" in medicine is the kindly touch that comes from the teachings of those to whom cruelty is a wicked thing when applied to the man in health, and a double wickedness when applied to the helpless child or the feeble woman, the mother in distress or the father in pain.-Lloyd, Eclectic Medical Journal, October, 1912.

Schools of Medicine.-We hear very much in recent years about the science of medicine; that medicine is becoming so exact with recent discoveries in the laboratory that henceforth it must be classed with the exact sciences; therefore, there should be a merging of all schools into one; that it is absurd to have a science of Allopathic medicine, a science of Eclectic medicine, and a science of Homeopathic medicine. In this connection we hear much of advanced medical training and of a reduction in the number of medical colleges. Why this agitation for but one school of medicine? If the so-called regular school really possesses the only true scientific method of treating the sick, the people will not be long in finding it out and will

therefore employ only true and scientific physicians and the other schools will die a natural death. The people can be trusted to decide this question for themselves. This is seen in politics and religion, and why should not the people decide also in medicine? The fact is, that the so-called regular physician is less certain in his prescribing for the sick, therefore less scientific than either of the other great schools of medicine. So unsuccessful have the so-called regulars been in the administration of remedies that a large number, having lost faith in drugs, are following the teachings of Osler, who is generally regarded as a therapeutic nihilist, and those who still believe in the efficacy of drugs are divided as to the remedy and quantity in any given disease. The adherents of the other schools, Eclectic and Homeopathic, believe that there is a definite relation between diseased conditions and drug action; that certain pathological conditions are definitely described by well-known and positive symptoms, and when this relation between the symptoms, which is the expression of definite pathological conditions and remedies, are known, drugs can be prescribed with a degree of certainty that rarely disappoints. This has been proven so many times by thousands of well-educated practitioners of large experience that it seems futile to talk of all schools merging into one. So long as the sick are relieved and their health restored, so long will the people not only be satisfied to choose their own school of medicine, but will demand the right of choice. Just as long as the demands for new school physicians exceed the supply, as it is at present, it will be futile for organized medicine to attempt to legislate out of existence all medical colleges not conforming to their ideas of medical training. The control of medical colleges by the State will prove no more satisfactory than control of theological colleges by the State. The people must and will decide whom they will employ and therefore what colleges shall be permitted to exist. Thomas, Eclectic Medical Journal, July, 1912.

Individualization. This is really the keynote of success in Specific Medication. If we say a certain remedy is good for typhoid fever, or another is the remedy for pneumonia, or another for appendicitis (whatever the condition of the patient), we can expect failure in a large percentage of the cases. Every patient must be studied with reference to the conditions present at the moment of prescribing. The exact condition of this individual at this time must be determined, and the remedy carefully, accurately, and as precisely as possible must be adjusted with reference to its individual selection. Therefore, individualization applies not only to the patient, but to the remedy, and to the exact basic conditions present.

This great truth is being recognized by writers now of all schools, and it is gradually dawning upon even the most radical that generalization has no place in exact medication, but individualization is absolutely essential, and accuracy of drug action as applied to exact conditions can only be so determined.-Ellingwood, in Ellingwood's Therapeutist, September, 1912.

SELECTED ARTICLES.

THE ELOQUENCE OF INFANCY.*

BY LE GRAND KERR, M. D., BROOKLYN, N. Y.

In the Standard Dictionary, one of the definitions of "eloquence" is the quality of being eloquent or of moving the mind. We are then concerned with a definition which embodies two propositions; the quality of using eloquent speech and the quality of moving the mind. Mere eloquence of speech requires nothing but a thinking and feeling personality alive to some definite proposition and with the ability to thrust the thought eloquently forward into the spoken word.

And much of that which is spoken is lifted from the grade of the commonplace and elevated to the realm of eloquence by the tone of the voice, the pauses, the gestures, the expression; in short, by the personality back of the spoken word. However, the quality of moving the mind does not depend upon the spoken word, although articulate speech may be an important factor in the process. The sometime quoted "eloquence of silence" is more than mere poetic license, it is the recognition of a most powerful factor in eloquence and may become the direct stimulus which "moves the mind."

This power of moving the mind depends not alone upon the effort put forth to accomplish that object, but is influenced to a very large extent by the receptivity of the mind that is to be moved. No degree of eloquence can successfully move the mind that through ignorance, disinterest or antagonism sets itself above such influence, and even in those instances in which there is an attempt at co-operation there must also be an adaptability of the mind receptive to impressions through the influences of a knowledge sufficient to appreciate and understand the full import of what is expressed.

Then if we are to secure the full benefits of the quality that moves the mind, there must be application of the laws of adaptation, co-operation and definiteness. This entails upon the physician who would properly understand and correctly interpret the inarticulate expressions of disease in the infant, an intimate

Read before the Medical Association of the Greater City of New York.

knowledge of how and why such expression differs from that of adult life.

The diagnosis of disease in infancy offers difficulties and peculiarities which are not patent in the adult. The idea that the infant is an adult in miniature is a false one; the infant bears to the adult a relation of potentiality; nothing more. A complete description of all the changes in the economy which mark the infant from the adult would include each element of mental and physical growth. But even a general knowledge of these differences shows to one the error of attempting to apply exactly the same methods of diagnosis as are suited to adult life.

The clinical manifestations of disease in infancy and in maturity are vastly different; it is this difference that makes the appreciation of disease in the infant difficult. The familiar things which are used as the foundation for building up the superstructure diagnosis in the adult are in infants entirely absent, or are so totally different that they are misleading. In approaching the infant the inexperienced are at once confronted with a sense of loneliness similar to that which overcomes the stranger in a strange land; a land in which there are few familiar scenes and none to guide.

It would be impossible in the time allotted to me to consider in detail all of the phases of this subject, but the purpose of this paper will be conserved if I am able to attract practical attention to the fact that "Babies talk, but few understand the language."

While there are many of the diseases which are peculiar to the period of life known as infancy, it is the peculiarity of the patient as much as the disease which must interest us, for it is this that leads to the varied expression of disease. Of prime importance in the study of any disease, is the accuracy with which a diagnosis may be made. In infancy this entails that we must be acquainted with facts about the infant which have no direct bearing upon the disease present, but which must often modify or entirely change our usual interpretation of symptoms. For instance, we are always conscious of the insignificant influence of the mind upon disease in infancy, for the diagnostic possibility is appreciably limited by the fact that psychic neurotic influences are almost excluded.

The various tissues may also be incapable of exhibiting phenomena which are the result of certain etiological factors, or

in their immaturity they may respond more easily and certainly to other factors. And again, even in the presence of a definite symptomatology, the reasoning and deduction as to its cause must be entirely distinct from the same processes as they apply in adult life. For instance, the very young infant is comparatively free from convulsive seizures, because during the first three months of life, the acute systematic bacterial toxemias, which are potent factors in the etiology of convulsions, are infrequent. Then again, stimulation of the cortical motor centers and of the convulsive centers at the base of the brain does not excite convulsive movement easily, because the nerve force discharged from these centers is hindered in its dissemination by the under-development of the myelin sheaths of the fibers of the pyramidal tracts. These sheaths are gradually developed so that about the third or fourth month of life the pyramidal tracts have their functions sufficiently developed to bring the spinal cells and the cerebral convulsive centers into close touch.

But after the third month and until the end of the second year all of the nerve centers are most irritable, so that convulsive seizures are common. The clinical import of this is, that convulsions in the very young infant are of serious import and that not infrequently after their subsidence there is some weakness of the affected musculature. That convulsions occurring at the onset of some disease in an infant between the ages of three months and two years are of but little import and may be due to the most trivial cause, while in adult life any such event at any time would be sufficient cause for great alarm.

The necessity of recognizing these differences must be apparent, because it is by a correct analysis of them that we are enabled to determine the import of symptoms. Not infrequently apparently mild symptoms are interpreted as indicative of mild disease, while seemingly more grave ones arouse unnecessary alarm and foster the drawing of wrong conclusions.

Take for example, the symptomatology of an acute illness in the infant; we find that there is not the limitation of symptoms referable to the particular organ or region which is primarily involved as in adult life, but the infant becomes the subject of more general or constitutional symptoms. Thus the expression of the disease is more constitutional than focal and the younger the child the more striking the contrast.