are most common. Inductive reasoning | the work a clear, unbiased mind. He from symptoms as to conditions and must examine the facts of each case and measures for relief is practically im- determine their meanings in the spirit possible, only in very narrow limits, in of an explorer in a new country. Inesuch persons. The personality and con- briety is a question of scientific facts sciousness are defective, and organic and their meaning; there can be no and psychical memories unconsciously theories or opinions, no sentiments or bias all judgment. The sense impres- personalities. Each case is a new sions, formerly perverted and palsied province of psychological pathology by spirits, are aroused up again by the to be studied by itself. All efforts to contagion of others suffering in like understand such cases by the way of manner. The false ego of the patient the emotions, and sympathetic followafter a time impresses itself on the phy- ing of the damaged reasoning will fail. sician whose mind has been in a similar No group of facts are final, and no condition. The result is credulity and means of treatment can be asserted dogmost unreasoning dogmatism in regard matically. Each group of facts are to inebriates and the results of treat- held for the present until a larger and clearer view is obtained. Each student who treats inebriety is always ready for new means and measures of treatment.-Quarterly Journal of Inebriety.

ment.

The personal experience of the physician who is treating the case is always consciously or unconsciously the basis of all theories of treatment. The man who has obtained relief by certain drugs, or who has, by the pledge or prayer, or forced abstinence become temperate, will reason that these means are effectual in all cases. There is always a dangerous contagion in the emotional strain of assisting others out of the disorder so vividly impressed on the brain of the person who has suffered in a similar way.

Certain temperance and reform lecturers may go on for years appealing to the emotions of inebriates to stop drinking, but they all suffer more or less from psychical strain and contagion. Usually they all break down and return to spirits or drugs after a time. The reformed men who receive inebriates in their family and enter upon the work of personally treating them, living in the mental and psychical surroundings of such cases, usually fail. Notable examples will be found in the managers of the gold cure empirics. Every reformed man as a rule will relapse, particularly if he follows the business of curing others. In the history of asylums in this country, no reformed man has ever continued long in the work, or succeeded as a manager or physician in the medical and personal cure of ine. briates. The successful manager and physician in the personal study and treatment of inebriety must bring to

Coitus as a Disturbing Element.

We prefer to preface what we are to say on this subject by laying down some propositions which will probably be generally accepted. Most likely all will agree that married women are more subject to intra pelvic disease than single women are. Every one with only moderate experience will also have observed that married women respond less readily to treatment than do the unmarried. It is also a fact that the average mother with young children is not in as good health as she was before maternity, and that in this regard she is outranked by those of her acquaintances who have not married, or who, at least, if married, have no children. We are also well aware that the added cares of household duties and child's nurse are a tax upon the strength, and that the additional sapping incident to wet nursing makes the mother's lot a still harder

one.

But all these facts intensify the point we now desire to make.

With the sexual instinct in abeyance, there is saved to the organism, in earlier adult life at least, much energy that is conserved for future emergency or that expends itself in added nutrition, as evidenced by the vigor and bloom of youth. How many women lose this bloom and become relaxed after even a short married life, though conception

does not occur, who have rarely known | volve the uterus and ovaries.
a sick day before marriage? Many are
the cases of this kind that come under
the notice of physicians.

Many such changes have been traced to the disturbing influence of coitus. The sudden call into full and persistently recurring activity of those previously unexercised parts, causes local congestive and inflammatory troubles, actively maintained by a continuance of the original exciting cause. The suffer ing woman submits out of a conscientious and even fervid sense of martial | duty. The man persists in blissful, but eventually bound to be painful and expensive, ignorance of the damage he is causing. If the physician is eventually consulted for leucorrhea, backache, dragging sensations in the hips, and hypogastrium, and the many other ills peculiar to intra-pelvic troubles, he usually adopts routine treatment, complacently pockets his fee, contentedly conscious of duty well performed, whilst his patient does not get well, but is induced by him to bear her sufferings philosophically and with gratitude because she is at least getting no worse. This portrays a condition that most practitioners can readily recall, and that even many patients would not be slow in recognizing.

The local factors causing this misfortune are frictions and associated active disturbance of the relation of the uterus and its adnexa to the pelvic walls and other pelvic contents. To this must also be added the nervous strain of simulating pleasure where there is but pain, and the morbidness caused by secret suffering; for those matters appear of so delicate a nature to a retiring, modest woman, that she is loath to mention them even to her trusted medical adviser. Thus the condition steadily gets worse. A small vagina or a large male organ usually causes trouble, even if gratification is infrequent. Excessive use of these parts is almost always at the expense of general as well as local well-being. The first effects of initial coitus exclusive of the common rupture of the edge of the hymen, is congestion, usually of the vaginal mucous membrane.

Frequent repetitions soon in

These

conditions are aggravated by the menses. Then follows a train of ills, the weakest part succumbing first, such as endometritis, versions, flexions, vesical irritability, and ovarian tenderness and congestion. These the physician is called upon to treat.

That removal of the cause constitutes the first requisite to successful and intelligent treatment, is an axiom in medical practice. Few, however, interdict coitus in treating these affections of married women. Yet they cannot help observing the difference in responsiveness to treatment for these conditions in the married and in the unmarried in favor of the latter. Few men even consider the advisability of interdicting coitus until the patient is well, and many of those who do appreciate, at least in part, the desirability of abstinence, refrain from advising it on diplomatic grounds. But this is cowardly, an injustice to the patient, and debasing to the guilty physician. We have repeatedly seen so many good results follow total abstinence from sexual gratification, that it was the only necessary treatment in many instances.

The

Thus far, allusion has been made only to intra-pelvic trouble caused by coitus; but it is a much greater factor in continuing and intensifying intra-pelvic disease of other origin, and there is where it is most baneful, because much oftener a disturbing element. lesson to be learned, therefore, from this discussion, is the extreme value of rest of the sexual organs in treating them for congestive or inflammatory trouble. It is not enough, however, to advise the poor suffering woman on this subject, for she is very likely to say nothing about it to her husband, for the double reason that she has a natural delicacy about telling him of conversations upon that subject even with her physician, and she is loath to veto an act to which she conscientiously believes it her marital duty to consent. most satisfactory plan, from every standpoint, is to spare our patient the indelicacy of the injunction, but to request her to send the husband, to whom the necessity for abstinence can be fully

The

explained, as well as the probable to the Bellevue School, and, in antici

dangers of a disregard of the injunction. If subsequently found to be necessary because of the husband's failure to protect his wife against his own aggressions, she should be sent away to rest whilst undergoing treatment. We affirm that the practitioner who will reason and act upon these suggestions will find many obstinate cases promptly yield, though having failed to respond to any other kind of treatment.-Med. Council.

The Consolidation of Two Great

Medical Schools.

pation of the expiration of the lease, a site for a new building was purchased. This adjoins the Carnegie Laboratory, and has a frontage of 75 feet on 26th Street and 150 feet on First Avenue. On this lot, it is announced, a handsome and commodious structure will be erected, and, in addition, the University Medical College Building, which stands near by, will be enlarged by the addition of two stories, making it eight stories in height. The manner in which the various professorships in the consolidated institution will be arranged from the faculties of the two schools has not yet been made public, and probably has not as yet been fully determined upon.-Boston Med. and Surg. Journal.

Etiology of Hepatic Cirrhosis.

A measure which has created much surprize in the profession, but which, it appears, has been in contemplation for some time, was made public on April 8, when it was announced that the State Board of Regents at a meeting held in Albany on that date had effected the consolidation of two of the Scagliosi discusses (Virchow's Arprincipal medical schools of New York chiv-Medicine) the etiology of cirrhoCity, namely, the Medical Department sis of the liver, especially in its relation of the University of the City of New to alcohol and the acute infectious disYork and Bellevue Hospital Medical eases. Aside from the alleged frequent College. The name of the consolidated causal rôle of alcohol, he calls attention institution will be the New York Uni- to the fact that a series of cases is conversity Bellevue Medical College, and stantly encountered in which the etiit is hoped to make it one of the largest ology of hepatitis is entirely obscure. and most thoroughly equipped medical Clinical observation demonstrates that schools in the world. It is stated that in these cases neither alcohol, malaria at the beginning it will have an annual nor syphilis is the cause of the hepatitis, income of about $160,000, and the belief especially in children and in the newis expressed that this will from time to born. Many authors suspect that spices, time be increased by gifts and legacies. coffee and other drinks taken in excess The first formal step in the matter of exercise an influence upon the liver the union was taken on March 17, when analogous to that of alcohol. The exthe University corporation adopted a perimental evidence on the subject of resolution inviting the faculty and trus-alcoholic cirrhosis of the liver is contees of Bellevue to join in the consolidation of their institution with theirs, upon a plan similar to that recently adopted when the University Medical College placed itself under the immediate care of the University. It is prob. able that the project of consolidation was hastened by the fire which two months ago partially destroyed the Bellevue building, which stands within the grounds of Bellevue Hospital, on city property, the lease of which expires in two years. Pending the refitting of the building the college was transferred to the Carnegie Laboratory, belonging

flicting. For example, in Von Kahlden's experiments, 15,800 grammes of spirits were injected into a guinea-pig, and at the end of 158 days some fatty changes, and some extravasation of round cells about the portal vessels, were noted, but there were absolutely no cirrhotic changes, not even in the incipient stage.

Scagliosi has considered the relation of infectious diseases to cirrhosis of the liver; he cites the experiments of Wolff, who produced a marked cirrhosis of the liver in rabbits by the injection subcutaneously of fluids containing bacteria. Roger proved experimentally that the

bacillus septicus putridus injected into | teen grains were given daily, and well the lower animals would produce cir- borne. In all cases the volume of the rhosis in from two to eight weeks. urine increased, and its specific gravity Clinical evidence shows that cirrhosis often follows the infectious diseases, especially scarlet fever or measles. Laure and Honorat describe cirrhosis following inflammation of the bile vessels, angeiocholitis. Following the last epidemic of influenza many cases of cirrhosis were observed. Kernig, Brun and Pilliet observed inflammation about the portal vein after puerperal fever and infectious enteritis. Bichart observed the same changes after small-pox; Hanot and Gilbert, after cholera. In tuberculosis and after typhoid cirrhosis is often observed.

The experimenter comes to the conclusion that alcohol or similar irritating drinks may produce a cirrhosis when the liver is weak congenitally, but that infection is the real cause of cirrhosis. He tabulates the results of his experiments as follows: First, alcohol influences the normal liver scarcely at all; second, the lower animals react variously to different infectious agents, but in rabbits especially, cirrhosis and incipient interstitial hepatitis can be caused thereby; lastly, if the process has not advanced far the lesion may heal. Med. Standard.

Strontium Lactate in Bright's
Disease.

Bronowski (Wien. med. Presse) makes a preliminary statement of the results of his clinical and experimental investigations into the action of lactate of strontium upon the kidneys. His first experiments were upon rabbits, and consisted in the daily subcutaneous injection of a quantity equal to double the dose proportionate to the body weight. After a month one rabbit had gained seven ounces in weight, and the second ten ounces, while the third had not altered. They were perfectly well in every way, and after they had been killed the internal organs were found to be normal. The drug was then tried in ten cases of kidney disease, three of which were acute parenchymatous nephritis, six mixed nephritis, and one interstitial nephritis. Six doses of fif

fell. This effect began on the second or third day, and was most marked on the sixth or seventh, and persisted two or three days after the drug had been discontinued. The action was most marked in acute cases and was much slighter in the chronic forms; the albumen diminished parri passu with the increase in the urine. In acute cases it disappeared entirely, but in chronic no diminution was observed. The ethereal sulphates in the urine, by which the amount of intestinal putrefaction may be estimated, were unaffected, nor was there any constant change in the pulse or blood pressure. The antiseptic properties of the lactate of strontium were tested upon a patient with an intestinal fistula in the cecal region, and found to be extremely slight. A further series of experiments was made upon dogs, varying strengths of a solution of the drug being injected intravenously. The blood-pressure was at first unaltered, but fell rapidly when the dose was increased; the rapidity of the pulse and respiration were increased, and the volume of urine was doubled or trebled. With enormous doses the volume again diminished, and the urine was found to contain red and white corpuscles. In this case there was seen post mortem (the animal having been killed by bleeding) hyperemia of the kidneys and hemorrhages into their capsule and parenchyma. The author concludes that strontium lactate is a pure diuretic, and is more valuable than any other remedy in the treatment of acute inflammatory conditions of the kidney.-St. Louis Med. and Surg. Journal.

Malarial Poisoning.

Prof. Wm. Osler, of Johns Hopkins University, read a paper recently before the County Medical Society on the trite subject of malaria. It goes without saying that the address was practical and interesting. His differential points. between malaria and typhoid fevers, tuberculosis and other affections, were clear and concise. High tribute was paid the Italian investigators, especially