practice of the profession of medicine. I fees, and where the contingency is Neglect and slipshod methods will not practically placed beyond their reach do in any case, but the physician should they will not be so ready to accept or always be ready to do his very best. A hunt up business of this sort, as only multiplication of visits may be charged obloquy can come to them in the proseagainst him as being unnecessary and cution of such cases. made for bill purposes, but where and whenever his judgment says they are justifiable they should be made, regardless of insinuating mercenary remarks. Better to be guilty of making ten visits more than are actually required in a case, than to be neglectful of making one that should have been made in the interests of the patient. The medical profession of Ohio are under personal obligations to Judges M. F. Wilson and William Taft for their clearness of insight and appreciation of the working-men in the medical profession, and in their courts establishing a safe, just and reasonable precedent in the conduct of malpractice suits. It is necessary that laws should exist for a just protection of the people from the practice of ignorant and disreputable men and women who engage in the holiest of all callings. It is for this reason that the Ohio law of registration and examination was enacted, and, per contra, members of the medical profession who have spent large sums of money and many years of hard labor in qualifying themselves for engaging in this work, should have a just and reasonable protection given them by the courts. Only this much is asked by the physicians, and nothing more. Unqualified and disreputable physicians have the profound contempt of educated members of the profession, always and everywhere. The clear and intelligent decisions of Judges Wilson and Taft come to reputable physicians as a priceless boon, as they afford protection from shysters who take such cases for contingent THE CINCINNATI HOSPITAL TRAINING SCHOOL FOR NURSES. The annual commencement exercises of this institution took place at the hospital, Thursday, January 14. The graduates were sixteen in number, and the exercises of the occasion were exceedingly pleasant. Diplomas and badges were conferred, after which there was a pleasant gathering of the graduates and their friends in the hospital library, where ice-cream, cake and happy smiles were served to all invited guests. Lest there be a misunderstanding as to the make-up and special character of the smiles above alluded to, it may be said they were not of the special kind that produces inebriety in the person of the recipient of the aforesaid smiles, but they were just as bewitching, just as touching and heart-searching as those given out by any of the self-styled two, three or four hundred. The training school of the Cincinnati Hospital is doing a grand good work. Sixteen well-qualified nurses are at the service of the people of every part of the city and country that is tributary to Cincinnati. This assertion is emphawriter in that he knows sized by the whereof he speaks in this relation. Every one of the sixteen has served a pupilage of two years, and been rotated through the medical, surgical, obstetrical and ophthalmological wards, in every instance receiving careful instruction in the practical work of nursing and caring for the sick, wounded and injured, a result of which is that every one knows how and what to do in a sick-room. Furthermore, these young women are well-bred, polite, and especially fitted to be companionable and agreeable in families and households where they may be employed. It is never a luxury to the sick, although some people do actually enjoy poor health; but as sickness at some time or other comes to almost every one, that sickness may be greatly ameliorated by the tender care of a qualified, good-dispositioned nurse. In any instance where a reputable physician is in need of a superior nurse, a message to Miss. Fisher, who is at the head of the Cincinnati Hospital Training School, will secure an immediate response. Physicians who live outside of the city will do well to make a memorandum of this in their call-book. RESOLUTIONS.-The following resolutions were adopted by the Academy of Medicine of Cincinnati at its meeting of January 18: Dr. A. Rosenfeld, a respected member of the Academy, is dead. He uttered his mute farewell on January 8, 1897. A resident and a practitioner of medicine in this city since the year 1853, he has gone to the reward of a good physician. For the last few years, owing to failing health, he had retired from active practice. Few of his cotemporaries and colleagues are left to tell of his good traits. He was the good family physician in the fullest meaning of the word. The profession has changed and people have changed in the belief that specialists are necessary, still the place of the general practitioner exists. To know man in his physiological, as well as his pathological state, to be a man of high education, of abounding charity, of great patience, of a thorough knowledge of man intellectually, morally and physically, constitutes in its true sense the general practitioner, the adviser, the friend, and comforter of the sick. Dr. Rosenfeld was such a practitioner. He was modest, like all students. He was an honorable man, and a kindly disposed gentleman. He enjoyed in his active days a large practice, and the respect of all who knew him. The Academy hereby expresses its sorrow and sympathy with his family. Your committee respectfully requests that a copy of this memorial be sent to the family by the society. JOHN A. MURPHY, J. C. CULBERTSON, W. D. HAINES, Miscellany. EWING VS. GOODE. OPINION OF THE COURT ON MOTION TO In this case, the petition of Nellie Ewing, the plaintiff, alleges that she employed the defendant, Goode, a surgeon and oculist, to cure her of a certain malady, for a reward to be paid therefor; that defendant entered upon such employment, but did not use proper care and skill in the operating on the eye of plaintiff, and did not bestow proper attention and treatment upon the eye after the operation, causing her to suffer great pain and to lose the right eye entirely and to impair the sight of her left eye. The answer of the defendant denies unskillfulness or lack of attention on his part, and any injury to the It is well plaintiff caused thereby. settled that in such an employment the implied agreement of the physician or surgeon is that no injurious consequences shall result from want of proper skill, care or diligence on his part in the execution of his employment. If there is no injury caused by lack of skill or care, then there is no breach of the physician's obligation, and there can be no recovery (Craig vs. Chambers, 17 O. S., 253-260). Mere lack of skill not causing injury gives no right of action and no right to recover even nominal damages. This was the exact point decided in the case just cited. In Hacke vs. Hooper (7 Car. & P., 81) Tindal Ch. J. said: "A surgeon is responsible for an injury done to a patient through the want of proper skill in his apprentice; but in an action against him, the plaintiff must show that the injury was produced by such want of skill, and it is not to be inferred." Before the plaintiff can recover she must show by affirmative evidence, first, that defendant was unskillful or negligent; and, second, that his want of skill or care caused injury to the plaintiff. If either element is lacking in her proof she has presented no case for the | own inferences from the facts and accept consideration of the jury. The naked or reject the statements of experts; but facts that defendant performed oper- such cases are, where the subject of ations upon her eye, and that pain fol- discussion is on the border line between lowed, and that subsequently the eye the domain of general and expert was in such a bad condition that it had knowledge, as, for instance, where the to be extracted, establish neither the value of land is involved or where the neglect and unskillfulness of the treat value of professional services is in disment nor the causal connection between pute. There the mode of reaching conit and the unfortunate event. A phy- clusions from the facts when stated is sician is not a warrantor of cures. This not so different from the inferences of is the rôle which the quack usually common knowledge that expert testiassumes. If the maxim, "res ipsa mony can be anything more than a mere loquitur," were applicable to a case guide. like this, and a failure to cure were held to be evidence, however slight, of negligence on the part of the physician or surgeon causing the bad result, few would be courageous enough to practice the healing art, for they would have to assume financial liability for nearly all the "ills that flesh is heir to." But when a case concerns the highly specialized art of treating an eye for cataract, or for the mysterious and dread disease of glaucoma, with respect to which a layman can have no knowledge. at all, the court and jury must be dependent on expert evidence. There can be no other guide, and where want of skill or attention is not thus shown by expert evidence applied to the facts, there is no evidence of it proper to be submitted to the jury. Again, when the burden of proof is on the plaintiff to show that injury was negligently caused by defendant, it is not enough to show the injury, together with the expert opinion that it might have occurred from negligence and many other causes. Such evidence has no tendency to show that negligence did cause the injury. When a plaintiff produces evidence that is consistent with an hypothesis that the defendant is not negligent, and also with one that he is, his proof tends to establish neither. The preliminary question for the court to settle in this case, therefore, is whether there is any evidence sufficient in law to sustain a verdict that defendant was unskillful or negligent and that his want of skill or care caused injury. In the courts of this and other States the rule is that if the party having the burden of proof offer a mere scintilla of evidence to support each necessary element of his case, however overwhelming the evidence to the contrary, the court must submit the issue thus made to the jury with the power to set aside the verdict if found against the weight of the evidence. In the Federal courts this is not the rule. According to their practice, if the party having the burden submits only a scintilla of evidence to sustain it, the court, instead of going through the useless form of submitting the issue to the jury and correcting error, if made, by setting aside the verdict, may, in the first instance, direct the jury to return a verdict for the defendant. Hence, our inquiry is, does the case now submitted show more than a scintilla of evidence tending to show want of skill or care by defend-gaged ant, or injury caused thereby? In many cases, expert evidence, though all tending one way, is not conclusive upon the court and jury; but the latter, as men of affairs, may draw their These facts may be taken as undisputed in this case. Mrs. Ewing, the plaintiff, lives with her husband in Covington, Ky. He was a printer, engaged in the office of the Commercial Gazette Printing Office, in this city, during the time of the existence of the professional relation between his wife and the defendant. the defendant. Dr. Goode is a highly educated and experienced phy. sician and oculist of the city, now en eye. solely in treating diseases of the In September, 1894, Mrs. Ewing began to feel a haziness in her right eye. It grew worse, so that in the spring of the next year she consulted Dr. Tange man, an oculist of this city. He told her | of the bandage. The treatment pursued that she had cloudiness of the lens. Becoming dissatisfied with his treatment, she went, upon the recommendation of Dr. Kebler, her family physician, to consult Dr. Goode. He examined her and told her that she had cataract in both eyes, that an operation would have soon to be performed in the right eye. Plaintiff's own expert witness, Dr. Buckner, who examined the left eye in June, 1896, confirms the statement that there is a cataract in the left eye. Cataract is a disease of the lens of eye which renders it cloudy and opaque, and prevents the passage through it of the rays of light, which in its normal condition it focuses on the retina. The operation of cataract is an operation by which the whole lens is removed from the capsule covering in which it is enclosed and suspended in the eye. The removal is usually effected by cutting a passage way for it through the cornea and the iris, both of which are situated in the eye in front of the lens. This may be done at the same time with the main operation, or long enough before to permit the healing of the wound necessary in the cutting before removal of the lens. The defendant pursued the latter course. The auxiliary operation is called the preliminary iridectomy. It was performed on the 8th of July, 1895. It was a smooth and successful operation. The wound healed quickly. No inflammation or formation of pus ensued. On the 25th of September following the main operation was performed. Through the passage way in the iris an instrument was inserted and the covering of the lens capsule was ruptured, and then through this opening the lens was gently pressed out through the hole cut in the iris. The operation was smooth and successful, and after a week or ten days the wounds made were very nicely healed. Close attention was given by the defendant and his assistant, Dr. Heflebower, to see that no piece of iris tissue should be caught or incarcerated in the lips of the wound. No inflammation or pus followed the operation. There was pain in the right eye on the first day, which was relieved,apparently, and at least for a time, by a loosening after each operation is that approved by the medical profession. After ten days, three to four-tenths of vision was found to be restored to the right eye with the use of the cataract glass, which is the lens needed to supply the place of the lens which was extracted. By the use of the ophthalmoscope the whole interior of the eye was explored, the media were found to be clear, and all the parts were normal. After two or three weeks the plaintiff was able to go about, and upon the 19th of October came from her home in Covington to visit the defendant, and paid him ten dollars on his bill of one hundred dollars. An examination of the eye showed that it was in good condition, and the test for vision was as stated above. The treatment testified to, and not denied up to this time, was in accord with the best approved views of the profession. During this period the plaintiff visited Shillito's store several times, and did some of her housework at home, and on the 11th of November came again to visit the defendant and pay him ten dollars. He examined the eye and found it in good condition, without the slightest indication in it that there was anything wrong. On the 19th of November the plaintiff complained of pain, and another examination of the eye was had, but no cause for the pain was found in an exploration of it with the ophthalmoscope. The complaints of pain continuing, the defendant attributed it to neuralgia of the fifth nerve, because there was no other explanation of it, and applied leeches to the flesh surrounding the eye, upon the 24th. The pain continued, and in the first week of December the defendant and Dr. Heflebower again carefully examined the eye at defendant's office, and confirmed their conclusion that the pain was neuralgia. On the 8th of December, which was Sunday, in the absence of the defendant from his office, the husband of the plaintiff called Dr. Heflebower to assist the plaintiff and relieve her from pain, of which she was complaining bitterly. He again examined the eye with the ophthalmoscope, and found no evidence of reason for the pain in the eye, and fortified his cataract operation, hope of recovery is so slight is that just such a passage way has already been cut for the removal of the cataract, and if that does not serve to relieve the pressure the chance that a second one will do so is very, very small. previous judgment that it was only | cavity of the eye to open a canal for neuralgic pain. He prescribed a drop the release of the secretions. The reason of cocaine and powders of phenacetine why, in secondary glaucoma after a and salol to relieve the neuralgia. On the next day, the 9th of December, which was Monday, Heflebower saw Goode and advised him of his visit. Defendant visited plaintiff that day, and after a thorough examination of the eye thought he detected a slight increase in the tension of the right eye, but was doubtful of it. Although the eye had been carefully examined since July 8 for tension, never until this date had there been the slightest evidence of an increase. Increased tension of the eyeball is the predominant symptom of the disease of the eye known as glaucoma. This is a disease the causes of which are but little understood. It is supposed to be an abnormal increase of the secretions of the inner eye and a consequent pressure of one part of the eye against another, so as to close and stop up the canal for the escape of the eye's secretions, known as the filtration angle. It may appear in an eye un affected by injury or disease, in which case it is called simple glaucoma. It may appear in an eye diseased or injured, in which case it is called secondary glaucoma. The name secondary glaucoma does not necessarily indicate that it is caused by the prior condition of the eye. In cases of simple glaucoma there are perhaps 50 per cent. of recoveries. In cases of secondary glaucoma, owing to the diseased or enfeebled condition of the eye when glaucoma sets in, the percentage of recovery is much reduced, and when it sets in after an operation for cataract the eye is almost certainly doomed. Glaucoma can rarely be diagnosed in the absence of an increased tension. It is frequently accompanied by pain, and the media of the eye become obscured or cloudy and vision is lessened, but in the absence of increased tension the other symptoms do not indicate glaucoma. There are but two remedies for glaucoma; one is the use of a drug called eserine, and the other is the cutting of a passage way through the cornea and iris into the On the 9th of December, when the defendant visited the plaintiff and suspected slight increased tension, he prescribed eserine. The prescription was not filled till the 11th. It directed "the use of a drop a day in the eye." The phenacetine prescribed by Heflebower to relieve the pain he approved the use of. He On the 10th of december defendant visited plaintiff again and found that there was no increased tension and no other evidence in the eye itself of glaucomatous conditions, though the pains continued. He confirmed his conclusion that no increased tension existed by another visit and examination on the 11th of December. After that he remained in the city until the 18th, and received no call from the plaintiff. then left for Pittsburg to perform an operation and to spend the Christmas holidays. He asked Dr. Heflebower, a competent oculist, who was familiar with the plaintiff's case, and whom plaintiff had called in before when she could not get defendant by telephone, to attend to plaintiff's case should she call for him. Whether she did call Dr. Heflebower and whether he went over or not are matters of evidence in dispute. He says that he went twice about Christmas or later and found the eye in good condition, with no increased tension; that she was taking the eserine, but that the pain continued; and that he attempted to relieve her by continuing the phenacetine and by hot applications. Plaintiff denies that Heflebower was at her house in December. On the 6th of January defendant returned and answered a call from plaintiff, and on examination of the eye found increased tension, amounting to plus 1, and distinct symptoms of glaucoma. He requested her to come to his office, which |