so much as an answer to his call bell. Nor does such a patient, accustomed to the respectful consideration and civility of those to whom he pays his good money for such attentions, relish the high-handed and dictatorial treatment which he so frequently receives from the nursing staff and orderlies. He is, of course, content to submit himself to the commands of his doctor, and to abide by the reasonable rules and regulations of the institution which are necessary for his own and the other inmates' good. But he feels, and rightly feels, that the personnel of the hospital system from the superintendent down to the elevator boy, are there for his express convenience, just as truly as the small army of chiefs and underlings that wait upon him in a hotel.

Nor is this commercial viewpoint the only consideration. The patient who is subjected to these petty annoyances and discomforts is, in his sick state of body and mind, more than likely to be unduly ruffled and upset, and to have his recovery to just that extent hindered and retarded, instead of hastened and enhanced. And thus a hospital regime, except for cases of extreme illness or major operation, and as long as such cases hold the attraction of great urgency and interest for the hospital staff, is made rather a disadvantage than an advantage to both physician and public.

As stated, we do not suggest that hospitals deliberately and maliciously practise these sins of commission and omission. They are largely the result of inefficiency and mismanagement. Yet they are none the less reprehensible; and every physician knows, of his own experience, that they are common conditions. For our part, we cannot for the life of us understand how hospitals which exhibit such slovenly disregard for the comfort and convenience of their patrons can expect to hold good patronage; indeed, we marvel how they have done so as long and as well as they have. But neither the public nor the general practitioner (who are, after all, the main support of the hospital) will tolerate such conditions forever. Hospitals, as well as all other public hostelries, must keep abreast of the time. If there be any crusade worthy of the efforts of a large organized medical body-the American Medical Association, for example-and if such a body be really and genuinely anxious to do something for the public welfare, we respectfully suggest that the overhauling of the hospital system offers a most excellent and fruitful field. Perhaps, on second thoughts, if the American Medical Association should undertake such a task, the situation would be made worse rather than improved; for favoritism and "interests" would be sure to enter into the process. However, there is room for a reformation from some source and by some channel.

IT

NEGLECT OF MEDICAL HISTORY

T is little short of astonishing that in a presumedly learned profession, whose doctrines are inspired and its conduct governed to so large an extent by conservatism and tradition, there should be such a lamentable ignorance of medical history. Quite aside from any considerations of educational thoroughness and practical utility, one might suppose that among a class of men representing more than the average degree of intellectual culture, there would be a goodly proportion of purely esthetic interest in the history of their own science and profession-rich as it is in the most absorbing and significant lore, pertaining to both men and processes. One of the oldest, if not the very oldest, of human avocations, as old as man himself, antedating even religious cults, many of which flowed out of the physical needs of mankind—it would seem that the history and development of medicine would offer an attractive field of reading sheerly on the ground of its own innate relationship to the humanities. And when one further considers that it is directly concerned, and

has always been closely associated, with the most elemental and intimate experiences of individual, family, and national life, it is hard to understand how any physician with the least glimmering of philosophic interest in his craft can have escaped its spell. Yet the fact appears to be that, as a class, the medical man is not only profoundly ignorant of, but utterly indifferent to, the historical aspects of his calling.

But it is not merely the esthetic or literary viewpoint that makes an appeal to the medical profession for a wider and better acquaintance with its own history. Against that appeal, by itself, it might be urged that the average practitioner, busy with the practical phases of his vocation, has but little time, even if he had the inclination, to browse among its historical lore; and that this dilletante indulgence of the esthetic faculty must, in the nature of things, be restricted to the favored few who have both the taste and the leisure. Such a summary disposition of the matter, however, will not avail, even from the most practical and materialistic quarters, because both the science and the practice of medicine are of such a nature that it is impossible to divorce their historical and their pragmatic aspects. As a science, medicine did not spring, Minerva-like, from the brain of Jove, but is a composite product of a slow evolutional process, to which every age, almost every people, and certainly every scientific and philosophic epoch, has contributed. Into its crucible have been thrown the theories and empiricisms of hundreds of centuries, all of which have been subjected to the inexorable smelting process by which the noble metals are separated from the base. The process, advanced as it is, has not been perfected-it is still a process-and it is hard to see how the present contents of the melting-pot can be intelligently evaluated or adequately utilized without some little knowledge, at all events, of the flux of which they are the net resultant,— at least of the salient stages and their significance. It does not seem that any man can be thoroughly equipped to the task of interpreting the physical maladies of mankind-in which are included all the agencies of etiology and diagnosis-or of applying remedies--in which are embraced all the resources of modern therapeutics -who is not at least on speaking terms with the history of medicine.

If a real and valid excuse be sought for the ignorance of, and the lack of general interest in, medical history among the profession at large, it might, we think, be found in the almost utter lack of the right kind of literature on the subject. We are not overlooking or belittling the fact that there are several histories of medicine in the field which, regarded from the standpoint of sheer historical accuracy and wealth of data, satisfy the most exacting standards. There are even works extant which attempt, after a fashion, a more or less philosophical interpretation of the data. But we must confess our feeling that they are not such histories as the average man in the profession could be expected to read with any degree of interest or understanding. What is needed—and badly needed--is a historian with a proper sense of proportion, a keen discrimination between the essential and incidental, and a charming literary style, who shall, in a work of moderate dimensions, weave for us the fascinating story of the birth and growth of medical science, in language that all may understand, with an authoritative correctness as to facts (but not too many of them) which none can gainsay, and in a perspective that shall clearly display each epoch and landmark in its true and natural relationship to the bent and development of the process.

Practical Value of the Temperaments.

By H. J. H. HOEVE, M. D.,

Professor of Anatomy in the College of Medicine of Drake University, Des Moines, Iowa.

ONFRONTED with the theoretical question, we should doubtless all

C admit the importance of temperament in the physical and mental

make-up of the individual. Indeed, temperament may be fairly regarded as the net resultant of all the variations that go to make up an individual's heredity. The insurance companies, who are the wisest of all in such matters, take serious account of it. But we medical men, as a rule, are all too prone to scoff at it, or to ignore it altogether. Therefore, Dr. Hoeve's able paper is both timely and practical. It calls attention to the physical and clinical significance of the temperaments, adopting Jacque's classification, based on anatomical characteristics, namely, the vital temperament, the mental type, and the motor type, all of which are admirably described by the author, and skilfully differentiated. These are the days of biological medicine, and every physician should acquaint himself with the truths of biology in their widest and profoundest aspects, as they relate to health and disease.

TH

HE temperaments are mostly referred to as the varieties of the physical constitution in man. Some of the older classifications of the temperaments used to consider them under three heads: the phlegmatic, choleric and the melancholic. Spurzheim's classification increases the number to four, viz., the lymphatic, sanguine, bilious and the nervous temperament.

But while all these classifications seem to meet the requirements, at the same time, they are very hard to differentiate so far as the general practitioner is concerned. We all know that the particular state of the constitution depends upon the relative proportion of its different masses and the relative energy of its different functions. The body is tempered, in fact, by the combination of these constitutional elements in various proportions. The predominating element determines the temper or temperament. Of course, the others may be present in innumerable modifications so that most important arrangement would be to classify the number of individual pecularities in their simplest elements and adopt some

we

could

classification under which
group persons who resemble each other
in certain peculiarities, or persons who
have similar organizations. In order to
accomplish this, writers on this subject.
have usually considered temperaments
under from three or five heads. The
simplest classification seems to be that
of Dr. Jaques. He classifies the tempera-
ments according to an anatomical basis.
Motor mechanical system, the vital or
nutritive system, the mental or nervous
system.

According to the different peculiarities the temperament is classified. For instance, the motor type would be the easiest to recognize. We find the framework and the musculature enormously developed. Of course this type would be more frequent in males. They are generally tall, with broad shoulders; adipose tissue is lacking and the joints are large and prominent. Neck rather long but enormously developed muscularly. Face oblong or angular. Front teeth large, of a yellowish hue; lower jaw massive, frequently square. (See prize-fighter's jaw -Woolsey.) Malar bones prominent

Three Cases of Extra-Uterine Pregnancy

By HOWARD HILL, M. D.,

Prof. Surgical Anatomy in the University Medical College, etc., Kansas City, Mo.

XTRA-UTERINE pregnancy is far more common than is generally supposed, and yet cases of this nature continue to be misinterpreted and wrongly diagnosed with all too great frequency. One of its most conspicuous characteristics is its atypicality, to which must be attributed the common tendency of the physician to overlook. Hence the importance and value of hearing from every quarter where the trouble has been properly diagnosed, with a clear and faithful account of the signs and symptoms by which it was recognized. The author of this article cites three cases, two of which were irregular and atypical, and the third a typical instance of extra-uterine pregnancy with rupture. The last case serves as an admirable foil against which to study the other two, one of which was diagnosed and operated upon before rupture, the other after rupture. Both were attended with menstrual irregularity. There is much to be learned from the recital of these three cases.