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who entered the mouth of the hungry ent journalistic media of medical exP. G. school, passed immediately pression. “Nothing in drugs,” he through its short, angleworm-like wails; "send 'em to me and I'll cut primae ciae and promptly tumbled ’em." He forgets that modern science down the back steps with a special has not yet conquered the lay aversion course certificate in their hands, have to the knife, nor the honest practitionnot seldom outheroded Herod-which er's belief that, after all, the knife is means that where the haughty profes- often a confession of our limitations sor of the special P. G. course hath and weakness. And there is much in slain his dozens, some of hi shalf-baked the training of the experienced practispecial students have slain their scores, tioner which inspires him with theraaye, hundreds.
peutic hope in a vast number of ills The independent medical journal of the flesh. By drugs he can produce meets the demand of the everyday anesthesia, local or general, relieve pain, practitioner who wants to know "what produce sleep, stimulate or depress the to do."
The self-styled high-class circulation, allay nervous irritability, medical journal-and there is really aid digestion, relieve constipation and only one "high-class" journal, you hepatic torpor, produce emesis, diapknow, which is climbing so high that hosesis and diuresis, antidote malaria its head looks from below very like and cure syphilis. What wonder that that of a pin-often gives him a stone he has confidence in drugs per se while when he asks for bread. He seeks for rather skeptical of our knowledge of light on the treatment of disease, and them? "There must be a remedy. If on looking over the menu card pre- I only knew"—is a brow-contracting sented by the “most high" he finds reflection familiar to the conscientious such things as "Vy Last Thousand practician. And so long as there are Cases of Excision of the Calamus sick ones to heal so long will he search Scriptorius," "My New Postural Meth- for remedies--and so long will he read od of Catheterizing the Iter a tertio ad and believe in the literature that oiquartun tentriculuu,” The Opsonic In- fers therapeutic hope. dex in the Care of the Second Bicus- Apropos of the snobbish question, pid," etc., and editorials in which the "Why do you write for X's journal?" mantle of dignity conceals vast intel- I myself have something of an eye to lectual abysses. In despair he turns the "medium of expression" end of to that cemetery in which so many medical writing. If I have anything fond therapeutic hopes lie blasted and of value to say, I fancy that it does buried under tons and tons of thera- the greatest good to the greatest numpeutic nihilism, Osler's Practice-and ber in the journal that reaches the still he finds no balm in Gilead. And largest number of average practitionthen he turns to the independent jouir
Moreover, there's where it does nal and is consoled-Which is a bless- me the most good—and be it remarked, ing, e'en though he be sometimes ca- I am not one of those who profess to joled into belief in things usubstan- be writing "for the good of humanity" tial. And the proof of the pudding is first, last and all the time. I believe that thousands upon thousands of doc- that the product of my pen which does tors buy and read the very journals the profession and humanity the most upon which the “lily whites” of medi- good, is the stuff that is most likely cal journalism frown so blackly. to do me good, and vice versa. The hy
The ultra-scientific one who does not pocrisy and conceit of the medico-litovermuch believe in treatment and erary snob with a heaven-born "mesrecognizes naught but the scalpel and sage" make me seasick. The pinheaded hemostatic forceps sometimes marvels egotist wasting midnight oil in comthat any one could condescend to read, piling ideas-or "facts,” rather, for an much less contribute to our independ- idea would addle his composition
from other men's work for his message The independent journal that has been to an eagerly expectant scientific world the representative at court and the is a spectacle for gods and men! And great educator of the medical rank and what shall we say of the toiling broth- file, will be no more--and the rank and er, primarily infertile of brain and who, file will die of intellectual inanition. dreading the pains of even the me- starved to death on the mental breakchanical operation of literary parturi- fast foods prepared by the great medition, merely affixes his name and mani- cal trust whose bat-like wings are alfold unearned titles to a compilation ready casting baleful shadows over the prepared by some poor devil of a med- profession. The average practitioner ico-literary hack? I once heard voci- will hunger and thirst for intellectual ferous and earnest applause at an over- pabulum-and he will get the shavings flowing meeting of a great medical so- and gelatine broths dispensed by the ciety rendered a paper which had but hierarchy. one original line in it--the name of the The struggle of the medical babies author-and that was composed by his to keep their erythematous rear elevaparents and written by his typewriter. tions covered with the ethical
garAlas! poor literary Adam. And this is ments inherited from our medical dadthe sort of stuff that fills some of our dies is agitating to one's sense of huultra “high-class” journals to overflow
No use; our professional dading
dies didn't employ wool soap! Still A special feature of the independent less did they use good horse sensemedical journal which commends it- if they had, they would have realized self to me is the possibility of individ- that the medical man is a creature of ual expression in its editorial pages. his environment and must adapt himVigorous independent thought trench- self to it or be a social anachronism antly expressed is what the medical and a political nonentity. man most needs. And the thought ex- Moral-Don't be a clam merely bepressed should not always be medical cause the paleozoic senilescents of a dry bones.
Medicine is broad. It dead and gone medical age were conshould embrace things literary, politi- tentedly stuck in the fossiliferous mud cal and sociologic. Take the editorial on the shores of the ocean of progress. columns of the independent medical Let the dead past bury its dead-and journals away from him, and the over- bury it deep, and—let us not often worked practitioner will be in a bad open the doors of ethical muway for intellectual pabulum. The edi- seuns. tor of an official “society organ” who It has occurred to me that the amshould venture to express himself in bition of the doctor to own and opterms stronger than a literary milk- erate a medical journal is conducive to shake couldn't hold his job for twenty- the best interests of the profession. four hours. Take away editorial inde- The medical editor has in general stood pendence and what would the organ- for what is best in medicine. He has izers of a professional monopoly or a often gone astray, it is true, and has medico-political trust have to fear? sometimes pandered to the proprietors What check would there be on their of worthless or doubtful drug preparasystem? Why, they would not meet tions, but on the whole the profession even criticism of any degree of po- has benefited by the influence of the tency.
independent medical editor. He has The leaven of consolidation, unifica- been our watch dog in a way, and tion and trustification is working most while by no means perfect—he is hupotently. By and by the firmament of man, you know-has been a pretty American medical literature will con- creditable part of the body professiontain naught but a central literary sun al. Where he has made a living out and his satellites, the "State” journals. of his journal he has been useful by
demonstrating a bread and butter out- certain class of cases which is nearly let for the energies of medical men, or quite inaccessible to examination. and we have, alas! only too few such For who engaged in the study of menresources for physicians.
tal disease has not spent many hours Had I ever wavered in my opinions in nearly futile speculation as to what as to the ethics of contributing to in- is going on behind the mask of mutism dependent medical journals my faith and katatonia? It is only upon long and courage would have been restored and careful observation of these cases by something I saw a few short weeks
that one may perhaps obtain the key to ago in a journal which the ethical ul
the mental process and avoid the very tras regard so unfavorably that they mistakes in their conduct that are rethrow an autotoxic fit and roll up their ferred to by Mr. Beers. eyes like a dying jack rabbit whenever
During his period of exaltation and they hear it mentioned. It was an ar
mental hurry, the author conceived his ticle by "Saint George," of Philadel
plan of asylum reform, the details of phia. And, mirabile dictu, it was head
which have been tempered and readed by his picture! Think of it—the justed by his return to sound judg. peerless St. George, the erstwhile ar
ment and by his willingness to seek the biter elegans of, medical literature, slay
best advice, a plan the author has ader of ethical dragons and mastodonic
hered to with remarkable tenacity. Iu hypocrites and humbugs, peerless
fact so zealously did he endeavor to knight of the medical ink pot, had an
carry out his mission that overwork at article and picture in a journal owned
so early a period was no doubt responand controlled by a manufacturer of
sible for a partial relapse. Only by a pills and "sich !" And-oh; joy! I
rare insight into his mental resistence had an article-- with picture--in the
and by an unusually early development same issue of that proscribed maga- of that experience in detecting danger zine.
signals, not uncommonly found in
those who have recovered froni mental “A MIND THAT FOUND ITSELF."
illness, did he save himself from re
curring attacks with their almost cerAn Autobiography by Clifford Whit- tain resulting deterioration. tingham Beers.
A tremendous amount of hard work
and investigation has been done in his REVIEW BY DR. J. A. MACDONALD, OF IN
studies; indeed as the author says it DIANAPOLIS, LATE PHYSICIAN TO THE
was even necessary for him to learn CENTRAL INDIANA HOSPITAL FOR IN
how to write a book, a task that he has SANE.
accomplished successfully. His work
is excellent in composition and consecThis book is a narrative of compell- utive interest, remarkably temperate ing interest, a wise and for the most
and as dispassionate as can be expectpart a kindly criticism of existing meth
ed. However, his information is better ods in some of the insane hospitals of
in regard to hospital administration the country and an outline of means than it is in the classification and pathfor their betterment.
ology of mental diseases. For example, The author has himself passed
has himself passed he says: “A violent ward is not a through the Valley of the Shadow,
place where insane patients violently having suffered an alternating insanity, attack their keepers and fellow patients evidently maniac depression in type if except in the rarest instances and then one may classify from his description. a rule only after they have been The book is of great value if for no goaded into a revengeful madness by other reason than that it contains a unremitting cruelty.” Here he evidentrare account of the subjective side of a ly largely fails to take into account the
crises of paresis, epilepsy and mania, to portant part of the new
era of psysay nothing of deliberate outbreaks of chiatry must be the utilization of inparanoics and those patients acting un- sane wards for thorough clinical teachder delusions of persecution and self- ing in every medical college. aggrandisement. Such outbreaks do at
The "National Committee" as protimes occur even under excellent con- posed by the author would be without ditions of classification, the abolition
other than advisory functions and of violent wards with careful redistri
would of necessity consist in considerbution of patients and the most gentle able part of well meaning but totally individual supervision.
untrained and largely ornamental "repNo doubt it is quite natural in view resentative citizens." And, since of Mr. Beers' experience and opportu- every great asylum is a community in nity for observation that he should ex- itself the superintendent must, so long hibit a certain finality in the expression as he holds office, be in absolute auof his views as to the best method of thority. There will then be more perhospital reform. But this problem is fect understanding, less lost motion being attacked along slightly different and more prompt and uniform results lines by others, chief among whom are if the advisory board or state commitcertain eminent physicians. Within a tec be composed of thoroughly trained few weeks a Chicago daily paper has and experienced physicians who republished at length an address by Dr. quire a minimum of groping to obtain Frank Billings recounting the past two information. vears work by the Illinois Board of
lle would, if our pen had sufficient State Charities, of which Dr. Billings power, add emphasis to Mr. Beers' plea is a member. In Illinois, every- for the great principle of "Non-rewhere, the fundamental difficulty has straint" and for the non-employment arisen from adverse or niggardly legis- of ignorant and unsympathetic attendlation by an uninformed or politically ants through whom the great majority interested legislature. Notwithstand- of instances of abuses and neglect ing legislative negligence and neglect, must have been admitted. These evils great advance has been made and it has will disappear entirely when enlightbeen shown that physicians of intense- ened legislative bodies supply as raply active professional lives are willing. idly as possible sufficient funds for reto sacrifice time and income to this construction of asylums which must great work. It is among those finely have as a unit the small pavilion with trained in hospital organization and perfect modern equipment, and then whose probity and unselfishness need place in the hands of superintendents no scrutiny must be found the men to ample means for administration as hoscarry on this work.
pitals rather than as asylums. This We strongly advise that the develop- of course, implies the maintenance of a ing of better psychiatric equipment be training school for nurses and a suffileft in the hands of the medical profes- cient medical staff. sion to be organized and directed Every general hospital in a town or through the State Society, as each state city of considerable size should have a is the unit in hospital administration. detention or psychiatrical department For further organization the American which should also admit acute mental Medical Association is best equipped cases from adjoining counties which to carry on this work since in perfec- can not support such wards and the tion of organization, in number and State should aid in support to that expersonnel of membership and in facil
tent. Admission to this department ities for publication no other body in should be upon voluntary application this country may be compared. This or by a simplified short term commitmethod is most logical since an im- ment so that admission may be prompt and without publicity. This class of fitted wit ha stylet like a trocar, but borderland and acute cases is also the in this case the needle is sharp and the most valuable for clinical instruction. stylet blunt. The needle is marked in
It is perhaps not untimely here to centimeters. With the stylet withsound a note with reference to the drawn the needle is pushed through many luridly illustrated though other- skin and subcutaneous tissue; the stywise excellent articles on almost every let is then pushed down to make the medical subject that are appearing in instrument blunt and needle is inserted the popular periodicals. Their number to proper depth. A separate route is and variety of subject matter has in- taken for each division. The ophthalcreased insidiously since a few years
mic division is reached by inserting ago when the fashion was set by the the needle at the external markin of perfectly proper campaign of publicity the orbit and passing it along the exregarding tuberculosis and other con- ternal wall to a depth of 3.5 to 4 cm. tagious diseases. However, that was The author has made this injection a matter vastly different from the con- only once. For the middle branch the tent of some of the articles which are needle is inserted at the lower border now encouraging an already neurotic of the zygoma 0.5 cm. behind a vertical public to further introspection. It is line drawn from the posterior border likely that a fuller measure of good of the zygoma 0.5 cm. behind a vertical would have resulted in the instance of line drawn from the posterior border this particular book if some kindly of the orbital process of the malar philanthropist had enabled its author to
bone. At a depth of 5 cm. the nerve is place a limited edition in the hands of reached at its emergence from the forthe legislators and physicians of the amen rotumdum into the pterygo-maxcountry rather than to have placed it illary fossa. The inferior maxillary difor popular sale upon the book stalls. vision is reached at a depth of 4 cm.
With all kindness and appreciation from a point at the lower border of the of Mr. Beers' work it is to be hoped zygoma. The solution used is 75 per that in a future edition he will entirely cent. alcohol to which a little chloroeliminate the chapter detailing his sui- form and cocaine are added; at subsecidal mental process and attempt at quent injections 85 or 90 per cent. alcoself-destruction. Longmans-Green & hol is used. Co., New York, $3.00.
Uncertainties and Dangers:..On ac
count of variation in the conformity of THE TREATMENT OF TRIFACIAL NEUR.
the bones, particularly in the zygoma ALGIA BY MEANS OF DEEP IN. and coronoid process, one never is cerJECTIONS OF ALCOHOL.
tain of striking the nerve at any given time. The author thinks he has missed
oftener than he has struck it. This unT. PATRICK, M. D., CLINICAL certainty is the only difficulty in he ROFESSOR NERVOUS
MENTAL method, and the known dangers are DISEASES, NORTH WESTERN UNIVERSITY
few. Infection has never occurred. A MEDICAL SCHOOL, CHICAGO. ABSTRACT few times transient abducens paralysis BY THE AUTHOR FROM JOURNAL A. M. A. has been produced, and once the solu
tion went into the orbit causing great
edema of the eyelids, but no injury to Doctor Patrick in this article relates
No anesthetic is required. his experience with the use of deep alcohol injections by the external route
When the nerve has been reached the in trifacial neuralgia as devised by patient feels pain in the area of its disLevy and Baudouin of Paris. The in- tribution, and immediately after the instrument employed is a straight needle jection this area has a swollen, stiff 1.5 mm. in diameter an d10 cm. long, feeling and is relatively analgesic.