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rare foresight he thus intimates the reform that would remedy this evil: "Humanity, economy, and philosophy, all concur in giving a preference to the conveniences and wholesome air of private houses; and should war continue to be the absurd and unchristian mode of deciding national disputes, it is to be hoped that the progress of science will so far mitigate one of its greatest calamities as to produce an abolition of hospitals for acute diseases." That hospital architecture has made great advances among us is undeniable; but it has, as yet, failed to remedy the evil. Deficient ventilation has been justly regarded as the chief cause of the evils of our hospital system, and multifarious are the measures for accomplishing the desired improvement. The natural courses of cold and hot air have been carefully studied; curious ventilating apparatus has been constructed to conduct the air along the channels which it seeks, or forcibly compel it through devious paths from which it recoils; ceilings have been elevated and wards enlarged to give a larger atmospheric area; but still we have not reached that degree of perfection which is attainable. The fundamental error in our present system of hospital management is in the aggregation of the sick. Whatever may be the mode of ventilation, however cleanly wards may be kept, there will be a constant and overpowering generation and accumulation of the causes of those diseases dependent upon large collections of persons.

XXI.

OUR STATUS ABROAD.

A

N American, it has often been remarked, is decidedly cosmopolitan in his sympathies. He refuses all restraints in his intercourse with the world, whether in trade, in science, or in literature. This feeling not only leads him to seek freely for whatever may interest cr gratify him wherever it may be found, whether at home or abroad, but it tends to make him acknowledge unreservedly the source from which it is obtained. To what these national peculiarities are due it is not easy to decide, though we may surmise, that as the American people is a mélange of all the nations of the earth, there exists among all ranks and conditions of society a filial affection for the older countries. What is true of the American people in this general sense, is also true of the medical profession. We are accustomed to seek knowledge in every quarter of the globe, and are quite as much rejoiced to learn the discovery of a new principle in medical science if the discoverer be an Englishman, Frenchman, or German, as if he were our next-door neighbor and "a true American." It is alleged, indeed, that we are so accustomed to look to

other countries for our medical knowledge, that we do not advance medical studies at home; that we have no national medical literature, and never can have, until we exchange our free-trade policy for protection. However that may be, it is nevertheless true, that the general and rapid diffusion of information in the profession, gathered from all sources, must create a constantly increasing demand for an improved medical literature, and gradually elevate the tone of public medical sentiment. This trait in our character has been attributed to our weakness, to our want of resources, and the like; but such is not the true explanation. It is rather, as already intimated, an inherent national peculiarity, growing out of the make-up of our people. It is an admirable trait and one of which we may well be proud. While Englishmen discard everything French, and the French everything English, and the Germans reject Anglo-French ideas, and all distrust the "Yankee Nation," the American physician, as a member of the Republic of Medicine, accepts, in full faith and confidence, whatever new and useful is communicated to him by one of his fraternity. While we pursue this liberal policy out of the most generous regard for the rights of others, and the interests of medicine, it accords little with our sense of justice to find cases published by American physicians, styled by foreign journals "American Stories," and repudiated simply because they were related by an American.

It can not be denied that American physicians have reported a large number of extraordinary cases; but many of them have been remarkable only because they were the first of the kind placed on record. We may instance McDowell's case of ovariotomy; Mott's cases of ligature of the arteria innominata, of the common iliac, and of exsection of the clavicle; the case of Alexis St. Martin, with a fistula leading into the stomach; and finally, the case of Gage, who had a bar of iron driven through his head and recovered. These were all very remarkable cases, and were probably at first pronounced "American Stories;" but who now denies the accuracy of the reports? McDowell's name, with universal consent, is recorded among the first ovariotomists; Mott's patients still vindicate the correctness of the many extraordinary cases which he published. Every text-book on physiology attests the importance of the investigations into digestion conducted through the fistula in St. Martin's stomach; and finally, the patient till recently survived through whose head a tamping-rod (three feet seven inches long) was projected from base to apex, as do many reliable witnesses to the accident. It is undoubtedly true that cases can be cited where American physicians have made exaggerated statements, but it is altogether unjust to infer from this circumstance that the profession of this country is thereby rendered obnoxious to the charge of publishing "exaggerated facts and strained con

clusions." We believe our current medical literature, so far as relates to a conscientious regard to accuracy of detail, will not suffer in comparison with that of any European country. But aside from this grievance, the American medical profession have another and just cause of complaint against their foreign brethren. Not only do the latter too often discredit the statements of our writers, but they not unfrequently seize upon important discoveries in practical medicine, first made among us, and without due acknowledgment of their indebtedness, introduce them to their countrymen as their own inventions. We could mention several instances in illustration, but the following example will suffice. The method of reducing dislocations at the hip-joint by manipulation no sane medical man who has any knowledge of his profession will deny was introduced into practice and completely illustrated by Dr. Reid, of Rochester, N. Y. (U. S. A.) This method of reducing dislocations was never alluded to by any foreign journal that we receive, until the full details were republished in one of the English semi-annuals. Several weeks after its appearance, a London journal announced that a surgeon of one of the hospitals of that city had discovered a method of reducing dislocations at the hip-joint by simple manipulation, and had succeeded perfectly in three instances. The details of the method were given, and they were precisely those published by Reid.

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