maladies. The condition of mind which the physician exhibits under such trying circumstances has, to a greater or less extent, been reacting upon the community in which he lived. With commendable heroism he strives against hope in many a case, rather than yield to allconquering fate. He has appealed to past experience, and has ransacked the materia medica, but all in vain. Such zeal is not lost on patient and friends. Every new pill or potion is hope renewed; but disappointment is the inevitable result; alternating thus, the disease steadily progresses to its inevitable termination. The impression created in the mind of all is, that the physician regards the resources of his art as quite equal to every emergency. If they subsequently lose confidence in him, they do not doubt the power of drugs to relieve all human ills. He may, and doubtless will, regard his lost patrons as sceptical in regard to the efficacy of drugs; but their faith is really not shaken, except in himself. Incurable maladies furnish quackery, in every form and grade, its chief source of support and profit. Could these affections be stricken from the list of human ills, or could specific remedies be found adapted to their prompt cure, there would never be another medical pretender. Equally fatal to the pretensions of charlatanism would be a profound and unalterable conviction in the popular mind of the absolute incurability of certain diseases. The attempt to create such a

belief will be deemed utopian. But may we not rationally conclude, that the same course of instruction, which has established the present universal belief in the efficacy of medicines, could, rightly directed, not only remove this illgrounded faith, but in its stead implant in the mind of at least every rational person a firm conviction of the incurability of many diseases? The statement is susceptible of demonstration so far as regards many families, and even communities, which have been fully under the influence of a candid and earnest physician. If we should fail in such an undertaking, we do no more than our duty in ceasing to attempt impossibilities, and confining our labors to the practicable. We do not mean to discourage rational efforts to discover remedies curative of diseases now considered incurable. All such inquiries are praisworthy and commendable. But we would discourage that routine practice, so prevalent, of repeating the trial of vaunted specifics in diseases thus far justly reputed irremediable. We degrade rather than advance the science of therapeutics by such practice. It is an important question, then, how far we ought to give hope by promises of new remedies in incurable diseases. An eminent writer, Dr. Latham, says:

"But let us concern ourselves only with actual diseases, diseases existing and in progress. And of these let us ask whether the fact that they are, or are deemed to be, incura

ble or intractable--the fact that there is no medicine or method of treatment known by which they have ever been successfully managed-whether this fact be enough to warrant physicians in doing and trying anything or everything indiscriminately upon them?-enough to justify or excuse us in falling in altogether with the world's notions, and adopting the world's practice of medicine, as far as they are concerned? I think not; for this would be mere gambling with drugs, and not the practice of medicine."

Sir William Gull has recently taken similar ground in regard to the treatment of many forms of hereditary diseases, contending that physicians should recognize the fact that these alleged diseases are but normal conditions of the tissues which will not yield to treatment. He says:

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Many states are still considered and treated as diseases which are certainly not diseases at all. Thus it may be fairly said there are some people who are made to ail, and without having disease, are born to suffer. Under the present condition of things they can not maintain a comfortable equilibrium. They are always ailing. Medicine fails on such. Unstable health is their law, in spite of the pharmacopoeia. In practical medicine it is important to recognize this. Yet I may appeal to my hearers if they can not recall cases where they have prescribed all the farrago of so-called tonics, with as good a purpose as if they would thereby strive to prevent the setting of the sun."

It is not contended that the services of a physician should cease when a disease is proved to be incurable. All such diseases may be palliated, and the progress of many may be materially arrested by proper treatment.

XXXII.

MORTALITY IN HOSPITALS.

IN

N the first lines of the preface to her admirable work, Notes on Hospitals, Miss Nightingale remarks: "It may seem a strange principle to enunciate as the very first requirement in an hospital that it should do the sick no harm." It does indeed seem strange that, in this day of the universal recognition of the necessity of hospitals, one of the ablest writers on this subject should lay down as the first principle in their construction that they do the sick no harm. We have been accustomed to regard the hospital as an asylum where every arrangement and appliance necessarily tended to restore the sick to health. To the temples of the ancients flocked the sick, the lame, the blind, as to shrines of health, to be healed of their infirmities. Out of this custom grew the modern hospital. Is it really true that, after centuries of experience, we have so far departed from the original idea in the establishment of hospitals that we need to be admonished of the real object of such institutions? Must we learn anew that hospitals are designed for the cure of the sick? Whoever calmly views this subject in the light of experience, must

acknowledge that Miss Nightingale has stated a truth full of significance and deserving of the most serious consideration. It is too true, as she remarks, "that the actual mortality in hospitals, especially in those of large crowded cities, is very much higher than any calculation founded on the mortality of the same class of diseases among patients treated out of hospitals would lead us to expect." This is especially the case with those diseases classified under the general head of typhoid, as erysipelas, pyæmia, continued fevers, etc. Our large metropolitan hospitals always show an excessive death-rate from these diseases. But there is a still more significant sense in which hospitals may be allowed to prove harmful to the sick, viz., by exposing them to local causes of diseases, which should never exist in a hospital. It now not unfrequently happens that patients enter general hospitals with simple diseases, but contract other maladies of a more fatal character, of which they die. The aggregate mortality of this class from fever and typhoid diseases in large city hospitals is not inconsiderable. In every lying-in ward or hospital we find striking proofs of the truth of this statement. Every life sacrificed from such causes is needlessly wasted. The practical direction which we wish to give to these facts is upon those who are interested in the establishment of new hospitals. Let us briefly glance at some of the causes of excessive hospital mortality. First, and chiefly, is an in