any effect upon the principal affection. Later, we had several seances of galvanization and Faradization combined. These various applications were continued for more than three months, three or four times weekly, and did not give even a shade of amelioration.

It was then that Mr. Wolff undertook the care of the case. The treatment under his direction lasted exactly fifteen days. At the end of this time the patient was able, in the presence of Prof. Charcot, to write slowly several lines without stopping (patient said he had lost the habit). He informed us that he wrote four hours a day for exercise. Mr. Wolff considered the cure accomplished, and left the patient to himself, after giving him minute instructions.

CASE II.-M. F, twenty-seven years of age; designer in a railroad administration; robust appearance; usual health good, antecedents excellent. This affection has appeared within three years. Patient has habituated himself to design and write with the left hand, which he does with facility. At the clinic of Prof. Charcot he could trace a few letters with the right hand, but slowly and indistinctly, being interrupted by spasmodic movements, which were produced principally by the muscles which move the wrist and hand upon the forearm. There were alternations of flexion and extension; then the entire arm was in abduction, and designing was no longer easy, as he could not trace even a line continuously.

One peculiarity noticeable was the following: the functional trouble was not limited to writing and designing, but all acts which required movements of slight extension and precision of hand and fingers were impossible. Also with the right hand the patient could not turn the leaves of a book, nor twist his mustache, etc., without a spasm.

The treatment under Mr. Wolff's direction commenced Dec. 9. The 24th of same month the patient wrote before Prof. Charcot quite rapidly a few lines, and designed easily. His writing is the same as before the attack. It is useless to add that previously he had submitted to various modes of treatment without success. These two cases of success appear more significant when we consider that Mr. Wolff has certificates signed by the principal physicians of Germany and Austria: Nussbaum, Bamberger, Benedikt, Billroth, Esmarch, etc. He proceeds with a surety really astonishing, knowing the universally recognized fact of the almost incurability of this affection. Without doubt, by various methods, some isolated cases of success have been attained. Lately Dr. Vigoureux records a case of cure by the hot iron; another success obtained by static electricity; and other processes have given occasionally good results. It is only with a last hope

that a spontaneous cure is realized. Thus a patient seen several years ago was attacked in the same manner as his father and uncle, and at nearly the same age, by writers' cramp, which disappeared after an uncertain time. But we repeat, these are only isolated cures, and nothing which can place the physician upon the road to a rational cure.

Here is the method of Mr. Wolff, it can be reduced to two points gymnastics and massage.

Gymnastics both active and passive. The patient executes a series of movements of the upper extremities, three times a day, successively in all directions. These movements are generally rapid, with hands sometimes open, sometimes closed. The number of movements in each series, and the length of time of each seance, are increased gradually, according to the case. For the first patient the seance was, for the first five days of treatment, from thirty to thirty-five minutes, three times a day, besides a fourth of twenty to twenty-five minutes, over which Mr. Wolff himself presides. For patient No. 2 gymnastics were practised even longer, since he had three series a day, each one lasting one hour and a half.

The passive movements consist in the distensions more or less forced, almost the elongations, of muscles which are especially affected. It is the most delicate part of the treatment, because it is dangerous, according to Mr. Wolff, if carried beyond a certain limit. The patient himself repeats these manoeuvres three or four times daily.

The exercises in writing commence from the diminution of the spasmodic actions, that is, from the early days.

The massage and the friction are also practised very carefully by Mr. Wolff every day. He insists on the importance of what we will call the tapping or patting of the muscles.

The treatment is not painful. One has no relapses, says Mr. Wolff, based on his ample experience. He has among his cases one observed by Nussbaum, where the cure was verified two years after treatment. This explains itself, for the patient can continue the treatment himself until he feels he has recovered the normal state.

As to the duration of the treatment which takes place under the immediate direction of Mr. Wolff, it is, as we have said, about fifteen days. A case which, after four or five seances, shows no amelioration should be abandoned.

By this method the essential part is the tapping of muscles too excitable; but the long seances of gymnastics and massage by percussion ought also to be of some importance.

These indications, which it would be useless to give minutely, will lead many physicians to attempt to obtain the same results

by themselves. Meanwhile it is worth considering that Mr. Wolff, with a liberality which we cannot praise too much, explains freely his procedures; he cannot, at the same time, transmit his experience or practical skill, nor especially the sort of medical instinct which has led him to find this method, and guide him in his applications.

It is necessary to add that Mr. Wolff is not a physician, and has no pretensions to pass for such. It is simply in his position as teacher of writing that he has had occasion to observe and Occupy himself with writers' cramp. It is useful to know that Mr. Wolff employs, with success, his method for functional spasms in general, the cramp of pianists, violinists, telegraphists, etc.

THE RATIONAL AND EMPIRICAL METHODS IN

MEDICINE.

BY WALTER WESSELHOEFT, M. D., CAMBRIDGE, MASS.

[An evening lecture delivered before the students of the Boston University School of Medicine.]

LADIES AND GENTLEMEN: It has been our custom in former years to meet occasionally, during the long term, in some sort of entertainment, partly for the purpose of bringing about that better acquaintance which should exist among all connected with our school, and partly to enable the Faculty to offer advice and instruction on many matters which it is impossible to discuss in the lecture-room. These meetings were pleasant, but it soon appeared that they failed to call forth that readiness to question and answer which had been looked for, and that consequently, so far as instruction was concerned, they were not what we sought. For this and other reasons they were discontinued. But the need for instruction remains. We have now, as had then, the wish for more friendly relations with yourselves individually; but in the face of all the doubts and perplexities constantly arising in the minds of every thoughtful and earnest student, and the innumerable questions for which neither lectures, demonstrations, nor text-books can supply the answers, we also feel that the three or four years during which you remain with us are far too short to admit of our spending any time together that is not turned to the best account.

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To meet your needs in some measure, and at the same time to comply with the wish expressed repeatedly by those who have escaped from the benches you now occupy, we propose to discuss from time to time, in a series of evening lectures, certain points which do not come well within the province of our regular course,

and which are yet of no small moment in determining the growth of your knowledge and the direction of your studies, as well as the relation of our school to the profession at large.

The difficulties, however, of carrying out this idea in the spirit in which it was originally conceived are by no means slight. In the first place, these lectures were to be both entertaining and instructive, in order to afford you some needed relaxation from your daily tasks. To me this demand presents difficulties of a most formidable nature; for all questions pertaining to the principles we have assumed the grave responsibility of teaching here appear to me so far removed from everything that is usually looked upon as entertaining, that it is impossible for me to treat them in anything approaching a light or pleasing vein. I fear, on the contrary, that I must appeal, first of all, to your patience in my efforts, and then to your most sober sense, to have any assurance that you will follow where I wish to lead.

A second and greater difficulty meets me in the fact that the discussion of all general principles has long been looked upon among practical people, young and old, in our profession, as mere theorizing, speculation, and idle words. I am conscious that such attempts are, in point of fact, wholly at variance with the spirit of modern medicine, which causes the best energies to be expended in the search for new data having an immediate scientific or practical interest, without bestowing much thought on those wider generalizations which alone can give to particular facts their highest value.

In the main this is as it should be; and if we look back upon the past, we may be thankful that we live in a day when, as Littré says, "the spirit of generalities has taken its place below the spirit of particulars." But, grateful as we must be to live at a time when the spirit engendered by the progress in the exact sciences dominates in all departments of knowledge and inquiry, we must not forget that the chief purpose to be served by the accumulation of new facts is to get a wider range of vision, which will show us their connection and general relations, in other words, the principles which make them intelligible and subservient to useful as well as to scientific ends.

My difficulty is, that minds eager only for facts are not easily led to recognize principles. In illustration of this, I may mention that a young physician, who recently read a paper before a medical society of the old school near by, and had occasion in doing so to deal at length with the subject of medical logic, was reminded at the end, by his more experienced colleagues, that logic would neither set a broken leg nor cure a typhoid fever. In the same spirit we have constantly to hear on our side, that the discussion of principles is the misleading occupation of doctri

naires and visionaries, and of no weight whatever, beside the proving of a drug, or its correct application at the bedside. In a limited sense, this is true; for what you wish to learn is, above all things, the speediest, the safest, and the surest way to relieve suffering and avert danger; and nothing can be more reasonable than such a wish. But let me remind you that these superlatives of speedy, safe, and sure are by no means matters on which the profession is wholly agreed. In fact, doctors continue to differ as widely to-day concerning them as at any period in the history of medicine; and the nearest approach to an agreement that has been reached is the agreement to differ amicably within party lines. Under this semblance of an agreement, however, nothing is more apparent than the determination of each individual to follow only his own notions. To the great majority of intelligent practitioners, the mere mention of principles suggests either vague hypotheses, or, what is worse, dogmas and the assumption of unwarranted authority to which no one will or can submit.

In his opening address before the recent international medical congress, Sir James Paget, the president, took especial pains to affirm that the discussion of principles is a thing to be avoided by doctors. "May we not," he asks, "declare some general doctrines which may be used as tests and as guides for future study?" And he answers, "We had better not." Nevertheless, it must be possible, after nearly three thousand years of medicine as a science and an art, to reach not only vague and loose points of agreement, but also some general standards or tests by which the soundness of doctrines and of practices may be measured, some deductions of sufficient force of which all must acknowledge the supremacy. Without them, there can be nothing worthy of the name of medical science, for a mere accumulation of facts, however accurate, is not a science; and without acknowledged principles the healing art can never be better than a loose, disorderly mass of shifting and uncertain rules of which every practitioner's intelligence is the only measure of truth and soundness. This, indeed, is the condition of things as we find it in medicine to-day; and I hold it to be the foremost mission of a school like ours, which has cut loose from the traditions of the profession and recognizes no authority merely for its authoritative position, to set forth those general truths which are lost sight of in the search for particulars.

It is true, that we must all be guided largely by individual experience and fall back for resources upon such ingenuity as we possess whenever established rules or clear and direct inferences from plain circumstances fail us; and it is one of our leading tenets that every case of disease must be treated strictly accord