vancement of medicine in all its particulars if no one could judge of his excellence or otherwise? This was the reason why so many men ceased to be students when comfortably settled in practice. They found the easy, charming and pleasing manners as acceptable to patients as sound medical skill. These men found it easy to make their way in life. There was nothing wrong with that, quite the opposite, but they were. apt to make these graces and accomplishments do the work of better qualifications and hard study. It was in this way that even in the Church the art of pleasing was now made to do the work of the scholar and the brainworker. The pulpit was paralyzed and religion made an affair of emotion instead of intellect, which was its only safe basis. Thus medical men were apt to become servile, a kind of superior servant to the great man, a trifle above his butler. These persons were so apt to neglect those who were poor, and it was impossible for medical men to maintain the high position of the profession if they broke their connection with the poor. There the best work was done. It was done for no praise. It was there that the best of the men came out, partly because they were not concerned in pleasing the patient, and so could do what was best for him. In that work they should not even expect gratitude for doing what they conscientiously knew to be the best. Social and influential position was dearly bought if it led to the degeneration of the whole man. If the medical man wanted satisfaction in his life's work it must be because it had been done in the most absolute self-sacrifice. Success in society was not the chief end of the true physician, though it might seem so to him who was merely a student or practitioner in the art of pleasing. În an assembly of medical men it was not always presidents and vice-presidents or hospital physicians and surgeons who were necessarily the best men present in point of medical knowledge or experience or training. Professional success consisted in doing the greatest good to the greatest number of people. The future of the race was in the hands of the

There

profession, and the work of the doctor in obscure streets, in cottages and hovels, improved the populace, rendered the children healthy and strong, improved the manhood and womanhood. was no better work done in this country than that done in the East and South of Glasgow and London. The promise given long ago of a time to come when "the people would walk and not be weary, and run and not faint," would doubtless be attained, and in its attainment the medical profession would play the greatest part. Those listening to him would shortly have an opportunity of taking part in the work and of bringing it about. It was the poor work that would enable them to do all work well, and their work was worth doing well. From the very day on which they received diplomas they would affect not only the lives of those whom they were called upon to cure, but the lives and welfare of generations to follow.

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THE PHYSICIAN AS A LAW MAKER.— The prominence given the subject of State Medicine in the recent proceedings of the American Medical Association in this city, says Ralph Robinson, LL.B., of the Baltimore Bar, in the Bulletin of the Woman's Medical College of Baltimore, furnishes assurance that this branch of Medical Jurisprudence is being rapidly accorded its proper position in the college curriculum.

State Medicine is the medical police of Paris and Fonblanque. These writers were the first to accentuate the division of the general subject of medical jurisprudence into medical police or State medicine and forensic medicine, or the medical jurisprudence of the text writers.

While the topics considered under the head of forensic medicine have remained about the same, State medicine has in recent years so developed that it has become from every point of view the more interesting and important branch of the subject.

A glance at the recent statutes of any State suffices to illustrate the increasing volume of that class of legislation which is designed to promote human health

and happiness by enforcing not only such sanitary measures as the inspection of plumbing under authority of law, but also such a radical measure, as the compulsory reporting of inflamed conditions in infant's eyes, with a view to preventing the affliction of blindness.

This is readily explained by referring to the insistance in recent years upon the fact that the true relation of the physician to society is preventive rather than curative. This has led to an earnest and intelligent investigation into the cause of every variety of human disorder, with a view to preventing inception, and has disclosed a most fruitful and practical field of investigation and research. The physician who enters this field, however, does not discharge his duties or conclude his labor upon making some important discovery. The claims of citizenship lay hold upon him and constrain him to make known in some practical way to society how it may avail itself of the results of his labor. He must be relied upon not only to ascertain the cause of disease and the means of preventing it, but also to arouse the public sentiment to the advisability of adopting those sanitary reforms. through intelligent legislation that renders its occurrence less probable.

Any of these sanitary reforms, however, involves a serious interference with freedom of enterprise and the conduct of business, as notably all food inspection and condemnation laws. The physician, therefore, in order to win and maintain the public confidence should show at least some degree of familiarity with the fundamental laws of the State. Here, then, law and medicine are really tangent; a point of contact that gives a most practical and efficient connotation to the term, medical jurisprudence. However much society may rely upon the lawyer to properly draught and administer this class of legislation, the physician must be relied upon to arouse public sentiment to the necessity of its adoption and proper observation afterwards.

However desirable for the health of a community the adoption of a sanitary reform may be, it can only be secured

Few

THE DANGERS OF COCAINE. drugs in recent times, says the Lancet, have received more general commendation than cocaine; its advantages as a local anesthetic, received with some incredulity when it was first introduced, have been so abundantly proved that there may be a tendency to overlook the fact that there are certain dangers attendant upon its too frequent or reckless employment. As a local anesthetic it has won golden opinions where small operations were required upon superficial parts; in ophthalmic and laryngeal surgery it may fairly be said to have revolutionized the methods of a few years back. But every now and again warnings are brought forwards which indicate that with cocaine, as with opium and other modes of producing local or general anesthesia, there is danger in the familiarity which breeds, if not contempt, at least disregard of ordinary

precautions. Verdicts of misadventure are no consolation to those concerned, if there is an underlying conviction that the fatality might never have occurred if there had been any due appreciation of danger. Cocaine is a drug which shares with opium and many others the questionable credit of developing a "habit" i. e., of leading, by the benificent effects experienced after small doses, to a desire for the repetition of the relief; and as a consequence the dose employed tends to become greater, and the precautions which, perhaps, were taken at first are gradually relaxed. "Cocainism" is not so well recognized in this country as in America, but it undoubtedly exists as a form of self-indulgence or as a practice which, like morphinism, originally employed as a means of alleviating some chronic trouble, has ultimately developed into a form of selfindulgence, in which the need of restraint and of precautionary measures are entirely lost in the fascination of the relief afforded by the drug. In a recent inquest the evidence showed that the drug had been originally prescribed for the relief of pain in the gums, and the symptoms immediately preceding the termination were merely those of collapse; there was no indication of the amount employed or taken. In most cases collapse is the most marked feature, and this symptom may arise when the drug has been employed as a local application in the form of hypodermic injection or spray, and may frequently I call for stimulant treatment after employment of the spray in laryngeal examinations. It must not be forgotten, however, that a true cocaine habit may be developed when the drug is taken internally in any quantity, and that this condition is occasionally marked by curious hallucinations and perversions of moral sense which, if the use of the drug is not discontinued, may lead to more serious central disturbances. The summary of the whole matter may be expressed in the proverb that "fire is a good servant but a bad master." Cocaine, or any other drug which allays pain, has its limitations, and these are reached when the craving for the relief

afforded leads to disregard of the attendant dangers.

SEMINAL EMISSIONS.-Potassium bromide, says the Philadelphia Polyclinic, the popular remedy, is often unsatisfactory; sometimes it even aggravates the condition, perhaps deepens the despondency that commonly accompanies this condition. A number of physicians have given up the alkaline bromides, preferring hyoscine, administering yo of a grain at bedtime. The effect is nearly always favorable, and frequently affords permanent relief. If hyoscyamine is employed instead of hyoscine, it is important to stop short of the point where the physiological effect of the drug is manifested. One advantage is, either hyoscine or hyoscyamine properly administered can be continued for months without appreciable ill effects.

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IODOFORM INJECTIONS IN JOINT DISEASE. Ferraro (British Medical Journal) reports the case of a man, aged 37, who after a long walk first noticed pain in the right knee, which was uniformly enlarged, red and tender, and contained fluid. The joint was incised, and a considerable quantity of flaky pus let out. Two or three weeks after this, during which time the joint went on well, a small abscess formed in the upper third of the tibia; this was scraped. A similar purulent focus also appeared in the shaft of the tibia. The knee-joint became worse. The author then tried endo-articular injections of iodoform emulsion in sterilised glycerine (1-10) at intervals of twenty to twenty-five days. After each injection there was fever of maximum grade on the second or third day. The tubercle bacillus was found in the joint secretion. Slight improvement followed the injections, which were used five times, but the patient not being satisfied, resection of the joint was finally done. It was then seen that the cavity was full of a mass of adipo-muco-fibrous connective tissue, the caseous substance being almost all gone, the osteitic foci cured or in process of cure, and the tuberculous nodules undergoing fibrous change. No

EMPYEMA IN CHILDREN.-Dr, Edmund Cantley of England gives, in the International Medical Magazine, the following general summary of the treatment of empyema in children, as based on eighty-six cases :

1. When pus is found to be present in the pleural cavity the proper treatment is to remove it.

2. The best method to adopt for its removal is simple incision and drainage. 3. The best site for the operation is the fifth space in the mid-axillary line.

4. Irrigation is unadvisable, and is indicated only in cases of fetid effusion.

5. Exploration and scraping of the cavity are not necessary.

6. Resection of rib is practically never necessary in children as a primary procedure to procure efficient drainage.

7. Resection of rib may be necessary to secure the closure of the sinus, subsequently, by allowing the chest wall to fall in.

8. Collapse of the chest wall is not a result to be desired in the early stages of the treatment.

9. Rapid and complete expansion of the lung is the great object of treatment. 10. The tube must be removed early.

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THE DIFFICULTIES OF MEMORIZING. Sir," once said a black house-boy at a Chicago hotel to a distinguished English doctor, can you give me anything to help me to memorize? You see, sir, if I could only memorize orders I could get a place in the restaurant ; but my memory is so short that by the time I have got to the kitchen I have forgotten the order." Alas for this dusky applicant, says the British Medical Journal, and for others with short memories, no medicine has yet been discovered to enable one to memorize. We can help our patients to forget, we can, by the aid of drugs, give them for a short time a bath in the waters of Lethe; but, as every student knows who labors at his memoria technica, medicine will

not help him to remember. In illustration of the difficulties some people find in remembering the small details of daily life an amusing story is told of Walter Savage Landor. He was extremely forgetful and was apt to arrive at a friend's without the keys of his portmanteau. Starting once on a journey he determined not to forget his keys. He carefully placed them in his pocket, and took them out several times during the journey to make sure they were there. On arriving at his journey's end he produced the keys with pride; but his treacherous memory had again played him a trick, for this time he had forgotten his portmanteau.

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RESULTS OF TREATMENT OF HYDROCELE. Spalinger reports, in the American Medico-Surgical Bulletin, forty-eight cases of injection of iodine for hydrocele of the tunica vaginalis, with 14 per cent. of relapses. From other sources he obtains about 300 cases so treated, with 8 per cent. of relapses, while in 130 cases treated by operations of various kinds there were 3 to 4 per cent. of relapses. In his own seventeen operations he had no relapses, although obstinate fistulae remained in three cases. Considering the slight disability caused by the affection, he believes that the mild treatment should be given a trial first, and operation reserved for relapsing or otherwise unfavorable cases (thick sacs, etc.).

TURPENTINE IN INCONTINENCE OF URINE. The unpleasant smell emitted by persons suffering from incontinence of urine can be conveniently covered, according to Dr. Emminghaus in the Lancet, by means of ten drop doses of turpentine administered in milk or water three times a day. This converts the smell of stale urine into an odor resembling that of violets, as is well known to persons who have taken turpentine. The remedy is perfectly harmless in most cases, and has been given by Professor Emminghaus for many weeks at a time. without any inconvenience. It is, however, contraindicated in ulcer of the stomach, gastric catarrh and nephritis.

MARYLAND

of their insane has crippled its resources and checked its legitimate development.

It has long been unable to care for the

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BALTIMORE, AUGUST 3, 1895.

MARYLAND as a State has always made inadequate and grudging provision for her dependent insane. The The Dependent Insane first public accommodaof Maryland. tion for insane patients was in connection with the Maryland Hospital, a general hospital, built partly by the State and city and partly by individual charity and the proceeds of a lottery.

This institution was the forerunner of the present excellent Maryland Hospital, popularly known as Spring Grove, which owes as much to private charity as to State aid and has never been adequately maintained by the State which it honors. Appropriations for its support have been small as compared with those of other commonwealths in no wise more wealthy than Maryland and the failure of proper legislation to enforce the just payment of sums due from counties for the care

the latter has been compelled to erect in connection with the Bayview almshouse large and costly buildings for the accommodation of upwards of four hundred insane persons and to maintain nearly as many more at large expense at the Mount Hope Retreat.

Nor is this all. For many years it has been necessary for many counties in order to secure treatment for cases of recent and acute mental disease to remove chronic insane patients to county almshouses and jails to make room at Spring Grove until throughout the entire State little collections of the insane are to be found. They are badly housed, generally destitute of proper medical treatment or care and are likely to become, if they are not already, a source of demoralization to the communities where they reside.

The Lunacy Commission has repeatedly called the attention of the Legislature to these unfortunate patients who are kept in these improper places in violation of the law, but to little purpose. Spring Grove, Mount Hope Retreat and Bay View are all hopelessly crowded and vacancies for acute and dangerous cases of insanity can alone be secured by these illegal measures.

In 1892 an act was passed to establish an additional institution to partially relieve this deplorable state of affairs but it did not receive the approval of the Governor. Two years later the medical profession of Maryland became enlisted in the establishment of a second hospital for the insane and as a result of this agitation a small and inadequate appropriation was made for the location and erection of a cottage hospital. This was fifteen months ago and the Commissioners, who were promptly appointed by the Governor, have not yet secured a location.

If the delay arises wholly from the inability of the Commissioners to find a suitable location let them call upon some of the superintendents or managers of Spring Grove, Mount Hope or Sheppard to assist them. If the delay is due to a less worthy cause let the profession of the State assert itself and demand that a location be found immediately.

Too much valuable time has been thrown away already. The people of Maryland are vitally interested in prompt action.