A Charming Outing.

To the invalid, the busy man, and the pleasure seeker who are looking for the best place to go for a week or two, and at the smallest cost, we can recommend the Georgian Bay trip in the fullest assurance that everyone who takes it will come home with nothing but words of praise for those who have planned so charming an outing at so small a cost. For instance, one can leave St. Paul or Minneapolis in the evening, by the "Soo Line," and the next morning he will be on the steamer for a trip through the 30,000 islands of Georgian Bay, where he will find some of the most beautiful lake scenery in this country; and if he takes the short trip known as "Route 2," he will be at home in a week. During this time he will have had four or five days on the lake in a beautiful steamer, with good beds and an excellent table. He will have found a rest for mind and body, and the total expense with no extras, will have been only a little over $25.00, which is only a trifle more than the regular railway fare from here to the "Soo," where he takes the boat for the four-day trip. If he wishes to extend the trip for another week, or even longer, the additional expense will be small.

We know of several physicians who have taken this trip, and have recommended it to patients; and they say they have never spent so delightful and restful a week.

The ticket agents of the "Soo Line" in St. Paul and Minneapolis will cheerfully furnish descriptive circulars of the various routes, over twenty in number, which include the shorter one above mentioned.

A Testimonial.

Very seldom do I say anything for a preparation that might be used as a testimonial, but I feel that I have sufficienty tried Unguentine to lend a word of encouragement to its varied uses. I used it almost exclusively in a case of severe conjunctivitis, due to strong caustic Silver Nitrate, with the most gratifying results. The severe pain ceased almost instantly, the severe burning subsided and the lachrymal fluid checked. Patient comfortable in twenty minutes and slept soundly for the night. He never had any more swelling or further alarm. I have treated another case of conjunctivitis with similar results, that was brought about by Chrysophanic Acid, used for ringworm. We use Unguentine exclusively in our family for all sores, bruises, diseases of the skin (including parasitic troubles) and mucous membranes, such as hæmorrhoids, etc. We have equally as good results in general practice. I treat all my cases of operative hæmorrhoids with Unguentine, successfully. Endomitritis is treated handsome

ly by filling six grain capsules with Unguentine and putting two or three of them as far in the uterine canal toward the fundus as possible with suitable forceps and adjusters. The results have been fine with all I have treated so far.

Unguentine is the fat man's friend. I speak from personal experience. It has no superior for chafes. It is worth it's weight in gold for this alone, to fat folks. The so called "Tetter" in the hands of our fishermen and watermen has no show for existence when Unguentine is applied freely twice a day.

I am, very respectfully,

F. P. Gates.

Diet in Acute Gastro-Intestinal Catarrh. In some cases a cream mixture agrees better than diluted milk, or whey thickened with a small quantity of malted food or predigested gruel, is retained when other forms of food are rejected. Gradually, and with caution, the amount of milk is increased, until at last the child is able to take the full allowance suitable

to its age. Even when the stage of convales

cence is well advanced, it is advisable to restrict the infant to a milk diet, with or without Mellin's Food, and to avoid the use of unmalted foods for some time.-From "Disorders of Digestion in Infancy and Childhood," by W. Soltau Fenwick, M. D., B. S.

Practice in Minneapolis For Sale.

A Minneapolis physician who is about to retire from general practice to take up a specialty, offers for sale his household and office furniture and his horse and carriages. All articles in good condition and are of good quality.

To the purchaser he will turn over his practice without charge, giving him a proper introduction, and doing whatever he can to install such successor in his practice, which has been established eleven years.

The publisher of the Lancet believes this to be an excellent and an unusual opportunity for any one wishing to begin practice in Minneapolis.

For full particulars address "Doctor," care of N. W. Lancet, 734 and 735 Lumber Exchange, Minneapolis.

LECTURES AND ADDRESSES.

THE HISTORY OF MEDICINE AND OF THE MEDICAL PROFESSION.*

By Burnside Foster, M. D.,

Clinical Professor of Dermatology in the University of Minnesota.

St. Paul.

(Continued from LANCET of July 15.)

Following Harvey and an ardent supporter of his theory of the circulation was Marcello Malpighi, a professor at Bologna who discovered and demonstrated the connection between the arteries and the veins which we know as the capillary circulation. He was familiar with the use of the microscope, which although invented early in the century was little known until the latter years of it, and by means of it he discovered the blood corpuscles and witnessed for the first time their actual movements in the capillary circulation in the lungs and mesentery of a frog. He also first described the pigmentary layer of the skin, which preserves his name as the rete Malpighi. Other investigators in this direction were William Cowper, Anton Van Leeuwenhoeck and William Molyneaux, all of whom witnessed and described the capillary circulation, the most complete demonstration of which, however was made by Frederick Ruysch, a professor at Amsterdam, who invented a method of minute injection which has done so much to advance anatomical teachings. Ruysch also made the first important collection of anatomical preparations which was afterwards purchased for an enormous sum ($75,000) by Peter the Great and transported to Russia. It is said that the men who were intrusted with the transportation of the collection drank a large part of the alcohol in which the specimens were preserved, so that many of them were ruined. (It would seem as though the theft must have carried its own punishment with it, and that the punishment must have fitted the crime!) The enthusiastic study of the phenomena of the circulation, which was stimulated by Harvey and his disciples, soon led to the discovery of the lymphatics and the thoracic duct, the termination of the latter in the left subclavian vein being demonstrated by Jean Pecquet, of Dieppe, a professor in Montpelier, and later (in man) by Jan Van Horne, of Leyden.

*Extracts from a course of lectures delivered before the students of the University of Minnesota, during the winter of 1898.

Nicholas Steno, of Copenhagen, who discovered Steno's duct, was another Harvey enthusiast, and further illustrated the physiology of the circulation. He first showed that the heart is a muscle and that the blood is propelled by its contraction. At the same time that all these investigations and discoveries concerning the circulation were being made, another line of research also originated and set in motion by the work of Harvey was being followed. The publication of his work on generation had made an epoch in the history of embryology, and his methods of investigation were taken up by many students who added much to what he had discovered.

The correct theory of generation was pretty well completed by the discovery of the spermatozoa in semen, made by a young microscopist of Leyden, Ludwig von Hammen. The function of the spermatozoa as the fertilizing power of the ovum was not immediately appreciated, and there was much dispute as to whether the spermatozoa or the ovum was the essential factor in generation; but the light which illuminated the path towards the complete elucidation of this complex subject had been shed from the lamp first kindled by William Harvey.

The anatomy of the testicle was accurately studied about this time by Nathaniel Highmore, of London, who described the seminal ducts, the epididymis and the so-called corpus Highmorianum. The many experiments upon animals and the increased activity in the study of both gross and minute anatomy, which took place. during the seventeenth century resulted in much new physiological knowledge, especially in regard to the nervous system and the organs of special sense. Thomas Willis studied the anatomy of the brain and was the first to appreciate its function as a general presiding organ over the nervous system, and to assign distinct functions to different parts of it. He practically inaugurated the modern theory of cerebral localization. The circle of Willis perpetuates his name. The most complete and accurate description of the anatomy of the central and peripheral nervous system was given by Reymond Vieussens, a professor at Montpelier, who also wrote extensively on the anatomy of the heart and on the circulation. Ruysch, Leeuwenhoeck and Kepler elucidated the anatomy and physiology of the eye, the latter demonstrating that the crystalline lens was not, as previously supposed, the seat of vision, but that the expansion of the optic nerve into the retina was the essential part of the organ of sight. Casserius studied the minute structure of the ear and described the ossicles, the muscles of the internal ear, the semicircular canals and the auditory nerves. Glisson, a professor at Oxford, first recognized the

property of irritability of the nerves and was also an able anatomist. He succeeded Harvey as lecturer before the College of Physicians.

One of the most eminent physicians and as a practitioner of medicine, perhaps the most eminent of the seventeenth century, was Thomas Sydenham. Although not an investigator of either anatomy or physiology he was an eminently scientific man, and devoted himself chiefly to the study of the symptoms of disease and their treatment. He was the son of a prosperous farmer of Dorsetshire and was born at Winford Eagle in 1624. At the age of eighteen he entered Oxford, but his studies there were interrupted by the Civil War and for a time he served in the army, on the Parliament side. It is interesting to remember that at the same time William Harvey was in the service of Charles I. He afterwards returned to Oxford where he took his bachelor's degree in 1648. He then went to Montpelier, and on his return to England took the degree of doctor of medicine at Cambridge, after which he settled down to the practice of medicine in London, where he became a busy, distinguished and successful practitioner. He was possessed of a cool, well balanced mind, absolutely free from prejudice and which refused to be influenced by any of the systems and irrational doctrines so common in his time. In his methods of thought and reasoning he followed Hippocrates (indeed he has been called the Hippocrates of England), and his views were entirely based upon experience and observation, which taught him much more than he could learn from books. His writings, which were numerous, and many of which may be read with profit by physicians of today, consisted chiefly of careful descriptions of the symptoms of disease and of such methods of treatment as his experience had taught him to be useful. His minute and accurate descriptions of the various febrile diseases and his treatise on the gout (from which he was himself a sufferer and of which he finally died), have rarely been surpassed.

The great plague of London occurred in 1665, while Sydenham was in active practice. He remained at first in the city, but when the disease was at its height he removed with his family into the country, but returned again before the worst of it was over, and has left a very accurate description of its nature. This fearful epidemic which was the bubo plague, and which but recently existed with such a fearful mortality in China, has been so graphically described both by Sydenham and by De Foe, who remained in London during its entire duration, that I shall give you an account of it, chiefly taken from their writings:

In September, 1664, there began to be rumors in London that the plague was again rag

ing among the Dutch, and in the latter part of November two men said to be Frenchmen, died of the plague in a house at the upper end of Drury Lane. During the next few months there were occasional cases in the same part of the city, but it was not until early in the following May that there began to be any serious apprehension. With the warm weather the cases became more numerous, and in the second week in June, about one hundred died of the plague in the out parishes, and the disease began to appear in the city, and by July 1 the pestilence had become so general that business of all kinds was suspended, and many of those who had the means to do so shut their homes and places of business and fled to the country. The panic among the people became so great that many went mad through fear, and others deliberately committed suicide to avoid the infection. Great numbers of quacks, mountebanks and imposters seized the opportunity to prey upon the fear and credulity of the people.

De Foe records that the posts of houses and corners of streets were plastered over with doctors' bills and papers of ignorant fellows quacking and tampering in physic and inviting the people to come to them for remedies.

"Infallible, preventive pills against the plague. Never failing preservatives against infection. Sovereign cordials against the corruption of the air. Anti-pestilential pills. Incomparable drink against the plague. The only true plague water. The Royal Antidote against all kinds of infection, and such a number more that I can not reckon up, and if I could would fill a book of themselves to set them down."

Others assuming specious titles, summoned people to their lodgings by such bills as these:

"An eminent High Dutch physician, newly come over from Holland, where he resided during all the time of the great plague last year in Amsterdam and cured multitudes of people that actually had the plague upon them."

“An ancient gentlewoman, having practiced with great success in the late plague in this city, Anno 1636, gives her advice only to the female

sex."

"An Italian gentlewoman, just arrived from Naples, having a choice secret to prevent infection, which she found out by her great experience, and did wonderful cures with it in the late plague there, wherein there died 20,000 in one day."

"There is no doubt," says De Foe, "but these quacking sort of fellows raised great gains out of the miserable people, for we daily found the crowds that ran after them were infinitely greater, and their doors were more thronged than those of Dr. Brooks, Dr. Upton, Dr. Hodges, Dr. Berwick, or any, though the most famous men of their time."

The Lord Mayor and Aldermen adopted very sensible and very stringent measures for the separation of the sick from the well, and for general disinfection, which doubtless had a considerable effect in controlling the disease. An infected house was at once shut up and a watchman appointed to guard it day and night, to see that none entered or left it without special permission. By this means, harsh and cruel as it was in many instances, the infection was to some extent confined and localized. During August the deaths became so numerous that it was impossible to give decent burial to the bodies. Great ditches were dug, and the bodies, without discrimination were cast into them. It was estimated that above ten thousand houses in London were deserted and that about two hundred thousand people left the city. From August 8 to October 19, according to the mortality bill, there died in London 59,810 people, of whom 49,605 died of the plague. The total number of deaths from the plague during the epidemic is placed by De Foe at 100,000. From November I the number of cases began to diminish, the death rate of those attacked became smaller, and as winter came on, people returned to London, resumed their business, and by February of the next year, the Great Plague was over.

A very accurate clinical description of the disease is given by Sydenham, and I will presently refer to it. In regard to the nature of the infection by which the disease is spread, De Foe, after discussing various opinions, says: "Others who talk of infection being carried through the air only, by carrying with it vast numbers of insects, and invisible creatures, who enter into the body with the breath or even at the pores, with the air, and there generate or emit acute poisons or poisonous ovæ which mingle themselves with the blood and so infect the blood." Strange that the actual discovery of germs and of the ptomaine theory should have been delayed for two centuries!

The symptoms of the disease are thus described by Sydenham:

"Its first approach is almost always accompanied with shaking and shivering like the fits of an ague; presently violent vomiting, a pain about the region of the heart, a burning fever, with the usual concurrence of symptoms perpetually afflict the sick till either death itself or a happy eruption of a bubo discharges the morbific matter and so frees them from that deplorable condition. It does now and then happen that it comes without any sense of fever before, and suddenly kills men; the purple spots which are the forerunners of death breaking out as they are about their business. But this sudden death scarce ever happens but at the beginning of a dreadful plague. It sometimes also happens that swellings appear when neither a

fever nor any violent symptoms went before. The victims sometimes died within a few hours of the first symptoms, and rarely lingered beyond four or five days. If the buboes suppurated it was considered to be a favorable circumstance, and they were therefore treated by incision or by caustics."

The other local manifestations were carbuncles, furuncles and ecchymoses. A peculiar and characteristic stench was emitted from the bodies of the sick. At the beginning of the London Plague upwards of 90 per cent. of those attacked perished. Towards the end of the year the disease seemed to become milder and the mortality was much less.

Although it is true that Sydenham left London during the height of the plague, it was probably more on account of his family than any fear of his own account, and he soon returned. He frankly describes his conduct as follows, and I quote directly from his own book, of which I am fortunate enough to possess a copy: "When I was endangered by the near approach of the plague to my own home, at length, by persuasion of friends, I accompanied the vast numbers of those that left the city, and removed my family some miles from thence, yet I returned so soon and when the plague continued so very violent, that it could not be, but by reason of scarcity of better physicians, I should be called to the assistance of those who had the plague." In another place he says: "As to the cure of these fevers, some may count me rash and arrogant, for pretending to write of this disease, being several miles distant from the city the greatest part of the time the plague reigned; and so not sufficiently furnished with observations; but seeing more skillful physicians who bravely ventured to continue during so very dangerous a time have not yet published those things they frequently observed concerning the nature of this disease, I hope all good men will pardon me for publishing my opinion concerning this dreadful disease, raised from my own observations."

Sydenham, in his methods of treatment, departed often very widely from the methods of the then existing authorities, but always having a clear and well defined reason for all his therapeutics, and ably defending his views, often against the greatest opposition and prejudice. This was particularly so with regard to the treatment of fevers, which he treated by the plentiful admission of fresh air and cooling, acid and diluent drinks, a plan directly the reverse of that of most practitioners of his time. Like Hippocrates, he had a high regard for the "vis medicatrix naturæ," and his efforts to cure disease were always directed towards the assisting of nature by encouraging what seemed to him the natural methods of ridding the system of

its malady. In the opening sentence of his work on acute diseases he says: "Reason dictates, if I judge right, that a disease is nothing else but Nature's endeavor to thrust forth with all her might the morbific matter for the health of the patient; though the cause of it be contrary to Nature." His practice was large and lucrative, and his reputation extensive, and he enjoyed the familiar friendship of the most eminent men of his time, although on account of his political opinions (he having served on the side of parliament during the civil war) he was not in favor at court. The manner of his death, which occurred in 1689, is thus quaintly described by the translator of his works: "He died in the 68th year of his age. A great age it was for one that had been closely besieged near half the time, with the "opprobium medicorum," the gout, which finding its frequent efforts repelled by his great skill, called in its auxilliary the stone, and together, with much ado, they stormed the tottering tenement of clay, when by reason of age it was scarce tenable any longer." The three greatest pioneers of modern medicine were beyond question, Thomas Linacre, William Harvey, and Thomas Sydenham.

The first was a profound scholar; the second, an original and scientific investigator; and the third, by combining and applying the learning and knowledge of the former two, and adding thereto the accurate study of all the phenomena of disease, and by fearlessly maintaining the courage of his own convictions in spite of the strong prejudice of his time in favor of theoretical systems and absurd doctrines, became the perfect type of the practitioner of medicine, not alone of his own time, but a worthy model for all time.

During the first half of the seventeenth century a discovery of the greatest importance to medicine, and which has given us one of the most important drugs we possess, was made in the knowledge of the properties of the Peruvian bark. Its introduction into England is said to have been due to the fact that the Countess of Cinchon, wife of the Viceroy of Peru, was cured of a fever by its use, and that she caused a great quantity of it to be imported into Spain, from whence, its valuable properties being recognized, it soon became distributed over Europe. It was at first called "The Countess' Powder," but afterwards received the name of cinchona, by which it is known today. Its high price at first caused it to be much adulterated, and for a time it fell into disrepute in England, but its universal value in malarial fever was recognized by Sydenham, and it was chiefly through his influence that it became generally used. The true botanical history of cinchona and the chemical nature of its chief alkaloid quinine, were not known for a century after Sydenham's time.

(To be continued.)

ORIGINAL ARTICLES.

ELEMENTS OF ERROR IN INTERPRETING THE WIDAL REACTION

IN TYPHOID FEVER.*

By Louis Blanchard Wilson, M. D.

First Assistant Bacteriologist of the Minnesota State Board of Health.

In the two years which have passed since the first publication by Fernand Widal' of the serum reaction for typhoid fever, the results of the test in several thousand suspected cases have been reported in the literature of the subject. Of the many observers, only one gives a low percentage of accuracy, seventy-seven per cent. This observer, reporting on 194 cases, includes in his list of possble errors many cases on which it is evident that too early and too few observations were made. •

Aside from this list the percentage of accuracy claimed by the various observers ranges from ninety-two per cent. to ninety-nine per cent.

Up to May 1, 1898, some three thousand specimens of blood from 1595 patients had been tested in the laboratory of the Minnesota State Board of Health. Only the first thousand of these cases have as yet been accurately tabulated, but the percentage of error appears to be a trifle over five per cent., or accuracy above ninety-four per cent. Dr Barber, of this city, has studied clinically 350 and reported on 205 of the cases tested in the State Board laboratory, and notes but one error in all, or a percentage of accuracy closely approaching one hundred.

When the Widal reaction for typhoid fever was first brought before the scientific world there were many who from reasonable premises, prophesied that it would become almost a pathognomonic sign for the disease. But though the degree of accuracy attained, as will be seen from the foregoing figures, is already very great, probably averaging ninety-five per cent., yet the test is not apparently as certain as sputum examinations in pneumonic phthisis, as throat cultures in diphtheria nor as animal inoculations in rabies. What, then, are the elements of error in this which would appear, on bacteriological grounds, to be a highly specific diagnostic phenomenon?

First of all may be considered errors of technique. It is obviously necessary that a chemical or bio-chemical test, which as usually made is microscopical as well must be made with

*Read before the Section of Practice of Medicine of the Minnesota State Medical Society, June 14, 1898.