mania, melancholia, and settled insanity, not a bad classification. He described lead colic, and other disturbances due to lead poisoning. In obstruction of the urethra by vesical calculus, he employed the catheter. He removed stone by incising below the scrotum, and cutting inward to the neck of the bladder until there was an escape of urine and calculi. He deserves credit for his endeavors to found pathology upon an anatomical basis. He had few queer notions. It is true, in conformity with the custom of his age, he was too fond of venesection, but he always warned against excess of bloodletting, claiming it was better to err on the side of chariness. He believed Castor was a remedy in all diseases of the nerves, and that White Hellebore would vanquish any case of gout. For this we must not blame him severely, for there is scarcely a physician who has not at least a couple old standbys by which he swears. An idea of the nicety of his observations may be gained from a random passage; in discussing methods for procuring sleep he writes: "Gentle rubbing of the feet with oil, patting of the head, and particularly stroking of the temples and ears is an effectual means; for by the stroking of their ears and temples wild beasts are overcome, so as to cease from their anger and fury. But whatever is familiar to anyone is to him a provocative of sleep. Thus, to the sailor, repose in a boat, and being carried about on the sea, the sound of the beach, the murmur of the waves, the boom of the winds, and the scent of the sea and the ship. But to the musician the accustomed notes of his flute in stillness; or playing on the harp or lyre, or the exercise of musical children with song. To a teacher, intercourse with the tattle of children. Dif ferent persons are soothed to sleep by different means." Here is a bit of psychology which every medical man will endorse: "This is a mighty wonder, that in hemorrhage from the lungs, which is particularly dangerous, patients do not despair, even when near their end. The insensibility of the lungs to pain appears to me to be the cause of this; for pain even when slight makes one fear death. In most cases pain is more dreadful than pernicious, whereas the absence of it, even in serious illness, is unaccompanied by fear of death and is more dangerous than dreadful." There is another sentence which I wish to quote, as it will arouse a response from every physician who has been called at the last moment or when there was no hope for recovery: “If you give a medicine at the height of the dyspnea, or when death is at hand, you may be blamed for the patient's death by the vulgar." What a world of reserve and dignity is in this simple remark! The shoulders of Aretaeus the Cappadocian were broad enough to wear becomingly the mantle of Hippocrates. Twenty centuries ago Aretaeus knew the knack of driving a point home by a good story. Wishing to illustrate that the gout may intermit, he relates that a person subject to gout won the race in the Olympic games during the interval of the disease. And he closes his chapter on melancholy thus: "A story is told, that a certain person, incurably affected, fell in love with a girl; and when the physicians could bring him no relief, love cured him. But I think that he was originally in love, and that he was dejected and spiritless from being unsuccessful with the girl, and appeared to the common people to be melancholic. He then did not know that it was love; but when he imparted the love to the girl, he ceased from his dejection, and dispelled his passion and sorrow; and with joy he awoke from his lowness of spirits, and he became restored to understanding, love being his physician." Aretaeus shows himself a true physician by his concern and sympathy for the patient, in small matters and great: "Inunctions are more agreeable and efficacious than fomentations; for an ointment does not run down and stain the bed-clothes-a thing very disagree able to the patient-but it adheres, and being by the heat of the body, is absorbed. Thus its effects are persistent, whereas liquid preparations run off." Elsewhere occurs this noble phrase, rarely equalled and never bettered: "When he can render no further aid, the physician alone can still mourn as a man with his incurable patient. This is the physician's sad lot." Some authors call their work "a confession"; this is unnecessary, as all writing is autobiographical. Write, and in spite of your best efforts at concealment, your feelings, passions, prejudices, predilections, your good qualities, wisdom, sympathies, will become apparent; where you least expect it, you will give yourself most away; your IS THIS SUFFICIENTLY DRASTIC? true self will lurk between the lines, and it will peep from the pages. I am confident that from the excerpts here given, the reader has already formed a high opinion of Aretaeus. If ever a man cast credit on the art of healing, it was the loftysouled Cappadocian. He was a disciple who not only followed in the footsteps, but caught the spirit of the immortal Father of Medicine. Aretaeus should not be a forgotten physician, for no one better than he could repeat with decorum, the Hippocratic Oath: "With purity and with holiness I will pass my life and practice my art. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females. and males, of freemen and slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, I will not divulge, as reckoning that all things should be kept secret. While I continue to keep this oath inviolate, may it be granted to me to enjoy life and the practice of my art, respected by all men at all times. But should I trespass and violate this oath, may the reverse by my lot!" journal which carries the ad. of a "The Committee recommends the expulsion single preparation not approved by the from the Association of anyone connected with a journal which publishes advertisements or reading notices of fraudulent proprietary articles." I will go Dr. McCormack one better. Here is mine: Council on Pharmacy and Chemistry, should be summarily expelled from the American Medical Association. Should this not prove a sufficiently drastic deterrent, then the culprit should be deprived of his license to practice. A term of imprisonment might be considered later on. I suggest that anybody who edits, publishes, contributes to, subscribes for, or receives free or as an exchange, But I would make all these punishor has in his possession-either about ments retroactive. How is that? his person or on his desk-a medical Critic and Guide, July. Physical and Mental Training in the Treatment of Nervous Diseases 1 1 By B. E. MCKENZIE, B. A., M. D., Toronto, Can. The nervous diseases here referred to are such as naturally seek the advice and guidance of the orthopedic surgeon. As a clinical contribution to the subject, it is my purpose to emphasize the educational and disciplinary elements of physical training. The terms physical and mental are both used, yet it might suffice to have employed the term physical only as such training properly directed must invariably be a means of mental discipline, resulting in greater concentration, alertness, promptness and quickness of decision and action. Diseases of the nervous system are very commonly and conveniently classified as organic and functional. Functional affections are those whose symptoms cannot be referred to any appreciable lesion or change of structure; they result from a derangement of an organ or of organs by some cause often unknown and not detectable. The term functional is used in contra-distinction to the word organic; the latter implies disorder in which there is a morbid process recognizable in the part deranged. Tho the borderline between the organic and functional is not well defined and tho it may be doubted whether there is any true nervous disorder which is not accompanied by and dependent upon organic change if only our means could detect the alternation in cell and neurone, yet it is quite possible to discern certain generic signs which are distinctive of the neurotic disorders, some underlying symptoms common to all. Among the terms employed to signify the many functional nervous affections are such as these: nervousness, hysteria, neurasthenia, nervous prostration, nervous collapse, breakdown, etc. These terms commonly and loosely employed, not only by the laity but by the medical profession. are Of the various nervous affections. amenable to treatment by physical training the functional are those in which the most striking results are obtainable. Since, however, the publication of a class work by Frenkel 2 of Switzerland and even at an earlier date (1889) when he presented a paper before the Congress of Scientists and Naturalists at Bremen, the treatment of some organic diseases, notably tabetic ataxia, by systematic and graduated exercises, has shown brilliant results, thus bringing much light and encouragement where previously there had been only darkness and despair. Of the organic diseases amenable to treatment by training there are none which afford more satisfactory results than those of locomotor ataxia, and of infantile spinal paralysis. In the treatment of any of the ner 2 "The Treatment of Tabetic Ataxia by Means of Systematic Exercises," by Dr. H. S. 1 Read in Montreal at the meeting of the American Association for the Advancement of Physical Education, Feb. 22-24, 1912. vous diseases by training emphasis must be laid upon one meaning of the term in one class of diseases and more emphasis upon another signification of the word in other cases. In the treatment of tabetic ataxia the process is essentially one of re-education; in the treatment of infantile paralysis it is in a more marked degree one of development; in the treatment of neurotic disorders emphasis should be laid upon the word discipline. TABETIC ATAXIA Briefly it should be stated here that tabetic ataxia is a well-recognized organic disease of the spinal cord, characterized by peculiar disturbance of gait and difficulty in co-ordinating voluntary movements. The lesion is located in the posterior columns of the cord so that sensation is greatly disturbed or lost; thus the reflex nerve arc, so necessary for the complicated acts of locomotion, is interrupted. The task which Frenkel sets himself is to make up for this loss by a direct control of the motor functions by attention and re-education. In order to learn a movement it is essential that the motor stimulus be repeated again and again and that the patient's attention be directed to it. Beginning with the simplest modes of action one proceeds gradually to those more complicated, calling into play the powers of muscular co-ordination until locomotion may become well restored The treatment of tabetic ataxia is based chiefly upon education of the central nervous system. The unfailing certainty of the improvement of a symptom which has been caused by an organic lesion attaches special interest to this movement treatment. The symptom to which attention and treat ment are directed is a motor disturbance which has its origin not in diminution of the motor power of the muscles but in a loss of sensation. The result for betterment is brought about thru calling into action the cardinal quality of nervous matter to increase in function by exercise, provided that the motor apparatus is intact. The principle employed is identical with that called into play by a healthy person who would learn a complicated combination of difficult movements as in rope-dancing. The accomplishment of the striking results obtained by Frenkel and others, who have followed his lead, is a notable event in the history of medicine and places many sufferers and the medical profession under great obligation. To illustrate the principles and practices employed here I shall present only one report of a case, not of tabetic ataxia, but one affording a more difficult problem. Case 1. L., a man 44 years of age, a carpenter, while working on a building was struck on the shoulders by a falling timber, which doubling him forward, fractured his spine at the tenth dorsal vertebra. Loss of sensation in parts below was complete, and the manifestation of motor power was irregular and uncontrolled. By operative means fragments of bone which had been forced into the spinal cord were removed; but the posterior columns at the point of injury had been destroyed and the anterior columns much injured. Consideration of this man's condition and of the physiology of walking will at once suggest the impossibility of his ever regaining that power. In the Orthopedic gymnasium is arranged a track on which runs a little car after the manner of a trolley. This track is parallel with and twelve feet above the floor and extends over a distance of twenty feet. Suspended from the car is a rope and crossbar to which are attached comfortably adjusted padded straps passing under the chin and occiput as used in applying a plaster-of-paris jacket. In this way the patient may be held up standing by direct traction upon the spine. Two ropes are used running parallel across the gymnasium placed at a convenient height so that the patient may use them to pull himself back and forth, while the body weight is borne by the car on the track referred to. While thus pulling himself along he uses his arms, his trunk muscles and the ropes to enable him to move his lower extremities much as they would move in walking. His motions, at first irregular and awkward, soon improved so that his movements approached more nearly to the ordinary manner of walking. When practice has brought about a fair degree of proficiency braces are applied extending from the boots to the perineum so as to prevent the knees from giving way and the practice is continued. After requiring considerable facility in moving in this way the ropes are removed and the patient is given crutches. It now frequently requires several weeks of arduous work to enable the patient to use the crutches as his means of propulsion. When facility has been acquired the straps under the chin and occiput are gradually slackened and finally removed, leaving him educated in new methods of locomotion, permitting a fair amount of independent activity instead of leaving him dependent upon others. The attainment of this end would have been much less difficult if this particular patient had not lost sensation in the feet. Altho in the course of his training he had reached a point where he could move quite freely aided by crutches and leg braces so long as he was kept erect, yet because of lack of sensation in the feet it seemed impossible for him to learn to balance himself. A simple explanation of his difficulty, urging him to pay attention to his arms and crutches and to "feel” in this manner his position in space, much as a surgeon "feels" the metallic bullet, or the necrosed bone at the end of his probe, opened up for him a new avenue of sensation, which he was quick in appreciating and assiduous in putting into practice. After this instruction a few weeks of daily practice fitted him for self-locomotion. This case is submitted by way of illustration and to lay emphasis upon the educative element of physical training in raising this man from a condition of helplessness to one of self-activity. Two days before he left the Hospital he walked more than two thousand feet in the manner above in |