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In conversation with a prominent specialist the other day we learned that the medical nosology is about to be enriched by a new disease, to wit, "chronic cocaine rhinitis." He states that inflammation of the Schneiderian mucous membrane in consequence of the habitual use of cocainized snuffs is so common as to call for a naine which shall characterize the disease both etiologically and pathologically.

But this local affection, however deplorable, does not represent "a tenth part of a tithe” of the pernicious effects of the cocaine habit induced by the at first innocent use of these villainous snuffs.

We are happy to learn that the Massachusetts State Medical Society is to consider the matter. Let every Medical Society of the land do likewise, with the hope that we may soon secure some genuine prophylactic and sanitary legislation in a matter of as much importance to public health as good water or food supply, or defenses against the great epidemics of the world.

Notes and Queries.

THE INFLUENCE OF PATHOLOGY UPON THERAPEUTICs.—“The art of medicine,” says Pye Smith in a recent lecture upon the subject of the influence of pathology upon therapeutics, “deals with the most diverse objects: Mechanical causes, like a fracture or a hernia; the results upon the system of an insufficient supply of food; the presence of a foreign body in the tissues; the complications of a physiological process, such as parturition; the natural decay of a living organism, or the results of its invasion by a swarm of parasites. But like other arts, such as navigation, architecture, or engineering, it depends upon science in such important departments as the prevention of epidemics of infectious diseases, the treatment of poisoning by the proper antidotes, correction of deformities of limbs, and other matters too many to enumerate.

"We may speak of physiology, pathology, and pharmacology as the medical sciences; so we may speak of the science of war; but preventive and curative medicine, like strategy and tactics, still remains an art, and medical science means only physiology in its widest term, including the physiology of disease and the effect of drugs and poisons."

Pathology, as studied to-day, is not mere morbid anatomy, but an inquiry into the natural history of disease, into the causes of disturbed bodily

processes (whether heat or cold), the effect of mechanical agents or of the invasion of the body by parasites.

It is only within our own memory that the indispensable method of experiment has been added to that of observation. The new pathology differs from the old in that it does not consider the hepatized lung, the calculus of the kidney or the tumor of the brain as the disease, but regards disease as a process of which the origin as well as the results demand investigation. Diseases are processes just as natural and necessary as health, and they exhibit disturbance, not abolition, of the processes of physiology. Involution, degeneration, decay, and death are as much normal events as evolution, growth, and birth. And this is an encouraging view to take, for if disease is only perversion the perverted function may be restored; if we know what sets things wrong we may hope to set them right again. When we discover a parasite we may hope to poison it; when we isolate a toxin we may hope to find an antitoxin."

The statement that if the labor and skill employed on pathology had been devoted to therapeutics the art of medicine would be more advanced, will not bear analysis. Now and then a great discovery, like that of vaccination, has been made by observation and experience alone; but not until many years have been spent in study and experiment do we learn that vaccination is only a general example of the method of combating disease by means of attenuated virus. Such results as the prevention of cholera and enteric fever by the discovery that their virus is conveyed by drinkingwater, and the prevention of post-operative and puerperal sepsis by the avoidance of infection by pathogenic bacteria, are among the direct results of the application of pathology to practice.

The application of pathology to practice does not exclude the salutary check of experience, any more than does the application of the higher mathematics to the art of bridge-building. Pathology can merely indicate a probable line of treatment; clinical experience must show whether it is trustworthy. Sometimes we find that the results of clinical trials differ for the worse from those of laboratory experiment, but we can all call to mind a sufficiency of examples of the brilliant clinical success of the results of pathological experiment.

The kind of practice which is not based upon pathology is found to be not only irrational but futile in results. The "depletory” and corroborant" systems of medicine, those which depend upon “sympathies," the systems of "allopathy” and homeopathy are not wrong answers to a serious question, but attempts to solve a meaningless problem. “Disease in the abstract” does not exist. Diseases are as natural as health, and the reaction of the living organism to injurious stimulants is evidence of life, not of death.

“If we fix our attention on symptoms and direct our treatment to them alone, we may please the majority of our patients (who can always supply us with the seat and the cause of their disease and expect from us only the

appropriate remedy), but we shall never satisfy our own conscience. For we know or ought to know that symptoms are only indications of the 'seat and the causes of diseases,' and that while these are undiscovered those can only be dealt with in the dark-uselessly or injuriously....

"Surely we must condemn not only the exploded systems of sympathies aud signatures, the Brunonian and the homeopathic, but all systems as systems and all attempts to base treatment on occult properties. The one touchstone for efficient treatment is experience, spread over many lands, prolonged for many years, attested by many competent witnesses. And the one safeguard that our practice shall be rational and honest is that it follows the teaching of pathology."--Boston Medical and Surgical Journal.

MORTALITY STATISTICS FOR 1897.—The New York State Board of Health reports that during the year 1897 there were 117,075 deaths in the State, about 3,000 less than in 1896, and the smallest number in any year since 1889. The mortality from zymotic diseases constituted 14 per cent of the deaths. In 1896 it was 15.06 per cent, and for the last few years has averaged about 18 per cent. As compared with 1896 there were fewer deaths from diarrheal diseases (by 1,500), diphtheria (by 500), and measles (by 600). Whooping cough and typhoid fever also showed a decrease, while there was a moderate increase in the deaths from scarlet fever. Influenza caused 3,000 deaths early in the year. Consumption caused 12,638 against 13,265 in 1896, and the infant mortality was 32.6 per cent lower than usual.

THE KENTUCKY DEFINITION OF THE PRACTICE OF MEDICINE. Judge Thompson, of Kentucky, in pronouncing sentence upon an osteopath who was convicted of subjecting a child with tuberculous disease of the hip-joint to cruel and unnecessary torture, gave the following definition of the practice of medicine: “Any person, who, for compensation, professes to apply any science which relates to the prevention, cure, or alleviation of the diseases of the human body, is practicing medicine within the meaning of the statute.” This concise yet comprehensive definition, which will doubtless serve as a precedent, is broad enough to include every form of pretender from the itinerant advertising quack to the so-called Christian Science and Faith Cure healers. New York may well do homage to Kentucky, whose noble profession has driven from its borders every irregular practitioner of whatsoever kind, system, or genus.-Buffalo Medical and Surgical Journal.

A CHINESE EDITION OF GRAY'S ANATOMY."-Dr. H. T. Whitney, president of the Medical Missionary Association of China, is engaged in the laborious task of translating “Gray's Anatomy" into Chinese. The undertaking has impressed Dr. Whitney's former associates in the Northern Ohio District Medical Society as one of such magnitude that they have come to his assistance by passing a special resolution congratulating him and wishing him God-speed in his work.

Special Notices.

A WINTER REMEDY.—That Codeine had an especial effect in cases of nervous coughs, and that it was capable of controlling excessive coughing in various lung and throat affections, was noted before its true physiological action was understood. Later it was clear that its power as a nervous calmative was due, as Bartholow says, to its special action on the pneumnogastric nerve. Codeine stands apart from the rest of its group, in that it does not arrest secretion in the respiratory and intestinal tract. The coal-tar products were found to have great power as analgesics and antipyretics long before experiments in the therapeutical laboratory had been conducted to show their exact action. As a result of this laboratory work we know now that some products of the coal-tar series are safe, while others are very dangerous. Antikamnia has stood the test both in the laboratory and in actual practice, and is now generally accepted as the safest and surest of coal-tar products. Five grain "Antikamnia and Codeine Tablets,” each containing four and three-quarter grains Antikamnia, onequarter grain Sulph. Codeine, afford a very desirable mode of exhibiting these two valuable drugs. The proportions are those most frequently indicated in the various neuroses of the throat, as well as the coughs incident to lung affections.

I have used Phytoline in Obesity and Rlieumatism with truly wonderful results. In one case the reduction was so great that it seemed really miraculous. Although I could not induce the patient to be weighed, estimate her weight before taking at 430 pounds. She was compelled to have a special carriage to assist locomotion. I quote the patient's exact words: “As near as I can tell I lost about 190 pounds. I had not taken the Phytoline more than three weeks when I noticed the change in my clothing, and at the end of four months I was weighed and had lost about 65 pounds. I stopped taking the medicine two months and then began again. In all I have lost about 190 pounds. It has also done me so much good for my Rheumatism; could hardiy stand on my feet to do any thing, now I can be on them all day and never get tired. I did not entirely follow directions in diet.” I have been acquainted with this lady and her family for many years, and the case speaks volumes for Phytoline.

J. E. PILLING, M. D. Burlington, Iowa. I TAKE pleasure in offering my testimony to the great value of Cactina Pillets in cases of weak and irregular action of the heart. I have used them for four years, and have never been disappointed in them. They not only stimulate the heart, but improve that organ permanently. I find them very useful in all cases of typhoid fever and pneumonia.

C. B. MATTHEWS, M. D. Kent, Ind.

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Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.



In selecting the theme “Consumption ” for the subject of my paper this evening, I do so with a twofold purpose. First, that we may review together the history of a disease that is, in the language of Watson, “claiming the young, the most gifted, and the most beautiful of our race;” and, secondly, to elicit a free and open discussion of its management.

You will recognize many familiar passages in this review, for all that I shall say has been taken from the writings of masters and men of authority in their time, and you must pardon me if I go too far back to bring out old and long-forgotten fallacious skeletons that once walked

up and down in our ranks as living truths; for it is with such things before us that we, as modern medical men, are able to fully appreciate the changes that mark us “ progressive."

I shall not dwell upon the various histological and clinical divisions of the subject, nor more than touch upon the treatment, leaving that to better hands; but let us look for a moment at the evolution of the pathology of pulmonary consumption, which, as Latham says, is no more than a fragment of a great constitutional malady.

The earliest writers recognized only “pulmonary consumption,” or “phthisis," and so named it from its anatomical location and * Read before the Louisville Medico-Chirurgical Society, January 14, 1898. For discussion see page 179.

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