redness of the face. There is a desire to get in the open air, and badly ventilated or close apartments are unendurable. An habitual smoker will sometimes find tobacco smoke repugnant. In more severe forms the patient may stagger, fall, or gradually sink to the ground; he cannot speak for a few seconds, though consciousness is rarely completely lost. The recumbent position is usually sought, or the patient clings to some object, and after a period of from five to twenty minutes the feeling passes away, leaving him rather languid, with an inclination to sleep, and usually mentally depressed and apprehensive. At first he attributes the attack to anything and everything that in his estimation can cause a departure from health, and usually establishes a close watch upon his diet, habits, and mode of life; is inclined to avoid exercise and exertion of any sort, fearing to precipitate an attack, or to go by himself on the streets-in short, becomes an invalid with hypochondriacal tendencies.

In a remarkable monograph on this subject, Professor J. Grasset,* of Montpelier, divides the vertigo of arterio-sclerosis into three forms: (1) Simple vertigo; (2) Vertigo with epileptiform crises; (3) Vertigo with slow pulse and syncopal or epileptiform attacks. Some of the features of the slighter attacks, as already roughly sketched, undoubtedly suggest a similarity to mild epileptic seizures-for instance the paleness of the face, the oppression and the final confusion, depression and tendency to sleep-but personally I have never encountered well-marked convulsive phenomena reasonably attributable to this cause.

With Huchard, Grasset is in some cases inclined to attribute acquired habitual extreme slowness of the pulse, which, in numerous reported instances, has ranged from twenty to forty per minute, or even less, to the effect upon the medulla of an arterio-sclerosis acting mechanically to lessen the blood-supply to the cardiac centers. As far as I have been able to ascertain, this hypothesis has, as yet, received no positve anatomic or experimental support, though it is seductively reasonable. The bradycardia is almost always marked by syncopal and vertiginous features, and arises in individuals predisposed to to or actually the subject of

marked arterio-fibrosis.

The diagnosis is often one of extreme difficulty. Symptomatic vertigo has been confused with Ménière's disease by a very competent *Du Vertige Cardio-vasculaire, Paris, 1890.

specialist in nervous diseases; for it may, as in that particular instance, be of a systematized character that is to say, marked by a sensation of falling in a given direction, or of being rotated in a constant manner to the right or left, and even associated with a suggestive stagger. If to this a little middle ear catarrh is added, a diagnosis of aural vertigo might be easily reached, but a closer, wider examination will detect the integrity of the auditory nerve and the presence of the arterial fibrosis, with the underlying predisposition of alcoholic excess, syphilis, gout, rheumatism, chronic lead-poisoning, or other constitutional state of ætiological signifi

cance.

In the treatment, the basic element is the object of attack; and whatever this may be, potassium iodide will find an indication in the arterial change, which if recognized in its incipiency can practically be controlled, providing the patient is manageable. It is the sheetanchor, and from its exhibition in moderate doses of from thirty to ninety grains a day for a number of months, much benefit and often a substantial cure can be expected.

Vertigo is a very early symptom of a con. dition that, neglected, leads to distressing and even fatal results, and which unrecognized is the source of endless anxiety and misery to the patient and of chagrin and disappointment to his medical attendant.

PLACENTA RETENTION.-Dr. N. G. Richmond ("Medical Record") reports the case of a thirty-nine-year-old V-para who had had a miscarriage. Upon visiting her the next day she informed him that the placenta had not been passed. She was not flowing, and her symptoms were favorable. He plugged the vagina, removing the tampon the next day, but the placenta remained. Daily for ten days he visited her, expecting and prepared to remove the placenta should symptoms suggestive of complications appear. She, however, made satisfactory recovery. He dismissed himself from daily attendance, fully explaining to her the state of affairs. During the first month hæmorrhages occurred; after this menstruation became regular. She seemed as well as usual, did her own housework, and walked long distances. She was under his casual observation during this time. Just four months after the miscarriage the placenta came away intact. The patient brought it to his office. It was in a normal condition.

THE “New York Medical Journal” sustains, in the following editorial, a position repeatedly taken in the MEDICAL STANDARD anent the radical defect of the American Medical Association:

Verily the medical profession has progressed since the organization of the American Medical Association. and features of that day and generation are not matters of overwhelming interest to-day. As long as the association devotes so much of its time to the discussion of ethics, carrying it on in such a manner that the report reads: "The excitement was so intense and the discussions so heated that we deem it prudent to omit them," so long will the more prominent members of the American medical profession refrain from attending the meetings. Contrast the programme for the coming meeting of the British Medical Association with that of the recent meeting of our own association! And not only for this, but for many years has the former been infinitely better. It works scientifically; ethical discussions are as alien to it as they are within a first class scientific organization of any sort. Insistence upon such discussions has resulted in the organization of the various special societies. and of the triennial meeting of a general congress of all these societies. Some day the American Medical Association will realize that tomes on ethics will not be looked upon as its legitimate work, and we hope this awakening will not come too late to enable the association to regain the ground it has lost.

The "awakening" has come. The section executive committees are evidence of its appearance. The time is not far distant when ethical "fakes" and the "fathers" will be relegated to the limbo of deserved obscurity to the infinite benefit of American medical science. Science and cant don't agree. The capital of the "fathers" has been "ethical" cant as an advertising dodge.

THE increasing number of medical-practice acts rendered necessary the conference of examining boards at Washington in 1891. These have effected a permanent organization with the following officers: Dr. John H. Rauch, of Springfield, Ill., president; Dr. Wm. W. Potter, of Buffalo, N. Y., vice-president; and Dr. Hugh M. Taylor, of Richmond, Va., secretary and treasurer The objects of this organization are to elevate the moral and mental tone of the medical profession, of divorce the medical licensing from the teaching powers, to encourage the establishment of medical examining and licensing boards, to secure harmony of action throughout the union by the interchange of thought and experience, and to attain, as far as practicable, a uniformity of requirements for practice in the several states. The annual meetings are to be held during the second day and at the place of meeting of the

American Medical Association. Active and exmembers of the state medical examining and licensing boards are eligible to membership. No action of the conference is in any way binding upon the respective boards through the members who may participate in the conference-the sole mission of the conference being the diffusion of knowledge relative to the work of examining and licensing boards, and no board as a board is represented or committed; but the active and ex-members participate in the meetings and give and receive information which will help them in their work. There are many vexed questions in medical legislation which can best be served by this body, and it should receive the hearty support of the profession.

DR. LEFFINGWELL in a recent work makes the following contribution to the statistics of illegitimacy: Ireland has the smallest number of illegitimate births, 26 in 1,000. Next comes Russia with 28 in 1,000. Then Holland and England jumps up

Germany with 32 in 1,000. to 48 in 1,000. Sunny Italy 74 in 1,000. Protestant Scotland makes a bad showing at 82 in 1,000, and Catholic France also records 82 in 1,000. But Norway, Sweden, Saxony and Bavaria do still worse, as their illegitimates number from 100 to 140 in 1,000. The worst place of all is Catholic Austria with 146 in 1,000! The influence of morality, however, is much less in determining illegitimacy than would at first be assumed. Ireland has four factors tending against illegitimacy: Easy marriage, absence of prudential prejudices against early marriage, absence of manufacturing establishments and the influence of the old clan system by which the whole clan felt an insult offered to one member. The illegitimacy rate among the Irish rises enormously when these four factors cease to operate, In Catholic Austria legal marriage is difficult, whence unions result which are permanent and would be legal in other countries. The most important moral factor in the case of the Irish is the old clan system which has long retained its force and stigmatizes to some extent the male. Commercial civilization tends to increase illegitimacy by enforcing prudential restraints on marriage. Laws allow ing the male parent to legitimatize the offspring by acknowledgment decrease illegitimacy rates.

Leffingwell makes the curious assumption that miscegenation among American whites and blacks is on the increase. It would be difficult to produce justification for this notion.

DISCUSSING skatological literature the "British Medical Journal" says:

Probably most of us who have studied ancient prescriptions, and read with disgust the list of horrible ingredients which patients in the olden time had to swallow, thought that the Greek, Roman, and medieval physicians had very nasty ideas, and prescribed filthy remedies without any other reason than caprice and the desire to be mysterious. Investigators of folk-medicine are not inclined to dismiss the subject of the pharmacy of the past quite so contemptuously, and, as the ethnologist does not call anything "common or unclean" which throws light on the habits and ideas of the human race, it is scarcely surprising that learned treatises are being written on ordure and urine in medicine. Occult influences have been everywhere ascribed to ordure and urine and other excrementitious remedies. Hair, human saliva, ear wax, human sweat, after-birth and lochia, catamenial fluid, human semen, human blood, brain, moss growing on human skulls, lice, the tartar from human teeth, renal and biliary calculi, human bile, bezoar stones, and a host of other disgusting remedies" have been used from time immemorial, and some are used at this day as medicines for various ailments. Pills made from the dung of the Grand Llama of Thibet are used as infallible antidotes to disease. From the days of Pliny the dung of almost every kind of animal has been used in medicine. Dog dung mixed with honey was prescribed for soar throat, and wolf dung as an anti-colic. Goat dung was considered of great value in tumor of the spleen, and cat dung for gout in the feet. Lion dung was an anti-epileptic, and mouse dung in the constipation of children. Dr. Jacob Hunerwolf, in 1694, actually wrote a treatise on mouse dung as a laxative, in which he very highly extolled the remedy. Human urine is considered in many places as a most valuable tonic medicine. Daniel Beckherius ("Medicus Microcosmus," London, 1660,) recommends a drink of one's own urine, taken while fasting, for obstruction of the liver and spleen, 1or dropsy and jaundice. The urine of boys was recommended in fevers, and a "spirit of urine" was distilled for the gout.

Although "Mark Twain" credits homoeopathy with driving such products from medicine, similar products are used now by homoeopathists alone, and for sale with similar products like psorin or itch pus, among the "nosodes" of a homœopathic pharmacist.

THE Chicago Medico-Legal Society seems to be singularly unfortunate in its attempts to protect the interests of the medical profession. Founded for purposes of "mutual protection against blackmail," its first president (with the best intentions possible) endorsed and loyally supported the vilest and meanest blackmailing scheme ever devised by any sensation scavenger that received a penitentiary sentence. Its present president, acting in his judicial capacity, has, after very demagogic remarks, cut the fees of two leaders of the medical profession far below what he would dare to do in the case of lawyers

of similar status. A dipsomaniac sheet interested in inebriety cure "fakes" has been punishing the medical profession for its exposés of such "fakes" by denunciation of medical fees. This judicial demagogue, whose term expires this fall, evidently hopes to secure a renomination through the favor of this inebriate sheet.

VICTOR HUGO says ("L'Homme qui Rit") anent a sect that practiced very sinister prosthetic surgery:

The "comprachicos" were a bizarrely hideous, nomad association famous in the seventeenth century, forgotten in the eighteenth and unknown today.

They were honest men. They opened a door, entered. bargained for a child, paid and carried it away. The comprachicos were Christians and even good Christians as befits an association which had its origin in pious Spain.

Commenting on this statement the MEDICAL STANDARD Some years ago (Vol. VIII, p 123) said:

The artificial manufacture of "freaks" by these procedures, however, lasted much longer than Victor Hugo indicates in his quasi-historical remarks. In the early part of the present century, a Dr. Harper was detected in England in the manufacture of "freaks" for the English and continental market ("Chicago Medical Review", Vol. III.) He twisted a child's head in an apparatus devised by himself, so that it would look permanently over one shoulder. He grafted a rat's tail on a child's nose. He manufactured "double monsters" by removing from the backs of two children slips of flesh and allowing the wounds to cicatrize together. After the children recovered, they were taught music, dancing, French and Italian. He was particularly strict about their observance of the Sabbath. He had a regular catalogue of prices to showmen who were allowed a discount when the subject was furnished.

The following account of French legislation demonstrates that Victor Hugo's "comprachicos" still exist in Spain, ("Medical Record", Vol. XLII, p. 26) and practice prosthetic surgery from the old mixed motives:

The

There are in Paris some twenty culs-de-jattes or beggars without legs whose condition has been brought about by art. In Spain there are wretches who buy children (generally selecting the infirm, deformed or idiotic) from their parents. When these unfortunates reach seven or eight their legs are swathed so tight as to stop the circulation. limbs thus atrophy, but when the child is exceptionally strong only one leg is a "success"; the other being merely anchylosed. In this cruel business perverted religion plays a part; the children being made to believe that they are gaining paradise. The parents receive a dime a day for a year, this being doubled if their child is blind or has lost an arm. In 1887 the French minister of the interior forbad these culs-de-jattes to enter French territory.

The manufacture of "freaks" was practiced from very early times. Dr. Ebers in "Uarda" depicts an Egyptian procedure of the time of Rameses II of this type. Victor Hugo insists with very great probability (justified by the work of Dr. Conquest) that anæsthetics were used by the "comprachicos". The plot of "L'Homme.

qui Rit" turns on the transformation of the son of an English adherent of the Commonwealth into an ever-laughing "freak".

WHEN Dr. Mulheron said, in a somewhat Hibernically bovine style several years ago, that the "rectum" was the "womb" of the future, he hardly anticipated that the moral nature would be treated by excising mythical rectal "pockets," still less did he expect that medico-literary researches anent the termination of the rectum would divide with the Pythagorean bean the serious consideration of the sober Bostonese. Cases of "musical anus" have led one Bostonian to discover that Dante referred to this phenomenon, while still another ("Medical Record") exhibits the following appalling erudition anent this odorous, sonorous subject:

Mor tai zne, in one of his many essays interesting to medical men ("On the Force of Imagination"), gives the following: "St. Augustin (de Civit. Dei xiv 24 and the Comment. of Vives in loco) speaks of having seen a man who could command his back trumpet to sound as often as he pleased, and Vives supports this statement with another example in his time who could do this in tone.

THE "Union Signal," the organ of the "alcoholophobists," advises, on the authority of Dr. N. S. Davis, a "non-alcoholic treatment' of states of unconsciousness, the chief element of which is spirits ammonia aromatic. How this 50 per cent alcoholic preparation can be designated as "non-alcoholic" other than in a Pickwickian sense, must puzzle all but “alcoholophobists."

THE "New York Medical Record" states that in a New York City hospital, a dangerous operation was being performed upon a woman. Old Dr. A- a quaint German, full of kindly wit and professional enthusiasm, had several younger physicians with him. One of them was administering the ether. He became so interested in the old doctor's work that he withdrew the cone from the patient's nostrils, and she half roused and rose to a sitting posture, looking with wild eyed amazement over the surroundings. It was a critical period, and Dr. A——— did not want to be interrupted. "Lay down dere, voman," he commanded, gruffly. "You haf more curiosity as a medical student." She lay down, and the operation went on.

THE Illinois Supreme Court has rendered the following decision which is of interest to physicians in attendance on victims of railroad accidents:

Where the plaintiff in an action to recover damages for a personal injury, alleges that he was compelled to and did pay out and expend large sums of

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money in and about being cured of his injuries. it will not be sufficient for him to prove merely that he has paid a certain physician's bill in order to its recovery. but he must also show that by reason of his injuries he necessarily incurred such bill and that it is reasonable. In such case the court, on specific objection, may, before admitting proof of the plaintiff's liability incurred in curing himself and its amount and reasorableness, require an assurance from counsel that he will follow up the evidence by proof of payment. On failure to prove that such a bill has been paid, defendant should move to exclude all evidence in relation to the physician's bill, or ask the court to instruct the jury to disregard it. Where the question of a physician's qualifications and right to practice in his profession arises only collaterally, proof that he has practiced medicine in the state for a long time will show prima facie that he was lawfully entitled to practice. But if he were to sue to recover for professional services, he would doubtless have to show affirmatively his compliance with the law regulating the practice of medicine

DR. MEAD, an English "society" physician of the early eighteenth century, exhibited a rather peculiar variety of sexual perversion. He had intense pleasure from combing the hair of nude females. He was a regular visitor at the Turk's Head, on Gerrard street, where a waiter had a standing order to supply him with females having fine heads of hair that he might indulge his passion for combing.

REESE, in his "Medical Jurisprudence," makes the following remarkable blunder anent medical practice:

"While the law prescribes no one absolute system of medicine, a practitioner is expected to practice according to the system he professes and avows; a departure from this system, if accompanied with some serious or fatal mistake of remedy, would render him justly amenable to a criminal charge. Hence, a regular practitioner, and one employed as such, if he should surreptitiously, and without the patient's consent, use homeopathic or botanical treatment to the detriment of his patient, would clearly be liable for damages to the latter; and moreover, he could not recover his compensation for attendance, in a suit at law, because he had departed from his avowed system of practice. For the same reason, a homeopathic or botanical physician, practicing either of these systems avowedly, if he should have employed the regular system, instead of his own, and his patient fail to make a good recovery, would equally be held liable for damages, and would equally be exposed to a nonsuit in any attempt to collect his fee, in a civil court."

There is no "regular" system of practice in the label sense in which the term is here used. The distinction between the physicians and the sectarians turns entirely on the use of the label. A physician makes an implied contract with his patient that he will use any remedy needed in the case. The same is true of the eclectic. The homeopath, botanic and physio-medicalist are guilty of malpractice if they use remedies other than those indicated by their label, and are guilty also of obtaining money under false pretenses in such event.

AMONG the materia medica of the Massachusetts Medical Society pharmacopoeia, compiled in 1807, are aconite, Botany-bay gum tree, æsculus hippocastaneum, balm of Gilead, apium petroselinum, uva ursa, aristolochia serpentaria, burdock, pleurisy root, carduus marinus, lobelia, phytolacca decandra, rhus toxicodendron, viola odorata, xanthoxylum, and several other remedies supposed by homoeopaths and eclectics to be peculiar to their pharmacopœia.

DR. THEOPHILUS PARVIN, discussing the "influence of maternal impressions upon the fœtus," cites ("Internat. Med. Mag.") Dr. Fordyce Barker as stating that:

"Three of the most distinguished writers of fiction in modern times have based incidents on this belief, in a way which they would not have done if they had supposed these incidents would be rejected by their readers as improbable. Goethe, in his 'Elective Affinities,' describes a case in which strong mental impressions at the time of conception, or soon after, affected the child. Sir Walter Scott, in the 'Fortunes of Nigel,' explains the extreme horro: which a drawn sword always excited in James I., owing to the brutal murder of Rizzio having been committed in the presence of his unfortunate mother before he saw the light. The theory of maternal impressions is the ground work on which is constructed 'Elsie Venner,' that remarkable novel by Oliver Wendell Holmes."

Dr. Parvin further points out that:

Sir Walter Scott in "Redgauntlet" plainly avowed his faith in the influence of maternal impressions upon the foetus. Redgauntlet's "horse-shoe frown" is continued through several generations. In one of the Grimm's "Fables" a like belief is indicated. In a Scandinavian novel, entitled "Released," by Elin Ameen, a most thrilling narrative relating to such impressions is found. A young wife, two months pregnant, has a husband working in a factory; an accidental explosion occurs, he is killed, and his mangled corpse, every limb and feature torn out of recognition, is brought home, and she falls fainting to the ground at the dreadful shock. Seven months after her child is born, a boy, with only one arm and no lower limbs. The story goes on to tell with deepest pathos, how the mother, dwelling upon the sad fate of her helpless child when she can no longer care for him, determines that she will release him from it, and so, after baptizing him, believing that without baptism the little Hans cannot meet his father Hans in heaven, places him in his cradle, and, putting a pillow over his face, suffocates him. "No more tears for Hans!" she says. Later we see her in her convict cell, pining away her life with no hope in this world, and, since the priest has told her she must repent, and she cannot, none in the next. "But I released my boy!"

Dickens in "Barnaby Rudge" illustrates the results of a maternal impression. Barnaby is born an imbecile with a horror of blood, because his father's crime is revealed, under circumstances of horror, to his mother. In Charles Reade's "Put Yourself in His Place," the bursting of a grindstone kills a workman and renders his unborn child an imbecile. Hawthorne in the "Scarlet Letter" enunciates anent Pearl, the daughter of Hester, and Mr. Dimmesdale much

the same views of maternal impressions that Dr. Holmes does in "Elsie Venner."

THE "Medical Era" soberly cites from the 'British Journal of Homœopathy" the following method of what it calls "moonshine" potencies by the "bottle-washing" method:

"The employment of dilutions above the 200th being an advance on the practice of Hahnemann, who rarely used anything higher than the 30th, a corresponding advance in the method of preparation has been found necessary. The time requisite to prepare the 1m dilution according to his directions would be so great that in all probability one could never rely on getting the potencies desire i by that means. To illustrate this difficulty, I here quote a paragraph from a paper by Dr. Rhees (Medical Advance,' October, 1891). The writer calculated that 'a man in good health could make the 1m. in 4 days of eight hours each, by constant unintermitting labor, providing his arm held out. At the same rate, the CM. would require 416 days, and the MM. thirteen years. The time in each case might be reduced by one-half by measuring the alcohol instead of dropping it. Thus, the time required to raise one remedy from the tincture to the CM potency by the quickest process viz.: by measuring the alcohol instead of dropping it, is 208 days. To raise 200 of the most important remedies would require more than 132 years, and you would then have only a single drachm of each potency." To overcome this great obstacle of time, what is known as the 'fluxion process' has been devised. This process consists, briefly, in allowing a stream of water to flow into a vessel containing a measured quantity of fluid, by means of a tube carried down to the bottom of it. Connected with this there is a clockwork mechanism, by means of which the vessel is rapidly filled and emptied a given number of times relatively to the potency required; and in this way the highest dilutions can be prepared in a comparatively short time. I will be at once observed, however, that whatever advantage this m- thod may possess in saving time, it can hardly be so accurate as the hand method. Calculations have inde-d been made which show, or are alleged to show, that the dilutions prepared by the fluxion process are not really what they profess to be. Thus, it has been asserted that the CM.'s produced by Swan and by Fincke are in reality only equal to the 15,000rh. if prepared by hand on the Hahnemannian centesimal scale. In view of the doubts that have been raised as to the true degree of attenuation of these drugs, it might be more satisfactory to employ only the handmade preparations. In that case we would be certain that the dilutions were really what they were numbered, though, by this restriction, we could never go beyond the 200th, that, I understand, being the highest hand-made potency."

Under the Hahnemannian notion that "dynamization" was produced by animal magnetization, high potencies produced by this "bottle-washing" would seem to be contra-indicated.

THE American Neurological Association took a step in the right direction when it adopted the following resolution:

"It is the unanimous sense of the American Neurological Association that the proper care of the epileptic class, so long delayed, be urged upon the public, upon state authorities, and especially upon all interested in the care of the sick and defective poor. whereby they may be relieved from asylums and almshouses, and may receive the required care in such separate establishments as their deplorable situation demands."