cessful for the relief of the stomach, but other arrangements of the poles were required to relieve the uterine trouble. On account of an obstinate constipation and resulting hemorrhoids it was necessary to use the rectal electrode. If constipation exists in connection with functional dyspepsia the positive pole attached to the Einhorn electrode in the stomach and the negative pole connected with the rectal electrode often yield excellent results, as in this case.

FIG. 4.-Rectal Electrode.

tenderness over the stomach than over the
pelvic region, as sometimes occurs, the posi-
tive galvanic pole should be placed over the
epigastrium and the positive faradic over the
pelvis.

muscular tone, excites the nerves and increases the blood supply, thus aiding nutrition-the most essential element in restoring the tissues to their normal condition. Most cases of indigestion and dyspepsia for which relief is sought are not due to organic lesion, suffer no structural change, but are due to deficient secretion of gastric juice or lack of muscular tone.

These conditions and feebleness of the organ as shown in diminished movement are positively benefited by electricity. If secretion is diminished the negative Several gastric diseases or morbid conditions are ben- pole of the galvanic current should be placed intra-venefitted by applications of electricity. All forms of neutral. The faradic battery-the labile pole over the epiroses, as gastralgia, hiccough, vomiting, nervous belch- gastrium, the stabile pole in spinal region-does well ing, functional dyspepsia in any form may be properly when atony of the muscles is the only source of trouble treated by electricity. In those neuroses de- especially if the current is of high tension and rapid pendent upon derangement of the central interruption. Atony with diminished secretion—a common condition-may be treated with the combined cur. nervous system, central galvanization or fara. dization will often produce marked benefit. I rent. The tendency of electricity in these cases is to have obtained success in neuroses due to increase the quantity and modify the quality of the uterine or ovarian irritation with functional secretion. Whether the derangements of digestion dedyspepsia by applying the positive galvanic pend upon an exhaustion of the nervous system which pole over the sensitive pelvic region, the interferes with the normal activity of the process of positive faradic pole over the epigastrium secretion or whether the vascular supply is deficient in and the combined negative pole (Einhorn quantity or quality the power which electricity has to electrode) in the stomach. If there is greater modify the physiological functions of the body suggests it as a most valuable remedy; and its use in these cases has strengthened the confidence which theory had aroused in this agent. General faradization is espeThe current controller should be used cially valuable. with both forms, the faradic and galvanic. Lately I If the gastric neurosis is due to some local never apply electricity in either form to a patient withcause the poles may be applied to the back out the controller. The sudden shock of the faradic current when this instrument is not used is distressing and epigastrium provided the sensitiveness is to most patients, and the general increase of the galexternal; if the gastric mucous membrane is vanic current by this means has a much better effect hyperesthetic the positive pole should be than the successive addition of cells. In sensitive conused intra ventral. In some cases the intra ditions of the stomach this regulation of the current is ventral use of the electrode must be avoided; in such especially desirable. Paralysis and nervous spasm cases the poles must be applied to the epigastrium a the stomach are generally benefited by electricity. The little distance apart, or one to the epigastrium faradic current may be thus applied: anode, large elecand the other in the cervical or dorsal region of the trode, a little to the left of the spinous process, at the spinal column. The positive pole should be used in the level of the cardiac end of the stomach; the cathode, same way in gastralgia or gastrodynia, and in hyper-small electrode, labile (moving), over the epigastrium. secretion of gastric juice; but in diminished secretion The galvanic current may be similarly used. I often the negative pole should be internal. It goes without saying that gastric neuroses due to reflex nervous irritation or central nervous disease will not yield to treatment which fails to recognize the primary pathological condition. The dosage will vary from 10 to 25 mil. liamperes.

The faradic will often give relief in gastralgia as quickly as the galvanic current. The same is true of the rapidly interrupted static induction current.

find the anode at the base of the cranium gives most excellent results. In most of these cases we desire to affect the vagus nerve, as we do in prolonged vomiting and gastric manifestations of hysteria.

Chronic gastrectasis (dilatation) due to atony, gormandizing, spasm of the pylorus and possibly to fibroid thickening is often amenable to electricity. These cases may be treated in the same manner as cases of atony. If the dilatation is due to cancer or ulcer the

The best results from the use of electricity in disuse of this agent will be of little value. eases of the stomach are found in the neuroses, but the therapeutic applications of this agent may with confidence be extended to other derangements.

In atony of the gastric mucous membrane and parieties electricity produces excellent results. It restores

The following case will illustrate: A young woman with dilatation of stomach came to my office. She had no special pain except at apex of left scapula. She was nervous, had some dyspeptic symptoms-occasional eructation of gas, at times slight distress after meals;

cine has moved but slowly, that its principal aims have not yet been attained, and that across most of those highways along which death urges his victims, it has placed, as yet, but feeble barriers, scarcely more effective than those of days long since passed by.

fickle varying appetite and almost constant pain at lower quirements and indisputable successes of medicine, we angle of left scapula. The bowels were regular, gener- may, for a moment, conceive that our art has also proative organs normal. Examination of abdomen led to gressed as rapidly as other departments of knowledge the discovery of a tumor of the pylorus. The stomach or action. But in our cooler moments we are forced was dilated to twice its normal size. Analysis of the to admit that in comparison with the rapid and occastomach contents showed no variation from the normal sionally tumultuous advance of physical science, mediin HCI or other constituents of the gastric juice. She had been suffering in this manner for two or three years. There had never been vomiting nor any pain in the region of the tumor-she was not aware of its presence. It was not tender, did not pulsate, moved with the stomach. Believing it to be a fibrous growth I had no hesitancy in recommending electricity. The combined galvanic and faradic positive pole was applied at the seat of pain in the left infrascapular region. The negative galvanic pole (Fig. 4) was placed over the tu mor, the negative faradic (Fig. 3) over the distended stomach. The current controller was turned on until 40 milliamperes were given. This was gradually in creased to 75 milliamperes. The result was gratifying. The pain subsided, the patient grew better and gained in flesh, the stomach slightly diminished in size, and the tumor grew perceptibly less. At the end of three months she passed from under treatment and has not been seen since-more than six months; but she has written to me that she is still better and is now able to work.

It is true that in no department of science whatever, have the methods of scientific analysis and classification been more rigidly and exactly applied, than in the cardinal subdivisions of medicine. Since the days of Paré, of Caesalpinus and Harvey, of Vesalius and Morgagni, medical study has engaged the best minds of all successive ages, so that the main fields of medicine have now been at least accurately surveyed and mapped out.

A huge mass of facts, of inestimable value, is in our keeping. Theories presiding over certain groups of these data have been drawn from mechanics, chemistry, hydraulics, optics, acoustics, etc. Fortunately, the constitution of the human body, to a very considerable degree, permits of a scientific application of the laws of pure physics to many of its phenomena, for the body is

More decided results than this can be secured in dila of the earth, and is subject to every physical influence. tation due to atony.

Taken all in all I believe electricity to be a very valuable therapeutic agent for the treatment of diseases of the stomach; but I repeat that its greatest field of usefulness is found in the neuroses.

The combination of such facts with well understood physical laws constitute the truly scientific part of physiology, in which deductive methods are fairly capable of application.

What we rely upon in the use of therapeutical agents or in the direct management of disease, has in all cases received the sanction of trial. The practical medicine

The Present Status and Needs of Medicine. of our day is directly based upon previous accomplish

BY W. HUTSON FORD, MD, ST. LOUIS, MO. Medicine is that subdivision of the study of man in general which concerns the conditions affecting his birth, maturation, senescence and death, having for its purpose the elimination of whatever is extraneous, as we deem it, to the natural performance of his physical and mental functions.

From remote antiquity held in high esteem, in our day, the medical profession is recognized as a repository and advisory council for all that relates to individ ual or public health. Yearly growing in popular esteem, it feels a just pride in its achievements and use fulness, while at the same time it is deeply conscious of the responsibility of its attitude towards the public, and candidly admits its numerous incompetencies.

When we contemplate the astonishing growth of the physical sciences, and the equally wonderful development of the industrial arts based upon them,-when we consider the activity of thought and wide dissemination of learning which characterize our times, kindling in sympathetic enthusiasm and reflecting upon the vast ac

ment, upon precedent. Its facts have been originally determined by experiment on animals or man, as well as by observing the customary demeanor of disease. We have found that every distinct affection exhibits itself under certain general aspects, as to its inception, coure and results. Such a sequence, in any special morbid state, we may dignify under the term of pathological law, though it is no more than a restatement of of the usual phenomena of disease, for nearly all socalled laws of this kind, like the laws of malignant growths, or of gout and rheumatism, or of malarial fevers, in the present condition of our knowledge, fail to extend sufficiently far to reach the legitimate domain of other so called pathological or even of accepted physiological laws. At present, therefore, each pathological area necessarily remains isolated and distinct from every other, beginning and ending in a circumstantial cul-desac. The true law, or why disease of any kind is in. vested with its characteristic features is in nearly all cases as yet unknown to us.

Such uncertainties attending pathology physiology and therapeutics, medical prediction in any given case is exceptionally hazardous, and it is impossible, at the

How can the nutrition of the body, and the forces which determine the growth of new elements be measured, when these are so intimately dependent upon an inherent vitality which varies in every individual, in every part, and is only revealed to us in countless modifications of quality and degree?

Thus it is that medicine is compelled to face the unknown, we may even affirm, the unknowable. For this reason we fail to grasp the main subservient conditions which we so earnestly strive to determine. Hence it is that we dare not boldly affirm that even what we accept as true has been finally proved in the strict scientific sense recognized by the physicist. In the domain of medicine, the cause, as we believe, being removed, the effect, nevertheless, not unseldom remains. Indeed it would be contumacious effrontery to claim that we have attained final certainty in any of the great theories of medicine in the face of such overwhelming difficulties, when in the comparatively simple fields of physics, not even chemical affinity, nor polar force, nor the nature of light, of radiation, of electrical induction, nor even of gravity itself are yet approximately understood. Great areas even in elementary physiology remain undeveloped. We know but little with regard to the

present day, so well are these things known to medical of disease, when the mutual dependence of their vari men to secure their adherence to any new proposition ous stages is yet so little understood, the natnre of mortheoretical or practical, unless it has been exhaustively bid processes mostly, if not quite unknown, and whole tested and thoroughly approved by those who have regions of vital activity still practically unstudied? analyzed it in all its possible aspects and applications. In the strictly physical sciences, induction is based upon facts which are more or less easily determinable, and deduction from theoretical principles thence gained and established firmly thereon, is an absolutely certain procedure, if all the conditions are taken into account. This is so in astronomy, geometry, mechanics and to a great extent even in chemistry, the process being intellectually simple enough. But from these domains one element is always absent, which universally masks and involves the organized fabric and beclouds the scientific gaze. Where physical law alone prevails, the instrumental armament of the philosopher is mostly adequate to determine such variations from any given mean, as by comparison and analysis, will lead him to incontrovertible and unchangeable determinations. The fields of medical inquiry, on the other hand, are not only ruled by all the forces of Nature which prevail in the material world, but are especially dominated throughout by the genius of life—the molecules of which organic bodies are composed, whose physical character istics are easily determinable, are directly controlled by this unknown principle of existence. By it they are moved, directed, collocuted and disintegrated, by means of a bond and by virtue of a power of which we know absolutely nothing. By it the chemical antagonisms of the nervous system, of the anatomical sites of inhibition and reflex action, absolutely nothing elements which compose organized beings are swerved in directions we cannot predetermine, with degrees of of the functions of the thyroid gland, of the thymus, of the supra renal bodies or even of the lymphatic force we can not estimate, with results we can not pre- glands, nothing whatever of the origin or destruction of dict, though with an order and comprehensive harmony the enzymes and but little respecting their metamorwhich utterly transcends the scope of our imagination. phoses. The varying degrees and effects of hyperThis principle of life is intangible yet everywhere sen. tient; immaterial, yet the source of all organic action, oxygenation of the blood, and of hemal and tissual The vital reactivity everywhere diffused, yet central in each and every in polarity have never been studied. dividual. It is joined with matter yet separable from of the organism as expressed in the maintenance of its it, the focus of every intellectual and moral quality in customary balances, and the establishment of special reactive mechanisms against unusual disturbing influthe highest of animals, yet a mere spark in the humblest ences are thus far terræ incognito.

creatures.

In the animal body it pervades the very granules of the germ, fashions the frame and its organs, and invests each special cell with distinctive attributes. It balances the functions against each other, marks out the vascular canals and the pathways of nervous impulse, subjects all parts to a central domination, stands ready to modify the organism in response to exigences of environment, and in general, to direct, control and record all organic action as long as the correlated members are compe tent to fullfill their offices.

What can the mere physicist accomplish in the pres. ence of this inscrutable and ever-changeful agency? What elucidation is possible to the chemist when his utmost art is inadequate to unravel the complexities of the simplest form of protoplasm? How can the physi ologist attempt to portray the sequences of normal function, or the pathologist to define the antecedents

Ingenious hypothetizers in the past and even in our day, have ventured to project upon their generation systems of life and disease whose conspicuous incompetency necessarily dooms them to ultimate repudiation.

Such systems unfortunately possess an irresistible charm for our feeble intelligences. It is most pleasant to believe that we have reached finality and happily comprehend at last the causes of things. Fortunately, all such cramped and special doctrines fail eventually for lack of support by the sturdy common sense of our profession. Most assuredly we have not yet reached the summit of any eminence, so commanding, that our gaze may sweep at once over the entire field of medicine.

Claude Bernard, one of the most exact and philosophical of modern experimentalists, insisted continually upon the complexity of physiological conditions, which renders it futile to make a priori predictions with re

spect to the results of any new experiment or untried disease distort and confuse our entire pathological field, method.

In physiology, every postulate must be determined by trial, by experience, by experiment. So also in path ology, which is naught else than the physiology of dis ease, observation and direct experiment alone can guide us in our search after general laws or even when in quest of remedial agents. In neither of these domains is it now possible to apply deductive methods except as mere guides to experiment.

and most unfortunately obscure the real correlations of health and morbidity. Their popularity is easily comprehended when we recollect that the great majority of practicing physicians are easily induced to receive such current hypotheses as medicine may offer, even while knowing them to be but partially reliable. The practitioner needs only working rules and finds neither time for analyzing them nor opportunity for testing them by experiment amid the cares of his professional occupa Modern medicine has been long since impressed with tions; he neither believes nor denies, he simply accepts. views like these. Apart from the direct determinations Notwithstanding, however, the enormous difficulty of of the anatomist and chemist, and the simpler normal its tasks, the peculiar obscurity of its fields of labor, mechanisms already alluded to, all the principles and the incompleteness and irrational preconceptions of which guide us, incomplete and imperfect as most of the human mind, medical art can justly claim to have them really are, have been acquired by careful observa tion and extensive and elaborate experimentation. This noble accummulation is the glory of the past and our proud heritage. The philosophy which supported and prompted the labors of past generations, constitutes our safest guide, and its faithfulness our deepest inspiration. Our predecessors have thus bequeathed to us a rich treasury of material, and invaluable precepts for utiliz ing it to the best advantage. Cotemporary medicine is thoroughly perfused with the spirit of inquiry. The seeds sewn during the earlier half of this century have grown and fructified in all civilized countries,so that from the Urals westward to the Yellow Sea this secular genius prevails. An overwhelming mass of experimentation is every day conducted in order to determine the value of new methods of practice, and the efficiency of new therapeutical agents.

already greatly mitigated the sorrows of our race. According to Meech's Standard Insurance Tables, within the past forty or fifty years, it has diminished the death rate of large cities and even of whole countries by 12 or 13 per cent It has extended the period of human life by ten or eleven years, and increased expectancy at the age of thirty by 20 per cent. In consequence of the discovery of antiseptics and by a recognition of the ability of the economy to react successfully against wounds and disease, if only septicity be prevented, an enormous field has become accessible, which has been not only promptly occupied, but almost over crowded and overworked by enthusiastic and daring practition. ers of all kinds. Nor should we omit to bear tribute to the keen discriminations of modern diagnosis, to the elaborate analysis of indications, the logical variations of treatment prescribed, and the more rational and restricted employment of remedial agents.

We must also gratefully chronicle parallel advances in the discovery and preparation of drugs, in the highly ingenious construction of surgical instruments, in the appointment and regulation of hospitals, and in the systematic training of nurses.

That all this is productive of immediate benefit admits of no question. But in the times of the earlier physiological experimentalists, the elaboration and dis covery of dominant principles were main objects of pursuit, with the ultimate purpose of solving pathological problems. Working in fresh fields and stimulated by noble discoveries, men of a past generation did their While intent upon the promblems of treatment and best to lay a stable foundation, so far as their insight cure, medicine has not neglected the important province went, for us who were to follow them. Nevertheless, of the prevention of diseose-our advanced hygiene, in our times, before such guiding principles have been our antisepsis and asepsie, quarantine and vaccination well established, and indeed in pure default of much are of this nature. Preventive medicine, however, is indispensable information, experimental research is al- applicable to only a small minority of morbid condi most exclusively directed towards what are termed tions. Not more than five or six per cent of cases are practical objects. Immediate returns are demanded to amenable to the procedures of asepsis, and high death be utilized in applied medical science, and experiment rates declare, that the chief outlets of existence remain is undertaken in order to achieve either by lucky acci yet widely open. We are still compelled to deal in a dent, or by the use of some empirical hypothesis, re therapeutic way with morbility which for some sufficient sults directly useful. reason has escaped the cogency of our preventive measAbstract inquiries of a physiological nature are ures however theoretically or rigorously enforced by lamentably neglected. This would not obtain so dis- law. We must still hold ourselves ready to combat tinctly were medical men sufficiently impressed with preventable diseases of all kinds, with as full a knowl. the fact that pathological states are but variations edge of them, and complete armament against them, as or unusual groupings of physiological ones, and are not if prevention were unknown. With the present facili. distinct and separate entities due to special influences ties of intercourse throughout the civilized world, the active solely ab externo, having, therefore, no necessary prevalent selfishness of capital, the miserable extremes relation to the common movements of the organism. of poverty and ignorance, of individual helplessness and Past and prevalent doctrines of the specific nature of indifference, conditions destined to last for many centu.

ries yet, we will constantly witness epidemics, pestitions, while in truth (so great is the variety of life and lences, zymotic diseases of various kinds, and puerperal of disease), such exact reproductions of typical morbid and surgical septic affections. So that however import-states, or the perfect realizations of any abstract standant and effective preventive medicine is justly conceded ards, are very rare, if indeed they ever occur; the preto be, it can not be regarded as the main object of cedents exist, but the consequents are absent or modern medicine, as has been incautiously affirmed of irrecognizable.

late years.

What medicine urgently needs to day, is a better in

Much more than what prevention can accomplish, sight into normal vital action, a more extended and may be hoped for and even confidently anticipated. deeper study of physiology, not merely for the sake of While preventive medicine should still be prosecuted determining its abstract truths, though in reality this is even with increasing ardour and discrimination, the truest and freshest energies of our art should be directed towards the treatment of morbid states. This has always been, and will most probably remain the chief end of our difficult art, as long as the human race exists. Already we witness in the attempts of late years, and even conspicuously at present, endeavors to arrest, or fortunately, swerve towards health, a number of dis eases well known to be fearfully lethal. Some of these attempts appear to have hitherto failed, to the regret of the entire medical world; others are yet upon trial and, except in the case of diphtheria, rabies and perhaps tetanus, cannot be said to have been fully or even ap proximately successful. Medicine has not succeeded in either wholly preventing or in surely arresting such affections, for the plain reason that the relation of their characteristic features to normal action has not been ascertained, and that this essential relation is deter mined by laws of the economy as yet unknown. Statis tics show that in unvaccinated cases, small pox is just as fatal now as it was in the last century, so that with all our medical advance, great or but slight as we may esteem it, we are not able to deal more effectively with it than our grandfathers could. Scarlatina, measles, the plague, yellow fever, cholera, pyemia, many septic affections, lepropsy, tuberculosis and cancer remain ab solutely intractable. Although it may be imagined that we possess specific remedies for a few well individual ized conditions, this cannot be strictly true, for we know but too well, how inadequate such supposed specifics really are in advanced stages of the diseases indica ted; though especially useful, they are not logically or naturally antagonistic to the essential features of the morbid states in question.

By the experimental investigation of morbid states alone, under the guidance of provisional hypotheses, mostly indeed the method of research up to this time, although great accomplishments are possible, as in the discovery of vaccination, nevertheless the unscientific nature and excessively uncertain and cumbrous charac ter of the method give no certain promise of any speedy solution of these pressing but complex problems.

the highest aim of all true science, but from a conviction, that without a knowledge of such truths, pathology must forever remain dark and incomprehensible. Pathological knowledge capable of enlightening us in the the treatment of those diseases in which therapeusis has signally failed can only be attained from the standpoint of physiology. This is more obvious now than it has ever been before. We need new and systematic investigations of the profounder movements of nutrition. We need researches with regard to conditions which we observe as obtaining in both health and disease, and studies therefore designed to establish the natural rela tions, mostly hidden from us at present, of morbid to healthy action. We must study the reactivity of the organism as evinced in its ordinary play and its capacity of resisting influences capable of disturbing its tranquility or of injuriously affecting it, the relation of the anabolic phenomena of plants and animals to animal metabolism and catabolism, of the usual phenomena of nutrition to septicity; of diathetic states to reactional incompetencies, of the general circulation to the pul. monary and portal; the underlying laws of the healing process, of inflammation and of fever and their relation to each other; the nature of telluric and atmospheric influences upon the animal body; the interesting and fertile field of morbid antagonisms, and especially, with renewed earnestness, and with the aid of collateral ad. vances, the humoral doctrines of zymosis. Studies of this nature can be pursued successfully, only on the inductive system-by step-by-step experimentation. Until we know the laws of the healthy body, we can not comprehend the phenomena of the diseased body. Any procedure, conducted in opposition to this maxim, is inherently perilous, and can succeed only by lucky chance.

Men should be assigned to this work of research who are fitted by special training and peculiar mental endowments to perform it. Such investigations, like all scientific inquiry of an abstract kind, must be conducted without any reference to preconceived results or desired effects. This is the essential genius of original research. Nature must be unceasingly interrogated, but with philMere observation, likewise, has been conspicuously osophic calmness and serene impartiality, "ohne hast, inadequate, for, although therapeutically, it may deter und ohne rast.” The practitioner can not engage in mine the least harmful or most advantageous method of such specialized labors, his training is of a different treatment of those at our disposal, it possesses no sug- order, his time devoted to the application of medical gestive qualities whatsoever. Precedents are valuable principles. Nor can the teacher devote himself suc. in the line of their logical descent and rules derived cessfully to investigation, for his office is to impart what from them are applicable only to their fac simile repeti- is already known.