SURGICAL.

1. Ovarian and Uterin Tumors Complicating Pregnancy. By Channing W. Barrett, Chicago. Discussion opened by Frank Boyd, Paducah, Ky., and L. S. McMurtry, Louisville, Ky.

2. A Further Contribution on the Subject of Fibroid Tumors of the Uterus. By F. D. Smythe, Memphis, Tenn. Discussion opened by John Wathen, Louisville, Ky.

3. Bismuth Paste in Sinuses and Intestinal Tract, as Shown by the X-ray. By W. D. Hanes and E. T. Bruce, Louisville, Ky. Discussion opened by A. B. Cooke, Nashville, Tenn.

4. Comparative Teaching Value of Photographs to Drawings in Technique of Hernia. By Chas. T. Souther, Cincinnati, O.

5. The Mechanism and the Clinical Interpretation of Choked Disc. By Geo. F. Suker, Chicago, Ill.

State Board of Health to succeed the late Dr. William Bailey, of Louisville, at a meeting of that body at the Seelbach September 13. His name was placed in nomination by Dr. J. M. Mathews, of Louisville, who for eighteen years was president of the board, and his election was unanimous. He is the fourth president of the board since 1876. The first president was Dr. Pinkney Thompson, of Henderson, and others were Dr. J. M. Mathews, and Dr. William Bailey, of Louisville, in the order named.

Just before the election of Dr. South, Dr. Mathews and Dr. W. A. Quinn, of Henderson, were sworn in as members of the board. Dr. Mathews was appointed a member by Gov. Willson to succeed Dr. Bailey, and Dr. Quinn was appointed to succeed himself. He ceased

to be a member when he was elected to a place on the Henderson School Board recently, and when he learned that he could not hold both offices, he resigned the latter. The Governor then reappointed him a member of the State Board of Health.

In placing the name of Dr. South in nomination for the office of president, Dr. Mathews said that as far back as he could remember old men had held the honor, and that he was in favor of reversing the order of things. The nomination was seconded by Dr. H. S. Keller, of Frankfort.

Dr. South is the son-in-law of Senator Bradley. Not long ago President Taft commented on Dr. South's good looks. Senator Bradley took him to call on the President, who after beholding the stalwart young Kentucky doctor, remarked: "I will make note that this day I met a very handsome man.”

Book Reviews

Diagnostic and Therapeutic Technic.

By Albert S. Morrow, M. D., Adjunct Professor of Surgery, New York Polyclinic. Octavo of 850 pages, with 815 original line drawings. Philadelphia and London: W. B. Saunders Company, 1911. Cloth, $5.00 net.

This book is in some respects unique. as it deals with a detailed description of "Diagnostic and Therapeutic Technique," in a way which is not possible in a larger book on surgery. First is described certain general diagnostic and therapeutic methods, as The Administration of General Anesthetics, Local Anesthesia, Sphygmomanometry. Transfusion of Blood, Infusion of Physiologic Salt Solution, Bier's Hyperemic Treatment, Exploratory Punctures, Aspirations, etc.; second, is a description of those measures employed in the diagnosis and treatment of diseases affecting special regions and organs of the body. Each procedure has been given in detail, leaving nothing to the reader's imagination.

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The book will meet a distinct need, as the measures described are in almost daily use by the practitioner and surgeon, or would be were they more familiar with them, and is to be thoroughly commended. The line-drawing illustrations are very good and add much to the text.

A Manual of Practical Hygiene, for Students Physicians and Health Officers.

By Charles Harrington, M. D., Late Professor of Hygiene in the Medical School of Harvard University. Fourth edition, revised and enlarged by Mark Wyman Richardson, M. D., Secretary to State Board of Health of Massachusetts. Illustrated. Philadelphia and New York: Lea & Febiger, 1911.

Dr. Harrington was preparing for a revision of his book when he was stricken and died in England. The chapter on Milk and Disinfection were completed, and Dr. Richardson has completed the rest of the revision.

Section 1 deals with The Nutritive Value of Food, etc.; 2, Animal Foods; 3, Milk and Milk Products; 4, Vegetable Foods; 5, Beverages; 6. Condiments;

7, Food Preservation; 8, Food Contamination by Metals. In the rest of the book is considered Air, Soil, Water, Habitations, Sewage, Garbage, Disinfection, Military and Other Hygiene, Vital Statistics, Infection, Vaccination, Quarantine.

Considerable attention is paid to the transfusion of tuberculosis through the medium of milk, with many references to the literature of the subject.

A very complete chapter on milk is given. One hardly realizes the many methods of adulterating milk until this very complete chapter is read. It is a great disappointment not to find any mention of certified milk in this chapter, a serious oversight.

So far as we can judge, the book is most thorough and complete in every detail, well illustrated and carefully prepared.

A Text-Book of Surgical Anatomy.

By William Francis Campbell, M. D., Professor of Anatomy at the Long Island College Hospital. Second edition revised. Octavo of 675 pages, with 319_original illustrations. Philadelphia and London: W. B. Saunders Company, 1911. Cloth, $5.00 net; Half Morocco, $6.50 net.

The author states in his preface "Anatomic facts are dry only as they are isolated. Translated into their clinical values, they are clothed with living interest." In this volume he has attempted to fix the comparative values of anatomy, by directing attention to the practical problems with which anatomic facts are associated. The essentials of practical anatomy, as are of value to the surgeon, are given in an attractive manner.

The usual divisions of the body are made in the book-Head and Neck Thorax, Upper Extremity, Abdomen and Pelvis, Spine, Lower Extremity.

The illustrations are very useful, many of them new in this edition, practically all being original drawings and photographs.

VOLUME 18

NUMBER 6

Original Contributions

MEDICAL TENDENCIES.* ROBERT H. BABCOCK, M. D., LL. D.,

CHICAGO, ILL.

To the thoughtful mind certain tendencies are apparent in the medical profession which it seems well to bring to your attention this evening. Some of these will affect directly the future members of the profession, while all are of vital interest to the people whom the coming doctors are to serve. Some of these tendencies are a direct result of changes in our notions of the causation of disease, changes that have taken place in the past thirty years coincident with the development of the germ theory of infection. Others are intimately connected with modern and advanced methods of medical

education, and will be considered first, because discussed at more length than those having a direct and easily recognized bearing on the public.

Medical Education.-So much has been said in various quarters regarding the danger of a too rigid reliance on laboratory methods as opposed to clinical study of disease that one hesitates to add further word on this subject lest he exhaust the patience of his medical hearers and also lay himself open to the charge of

*An address delivered by the President at the meeting of the Mississippi Valley Medical Association in Nashville, October 17, 1911.

being a "back number," and yet the tendencies in medical education cannot be discussed without touching on this phase of the subject. So indispensable have laboratory methods become to-day that one wonders how clinicians of fifty years ago ever succeeded as well as they did in the diagnosis of any but the commonest affections. Yet without doubt they could put to blush many a young physician of to-day trained in the use of the microscope and chemical re-agent, but untrained in the observation of diseases at the bedside.

In the course of a conversation on this subject last winter with a professor of medicine at the Harvard Medical College, who occupies a leading position on the staff of Boston's two largest hospitals, he stated that he had often been struck with the perfection in laboratory methods displayed by the graduates of one of the most prominent Eastern medical schools who became house officers in a certain Boston hospital, and on the other hand with the deplorable lack of knowledge derived from the clinical study of diseases in the wards. If such failure to give its students requisite clinical training can be charged against the medical school in question which is supposed to stand at the top in this country, then what can be said of other medical colleges with even fewer hospital advantages for bedside instruction! In my experience as a con

sultant I have become deeply impressed with the general reliance on laboratory methods shown by practitioners recently out of college and at the same time with their inability accurately to observe or appreciate the significance and value of symptoms as compared with the findings of the microscope or test-tube.

Various mechanical appliances for the recognition of pathological states are now in use and their number seems ever increasing. All this is well and undoubted; ly adds greatly to accuracy of diagnosis, without which medical skill is a delusion and a snare. But is there not danger of the science of medicine so overshadowing as to obscure the art of healing! Are there not signs in some quarters of the invasion of this country by that spirit of therapeutic nihilism with which European physicians have been charged! Is there not along with devotion to laboratory research and animal experimentation a tendency to make the study of pathology outweigh too greatly the application of remedies to the cure of disease! In none of the medical schools of to-day do the students receive that instruction in materia medica and therapeutics they did thirty years ago and doubtless this is well, for in the light of present day knowledge of the causation of disease and its pathology much of such teaching is worse than useless. Nevertheless this is a tendency that should not be permitted to grow too rank lest as previously stated. the art of healing be lost in the science of investigation of disease processes. Our medical colleges must enlarge their clinical faculties or it might be well to return to the good old custom of each student having practical training with an experienced preceptor.

Dr. H. A. Hare, of Philadelphia, in his address in medicine, “Dangers and Duties of the Hour," delivered before the Ohio

State Medical Society at Cleveland in May, 1911, called special attention to this tendency to therapeutic skepticism. It is fostered, he declares, by the increasing custom of having materia medica and therapeutics taught by trained pharmacologists who lack experience in the clinical application of remedies. By animal experimentation they illustrate the physiological effects of drugs and often draw the conclusion therefrom that they cannot produce the results claimed by clinicians. The testing of drugs on animals in order to determine their physiological effects and limitations is in accord with scientific principles and should be encouraged, but, as Dr. Hare asserts, this should be supplemented by their use on patients in hospital wards, since a drug that produces a certain effect on a healthy dog may manifest a different action on a sick human being. In this way alone can the physiological action of drugs employed as medicines be checked up and their value in the treatment of disease be accurately gauged. The practical therapeutist knows he can obtain certain results from some of the old fashioned drugs even though he cannot explain just how they work or though their action appears to be contrary to the assertions of pharmacologists. Consequently if there be a tendency to disbelieve in the efficiency of drugs it should not be encouraged and our medical colleges should see to it that the teachers of therapeutics have the opportunity of demonstrating to students the practical application of drugs to disease and not alone their effects on lower animals. Let me here quote from Dr. Hare's address as follows:

"It is a fortunate sign of the times that the error of requiring every student to know a little of all drugs is being replaced with a recognition that he should know much of a few." In recognition of this

principle the Association of American Medical Colleges adopted a set of resolutions in which they urged upon pharmacologists and teachers of materia medica and therapeutics the limitation of their instruction to the list of drugs recommended by the Council on Pharmacy and Chemistry of the American Medical Association, resolutions which I heartily endorse.

Fortunately teachers of medicine recognize the fact that, if their students are to be practical physicians, they must get their clinical training as diagnosticians and therapeutists during their school days and not be left to acquire these arts at the expense of mistakes mortifying to themselves and harmful to their patients. This object is being attained by the gradual elimination of small privately-owned schools and the development of strong medical colleges that are made so either by the coalescence of two or more weaker ones or by their being incorporated as an integral part of a university possessing sufficient funds to render it independent of fees derived from students. Such medical colleges may possess hospitals of their own or may control them to the extent of being allowed to send students into the wards for bedside instruction.

Then added to enlarged and improved facilities for laboratory and clinical instruction is a higher standard of preliminary education, in some medical colleges a degree of B. A. or B. S. being required, which requirement naturally tends to lessen the number of matriculants. Hence the effect of all this will be to improve the quality and at the same time to reduce the number of medical practitioners. This is bound, therefore, to benefit both the laity and the profession, since the former will receive more skillful attention and the latter will be saved much of the competition which prompts weak men to act

unworthy of the noble calling to which they belong.

It will be going afield to discuss the various influences that have been and are still working to bring about a higher standard of medical education, but it can be stated without fear of contradiction that the stimulus has come from within and not without the profession. It is the doctors themselves and not the people who have recognized the need of adequately trained practitioners of medicine. and who are striving to protect the public against charlatans and ignoramuses. Year after year they go up before the legislatures to protect the people against legislation hostile either directly or indirectly to the efforts of those desirous of seeing medical education in this country placed on the high plane of that in Europe. Fortunately the tendency in this direction has set in so strongly that the day is not far distant, nay, is already dawning, when students desirous of postgraduate clinical or pathological work will not feel they must go to Germany, but may be able to obtain equal advantages at home.

Still another reform movement in accord with this tendency to improved medical training is seen in what is taking place at Johns Hopkins Medical School. According to this plan the members of the teaching staff are placed on good living salaries and then required to give up private practice and devote their whole attention to clinical instruction. In a word, the teaching of students is to be paramount to all else instead of being a subordinate matter that may be set aside or relegated to an assistant whenever the professor finds the demands of private practice incompatible with his duties as an instructor in amphitheatre or ward. It would seem at first thought that the instruction might lack that practical and