ships between states of health might account for the been used for several years for clinical instruction. peculiar mental variations. Dr. Baker referred to the various definitions of per sonality as not being sufficiently inclusive of the facts to be of accurate use. He urged the importance of the study of the subject, especially in its bearing not only upon the causation of actual disease, but in its relation to educational ideas and practices as found to-day in our school.system. In this way may be found means of obviating detrimental traits, and also of making dominant those more desirable and healthful. Dr. Matthew D. Field, of New York, read a paper entitled Dr. Preston, of Baltimore, remarked that the lunacy laws of Maryland are inadequate. Endeavors are being made to establish a detention-ward. At present insane patients are kept at police-stations, as no general hospi tal is prepared to receive them. This method of dealing is entirely unsatisfactory. The president said that in Chicago there is detention. ward in the City Hospital in which cases of insanity are kept until transferred. The commitment laws of Illinois are now quite satisfactory. Dr. Frederick Peterson, of New York, read a paper upon THE TEMPERATURE IN GENERAL PARALYSIS which was based upon observations, made with the as- DETENTION HOSPITALS FOR THE INSANE. After speaking of the wrongs inflicted upon the insane by committing them to county jails and prisons, there to mingle with tramps while awaiting the appointing of physicians to pronounce upon their mental condition, he gave a description of the Reception Pavilion for the Insane at Bellevue Hospital, and the methods of examination and commitment by the city examiners. He declared the pavillion to be in every respect a hospital with resident physicians and competent trained at tendants. Though a plain and inexpensive building, it served its purpose very well. He advocated the establishment in all large cities of similar hospitals for the reception of those suspected of lunacy. He said that an ideal institution for this purpose would be a hospital When unusual variations of temperature occur in gen constructed on the pavilion-plan for the reception of the eral paretics, the cause must be sought for in conditions insane, inebriate, and neurotic, with a small amphi- not related to the pathologic phenomena, but depending theater and sufficient wards for proper classification and upon other thermogenic features unrecognized by the detention for a reasonable time. A competent visiting, physician, or "masked" by the mental state of the resident, and examining staff of medical officers should patient. Thus, in one case an increasing hyperpyrexia be chosen and clinical instruction regularly given. Such was noted during the second week, but the pneumonia a hospital would secure prompt, humane, and scientific causing it was "masked" until the fifth or sixth day, treatment. The opportunity for longer observation, se- the patient dying on the sixth day. In another case, in curing histories and examinations, would result in more which the highest single daily oscillation was 35°, and complete and accurate certification. There being no the average daily oscillations for the week 2 2° Fahr., need for hasty transfer to other institutions, the feeble, the patient had bedsores on the sacrum and heels, and sick, and certain selected cases could be detained for was undoubtedly septicemic. That the temperature treatment, and clinical instruction would be easily ac might vary in the paralytic seizures of these cases was cessible to the entire medical profession. not gainsaid, no observations having been taken in such conditions. Dr. Gray, of New York, said that a large number of different pathologic conditions are often included under the name of general paresis. Some represent the ter. minal stages of intra-cranial syphilis. Dr. Knapp, of Boston, said that there are no detention hospitals in Boston, and that no urgent need for them has been felt under existing laws. A few emergency cases requiring immediate restraint are admitted to the general hospitals. Others can be taken at once to the nearest asylum on emergency certificates. These consist of two separate certificates. A bond must be given by the the superintendent, or one of the physicians, to the effect that the patient is to be formally committed, or released within five days. This system has proved eminently satisfactory, and has rarely been titled abused. Dr. Mills, of Philadelphia, stated that the method described by Dr. Field is in vogue at the Philadelphia Hospital. There is a detention ward for isolating cases of insanity. Two physicians are assigned to examine these patients before commitment. This ward has also Dr. Charles K. Mills, of Philadelphia, said that the diversity of the manifestations of general paresis will account for the different experience of various observers. Dr. Joseph Collins, of New York, read a paper en THE ANATOMICAL CHANGES IN THE SPINAL CORD IN AN OLD CASE OF INFANTILE PARALYSIS, demonstrating numerous sections and reporting the history of a case. Dr. G. M. Hammond, of New York, read a paper an PROGRESSIVE MUSCULAR ATROPHY. He exhibited microscopic specimens and made a pa thologic report of two cases, and referred to the fact that considerable confusion is occasioned by the misap plication of the term "peroneal type" to a disease totally dissimilar to the one under consideratiun. The first patient was a woman, forty-six years old, without a history of gout, rheumatism, or syphilis, who a few days after stumbling over a chair and bruising the right shin slightly, was unable to walk as well as previously. In a little while marked weakness of the flexors of the foot and the extensors of the toes developed. In the course of a year there was complete paralysis of the entire right leg, with reaction of degeneration, loss of power, and of electric contractility in the anterior tibial muscles of the left leg, and atrophy and loss of power in the thenar and hypothenar musclesof the right hand. Gradually but rapidly the other ex tremities became involved, and ultimately the abdom inal and intercostal muscles were affected. Death took place suddenly from either cardiac or respiratory paralysis. The sections of the cord showed sclerosis of the pyramidal tracts and atrophy of cells in the anterior horns, and degeneration of Gowers' column throughout its entire extent. The conclusion to be drawn from the clinico-pathologic study of this case is that the muscles of the hand were supplied from the mesial group, and the muscles of the forearm from the anterior group of cells in the anterior horn. tion of gray matter throughout the cord. Despite the violence of the process, portions of the anterior and lateral cell-groups were preserved. Dr. F. X. Dercum, of Philadelphia, read a paper entitled OPTIC NEURITIS, BLINDNESS, DEAFNESS, AND THE KNEE-JERK IN CEREBELLAR DISEASE. He said that many of the symptoms of cerebellar disease are both inconstant and variable. They are difficult of explanation and frequently impossible to correlate. Seven cases were reported in which optic neuritis, blindness, deafness, and modifications of the knee-jerks were present. It is a matter of common experience that high grades of neuritis may exist without marked impairment of vision. It seems, therefore, that the added symptom of blindness gives a special significance to the optic neuritis found in these cases. It appears that if for any reason optic neuritis is present in cerebellar disease, it is likely to be intense in degree, and sooner or later associated with total blindness. The proximity of the quadrigeminal bodies has natu rally suggested itself as in some way explaining this blindness. The ataxia and titubation at once suggest disease of the vermiform process. Anatomic considerations, as well as the results of the autopsy in one of the cases, show that if a growth be situated in the vermiform process, especially anteriorly, and if the growth continue to enlarge, it will sooner or later press upon the superior cerebellar peduncles and very probably If the re In the second case the disease only affected the upon the quadrigeminal bodies themselves. muscles of the left thumb. The patient was under oblation of the fibers of the optic tract to the primary servation for eleven years. The case ran the usual optic centers be recalled, it can readily be understood course, and was in every way typical. At the time of how a neuritis should result if pressure or irritation ocdeath all of the muscles from the level of the armpits cur at this point.The directness of the irritation will ex. upward, except the facial muscles, were atrophied, as plain why the neuritis should be of a high grade, and, well as those of the upper extremities. The woman be- sooner or later, associated with total blindness. came maniacal, and finally died from exhaustion. The cord and medulla were examined, and the changes were identical with those described in the preceding case. The conclusion was reached that these case demonstrate that progressive muscular atrophy is due to a degeneration of the cells in the anterior gray masses and the antero lateral white columns; also, that it is superfluous to divide progressive muscular atrophy into different types, because the disease does not invariably begin in the same group of muscles. The deafness present in some cases of cerebellar tumor may perhaps be explained in a similar manner. The studies of Spitzka, Monakow, and others, have made it extremely probable that the posterior quadrigeminal bodies stand in the same relation to the auditory fibers as do the anterior to the optic fibers. It would simply be necessary, therefore, that the pressure involve these structures in order that deafness should be a symptom. The condition of the knee jerk presents a problem of peculiar difficulty. The loss of knee-jerk in disease of the cerebellum may be ascribed to loss of muscletonus. Dr. Sachs said that while there could be no doubt that the Aran-Duchenne type is of spinal origin, it is not certain that the case of Dr. Hammond represented It is extremely probable that lesions of the cerebellum the peroneal form of progressive muscular atrophy as act as do lesions elsewhere, in one of two ways, i. e., described by Charcot, Tooth, Hoffman, and himself. If either by destroying tissue, and thus destroying func the case were such a one, the findings in the spinal cord would have been of great importance. There is yet doubt whether the peroneal form represents a spinal disease or a peripheral affection. Dr. Putnam referred to a case of progressive muscu lar atrophy in an adult in which there was rapid destruc tion, or by causing irritation. It is, perhaps, in this way that the fact can be accounted for that in some cases of cerebellar disease the knee jerk is absent and in others present or even exaggerated. When the disease was advanced there was loss of reflex action to light Dr. Putnam spoke of a case of long-standing optic than justify its existence. Its membership has been atrophy, with practically no other symptom. Although augmented from year to year until it now constitutes the optic neuritis persisted for two years, the autopsy the largest and the strongest sanitary body in the world showed a cyst and tumor of the cerebellum. Dr. Preston said that he had noted loss of the muscular sense in two patients. In four cases the kneejerks were irregular, disappearing and occasionally returning. and embraces in territorial extent the United States, the Dominion of Canada, and the Republic of Mexico. Under the impetus given by its work, state and local boards of health and sanitary associations have been organized, sanitary publications increased, and hygienic Dr. Knapp said that in all of his cases confirmed by knowledge widely and extensively diffused. The Assoautopsy there was neuritis or optic atrophy. In one ciation has already published eighteen large and valuacase in which a cerebellar tumor was suspected, neuritis ble volumes, increasing at the rate of one a year, and had not developed. Blindness had not been so constant containing the papers, reports, and discussions presented In another case the light reflex was lost when the pupils at the annual meetings. These volumes constitute in became dilated. Pressure on the corpora quadrigemina themselves a library upon sanitation; they are elegantly is most likely to produce blindness. Dr. Knapp has never noted deafness. He considered untenable the view that disease of the middle lobe of the cerebellum is responsible for the atactic gait. Dr. Leszynsky, of New York, expressed the view that the concomitant basal meningitis has much to do with the production of the optie neuritis, by extension of the inflammatory process along the nerve-sheath. In many cases the neuritis is a late symptom. When the neuritis or optic atrophy is accompanied by loss of lightperception, the pupillary reflex is always absent. Dr. C. L. Walton, of Boston, read a paper entitled LOCATION OF THE CERVICAL VERTEBRAE. printed and bound, and are alone worth more to any person interested in hygiene than the cost of membership. Each member is entitled to the annual volume, delivered free of expense. In addition thereto, the Association has published a standard work upon "Dis. infection and Disinfectants," besides the Lomb Prize Essays, now so widely known to the American public. Among its members may be found physicians, lawyers, ministers, civil and sanitary engineers, health officers, teachers, plumbers, merchants, etc.,-in fact, every profession and many of the industries are represented in its list of members. The only qualifications required for membership are a good moral character, an interest in hygiene, and the endorsement of two members of the Association. Cost of membeship, five dollars a year. For blank applications for membership, or particulars relating to the Association, address the secretary. BOOK REVIEWS In illustration of the method, let it be supposed that the left articular process of one vertebra has slipped forward over that of the vertebra below, and has fallen into the depression anterior to the articular process. This bends the head to the left, and turns the face to the right. The reduction is accomplished by extending the head diagonally backward to the right, so as to elevate the articular process, after which rotation to the left replaces the displaced vertebra. The transverse processes on the right act as a fulcrum. The ligaments that hold the vertebra firmly in the false position make A Treatise on Ophthalmology for the General Practitioner-By ADOLF ALT, M.D.; J. H. Chambers & Co., publishers, 914 Locust Street, St. Louis, Mo. no opposition to this maneuver, which requires no force. In bilateral dislocation the same movements should be made, first on one side, then on the other. [TO BE CONTINUED.] American Public Health Association. The twenty-first annual meeting of the association will be held at Chicago, October 9 to 14, 1893, and the convention with the World's Congress Auxiliary of the World's Columbian Exposition will constitute an International Congress of Public Health. The second revised and enlarged edition of this exceedingly practical work is considerably more voluminous than the first edition. It contains one hundred and forty illustrations and is written throughout in a clear and easily comprehensible style, and in general makes the impression of originality. All the chapters in Ophthalmology that are of real value to the general practitioner are treated in a clear and concise manner, giving all that is important without encumbering the memory with such details as would have to be considered in a work for the specialist only. For the use of the general practitioner as well as the student, we know of no other work that could be more The American Public Health Association was organized in 1872, by a few public-spirited men who foresaw the need of bringing together in one body the ablest sanitarians in the country, for the purpose of inaugurat ing measures for the restriction and prevention of contagious and infectious diseases, and for the diffusion of sanitary knowledge among the people. The growth of the Association and the work it has accomplished more highly recommended. NOTES: AND ITEMS The Proposed Bill of the New York Acad emy of Medicine to Establish a National Health-Bureau. -As reported by the Committee of the Academy, the following is the proposal: the Attorney General from the Department of Justice. These four members shall receive no compensation. ANNUAL SESSION AT WASHINGTON SECTION 3. That the members of the commission shall meet at such time and place as may be designated by the Secretary of the Treasury, and organize by the election from their own number of a president who shall be one of the members at large and who shall receive $5 per diem in addition to the $10 per diem pro A Bill to establish within the Treasury Department a vided in the last section, when actually engaged in the Bureau of Public Health. Be it enacted by the Senate and House of Representatives of the United States of America in Congress as sembled: SECTION 1. That for the purpose of this Act the States and Territories of the United States be and are hereby grouped into districts, to be known as "the sanitary districts of the United States," as follows: The Northern Sanitary District shall include the States of Illinois, Indiana, Iowa, Michigan, Minnesota, Ohio, Wisconsin. The Northeastern Sanitary District shall include the States of Connecticut, Massachusetts, Maine, New Hampshire, New York. Rhode Island, Vermont. The Northwestern Sanitary District shall include the States of Idaho, Montana, North Dakota, Oregon, Washington, and the Territory of Alaska. The Eastern Sanitary District shall include the States of Delaware, Maryland, New Jersey, Pennsylvania, Virginia, West Virginia and the District of Columbia. The Western Sanitary District shall include the States of California, Nevada, Utah, and the Territory of Ari zona. The Southern Sanitary District shall include the States of Arkansas, Alabama, Kentucky, Louisiana, Missouri, Mississippi and Tennessee. The Southeastern Sanitary District shall include the State of Texas, and the Territories of Indian Territory, New Mexico and Oklahoma. The Ceutral Sanitary District shall include the States of Colorado, Kansas, Nebraska, South Dakota, and Wyoming. THE HEALTH BUREAU. SECTION 2. That there shall be established in the Treasury Department, under the direction and supervision of the Secretary thereof, a Bureau of Public Health, to consist of a commission of fifteen, of whom eleven shall be appointed by the President, by and with the advice of the Senate, as follows, viz.: One medical commissioner from each of the "Sanitary Districts of the United States," provided in Section 1 of this Act, and two commissioners at large; the compensation of the medical commissioners, when actually engaged in the performance of their duties under this Act, shall be $10 per diem and reasonable expenses. performance of his duties under this Act. The commission may appoint a secretary, not one of its number, and fix his salary at a sum not exceeding $3,000 annually. The commission shall thereafter meet annually at Washington, on the first Tuesday of October, and at such other times and places as the president of the commission, with the approval of the Secretaty of the Treasury, shall designate. A COMMITTEE OF HEALTH-SENTINELS. SECTION 4. That there shall be an Executive Committee of the commission, consisting of its president, the Surgeon General of the Army, the Surgeon-General of the Navy, and the Supervising Surgeon-General of the Marine-Hospital Service and the officer detailed by the Attorney-General. The commission shall from time to time prescribe the duties of the Executive Committee, and may make all needful rules and regulations for its own control and for the guidance and discipline of all its officers and employes, and shall establish all rules and regulations for the government of national sanitation in all of its foreign and inter-State relations and special departments in the enforcement of the provisions of this Act. EXTRAORDINARY CONFERENCES WITH STATES. SECTION 5. That when, in the opinion of the president of the commission, the interests of the public health would be promoted by a conference of the commission with the State Boards of Health of the several States, or of any sanitary district or districts, he is hereby authorized to invite, with the approval of the Secretary of the Treasury, said State Boards of Health, or such number thereof as he may designate, each to delegate one of its members to meet the commission in conference at such time and place as he may appoint. The president of the commission shall be the president, and the secretary of the commission shall be the secretary of any such conference. The delegate in attendance upon the conference from each State Board of Health shall be entitled to receive reasonable compen. sation for expenses for a session not exceeding three days, to be paid on vouchers provided by the Secretary of the Treasury. Medical Practice in Colorado.-The Colorado State Board of Medical Examiners announces that The other four members shall be the Surgeon-Gener- hereafter it will recognize only diplomas from threeal of the Army, the Surgeon General of the Navy, the year schools as entitling their holders to license. The Supervising Surgeon-General of the Marine Hospitall courses of lectures must have been of at least twenty Service, and an officer learned in the law, detailed by weeks each, and have been given in three separate years, Another attorney of this city is receiving the con and a preliminary examination must have been required. Instruction must have been given in anatomy, chemis- gratulations of the press and his frieuds on the receipt try, physiology, pathology, materia medica and thera peutics, obstetrics and gynecology, surgery, medical jurisprudence, theory and practice of medicine and hy giene. In default of such a diploma the candidate for license must pass an examination in anatomy, chemistry, physiology, pathology, surgery, obstetrics and gynecology, and theory and practice of medicine. Doctors' and Lawyers's Fees.-We had a great excitement a few weeks ago in San Francisco (Pacific Med. Jour.). Men who scarcely knew each other and were in the habit of passing with the slightest rec. ognition, stopped, clasped each other's hands, looked earnestly into each other's faces, spoke in a subdued tone of voice and showed all the evidence of having heard portentious news. Nothing else was talked of at the clubs, chestnuts were at a discount, and even club scandal was neglected for the time. The great daily papers as well as the weekly news scavengers lent their assistance to fan the popular excitement. John W. Mackay, the many times millionaire, had been shot by a would-be assassin; this, however, was not the cause of the excitement (shooting a man, even a millionaire, in California, has long since ceased to be a novelty). The excitement was about the fact that two medical gentlemen who extracted the bullet and saved the mill ionaire's life had charged him $12,500. For the too little sympathy that the millionaire received when he was shot, everybody, press and paper, made up for the neglect now. Millionaires congratulated each other that they were not in need of medical service, and hoped when their taking off time came, their departure would be a sudden one-no chance for a physician to wreck their estate. The foolish fellows tn their excite ment forgot that their estates were in no danger of be ing wrecked, forgot that their attorneys would protect it. Since recovery from his wounds and the $12,500 indignation shock, he has asked the probate court for per mission to distribute the property and close an estate for which he was executor. Among the items of expense which he incurred as executor of this estate, is attorney fees $26,160; for what? for piloting this will through the probate court, an automatic procedure that required neither skill, ability, learning nor judg ment. Will John W. Mackay explain why he was will ing to allow the attorney $56,160 for the service ren dered, and refused to pay his physicians $12,500 for services that required much more individual skill and judg. ment and a thousand times more responsibility on their part than was required of the attorney? The $26,160 item created no excitement, but one newspaper seems to have noticed it, and congratulated the attorney on having received a good fee. Perhaps the daily cr weekly press will explain why a millionaire should not pay a physician as liberally as he does an attorney. a few days ago of a fee of $75,000. The attorney received one fifth interest in the estate, which was then involved in litigation. What would be thought of a physician who would undertake to cure a patient for a certain interest in his (the patient's) estate? A Healthy Month.-Dr. J. R. Laine, Secretary of the State Board of Health (Pacific Med. Jour.), in his report for June, 1893, from ninety-seven cities, villages, towns and sanitary districts, aggregating a popu lation of eight hundred and twenty-six thousand seven hundred and ninety-four, gives a mortality of nine hundred and sixty-one from all causes. This corresponds to a death rate of 1.16 per thousand per month, or 13.92 per annum. There were one hundred and forty-six deaths due to consumption, sixty seven to pneumonia, twenty.three to bronchitis, two to congestion of the lungs, fifteen to diarrhoea and dysentery, twenty three to cholera infan. tum, sixty-four to other diseases of the stomach and bowels, ten to diphtheria, four to croup, seven to scarlatina, one to measles, four to whooping cough, thirtyfive to typhoid fever, four to malarial fevers, eight to cerebro spinal fever, twenty-nine to cancer, one to erysipelas, seventy-one to diseases of the heart, eight to alcoholism and four hundred and thirty-nine to all other causes. One of Bismarck's Habits.-Once when Bismarck was a cavalry officer he was standing with some other officers on a bridge over a lake. As he was about to give an order his groom, Hildebrand, rode one of the horses to water close by the bridge. Suddenly the horse lost footing, and Hildebrand, clinging to the animal, disappeared with it in the water. Before the other officers could collect their senses Bismarck had cast off his sword and his uniform and had thrown himself in the lake to save his servant. By good fortune he seized him, but the man clung to him so closely in his death agony that he had to dive before he could loose himself from him. Bismarck rose to the surface, raising his servant with him, and brought him safe to land in an unconscious condition. The next day the servant was as well as ever. But the little town that had witnessed the brave rescue was in great commotion. They petitioned the superintendent, who obtained for the young officer the medallion "for rescue from danger." And now on great occasions, the well known Prussian safety medal may be seen beside the proudest stars in Christendom on the breast of the famous creator of united Germany. Bismarck, it is said, is prouder of his first medal than of all the rest put together. One day in the plenitude of Bismarck's power a noble minister approached the premier, and with a tinge of satire asked him the meaning of this modest decoration. He at once replied: "I am in the habit sometimes of saving life." The diplomatist lowered his eyes before the |