gland. This form is also often accompanied by adeno- both lungs, was the point of departure of an extensive matous and polypoid growths. The third form consists medical literature.

in an abundant proliferation of the epithelial cells of the pylorus accompanied by an atrophy of peptic glands.

Jean Martin Charcot.

The life of Charcot, the great neurologist, came to an end about the middle of August, 1893. Being born at Paris in 1825 he was sixty-eight years old at the time of his decease. Death came on suddenly, nothing having occurred by which his friends might have forecast such an event, his vigor of mind and interest in scientific subjects remaining the same to the last, yet his physical vigor had been obviously impaired. His death appeared to be due partly to overwork, for he habitually took too little rest. The Boston Medical and Surgical Jourual gives the following description of his activity in the

field of medicine:

Charcot's contribution to diseases of the lungs con. stitute two volumes of the new series of his writings. No one now describes the lesions of broncho pneomonia without referring to his work. In the study of pneumokoniosis and anthracosis his experiments on guinea pigs, which were made to inhale in bags mineral or coal dust gave valuable aids to the comprehension of the patho geny of a disease often observed in men as a result of occupations exposing them to the action of solid particles diffused in the air. His anatomo pathological researches on phthisis and chronic pneumonia have furnished valuable data and introduced system where it was before wanting.

His contributions to the subject of diseases of the liver and kidney are embodied in a volume published in 1882. He experimentally determined in guinea pigs hypertrophic cirrhosis of the liver of biliary origin, and showed its identity with the disease which develops in man as the result of obstruction of the common bile duct. The different stages of the process he divides into angiocholitis, periangiocholitis, cirrhosis. His re

In 1853, Charcot published his thesis for the doc torate, entitled, "A Study of the Affection described under the Names of Primary Asthenic Gout, Nodosities of the Joints, Chronic Articular Rheumatism." searches on the common or atrophic form of cirrhosis His researches in this disease comprehend a vast num- of the liver are also well known. He, more than any ber of clinical and post mortem observations made at of his predecessors, has insisted on periphlebitis as the the Salpetriere. One of the most important facts cause of this affection, and shown the extension of the brought to light by these researches is that affections inflammation from the veins to the connective tissue. of the heart, such as pericarditis and endocarditis, be- His observations clearly differentiate this form from the long to the generalized form of chronic articular rheu- other types of interstitial hepatites. Charcot's re matism, as well as to acute rheumatism. Another re-searches on grave icterus, on interstitial nephritis, which sult is to establish an identity between the affection he was the first experimentally to produce in animals by known in surgery under the names of dry arthritis, ligature of one of the ureters, an experiment which arthritis deformans, etc., and nodular rheumatism. The separation of gout and chronic articular rheumatism is maintained. He showed that the presence of uric acid cannot be detected in the serum of the blood in chronic articular rheumatism, while in acute and chronic gout the existence of crystals of uric acid has always been recognized.

In a subsequent memoir, he considers the alterations of the kidney observed in the gouty, and gives new researches on the alterations of the joints. Gouty nephritis he believes to be by no means rare, to be at tended by deposits of urates in various parts of the kidney, and frequently with the symptoms of renal colic. The lesions may be those of parenchymatous or interstitial nephritis, and the general symptomatology is that of Bright's disease.

Charcot published numerous memoirs on arterial and capillary embolisms at a time when this study was new, and German pathologists were just beginning to give attention to the subject. A brochure "On Sudden Death from Obstruction of the Pulmonary Artery by Blood. clots, etc., contains the first observation of death by pulmonary embolism published in France. His paper "On Ulcerative Endocarditis," published in 1862, based on a case of ulcerous affection of the tricuspid valve with typhoid state and the formation of multiple abscesses in

showed that the alteration of the epithelium precedes the connective tissue proliferation, and on the various forms of Bright's disease, may also be noted.

He has also published valuable memoirs on fevers and on cholera, on skin diseases and on exophthalmic goitre, and his "Clinical Lectures on Diseases of Old Age," a work which embodies many of the researches and studies which he had previously made on gout and rheumatism. His contributions to the study of diseases of the nervous system-memoirs and treatises more than a hundred in number—are of great importance. In fact, it is in this department of medicine that he is best known.

Since January, 1882, Charcot held the chair of Clinical Instruction in Diseases of the Nervous System at the Salpetriere, and gave almost his undivided attention to nervous diseases.

Among his contributions we may mention his clinical and anatomo-pathological researches on encephalitis; his "New Researches on the Pathogeny of Cerebral Hemorrhage," which contain his description of miliary aneurisms, consequence of endarteritis, and cause of the cerebral hemorrhages which characterize especially the apoplexies of old age; his studies on secondary de generations of the spinal cord, on localizations in dis eases of the cerebrum, on localizations in the cerebral

ganglionic masses of the hemispheres, lesions of the inpute. Frerichs ascribed the coma to acetonemia. ternal capsule in particular; his memoirs on cerebral This, too, is theory. The kidneys quite frequently hemianesthesia by organic lesion, and on secondary de show parenchymatous changes. The epithelial cells generations of the spinal cord in cortical lesions of the lining the looped tubes of Henle undergo glycogenic hemispheres, showing that lesions of the so-called degeneration. I have had occasion to see a few of motor zone even without participation of the internal Ehrlich's specimens, who first made known this fact. capsule produces secondary spinal degenerations. We It is an observation easy to confirm. It is recognized must pass by his valuable contributions to the study of by the chemical reaction with iodine. These changes localizations in diseases of the spinal cord. His dis coveries in the subject of the scleroses alone-locomotor ataxia, multilocular sclerosis, fasiculated sclerosis of the lateral columns, also in the department of infantile paralysis, amyotrophic paralysis of the adult, labioglosso-laryngeal paralysis, are of the greatest im portance.

are regarded as secondary. The lesions in the liver are protean. In some instances the organ is found in a condition of passive hyperemia, in others fatty, in still others slightly cirrhotic. In short, there is nothing from which to draw etiological deductions, as many have done. The liver cells, too, give the reaction with iodine. The heart, spleen, and intestinal tract in cases The modern study of hypnotism is intimately asso seen by the writer showed nothing of pathological ciated with the name of Charcot. His scientific methods interest. Most writers refer to the fatty condition of of studying the subject, as opposed to the school at the blood in this disease. While this condition of the Nancy, are well known; in fact, the intimate association blood is not constant, it may at times, as in a case of his name with hypnotism has masked the importance which I saw, be so pronounced as to give the blood a of his work in other directions. milky appearance. It was so lipemic in this case that when placed in a glass and left standing a thick layer of fat floated on the surface. The presence of fat emboli in the lungs in these cases is apparent. Is this lipemic condition of the blood dependent on lesions or interference with the function of the pancreas? I am disposed to advance this theory for a few cases from

To enumerate his titles and honorary offices, or the titles of his contributions to medicine would require more space than is at our disposal. Besides being con nected with the founding and management of these medical reviews, he published over two hundred and fifty memoirs, chiefly pathological, in all of which something valuable was added from his own investi- the fact that the pancreas plays an important part in gations.

in the pathology of this disease. "Facts bearing upon the relation of pancreatic disease to diabetes have been The Pathology of Diabetes Mellitus. accumulating since Cowley first discovered calculi in the pancreas of a diabetic, and Bright's pancreatic canWilliam Moser, M.D. in the New York Medical cers in a similar case" (Tyson). In a case which I saw Journal says: The morbid anatomy of diabetes is very in the Berlin Pathological Institute an aneurysm of the varied, and has been the source of much discussion. arteria pancreatica was found at the autopsy. Atrophy The disease presents no lesion or series peculiar to it. of the pancreas is not infrequent; hypertrophy and It is not a distinct disease I mean that it has no fatty degeneration of the gland cells are sometimes common cause; that it has no characteristic symptom-seen. I have seen a few cases of the latter condition. atology or pathology; that its principal clinical manifes- A good specimen came under observation only recently tations-viz, persistent sugar in the urine, etc.-are de- at St. Catharine's Hospital. It must be admitted, howpendent upon various morbid processes. It appears ever, that these cases (atrophy, hypertrophy and fatty evident, from a review of the literature, that cause and degeneration) are not so clear as those mentioned effect have frequently been confounded; that at autop. above; that the factors which bring about these changes sies we are generally dealing with effects and not with as well as the pathology of those cases in which the causes appears to have been overlooked. Laboratory organ remains unchanged, are problems yet to be solved. experiments have not enlightened us much in solving the pathogenesis of this disease. The chemical theories so far advanced have proved unsatisfactory. What are the lesions found at autopsies? Theoretically we ex- The Boston Medical and Surgical Journal writes: pect to find changes in the fourth ventricle, but practi- The Greeks made their gods simply themselves, with cally they are conspicuous by their absence. Various all their potentialities glorified into certitudes, as if to lesions are found in the brain, such as hemorrhages, tu- demonstrate what a Greek could be at his finest and bercular meningitis, etc, but they have no causal rela best. The hero was merged into the god. The world tion to the malady in question. The lungs are frequent has ever been quick to recognize valor, delights in ly tuberculous, at times edematous. Sanders and brave exploits, exults in signal instances of moral Hamilton regard diabetic coma as dependent upon fat courage, and makes haste to raise monuments to its emboli in the pulmonary capillaries, with consequent heroes. Humanity loves to see itself at its best. Our slow carbonic-acid poisoning. Of course this is theory. rich inheritance from the ages in stories of daring on That fat emboli do occur in some cases is beyond dis- the battle-field, or heroism on the quarter-deck, has,

Greater Love Hath No Man Than This.

perhaps, blinded our eyes to the silent, single-handed impassive exterior will be found "the stuff of which combats where there is no enthusiasm of numbers, no martyrs are made." He holds his life none too precious excitement of banners and drums, no shout of victory. to be sacrificed, if need be, in relieving humanity's And perhaps among the glorious company of heroes physical suffering, and surely "greater love hath no unchronicled and martyrs unsung, no profession holds man than this, that a man lay down his life for his so large a place as that of medicine.

The physician knows that a foe as deadly as a bullet and far more insidious lurks iu the micro-organism. But undaunted, high-hearted, strong in his professional loyalty, he takes the risk which personal contact involves, with no thought but wresting his patient from the grasp of death. But the world too often fails to see that thus the doctor merges into the hero.

friend."

Rheumatism and Arterio-Sclerosis. - Dr. Manteuffel discusses the relation of so-called rheumatism in the lower extremities and vascular disease. The pains complained of are situated in varying parts of the feet and legs, the feet are cold, and numbness may be Every physician knows many instances in which his experienced. The skin looks pale, and is often des professional comrades have fallen by his side, struck quamating in minute scales. Sometimes patches of down by infectious fevers or septic absorption acquired characteristic erythematous edema may be seen with an at the bedside of a patient. Notable instances have re- increase in the symptoms above described. In these cently brought this peril afresh to our minds. A con cases the pulses should be carefully examined. Differ temporary journal, in the last issue, records the death ences may be present, and the arteries may be found of a practising physician who caught the infection of degenerate. These manifestations are not to be con yellow fever from a patient whom he was attending, founded with articular affections, nor with sclerosis of and also the death of a promising young doctor to whom the veins. No varices or pigmentation are present, the infection of typhoid fever was communicated from Localized edema is, of course, not to be mistaken for a child-patient at the New York Hospital. Last week it was our melancholy duty to report the death of a bril liant young physician, of unusual qualities of mind and heart who caught diphtheria at the Boston City Hos. pital.

It will be observed that the personal risk is greatest to the hospital physician, not only on account of the large number of patients and variety of diseases which come under his care, but because the most malignant and extreme cases are naturally aggregated within hospital walls. It must be remembered that the physician and surgeon runs his greatest risk in that part of his calling where his skill and services are bestowed gratuitously. Every call for medical aid in great epidemics has always brought a swift response of willing hearts and ready hands. Physicians have set aside all personal comfort,and gone to the unpleasant surroundings of loathsome disease, doing not only the work of nurse but even of household drudge, because all others had fled in terror from the dead and dying. Self-sacrifice is, after all, the real essence of heroism. The great scourges, formerly regarded as dispensations of Divine wrath, but now known to be the results of sanitary pollution, are yet full of imminent peril to the practitioner. The very scientific knowledge which helps him more intelli gently to combat disease has also revealed the extreme subtlety of his invisible foe, and made clearer his hazardous calling. But increase of knowledge brings no shrinking to the physician. He puts fear under his feet, and walks serenely on in the path of his selfappointed duty. Carlyle says of the hero, "Now and always, the completeness of his victory over fear will determine how much of a man he is."

To the unthinking, the surgeon at the operating-table or the physician in the wards for infectious diseases is only a man pursuing his profession. But under the

more general edema due to venous obstruction. It may be difficult to distinugish this affection from neuralgia, and in cases of arterio sclerosis the nerves may also be involved. For proof from morbid anatomy the author refers to cases of angio sclerotic gangrene slowly de veloped and preceded by pains. He cites a case of gangrene in a girl, nineteen years of age, with diseased arteries, in which rheumatic pains had long preceded the gangrene. As to whether these rheumatic pains are a preliminary stage to gangrene cannot be denied with certainty in some cases. If the collateral circulation is insufficient gangrene occurs, but this late stage is often not seen. The author warns against local massage in these cases of arterio-sclerotic rheumatism. Some pa. tients whose disease is written of as rheumatism, or even hysteria, thus really suffer from arterio-sclerosis.-Deut. Med. Woch.; Med. Rec.

Destruction of Microbes by Infusoria —D. Harvey Atfield (Brit. Med.Journ.), a student in the Hy. gienic Institute of the University of Munich, recently carried out a number of experiments at the suggestion of Dr. Emmerich for the purpose of determining whether microbes of polluted river water are destroyed by infu soria. The experiment shows very cleary that the low forms of animal life which abound in river water are exceedingly active in the destruction of bacteria, and hence of service in the purification of water. In one instance, water which contained 3,000,000 bacteria per cubic cen timeter (dram) was found to contain at the end of ten days after infusoria was introduced only 13,000 bacteria, a proportionate decrease of 200 to one. In another case the decrease was 500 to one. In another case of water placed under the same conditions, without the infusoria, the number of bacteria increased from 700 per cubic cen timeter to 121,500.-Modern Med.

A System of Genito-Urinary Diseases, Sy-
philology and Dermatology. - By Various
Authors. Edited by PRINCE A. MORROW, A.M., M.D.
In Three Volumes. Vol. II. Syphilology. Royal M.D., Austin, Texas.
8vo., pp. 917. With Illustrations. [New York: D.

Appleton and Company. 1893. Price, Cloth, $6.50;

The book is handsome from a purely mechanical point of view. The best of paper, clear type, and fine binding have not been spared and the illustrations, both excellent and numerous are almost all original, thus enhancing the value of a work which no physician can afford to do without. We would advise every prac-ion, two weeks and one half later. Weintraud points titioner to obtain a copy of the entire work, of which the present is the second volume.

Essentials of Minor Surgery, Bandaging and Venereal REVIEW

ABSTRACTS

less general than it was a few years ago, still holds its ground to some extent. We would commend to the profession the determination of the following question, which lies at the root of the problem: Supposing it be

of more definite views regarding the different effects of the various sanatoria upon its progress and palliation or cure. The high altitudes, the ocean voyage, and the desert air are all known to possess considerable efficacy, but although the literature of the subject is rapidly increasing, it can not be said that the profession generally has assimilated the opinions of experts on these subjects. Pneumonia is still more or less of an opprobrium to

Some Therapeutic Problems Awaiting granted that bacilli are the cause of phthisis and that Solution.-The Lancet says: Complaints are fre- their dostruction is the legitimate object of the efforts quently made regarding the backwardness and slow of the physician, is there any evidence to show that an progress of therapeutics. In view of the complexity antiseptic solution or vapor can reach the seat of the of the phenomena which are involved, the wide range of disease in sufficient strength to effect this object? We individual idiosyncrasy, and the impossibility in many fear that, for the present at least, there is no such evicases of instituting anything in the nature of exact ex dence; and without discouraging further experiment we periment, it is possible that these complaints may be a very decidedly deprecate the use of inhalers and inhala little unreasonable. No one doubts that rapid and bril- tions which are theoretically indefensible and manifest. liant progress is continually being made in our knowl-ly ineffective. Then, again, with reference to the same edge of the pathology and the clinical history of disease, disease, much advantage would arise from the diffusion and when the conditions of the question are fairly considered it will not seem surprising that therapeutic progress should follow rather than procede advances in pathology and clinical medicine. However this may be it is desirable that we should from time to time review our position regarding some of the as yet unsolved or imperfectly solved problems of medicine. Time leaves little unchanged, and even in the absence of any notable experiments or discoveries it will always be found that the therapeutist. Vigorous stimulation still commands we are from year to year insensibly altering our attitude the approval of the great majority of adherents, but toward the great therapeutic controversies of our age. thoughtful physicians can hardly repress a doubt as to Experience always teaches something, even if it be only whether it is universally applicable and whether a place caution and skepticism, and every day facts arise which might not still be left for venesection and antimony. tend either to confirm or to undermine pro- Sweeping generalizations in medicine are hardly ever visional theories and working hypotheses. Truth pre- true, and the time may come when greater therapeutic vails very slowly and error is as slowly expelled; but distinctions will be drawn between the different types the intellectual atmosphere is ever changing. Doctrines that seemed to be probable a decade ago appear to be hardly worth contending against to day. Theories that gave a passing satisfaction to the thoughtful physician of the last generation seem to be strangely outworn to day, although little may have been accomplished in the way of tangible disproof.

of case, to the great advantage of the patients. Then we need further to make up our minds whether cardiac failure is really the chief source of danger in pneumo. nia, and, if it be so, whether we have made sufficient use of our great cardiac tonic, digitalis.

It is not so long since one of the great battle grounds of practical medicine was the identity or non identity of laryngeal diphtheria and membranous croup. This question has never been authoritatively settled, and although the doctrine of identity has tended to prevail, somehow or other the question has lost its interest, and we have come to see that its practical importance had been overrated. What is certain is the clinical fact that a membranous affection of the pharynx is only moderately perilous, while a membranous affection of the larynx is excessively dangerous, and in young children is very frequently fatal. In view of these clinical facts, the question of the precise pathological character of the membrane in the different cases bePhthisis comes of minor interest. More important are the ques tions whether the removal or destruction of the mem. brane is ever advisable and when tracheotomy should be performed. The former question is now usually answered in the negative; and the latter raises one of the most difficult points in therapeutics, and one which is further rendered perplexing by the fact that foreign experience seems to be at variance with our own. As regards the last disease on our list-viz., typhoid

We may find illustrations of our remarks in such dis eases as syphilis, phthisis, pneumonia, diphtheria, and typhoid fever. It is not so long since the revolt against the abuse of mercury was in full swing and had gone so far that certain accomplished observers maintained that some of the worst features generally attributed to the disease were really due to the remedy. Now we feel that this question has passed out of the sphere of seri ous discussion. With a practical unamimity we ac knowledge the value of mercury, and the only problems that await solution in this connection are the proper form of the drug to employ in a given case, the correct dosage, and the mode of administration. affords a more difficult case. For the present, treatment by inoculation stands condemned, and it is not likely to be generally revived unless more extensive and authen tic evidence of its utility than that which first gave it vogue is forthcoming. We have not, however, yet finally determined whether the antiseptic treatment of phthi sis is as sound in practice as it seems to be plausible in theory. The use of antiseptic inhalations, though much