p. 499), in commenting on the above, express themselves the medical man who must always be ready with his as follow: "Admitting the truth of this rule, it does lamp filled and lighted and mind clear and fully prenot follow that the condition of the chancer in any pared to meet any and every adversary of health and manner determines the severity of subsequent symptoms, soundness of body and mind the moment it appears. but merely that it is an indication of the activity of the virus and of the state of the patient's system-the two causes upon which the severity of the attack chiefly depend." The latter observation does not corroborate the history given both by my patient or the members of his family. It was particularly claimed that he had enjoyed unusually good health throughout his life, and the quantity of alcohol which he made use of was not in excess of that commonly used in his occupation. Regarding the presence of the nodules on the tibia, these latter occurred after a longer period of time than in the case (Obs. VII.) reported by Mauriac, yet the gummatous ulceration of the hard palate at so early a period is, as far as I can discover, without detailed precedent, and certainly places this history prominently among similar records. Welcome Address. BY DR. A. B. SHAW, ST. LOUIS, Delivered before the First Annual Convention of the Southwestern He is truly an emergency man, one of the most precious of a merciful God's good gifts to humanity, of the most perfect developments of the medical profession, so far as its ability to cope with emergencies is concerned, is before me to-day in the Railway Surgeon. Through untiring energy and persistent effort railway surgery has been developed from a very small beginning into a distinctive, well defined individuality of no mean proportions, pregnant with great possibilities of still further advancement. In 1866 the Central Pacific established a railway bospital. In 1879 Dr. J. W. Jackson, on lines furnished him by Dr. W. B. Outten established a hospital on the Missouri Pacific. In 1881 Dr. Outten, induced the Iron Mountain to establish its Hospital Department, and succeeded in securing by railroad corporations the recognition of the necessity for and establishment of the office of Surgeon in Chief for a railroad system, and placing such official in charge of the hospital. Prior to this time the hospitals had been managed by the railroad officials themselves. In 1888 the first National Association of Railway Surgeons convened in Chicago with a membership of 288 in attendance, this National Association now has a membership of nearly 2000 with a record of 1400 in at tendance at its last convention held at Omaha this year. However it may be with others I know that one of the most prominent roads of the west looks upon the railroad surgeon as one of the most essential factors in the proper conduct of its affairs. Depending upon his judgment and advice rather than on legal processes in the determination of what is fact and justice as between man and man in the settlement of claims against it for injury sustained while in its employ or on its roadway. MR. PRESIDENT AND GENTLEMEN OF THE SOUTH While every gentleman before me had probably WESTERN ASSOCIATION OF RAILWAY SURGEONS.-I am made a personal sacrifice in order to be at this meeting very sensible of the distinguished honor that has fallen I have no doubt but that great benefit to each and every to my lot in being permitted to welcome you in behalf one of us will result from thus coming together. Such of the Medical Profession of St. Louis to the acknowl- conventions as this have been the means of placing the edged commercial, medical, and scientific metropolis, medical profession in its proper relationship with railand exponent of that chivalrous hospitality so eminently road corporations, for railway surgery surgeons are now characteristic of the great, grand, and growing South-employed for their surgical ability and honesty, and are west with its glorious potentiality and possibilities in no longer made use of to further interest a part from every direction in which the present advanced civiliza those in harmony with the dignity of their calling. tion is supposed to excel. As strangers we welcome you and give you the freedom of our city, as medical men and scientists we throw open to you our hospitals and colleges, and wish you God's speed in your compara tively new enterprise which tends to the greater im provement of the means and methods of caring for the loved ones of numerous households, the bread winners for many homes, the artisan, the statesman, the com mercial giant or that parasite the tramp, without regard to station or degree, when overtaken by that most hor rifying and dreadful of all calamities a railroad wreck. While each member of every department of industry, art, science, or of the learned professions is presumed to be able to successfully meet any emergency presenting in his individual domain, in many of them the time of accomplishment is not always an essential feature, and the artisan, the lawyer, the scientist, or the eclesiastic may deliberately prepare for such conditions as may call for an exhibition of his skill; but it is not so with To the advent of the Railway Surgeon of to-day is to be attributed the lively appreciation by railroad corporations of the economy of justice in its settlement for damages. No longer can a railway surgeon be made the tool of the legal profession. The genius is not yet born who can successfully maintain a lie and only an idiot will attempt to do so. Always adhere to the unvarnished truth, it and it alone will stand the test in this age of science. Prior to the formation of the National Association of Railway Surgeons in 1838 there was no literature worth the name on railway surgery, but since that event there has been evolved a nucleus of EDITORIALS L. T. RIESMEYER, M.D., EDITOR. DEPARTMENT EDITORS: DR. F. J. LUTZ, General Surgery. Voice Without a Larynx.-At a meeting of the College of Physicians, on the 4th inst., Dr. J. SolisCohen exhibited a patient who speaks without a larynx; and the College desired the President to appoint a com-ion will be paid to anonymous communications. mittee to investigate the manner in which the voice is produced. Med. News. TO CONTRIBUTORS AND CORRESPONDENTS. All letters whether intended for publication or not must contain the writer's name and address, not necessarily for publication. No atten The larynx and the uppermost tracheal ring of this patient was removed by Dr. Cohen some eighteen months ago for an intraneous and extraneous laryngeal adenocarcinoma. The upper end of the trachea was drawn forward and then stitched to the skin, so that there has been no communication since the operation between the lungs and the mouth. Yet the man speaks with a fairly well modulated voice, sufficiently audible for all practical purposes. He breathes without a tracheal canula, through the upper orifice of the trachea, which presents externally. When he is about to speak the skin above the trachea becomes distended into a small vesicle of air, the contents of which are propelled in a stacatto-like manner against some structures just at or above the orifice of esophagus, and which Dr. Cohen takes to be the hori zontal fibers of the inferior constrictor muscles of the pharnyx. Secretaries of medical societies will confer a favor by keeping us (nformed of the dates of the meeting of their respective societies, and of officers elected. Members of the profession who send us information of matters of general interest to our readers will be considered as doing them and is a favor, and we shall take pleasure in inserting the substance of such communications. All communications for the editor, and all books for review, should be addressed to the editor, 914 Locust street. All letters containing business communications or referring to the publication, subscription, or advertising department of this REVIEW, should be addressed to 914 Locust Street, St. Louis. Entered at the St. Louis Postoffice as Second-class Matter. Legislation in the United States for the It is a In consideration of the large percentage of blindness due to ophthalmia neonatorum it seems a wonder that in this progressive age no law exists in the vast majori Church of England Sanitary Assocation.―ty of the States of the Union with regard to the preven Sir Spencer Wells, Bart., speaking at a recent meeting tion of blindness due to this frequent source. of the Association upon "Cremation," said that the well known fact that in institutions where it has been distinguished German engineer, Mr. Lindermann, in an invariable rule to introduce a drop of a two per cent sinking wells below the bed of the Rhine to obtain a solution of nitrate of silver into the eyes of the infant supply of water for a neighboring town, had found the immediately after delivery, blindness resulting from water so impure that it could not be used, and he was blenorrhea neonatorum is an almost unheard of occurable to trace the source of contamination to another rence. It should be the endeavor of the physicians of town about 20 miles off. Professor Groves, F.R.S., had all the States to use their influence with respective stated that where there was drainage or infiltration legislative bodies to have a law passed to require midof water from burial grounds, the water passing into wives and nurses to report every case of reddened or wells or streams caused them to be contaminated inflamed eyes of infants to a legally qualified practiwith easily decomposable nitrogenous organic matter; tioner and, with our confidence in the progressive spirit but he was unable to give an opinion as to how far of the American profession we may safely predict that disease might be communicated in this way. The in- in the near future an effort will be made in our State fected germs remaining in dead bodies were believed, as well as all other States of the Union to have a law by scientific men of the highest distinction, to be pre- passed to this effect. In order to add our mite in served for many years by burial in the earth to multiply bringing about this reform we take the liberty of reprothere, and in due time to renew their deadly influence ducing a paper read upon this subject in the Section on by polluting earth, air, and water.-Med. Times and Ophthalmology, at the forty-fourth annual meeting of Hosp. Gaz. the American Medical Association, by Lucian Howe, M.D., of Buffalo, N. Y., which we have perused with words, on examining the figures carefully, we can say great interest. The following is the paper, in its full text, for which we are indebted to the Journal of the American Medical Association of November 25, 1893: At the meeting of the American Ophthalmological Society in 1887, I presented a short article in regard to the increase of blindness in the United States, calling attention to the fact that according to the census reports, the number of blind in this country was increas ing much more rapidly than the population. The So ciety was kind enough to appoint a committee to exam ine into the subject, as did also the Medical Society of the State of New York, after the same figures had been presented there for consideration. The committee in both of these Societies reported the advisability of some legislation to limit the further increase of what may be considered one of the principal causes of blindness, namely, ophthalmia neonatorum. Since that time, the States of New York, Maine and Rhode Island have all passed laws which have for their object the preventative treatment of this disease, and I wish here to show the desirability of similar laws in other States. The facts in regard to the subject were published in the Transactions of the New York Medical Society and of the American Ophthalmological Society so completely that there seemed but little to add to the subject. Since then, however, the statistics gathered by the census of 1890 have been obtained, and these furnish sufficient additional data to warrant my calling attention to the subject again, and recapitulating briefly the reasons why legislation in various States should be enacted for the prevention of blindness. In 1880, for the first time, a systematic attempt was made to ascertain the entire number of the defective classes-these among the rest-and when the statistics for that year were compared with previous years the apparent increase was astonishing. When, however, the number of blind in 1890 is compared with the number in 1880, we find that there is an increase of only 2.20 per cent, there having been in 1880, 48,929 blind and in 1890, 50,411. There are good reasous, however, for considering that this last census gave a much less complete record of such persons than did the census of 1880. I am indebted to Hon. Robert D. Porter for a type-written copy of the returns concerning the blind taken June 1, 1890. The summary shows that there is a total of 50,411. Male, 27,983; fe male, 22,458; white, 43,351; colored, 7,060; natives, 41,265; foreigners, 9,146. that without fear of exaggeration there are wellnigh five thousand blind in the United States, who are in that condition merely because of neglect on the part of those who had charge of them in early infancy. If the estimates were based upon the number of blind in asylums the percentage would be almost twice as large, as has been proved by an examination of a large number of inmates of the blind asylums, not only in this country but also in Europe. The details of this are referred to in the papers already mentioned, and the facts can be easily substantiated by reference to the works of Fuchs, Magnus and others. On an average it may be stated, with a considerable degree of accuracy, that at least eighteen and one-half or nineteen per cent of all the blind in early life are in this condition from oph. thalmia neonatorum. This fact would bear statement in detail were it neces sary, or were it in accordance with the limits proposed for this short communication. Another fact which I would mention is one which also can be briefly stated before a society of those accustomed to treat ophthal mia neonatorum. This is, that ophthalmia neonatorum can now be considered a preventable disease. I need not elaborate this by calling your attention to the figures presented by Crede and others, or by referring to my own experience, or that which occurs in the practice of every one who has to deal with this disease. We all know how favorable a prognosis can be given in the early stage, and on the other hand we know how extensive are the ravages which may follow after ulceration of the cornea has once begun. All agree, I think, that when these cases are seen within the first week after birth a generally favorable prognosis may be given. This brings me to the next point which I wish to make: that is, the desirability of legislation which should force nurses and attendants to bring these chil dren to the notice of practitioners while the disease is still in the very earliest stage. The story is a familiar one of the infant being brought to the office of the ocu list, with the cornea ulcerating or perhaps perforated, and the mother and sometimes the attending physician thinking that the child has "taken cold" and requires perhaps no further treatment than the hot water or milk which has been applied to the eyes. And the scene, also, is unfortunalely familiar, of the mother weeping over a hopelessly blind child, all simply because the nurse has supposed that the infant has merely taken cold and had been relying upon some of the numerous household remedies just a little too long. The question In some States this increase has been very slight; in before us, therefore, is what means can be adopted to others quite marked. But whether the number is large bring these children as soon as possible to the notice or small, the important fact remains that a really large of a competent physician. Education of the laity is percentage of the blindness is caused simply by neglect useless. Urging the nurses, professional or others, is in early childhood. I mean, as a result of ophthalmia equally insufficient. It remains only to place the reneonatorum. It is difficult to estimate exactly what sponsibility at once where it belongs, by imposing upon percentage these cases bear to the total number of the such persons a severe penalty. The surest and best blind, but various authorities estimate this from nine means of accomplishing this is undoubtedly by legisla and one-half to ten per cent, or even more. In other, tion. This was the view taken of the subject by those who have considered it most carefully; and following the plan which had been partially adopted before in Switzerland, and elaborating it, a concise but explicit bill for the proper protection of these infants was passed by both houses of the New York Legislature, 1890, with out a dissenting vote, and became a law. The law was known as Chapter 41 of the laws of 1890, and was as follows: such infant are inflamed or reddened, whenever such shall be the case, or who applies any remedy therefor without the advice, or except by the direction of such officer or physician, etc. It is further provided that this is to be punishable as a felony. We can, therefore, consider that in New York we have a law sufficiently stringent to teach nurses and midwives what their duties are, and parents what risks their children run when there exists what is ordinarily called a simple "cold in the eyes." It is important that the first cases should be so clear as to make conviction a practical certainty and in my own vicinity, at least, some cases of probable guilt have been allowed to pass AN ACT FOR THE PREVENtion of Blindness. SECTION 1.-Should any midwife or nurse having charge of an infant in this State, notice that one or both eyes of such infant are inflamed or reddened at any time within two weeks after its birth, it shall be the duty of unpunished. But it can only be a question of a short such midwife or nurse so having charge of such infant, to report the fact in writing, within six hours, to the health officer or some legally qualified practitioner of medicine, of the city, town or district, in which the parents of the infant reside. SECTION 2.-Any failure to comply with the provis ions of this Act, shall be punishable by a fine not to exceed one hundred dollars or imprisonment not to exceed six months or both. time before a good typical violatien of this statute comes under some one's notice, and after having been once tested subsequent convictions will be easy. The State of Maine was the second to pass such a law. There the matter was taken in hand by Dr. Holt, of Portland, with his associates. The bill was known as number 97 of the Senate, and has become part of the laws of 1891. The text is as follows: SECTION 1.-Should one or both eyes of an infant be SECTION 3.-This Act shall take effect on the first of come reddened or inflamed at any time after birth, it September, eighteen hundred and ninety. shall be the duty of the midwife, nurse or person having charge of said infant, to report the condition of the eyes at once to some legally qualified practitioner of mediciue of the city, town or district in which the parents of the infant reside. SECTION 2.-Any failure to comply with the provis ions of this Act shall be punishable by a fine not to exceed one hundred dollars, or imprisonment not to exceed six month, or both. SECTION 3.-This Act shall take effect on the first day of June, eighteen hundred and ninety-one. The third State to have such a law was Rhode Island. In that State the subject was brought to the attention of the Legislature, principally through the exertions of Dr. F. T. Rogers. That was passed at the January Session of 1893, and the text is as follows: My own impression is that this law was sufficient to cover all cases, and a sufficient number of convictions could have been obtained under it, not only to call pub lic attention to the existence of the law, but also to prove a wise and very excellent lesson to the class whom it was practically to affect. A few convictions would have more effect in educating the laity and those who pretend to be nurses than would any number of lectures, leaflets or appeals of any kind. One or two partial attempts were made under that law to bring nurses to trial in New York City, especially by Dr. Derby of the New York Eye and Ear Infirmary. He thought, however, that a loop-hole was left by the word, "notice," because nurses would be apt to say when placed on the stand that they had not noticed any such redness of the eyes or discharge from them. This is SECTION 1. Should any midwife, or nurse, or person such a small excuse that it ought not to prexent the acting as a nurse, having charge of an infant in this working of the law as there presented. Another objec- State, notice that one or both eyes of such infant are tion to this, was that it was not quite strong enough, inflamed or reddened, at any time within two weeks and not being a felony, it might be difficult to place the after its birth, it shall be the duty of such midwife or responsibility on the proper person for beginning a suit. nurse, or person acting as nurse, so having charge of The matter, therefore, was taken in hand by Hon. such infant, to report the fact in writing, within six Elbridge Gerry, who for twenty years has identified hours, to the health officer or some legally qualified himself with legislation for children. The substance practitioner of medicine of the city or town in which of this law has been incorporated in another, known as Chrpter 355 of the laws of New York for 1892. The clause in regard to this teads as follows: the parents of the infant reside. SECTION 2.-Every health officer shall furnish a copy of this Act to each person who is known to him to act as midwife or nurse in the city or town for which such health officer is appointed, and the Secretary of the State shall cause a sufficient number of copies of this Act to be printed, and supply the same to such health officers on application. SECTION 3.-Every person who shall fail to comply with the provisions of this Act shall be fined not exceeding one hundred dollars, or imprisonment not exceeding six months, or both. SECTION 4.-This Act shall take effect July 1, 1892. It will be observed that the three laws now in exist ence are very similar, and as that of the State of Maine omits the word "notice," and is still complete in itself. it is perhaps the best thus far enacted, except that the penalty is too light. they advocate. The personal co-operation of the Governor is also a warrant of success from the first. But the average legislator is ready to listen patiently to any such claims of an unfortunate class, and his assistance for the bill is not difficult to obtain, being certain, as he is, that the originators of it have only the best mo tives. If the politicians hesitate or are inclined to smile at measures for the relief of sore eyed babies they are quickly brought to their senses, if confronted by A question might arise as to what advantage it is to such evidence as is unfortunately always at hand in oblige nurses and midwives to report to physicians a every large city, or can be easily obtained among the disease of which a certain class of so-called doctors are inmates of every asylum for the blind. Such men real almost as ignorant as the nurses themselves. The anize that they have with them the hearty approval of their swer to this is three-fold: constituents, of the press, and of the people, and that 1. The nurse is made to appreciate her responsibility, they are saving from a life of misery, to which death not only in that case but in others, and to know that the is often preferable, a large class of those who would condition indicated by the redness and discharge is not otherwise be hopelessly blind. anything to be trifled with. A License to Practice Medicine Includes 2. The parents also become alarmed when they know that the disease is sufficiently serious to be the subject of special legislation, so that in choosing a practitioner Surgery.-Many are the devices resorted to for the they select with rather more than ordinary care. Finally, as for the physician himself. If he accepts the case he feels that he must understand it thoroughly and he will be apt to look it up with considerable care in his text books and treat it intelligently. Above all, if he fails to do that, the parents have a responsible in dividual against whom they can with perfect justice enter a suit for malpractic, and if he has proved himself incompetent he not only suffers the penalty which a law has provided for him, but one such case would be an example to him and to other practioners in the commu nity in which it occurred. purpose of avoidnig the payment of doctors bills. (Journ. Amer. Med. Asso.). In the case of Stewart v. Raab, decided by the Supreme Court of Minnesota, Sept. 8, 1893, just reported, it was contended that a person holding a certificate to practice medicine could not law. fully practice surgery, nor recover for professional services which included the performance of surgical operations. The statute under which this question was raised is entited, "An Act to regulate the practice of medicine in the State of Minnesota," and the first sec tion prescribes that every person practicing medicine in any of its departments shall possess the qualifications It seems needless to urge further the advisability of required by the act. To persons possessing these similar laws in other States, especially in those where qualifications, certificates shall be issued by a board of there is a large proportion of foreign emigrants in the examiners, and these certificates authorize the possesspopulation. We know that their children are not only ors to practice "medicine and surgery" in that State. often cared for by midwives, but also often given over The terms, "practice medicine," in the title of the Act, to them entirely at an early stage, and women when ac- and "practicing medicine," in its first section, are used, customed to assume any such responsibility must be the court says, in the broad and popular sence in which taught this part of their duties. If they will not learn they are generally understood, applied and, in fact, in any other way, a heavy fine or imprisonment is but a defined. One practicing medicine, practices "the art of small penalty for the crime of having blotted out the preventing, curing, or alleviating diseases, and remesight of a human being. Where the German population dying as far as possible the results of violence and is large the children are often cared for entirely by accident" Therapy is the treatment of disease, and midwives and these, though usually well qualified by instructions obtained in their native countries, are also not infrequently ignorant and careless in the extreme, and need to be taught that the hand of the law may interfere for the protection of the children given into their change. surgery is therapy of a distinctly operative kind. A certificate which, in terms, authorizes the possessor to pursue the practice of medicine under the conditions of such a statute as the above, necessarily includes surgery, The statute does not require a license or certificate for each department in medicine. Consequently there is nothing whatever in the point that because surgery is not expressly mentioned in the certificate, the holder thereof violates the law when performing surgical operations. Having shown that such legislation should be enacted, and that it is our duty to lend our efforts and personal influence to obtain it, I wish to say, finally, that it can be done usually with little effort. Of course in any such undertaking it is necessary to enlist the sympathy and co-operation of a few leading men in each branch of the Legislature-those whose standing and character is such as to command respect for any measure which REVIEW Now is the time to subscribe for the MEDICAL |