vices, and every medical journal sustains him in his efforts. The profession is doing untold good in diminishing the chances for the spread of disease; and it is certain that the present increased expectation of life, which life insurance companies prate about so much, although without reducing their rates, has been due to the persistent and unselfish efforts of the medical profession. An enlightened public is gradually observing the rules preached so assiduously. And yet, by losing the idea of proportion, and insisting upon the public absorbing knowledge on prophylaxis with every act of respiration, it tends in time to discredit all the physicians' efforts. Carlyle had an immense audience to his preachments, until by harping too long on one string he earned pity rather than respect. Let the learned doctors of medicine remember that surfeit is worse than starvation.

HYSTERIA THE RESULT OF PSYCHIC TRAUMA.

TH

HE fundamental or predisposing cause of hysteria, suggestibility, no doubt constitutes an etiological factor common to both the social and the individual forms; yet the direct environmental infringements or psychic entanglements which may favor the development of one or the other, are not the same. The social forms reveal for us the victims of the hysterical diathesis. It takes some accident bearing a peculiar relation to the individual himself to reveal the true hysterical. Without much fear of contradiction, the affirmation may be ventured that hysteria is usually the result of some psychic trauma; upon some mental shock coming perhaps during a period of brain fatigue, or at that age when the physical development being most active, the vital forces, as it were, too busy in quarters other than psychical, we must place the blame. For this reason it is often only an accident that determines the development of dementia precox in one individual and hysteria in another. They are both essentially diseases of the developmental, the evolutional period (fourteen to twenty-one), when the organism is emerging from the more or less stable equilibrium of youth to a definite state. of maturity. They both frequently seem to rest upon a defective nervous endowment, some constitutional inferiority, an improper education, and a lack of character training. The mental shock, added to the defective mental endowment, results in a sort of psychic entanglement; the lines of psychological association become raveled, trammeled up, snared and labyrinthed, and often it is a task of great difficulty to trace the associational cham to the point of

trouble, bring the knot to the surface and untangle it. In addition to an ordinary mental shock, many times an idea acquired by the patient that he has suffered some real injury, is necessary for the development of a hysteria. Whether the individual does suffer such an injury or not, has nothing to do with the case. In fact, where a real injury has been suffered there is less room left for development of a hysteria. The psychic injury may fracture a personality, just as a real injury may fracture a bone. Janet tells of a man who was knocked down in the street, and, while he was not run over, a heavy wagon was almost upon him, and in his confusion he thought it had actually passed over his legs. As a consequence, both legs were totally anesthetic. In another instance a man attempted to climb from the steps of one railroad coach to another. He suddenly saw the train approaching a narrow tunnel. He was not struck, but for the instant he thought he was about to be. He drew himself inside the coach and found that he had a complete hemiplegia of the exposed side of the body. A patient of my own was bitten on the thigh by a dog. The wound resulting was scarcely more than a scratch, yet he suffered from a total psychic paralysis of the limb for several hours, and it was three days before I could reestablish completely in his mind the idea that he could use the leg freely.

These considerations have an important bearing upon many damage suits. No situations more liable to produce, if not a real injury, the vivid idea of injury-i.e., a psychic trauma—than railroad or street car accidents, can well be imagined. Such psychic injuries may last for a long time after the physical injury-even if one has been sufferedhas disappeared. There may be good grounds for the recovery of damages, even when it cannot be determined that any physical injury whatever has been suffered. Putting to one side all questions of conscious simulation, such hysterical states are more likely to become fixed and chronic the more the litigation is prolonged, and no doubt of the plaintiff's sincerity is implied when it is said that a settlement of the case at court usually ends his symptoms. RALPH REED.

March, and now first published (Senate Document No. 48), is most apropos to this matter. In "A Plea for the Establishment of Hospitals for the Rational Treatment of Inebriates," by C. A. Rosewasser, some strong arguments are made for the establishment of hospitals for inebriates "as a means of preventing insanity, diseased and degenerate offspring, and dependency and crime." The author lays stress upon the fact that if an inebriate is left to himself he is practically helpless and hopeless. Like insanity, which has yielded in many instances to appropriate scientific treatment, inebriety is believed to be amenable to rational treatment.

The Dependency and Crime Commission appointed by the governor of New Jersey to make inquiries as to the causes of dependency and criminality, reported as follows:

"We desire to call attention to the importance of the establishement of a hospital for persons who are afflicted with the habitual addiction to alcohol and other narcotic drugs, so that they may be scientifically treated and restored to usefulness. It is the consensus of opinion that our present method of dealing with the inebriate who falls into the hands of the law, as he is very apt to do, is barbarous and inhuman, and is a relic of the Dark Ages. Punishment for drunkenness has been meted out for centuries, and has been proven to be an absolute failure. Why should this method be allowed to continue when there is a more rational method of dealing with these unfortunates, many of whom, through heredity and environment, are more sinned against than sinning-a method which in the light of modern progress is as bright and full of hope as the present method is full of darkness and despair? The State needs most urgently a hospital for inebriates. Aside from its incalculable value as a saver of men and women, it would be a great financial gain in the end."

We expect to enlarge on this subject on a future occasion, suggesting perhaps a cause for inebriety which the average man dislikes to have foisted upon him because it makes him think. The publication of the document is of sufficient importance, however, to ask physicians generally to secure a copy from the authorities at Washington.

THE smallpox mortality in Germany during 1907 was at the rate of 1.02 per 1,000,000 inhabitants during the year under consideration (1907), for the preceding year 0.77, and for the ten-year period (1897-1906) the average was 0.51. Among the 63 deceased in 1907 were 15 foreigners, corresponding to 23.81 per cent. of the total number, 10 being Russians, 3 Luxemburgers, 1 an Italian, and 1 a Swiss.-Public Health Reports, February 11.

LEPROSY is not due to the eating of any particular food, such as fish. There is no evidence that leprosy is hereditary; the occurrence of several cases in a single family is due to contagion.-Public Health Reports, February 11.

In taking up this subject again the writer has no desire to crowd the discussion or monopolize it. Not having had the opportunity to read the full text of the several bills under consideration, it has ben assumed, however, that the brief presentation of them which we have had before us is substantially correct as to the main purport. While not wishing to reflect on the integrity and earnestness of the committee, which has had the drafting of these measures in charge, the writer sees no reason to modify the tone or substance of what he has said against the abortion bill and the criminal sterilization bill.

While these are two separate and distinct measures, they have been placed in close juxtaposition before the professional eye, and evidently form important and contrasting parts of the same legislative program.

The moral and logical inconsistency between the two is sufficient to destroy all claim of serious consideration for either one. If surgical considerations are to be laid aside, and if it be determined to be morally and legally proper to perform ovariotomy upon a criminal or insane woman in order to prevent her begetting criminal or insane progeny, it is equally morally and legally proper to perform an abortion upon her for the same purpose. The mere logic of the situation is inexorable and there is no escape.

In replying to Dr. Silver's letter, I might suggest that my friend becomes something of a humorist when he holds us all particeps criminis in allowing the "slaughter of a hundred thousand innocents. more or less." As a member of the medical profession, I must decline to admit the responsibility, and so have no remedy to propose for the horrible situation.

Perhaps my friend of the opposition was influenced in some degree by considerations of the "rights of the fetus," or by contemplation of the enormous importance and the stupendous possibilities of the product of conception.

"Hands that the rod of empire might have swayed, Or waked to ecstasy the living lyre." Or picked a lock, perhaps.

The main argument seems to have headed itself around the unsavory subject of abortion. The carnival of morality which is sweeping the country has had many ramifications. They have all had apparently the same psychological basis-that it is so much easier to contemplate, to moralize, than it is to think.

In the face of the present situation we ought to remember that we are chiefly and primarily physicians and surgeons and not moral censors.

In deciding the famous Playfair case, the English justice observed that for a physician or surgeon to "constitute himself a moral censor is intolerable." The large amount of damages awarded to the plaintiff is a matter of history.

The oath of Hippocrates has very little weight with the mother of from nine to fourteen children who, through force of circumstances, is recently charged with the care of an infant grandchild.

The laws on this subject which we already have have been at times shamefully abused, and the one now proposed appears only to contain an additional menace to the physician in the discharge of certain necessary duties.

The strenuous endeavors to provide through legislation the ways and means to implicate somebody and create a scandal can only result in scandal and complications.

What the profession needs to attain the best good to itself and the public in the whole matter is not to look at everybody else with suspicion, but to stand united and fortify itself on its own ground, setting forth clearly the dangers to the mother of arousing an unsuspected latent infection, making clear the risk and the surgical peril.

F. O. MARSH, M.D.

ADVERTISING OF NOSTRUMS. ELMWOOD PLACE, O., February 12, 1910. EDITOR LANCET-CLINIC:

The government has denied the use of the mails. for vending nostrums advertised to cure tuberculosis. "Piso's Cure for Consumption" was restricted to coughs, etc., by the government. But notice this advertisement, which appeared in a recent issue of a Cincinnati daily:

"OZOMULSION.

"The Distinguishing Feature of Ozomulsion is its CURATIVE QUALITY, Which All Other Emulsions Lack.

"HOME TREATMENT FOR TUBERCULOSIS.

"It is not necessary to go away from home and incur the great expense of the "Outdoor Sanitariums" to cure Consumption. Many thousands-victims of tuberculosiscannot afford it.

"Fortunately there is a method of treating this dreadful disease whereby the poor have equal chance with the rich.

"It is not a question of any particular climate or outdoor living in luxurious "Homes for Consumptives."

"PLENTY OF FRESH AIR, SUNSHINE and Wholesome Food at Home, together with OZOMULSIONwhich is within the reach of all-will, if taken in time, afford all the relief that the most expensive sanitariums offer."

These kind of ads. often defeat the removal of victims of the white plague to curative climates where many of them would otherwise recover. It seems that the medical press should protest to the Federal authorities against this class of conscienceless, ignorant, positively harmful ads. under the Pure Food and Drug Act. JNO. G. REED, M.D.

THE WEEK'S NEWS.

The Chillicothe, O., Board of Health reports that the smallpox situation in that city is well in hand.

It was stated at the last meeting of the Clark County, O., Medical Society that the social sessions will be abolished in the future.

In his health report for January the health officer of Nashville shows that in that city pneumonia causes twice as many deaths as tuberculosis.

The Hamilton, O., Board of Health has distributed to the various school rooms cards entitled "How to Keep Well." Similar cards on the care of the teeth will soon be prepared.

The investigation of the cold storage houses of Louisville, which has been ordered by the health officer, will not show the results anticipated by the public. So far no over supply of eggs or meat has been found in cold storage.

Texas does not admit Oklahoma physicians to practice in the Lone Star State without securing a license from the Texas Examining Board, and the Oklahoma Board, in retaliation, will arrest Texas doctors who attempt to practice in Oklahoma.

The Atlanta, Ga., Board of Health, at its last regular meeting, adopted resolutions authorizing the city health officer to employ all necessary assistance and begin a house-to-house campaign of compulsory vaccination, taking young and old, rich and poor alike.

The action taken on February 10 by the Board of Trustees of the North Carolina State University, in ordering the Raleigh branch of the University Medical School to be discontinued at the close of the present term, it is said will result in the erection and equipment of a medical university at Raleigh.

At the present time the Huntington, Ind., Health Department is puzzled as to what to do regarding condem nation of hogs fattened on offal. Despite warnings the feeding of hogs on such refuse is continued and animals so fed will be reaching the Indiana markets within the next few weeks.

Through a change in the by-laws, which has been agreed upon by the executive committee and recommended to the Board of Directors for adoption, the control of the Macon, Ga., Hospital will shortly pass from the physicians represented by a medical board to either the executive board or the directors.

The fact that the sanitary condition of the city of Nashville is gradually becoming better and also that the city's health is being brought to a high state, is shown by a report of the city health department for the year 1909. During the year a total of 1,990 deaths were recorded, as against 2,114 for 1908.

The régime of the health officer who is considered a "joke" has come to an end in Indiana, according to a statement made by the President of the State Board of Health in an address last week before the county health commissioners, meeting jointly with the State Board of Health at Indianapolis.

Akron, O., is experiencing the same troubles larger cities have had in the matter of securing a pure milk supply. Prompt protest comes, not only from dairymen and farmers, but from city people as well, against the proposition advanced by the local Board of Health to the effect that all milk brought into the city should be bottled.

The Board of Control of the Good Samaritan Hospital, Vincennes, Ind., decided to appropriate a sum of money sufficiently large to establish a colony of portable cottages for tuberculosis patients who are consigned or taken to the hospital for treatment. A number of these cottages will be bought and will be added to as the number of patients grows.

In his annual report the health officer of Hamilton, O., has this to say of vaccination: "While I ardently advise vaccination, yet I do not believe in compulsory vaccination. If parents in this day are so ignorant as to know little of the Scourge of smallpox, and how easily it is prevented by vaccination, then they can hardly be enlightened by an order (Continued on page 224.)

I

Contributed Articles.

VENEREAL DISEASES: THEIR ANTEPARTUM, PARTUM AND POSTPARTUM EFFECTS.*

BY E. J. KEHOE, M.D.,

CINCINNATI.

T is a remarkable fact that we are notoriously lax in our conduct towards the protection of our women against the baneful effects of venereal disease, as a general thing pape being so much concerned as to future son-in-law's financial standing that he is serenely unconscious of the grave dangers into which his loved one may be innocently venturing. As, of course, such a subject is never mentioned at home unless daughter is not within. hearing, the one who by every right should be conversant with the dangers is kept in blissful ignorance, and is often sent to a horrible fate amidst great rejoicing upon the part of her family and friends, the latter as blissfully ignorant as herself. Our Department of Health, not to be outdone in this game of blind man's buff, takes away all vestige of protection and gives the foul monsters free reign; a case of measles must be quarantined, but venereal disease may run rampant, trusting women and innocent babes may be maimed for life, yet the municipality makes no effort to arrest these loathsome destroyers of lives and homes.

The thick-headed policy of parents who hide the facts from their children because of alleged modesty cannot be too strongly condemned, for it is about as logical to attempt to save a man from a fall over a precipice by keeping him in ignorance of its presence as it is to think we can save a girl from the evils of venereal disease by denying her all knowledge of its effects and character.

The public and especially our women should be made cognizant of the fact that marriage does not always bestow everlasting bliss, but that, on the contrary, it may be the medium through which untold. misery may be visited upon countless innocent beings. The fond parent should be taught that a clean bill of health from future son-in-law is equally as important as a substantial salary, and may prove far more important to the poor woman in the case. By reason of these sins of commission and omission, pure women are being condemned to lives of misery by the ones who solemnly promised to love, honor and protect them, and when, in the course of events, these women come into the hands of the obstetrician, it is he who must dig up the history and institute treatment looking to the salvation of the woman and her unborn child.

The obstetrician, therefore, should be ever on the alert for the evidences of venereal disease in the pregnant woman, and should by careful inquiry into the history (paternal and maternal), and by thor

*Read at a joint meeting of the Obstetrical Society of Cincinnati and the West End Medical Society, Dec. 7, 1909.

ough examination, satisfy himself as to the presence or absence of these diseases. Failure to comply with these precautionary measures may prove disastrous to the physician's peace of mind, inasmuch as the birth of a little shriveled-up syphilitic child or the development of a case of specific ophthalmia is likely to remind him of his shortcomings in a most embarrassing manner.

Syphilis, one of the most frequent causes of abortion or premature labor, influences pregnancy differently, according as to whether infection has occurred before pregnancy, at the time of conception or during pregnancy. If infection occurs before conception abortion or premature labor usually results, usually the latter.

Le Pieur, to show the disastrous effects of syphilis upon pregnancy, studied the reproductive histories of 130 women before and after the inception of syphilis, and as a result of these investigations reports that 3.8 per cent. of the children were born dead before, as compared with 78 per cent. after infection. A dead child is the usual result of premature labor due to syphilis; rarely the child may be born alive bearing the marks of the disease, and yet more rarely it may be born without syphilitic manifestations, which, however, make their appearance later; and, again, if infection has occurred many years before labor, the child may never manifest any signs of the disease. Infection at the time of conception always results in a syphilitic child, but as to whether the child owes its disease to maternal or paternal influences is a question. If infection takes place in the early months of pregnancy the fetus generally suffers; if later, however, the child escapes. The peculiar case wherein a woman gives birth to a syphilitic child (infected by the father) and yet shows no signs of the disease herself, even nursing the infant with impunity, is said to be due to the fact that she acquires immunity from the fetus, or suffers from an attenuated form of the disease, so-called post-conceptional syphilis. Syphilis extorts a most frightful toll of infantile lives, being by far the most frequent cause of fetal death. It is shameful, therefore, that no concentrated effort is made to stamp it out.

When infection occurs at the time of conception, it is believed that transmission occurs through the ovum; if, however, it takes place during pregnancy, the disease reaches the child through the placenta. Williams believes that in most instances the disease is of paternal origin, and is transmitted through the spermatozoa, and whether the mother contracts the disease or not depends on whether the father does or does not present infectious lesions at the time of coitus, and since these are usually absent the fetus. suffers and the mother escapes.

The recognition of syphilis in the fetus is of very great importance, as upon such recognition the future treatment of the patient often depends. The syphilitic fetus is undersized, the subcutaneous fat poorly developed or absent, and in the living child

the skin has a dry, drawn appearance and a peculiar grayish hue; is very brittle, particularly over the flexor surfaces of the joints, where abrasions readily occur and expose the corium; the plantar and palmar surfaces are thickened and glistening, and, as Williams puts it, "suggest the hands of the washerwoman." Pemphigoid vesicles may appear on the hands and soles.

If death occur in utero, maceration is rapid, the slightest touch peeling off the skin and exposing the discolored corium; this condition, however, is not peculiar to syphilis, and may obliterate or obscure specific skin lesions.

There are interstitial changes in the lungs, liver, spleen and pancreas, and osteo-chondritis in the long bones. The lungs are enlarged, pale, and scarcely float in water, and microscopically the alveoli are found filled with cast-off epithelial cells, or in other cases there is an increase in the interstitial tissue between the alveoli, compressing the latter but not rendering them completely impervious to air. In the liver we find hypertrophic cirrhosis, the organ being markedly increased in size and weight, increasing perhaps to one-tenth instead of one-thirtieth of the body weight, as normal; there is a marked increase in the connective tissue surrounding the lobules and acini, with here and there round-cell infiltration. The spleen is also markedly enlarged, and frequently increases to two or three times its normal weight (one three-hundredth of the body weight). Like changes are found in the pancreas.

Authorities tell us that, given an enlarged spleen and liver in a suspected case, we are justified in making a diagnosis of syphilis. However, the changes found at the junction of the epiphysis with the diaphysis in the long bones should always be sought, as they are a much more characteristic sign, and are more readily detected, consisting in the appearance of a thick, jagged, irregular, yellowish line separating the epiphysis and diaphysis, instead of the narrow whitish line seen in normal bone. In some cases there is complete separation of the epiphysis and diaphysis.

Microscopically, we find areas of bone formation scattered irregularly through the lower portion of the epiphysis, presenting an irregular appearance, instead of the parallel rows of cartilage cells seen in normal bone. These changes are most readily seen at the lower end of the femur, tibia and radius.

The syphilitic placenta is larger and paler than normal, and, if the fetus is dead, often presents a dull, greasy appearance. In bulk it may represent one-fourth instead of one-sixth of the body weight of the fetus.

Of still greater value are the characteristic changes in the chorionic villi, which appear thicker, more club-shaped, and devoid of their arborescent appearance when teased out in salt solution. There is a marked decrease in the number of blood-vessels, which disappear almost entirely in advanced cases, partly because of endarteritis, but primarily from a

proliferation of the stroma cells, which lose their normal stellate appearance, becoming round or oval in shape and closely packed together.

Passing from syphilis and the frightful train of horrors associated with it, let us now consider that other great venereal disease, gonorrhea, which is, I think, far more prevalent than lues, and certainly more damaging to the unfortunate woman who affords an abiding place for its almost invulnerable micro-organism. I remember well the words of my professor on gynecology, that splendid teacher, Dr. Rufus B. Hall, who said: “A woman may go on unsuspectingly for an indefinite period, until at length a child is born, the tissues are lacerated, innumerable avenues are opened for the gonococcus, and presently the poor woman begins to experience pain in the pelvis." You all know how terribly true these words are, and how the doctor is called in and renders a verdict of pyosalpynx, with unsexing of the woman the final judgment, and all because the unfortunate woman did not appreciate the significance of that discharge and those vague pains which her kind neighbor assured her "did not amount to anything-women always got them," and because some unprincipled biped, mistakenly termed a man, was licensed by the great State of Ohio to blast the life of a good woman by polluting her with the rotten fruits of his licentious career.

While gonorrhea usually expends itself in the pelvis, destroying the appendages and giving rise to inflammatory conditions that will lead to abortion, it may and ofttimes does become a systemic disease, giving rise to febrile phenomena, and has, in a case reported by Dabney and Harris, produced an endocarditis in a woman delivered at Johns Hopkins Hospital. In 1893 Krönig reported nine cases of mild infection, in all of which he was able to obtain pure cultures of the gonococci from the uterine lochia, and later he reported that he was able to cultivate the same organism from the discharges of 50 out of 179 patients presenting febrile puerpera. Newman reports that he was able to demonstrate the gonococcus in the tissues of decidual endometritis.

While gonorrheal infection usually pursues a favorable course as to life, Dabney and Harris report a fatal case, and when we consider the ultimate condition of some of the patients after their alleged recovery, it is questionable if death would not have been the most favorable termination of the two.

The migratory possibilities of the little Neisser bug is demonstrated by Sarsert, who found the gonococcus in abscess of the breast.

The importance of discovering and treating an existing gonorrhea in the pregnant woman is twofold, inasmuch as by so doing we may save the woman's procreative life, and last, but by no means least, we can save what is as precious as life—a human being's sight, and those of us blessed with the use of our eyes cannot conceive what the loss of that blessed sense means. Think of a life spent in darkness, shut off from the glorious sunshine,