influence of a strong solution of atropia sulph. for the purpose of relaxing the ciliary muscles, dilating the pupil and enlarging the ciliary vessels, that the increased quantity of aqueous might readily be carried off and also to relieve the ciliary neuralgia. Having treated other cases with success in the same way, I feel that I can confidently recommend the treatment to my brothers in the profession.

[VIII.]

THE ECLECTIC

METHODS OF TREATING ANAL

FISTULA.

BY A. J. HOWE, M. D.

The treatment of any disease according to enlightened experience, and liberal and rational views, is eclectic. The surgeon who slits open every fistula that falls into his hands, and declares that such is the best course to pursue, is not eclectic; and the mountebank who always employs a ligature in the management of anal fistula, and says the method is uniformly the best, is also not eclectic. An old man, with one buttock as full of fistulous canals as an ant-hill is burrowed with passage-ways, should be treated with a ligature carried through the main sinus that enters the anus and reaches an opening in the skin some inches from the anal aperture. This ligature is to be tied and then allowed to cut its way outward, weeks, and even months, being consumed in the process. The ninety and nine branches, more or less, are to be followed with a grooved director and slit open with a bistoury. By this thorough and radical means, all the fistulous tracks can be found and rationally treated. No alarming hemorrhage need be feared, for the bleeding will be moderate. The incisions are to be watched, as they will bridge over in places, creating sinuses not inclined to heal. Lint, wetted in a weak solution of chloride of zinc, should be crowded into the cuts every day. By the time the incisions have healed from the bottom, the ligature will have cut its way nearly out, all traumatism coming to an end at about the same time. If a man or woman have a single fistulous pipe, either

leading to the mucous surface of the anus or near that point, the sinus may have a grooved director sent clear through it, and the thin unpunctured lining of the anus, and then the fleshy covering may be slit open with a knife. If the local and constitutional treatment be good, the fistula will be cured in two weeks; but if a branch exist, and it be not incised, weeks will be consumed in futile treatment.

If a fistula exist at some distance from the anus, and there be no inclination for the morbid pipe to burrow in the direction of the outlet of the bowels, a ligature in a needle may be used, the point of the implement entering or emerging from the fistulous opening in the skin, and cutting a new passage the remainder of the way. It is equally as good to lay open the incomplete sinus.

A long fistula of recent origin, which begins near the sulcus, between the nates, and extends out to either buttock, just beneath the skin, is to have a ligature placed in it, a probe, ten or twelve inches in length, being employed as a bearer of the ligature, and the point cut upon when it has reached the blind extremity of the fistula. This ligature is to be left in place for a week or ten days, and then removed. The inflammation excited by the presence of the cord will cause the back to granulate and heal. This saves scarring the integument of the nates in a useless manner.

In the treatment of fistula in ano, it must be borne in mind that no permanent and satisfactory cure may be expected without systemic impressions, made by appropriate remedies. I will not undertake to cure anal fistulæ unless constitutional means be faithfully employed.

Several years ago, while I was treating patients affected with phthisis, and who incidentally had fistulæ about the anus, I was, on several occasions, told that the fistulous pipes were cured through the effects of internal medicine alone. This led me to employ similar remedial agents when treating fistulæ in patients who had no lung complications. Since I adopted that course, I have had no patients with fistulous disease whose morbid conditions have baffled my efforts to effect cures.

M. Sig. Half a teaspoonful every three hours. If the bowels be constipated, let a laxative be given as the conditions may indicate the need of such medicine.

Let the diet be simple, yet nutritious. The idea is to overcome the dyspepsia, tuberculosis and bodily waste that beget and sustain a fistulous disease. The prescription given above

promotes digestion, absorption and assimilation.

[IX.]

AUTOMATIC MIMICRY.

BY J. TYLER KENT, M. D., ST. LOUIS.

The unconscious tendency to mimic each other exists in animals as well as human beings. This imitation is made possible by exercising an attempt to act like a person or animal, which shows that the will may be made to limit or originate a mimicry of action or thought. But originally this imitation is a part of our consensus. In all the lower acts of our animal natures, we are inclined to imitation. It is not an act of the will when one canine imitates another in the act of urinating at a post or corner-stone. The same imitation is noticed in human beings in the act of yawning. I have noticed one person in a large party, who had been vulgar enough to yawn, to be followed by an effort to suppress the act by nearly all parties in the room, and it was done unconsciously. I have often observed the grimaces of the tragedian reflect themselves upon the faces of the audience. I have often exercised my will to overcome these tendencies to imitate. It is a part of human nature also, to shed tears in trying scenes of entire strangers, who, we see, are crying. An audience will keep pace with the actor at all times, manifesting the changes by facial expressions which correspond with those of the actor, if he play his part in harmony with nature. Many spasmodic ailments reflect themselves upon those susceptible to imitating diathesis.

Hysterical females have a greater tendency for some kinds of spasmodic mimicry, and some seasons and localities have been favorable to a diminished will power or inhibitory influence over the consensual defects. An impairment of inhibitory centers would seem to be the essential wrong in choreic movements that have appeared from time to time as dances in endemic form. Such an impairment may be the result of an unknown influence, confined to any locality. Examples of this may be found by referring to the history of ancient dances in many of our text-books. The diminished inhibitory power may some day be better understood; then shall we the better comprehend such imitations as carry us into pathology. It would seem, then, that this tendency to enter into all the details of movement performed in sight, is a part of our nature when the inhibitory force is lost or in some manner not elaborated-when the will is unable to exercise the influence that causes the inhibitory force to manifest itself. This inco-ordination, or broken harmony, is observed in men and women, but oftener in the latter. This feature is a salient condition with all hysterical women. With slight depressing influences, the volitional centers manifest their weakness and the patient gives up to go with the tide. These characters are as numerous as they are prominent throughout the history of medicine. The pandemic dancing mania of the middle ages furnishes some prominent specimens. It existed during the fourteenth and fifteen centuries in the region of the Rhine. Crowds gathered, of men and women, and danced in open street, both night and day. It is written, at first many lookers-on were not afflicted, but these finally danced as well. The contagious mimicry could not be resisted. It is known that this dancing mania followed the plague; doubtless the fear instilled by the existence of the plague reduced the inhibitory force and predisposed these people to the disease then denominated as St. Vitus' dance. It was thus called from the fact that they were sent from Strasburg by the magistrate's order to the chapel of St. Vitus, in Zabern, where they might obtain masses for the relief of demons which possessed them. Traces of this mimicry have appeared from time to time to the present.

Even now, cases are occasionally observed in which hysterical mimicry is prominent. A woman, predisposed, may appear perfectly well until she is brought into the presence of a violent hysterical female, when she will soon manifest the disease in its highest state of development. These are not all malingerers; they lack power to control their actions, and they give way. I have several times witnessed mimicry of this kind. A female among my patrons was once suffering from an active hysterical mania, and convulsions of cramping. Indeed, it was exciting to attend her, as she needed close attention to prevent violence. Shortly, my only assistant, a lady of good breeding, began to scream, dance and pull her hair in a wild and excited manner; fortunately, I was relieved by the opportune appearance of a neighbor lady, who had heard the cries of these women. I have attended females in labor where an attendant would affirm that she had regular pains. Often the imagination is colored by such a belief, and a close study of this automatic mimicry adds to the interest of such pictures in the imagination. This motor mimicry needs only a passing mention here, but another and different aspect of mimicking is that of thought and word imitation. Some persons are such imitators of facial grimaces and expressions, that the thread of thought, which always accompanies such an expression, is mimicked as well as the facial expression.

For experiment, let any person assume the precise expression of an individual, and note the thought or character of feeling, and he will find the order of thought and feeling will be similar to that of whom he was mimicking. To make this experiment a success, the mimicker must be correct in his mimicry of such facial expression.

Burke says of the great physiognomist, Campanella: “When he had a mind to penetrate into the inclinations of those he had to deal with, he composed his face, his gestures and his whole body, as nearly as he could, into the exact similitude of the person, and carefully observed what turn of mind he seemed to acquire by this change. So that, says my author, he was able to enter into the dispositions and thoughts as effectually as if he had been changed into the very men."