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with or without a shortening of the base of the skull, and is partially curable. The idiotism of cretinism causes a fairly uniform set of symptoms; that which depends on other causes exhibits varieties, though not so many as imbecility, which, too, should not be taken to be the result of a single case. Osseous and cartilaginous anomalies about the nose are pointed out by William Hill, chronic pharyngitis and nasal polypi by Heller, enlarged tonsils by Kafemann in one-third of the cases, some pharyngeal or nasal anomaly in four-fifths by Schmid-Monnard. noids are frequently found as complications. Operations to meet all these anomalies have been performed with improvement of the mental condition in some, of the physical in many more, mainly when the anomalies were complications only. But after all, we should beware of the belief in miracles and in infallible cures. Mainly the tonsils have been puffed up to be the chief causes of many human troubles and their removal a panacea. According to a modern writer, it prevents tuberculosis, but the prophet is a little too bold, for he adds that, with the exception of himself, there are very few able to accomplish it. Defective or diseased brains are frequent in most conditions. The former class allows even imbeciles to excel in some ways. In that class may be found calculating experts, chess-players, or mechanical draughtsmen.

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Imbecile persons may be taught sufficiently to prepare for the simple duties of life. There are, however, many transitions between the complete imbecile, the mild imbecile, and the merely slow and dull. That is why the condition is frequently not appreciated. his school the imbecile child is slightly or considerably behind his class, and the laughing-stock of the rest. As he is intellectually slow, so he is morally perverse or is made to become so. He knows enough to lie and libel, to run away from school, and from truant to become a vagrant. It is true it will not do to declare, the imbecile per se identical with the typical criminal, but as many of them are illegitimate, or of defective or alcoholic parents, or maltreated at home, or diseased and deformed, they get, by necessity, into conflict with order and the law. Thompson found 218 congenital imbeciles among 943 penitentiary inmates, Knecht 41 amongst 1,214. When the imbecile is once a prisoner his condition is not liable to be noticed on account of the stupefying monotony of his existence.

What is more to be pitied, the fate of the immature or imbecile half-grown child that naturally acts differently from the normal, or the low condition of the State which, instead

of procuring separate schools for the halfwitted, or asylums, has nothing to offer but contumely and prison walls, and increasing moral deterioration? This is the stone instead of the bread of the Gospel.

Modern society has commenced. however, to mend old injustices. Every civilized country admits irresponsibility before the law below a certain age, and gradually the mental condition of the criminal is taken into consideration and made the subject of study. But still, thousands of children and adolescents are declared criminal before being matured. The establishment of children's courts is one of the things, imperfect though they be, that make us see the promised land from afar. When crime will be considered an anomaly, either congenital or acquired in childhood, or a disease; when society will cease to insist upon committing a brutality to avenge a brutality, when self-protection will take the place of revenge, and asylums that of State prisons-then we shall be a human, because humane, society.

CONCLUSIONS.

Pedology is the science of the young. The young are the future makers and owners of the world. Their physical, intellectual and moral condition will decide whether the globe will be more Cossack or more republican, more criminal or more righteous. For their education and training and capabilities, the physician, mainly the pediatrist, as the representative of medical science and art, should become responsible. Medicine is concerned with the new individual before he is born, while he is being born, and after. Heredity and the health of the pregnant mother are the physician's concern. The regulation of labor laws, factory legislation, and the prohibition of marriages of epileptics. syphilitics, and criminals are some of his preventive measures to secure a promising progeny. To him belongs the watchful care of the production and distribution of foods. He has to guard the school period from sanitary and educational points of view, for heart and muscle and brain are of equal value. It is in infancy and childhood, before the dangerous period of puberty sets in, that the character is formed, altruism inculcated, or criminality fostered. If there be in the commonwealth any man or any class of men with great possibilities and responsibilities it is the physician. It is not enough, however, to work at the individual bedside and in a hospital the near or dim future, the pediatrist, the physician, is to sit in and control school boards, health departments, and legislatures. He is the legitimate adviser of the judge and the jury, and a seat for the physician in the

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councils of the republic is what the people have a right to demand. Before all that can be accomplished, however, let the individual physician not forget what he owes to the community now. Mainly to the young men amongst us I should say, do not forget your obligations as citizens. When we are told by Lombroso that there is no room in politics for an honest man, I tell you it is time for the physician to participate in politics, never to miss any of his public duties, and thereby make it what sometimes it is reputed not to be in modern life-honorable. A life spent in the service of mankind, be our sphere large or narrow, is well spent. And never stop working. Great results demand great exertions, possibly sacrifices. After all, whether everything in science and politics that now is our ideal will be accomplished, while we live or after we shall be gone, we shall still leave to our progeny new problems.

TOBACCO AND THE SENSE OF HEARING. At the Congress of Otology at Bordeaux, M. Delie read a paper upon "Tobacco and the Auditory Sense." Tobacco, he said, exercises a direct and selective action upon the auditory nerve, and nicotine brings about circulatory troubles, owing to its exciting action upon the great sympathetic. It also gives rise to, or stimulates, a trophoneurosis which ends in neuritis of the auditory nerve. Tobacco should be used in moderation, and practitioners should warn patients in whom there is already auditory trouble that its action is specially harmful in their cases. In persons who are already suffering from arteriosclerosis or who have a family history of such a condition it ought to be forbidden, and all the more if they are comparatively young. --Lancet.

FRUIT BREAKFAST.-There is a class of cases which makes the most enthusiastic doctor alive wish he had chosen any other vocation than medicine. Patients with thick, non-circulating blood, torpid lymphatics and dormant secretions. Patients with stiffened joints, gouty deposits, chronic neuralgias, torpid livers, uric acid kidneys, and the irritable nerve centers that go with them. These patients, and others who suffer from errors of nutrition, can be greatly benefited, not to say cured by the simple dietetic procedure known as the fruit breakfast. This means just what it says. Fruit, all the patient wants, and nothing else, for breakfast. No chops, bread, cereals, coffee, tea, or anything but fruit before twelve o'clock. By fruit is meant apples, oranges and grapes only. Chicago Clinic.

The Underfed.

THERE is no one problem in internal medicine of of such importance as that of nutrition. To malnutrition both as a cause and an effect may be attributed many of the complex problems of disease, which in the light of modern inquiry have become of such vital interest. Chemical pathology in its unfolding in the hands of such workers as Herter, Stern, Crofton, von Noorden, Lepine, Grube, Inonge and others, has opened the way for greater advancement in practical therapeutics and a more comprehensive view of the varied problems of nutrition. The recent American literature pertaining to the metabolic diseases is indeed, a credit to American medicine, clinical research and laboratory investigation. The family practitioner should familiarize himself with this advancement as upon him rests the decision as to the success or failure in working out the practical end of such work. The practical contributions of Stern and of Crofton are of especial value in aiding in the recognition of the essential factors, nutrition in the treatment of disease.

In a recent paper (Medical Record, December 31, 1904) Stern discusses "The Yolk Cure" in the treatment of the underfed, and in so doing gives a valuable contribution which will be of aid to every physician in the perplexing problem of the underfed." He says: "It is absolutely useless to try to check bodily decline by forecd feeding, without paying attention to the general condition of the digestive organs and the general assimilatory qualities. As soon as the organism is able physiologically to dispose of the digesta the tide of body-decay is stemmed in all these instances in which some digestive-assimilative disturbance, directly or remotely, stood at the foundation of the malnutrition.

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advanced cachectic states, of course, when preparation of the digestive and assimilative functions cannot be any longer accomplished, body-decline will continue, uninterruptedly, as a rule.

"The treatment of the so-called wasting diseases resolves itself in the prevention of waste. The secret of success in the treatment of consumptive affections lies in the proper management of the organs of digestion and assimilation. The most potent factor in maintaining physiological digestion and assimilation is an adequate food-supply, that is, a nourishment not only sufficient as regards the quantity, but one which the declining organism with the weakened or impaired organs is able to anabolize one, in other words, which furnishes the needs of the specifically affected and altered organism. If the food is not adapted to the digestive and assimilative capacity of the patient, he will slowly starve, although his food receiving organs may be filled with it to the point of bursting.

"The most rational therapy for the digestive and assimilatory apparatus of the underfed as well as for the condition of the underfed, is the one in which the diet plays the most prominent part, that is, that diet which is not selected for the disease but for the individual, that diet which is altered as the patient's condition alters, that diet, in short, which does not call forth anoreia, sitophobia, cardiac irritability, dyspnea, or other untoward phenomena, but that diet which is the least bulky, the least burdensome to the alimentary organs, the richest in heat-units, and the most potent protector of body substance.

"Under "yolk cure" I understand a dietary regimen in which the greater portion of calories is yielded by the yolk of the hen's egg, and in which the latter forms the only fatty substance. Besides this rigid "yolk cure" we may speak of modified forms of the same. A modified "yolk cure" is a dietary regimen which is either (a) not a succession of "yolk days" (that is when days on which yolks do not preponderate in the diet are inserted), or (b) when the yolks although contained in the diet in a certain amount, do not furnish the bulk of the calories and are not the sole representatives therein of the fatty ingesta. a majority of instances a modied "yolk cure" will be found to offer certain advantages over the strict regimen when the patient's alimentary tract is in good condition and after the susidence of the acute decline, or after the patient has started to gain in body-weight. Moreover, the "yolk cure," modified according to the individual needs and desires and remodified from time to time in accordance with the changed conditions in the organism

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is the only means by which a yolk diet may be continued for many months and even for years.

"Yolks are well assimilated. This is proved by the comparatvely small amount of fat in the feces when yolks had formed the exclusive fatty substance in the diet. It is a known fact that the higher the melting point of a fat the slower and more incomplete will be its assimilation. The raw yolk, beaten up, being liquid, is quickly and almost totally absorbed.

Yolks are well-borne and well-liked in almost any amount by almost every individual. This cannot be said of any of the other fatty ingesta. Suet, lard and tallow are not well tolerated by the ordinary stomach in large amounts, and certainly not in quantities that yield the bulk of the necessity heat-units. A great proportion of these fats, 10, 12, and more per cent, usually reappears in the feces. Olive oil, like all vegetable fats, is not wellborne in larger than the ordinary amounts. Besides, the individual of our zone does not easily develop a taste for large quantities of vegetable oil; the acquisition of an aversion for it is much more frequently the case. Cream and butter are agreeable to the patient as a rule, but when taken in amounts to furnish the mass of body-fuel they are liable to decompose in the stomach, setting free thereby fatty acids of low molecular weight.

"Furthermore, the yolk of the hen's egg contains a diastatic ferment assisting in the conversion of amyloid substances. It does not exhibit the fermenting qualities of either the pancreatic or salivary starch-converting enzyme; its ferment-properties, however, are important nevertheless and should not be underestimated. Again, yolks are efficient stimulators of gastric secretion and may be looked upon in certain respects as digestants. They may be partaken of in hydrochlorhydria and in all conditions characterized by deficient flow of the gastric juice. That lecithin is contained in the yolks is a fact too well known again to receive attention on this occasion. The ingestion of yolks hence may tend to the restoration of nerve force and the amelioration of the state of subalimentation.

"Yolks supply but very small amounts of nitrogen. However, it is body-albumin-saving in a much higher degree than any other article of food with which I have experimented. Of course, the excreted nitrogen while under the rigid, unmodified "yolk cure" exceeds that which had been ingested; the deficit, however, is so trifling that, practically, it does not need to be taken into account. The modified "yolk cure, on the other hand, may be so devised that the patient remains in nitrogen balance.

"One fact we may be assured of, namely, that the yolks are well-tolerated by almost every underfed individual. Yolks hence are to be the basis of the nourishment of the underfed. It is for the clinician to determine in what kind and in how much of a menstruum the yolks are to be ingested. Here it is where the difficulty arises. In some cases it will be found the yolks are best administered in milk, coffee, or tea. In others in the form of a modified eggnog. Their beneficial effect in many instances are only noticeable when they are taken together with certain carbohydrates in suitable amounts. Taken in soup or broth, together with beef, lamb, or chicken, they often give rise to bodily improvement which does not ensue in the same degree when other types of ingesta as vehicles. Again, in other cases, especially in those of phthisis pulmonum, an ordinary mixed diet in which the fat substances are merely replaced by the yolks, is frequently all that is necessary to stimulate the assimilative properties and to cause increase of weight, vigor and resistance.

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"In a prolonged yolk diet the proportion of the various types of nutritives may and must be altered according to the prevailing alimentary circumstances; a dietary as outlined in the foregoing, however, may be looked upon a standard in a the suitable cases. The whole eggs may be looked upon as a standard in the suitable cases. whole eggs may be well tolerated in certain cases; when whole eggs are employed extra yolks may be added to them. In order to avoid a monotony and aversion, the latter being invariably the consequence of the longcontinued use of the same kind of farinaceous material, a variety of dishes in which yolks may be incorporated should be devised. All yolk dishes must contain salt in sufficient amounts. Flavoring and seasoning substances may be added to the various articles of food as long as there is no contraindication to their employment; it should always be borne in mind that spices are not inert substances, and that their use may as well retard as increase digestive activity, as the case may be. As a general rule, patients under the "yolk cure" are not subject to obstipation. Mild laxatives may be employed in cases tending to this condition. The "yolk cure" in its various modifications has nothing in common with the legion of unnatural and irrational feeding-systems extolled there, here, and everywhere. It is not a fad with me and I hope it will not become one with others."

F. P. N.

SUBSCRIBE for The Medical Fortnightly.

A Criticism of the Critic.

THE editor of the California State Medical Journal has broken through the rules of genuine criticism, when he serves up a malady of mystic, ataxic confusions in his diatribes against the Journal of the American Medical Association. His vibrations have become aciduious, they should be filtered through good judgment before this inexcusable passionate malady becomes epidemic. There is a hint of the amateur spirit of criticism in his, at times, puerile convulsive attempts at "casting the fly" in search for truth. The first rule of criticism is to search truth to the utmost, and in this he lacks the mathematical exactness which should make his endeavors stand for more than a petulant attack of passion, wherein logic gets mixed with sour grapes and reason with personal animosity.

Editor Jones allows passion and prejudice to get away with his judgment. At times he is paradoxical, and it is like trying to look at the two rings of a circus at once to attempt to follow his criticisms. An editor should keep himself in hand, otherwise his severity of criticism becomes amusing. He should not follow theory too closely, which many love more than truth, but should be an ardent, unswerving devotee of his calling and take facts, not fancies, as the basis of criticisms. The saving grace of criticism is to be a worshipper of truth, then folly will not lead one into the mires where mud slinging (supposedly an evidence of antedeluvian journalism) is resurrected. A critic has no right to have "pipe dreams," he must not be "seein' things at night," but must take communion with himself, search his own little conscience and stick to facts. Such criticism is worth reading, and is an evidence of the fitness of the critic as a thinker "A critic is neither to laugh nor to cry, but to understand."

Editor Jones is doubtless honest in his criticisms, but he lacks equipose, as evidenced in his missionary work, in sending his pensive lays to the members of the House of Delegates, with a hope that some seed will fall, which in the harvest will land him (the sower of good deeds) high in the ranks of journalism. His axe is dull, and he is asking the California State Medical Society to turn the grindstone while he poses as the critic. He should be mindful of the fact that his axe, which is now making the chips fly, may lose its cunning when it strikes facts. Editor Simmons of the Journal of the American Medical Association is a staunch old oak; he cares not for the chips now flying from his bark; he knows that the fibre

of facts in his make-up is resistible to such casual episodes in his life; new bark will cover and not leave a scar where "the picking" is now going on. The Publication Committee of the Journal American Medical Association as the real hewers are the ones to consider in any controversy, the merits or demerits of the Journal. They alone are responsible to the association for its rise and fall along the lines of policy outlined and maintained by them. Editor Simmons is doing his duty; he is sticking to his text, and thus far has sensibly ignored the bickerings of Tom, Dick and Harry, and in this he is sustained by all sensible men. The petty jealousies, fault findings and petulant naggings here and there seen in medical journals against the J.A. M.A., are no credit to higher journalism. It takes a large man, with large views and a belief in the eternal fitness of things to formulate new policies in the progress of government. It takes a large man with large views to formulate new policies in the progress of medical organization. We, personally, believe, and with malice toward none, that the ultimate end of the policies of Simmons will be an evidence to all real thinkers that truly triumphant democracy may exist in medicine as well as in civil government. It is time that full recognition be given to this real truth and let the good work go on. F. P. N.

The Use of Medical

In this age of such a wonderful production of books and journals and at such prices that every man, even though of very moderate means, can have a good working library and be kept in touch with the current happenings in his profession, it is desirable that every member of the profession, should know how to use a library to advantage.

Literature.

It is not the largest library that is the most useful one. We are often surprised at the vast amount of information which a man may man may have, although having access to only a small number of books and journals.

In the first place he reads them thoroughly and retains what he reads. In the second place very much that is published in the new books has already appeared over and over again in the old ones. If each new book was analyzed and all that had previously appeared was eliminated most of the new books would themselves be entirely elimin. ated.

Many men in the profession do not seem to understand how to make practical use of their medical libraries, and for this reason a great

majority of our medical men are still without good practical working libraries.

This subject is one which is receiving an increased amount of attention. One great journal thoroughly read and analyzed on some systematic plan is more useful than all the journals published simply stored shelves.

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The same is true of books. Few busy men take the time to read a new medical book through. It is bought for future reference. It is like an instrument to be taken out and used when required. Therefore, its usefulness very largely depends upon its index, which should be an analysis of its contents.

Everyone who has tried to use books understands how deplorably lacking many of them are in the arrangement of their topics and in the anyalsis of their index. One of the most expensive and elaborate works on "Operative Gynecology" (Kelly) has less than ten pages of index for two volumes of 550 pages each. Many of the most important things in the book are not mentioned in the index, and the arrangement of the contents is such that to find what is wanted one must go on an exploring expedition hunting here and there for it. and there for it. A complete analytical index to this work would triple its value.

Jaundice.

C. E. B.

THE word "jaundice" means yellow, and is a coloring of the skin and other tissues, due to the presence of bile pigment taken up from the blood. There has long seemed to be an unpardonable amount of misunderstanding regarding jaundice and a looseness in the use of terms which only serves to increase the obscurity.

Many attempts have been made to build up elaborate classifications of jaundice, but all of these have been unsatisfactory, owing in part to faulty preliminary education and in part to the early empirical condition of medicine, and to the extreme rapidity of inedical progress, and also to the fact that there is great indifference among physicians to the technical use of the terms which we employ.

In Rolleston's new work on "Diseases of the Liver, Gall Bladder and Bile Ducts, which in many ways is excellent, he starts out by saying that jaundice, like albuminuria, is a symptom and not a disease.

Following this he devotes a chapter of 60 pages to the consideration of the pathology and varieties of jaundice, describing in each variety the signs, symptoms, diagnosis, prognosis and treatment of jaundice. In addition to the general varieties of jaundice, which he