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there was also found affection of the optic or even in various generations, sometimes nerve and the oculo-motor.
one or two generations being omitted from In the course of time there were noticed the chain. It is very rare that a case should intermediary cases, viz., cases having both occur in a family without any predecessor, the pathological condition of the Fried- and it is for this reason that I report my reich's and cases of the Marie type. On the case, which is just one in kind. other hand, Senator reported cases of the As a rule, symptoms begin between the Marie type that in the course of time lost tenth and twentieth year of age, and ex
the patellar reflexes and assumed the char- tremely seldom as early as the third or acter of Friedreich's ataxia, and anatom
fourth year, but I have been able to find no ically they presented the characteristics of
case in the literature where the symptoms both types, viz., the hypoplasia of the assumed such grave proportions in the early cerebellar tissue and the sclerosis of the
age of three years, as in the case I desire to posterior columns of the cord,
present to you. Clinically speaking, these cases occur in Another point of importance in my case families (two or more in the same family) is the insidious onset which was of rather
short duration, probably six months. After three times a week for two weeks, and then the end of that period symptoms began to once every day, always in the morning soon assume a grave character.
after rising. This continued for six months, G. W., male, aged 572 years. Family at the end of which time he was vomiting history negative as to tuberculosis, alcohol- a few times a day. No medication could ism or syphilis. Child was born after normal stop it. labor, a breast fed baby; was one year old During these six months, father noticed when began teething without convulsions, that his gait began to be slightly unsteady one and a quarter years old when he began and that he could not run about as heretowalking, and 1/2 years old when he began fore. During these six months he also
talking. Was a well nourished and robust complained of severe headache, then baby up to the age of three years. At that vomiting suddenly ceased and the headtime, vomiting without apparent cause at ache left the patient
the patient when he the rate of once in two or three months taken ill with fever which left him after after drinking a cup of tea. Two and a three days, but unable to rise or walk withhalf years ago his vomiting came on once out being supported, and that condition is every week, soon after rising in the morn- present today. Six months after the onset ing, stomach being empty. After a few of this fever he began to show an ataxia weeks the vomiting became more frequent, in the upper extremities which is fully developed today. The musculature of the Marshall Field building contains a wonderbody is in decidedly hypotonic state; patel- ful collection of medical literature which is lar reflexes absent. Argyll-Robertson rapidly approaching a condition of compupil present.
pleteness comparable only with the National The gait is that of a typical tabes ; speech Library at Washington and the Library of is rather slow. Examination of the fundi the Academy of Medicine of New York and of the eyes showed negative results. No of similar organizations in Boston and Philnystagmus; hearing normal. Marked adelphia. A large reading room with exataxia in the upper extremities; no disturb- cellent tables is provided quite away from ance of sensation, sphincters normal. In the general reading room and trained attelligence of the child is absolutely intact. tendants are at hand to assist the readers Nogouchi's modification of Wasserman's who crowd every table from early in the reaction of the blood is positive. The morning to the late closing hour. All the child is unable to walk or stand without current medical journals are on file and are being supported; deep muscular sense never away at the binders and inaccessible, gone; otherwise doing very well.
for the binding is done in the building. In Second St., New York.
The books are conveniently classified and
very completely catalogued. THE MEDICAL LIBRARY AND ITS
But this is not the only medical library in INFLUENCE ON MEDICAL CUL
Chicago. Each of the medical schools and TURE AND REMUNERATION.
the University of Chicago has its own BY
medical library for the use of students and BAYARD HOLMES, M. D.,
professors. The collections are not very Chicago.
complete but they are large enough to give When I came to Chicago in 1882, the the students a conception of the medical Public Library was housed in the upper- horizon which those of a decade ago rarely most story of the City Hall and was under attained. They are large enough also to the management of that prince and pioneer allow improved methods of teaching which, of librarians, Wm. F. Pool. One north room unfortunately, have not been very generally contained the medical department, which adopted. was made up of donations from the Chicago For years the medical school has been too Medical Society, from local medical journals obviously a trade school. It has been so and from individuals. No additions were managed and the instruction has been on purchased by the library board and little at- such a plan that the university has not given tention was bestowed upon the so-called it that recognition as cultural training which medical department by the management. the school of engineering has commanded. While a student and interne in the County The motive and method of the medical Hospital I often visited this, the only medic school has been narrow and smug. Forcal library in Chicago, and remember my tunately for our profession which is now wonder that I was always alone, meeting no reaping the full measure of disgrace from other readers and seeing no attendants. such past neglect, a few schools have set
The present conditions in Chicago are examples of the highest standard in motive quite striking. The Crerar Library, in the and method and in almost every school ex
ceptional teachers have striven more or less every patient to sell him such services as wisely, more or less successfully for better he might demand; now an abortion, now a things. These teachers may not know the dose of poison to relieve a loved friend of extent of their influence on a minority of the horrors and sufferings of cancer, now their students but that influence was felt a placebo for imagined ills. How often is and will be more strongly felt in the future. the tradesman or the so-called business man
The professional man is distinguished shocked at the refusal of the doctor to use from the tradesman by his mental horizon. his knowledge profitably for a purpose The tradesman has a personal outlook, large which seems humane, reasonable and or small according to the extent of his per- charitable ! sonal experience. The professional man's The medical library furnishes the most horizon is bounded by his knowledge of the complete if not the only possible record of experience of the whole profession in the the experience of the medical profession. whole world, modern and ancient, national The text books of medicine are abstracts of and international.
this experience, incomplete, abridged and The tradesman is fixed in his ways and colored by the idiosyncracy and mental atmeans and adapts himself only with the titude of the authors or editors. The phygreatest difficulty to unexpected emergen- sician who goes to his text books and cies and unfamiliar surroundings. The cyclopedias alone for the experience of the professional man, however, who is familiar medical profession of the world will get a with the experience of the world of his pro- telescopic view with the telescope reversed. fession can scarcely meet an emergency
These views map-like and comprehensive which he does not share in memory with are corrected by the study of the original thousands of his colleagues. The education material as found only in the medical of the tradesman is designed to produce library. This study should be a large factor such skill as will produce the most uniform in medical education and in post graduate standard of commercially available excel- study. It orients the cyclopedic and text lence in the work of his hands. The education book view and reduces their horizon to the of the professional man should attain or be proper perspective. designed to attain the most comprehensive It is not difficult to understand the slow and masterful conception in the scholar of progress of pedagogy in the medical school. the complicated relations he may meet in his Barring the exceptional teacher the ancient professional experience. The tradesman method of Edinburg and Paris prevails in must produce the largest possible product most colleges with only the modern graft of of a definite but not necessarily excellent sapless, time consuming and unrelated standard. His whole duty is to his em- laboratory course. The natural conservaployer as expressed in the product of his tism of our profession has been further fixed labor. If he has any other obligation it is in our educational institutions by the Chinatoward himself as expressed in obligation to like written examination demanded by our his class or trade. The professional man state examinations for license to practice owes his first obligation to society as a medicine. The medical school has become whole. The doctor, for example were he one great quiz class. The best teacher is a tradesman would have his door open to the best quiz master. Our medical education is thus co-ordinate with the catechism profession. Where medical culture is low classes of the church.
and the quality of the men who compose it With such a system of instruction, for it is inferior the compensation is also low. can not be called education, the general Where the doctor is “the wise and the good" tradesman-like attitude of the medical pro- doctor, the economic reward increases. fession in relation to fads such as the But the pay is not for personal excellence X-ray treatment, the Bier's treatment and but for a general professional superiority. many other methods of limited or doubtful No trade unionism can raise the doctor's utility can also be understood.
fee. It is the public recognition of the The lumber room behind many a doctor's prevailing high standard of the whole prooffice stands as a mute reminder of the fession that commands the economic reward. easy credulity of our profession to the The system of the union may help the "lame suave argument if not instruction of the ducks” but it can not help the reputation of traveling salesman. The ready acceptance the medical faculty. of methods of doubtful utility, soon places It appears to me little short of a citasits monument more conspicuously in the trophe that so much attention is now given cemetery or in the sad memory of a com- to the trades-union aspects of our medical munity. With what tradesman-like avidity societies and so little to the promotion of did we receive the tuberculin cure of con- medical culture. With the trades-union sumption! How eagerly was the Crede movement in medicine has come the idea of ointment rubbed into our unfortunate pa- medical institutes, similar to the teachers' tients dying of septicaemia! How many institutes which preceded professional felons were opened and foreskins cut off pedagogic training. These medical instiunder the anaesthesia produced by the in- tutes may have a place in supplementing an jection of cocain into the cerebro-spinal inadequate medical education, but they prolake! What numbers of questionable pro- mote sordid mediocrity and encourage the cedures are now being undertaken in the tradesman's attitude of mind rather than profound sleep of scopolamin-morphine that traditional motive of our profession injections! In the same catagory and often which is after all the only thing which digwith the same mute monuments are the nifies our vocation. Describe the useful opposite acts of blind madness, such as the doctor's doings for only a single week in the failure to vaccinate against smallpox, to language of the street and you could not use the serum for and against diphtheria, hire a scullion or even a scavenger to go and the mercurials for syphilis. These through the same manipulations for twice fads and obstinate acts of conservatism are the doctor's fees. It is the attitude of mind not the only evidences of lack of medical and motive which ennobles menial personal culture and rational perspective which face service. us as a profession, but they suffice to en- Why is it that the lackey's uniform, the force our argument.
dress coat of the butler and the waiter, the The reward of the medical profession in white coat of the barber and the cook's cap our economic system depends upon the are hated, detested and abhorred by every general standard of usefulness of the united high minded young man, while the obstet