From the list of honorary members, Dr. Samuel G. Armor, of Brooklyn, has passed into the unknown, and by his untimely death our profession has lost, not only a genial and accomplished practitioner of its art, but also an eminent teacher of its science.

It would be a vain task, in the brief time at my disposal, to attempt any review of the progress of medicine during the past year.

One notable feature of medical thought and activity of the past few years, has within the past two years come more prominently before the attention of Detroit physicians. I refer to the organization of systematic training schools for nurses. A few thoughts in this connection have so occupied my own mind as to lead me to present them, in an informal way, for your consideration.

What I may say on this subject, is intended rather as an effort to lead you to give it your attention and careful thought, than as an attempt to excite controversy. I may say, however, that on many of the points raised, my convictions are, in fact, very positive.

What are the objects to be attained by training schools for nurses? What should be the scope of the training and instruction given in them? And where should these schools be located?

I think that all of you will agree with me in the broad proposition, that a nurse is, or should be, wholly subordinate to the physician in the care of a sick person, that the nurse's duties are to watch over the sick in the absence of the physician, and to carefully note, and report to the physician, at the time of his visits, all facts bearing upon the condition of the patient or the course of the disease, all symptoms, however seemingly trivial, that indicate any change, and the action of any remedies that may have been administered; in short, any new phenomena that can throw any light upon the patient's condition during the absence of the physician. In addition to this, it is the nurse's duty to nurse the patient; that is to say, to give to the patient those personal attentions which are essential to ensure the patient's comfort and well-being and to secure and maintain, as far as possible, the conditions most favorable to recovery. This, of course, includes constant attention to the temperature, ventilation and lighting of the sick-room, to the personal cleanliness of the patient in all its multiform aspects, the preparation and administration of food and of such medicine as the doctor may prescribe or direct, the care of all excretions, so that while they are not permitted to contaminate the air or communicate contagion to others, they may, if desired, be subject to the personal inspection of the physician.

The intelligent observation of symptoms, presupposes, of course, skill in the use of certain instruments of precision, such as the thermometer.

It may also be necessary for the nurse to be accustomed to the use of electrical appliances.

All these duties, however, are to be performed un

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The function of the

der the direction of the physician. nurse is to render effective the doctor's directions for the care and management of the patient, and not to supersede the doctor; it is to act as an efficient but subordinate ally, but never as an equal in assuming the responsibilities of treatment. The responsibility of directing treatment rests alone upon the doctor.

The monthly nurse is not to be an obstetrician nor an accoucheur; the gynecological nurse should not be a gynecologist; the surgical nurse has no need to be a surgeon; and the medical nurse has no need of that accurate knowledge of disease, therapeutics, and materia medica which will enable her to diagnosticate the disease of the patient and prescribe appropriate remedies. The necessity for the development of a class of "trained nurses" does not arise from the insufficient number, nor the inadequate attainments of the members of our profession. Indeed, it is the more skilled and proficient of our number who feel most keenly the need of trained and skillful nurses, and who most highly appreciate their services.

Is there not in the brief resumé of the duties of the nurse which we have given, scope enough to absorb all the rightly directed energy of any young man or woman of ordinary ability, leaving neither time nor strength for attention to other subjects with which, as nurses, they have legitimately nothing to do?

A serious danger to be avoided in the training of nurses, is in placing too much stress upon the value of lectures and didactic teaching. These undoubtedly have their place and are valuable parts of a system of training for nurses, but they must unquestionably be subordinate to the vastly broader and more essential task of training and developing the mental and moral faculties and habits, which can be attained only in the performance of the duties which are to engross her life energies.

This leads us to the obvious reflection that a training school for nurses must be in and an integral part of a hospital. You can no more make a nurse by lectures than you can teach one to swim without water.

The acquisition of a habit of close, accurate and comprehensive observation through the systematic training of the faculties, the acquisition of the ability to reproduce her observations in concise language for the physician's benefit, the acquisition of an intimate knowledge of human nature in all its morbid phases with the development of her own capacity to adapt herself to each varying phase are to be achieved only by actual experience and work under competent guidance in the care of the sick. It is thus, rather than in the acquisition of mere precepts that the qualities of a really skilled nurse soonest become manifest.

But we are asked: Can a nurse know too much? Is not all knowledge, especially that of disease and medicine, likely to prove valuable in the performance of her duties? To this we may reply by asking: If, in the pre

paration for any special calling or work, it is not the obvious part of a wise man to concentrate his energies upon the attainment of that which is clearly indispensable to the highest proficiency in his intended calling?

We may also add that, strange as it may seem, one may know too much of that of which he has no need,since by giving his time to its acquisition he has diverted his attention from that which is necessary.

Were all humankind perfect, to know a little of a wide and difficult subject might not interfere with the proper discharge of one's duties in a subordinate sphere to which this knowledge had no direct application. as the material out of which nurses are made is not perfect, and nurses are subject to like infirmities with the rest of us, the possession of a certain inadequate smattering of some of the branches of medicine will be likely to expose them to an almost irresistable temptation to put in practice their inadequate knowledge.

The old maxim, "Sutor ne ultra creipdam," is as wise as when first formulated.

What necessity is there for the nurse's knowing the action of drugs and their therapeutic doses, to enable her to discharge her legitimate duties as a nurse?

The answer will, doubtless, be: To guard against mistakes on the part of the attending physician.

Must the nurse then be made consulting physician, and her opinion be sought every time that the physician prescribes a potent remedy?

We raise no objection to any competent person's studying medicine to fit himself or herself to be a physician, but we do most earnestly pray the powers above to save us from nurses with a smattering of medical knowledge in its various departments, without that more than human grace which will restrain her from acting upon her own inadequate knowledge rather than upon the directions of the physician.

Let the nurse be thoroughly trained in the art of observing and reporting her observations; let her have learned at the bedside the thousand and one devices for

let her master the art of massage and lomi lomi and of passive exercise.

Let her be imbued with a sense of the importance and responsibilities of her legitimate duties. But let her bear well in mind that hers is not to be the directing mind in the treatment of the patient; her duty must ever be subordination.

Let the sailor be ever so learned; let him understand the secrets of the stars and the science of navigation if you will, yet it is of vastly more importance to the safety of the ship that he understands all the duties of the ordinary seaman and promptly executes the orders of the captain. Should he in the critical hours of the storm disregard the captain's directions and act upon his own judgment, both ship and sailor will helplessly be cast upon the rocks or şink in the depths of the sea.

May the present activity in the training of nurses receive a wise guidance, that in future years physicians may not find that they have trained them up to be thorns in their sides.

The further question arises: Who should be charged with the direction of the curriculum of the training school for nurses?

Should it be medical men, or a board composed of the laity? Or should it be merely a graduate of a training school for nurses and an experienced nurse?

In the light of what has been said, can there be any doubt as to the answer to this question?

Commending the thoughts so informally presented, to your further consideration; thanking you all for the forbearance and courtesy excercised toward your presiding officer for the past year, I wish that the coming year may be a more prosperous one for the Detroit Academy of Medicine than any previous one.

HYPNOTISM AT SALPETRIERE.

BY HENRI G. MC GREW, M. D.

let her have mastered the occult science of immaculate cleanliness; let her be well grounded in the art of preparing food for the sick, and so presenting it to them as to tempt and not disgust their morbidly sensitive tastes; let her be prepared to administer medicines with mathematical accuracy of dose, whether prescribed by drops, minims, drachms, ounces, teaspoonfuls, cubic centimetres, grains, grams, pints, or litres, as the case may be; let her be able always to give accurate measurements in litres, millimetres, inches, centimetres, feet, yards, or metres; let her not be puzzled if her thermometer gives only degrees in the centigrade scale, or if the physician order a bath of 40° temperature centigrade. Let her know all these things, not merely by reading of them, but by actual personal experience, and then, if her exuberant energies still demand new worlds to conquor,

teresting on account of its interesting connection with nervous and mental diseases and their treatment. There is at present edited in Paris a journal called the Révue de l'Hypnotism, the first number of which appeared on the 1st of last July, and is published monthly. This journal is devoted entirely to the subject of hypnotism.

The following is an account of a case I saw in the service of Prof. Charcot, at Salpètrière, on which hypnotism was demonstrated by Dr. Babinski, who supplies Prof. Charcot's place at the hospital during the summer vacation. Dr. Babinski stated that this one was rather more susceptible than others in the ward, therefore he had selected it. The patient was a young female, suffering from hysteria accompanied by an anæsthesia of the right side. Dr. B. divided hypnotism into

three periods, or stages, viz: the lethargic, the cataleptic, and the somnambulistic, and then proceeded to put the patient under each of these conditions.

The lethargic state was brought about by making pressure at a particular point on the shoulder, the patient having been told previously that such pressure would have that effect. In this state the patient seemed totally unconscious and to all appearances dead. The muscles were all relaxed, the organs of sense closed, the movements of the heart and lungs were regular but more feeble than in the normal state. From this condition the patient was put into that of catalepsy, by simply raising the eyelids. Here again a totally different condition of things existed. The organs of sense seemed open to external impressions, the muscles acted and responded quickly to stimulation, viz: pressure over the facial nerve occasioned violent contraction of the muscles supplied by that nerve, friction over the biceps produced contraction over the forearm, etc. These contractions remained, and in whatever position the limbs were placed, they retained that position, giving the impression that the patient was simply an

automaton.

Another interesting feature of this state was that the countenance, or facial expression, responded to the position of the limbs, for example, when the hands were placed to the lips, as in the act of throwing a kiss, the face assumes at once an expression of pleasure, and when placed in a pugilistic attitude, the expression changes to one of rage.

The next interesting phenomenon was that of causing one-half the patient's body to be in the lethargic state, and the opposite half in the cataleptic, which was brought about by simply closing one eyelid, whereupon that side immediately returned to the lethargic condition, as was clearly shown by the different tests, on the action of the muscles.

The third state, or the sonambulistic, was produced by friction on the forehead. In this condition the patient seemed, to all intents and purposes, to return to her natural condition, but was completely under the control of the physician, and it was in this state that suggestion was practiced, and the various phenomena which are commonly demonstrated by the so-called mesmerists, i. e., causing the patient to see and do various things which were suggested. The patient was restored to her normal condition by simply blowing or snapping the fingers in the face, and acted exactly as one awakening from a profound sleep. An interesting point concerning the anesthetic condition, was that on the application of a powerful magnet to the affected side, the anesthesia completely disappeared, and the opposite side became anæsthetic, as was clearly shown by passing a pin or needle through a thick fold of skin. Dr. Barbinski had many other cases in the ward, on which hynotism and

The painful nature of these incisions led me to resort to the Pictet liquid as a very proper agent to control the pain, and at the same time to thoroughly disinfect and sterilize the sloughs as they were exposed. The very volatile character of the liquid, and the rapidity with which it evaporates from the surface to which it is applied, makes it powerfully anesthetic through the intense cold it produces, while the sulphurous and carbonic acids which are suspended in it are powerful sterilizing agents and disinfectants.

I have now used this liquid many times for the purpose of allaying the pain caused by opening boils and abscesses in almost every region of the body, and have found it a most useful agent for that purpose, and it is mainly of its use in the treatment of carbuncle that I desire to speak in connection with the following case:

Mr. H., civil engineer, aged 30, of good habits, had been feeling badly for a week, when he consulted me about a large swelling on the back of his neck, on the right side, It was circular, two inches in diameter, with margins raised, and was studded with numerous yellowish crusts, which, after removal, disclosed openings leading down into densely indurated and necrosed tissue. In general depth the carbuncle reached the trapezius muscle, and involved much of the fascia and cellular tissue above it. The patient was exceedingly nervous and fearful of treatment, and had applied poultices of laudanum and flax-seed, with hopes of getting some relief from pain and much-needed sleep.

I applied the Pictet liquid by opening the valve in the bottle and holding the nozzle where the vapor would strike the surface of the carbuncle. While the vapor was evaporating, the skin to which it was applied changed