some master will be of far more benefit to you than any amount of time spent with a crowd of loafers, who will be only too glad to meet at your office. The waste of time is the waste of money; and if it is not uselessly spent, it may be employed in such a manner as will produce something good for yourself or for the benefit of the world.

Begin early in your career by living frugally, and always within your income; avoid debt, and make your daily balance in your own benefit; lay aside something, no matter how small the amount may be; but let not a single night close in upon you without being able to lie down in peace and feel that you have added something to your store. In no profession is this advice so hard. to follow as in medicine, for perhaps none are so poorly paid; but when you have passed the starvation period, watch carefully, lest you allow your expense account to outrun your slow increase. Leave here prepared to meet all kinds of disappointments, but especially those of a financial character; be ready to meet fate in the open arena, and with sleeves uprolled, wade into the battle of life armed with merit only, and with a determination to accomplish or die, and this spirit will win for you a place amongst the highest of your colleagues. Do not complain that the world does not appreciate you, or that your friends fail to recognize your ability; for the class of men who do this are usually the ones whose merit exists only in their imaginations. If, after giving the world a fair chance to form a judgment of our abilities, we find no recognition of the special claims to distinction on our part, we should feel pretty well convinced that we have been duped by our own self-complaisance, and that we have no such extraordinary ability as we had come to believe. In the long run, and in the majority of instances, the world puts a man where he belongs. If a man has true merit, some person or some circumstance will find him out and bring him to the front. He has only to bide his time, patiently developing his talents and enlarging his resources, and when the proper time comes, he may depend upon it, there will be a place for him.

Cultivate self-respect by avoiding most carefully every act or thought which lowers your own esteem of yourself when you

sit in judgment upon your own heart and life, and in so doing you will make yourself worthy of the esteem and respect of others, and you can depend upon it that your true value will be in due time appreciated.

I shall not weary you by drawing this out longer, but hasten to express our pleasure in having had the privilege of your presence with us for the past four years. As the days, the months, and the years roll on you cannot but look back with satisfaction to the times when we have all assembled together. The work that you have done, the courses that you have been over cannot fail to be a source of gratification. Other schools you may visit, in other lands you may travel while in quest of further knowledge, but your early training here will be in large measure your helmet, your shield, and your mental armamentarium.

Allow me to express my pleasure in having had the happy privilege of meeting you in the lecture room and of witnessing the interest you have always displayed in your work and in your desire to advance in your career.

The time has come when we must part, but it will ever be my wish, my hope, and shall I not say my constant prayer that you, each and all, shall succeed, in the fullest meaning of that word, in your chosen calling:

"Remember in the coming strife,

Be ever patient, firm, and true;
That in the mingling clash of life,

The world will break or bend for you;
Though bright the streams of knowledge flow,

The living fountain is the heart;

Of whate'er we think, or learn, or know,

Love is its noblest, grandest part."

HEMORRHAGES IN AND AROUND NERVE TISSUE.

BY HAZLE PADGETT, M. D., OF NASHVILLE, TENN.

HEMORRHAGES in and around nerve tissue have always been an interesting study, and man for some unknown reason is the

only member of the animal kingdom in which a spontaneous rupture of blood vessels occur, though we have in the cow that condition which resembles, in a way, apoplexy in man, and this is called parturient apoplexy and is an acute infection, and no hemorrhages in and around nerve matter.

Hemorrhages are situated extra-dural, sub-dural, and in various parts or subdivisions of the brain and cord and retina. Individually I have never found a hemorrhage or the remains of one in a nerve ganglion, and from the examination of hundreds of bodies in many of our large American and European hospitals, I have never found a ganglion hemorrhage, and I have never heard such of my master teachers as Virchow, Nothnagel, and Weischelbaum speak of such. The causes of hemorrhages are manifold, but all may be grouped in three different classes, viz. :—

1. Some force acting from without upon a healthy vessel, thus causing its rupture, and it is interesting to note how blood vessels break easily when a force is applied to the head externally and no fracture, and while we know we have concussion of nerve matter, but I am not convinced that in many such cases classed as pure concussion, that minute hemorrhages do not exist, and my experience clinically and post mortem in nerve work is that minute hemorrhages often exist in cases classed purely as concussion.

2. Arterial pressure acting upon a blood vessel that has undergone some histologic change, and this condition is the most

common.

3. Those blood changes in infections and other diseases in which the vessel allows the blood to pass through, and this is very common in Leukaemia and Purpura.

The result of hemorrhages in nerve matter is one of breaking up, tearing, interfering with local nutrition and softening and formation of scars, cysts. If the patient survives, the blood undergoes a chemical and physical change, restoration of tissue and function in many cases, and the only evidence of a past hemorrhage may be a little pigment. The spinal cord and vertebral canal are subject to the same kind of influences as the brain mass, possibly with the exception that in those infectious diseases and

blood conditions that often give hemorrhages in the brain and retina, not quite so common in the cord.

Cord hemorrhages are not quite so common from diseased blood vessels as in the brain, and yet they are frequent enough to demand more study. I have never yet found an extra-dural hemorrhage from any other cause than a force applied externally, and in death by electrocution the brain presents many hemorrhagic foci scattered through its substance, and yet I do not know of a single instance of one extra-dural under these conditions. The most common seat of hemorrhages in the brain mass is in the internal capsule and optic thalamus, but considering the most common seat independent of size and symptoms, I have found the retina affording the greater number. In examining two thousand and five hundred living retinæ for diagnosis and in studying the local manifestations of constitutional diseases and local ones, I have found the retina quite a favorite locality for hemorrhages. I do not mean to convey the idea that a retinal hemorrhage always means an impairment of function, because the hemorrhage is often situated far enough away from the macula to give no symptoms, and is only discovered by the ophthalmoscope as an incidental condition, but, however, the muscular region is a very favorite seat and then we get symptoms. The causes of retinal hemorrhages are in many instances the same as in the brain, as changes in composition of blood and vessel wall.

Septic conditions, pyaemia, septicaemia, ulcerating endocarditis, Leukaemia, Purpura, Brights, Anaemia, Haemophilia, thrombosis of central vein and embolism of central artery, traumatism, and sometimes by a sudden reduction of intraocular pressure. Allow me to state that retinal hemorrhages in elderly people may be a warning of future ones in the brain. In certain inflammations of the retina, as in all nerve tissue, hemorrhages will and do occur. Recently I had a young man with acute malignant Leukaemia under my care, and after several days of nose and mouth bleeding, his vision began to fail, and when I examined the eyes with the ophthalmoscope, I found retinal hemorrhages scattered all over the retina, and in the region of

the muscula. I have found retinal hemorrhages with no constitutional disturbance, and the only condition was one of refraction error. One patient absolutely free from all constitutional weakness had had several attacks of gall stone colic, and one day suddenly the acuity of vision in one eye was materially lessened. I found a hemorrhage around one macula. I believe it is a well established fact among those who have studied brain hemorrhages, that the internal capsule and optic thalmus are the most common seat of brain hemorrhages and from the study of six hundred brains, my experience is the same.

A

Primary hemorrhages in the lateral ventricles are not common, but often occur from hemorrhages elsewhere bursting into the ventricle. Hemorrhages in the floor of the fourth ventricle must not be overlooked in the study of sudden death, and all sudden deaths must not be credited to cardiac disturbances. man hit on the head with a club suddenly died. No fracture, and an examination revealed a hemorrhage in fourth ventricle. Hemorrhages in the Corona Radiata are very rare and no symptoms by which they can be diagnosed. Small cortical, both pial and brain hemorrhages exist under many conditions as injuries, electrocution, sunstroke, meningitis, blood changes, and convulsions as in puerperal eclampsia. It is interesting to note how many and varied are the hemorrhages in head injuries and these hemorrhages distant from the seat of injury. An illustrative case will be of interest. I was called in consultation to see a man hit on the head with a mail bag from a passing train. He was instantly made unconscious, and lived only a few hours. The post-mortem revealed nothing on outside of scalp. There was an interstitial hemorrhage in the deeper layers of the scalp. The frontal and parietal bones on right side presented a number of cracks, but no depressed bones. The tympanic roof was opened, and I lifted off the fractured piece, and through the opening removed the ossicles. The middle meningeal artery was ruptured and a large clot formed. The brain and pia were not torn or ruptured in any part. A number of small pial and brain hemorrhages in different parts of the brain and many of them far removed from the seat of injury.