ELECTION OF OFFICERS.

At the annual meeting of the St. JosephBuchannan-Andrew Co. Medical Society, the following officers were elected for the ensuing year: President, Dr. A. L. Gray: first vice-president, Dr. A. B. McGlothlan; second vice-president, Dr. F. H. Spencer; treasurer, Dr. J. M. Bell; secretary, Dr. W. F. Goetze; censors, Drs. Dandurant and Bansbach, delegate, Dr. W. T. Elam; alternates, Drs. O. E. Campbell and J. I. Byrne.

DR. A. L. GRAY

THE PRESIDENT-ELECT.

The newly-elected President of the St. Joseph-Buchanan-Andrew Co. Medical Society Dr. Albert L. Gray is one of the most prominent specialists of our city. He is to serve during the coming year as the head of the society. Dr. Gray practiced general medicine for many years at Fairfax, Mo., and he removed to St. Joseph as his home in the latter nineties. For a few years he continued as a general practitioner, but drifted into obstetrics as a lone specialist quite a number of years ago. He maintains a first-class lying-in hospital in this city, equipped in a modern sense. Dr. Gray has always taken an interest in medical societies; his poetical bump, in spite of the work of an active life, is still considerably enlarged, and our banquets

The year 1913 will no doubt see the practical working out of some of the greater problems of socialism and medicine. Forces are at work and interest, greater than ever before, has been awakened. Two excellent articles in this issue of the Medical Herald treat of these subjects, although along different lines, and from divergent viewpoints. We call our readers attention to the papers contributed by Dr. Daniel Morton, on page 25, and by Dr. Henry S. Munro on page 37. Both of them merit your careful reading.

INTERNATIONAL CONGRESS OF

MEDICINE.

According to the London correspondent of the Journal A. M. A., the International Congress of Medicine which is to be held in London next August will be one of the largest international gatherings held in this country for many years. It is expected that at least five thousand physicians will be present as delegates. Of those about two thousand will probably come from Great Britain and other English-speaking countries; about one thousand from Germany; one thousand from France and one thousand from other countries. For its largest meetings the congress will assemble in Albert Hall. There are twenty-six sections and subsections, most of which will meet daily; the meeting-places must therefore necessarily be somewhat scattered in various parts of London. The congress of 1881 over which Sir James Paget presided was notable for the presence of Huxley, who spoke on the subject of heredity, and, of Pasteur. While the program of the coming congress does not contain any names great as these, nearly every distinguished man in British medicine is among the officers, presidents of the sections, or contributors of papers.

SO

The congress will be presided over by Sir Thomas Barlow, president of the Royal College of Physicians. The general addresses to the full congress in the Albert Hall will be given by Professor Chauffard of Paris, on medicine; Geheimrat Professor Paul Ehrlich of Frankfurt, on path

ology; Mr. John Burns, M.P., on public health; Prof. Harvey Cushing of Harvard University, on surgery, and Mr. W. Bateson, F.R.S., on heredity. The proceedings in the sections will be conducted mainly in English, French, German and Italian; but with the assistance of interpreters, the delegates may speak in any language. To promote imperial feeling, the British committee has appointed on the various committees representatives of the profession in the oversea dominions. When it was first proposed to hold the meeting in London the invitation was given on behalf of the members of the profession in Great Britain only. Many representaMany representatives of Canada, Australia and India have now been nominated, and the whole empire will now play the part of host to the congress. A fund is being raised to meet the expenses of the meeting, which are expected to amount to $40,000.

Correspondence

OPHTHALMOLOGY ABROAD-SCHAFER'S ORIGIN OF LIFE.

Editors Medical Herald:

In my visits thus far with the several ophthalmologists in their eye clinics, I have seen some things of considerable interest. On reaching London, I naturally went first to Moorfields or the Royal Ophthalmic Hospital. The work there did not seem to me of the same high order with that done in former years. The great masters in ophthalmology, such as Wells, Bowman, Bowman, Lawson, Critchett, Jonathan Hutchinson and Nettleship have laid down their work; and they have as yet no worthy successors. There are now comparatively few graduate students who go to Moorfields for advanced study of the eye. Vienna instead draws the men who come abroad; but each year there is less necessity for American students to come here for instruction. We can offer them equal opportunities in our own institutions now, and European students even are coming to us. This is especially true I think for clinical and operative work. Americans are practical in science, as in everything else; and have no superiors as surgeons and clinicians, though the majority of them possibly find less interest than the Europeans in pure, original research. In my visits to several hospitals in London I saw no operative work of any special excellence; indeed it seemed to me that they were adhering to the methods of a quarter of a century ago. In my own field of ophthalmology for instance, I think I have seen Dr. Weeks, of New York, do the La Grange operation for glaucoma more skilfully than I have seen it done abroad. I may say, however, that I have not seen the operation made by its famous originator; but I have an in

vitation to visit his clinic in Bordeaux.

In Edinburgh, Arglye Robertson is gone, and Berry, his successor, has retired; but I thought that the ophthalmological work at the university there was in worthy hands. They seem to have made somewhat of a departure in the operation for cataract. open, allowing the light to come to the paThey apply no bandage, but leave the eyes tient immediately after the operation. saw several cases in various stages of convalescence, and Dr. Sym and his associates apparently get good results. But the method did not appeal to me, and I am of the opinion of Dr. Ramsay, of Glasgow, who remarked: "If I were to lose an eye by such subsequent treatment, I should feel

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personally responsible for the result." the way, Dr. Ramsay's clinical work is of the same high order as his publications; his Atlas for instance, with which we are familiar. He is besides a genial, hospitable man, and made our stay in Glasgow in every way delightful.

Throughout, I was much impressed by the scientific thoroughness of the work I saw in Scotland. When I went into the University of Edinburgh to see my old friend and master, Professor E. O. Schafer, I found that he had not yet arrived. But his associate, Dr. John Tait, at once laid aside his work and conducted us about, showing us the magnificent equipment of their department of physiology, and something of the fine work they are doing there. In the meantime Professor Schafer came in and insisted on our going to his country home in North Brewick, a charming village on the North Sea. Schafer has the honor this year to be president of the British Association, and his presidential address before that body, on the origin of life, has aroused the interest of the scientific world. His conclusions are the result of a lifetime of study and research. I can give you in this letter only a brief summary of his paper which provoked a storm of criticism in Europe.

He begins by saying that he does not regard life as identical with soul. Life is associated with matter. Then follows at length his reasons for 'believing that the phenomena which are generally regarded as characteristic of living matter, namely, motion, assimilation and disassimilation, growth and reproduction, are characteristic also of matter which we regard as non-living; and that such phenomena in either case are the results of chemical and physi cal action. He gives a brief epitome of his ideas perhaps in the following statement: "The researches of J. Loeb and others upon the ova of the sea-urchin have proved that we can no longer consider such an apparently vital phenomenon as the fertilization of the egg as being the result of living material brought to it by the spermatozoon, since it is possible to start the process of division of the ovum and the resulting formation of cells, and ultimately of all the tissues and organs-in short, to bring about the development of the whole body-if a simple chemical reagent is substituted for the male element in the process of fertilization. Indeed even a mechanical or electrical stimulus may suffice to start development." With all due respects to Schafer's theory, the majority of us will doubtless be satisfied to adhere to the old theories of re

production. The article was published in the issue of September 7th of the London Lancet.

On coming to Paris we found that there too, the old authorities, Penas, Stellwag and Galezowski, are dead. Emile Berger we found, still pursuing his scientific dreams. He is the same genial, delightful gentleman of my earlier acquaintance. At his home he showed me his automatic ophthalmoscope which he uses for detecting errors of refraction; and he explained also his theories of the value of the stereoscope in various experiments in complementary colors. Landolt, in his clinics, it seemed to me, has become less scientific and more commercial; in fact, in Paris I saw little of great interest in ophthalmology, either. practical or scientific. I might qualify this: At the Hotel-Dieu I saw some good work by De Lapersonne, the successor of Penas. He made the La Grange operation, and he impressed me as being in every sense careful, painstaking and aseptic. He exhibited to me, too, his lantern slides showing the diseases of the cornea and lids. The slides were made by a new process which reproduces colors as in living subjects.

I spent a little time in the clinic of Dr. John Galezowski, an earnest, scientific worker who promises, I think, to be a worthy son of his father. While there I met Dr. Poullain who has recently invented a spectacle known as the omnifocal. Both he and Galezowski believe that the glass will become universally popular. Poullain himself who is not only presbyopic, but has about five diopters of hypermetropia as well, was wearing a plano-convex lens having a higher degree of refraction at one edge than at the other. This lens, he stated, corrected the error of refraction, giving an omnifocus by which he could see at any and all the distances. He emphasized the value of the glass for artists and musicians especially, since they require a varying range of accommodation. Poullain asserts that the glass will correct all errors of refraction including aphakia. It is supposed to take the place of bifocal and double lenses and will soon be on the market.

On leaving Paris, we laid aside the scientific work for a few days for other pursuits. But it will be resumed again soon in Munich where I hope to see some little work of Hess. Here in Europe it seems to be the consensus of opinion that he is one of the very greatest of present-day authorities in ophthalmology; I hope to tell you more of him in a subsequent letter.

FLAVEL B. TIFFANY.

The Activating Motives of Professional Conduct.- What we see in any department of the practice of medicine depends upon what we are looking for, and a narrow viewpoint often reflects the individual's pet theory. Theories, giving as they to do excuses for conduct, are fighting tools. They are weapons of defense today, as were tooth and claw and club in the days of our chimpanzee-like ancestry.

We had better take notice of what the theorist means to do, whether in the realm of pathology, surgery, gastro-enterology, eye, ear, nose and throat, general medicine, psychotherapy, psychiatry, neurology, hygiene, sanitation, preventive medicine, sociology or any other department of life.

Let us look for the motive behind his conduct, revealed between the lines of his writing, or in his remarks, as the determinants to his actions, and then decide. is composed not alone of protoplasm, but also of purpose.

Man

Human life and action presents its greatest difficulties to our understanding, not for the welfare of the individual alone, but for the life of the group, which must also be considered. All human thought, action and conduct, as manifestations of life, centers down to and resolves itself into selfpreservation and species-preservationspecies-preservation "The Fight for Self" and "The Fight for the Other Than Self"-expressions of the nutritive and reproductive instincts.

Tell me what any living organism is doing, either in the morphological, physiological, or psychological realm and I can show you that its conduct is in response to the impulsions of one or the other of these primitive instincts. The physician is no exception to this rule, be he an idealist or a materialist.

Amid the unrest and commotion and "What is the matter with the profession?" that is so much in evidence at the present time let us for a motive of better insight be spectators to the professional drama and see ourselves in action, not being afraid to soil our hands by handling the facts as they

are.

In this age when specialists are so crowding our cities, the human organism is divided into compartments, and so especially important has become the treatment of this little gland, or that little kink, until the general practician is up in the air with his feet hardly touching the earth. Along with this state of affairs, we are hearing

much of "the deplorable predicament of the family physician." The spirit of "unity among ourselves" is preached by the presidents of the various departments of organized medicine, but the unity of the human organism and the unity of medicine has been relegated to the winds of the earth. "Oh! consistency, thou art a jewel."

With instruments of precision and facilities for diagnosis and general professional equipment that we have never had before, never was there as big a chance for the general practitioner as there is today. With chronic disease killing half of the. people who die in the United States, or about 750,000 annually, and with the incontrovertable evidence to show that half of these, that is 375,000 would not die if the average health were as good as it was thirty years ago, what clearer evidence do we need that we have given too much attention to non-essentials and neglected one of the most important departments of the practice of medicine. For over thirteen years have I insisted that we have been giving too much attention to the dead body in the post-mortem room, and to the study of the living organism not enough. There never was a discovery in therapeutics that has redounded to the good of the human race made in the dead room, or in the study of morbid anatomy.

We have treated results and ignored the cause. We have searched for structural change so much until we have become blind to the cause of the functional disturbance leading to gross pathological manifestations. Even in neurology we have paid so much attention to nervous inco-ordinations that we have been blind to toxic dis-organization, which was the cause, the recognition and relief of which was the first step toward the cure.

If you do not believe that the principles that I have fought for and given to the medical profession are sound, read the Harvean oration, "The Passing of Morbid Anatomy," by Sir James Goodheart, Bart., M.D., LL.D., Fellow of the Royal College of Physicians and Surgeons, delivered in London, October 18th, 1912, published in full in the October 26th edition of the British Medical Journal, and see how this high authority sustains me from start to finish.

Show me a single late authority on pathology that will dispute the saying that we are coming more and more to the study of

pathological physiology, and less and less to regard as essential the study of pathological anatomy. More and more are the leaders of the profession becoming con. cerned with the study and investigation of function.

Sir James Goodheart in this oration tells us: "The future of pathology will be a physiological one, the study of erratic function that has confined itself into an habitually baneful one. And I see no reason for limiting the pathology thus engendered to function only. It is surely permissible to hold that morbid function may bring about structural change. There is not an organ of the body of which this is not true, but how largely and obviously so when applied to the brain? A large part of the structural disease of the brain is led up to by slow and insidious misapplications of thought and action that ultimately declare themselves as pronounced disease, insanity thus becoming a cancer like mood of the cells of thought, as well as a mood of growth."

Again he says: "Long years ago our trusty and well-beloved Fellow, now Regius Professor of Medicine at Cambridge, wrote a short paper on mental anxiety as a cause of granular kidney. It was to me one of those illuminating suggestions that have added interest to my life. I believe it to be abundantly true, as I do that similar malign influnces, by dislocation in some way, as I suppose, of our correlated impluses, make for cancer. You must have often seen the nervous, anxious, worried man with the phenomena of high tension, and have felt able to predict in posse the future disease of this organ or of that. Such conditions, real diseases though they be, are but functional; but what a "wealth of pathology is wrapped up in them!"

With thousands of American practition. ers having felt the conviction of the truth in this viewpoint, so beautifully expressed by Sir James Goodheart, when I presented it to them years ago in personal lectures, as well as to the best of my ability in a book based upon this premise that has had a phenomenal circulation, and is now in its third edition, I am prepared to state that my long cherished dream has come true, i. e., that the day of the general practitioner is at hand, if only he will seize the opportunity that is within his grasp.

As bearing upon this subject, in a letter recently received from a general practitioner from a distant state, I quote the following extract: "It does seem to me that there is a concerted effort on the part of specialists to make the general practitioners sort

of distributing agents for them, and especially in the colleges the younger students and practitioners are being lulled to sleep by the silver tongued specialists who havc learned the art of closing their lecture on each and every subject with the admonition, this case should be turned over to the specialist.' I believe, however, that the general practitioners are waking up, and many a so-called specialist will be forced again into general medicine. And, perhaps soon, books will begin to come out that are a real help to the man who is up against the proposition in the field instead of being written by men in the study and in the laboratory. It would require only a few writers after your style to bring about the results that we poor devils who suffer have been praying for ever since suffering began."

The so-called specialties in medicine are a necessity. Specialism in all departments of life has come to stay, but it becomes parasitic when it does not contribute to the maintenance of the larger organization. The unproportionate remuneration of the men in the various specialties, as compared with that of the great mass of practitioners in general medicine is ridiculous. The situation but illustrates the incompetency of many so-called medical schools to give our prospective physicians the equipment required to keep them from being preyed upon and used for self-aggrandizement by those doing special work in the various departments of medicine. But the only man who cannot better himself and keep pace with the tremendous progress of the present day is the hopeless incompetent, the laggard and the idler. Efficiency isn't a birthright. It must come through selfeducation. You must take what belongs to you for your patients by sheer force!

Men, not man, have been the redeemers of mankind. The real advances in medical science and in medical art have been the achievements of giant natures, struggling successfully against prejudice and ignorance, competing not for profit, but for service.

We do not forget, however, that the benefactors of humanity have always paid a heavy penalty to ignorance and selfishness for having exercised the privilege of helping the world along, nor that we have endeavored to suppress the thinkers who urged us to desert the beaten patli. But what if they have? Life is in playing the game. But let us at least be true sportsmen enough to do it honestly and fairly, and not be false to the trust reposed in us by our patients.