This condition is painful and transitory, and may occur several times during the night. In cases of downward curvature of the penis due to inflammatory engorgement of the corpus spongiosum and spasm of the musculature of the urethra, the term chordee is applied.

(4) Priapism due to the ingestion of cantharides, which is a form that is seldom or never seen now, since this drug is so rarely used in medicine.

(5) Essential priapism. The latter form, which was the only one considered by the author, may be divided into four varieties: (a) Priapism caused by injury to the spinal cord (either high up or low down) and by blows or violence inflicted upon the peri

neum.

(b) Priapism which is a symptom of cerebral or descending spinal-cord disease.

(c) Priapism which occurs after alcoholic and sexual ex

cesses.

(d) Priapism which comes on a person in ill health in whom it is difficult to obtain data as to local injury and causation, and in which cases there is now a tendency to look upon leukemia as the etiological factor.

In speaking of the prognosis and treatment he says:

Prognosis. Few definite statements can be made as to the prognosis of priapism of any form. In those cases in which injury to the corpora cavernosa or thromboses can be made out, incisions may greatly expedite the cure. The existence of spinal disease necessitates a guarded prognosis. In very much run-down neurasthenic subjects, in sexual perverts, and in those suffering from leukemia the chances are that the priapism will be very persistent and that relapses are apt to occur.

Treatment.—In surveying the results of treatment of the cases of priapism already published, one is forced to the opinion that nothing like a routine method can be laid down. This much, however, can be stated with emphasis: Chloroform narcosis has failed. in every case in which it has been used; ice usually does more harm than good; electricity has no value, and may even be harmful; and leeches to the number of sixteen and forty have failed to produce any amelioration in the condition of the penis, and have been injurious in their depletory effects.

The speaker said that his own preference in dealing with these cases is to resort early to moderate and tentative incisions into the

most turgid part, or into parts which are the seat of continuous pain, or into nodular masses in all probability the result of traumatism. It is always good practice in priapism to use either the potassium salt alone or in combination with mercury, when a history of antecedent or present syphilis is elicited. A number of cases are on record in which the condition was relieved by potassium iodide. Bromide of potassium, chloral, belladonna and morphine may be of benefit, especially during paroxysms. Hot baths, hot and cold spinal douches, sponging with hot water, spinal cauterization, anodyne poultices and perhaps ice-bags may be found beneficial, but the latter must be guardedly used. Any ephemeral or systematic disorder should receive appropriate treatment.

MENTAL AND NERVOUS DISEASES.

CONDUCTED BY J. U. BARNHILL, A. M., M. D.

In Medicine for June, Dr. Harold N. Moyer has offered some very valuable suggestions on the nervous and mental phenomena following surgical operations. He contends that too little attention is paid to nervous states which predispose to shock; that if cases were studied in reference to constitutio-lymphatica-enlarged thymus gland-also with reference to the pupils, muscular tonus as shown by the tendon jerks, reflexes, and co-ordination, valuable data might be accumulated relative to nervous conditions which predispose to shock; their significance pointed out and thus some of the most deplorable accidents in surgical practice might

be averted.

He calls attention to the need of treatment and care

of patient before, as well as after, operation. Confidence in operator should be secured, suggestion employed to quiet mental condition of patient, and large doses of bromides before operation, if needed, to tranquilize the nervous system and lessen apprehension. In the after treatment the neurasthenic state should begin immediately after the operation. The point is well taken that a due appreciation of the importance of the nervous system in surgical important factor in preventing mortality and in restor

work is an

ing health.

DISTURBANCES OF SPECIAL SENSES IN LOCOMOTOR ATAXIA. -Peripheral atrophy or degeneration gives rise to sensory symptoms involving senses in almost all cases of posterior spinal sclerosis. Atrophy of the optic nerve is the most serious, as it is one

of the most frequent. The pale, shrunken disk and peripheral limitation of the field of vision and loss of color vision are common observations. Progressive límitation of the acuity of hearing, accompanying tabes, justifies the assumption of the atrophy of the auditory nerve. Dr. M. Klippel of Paris, publishes (Archives de Neurologie.) a considerable variety of interesting cases of tabes illustrative of disturbances of taste and smell in this disease. The severity of the symptoms varied from complete abolition to various degrees of impairment and perversion (subjective sensations of taste and smell). Sometimes there was marked disturbances of sensibility-commonly in the nature of a reduction of the mucous membrane of the tongue and nose. There was a corresponding reduction or loss of the reflexes, as for instance the nasoconjunctival and that concerned in the production of sneezing. These were sometimes unilateral but more frequently bilateral.

Disorder of smell is asserted to be rather more common and more pronounced than that of taste, but it generally happens that they are associated. Subjective perversions are usually intensely disagreeable; such substances as decayed fish and forces being referred to. These sometimes, though rarely, form the basis of genuine delusions of persecution. Paralysis of the muscles of deglutition, attacks of intense salivation, troubles of sensibility in the sphere of the trigeminus and permanent ptosis are mentioned as symptoms, some of which not infrequently accompany those of taste and smell now under consideration.

Like other sensory symptoms of tabes they appear early in the course of the disease, though when not of considerable intensity they are much less likely to claim the attention of the patient than ever so slight a defect of sight or hearing.

The author concludes that troubles of smell and taste are comparatively frequent in tabes. They are probably caused by a lesion of the nerves of special sensibility, the glosso-pharyngeal, perhaps a lesion of the branches of the trigeminus which preside over the nutrition of the mucous membranes of the nose and mouth, and possibly a primitive disorder of the muscular sense, exciting disgust. The foundation for this last conclusion is laid when the pathology is described. Finally these troubles are always associated, when marked, with others of manifest anatomy and pathology and has numerous references.-North American Practitioner.

FORENSIC MEDICINE.

CONDUCTED BY CLARK BELL, ESQ., NEW YORK.

MEDICAL WITNESSES FROM A PHYSICIAN'S STANDPOINT.— (Read before the Medico-Legal Society, May 9, 1894, by Hubbard W. Mitchell, M. D., President Medico-Legal Society.)-Much has been said and written during the past few years upon the subject of Medical Witnesses in courts of law. This subject has been the theme of many elaborate papers, in which are set forth, sometimes in very pointed and uncomplimentary terms, the unsatisfactory character of the testimony of medical witnesses in courts of justice. Most, if not all of these papers, have been written by members of the legal profession, and none, so far as I know, by physicians. Both the bench and the bar have united in the opinion that medical men, when called to the witness chair, have proved contradictory and generally unsatisfactory. The bench especially has declared that it could gain litttle or no enlightenment from the testimony offered by the medical expert; that their opinions were conflicting, and threw little or no light upon the subject in which they testified. The bar has been equally emphatic in expressing a like opinion, and stating that medical witnesses were biased and partisan, confusing to such a degree that both the judiciary and the legal profession look with unfavorable eyes upon the medical expert in the witness chair. They have not given him that degree of respect which his professional attainments deserve, and have sometimes withheld it altogether, and if his testimony can be dispensed with in any given trial, he is not invited to give it.

The question naturally arises what is the reason for this condition of things, why are medical men unsatisfactory in the witness chair, and why is their testimony held in such light esteem, an esteem which is justly due them. The causes are many, and difficult of explanation. A few only of these can be touched upon in this paper.

It is true that the profession of law is a high and most honorable one. Our courts of justice are usually pure and above reproach, and in the trial of cases they seek to obtain the exact truth, that they may base an opinion upon which to render a fair and impartial judgment. We can justly boast that there exists a better and purer and more competent judiciary in this country than perhaps in any other. Justice is within the reach of all, and

the law extends its strong and protecting arm about the weak, and all men are equal before it. This is the ideal, and it is also generally the fact, but in some cases a different state of things actually exists.

Judges are men; they are human, with the odiosyncrasies, the weaknesses, and the prejudices of other men, and while they mean to be fair generally, and usually are so, yet they are not always above the influences which sway other men, and it sometimes happens that judges are selected through political influence, and the same influence that elevated them to the bench is sometimes exerted to modify or change their decisions. We have had many notable instances of this in the past in our own country, and cases of injustice in other countries have been monstrous in the history of law. It has been a reproach in this and other countries that law is for the rich and not for the poor, and it has been said many times that the rich man cannot be convicted of crime. Shakespeare was aware of this fact when he said, “In the corrupted currents of this world, offence's gilded hand may shove by justice, and oft 'tis seen the wicked prize itself buys out the law."

In modern times the impartiality of the judiciary and its honorable desire to render purer and more strict justice to all is a gratifying sign of the advancement of higher and better ideas.

When a physician is called to the witness chair, the court usually treats him with courtesy and consideration. It recognizes the honorable and learned nature of the profession to which he belongs, and accords him a proper degree of respect.

Not so always the bar. In a given suit of law where medical questions are involved, the plaintiff calls to his side medical men whom he thinks will testify favorably to him, and the defendant does precisely the same thing. If the medical witness for the plaintiff gives testimony which is damaging to the defendant, the counsel for the defendant proceeds to cross-examine him, sometimes with a license that is truly appalling. The medical witness

in such a case is often treated with extreme severity and indignity, and no effort is spared to either confuse him, or to neutralize or render ridiculous the effects of his testimony. This is sometimes so irritating, discourteous, and unnecessary that medical men hesitate before placing themselves in such a position.

The differences of opinion among medical men are much less, when carefully and impartially viewed, than would at first seem.