Dr. Osler delivered his farewell address at the University exercises at Johns Hopkins University on Tuesday, February 23d. He leaves Johns Hopkins to become the head of the medical school of Oxford University.

Dr. Osler was born in 1849; hence he is 56 years old. His last American address contains a few unpalatable ideas, and will create the impression that Dr. Osler of today is not the man he was ten years ago. The startling statements that little is accomplished by a man over forty years of age, and that men of sixty years should be retired or chloroformed will not meet the approval of many men over forty.

The doctor also says that the effective, moving, vitalizing work of the world is done between the ages of 25 and 40. This is doubtless true in many instances, yet the value and worth of experience is sought from men of advanced years, that is, over forty.

The doctor shows his age in the statement that "Americans borrow their sciences and instructors from abroad." He ignores the American product, American ingenuity, and American practicability. If his statement is worthy, he should not go to Oxford, as he has but four years of usefulness, and then he should be chloroformed.

Dr. Osler criticises the system of American medical education, the teaching of mongrel systems, and the production of ignorant practition

Hopkins, according to Dr. Osler.

It seems fair to assume the existence of too many medical schools-of too many poor schools, yet many of the medical schools of this country are as well equipped with teaching faculties, and hospital and laboratory facilities, as is Johns Hopkins.

Dr. Osler is unfair in his broad criticisms, unjust in his assertions, and unfortunate in his suggestions. He might better leave this country with a gentle suggestion that would stimulate better work among medical men rather than with a crushing diatribe that condemns many able men to utter uselessness. Dr. Osler is like the pessimist that sees only the hole in the doughnut.

It is to be hoped that Dr. Osler will have no difficulties with his Oxford faculty. He will be obliged to pull himself up to their level, or they will have to come down to his semi-American ways.

Dr. Osler is admittedly one of the foremost men in medicine in the world, and his work in medical literature is standard. Naturally he is wanted at a great university, and America will miss his teachings. He ought to have remained.

here.

PERSONAL INJURY WITNESSES

The distrust and suspicion which surrounds the trial of a personal injury suit in court reached a climax in Chicago a few days ago when a physician confessed that he had made a false report concerning the injuries received by the plaintiff in the case. This doctor attempted to excuse himself by claiming that it was "customary to make such reports," and that many consequences "might" follow an injury.

In spite of this self-confessed liar the jury awarded the plaintiff the sum of ten thousand dollars. The case served, however, to bring out the fact that physicians do occasionally pad their report in order to bring about the settlement of claims against the city or some corporation.

It is very evident that such reports are not unfrequently given by unscrupulous physicians, and freely used by equally unscrupulous attorneys to force a settlement of unjust claims, particularly when the defendant is not aware of the existence of the injured person.

Many minor accidents occur of which no notice is taken by either corporations or individuals until prompted by plunderers. All large corporations require immediate investigation, full reports and the names of witnesses by all employees who are in any way concerned in the injury of any person, however trivial the injury may be. In spite of the watchfulness of the employee, and particularly in large cities, injuries may be alleged without foundation, and when substantial proof is wanting. It is not infrequent that cities. and corporations settle many fraudulent claims because they are unable to expose the system of the spoiler. It is comparatively easy to bribe witnesses to testify to a plausible and simple statement. It is not difficult to find a lawyer who is ready and willing to aid a cheat in order to divide a claim, and it is not unheard of to find a doctor who can discover injuries in almost any organ in the body. Three conspirators can put up almost any kind of a claim based upon no injury, or none to speak of, and thus rob a public or private treasury.

Occasionally a fraud is detected and the conspirators confounded and-unpunished. Once in a thousand times a perjurer is punished, but the nine hundred and ninety-nine escape. In the large cities the number of cases settled, tried, and resisted successfully indicate the fraudulent character of so-called injuries.

Corporations often are obliged to settle without trial cases that have no merit, but which, if brought to trial, would involve more expense than a quiet settlement or meet a possible verdict that would encourage other suits.

The court sees the injustice that escapes the eye and mind of spectators, witnesses, and jurors, and is able to set aside wrong deductions and absurd conclusions, and thus discourage indiscriminate frauds. Corporations and cities, as a rule, are willing to adjust and settle just claims, but both must resist the efforts of unrighteous claims and unprincipled litigation.

Doctors will differ, and juries will disregard expert testimony and arrive at their conclusions by sentimental or commercial routes, until the system of both is changed. No one has solved the problem, and no one will without enlarging. the scope of inquiry, the blending of the court and expert, and the prompt punishment of fraud and perjury.

BATTLE OF GERMS

Dr. Edward Waitzfeler, of New York, claims. to have found a remedy for cerebrospinal meningitis. The remedy is diphtheria antitoxin. Eight cases were treated, five of whom recovered, two improved, and one died. Eight thousand units of antitoxin were given each case every forty-eight hours.

This report comes through the lay press, and may be exaggerated, yet it bears a suggestion that is worth thinking about and worth using in these deadly forms of disease. The idea that the toxin of one germ may slaughter germs of an entirely different family is not new, but the application in these cases reported is new. Epidemics of cerebrospinal meningitis leave behind them deaths, cripples, and defectives. Any remedy in the early stages that promises relief from either of the sequlæ is what the profession has longed for. Perchance an antitoxin may be found beside tuberculin that will prevent the ravages of tubercular meningitis.

Our remedies against bacterial diseases must come from the laboratories; fresh air and cleanliness are not enough to overcome deep-seated invaders. Tissue changes or blood states demand a searching and direct combatant. The circuitous method of drugs is uncertain and disappointing.

The

SUBSTITUTION A GROWING EVIL The substitution of drugs is becoming an evil of such magnitude that the profession will soon be obliged to take steps to protect itself. New York papers of October 9th and 10th contain long accounts of a band of counterfeiters who have been selling, in enormous quantities, imitations of drugs in almost universal use among physicians, and the imitations were in some cases almost valueless, and in others were dangerous. It is said that one German firm has spent $100,000 in following up these men. If we are not yet aroused to the importance and the dangers of this subject, let us suppose that Prof. Dunbar next season puts upon the market his pallentin, and when it begins to come into general use, some chemist sends out a cheap but dangerous substitute. Where will it leave the profession? What effect may it not have upon untold numbers of suffering patients?

Does not the profession owe it to the public to

do all in its power to break up such a practice, whether the drug substitute is cheap and inert, or is cheap and dangerous? Of course, the profession cannot raise a fund to ferret out and prosecute men engaged in this business, but every physician can well afford to take some pains to ascertain that his prescriptions are properly filled, and when he learns the name of a substitute he can refuse to give him patronage and to warn his patients against such a man.

This is no plea for manufacturers of this or that preparation, but it is a plea for honest dealing with patients and for the protection of their health and lives.

F. A. KNIGHTS, M. D., SECRETARY A stated meeting of the Hennepin County Medical Society was held February 6th, Dr. D. O. Thomas, president, in the chair and about. seventy-five members present.

The Executive Committee reported by the secretary giving itemized account of receipts and expenditures for the year 1904, properly audited, showing the funds now on hand to be $115.98. They also presented an estimate of the expenses for the year 1905, showing the amount to be raised from dues to be approximately $1,400.00. The report and estimate were received and ordered placed on file, and the dues for 1905 were fixed at $7.00 per member.

Dr. J. S. McNie, P. and S. of New York, 1896, 610 Pillsbury Bldg., made application for rein

statement.

The Censors reported favorably upon the names of Drs. A. E. Johnson, Geo. H. Coffin, Geo. D. Crossette, Arndt E. Ofstad, M. A. Kiefer, and L. Jos. Coria, who were all elected to membership.

Dr. H. L. Staples moved the adoption of the following resolution: Resolved, That our delegates to the State Association be instructed to work and vote to abandon the publication of the papers in the Transactions of the Association. The motion was carried.

Dr. J. G. Cross made a report for the AntiTuberculosis Committee of the Associated Char

ities, and distributed registration cards and pamphlets containing information about the work of the committee and its plan of organization. The report showed the number of cases cared for to be 74 for the past year, most of them cared for by a visiting nurse, insuring treatment and registration of patients and instruction as to methods of preventing infection. Dr. A. W. Abbott presented the following resolution Resolved, That all business matters coming before the Hennepin County Medical Society, except election of officers, election of new members, and fixing of dues and assessments, be referred without debate to the Executive Committee with power to act; providing, however, that any member may object to such reference. Dr. Abbott moved that this resolution be referred to the Executive Committee without debate, and his motion prevailed. Mr. G. F. McNeill, of the Northern Pacific R. R., addressed the Society for five minutes, speaking of the plans of his road for the trip to the A. M. A. meeting at Portland, Oregon, July next, and asked an expression of approval of the plans from the Society, which request was granted by motion.

Dr. L. A. Nippert, for the milk commission, presented a request that certain bills for printing of labels for certified milk be paid by the Society, the Executive Committee having requested the Milk Commission to confer with Mr. Irwin concerning them. The Milk Committee was granted further time in which to confer.

The president announced the appointment of Dr. A. E. Benjamin and Dr. Geo. P. Crame on the Library Committee.

Dr. J. E. Moore read a paper on "Fractures of the Neck of the Femur" with illustrative charts describing his method of treatment. (See page 85.) Dr. Rochford, Dr. J. Clark Stewart, Dr. Little, and Dr. Mann joined in the discussion which was closed by Dr. Moore.

Dr. W. P. Spring showed a considerable number of lantern slides and negatives illustrating -ray work in diagnosis.

Dr. E. J. Brown read a paper on "Optical Quackery."

Dr. F. C. Todd exhibited a giant magnet, and reported two cases of extraction of fragments of steel from the arm by its use.

Dr. C. D. Harrington exhibited apparatus for producing stereoscopic effect with x-ray negatives.

VOL. XXV

No. 6

Headache in most instances is only a symptom. In some it is the most conspicuous symptom, while in others it is the only symptom, and may assume the dignity of a distinct disorder by itself. The kind of headache that I am most interested in, as an oculist, and what I shall speak of to-day, is that due to eye-strain caused by some error of refraction, and particularly that due to astigma, tism. In my experience, and I believe in the experience of every oculist, astigmatism causes more headache and eye disturbances than any other form of error. Hypermetropia, or farsight, comes second, and insufficiency of the external ocular muscles third. Myopia, per se, does not cause headache. Of course near-sight when combined with astigmatism is a factor in its production.

It was Donders, I believe, who first gave us a definite idea of what astigmatism is, and how to correct it. It is divided into regular and irregular. The last named I shall consider very briefly because it offers so few means for its relief.

"Regular astigmatism is that condition of the cornea, or lens, in which the refraction is different in the different meridians of the eye."

In irregular astigmatism we not only have a difference in the curvature of the meridians, but also a difference in the curvature of a single meridian, generally caused by some former disease of the cornea, as ulcers, pannus, etc. This condition of the irregularity of the cornea is extremely annoying to the patient, as he sees all objects in a blurred, distorted condition. It is obvious that glasses will not correct this condition

Read before the Fourth District Medical Society of South Dakota, April 13, 1904.

and our means of relief are limited indeed. In studying regular astigmatism we consider only the two principal meridians, and these we find are always at right angles to each other. The intermediate ones having no focal point we leave out in our calculations.

This subject, gentlemen, is not new, nor one unknown. On the contrary, it is well known by physicians, and by many of the laity, that eyestrain is a common cause of headache. But for all that, it is too often forgotten by physicians, as every oculist discovers day after day. One thing that is often deceiving, and not always known, is that a person may see well, and yet there be a defect in his eyes.

A lady was in my office a short time ago who has been treated for years by a competent physician for headache, without success, and she insisted that her eyes were all right, "for I can see just as well as anybody, and I'm sure my eyes have nothing to do with it." She repeated this several times during the examination. I found her vision 20-30 in each eye, and nearly one full dioptre astigmatism, axis vertical. It was corrected with a plus cylinder, and I am confident her headaches are improved, though I have not seen her. Examination with the test-card at twenty feet may show 20-20, or normal vision in many cases. With this rough examination, eyestrain is too often thrown out entirely, and if the physician does not find the cause, or cure the pain, the patient drifts to another physician, and he repeats the same process.

Good vision does not mean good eyes, although it is generally so considered by the laity. It was Dr. S. Weir Mitchell, who in 1874 pointed out to