General Officers: President, W. W. Dawson, M. D., Cincinnati, Ohio; Vice-Presidents, W. L. Schenk, M. D., of Kansas, Frank Woodbury, M. D., of Pennsylvania, H. O. Walker, M. D., of Michigan, J. W. Bailey, M. D., of Georgia; Treasurer, Richard J. Dunglison, M. D., lock box 1274, Philadelphia, Pa.; Permanent Secretary, Wm. B. Atkinson, M. D., 1400 Pine Street, Philadelphia, Pa.; Local Secretary, Valentine Mott Francis, M. D., New York; Librarian, C. H. A. Kleinschmidt, M. D., Washington, D. C.; Chairman Committee of Arrangements, H. R. Storer, M. D., Newport.

The General Sessions will be held at the Music Hall, Bellevue Avenue, adjoining the Ocean House, and those of the Sections at the Newport Casino, also immediately contiguous, which for the first time in its history, and as an act of courtesy, is permitted by its Governors to be occupied for other than the purpose for which its was built.

The following is the programme of the General Sessions:

FIRST DAY-TUESDAY, JUNE 25th. Assemble in Music Hall, Bellevue Avenue, at 11 A. M.

Meeting called to order by Dr. Horatio R. Storer, Chairman Committee of Arrangements. Prayer. Rev. Thatcher Thayer, D. D., the senior clergyman of Newport.

Reading names of delegates and others thus far registered, by permanent secretary, Dr. Wm. Atkinson, of Philadelphia.

Announcement of the programme for the day, of halls for the Sections, that papers not already listed be handed to Chairman of Committee of Arrangements for reference to appropriate Sections, that Judicial Council meet at 2 P. M. at Newport Casino, and that, to prevent the usual haste and confusion, the delegates from the different States hold their sepa

rate meetings to elect members of the Nominating Committee at 9:30 A. M., Wednesday, at the Music Hall, half an hour before the general session.

Address of Welcome by Hon. Thomas Coggeshall, Mayor of Newport; by Dr. Henry E. Turner, of Newport, President of State Board of Health, on behalf of the profession of Newport, and Hon. James H. Eldredge, M. D., of East Greenwich, ex-President of Rhode Island Medical Society, on behalf the profession of Rhode Island.

Presidential Address, Dr. W. W. Dawson, of Cincinnati, Professor of Surgery in the Medical College of Ohio.

SECOND DAY-WEDNESDAY, JUNE 26TH.

Meeting called to order by the President of the Association at 10 A. M.

Prayer.

Reading continuation of registry list, of programmes for the day, and call for reports of elections to Nominating Committee.

Address on Medicine, by Dr. Wm. Pepper, of Philadelphia, Provost of the University of Pennsylvania.

Report of the Trustees of The Journal. Consideration of proposed Amendments tothe Constitution.

Announcement of Nominating Committee, and that it will report at close of Thursday's general session.

THIRD DAY-THURSDAY, JUNE 27TH. Meeting called to order by the President at 10 A. M.

Prayer.

Reading of continuation of registry list, and of programmes for the day, and notice that all new business must be introduced at to-day's session.

Address on Surgery, by Dr. Phineas S. Connor, of Cincinnati.

Introduction of New Business.
Report of Treasurer.
Report of Librarian.

Report of Rush Monument Committee.
Report of Nominating Committee.

Editors American Practitioner and News:

NEW PHARMACOPEIA; TOTAL EXTIRPATION OF LARYNX; GERSTER'S URETHROTOME; WHITEHEAD'S OPERATION.-Pursuant to the established custom notices are out relative to the seventh annual revision of the Pharmcopeia. The convention will be held May next, in Washington, D. C. Owing to the rapid strides made by the medical and pharmaceutical professions in the last decade, this promises to be a very important meeting, bringing about the consideration of some very practical questions. A digest of the criticisms upon the present work, drawn from the current literature from the date of its issue to the present time, is to be placed in the hands of the revising committee.

During a recent visit to the New York Hospital, I was shown, through the courtesy of Dr. Wm. F. Bull, a case upon which he had performed a total extirpation of the larynx for a carcinoma involving this organ. The noteworthy feature of this case is the return of voice. So far as the voice is concerned, he has practically suffered no inconvenience from the removal of this organ. The sound of voice, after the removal of the larynx, has been the subject of some very interesting studies made. by Dr. Landois and Dr. Strübing (Erzengung einer pseudo stimme bei totaler extirpation des Kehlkopfes v. Langenbeck's Arch. f. Chirurgie, xxxviii, 1) The points brought forth by these physiologists are, that the consonants and vowels are produced in an essentially normal manner. The voice, consisting of somewhat indis

tinct articulations, is supplemented by a peculiar characteristic noise, which reinforces both consonants and vowels. This noise does not have its origin at all times in exactly the same place. By the removal of the larynx a dilated chamber is left, which has a constriction above, produced by the root of the tongue in front and the posterior wall of the pharynx behind. In addition to the dilatation so produced, which performs the functions of an air-chamber, there is a strong probability of a secondary dilatation at the upper part of the esophagus for the same purpose. This false voice has a double origin. It has been observed that during the act of speaking there was an approach of the root of the tongue to the posterior wall of the pharynx, and that the principal origin of these false voice-noises was in the first line of the depth between the root of the tongue and the posterior wall of the pharynx. Then, by the encroachment upon the lumen of this construction above, and the forced passage of air from below, there is produced one of the factors in the false voice. In addition, it has been shown that when the base of the tongue is depressed in a forward manner, or protruded and so retained, the voice is entirely lost. The second factor, or consonant formation, is produced by an intense muscular exertion rolling the tongue in a convex shape toward the arch of the hard palate, namely, as by the production of the K (laute) sound (des Gaumen) R and C H. This dilatation, which is exhausted in the production of one or more words, is again refilled by an entirely passive act.

Gerster's urethrotome is the latest addition to the American armamentarium chirurgicum. The instrument, in brief, is of an adjustable kind, consisting of what may be called three bars or pieces. First bar is furnished with a canal within its body for the reception of bar number two, and upon its upper surface a groove or cleat for the third bar. At its intraurethral extremity it is blunt with a recess for concealing the blade attached to the third bar. At its extra-urethral extremity is a thumbscrew to manipulate the dilator, and at the lateral aspect of the same extremity a gauge for recording the amount of dilatation. The second piece, which fits into the canal of the first,

is connected with the thumb-screw at one extremity and at the other is bisected, each segment of which is supplied with a blunt-edged ala. By means of the thumb-screw a projection is made to pass into the split, and by its passage produces a gradually increasing dilatation of the urethral canal. When in use the third bar is drawn forward within its groove, thereby bringing the blade from its recess, and the stricture is divided. The points claimed by the deviser for this instrument over others are, that of its kind it is simpler in construction, is less liable to become out of working order, and is more easily rendered aseptic. The subsequent introduction of a bougie to ascertain the caliber of the urethra after division becomes unnecessary.

Whitehead's Operation. I saw this operation. performed several times in New York last week, by Dr. Robert Abbe, at St. Luke's Hospital. It is certainly one of the most satisfactory operations in rectal surgery; and in those cases suitable for the operation it is far preferable to the Allingham operation. There is no trouble with hemorrhage or septic infection, the convalescence is rapid and the result most satisfactory.

INDIANA AND KENTUCKY STATE MEDICAL SOCIETIES.-At the recent meeting of the Ohio State Medical Society, Dr. E. S. McKee, of Cincinnati, said:

Mr. President and Gentlemen:

Having been elected as delegate from the Ohio State Medical Society to the State Societies of Indiana and Kentucky, I beg leave to report upon these respective meetings.

The Indiana State Medical Society met in its fortieth annual session at Indianapolis, May 1 and 2, 1889. There was a good attendance, the papers read were of high order and well discussed. This organization meets every year in Indianapolis, which to Indiana is a very central and accessible city. It is a great advantage in many respects to have a permanent and convenient place of meeting. If we had in Ohio so central a city as Indianapolis is to Indiana, I would favor a similar custom here. The one great feature of the

Indiana State Medical Society, however, is the thoroughness of its organization. Eighty out of the one hundred counties of the State have county medical societies. Every county society is auxiliary to the State Society. All members of the county organization are members of the State organization by virtue of their membership in the former; moreover, they can not become members of the State Society unless they belong to their respective county associations. The Hoosier doctor on his native heath is, as elsewhere, very agreeable, and the social features of the meeting were not neglected. It seemed, indeed, a reunion of friends tried and true. Your delegate was so kindly received that he feels himself and the Society he represents highly honored.

The Kentucky State Medical Society held its thirty-fourth annual meeting at Richmond, May 8, 9, and 10, 1889. This Society is always remarkable for the richness of its programme.

First, they have reports on all imaginable. special departments in medicine, about fifteen altogether, two gentlemen being appointed to discuss each report. The programme also had many papers on miscellaneous subjects, each paper having two gentlemen named to discuss it. The programme was so full that two evening sessions were required in addition to the day sessions for its completion.

The meeting this year was a very harmonious one, and the Society is to be congratulated on its safe passage through troubled waters which threatened a bitter schism at the meeting of last year at Crab Orchard. Kentucky hospitality is proverbial, but no one can fully appreciate the term until he has experienced the reality. The good people of Richmond did their utmost to render the meeting in their midst a memorable one. The Ohio State Medical Society was again honored by the many kindnesses showered upon its representative.

We may learn from the Indiana State Society the effectiveness of a body thoroughly organized, and from the Kentucky Medical Society how to compile an excellent pro

THE CONGRESS OF MEDICAL JURISPRUDENCE was in session at Steinway Hall, June 5th, 6th, and 7th, with Clark Bell, Esq., presiding. Among the papers read were Eccentricities of Insanity, by ex-Judge Noah Davis, of New York; The Criminal Insane, by Dr. Samuel W. Smith, State Commissioner in Lunacy; Medical Expertism, by Dr. Simeon T. Clark, of Niagara University; Medical Expertism from its Legal and Medical Standpoint, by Dr. Le Monnier, of New Orleans; Live Birth in its Medico-Legal Relations, by Dr. John J. Reese, of Philadelphia; and Volitional Insanity, by Austin Abbot, Esq., of New York.

THE HOUR OF DEATH-There is a widespread popular impression that a very large proportion of deaths from disease take place in the early morning hours-between four and six o'clock. That this is an error is well known to most medical men. From time to time careful observations have been made in hospitals which have resulted in showing that the act of death takes place with fairly equal frequency during the whole twenty-four hours of the day.

Very recently, as reported in the Journal de Médecine, of Paris, March 24, 1889, an investigation has been made, which showed that there was a certain falling off of the number of deaths between seven and eleven o'clock in the evening, but that, with this exception, the proportion of deaths is about even.

We refer to the matter because some of our readers may be glad to have authority for correcting a misapprehension which is of no very great importance, it is true, but which is held with great tenacity by persons who are hard to convince of error.-Medical and Surgical Reporter.

DANGER OF THE SUSPENSION TREATMENT OF LOCOMOTOR ATAXIA.-Dr. Vincent, of Clifton Springs Sanitarium, recently hanged himself unintentionally while experimenting with the Sayre suspension apparatus, which many physicians are now making trial of in the treatment of locomotor ataxia. This unfortunate accident is not the only one, for word comes from France that a man living in the Department of the Dordogne, who was suffering with locomotor ataxia, met his death in the same way. Both these deaths occurred while the persons were alone. The apparatus appears to be free from danger when it is employed under the watchful eye of the physician or in the presence of a skillful attendant.

THE grand jury in New York has found indictments for violation of the sanitary law against Drs. Irwin, Ferguson, and Hance, the physicians who performed the autopsy on the body of Washington Irving Bishop, the mind

reader.

IT is reported that the City Council of Newport, Rhode Island, has appropriated $3,000 for the entertainment of the American Medical Association, at its meeting there this month.

THE American International Congress of Medical Jurisprudence held its first meeting in New York City, June 4th.

MRS. JANE C. STORMONT, the widow of Dr. D. W. Stormont, has given $10,000 to the Kansas Medical Society.

VOL. VIII.

[NEW SERIES.}

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

THE PATHOGENESIS OF HYSTERIA.*

BY JOHN FORD BARBOUR, M. A., M. D. Lecturer on Nervous Diseases in the Hospital College of Medicine, Louisville, Ky.

While an immense amount of clinical material has been collected concerning hysteria, little real advance has been made toward a satisfactory knowledge of the nature of the pathological changes underlying the thousandfold symptoms of this protean malady. The ancient Greek writers were of the opinion that hysteria was produced by the migrations of the uterus throughout the body, pressing in turn upon the various organs, and thus causing the various symptoms of the disease.

Galen exploded this theory by showing the impossibility of such migration. It was then thought to be due to the retention of seminal fluid or blood in the uterus, to the presence of noxious gases (hence the term, "the vapors"), and finally to irritation of the sexual organs. Romberg defined it as "a reflex neurosis caused by genital irritation."

More recent writers have made use of such vague and meaningless expressions as "a peculiar constitution of the nerve elements," "a state of general hyperesthesia of the nervous system,” “an exalted excitability of the sensory portions of the brain and cord," etc. These are merely masks to hide ignorance.

Is it possible at this stage of science to Read at the May meeting of the Kentucky State Medical Society, Richmond, 1889.

No. 1.

formulate a hypothesis which shall be in consonance with the physiology of the nervous system and the morbid phenomena of hysteria, and which shall be sufficiently definite to have a clear bearing upon the treatment?

I shall make the attempt to formulate such an hypothesis, leaving you to judge of my

success.

The action of the nerve-cell was first compared to that of a Leyden jar by Schroeder van der Kolk. When the jar is surcharged with electricity it discharges itself automatically; so, he said, when the tension of nerve force in a nerve cell rises beyond a certain point, an analogous automatic discharge occurs, causing muscular contraction, or sensations, or mental phenomena, according to the character of the cell discharging. The nerve cell may also be compared to a safetyvalve which allows the steam to escape when the pressure rises too high.

There are many things which render this theory highly probable. When a muscle is firmly contracted it is not thrown into an absolute tonic spasm, but contracts and relaxes slightly at the rate of twenty vibrations per second. This looks as if it received stimuli from a number of nerve cells alternately filling up and overflowing with nerve. force.

There is a determination of blood to the head during cerebral activity, and, as a necessary consequence, increased nutritive activity on the part of the nerve cells and increased production of nerve force.

At times the tension of the nerve force rises so high that it is impossible to prevent its escaping in some direction, as, for instance, in a fit of anger.

The activity of the nerve cells increases