Book Reviews.

RETINOSCOPY. By James Thorington, M. D. Philadelphia: P. Blakiston, Son & Co. 1897.

In a little book of 63 pages the author makes a very valuable contribution to the literature of Retinoscopy. He regards it as the best of objective methods for determining refraction. He favors the plain or small mirror. An opaque shield with small perforation over chimney, close proximity of light to examiner (not over six inches) and the constant maintenance of one meter distance between surgeon and patient.

was com

THE EYE AS AN AID IN GENERAL DIAGNOSIS. By E. H. Linnell, M. D. The Edwards and Docker Co., Publishers. Philadelphia. In his introduction the author states that much of the work upon this book " pleted before the appearance of the encyclopedic work of Kneis entitled, 'Relation of Diseases of the Eye to General Diseases,' and I have freely availed myself of any information contained therein." In some respects it is to be regretted that this information was not availed of to a greater degree. On page 17, for instance, it is stated that "the fibers of the third nerve decussate in their intra-cerebral course." According to Kneis, page 18, there is, at best, only partial decussation while by some it is denied in toto. Again, on page 24, nothing is said about the generally admitted decussation of the fourth nerve, and clearly stated by Kneis on page 42. Generally speaking, the author sets forth the eye symptoms of remote lesions with considerable clearness. Throughout there is one fault. A too bare presentation of facts. This is well illustrated in Chapter I, Diseases of the Lids. Again, the rule on page 32, for determining the affected muscle in paralytic affections, works out correctly provided one knows beforehand about homonymous and crossed diplopia and the projection of images; but without this knowledge the rule given is dogmatism. The author could have greatly increased the value and interest of his book by giving more physiology and pathology, in omitting a number of unim. portant symptoms. In spite of these defects, however, the book is valuable. The intimate relation between the eye and general diseases is not unfrequently overlooked by the oculist himself.

Current Editorial Comment.

ERRORS IN MEDICINE.
North Carolina Medical Journal.

THE question is often asked, "Are there any practical results to be derived from the study of the History of Medicine?" It is indeed a question well worthy of our careful consideration and a thoughtful answer. It can be answered by asking another, "Do we profit more from the successes or failures of others?" While argument in abundance, on either side of the question, may be had, yet experience seems to lend the weight of its evidence in favor of the latter, since most of our real success is the avoidance of old

errors.

MEDICINE AS A BUSINESS.

Gaillard's Medical Journal.

IT is idle and Utopian to regard medicine as an ideal calling which we have entered and which we pursue for the good of suffering humanity. We must face the problem presented by "Medicine as a Business." Much ink and paper have been wasted in the effort to reconcile the humane with the mercenary element of medicine. The nearest approach we can make, as conscientious men and true physicians, is to adopt the golden rule, and this suffices amply to guide us in the path of true science, to cheer us in the more difficult labor of true humanity.

PREMATURE BURIAL.

Lancet.

It is impossible to assert that such a ghastly event as burial of the living has never occurred. There are well authenticated cases of bodies having been laid out for interment that yet retained their vitality; still, if the list of alleged burials of the living were subjected to critical examination we opine that it would dwindle to very narrow proportions. We ardently support the reform of death certification. No argument is needed to enforce the desirability-nay, the paramount necessity-of efficient death verification; but we cannot acquiesce in the proposal that no in terment should take place prior to the advent of cadaveric decomposition, believing as we do that a conscientious medical observer can verify the decease of a human being before the body is green in death and festering in a shroud."

162

Society Meetings.

BALTIMORE.

BALTIMORE MEDICAL ASSOCIATION, 847 N. Eutaw St. JAS. E. GIBBONS, M. D., President. E. L. CRUTCHFIELD, M.D., Secretary. Meets 2d and 4th Mondays of each month. BALTIMORE NEUROLOGICAL SOCIETY. Meets 3d Wednesday each month. SAMUEL J. FORT, M. D., Secretary.

BOOK AND JOURNAL CLUB OF THE FAC-
ULTY. Meets at call of President.
CLINICAL SOCIETY, 847 N. Eutaw St. Meets 1st
and 3d Fridays-October to June-8.30 P. M.
S. K. MERRICK, M. D., President. H. O. REIK,
M. D., Secretary.
GYNECOLOGICAL AND OBSTETRICAL SOCI-
ETY OF BALTIMORE, 847 N. Eutaw St. Meets
2d Tuesday of each month-October to May
WILMER BRINTON, M. D.,
(inclusive)-8.30 P. M.
President. W. W. RUSSELL, M. D., Secretary.
MEDICAL AND SURGICAL SOCIETY OF BAL-

TIMORE, 847 N. Eutaw St. Meets 2d and 4th Thursdays of each month-October to June8.30 P. M. J. B. SCHWATKA, M. D., President. S. T. ROEDER, M. D., Corresponding Sec'y. MEDICAL JOURNAL CLUB. Every other Saturday, 8 P. M. 847 N. Eutaw St.

THE JOHNS HOPKINS HOSPITAL HISTORICAL CLUB. 2d Mondays of each month, 8 P.M. THE JOHNS HOPKINS HOSPITAL MEDICAL

SOCIETY. Meets 1st and 3d Mondays, 8 P.M. THE JOHNS HOPKINS HOSPITAL JOURNAL CLUB. Meets 4th Monday, at 8.15 P. M. MEDICAL SOCIETY OF WOMAN'S MEDICAL

COLLEGE. SUE RADCLIFF, M. D., President. LOUISE ERICH, M. D., Corresponding Secretary. Meets 1st Tuesday in the Month. UNIVERSITY OF MARYLAND MEDICAL SOCIETY. Meets 3d Tuesday in each month. 8.30 P. M. HIRAM WOODS, JR., M. D., President, E. E. GIBBONS, M. D., Secretary.

WASHINGTON.

M.

PROGRESS IN MEDICAL SCIENCE.

THE ATTRACTIONS OF

are

SHORE. The delights and facilities which the Eastern Shore of Maryland and Virginia affords the rest- and health-seeker worthily commanding the attention of physicians in this and other localities. The climatic influences of these sections are attracting wider attention as they become better known. For invalids and children the opportunities for rest and recuperation are unsurpassed, while for recreation the tourist, the vacationist and the sportsman will find no better places than can be reached by the excellent system of railway and steamship routes of the Baltimore, Chesapeake and Atlantic Railway Co. The Company's new catalogue has just been issued. It is very handsomely gotten up and copies may be obtained by sending to Willard Thomson, General Manager, Baltimore.

A REMEDY IN NERVOUS DISORDERS when - The CHARACTERIZED BY MELANCHOLIA. "Reference Book of Practical Therapeutics," by Frank P. Foster, M. D., editor of The New York Medical Journal, which has recently been issued by D. Appleton & Co., of New York City, contains an article of which the following is an excerpt, which we feel expresses the consensus of medical opinion as 46 'Antikamnia is adduced by actual results:

an American preparation that has come into extensive use as an analgetic and antipyretic. It is a white, crystalline, odorless powder, having a slightly aromatic taste, souble in hot water, almost insoluble in cold water, but As an more fully soluble in alcohol. . . antipyretic it acts rather more slowly than antipyrine or acetanilide, but efficiently, and it has the advantage of being free, or almost free, from any depressing effect on the heart. Some observers even think that it exerts a sustaining action on the circulation. analgetic it is characterized by promptness of action and freedom from the disagreeable effects of the narcotics. It has been much used, and with very favorable results in neuralgia, influenza and various nervous disorders characterized by melancholia. The dose of Antikamnia is from three to ten grains and it is most conveniently given in the form of tablets."

As an

VOL. XXXVII.-No. 10.

WHOLE NO. 847

IN presenting this subject, I have neither medicine to sell, secret to extol, nor any scheme to make money out of the public, as titles like this are apt to suggest, but simply wish to lay before you the results of nearly five years' observation upon a reliable and harmless way to diminish over-fatness and the evils it creates.

A Few Facts on the Subject of Fat.That you may have a clearer conception of what is to follow, I shall first remind you that, by the natural law of proportion, fat should constitute about the fifteenth or twentieth part of one's weight, and that a person's heft may vary ten or fifteen pounds either way, from the standard of weight to height, without its being significant. Also, that a certain quantity of fat is a blessing, as it not only improves personal appearance, but is necessary to protect the various organs, and to maintain their temperature; and also to serve as nutrition in time of need. For these purposes it is stored in cells in various parts of the body, but more plentifully in some parts than in others.

If any one has a much less propor

tion than one-twentieth, leanness, lankiness, or emaciation is observable; a very much greater proportion than, say, a ninth or a sixth, constitutes corpulence, obesity or over-fatness, and although stoutness to a moderate degree is considered an element of good health, and indicative of the successful working of one's physiology, yet fatness alone is a very poor criterion of health, but, on the contrary, it is an element that has the power for serious mischief, because a very great amount of fat necessarily impedes respiration, circulation, locomotion, digestion and other vital functions, to such a degree, that the person who carries this troublesome bulkiness is more burdened than blessed.

In very fat persons, all the celluloadipose structures become filled to distension, more noticeably about the subcutaneous tissues, the breast and the abdominal walls, also in the omentum and mesentery; on the surface of the heart, and about the kindeys; and if the morbid accumulation grows to be excessive, these all become buried in fat, which mechanically interferes with both function and nutrition.

The Causes of Over-Fatness.-According to my observations, the common causes of over-fatness are either:

Congenitally small lungs with defective oxygenating capacity;

Eating excessively of all kinds of food;

Want of lung-expanding exercise;
Using alcoholics to excess.

The Anti-Fats.-There are numerous well known agents that more or less effectually reduce surplus fat, and also counteract its return. Among these, iodine, bromine, mercury, lead, arsenic, liquor potassii, lemon juice, sour wines, vinegar, purging, sweating, semi-starving, various kinds of baths, smoking and chewing, fish diet, bladder wrack, phytolacca, gulf weed, and various quack nostrums, have each more or less reputation for diminishing weight.

Be

Many of these have a proper place, and a useful power, when taken sparingly, or for a brief while, but unfortunately, when used in quantities sufficiently strong, and long enough continued, to destroy any considerable amount of fatty tissue, they likewise in jure other structures, therefore are necessarily dangerous to health. sides, they all act, either by saponifying the fat, or by producing numerical atrophy, either of which exerts such powerful influence on the lymphatic and absorbent systems, that they not only cause re-absorption and destruction of olein, stearin, margarin, protoplasm, nuclei, and other physiological constituents of the fat-cells, but go further, and annihilate myriads of cell-membranes, red blood globules, and other essential elements of the economy; and as these perish, all histologists know, vitality is reduced, and health is impaired.

It is also well known, that while destroying fat, many of these articles also act as slow poisons, and damage or ruin the alimentary mucous membranes, and the function of digestion; and thus cause mal-assimilation and mal-nutrition, with repugnance to food. class, therefore, is doubly injurious; and if used too heroically, or continued beyond a certain period, anemia, gen

This

eral debility, marasmus, consumption, or other fatal affections may be induced. Various Rational Agents.-No one, however fat, wishes to endanger his health, by unwise efforts to reduce himself, and many over-weighted persons, anxious to throw off naturally their unnatural burden, and aware of the danger of using anti-fat drugs, determinately avoid them, and resort to pedestrianism, bicycling, gymnastics, rowing, massage, electricity, restricted sleep, thyroid extract, skimmed milk and other popular means; while a few begin some dietary system: Banting's, Oertel's, Ebstein's, Bruen's, or others, which all aim to limit the supply of elements that form fat, and to increase its re-absorption; and I am glad to say, to the honor of their founders, that every one of these dietary systems with which I am acquainted seems to be based on rational principles.

But ball-and-chain rules, and ironclad regulations, requiring continuous discomfort, suffering, semi-starvation or abstemious dieting, no difference by whom recommended, are rarely persevered with to a successful degree by persons with simple over-fatness, and we rarely meet anyone wreathed in fat who has not begun on one, or another, or several different plans, and after awhile become tired and abandoned it in disgust.

My Method.-Neither with cases of enormous obesity, nor with celebrities of fabulous proportions, nor with over-fat invalids or semi-invalids have I had any experience whatever, but, if any healthy person weighing less than 300 pounds, with simple uncomplicated over-fatness, whether male or female, wishing to make a fair, honest and faithful trial of my plan to diminish over-fatness, will begin and drink a large glass of the artificial Kissingen water kept at drug stores and other soda water fountains, twenty or thirty minutes after each of the three daily meals, one day, and a similar glass of artificial Vichy water after each of the three daily meals the next day, and persistently continue to take them thus, week after week, he will begin and gradually lose fat, until he comes

down to medium weight and stoutness, and be correspondingly relieved of the discomforts of obesity; after which their use should be discontinued.

A Few Rules to Observe.-These are both cheap waters, and may be taken at the counter, or bought in syphons or in citrate of magnesia bottles, or even in five or six gallon tanks to drink at home. While using them, the person should as a necessary guide, and also for personal satisfaction, keep tally on his or her girth and weight, by taking the chest, (or bust) measure, the waist measure and the hip measure, and carefully weighing his body in the same clothes, and on the same accurate scales, every two or three weeks, and if he has lost much more than a couple of pounds for each week, take a smaller glass of each, at every drink, and if he has lost less than a couple of pounds for each week, squeeze a few teaspoonsful of lemon juice into each glass of the Kissingen to increase its acidity and also add one teaspoonful of the aromatic spirits of ammonia to each glass of the Vichy, to increase its alkalinity.

He should also lend assistance to the action of the waters by using starches, sugars, fats, alcoholics and all other fatforming food but sparingly; avoid over-eating, and use neither food nor alcoholics, except at the regular meals; also take light suppers, so that from then to breakfast, the longest of the three intervals between meals, there may be the least pabulum for fattening; and the best conditions for reduction, and especially that there may be complete emptiness of the stomach during sleep, so that nature may then utilize some of his surplus fat to meet the shortage. He should also take moderate out-door exercise, on foot or wheel, or in any other way that will increase and deepen his respiration.

Results. After drinking these waters and following these rules for awhile, he will find that he is losing part of his girth, and a couple of pounds of avoirdupois every week, and that the loss consists entirely of useless fat; and that his appearance, activity and feelings will all be improved. Just as if there

exists some natural antagonism between these waters, taken thus, and adipose tissue; more especially that located in the favorite fat-centers already mentioned.

Mode of Action.-Now, while it is extremely difficult to search out the ultimate of anything in physiology, for instance, why opium relieves pain and colchicum benefits gout, yet, after studying the subject thoughtfully, I am quite sure there exists either a specific physiological action, or some definite chemical affinity, between artificial Kissingen and Vichy waters, taken by this rule, and abnormally-fat human tissues, that results in a lessening of the fat, with neither purging nor sweating, or injury to brain, blood, muscle or general health; but how, or why, is still debatable.

They may reduce adipose, and prevent further infiltration or storage, in either of several ways: One is, by merely inhibiting or controlling the disproportionate activity of fat-cell nutrition; thus placing less fatty pabulum, and more blood, brain, muscle, nerve and gland elements, at the disposal of the absorbents, while the simple fatty tissue and oily material of the body, being the most lowly organized, are naturally the first to be removed by the corrected physiological processes.

Or, it may be that they act as alteratives, and restore equilibrium to the nutritive processes, by destroying or neutralizing some morbific fat-forming agency, occult derangement of digestion, or perversion of assimilation, that have been causing diminished oxidation, and a consequent accumulation of fat.

Again, when we study their analyses, and consider the complexity of the potent medicinal ingredients that lie hidden in each glass of these waters, another rational hypothesis arises artificial Kissingen being an acidulous saline, and Vichy an alkaline, and both containing salts of calcium, magnesium, potassium, sodium and other minerals, in decided and definite quantities, united with carbonic acid and other gases, it seems logical to suppose, that when alternately mingled with the