parties to the action and paid an additional compensation, which naturally biases his evidence in favor of the party which pays him. It would be better if a reasonable compensation were allowed to medical expert witnesses, to be determined by statute, or perhaps, within reasonable. limits, by the trial judge or magistrate, and any attempt at additional compensation by either party to these experts made bribery, with a corresponding penalty; this compensation in civil cases to be taxed and paid as other costs of action, and the witness placed on the same footing in regard to demanding fees as other witnesses; in criminal cases to be paid by the county where the trial occurs. This might take the matter of medical expert testimony out of the category of paid witnesses and relieve it from the present alleged stigma of subordina

The modern surgeon has of necessity invaded the domains of Biology. As custodian of the life forces and life structure of his own kind he must have to do with other life forces and other life structures. He recognizes the ceaseless strife among the countless forms of life force for the subjugation of every molecule and atom of matter. He occupies middle ground between the contending armies. He is in the midst of the fight, and watches with grim concern the maneuvers of the one and the defences of the other.

His skill depends largely upon a right use of acquirements essential to promote the best action of the life force on the one hand and the paralyzation of such force on the other. It is his province to familiarize himself with the form, habits and requirements of little things their needs as well as the agencies for their destruction; in short, to round up their whole life histories from incubation to dissolution. This he of necessity accomplishes at very long range-as far beyond the pale of his own unaided senses as are the problems to be solved beyond the perception of the unschooled mind of the

savage.

A judicious handling of heat, light, moisture, color and the microscope annihilates the long distance. He possibly may go still further and scan the bricks and the mortar of which the bacilli and cocci are builded, the spaces, molecules and atoms, by his ingenious right-angle illumination. Roentgen rays are his ever ready searchlight, with which he wanders through the multiplicity and complexities of tissue, or dispels the darkness that provides a congenial habitat for incubating germs that wither. in the glare, to the relief of a passive and too often otherwise helpless host. In this work he already anticipates the help to be derived from radium, uranium, polonium and other self-illuminants, and with keen alertness even now with these helps he is blazing his way into the hitherto obscure abodes of insidious and invisible foes, with evident demoralization and possible extermination. His mind's eye sees the principle of life broad and limitless, flowing on from everlasting to everlasting; not

fed by tributaries, but itself tributary to everything that lives; its bosom studded with Weismann's Idants and Idds, or by something representing them, to mold the species and genera and to transmit from parent to offspring form and habit and distinctive traits down through the ages. From the occult and heredity it is but a step backward to the impresses of environment, temperature and habit, and from these but another step backward to the less abstruse and more commonplace.

If it is true, as has been asserted, that the human eye is so imperfect that it is capable of utilizing but a small part of the light which everywhere surrounds us for visual purposes, it is also true, and in a much more emphatic sense, that the keenest human vision, unaided by optical devices, can perceive but a small part of the symmetry, order and beauty of the world about us, and that concerns us from the earliest to the latest moments of our present state of existence.

To those who find in beautiful flowers only sweet fragrance and delicately variegated tints, only summer verdure and cooling shade in the forest, and only sacks. of grain and the abundant rewards of labor in the golden harvest, there are but limited allotments in the way of enjoyment and of incentives to love and adoration of the Supreme Artisan who planned and executed the marvelous hidden as well visual symmetry and grandeur that distinguishes all the parts of what is to us an incomprehensible universe.

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Each of these is of itself a great assemblage of little things and their activities. Every leaf and twig of the forest is an example of systematic cell building, and every grain of the harvest an example of protected and provided for germ life, of such delicacy and beauty of fashioning as to put to shame the most skillful handiwork of maternal love. If the fire, and steam and plunging locomotive inspire us to a contemplation of the great fuel beds of the earth, and these of the great wilderness of flora during the Carboniferous age, swept down and buried beneath great avalanches of ice and drift, and these in turn of the hot vapors from the plastic mass of wandering nebulæ and condensing gases, why should there be less inspiration from the study of a little red blood corpuscle that flutters along through the channels of our own bodies, laden with oxygenated food for starving tissues, or why should there be less inspiration from observing the behavior of the little leucocyte that forces gateways, in size but one-tenth of its own diameter, to repair a breach in tissue structure, or to seize and strangle some lurking insidious foe of our own wellbeing?

A spear of grass, as we are accustomed to look at it, is in some sense a very insignificant thing; and yet, with its million cells of perfect form, its silica-laden cuticle, its vessels and chlorophyll grains, and the wonderful adaptation of its whole being to the environments of its existence, it becomes a study that broadens with every step of advancement. From its physical constitution we turn for a moment to its life work-its elimination of waste, its resolution of air, earth and water into new products prepared for its own food, and its transportation of these through its own channels to where needed for repair and growth. Then there is an apparent exer

cise of choice in sending its spears in the most favorable direction for air and sunlight, and the most rapid extension of its roots toward the best supplies of food and water. Who will say that it does not exult in the glory of sunshine or feel the torture of the crushing heel? The most learned chemist has never been permitted to enter all the portals of its laboratory, nor to scan the formularies of all its processes, and the alacrity with which nitrofying and underground bacteria obey its mandates in lending willing service to the silken tendrils of its roots might excite the envy of the most arrant human despot.

Our spear of grass, as a living object lesson, has already become too complex to begin our study with. We therefore change the conditions. We cut off the thread of life, and have at once set up another series of actions-that of retrograde metamorphosis. In the backward change of its substance to the air and the earth from which it was derived other living things war with each other for the liberated atoms of food from the decomposing substance of the spear of grass, and they in turn feed and fatten, propagate their own kind and die, furnishing with the substance of their bodies food for still other and different generations. We are now among the unicellular organisms, both plants and animals. Among them are our friends and our enemies. Some have near relationship to those that assist in preparing the essential conditions of our existence; others are pathogenic forms, whose substance or exhalations products are the toxic agencies in all the long list of blood-poison diseases.

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Unicellular organisms of one sort or another constitute the very first beginnings of our existence; others chirp the final requiems of our dissolving mortality. They are wonderful studies, these unicellular plants and animalsthese little things. A single cell, consisting generally of a nucleus surrounded by protoplasm, and that generally by a cell wall, feeding, developing, exercising volition and apparent choice, preserving precisely its own peculiar life cycle in all these as well as the propagation of its own kind, from generation to generation and from age to age, all through separate activities of cell walls and nucleus.

If we place a few of the spears of grass with a little water in a glass, and expose it to sunlight and warmth for a short time, we shall find, among other organisms thus brought into activity, the ameba. But before the appearance of the ameba we shall have various forms of bacteria nestling among the dead cells of the spears of grass and assisting both in their work and their substance, in providing food for the ameba and its kindred. The latter is a fair representative of animal uncellular life, the former of vegetable uncellular life. The ameba is a prototype of the first form of organized protoplasm with which our own bodies have a beginnning, the germinal vesicle; and of the white blood corpuscle, or leucocyte, with which they are builded up by growth and repair. It has no lungs and yet it breathes; no stomach, and yet it digests; no feet, and yet it has the power of locomotion. For a food it protrudes a part of its cell wall and moves off. To extemporize a mouth it depresses a part of the same cell wall nearest its coveted food, and the food is engulfed; the deepening and

closing of the cavity constitutes a stomach and digestive tract where food is digested and assimilated.

The vegetable form of unicellular life is largely represented by the cocci and bacillus, included in the general term "bacteria." A very large majority of the innumerable hosts of bacteria are to us entirely innocuous or harmless-nay, more, many forms assist in the normal performance of some of our organic functions. We ingest them in great numbers with our food, and its has been asserted that certain kinds are constant residents of the alimentary canal and perform an essential office in the function of digestion. On this line still greater extravagances have been indulged in.

Leucocytes and red-blood corpuscles, or their analogues, are the propelling forces, the infinitesimal engines that move the whole animal world. The vast labyrinth of machinery in every organism, however great or small, would weaken and sicken and die, but for the constant agency and force of little things. Hence it is that studies of the ultimates are of intense interest, and in every line of scientific study the trend of thought is of little things. Notice the psychologist bending over the ant and the insect world for some new light to shine upon the line of demarcation between instinct and reason, and the geologist, scanning the recently discovered footprints of Eozoon Canadense upon the grains of igneous and metamorphic rocks for molding forces in the earth's history. The theologian of to-day finds in the principles of biology the very essence of natural religion, if not of Christianity. A large part of the sands upon the seashore are just so many aggregations of silica, builded together, atom by atom, by the life force of pre-existing organisms in former times, directed by the same unvarying laws that are still to-day building the hoops and frustules of the present generations of diatoms, some of which are so small that 100,000 would lay upon a silver dime. The little grains are the imperishable framework that have withstood the crash of the elements for ages. What of the invisible tendrils and life throbs whose homes these empty shells once were? What of the woven webs that have long since perished, and of the spirit fingers of the weaver, and the life cycles as unvarying and as unbroken as are the cycles of the planetary or the starry universe?

The sanitarian lives in an atmosphere of laboratory biology, to study little things endowed with great possibilities, and too often great accomplishments. And the modern physician; ashamed of the pukes and plasters and purges with which his ancestors tortured the victims of invading foes, gives his attention to the foes themselves. He studies the little things without and within the body, first in health, then in disease. He takes cognizance of first forms and first activities more than he does of generalizations and ultimates. Cell-wall protoplasm, nucleus, nucleolus, cell division, budding, karyokinesis-these are some special studies during the first years of his preparation. He traces cells, these little things, into the builded walls of integument and muscle and bone and nerve, and studies their individual and collective activities. Thanks to the modern microscope, he sees beyond the horizon of natural vision into the curtained arenas of life change, and although he can never hope to understand all the

plays he is permitted to witness, he soon comes to regard the human body, not as an assemblage of organs merely, but as a whole nation, made up of various unlike communities and colonies and towns and cities, and these again composed of individuals of different mold and pursuits, varying in form, requirements and duties performed, and yet in which the faithful discharge of duty by each individual is essential to the well-being of the whole. The character of individuals, the little things, cells and molecules, determine degrees of efficiency, integrity and perpetuity, as well as symmetry. Without leucocytes in our organizations we should lack the means of growth, repair and defense. Is an organ or tissue to be builded up, leucocytes weld themselves together and the work is accomplished. Does a breach of continuity occur—a wound or a rupture of tissue substance-leucocytes flock into the breach and disappear, while emerging from the wreck is the new tissue endowed with new life. Do invisible foes, infesting the food we digest or the air we breathe, invade our organisms, leucocytes seize the enemy and engulf or smother it, or like valiant sentinels, they lug it out through the portals, going over the brink and down to death if necessary with their victims. That (as in other kinds of warfare) the leucocytes are sometimes overpowered by superior numbers does not lessen the glory of their many triumphs nor detract from the munificence of design in the grand scheme of universal creation.

Another unicellular servant doing service every moment of our existence, and in some sense endowed with independent life and volition also, is the red-blood corpuscle. It is a plain cell, not subject to change of form, as are the leucocytes, except under unnatural conditions. Out of the body it is a double-concave disk. It respires and for a time appears to possess independent life. Within the body and at its legitimate work it is a veritable craft of commerce. Loading up with oxygen from the air-cells of the lungs, it soon reaches with its cargo the most distant ports, to oxygenize assimilated food material into protoplasm, to repair and build up tissue with. This same red-blood corpuscle, having discharged its cargo of oxygen, loads with carbon evolved in tissue change for a return voyage to the air-cells of the lungs, where exchange for oxygen is again made. Thus goes on through life the commercial interchange of body waste. for body wants-a veritable commerce between the internal and the external world. Thus it is that carbon generated by the animal body is placed in the atmosphere for the subsistence of the vegetable world, which in turn provides by its exhalations the oxygen to sustain the demands of animal life.

Returning again to our grass infusion, we place a small drop upon a glass slide and proceed to examine it. We adjust our 1-5 objective and 1-inch eyepiece to get an image enlarged 500 diameters. We stain the organisms to render them more distinguishable and make a careful survey of our little drop of water. We do not expect to see much, and we don't. However, there is some appearance of a large bacillus in the field, but it is a long distance off and does not appear to be as large as onetwentieth of the smallest common pin. In the uncertainty we substitute a 1-12 oil immersion objective for the 1-5.

With this we discover a bacillus, and also traces of large numbers of other bacteria, which are too small to be well defined. Our bacillus even is so far away that we cannot determine definitely its classification, with the best instruments made. Very many appear much alike in the field of the microscope. The farmer would make slow progress in distinguishing wheat and oats and barley in baskets a hundred yards off, but he looks over his field of growing grain much farther away, confidently determining the one from the other. And so we in like manner plant our bacillus in congenial soil. We select of the many culture mediums gelatin, for instance; plant our bacillus by "inoculation," as it is called, under proper surroundings and conditions. Soon the gelatin at the point of inoculation liquefies in cup-shape form, and a whole colony of bacteria begins to be visible under the microscope. The colony is round and has a gray color, with depressed white center. The periphery is like a wreath with tiny rays projecting from it. No other culture is like this. We know now what we have-bacillus subtilis. As small as an individual of this is, it is a hundred times larger than many of the bacteria that we possibly might have found in the drops of grass infusion. They are all distinguished one from another by the peculiar behavior and appearances of their several cultures or colonies.

This hasty view indicates something of the line of study that characterizes modern medicine; something of the method by which we distinguish harmless from pathogenic bacteria. But it is only a glance. Many of the pathogenic forms refuse to be cultivated except in the living animal body, often necessitating the sacrifice of small animals as culture media.

This opens another line of study. I will only name still another, that of acquired immunity; that is, the subjection of the living healthy body to repeated inoculations of gradually increasing virulence, until there is tolerance of its presence instead of the usual morbid phenomena. In this way persons are rendered immune from a specific disease. On these lines the modern physician plies his best thoughts and energies. Is a member of the body stricken by zymotic or contagious or infectious disease, instead of moving against the unfortunate member with polished steel and ligatures he moves against the enemies. themselves. He has been a student of little things, and these same enemies, or their like, he has at some previous time decoyed into captivity. He has used strategy to study them. They have been provided with the most nutritious food and the most genial atmosphere and surroundings for their best development. Their apartments have been warmed by ingeniously contrived, self-regulating devices to insure uniformity of temperature. He has seen them at their best and has made careful notes of their likes and dislikes, their food and their poison, so that now he knows how to deal with them. He barricades against them, these insidious foes, 20,000 of whom might camp and execute their drills upon the head of a common pin. He makes pitfalls for them, or paralyzes their energies, or places poison in their food, and by the triumphs of skill and tactics returns his patient to health and usefulness for years to come.

This hasty and imperfect glance indicates something of

the significance and power for good or evil of little things, and of the high vantage ground upon which rests modern medicine. Rest is not the proper word. The study of medicines moves, and is moving to-day as never before. It learns from everything that lives, and from everything that dies. It lays tribute upon the air, the earth and the sea, and the universe broadens before it a thousand-fold as what it contains becomes the better understood. There is no exultation, but rather humiliation, because the finite can comprehend so little of the works of the Infinite. But such as it is permitted to have in the way of acquirement and of understanding, modern medicine brings with humble gladness to the shrine of human welfare.

In general, what a panorama spreads before us, beginning in incomprehensible little things and ending in magnitudes that stagger the most far-reaching grasp of human intelligence! All this under one common design, one code of uniform laws, equally simple and equally majestic, including in its jurisdiction the smallest and the greatest, and pervading, uniting, perpetuating and consummating the whole.

(This address was followed by a lantern exhibit of methods and cultures and slides from photomicrographs of pathogenic bacteria and pathologic histology.)

ON MENTAL DISTURBANCES FOLLOWING

SURGICAL OPERATIONS.

Dr. Lucien Picqué and Dr. Marcel Briand published a lengthy and important paper on mental disturbances or psychoses following surgical operations and make an attempt to summarize those facts which are well established and to add certain new observations made by themselves. Under the term "post-operative psychoses" they include only delusions with or without mental confusion and affecting the intellectual functions only. Other mental disturbances of a neurasthenic or hypochondriacal character which may manifest themselves after operation, and which have been already described in the Lancet, are not included in the category of post-operative phychoses. Moreover, all forms of cerebral excitement or delirium which may persist after the operation, and which may be attributable to an undue sensitiveness of the patient to the anesthetic are grouped by Dr. Picqué and Dr. Briand in a separate class, viz., as forms of toxic pseudodelirium. These are of transitory character, not lasting, as a rule, more than one or two days, whereas the true post-operative psychoses are serious forms of mental disturbance which require care and treatment in an asylum. Such cases of post-operative insanity usually reveal on inquiry a history of hereditary predisposition to mental disorder. Thus among the cases personally investigated by Dr. Picqué and Dr. Briand or collected from published records was usual to find on inquiry a pre-existing taint or history of mental cakness, hysteria, hypochondriasis, or other neurosis. Gynecological operations on women were not ford to be more often followed by mental disorder the other operations when cases of neurasthenia were excluded. The symptoms of the post-operative psychoses were very variable. They comprised maniacal excitement, delusions of persecutions, and melancholic depression with or without delusions. Operations involving the

loss of one or both breasts in women, castration, and colotomy with the formation of an artificial anus tended to favor the development of melancholia. The following cases serve to illustrate the points already mentioned: In Case I the patient was a Jewess, aged 36 years. Her father was a drunkard and she had a cousin who was insane. The patient herself was an excitable person. After undergoing a slight surgical operation she developed melancholia with delusions that parts of the body were dead or non-existent, halucinations, and suicidal impulses. In Case II the patient was a man, aged 47 years, and of intemperate habits. For about fifteen years he had suffered from attacks of vertigo and occasionally he had passed urine involuntarily during an attack. He had marked facial asymmetry. Eighteen months after an operation for inguinal hernia it was found that considerable mental deterioration had occurred and that fixed delusions of ruin were present. This condition was the result of a steady and progressive mental alienation which set in after the operation and in the course of which he suffered from attacks of stupor with loss of consciousness. Dr. Picqué and Dr. Briand cite in considerable detail the histories of seven other cases illustrating various points in regard to the etiology and development of post-operative psychoses and come to the conclusion that in predisposed subjects insanity may definitely show itself immediately after surgical operations.-Medical Bulletin.

THE PROPORTION OF ACCIDENTS AND

DISEASE.

By an analysis of a recent census report made by the Insurance Press, we learn that deaths due to accidents and

injuries were highest among those whose mothers were born in Italy (119.5 per 100,000 of white population); lowest among those whose mothers were born in the United States (62.7). The death rate due to accidents and injuries is highest among persons 45 years of age. and over. The average age at death from accidents is about 33.5. The proportions of death from accidents and injuries were greatest in the Cordilleran regions, the Pacific coast region and the western plains; they are least in the North Atlantic coast region, the Middle Atlantic coast region and the northestearn hills and plateaus. The warmer months show a larger proportion of fatal accidents than the cooler months. A person is more liable to meeth death by accidental injuries than by any other single cause, except tuberculosis, pneumonia or heart disease.

One is twice as liable to die from accident as from old age. Typhoid fever, cancer, apoplexy, inflammation of the brain and meningitis, paralysis, diphtheria, diseases of the stomach, liver and brain, all these are slight menaces to life compared with the accident hazard. If, as seems not unreasonable, a person is liable to die of any disabling accident that happens to him, what is to be said concerning the 11,000,000 accidents that happen every year? It seems to be true that a person is 100 times more liable to "catch" an accident than a fatal case of tuberculosis or pneumonia, and about 1,000 times more liable to "catch" an accident than a fatal case of liver disease.-American Medicine.

Never deplete or depress in erysipelas. Support and stimulate.-Fenwick.

sailor and latterly as a navvy, digging and wheeling barrows full of clay, etc. He has no pain whatever and can twist the arm completely round so that the palm of the hand looks directly upwards. His grip is sufficiently. powerful to prevent one's testing it a second time. The cause of non-union is not easy to ascertain, but there was no surgeon aboard his ship, the arm being set by one of the crew.

ALLEGED UNSANITARY SLEEPING CARS.

The first day's session of the recent meeting of the American Public Health Association at Washington was largely given up to attacks on the sleeping car.

Dr. G. P. Conn, as chairman of the committee on car sanitation, reported that while the committee was not prepared to suggest reforms which would at once settle the much-vexed question, yet it was believed progress was being made, and the managers of railroads were coming more nearly in accord with public opinion, and that the problem was gradually being solved. In car sanitation there were many obstacles to be overcome which were not necessarily given much thought when considering the question of the hygiene of a dwelling. The house on wheels not only had the atmospheric influences which at all times surrounded the dwelling, but at different rates of speed this pressure was immensely greater than that upon the ordinary domicile. One should always consider the character of the occupants who, for the time being, were tenants, and had but little or no thought of the sanitation or well-being of those who might be the next passengers to occupy the same seats, and who, perhaps, had little or no appreciation of what an expert in sanitation would consider a healthy condition of personal cleanliness or of a habitation. All such matters must receive attention when the problem of car sanitation was considered, and the standard of excellency which the public might desire should always be kept in mind, and conditions made as nearly the standard as possible. The more permanent the means and methods adopted by health authorities, the more satisfactory they will prove to the commercial world and the general manager.

Dr. J. H. McCormick of the state board of health of Kentucky declared that an official investigation into the subject made by him disclosed the fact that the blankets were cleaned only once every six months.

Dr. C. B. Dudley of Altoona, Pa., chemist for the Pennsylvania Railroad, demanded that the delegates furnish him the data on which they based their statements. It was not fair, he said, to require railroads to spend large sums of money in this direction until they knew where they stood. The cleaning of cars in transit he characterized as one of the most annoying things railroads have to contend with. He assured the delegates that the railroads are ready to utilize any practical system that will contribute to the general public health.

Dr. J. N. Hurty of Indianapolis, Ind., said there is unanimity of opinion regarding the transportation of common carrier of persons sick with smallpox, diphtheria. scarlet fever, leprosy, yellow fever and typhoid. Leprosy, he declared, is not as easily transmitted as tuberculosis, and compared to the latter in its destructiveness of human life it amounts to nothing at all. Yet, he said,