shall limit my remarks to the obstructive mechanical type, as I have little faith in surgical treatment in the cases where the renal tissue is alone responsible for the failure to secrete urine.

Complete suppression of the urine from mechanical causes presents itself in two varieties-the purely obstructive and the reflex. In the purely obstructive there must be obstruction of both ureters if there are two functionating kidneys present, or of the single ureter of the single functionating kidney where only one exists. In the reflex variety there are two kidneys present, one obstructed, and because of great intra-renal pressure on the obstructed side the uninvolved kidney governed by a reflex action through the nervous apparatus refuses to functionate. This condition was for a long time doubted by some surgeons, but it must now be accepted as a possibility, as it can be experimentally reproduced in the laboratory on animals.

Complete anuria can exist for twenty days or more before death occurs. As a rule, within seven or eight days uremic symptoms develop with fatal termination. It is unsafe to allow complete obstructive anuria to continue more than forty-eight hours. Many lives can be saved by proper timely interference. The treatment is a nephrotomy with drainage, preferably under gas anesthesia, of the kidney which last gave symptoms.

I have been able to save two lives by

this timely procedure-one a young man with obstruction of the ureter of a single functionating kidney, the other kidney being changed into a hydronephrotic sac without any kidney tissue; the other a young woman with obstruction of the ureter by stone of her single kidney, the other kidney having been removed several years before on account of tuberculosis.

CONCLUSION.

I have thus attempted to present to you a picture of the present status of kidney surgery, very different from the one that would have been drawn twenty or even ten years ago.

Modern surgery can now offer much in the treatment of many diseases of the kidney. Progress is being made rapidly, and we can hope that the future will add much to that which has already been accomplished. Diseases of the kidney belong for the most part to that borderland which must be cultivated by both the physician and surgeon in order to bring forth the best fruit. The physician who handles these cases must keep in close touch with the surgical progress being made. should follow the case to the operatingtable, and see for himself in vivo the pathological conditions which are responsible for the symptoms present. The surgeon must understand fully the value and possibilities of medical treatment before he can arrive at a true estimate of the value of surgical procedures.

PARADISE.

Whereupon she, after a pitying sigh,
Her eyes directed tow'rds me with that look
A mother casts on a delirious child.130
Three mirrors shalt thou take, and two remove
Alike from thee, the other more remote
Between the former two shall meet thine eyes.
Turned towards these, cause that behind thy
back

Be placed a light, illuming the three mirrors
And coming back to thee by all reflected.
Though in its quantity be not so ample.
The image most remote, there shalt thou see
How it perforce is equally resplendent.18

130. Paradise, C. I, 1. 102, Longfellow.

131

131. Paradise, C. H. 1, 94, Longfellow. See reference 104.

He

Of great Costanza this is the effulgence,
Who from the second Wind of Suabia
Brought forth the third and latest puissance.

"Constance, daughter of Roger, King of Sicily, who, being taken by force out of a monastery, was married to the Emperor Henry V, and by him was mother of Frederick II. She was fifty years old or more at the time, and, because it was not credited that she could have a child at that age, she was delivered in a pavilion, and it was given out that any lady who pleased was at liberty to see her." 132

132. Paradise, C. III, Cary's notes.

Yet behooves Thou rest a little longer at the board,

Ere the crude aliment which thou hast taken, Digested fitly to nutrition turn.133

Behooves thee still to sit awhile at table, Because the solid food which thou hast taken Requireth further aid for thy digestion.13

Though the matter under discussion was a theological question, it shows the Poet's oft noted tendency to illustrate his discourse with medical terms. It shows also

he well knew the necessity for rest after ingestion of an abundant meal.

Still doth the mournful Cleopatra weep
Because thereof, who, fleeing from before it,
Took from the adder sudden and black death.135

.The terrible puff-adder, a member of the viper family, is a native of Africa, and is one of the commonest as well as most deadly of poisonous snakes.

"Rattlesnake Bite.- The pain of the wound is severe, and is speedily followed by swelling and discoloration. Constitutional symptoms consist in progressive prostration, staggering gait, cold sweats, nausea and vomiting, quick and feeble. pulse, and slight mental disturbance. The patient may die within twelve hours.

"Bite of European Viper.-The bite is immediately followed by local pain of a burning character. The limb soon swells and becomes discolored. Great prostration, vomiting and clammy perspiration occur. In from twelve to twenty-four hours the severe constitutional symptoms may pass off; but in the meantime the swelling and discoloration have spread enormously.

"Bite of the Indian Viperine Snake.Sanious discharges from the rectum and other orifices are prominent features. When the patient has recovered from the severe prostration and symptoms of advancing paralysis, he suffers from hemorhagic extravasation in various organs, and from the bowels, lungs, nose and mouth."

" 136

body. Its powder taken in water cures diseases of the eyes and pains in the liver." 139 Not for the world which people toil for now In following Ostiense and Taddeo.140

Taddeo Alderotti was a distinguished physician and professor at Bologna, who flourished in the thirteenth century. Villani says of him: "At this time (1303) died in Bologna Maestro Taddeo, surnamed the Bolognese, though he was a He Florentine, and our fellow-citizen. was the greatest physician in all Christendom."

Thence it descends to the last potencies,
Downword from act to act becoming such
That only brief contingencies it makes;
And these contingencies I hold to be
Things generated, with seed and without.

"These contingencies are animals, plants and the like, produced by the influences. of the planets from seeds, and certain insects and plants, believed of old to be born without seed." 141 The doctrine of spontaneous generation, fully believed in up to the eighteenth century, even to the generation of the lowest forms of animal life, and not disposed of finally until within the last three decades.

In such composed and seemly fellowship,
Such faithful and such fair equality,
In so sweet household, Mary at my birth
Bestowed me, called on with loud cries. 142

You are my ancestor.

Then tell me, my beloved root ancestral,
Who were your ancestors.

With voice more sweet and tender, but not in
This modern dialect, it said to me:
"From uttering of the Ave143 till the birth
In which my mother, who is now a saint,
Of me was lightened who had been her bur-
den.144

Note again Dante's disposition to use. medical phraseology.

Ever the intermingling of the people
Has been the source of malady in cities,
As in the body food it surfeits on.145
For if thy utterance shall offensive be
At the first taste, a vital nutriment
'Twill leave thereafter, when it is digested.146

And as a sleep is broken and dispersed
Through sharp encounter of the nimble light
With the eye's spirit,147 running forth to meet
The ray, from membrane on to the membrane
urged.

148

See

And as at some keen light one wakes from sleep
By reason of the visual spirit149 that runs
Unto the splendor passed from coat to coat.150
Even as the sudden lightning that disperses
The visual spirits,151 so that it deprives
The eye of impress from the strongest objects,
Thus round about me flashed a living light,
And left me swathed around with such a veil
Of its effulgence, that I nothing saw.152
There is no babe that leaps so suddenly
With face towards the milk, if he awake
Much later than his usual custom is,
As I did, that I might make better mirrors
Still of mine eyes.153

But ye are sick,

And in your tetchy wantonness as blind
As is the bantling that of hunger dies,
And drives away the nurse.154

The King, by means of whom this realm reposes
In so great love and in so great delight
That no one will venture to ask for more,
In his own joyous aspect every mind
Creating, at his pleasure dowers with grace
Diversely; and let here the effect suffice.
And this is clearly and expressly noted
For you in Holy Scripture, in those twins
Who in their mother had their anger roused.155
Jacob and Esau.

"And Isaac intreated the Lord for his wife because she was barren; and the Lord was intreated of him, and Rebekah his wife conceived. And the children struggled together within her; and she said, If it be so, why am I thus? And she went to enquire of the Lord.

"And the Lord said unto her: Two nations are in thy womb, and two manner of people shall be separated from thy bowels.

"And when her days to be delivered were fulfilled, behold there were twins in her womb." 156

My tongue shall utter now no more, E'en what remembrance keeps, than could the babe's

That yet is moistened at his mother's breast.157
O speech,

How feeble and how faint art thou, to give
Conception birth! 153

Here vigor failed the towering fantasy;
But yet the will rolled onward, like a wheel
In even motion, by the Love impelled,
That moves the sun in heaven and all the
stars, 159

DANTE'S LETTERS.

When wounded thus, what I became, O Love,
Thou canst relate, not I,

Thou, the spectator of my lifeless state;
For though the soul again frequent the heart,180
Oblivious ignorance attends

The state of separation, while it lasts.
When I revive and gaze upon the wound,
Which ruin brought as sudden as the blow,
No comfort can I find,

But every limb is shaken by my fears;
And then the sad, discolored features show
What was the thunderbolt which struck me
down.161

"This is the sick sheep that contaminates the flock of its master by contact." "In very truth from her evaporating corruption she exhales an infections smoke, and thence the neighboring flocks all unconscious waste away.

162

That diseases both contagious and infectious invaded the flocks, Dante very well knew. He here makes the distinction between the two.

That pleuro-pneumonia is both contagious and infections has been proved by direct experiments performed in France, and reported by Professor Bouley. 163

In the cattle plague, rinderpest, sheep can be inoculated from cattle and cattle from sheep without modifying the virulence of the virus.16.

Variola ovina (sheep-pox) is a contagious and infectious eruptive disease analogous to small-pox and cow-pox. 165

Charbon (anthrax) was known to the ancients.

MEDICAL CONTEMPORARIES.

TADDEO ALDEROTTI, professor at Bologna,166

MUNDINUS (1275-1327), the father of modern anatomy, was one of the earliest teachers of surgery at Bologna, and his "Anatomia" remained the standard textbook on the subject for more than two centuries. 167

DINO DEL GARBO, philosopher, scientist, first physician of Italy in his day. He lectured at Bologna, and afterwards at Siena. He wrote commentaries on Hippocrates, Galen and Avicenna.168

TORRIGIANO, equal if not superior to Garbo. He studied at Bologna, and lec

160. The doctrine of Aristotle that the heart was the seat of the intelligent soul. See p. these notes on Purgatory.

161. Letter III, I atham.

162. Letter VII, Latham.

163. Veterinary Medicine, p. 146, Williams.

164. Ibid., p. 137.

165. Ibid.

166. Rashland: Universities of the Middle Ages, vol, i. 167. Rashland: Universities of the Middle Ages, vol. i. 168. History of Medicine. Baas. Trans. of H. E. Henderson, p. 288.

tured at Paris. He wrote commentaries on the Greek physicians, and several treatises on medical subjects. He died before 1327.169

WILLIAM OF SALICET (1200-1280). The first of his day who wrote on surgery from personal experience, and who did not blindly follow the opinions of the masters.170

LANFRANCE, pupil of William of Salicet. Taught surgery in Paris in 1295. He wrote on surgery. Died about 1306.1 171

ARNOLD OF VILLENEUVE (1234-1313). He discovered alcohol, oil of turpentine, aromatic waters, and introduced chemical compounds into therapeutics. He was one of the first to use brandy in medical practice, which he regarded as the elixir of life. He studied seven years in Montpellier, twenty in Paris, visited all the universities of Italy, and went to Spain to study

the Arabic authors.172

A TRAINED nurse with whom I talked expressed herself with some force on the idea that nurses are always watching for a chance to marry a rich patient. "Of course, there are many going into the profession holding that view and hoping for it. But where you find one in that class you'll find thousands who are in the profession because they love the work. We have read in the papers all the pretty romances, and there are a good many of them, but think of the great army of nurses who take hard cases, dangerous cases, I may say, without ever thinking of anything except the best interests of the patient. We are not self-seekers as a rule, and few there be in our ranks who marry for wealth."-Cincinnati CommercialTribune, October 5.

MR. CARNEGIE'S latest benefaction, the pension fund for Scotch heroes, widens somewhat the circle of life-savers privileged to receive a reward. But, if the ironmaster aspires to touch with his bounty every brave soul who delivers others from peril at great personal risk, we fear that he will have to part with all his worldly goods and live in a tub. There are the physicians, for instance; we believe the trustees of the fund have not attempted to honor every man who, for the sake of his fellows, has invited death in bacteriological laboratory and lazar-house. And yet the medical profession harbors the majority of our habitual heroes. Russia's cholera epidemic ought not to be needed to keep this fact alive in our thoughts. Fully conscious of the risks he is incurring, and yet accepting them day in, day out, the physician exhibits courage of a finer type than that of the boy who plunges, without a moment's thought, into the surf to rescue a drowning man. We may admire the boy's act, praise it, and even reward it. But we ought to call it instinct rather than heroism.-N. Y. Nation.

169. Ibid., p. 287. 170. Ibid., p. 300. 171. Ibid., p. 304. 172. Ibid., p. 268.

Correspondence.

BOVINE TUBERCULOSIS NOT A MENACE. CINCINNATI, O., October 10, 1908.

EDITOR LANCET-CLINIC:

The International Congress on Tuberculosis occupied the attention of the world for an entire week. In point of numbers the attendance of delegates has been immense; as for the real scientists, few in number. Veterinary medicine above all was rampant. In the past five years the horse and cow scientist has vied with the guinea-pig experimentalist in erudite contributions, to the exclusion almost of those truly great men whose names have become household words in connection with that most interesting subject—"the great white plague.”

Veterinary medicine, with the numerous legal enactments forced on a terrified and cowardly

humanity by many whose only motives were purely selfish, inasmuch as the inoculation of valuable herds of cattle under pretense of preventing consumption transmission by bovine contagion to mankind resulted, as was long ago predicted and foreseen by those most deeply interested in sanitary medicine, in a ridiculous fiasco, not in the least creditable to regular physicians, who bowed under the yoke of veterinarians until the common sense of the entire agricultural community revolted, and a halt was called on those pseudo-scientists who, acting under authority of the State, were guilty of the most stupendous fraud ever perpetrated on races of people supposed to have, at least, a modicum of horse sense. Thousands of cattle were destroyed and farmers not even paid for the stock taken from them under pretense that the valuable herds were laboring under a highly contagious disorder, the manifestations of which were induced by a process of pure and simple blood poisoning, the process being simply that and nothing more. Under cover of wonderful and protean forms of the various results of organic changes wrought by putrefaction and animal ferments, the innocent and terrified public, aided by an tional press, was really led to believe that veterinary medicine, without the least respect for the observation and experience of physicians of many years' investigation, study and practice, had triumphed. The horse doctors delivered lectures, read papers before the medical societies and the public, and harangued in the halls of legislation in the keen desire to secure coveted salaried positions as cattle inspectors, armed cap-a-pie with the authority of eminent domain over the lives of the property held by the agricultural element. Matters went on from bad to worse after the immortal Koch

ever-sensa

had recanted his first opinion, that at first caused such immense enthusiasm and afterwards such bitter recriminations, especially from those interested in regulating the control and sale of butter, cheese, milk and meat.

It was well that the International Congress on Tuberculosis met in this republic, that had gone to more extreme measures than even European governments in useless and criminal experiments on the finest herds of cattle on earth. Those who have carefully followed the wonderful exposé of the doings of alleged philanthropic scientists in the columns of the New York Herald for the past six months, can but stop and gasp in amazement that the American people have allowed themselves to be so hoodwinked by veterinary medicine in the past five years. No wonder, then, that the New York, Louisiana and other State legislatures have paused to reconsider some of their fool laws. Fine spun theories, the offspring of fertile imaginations in the softened cranial upper cavities of the multitude of horse doctors who have sprung up to protect humanity from the evils of the bovine curse, have received an awful and rude setback when confronted by the array of facts and statistics adduced by a host of long-suffering farmers, dairymen and cattle raisers. Daily, in the New York Herald, the hosts of personal observations made by men of many years of close study and personal experience, have opened the eyes of every ordinary intelligent man as to the ease with which the general public can be grossly humbugged by a brazen lot of veterinarians, who, bold in assertion without the least proof in fact, asserted and asseverated that bovine and human tuberculosis were one and the same thing; that the transmission of consumption through milk, cheese and meat was the real cause of the primary tuberculosis developed in mankind. No wonder that when Koch recanted, as said before, the entire camp of veterinarians, at first filled with consternation and dismay at the dire disaster threatened their salaried positions by Koch's change of view, should have then bitterly assailed him and cast on his truly glorious name all the contumely and contempt possible. Those of our readers old enough to recall the Koch episode will remember the defense made for the illustrious German scientist in the columns of THE LANCET-CLINIC of that day. The Cincinnati Enquirer (October 3, 1908), containing a lengthy account of the transactions of the International Congress on Tuberculosis, evidences the fact that the veterinary element, by all odds, in point of noise, the preponderant one in the Congress, is outspoken and emphatic in opposition to Koch.

Let it not be thought that this is a sneer at veterinary medicine in its entirety, but the arrogant and impudent assumption of the horse doctor and alleged cow scientist has grown to be unbearable, and deserves the reprobation of every honest seeker after truth in the medical practitioner ranks. In this whole International Tuberculosis Congress there are not one score of names that are worthy of the slightest mention or attention. Dozens of specialists, managers of sanatoria and cheap-John philanthropists who ever desire the notoriety attached to the association with a few great names, have figured prominently in the telegraphic despatches sent out by the Associated Press.

In view of the fact that the death-rate from tuberculosis has steadily decreased in the last quarter of a century, despite the new nomenclature that regards skin, bone and glandular diseases as only so many manifestations of consumption, it is well that Koch and a few real scientists, together with the common sense farming population of the country, have taken conservative steps to limit the insolent presumption of the veterinarians. Regular medicine, of late years, has been too apt to follow the theories and teachings of men who had never the least medical training. It is time to call a halt. It is to be hoped that the immense amount of valuable information collected and published in the past six months in the New York Herald will be reprinted and given the widest circulation, especially among the agricultural portions of our American population.

Several years ago, in THE LANCET-CLINIC, we published the action of St. Louis and other medical societies in regard to the notification of consumption cases to health departments. We say now, as then, that in over forty years' experience we have never seen the slightest indication of the contagion said to lurk in consumptive cases. Aware that this is vile heterodoxy from the modern medical standpoint, we know there are hosts of medical men of experience who will agree with us on this proposition. The State, in its restrictions of personal liberty, is going to dangerous extremes without the positive proof even of alleged dangers. The workingman or woman in shop or factory, with a family dependent on them for support, cannot, or at least should not, under the laws of decency and humanity, be regarded as a leper. Will the State maintain the families of those who are now claimed to be a menace to the public health and a source of personal danger to a community? If the disease vulgarly known as the great white plague is so common, as alleged, there would not be enough hospitals, were every other habitation made one, to