allowed him to gratify his taste.

The most of us, I regret to say,

cannot afford the pleasure of such surroundings.

With all his good qualities, he was firm in his opinions and carried on his discussions resolutely. I had occasion to have this meted out to me one evening at our debating club which met once a week to discuss some medical topic. The speaker who was to lead in the affirmative was J. Porter Peck of Akron, a fine debater and quite an orator. A young fellow by the name of Beckwith was chosen to present the negative. He was not an orator nor a good debater but possessed one of the qualifications of Mr. William J. Bryan in that he never surrendered, and when he was not familiar with his subject, he made the best of it. I spent all my leisure time investigating the topic, lying awake nights thinking of arguments to present, dreading to fail entirely and receive the jeers of the class. Prof. Cassels assumed the chair and announced the subject to be debated, "Resolved: That Homeopathy is the Greatest Humbug of the Age." You all know how the chair decided but he complimented my efforts.

My first lesson in the principles and practice of Homeopathy I received in the old Erie Street Medical College through study and contact with Drs. Wheeler and Williams who aided me in the battle. Lesson two I received from Prof. Kirtland in his introductory lecture "Coinciding Tendencies of Medicine," published by the class November 10, 1848. Lesson three came from Prof. Delamater when he gave three lectures on "The Fallacies of the Principles and Practice of Homeopathy." As I listened to his remarks, which I believe he thought to be true, I could not but wonder why he should devote to the subject three hours of his own valuable time and the time of 240 students.

At a time when blood-letting was practiced on most patients, when large doses of health-destroying drugs were prescribed, these immense doses being forced down the throats of infants, I longed for something more humane. Today purging, puking, blistering and salivating are done away. Personal antagonism has among the better class of physicians disappeared. We meet together as a band of brothers striving each to relieve the suffering and pains of those who call us. As a result of our combined efforts during the past fifty years, great strides have been made in hygiene, sanitation and prophylaxis. Prof. Richard C. Cabot of the Medical Department of Harvard University says, "Our views of the founder of Homeopathy are far less divergent than they were fifty years ago. We recognize now that in his day and generation he stood for a great

and beneficient reform in medicine." I am glad that I have lived to see such a change in the medical profession so that we now meet as medical brothers, each striving to the best of his knowledge to relieve and benefit suffering humanity. My observations during the past few years have shown me that most of our best physicians give but little medicine though some of both schools still rely on large doses and combined drugs, which is wholly unscientific.

Prof. Ackley was a man of tall robust frame, of a bilious sanguine temperament, coarse in features-all of which indicates a man of strong passions and decided opinions. As a surgeon, he was at the head of his profession in Northern Ohio. He was a bold and successful operator. All good surgeons are admired by medical students, each one of whom hopes that some day he, too, may wield the scalpel successfully. He was original in thought and deed, and kindly, though to his associates he appeared cold and austere. He was a friend to the poor for he gave to them his services without money and without price. I believe that no one in the faculty had a kinder heart or a more liberal purse for the unfortunate. Had his home life been more lovable, he would have taken a higher place in the world.

Many stories are told of his eccentricities. A number of students were one evening invited to dine at his home. When we reached the house, we were informed that he would meet us at the American House, then located at the foot of Superior street. Wine flowed freely and it was an early hour in the morning when the feast ended. The professor did not appear in the lecture room for three days. The dinner at home was prevented by the tipping over of the tables after they had been prepared to receive his guests. So eccentric in many ways was his companion that by the advice of Prof. Delamater she was taken to a sanitarium. Returning, the doctor stopped for a three days hunt at Wellington. On reaching home he was greeted by her in a most forcible manner. tarium scheme was not a success.

The sani

His ability and reputation as a surgeon were a drawing card for students. At a clinic, he spent about thirty minutes explaining the variety and character of tumors. "We have one before us today," he once said, "whose fluctuation shows us it contains a large quantity of pus. The scalpal entered the tumor. No pus flowed. He bowed to the class and said, "We all make mistakes."

Prof. St. John was a tall, stately, fine appearing man. All his movements were easy, graceful and natural. He had the appearance and actions of a man accustomed to the ways of the world.

While he was wholly unpretentious he yet seemed the peer of his associates and his conversation attracted the students to him. He was of a nervous temperament and his great, high forehead betokened the intellectual development which was his. Notwithstanding these attributes, he was inclined to be rather reserved, not associating with the students and disliking very much to have them put questions to him. He was always prompt at his lectures, arriving exactly on the minute and withdrawing the moment the hour came to a close. As a chemist he was a thorough and practical teacher. I have during my life listened to many teachers but none of them excelled Prof. St. John. His language was fluent, his enunciation clear and his voice melodious. He had a remarkable memory. Not long after my year in the college, he left Cleveland, having received an appointment as chemist to one of the great institutions in New York. I was in New York in 1864 and while there met him as a fellow guest at a dinner. Looking me over, he said, "Were you not at one time a medical student in the college at Cleveland?" It proved to be a very pleasant meeting of teacher and pupil.

Prof. Jacob I. Delamater gave us a very thorough and practical course in Anatomy. He was however hardly the man for the place and never took a high position as an instructor. In 1848, he published a pamphlet on "The Medical Waters of Saratoga, Their Uses and Abuses." This was a very creditable work.

I have presented to you this evening the story in part of what I saw in the old college in 1848 and 1849. The memory of those pioneers has always been very precious to me. I have always revered and honored my first medical college teachers and even now when I enter the college building on the same old site, I feel that I have returned to a dearly, loved place.

A few words more. The work in which you are engaged is a great work both for the medical profession and for the people of Cleveland. Do not falter but make each succeeding year the best for the library. Let your motto be, "ONWARD, FAITHFUL DOCTORS, ON!"

Tonight I extend to each member of this association my heartfelt thanks for the great kindnesses and many courtesies shown me during the five years I have been one of your number, serving as chairman of the finance committee for two years and your VicePresident for three years. My motto throughout my life has been, "Accepting office, I will be faithful and punctual in my duties and work for others as I would work for myself." If I have failed here, it has been from the head and not from the heart. In eight weeks,

I shall enter upon my eighty-fifth year. Though not old, according to our President's views, I desire you to put in my place this evening some young man who has the interests of this great work in his heart and brain and who will put into it new blood. My association with the different members of the Council during the past five years has been a pleasure to me. Each one has been loyal in his work and all true as men and physicians to each other.

I wish for you all a very merry Christmas and during this coming year of 1909 may you all have health, happiness and prosperity. As your Vice-President, I bid you all farewell.

DIAGNOSIS OF CHRONIC BRIGHT'S.*

WILLIAM H. SMITH, M. D., CINCINNATI, OHIO.

I would amend this title to read, "The Early Diagnosis of Chronic's Bright's," or even to, "The Early Diagnosis of Probable Bright's," using the term "probable" to signify that, while the patients state does not justify a positive diagnosis of chronic nephritis, that affection is more than likely pending.

Some one asked me why I selected such a text-book subject and whether it was a hobby. My real reason for being especially interested is, that after about six years of laboratory work along this line, during which time I have examined hundreds of samples of urine, in the class at Pulte College, from my own private cases, and from the private practice of other physicians, I have come to the conclusion that too much dependence upon chemical and microscopical examination of urine is dangerous or, at least, misleading, as a patient must be well along in this disease before chemical or microscopical findings from one or two samples of urine will give positive results. I do not mean to reflect on the value of the results of persistent analytical research in a given case. However, physicians, as a rule, are too busy to make a third, fourth or even more careful examination if the first or second prove negative. Positive results, when found, are invaluable, but we must remember above all things that negative results in urinalysis are not necessarily conclusive of the absence of Bright's, as many patients with chronic Bright's will go weeks and months without a trace of albumen, and I have persistently precipitated with the centrifuge samples of urine in a given

* Read before the Cincinnati Homeopathic Lyceum.

ease only to be rewarded by finding casts after many fruitless searches.

On the other hand it is a fact that, often, the first intimation of Bright's disease is had when a patient, otherwise in apparently good health, has been examined for life insurance and has been turned down because the examining physician has found albumen in the urine. Such cases are exceptional, however, and I am reasonably certain that had this patient's family doctor carefully searched for the cause of, perhaps, repeated attacks of so-called "stomach trouble," or, perhaps, occasional attacks of insomnia, or, it may be, for the reason that a recent change in glasses did not improve his eye troubles, he would have found the Bright's disease long before the insurance examiner accidentally stumbled across the albuminuria. I honestly believe it is a serious reflection upon the family doctor when such a state of affairs exists. Some times, however, the family physician is not to blame, as oftentimes there may be more or less persistent albumenuria not due to Bright's. I have in mind one case turned down and diagnosed as Bright's which proved to be a stone in the bladder, another due to the passage of large quantities of oxalate of lime crystals, another to small hemorrhages from the prostate. The microscope cleared up the diagnoses in these cases, and the removal of the causes cleared up the condition. One could go on indefinitely reporting such findings. However, the conclusion to be drawn is that the diagnosis is to be made by a careful and painstaking clinical review of the case and the conclusion confirmed, if possible, by the laboratory findings but not necessarily negative. All honor to the good old clinical diagnostician, the man who, by means of a keen observation, a good working knowledge of physiology, and an exacting study of his case can out-Sherlock Holmes that interesting individual himself.

In my mind the first and in my experience the most nearly unfailing symptoms that should call the physician's attention to the condition of the kidney, is a pulse of about ninety or over (rather soft) in a patient over thirty-five years of age, without disease of the lung, acute febrile disease or organic heart disease. In other words, if the patient is not ill with an acute fever, chronic apparent disease of the lung, or a cardiac valvular disease and is thirty-five or past, his kidneys want close watching, albumen or no albumen, polyuria or oliguria, and if there are no casts in the first sample of urine just keep on hunting-the chances are that you will be rewarded. I have yet to see a case of Bright's disease in any stage with a pulse much under 90. Accompanying this rapid pulse but not as a causative