addition to a personal examination, and that they severally made certain statements about the suspected individual which led him to a decision. Attorney promptly moves that all this be stricken from the record, and taken from the jury, because it is mere hearsay-conversation had in the absence of the party at interest. And there you are. As a medical man, one is perfectly justified in taking-nay, one is obliged to take the statements of other people in making a diagnosis and directing treatment, as, for instance, the statement of the nurse as to whether a patient slept is much more valuable than that of the patient himself; but in law second-hand statements are worthless.

Only recently the writer testified in a divorce suit where he had previously, and without any knowledge at that time of a projected divorce suit, examined the woman and pronounced her a paranoiac and recommended an inquiry into her sanity. The inquiry was never had, but she was placed in the observation ward of the public hospital for a week or so and then discharged. The woman's counsela most conscientious and able man-put the question to the writer: "Would you still, in view of the fact that she has been under observation in the hospital and discharged, adjudge this woman insane?" Replying to which, the writer was obliged to remind the attorney that physicians do not "adjudge persons insane;" that that was the business of the probate court; that physicians, sheerly in their capacity as medical advisers, and with no legal relations whatever, make a diagnosis on the symptoms and circumstances; that in so doing they are justified in considering every kind of data, without regard to its legal value; and that in the case in question there had been sufficient data, both physical and circumstantial, to warrant advising an inquiry.

Here, we believe, is a real occasion of stumbling and misunderstanding, as between the expert witness and the court. Perhaps the illustrations we have cited are not as luminous as they might be, but at least they will serve to set forth the fact that the viewpoints of the lawyer and the physician are widely different, and that each is talking in terms of his own viewpoint. Is there any way of translating one into the other, or of reaching a common ground of neutrality, where neither viewpoint intrudes itself?

S

THE COMMON SENSE OF PSYCHO-THERAPY.

¡OME years ago—not so very many, either-in the city of Chicago, a professor of psychiatry, one Parkyn by name, used to conduct a post-graduate school in psycho-therapy. We believe that Dr. Parkyn afterward went into the real estate business, and exercised his suggestive influence upon prospective purchasers of improved property, from which he doubtless realized more material profit than he ever did from the teaching of suggestive therapeutics. Be it understood, however, that this is said in no spirit of satire or cynicism-except in so far as it implies satire or cynicism upon the obtuseness of a profession which was, in the main, utterly unable to appreciate the keenness of Dr. Parkyn's doctrines for there is not the slightest doubt in our minds that of all the theories and systems of psychotherapy ever promulgated for the benefit of medical men, his teachings contained the greatest modicum of common sense and practical truth.

To a certain extent, of course, a suggestive therapeutist is born, not made. Hence it is extremely unlikely that any of Dr. Parkyn's pupils in suggestive treatment could ever have achieved his success. He was one of those temperaments which naturally bend and shape others to their own will-not by bluster or mass force,

but as the warmth of the sun, in the old fable, compelled the traveler to remove his cloak. But the power which he wielded and taught was not altogether a natural gift. A great deal of it was nothing but the recognition and utilization of a very commonplace truth concerning sickness and human nature, such as anyone might, by the exercise of a little ordinary sense and tact, equally recognize and utilize.

Those who remember Dr. Parkyn's regnum, and especially those who were fortunate enough to attend his course (among whom, by the way, are included some of our most eminent physicians and surgeons), will recall the enormous range of cases that he treated, not only in matter of numbers, but, what is more to the point, in the matter of variety. From chronic constipation to infantile paralysis; from cold in the head to locomotor ataxia. They will remember that, whatever element of mystery there may have been in his treatment and its effects to the patients who benefited by it, or even to the physicians who witnessed and tried to profit by it in their own practice, he himself made no mystery out of it at all. Indeed, we are inclined to believe that the frankness and simplicity of his theory and practice were more or less of a stumbling block in the way of its more general acceptance. “If the prophet had bid thee do some great thing, would'st thou not have done it?"

He met with criticism and hostility, of course, from the powers that were; and the chief ground of such criticism and hostility consisted in the very aspect of the matter which ought to have demonstrated just where the real crux of his success lay, namely, that he extended his method of treatment (successfully, of course, for nobody bothers to fight unsuccessful practices) to diseases which, by all the canons of medical science, ought to be beyond its reach. We do not mean to say that he cured, or even half cured, but he improved such conditions as locomotor ataxia, hemiplegia, infantile paralysis, and the like. It was quite explicable, of course, and excusable, that he should benefit with his suggestion such neurotic conditions as neurasthenia, hysteria, and even habitual constipation; but that he should benefit organic diseases was both inexplicable and inexcusable. Yet here, as we have said, lay the whole secret of his suggestive philosophy--and it is an open secret that he who runs may read and profit by. It is simply this, that in every disease, functional or organic, there is always a certain percentage of the symptomatology, a certain proportion of the disability, which is superadded to the actual physical pathology by the mind of the patient; and this proportion is always subject to the influence of suggestion. Not only does this hold just as good for hopeless organic troubles such as we have cited above as for less serious disorders, but it applies even more emphatically to them; for the sheer knowledge that a disease is hopeless is sufficient to bring about in the patient a corresponding utterness of surrender which immediately adds its quota of helplessness to the condition. It is this mental complement, so to speak, which in our opinion constitutes the crux of all suggestive therapy. At all events it offers a place for the application of psycho-therapy in practically every diseased condition with which the physician has to do, and one which is easily and readily amenable to every practitioner who is possessed of only the most ordinary sensibility and tact.

In our department of "The Doctor Himself," in this issue, we are abstracting a very excellent article from the Lancet upon this very subject-the psychology of the every-day treatment of patients-which we earnestly commend to the thoughtful perusal of our readers, and also to their conscientious adoption. It will be found, we think, that the article in question bears out the principle which we have deduced in this editorial, and which we have ventured to illustrate by a reminiscent review of Dr. Parkyn and his system.

LISTER.

ISTER is dead.

L

We can not bring ourselves to call him Lord Lister, just as we could never accustom ourselves to speak of Lord Tennyson. Lister is dead, at the ripe age of eighty-five. It is comparatively seldom that it is given to one individual in his lifetime to witness such a period of marvelous evolution and revolution as it has been his lot to witness in the science and art of medicine. And still more rarely does it fall to any man to watch such a miracle of progress and development with the consciousness that he himself is the prime influence in the process. Just as biology divides itself into two periods, before and after Darwin: just as morbid anatomy and physiology fall into two distinct eras, demarked by the enunciation of Virchow's Cellular Pathology; so the practical art of medicine is separated into two great epochs, whose dividing line is the establishment of Lister's principle of antisepsis. It is not too much to say that the whole fabric of modern medicine and surgery is built around the keystone which Lister shaped-in rude, elementary fashion, it is true, but none the less effectively-five and forty years ago.

The influence of his doctrine is not limited to the operative aspect of surgery; not even to surgery itself. That is a very narrow and inadequate conception of antisepsis. If that were all that Lister's work implied, then he would take a subordinate place with thousands of lesser men who have from time to time devised surgical procedures and techniques of varying degrees of usefulness and permanence. Antisepsis (or Listerism, as we have come to call it) is something infinitely broader and further reaching than that. It is a basic and abiding principle of applied medical science. Whenever and wherever, in the treatment or prevention of disease, we protect the body, by means of germicides, from the invasion of microorganisms, or by the same means inhibit their pernicious activity after they have gained an entrance-there is Listerism.

It is significant of the fundamental nature of Lister's work that we had, long prior to his death, outgrown not only his methods, but in a large measure even his specific doctrine, without getting away from the essential spirit of Listerism. Not only have the modes, of antisepsis been elaborated and refined beyond the early dreams of its enunciator, but antisepsis itself has, as we know, been largely supplanted by asepsis. But the informing principle of Listerism is not thereby disturbed, nor its continuity broken. The oak is not the acorn, but both are sequential manifestations of the quercine life-principle. So is asepsis the perfect goal of antisepsis; and both are sequential manifestations of the principle of Listerism.

The actual practical virtues to the credit of Listerism, in the saving of life and the successful performance of otherwise unattemptable surgery, can never, we suppose, be even approximately estimated. We can only assert (and the statement will not be far out of the way) that all of our modern surgical achievements owe their impugnity and efficiency to the principle of asepsis and antisepsis; and that upon this same principle rest all the surgical possibilities which the future may hold in store.

With the death of Lister there passes from the medical horizon one of its great planetary lights; and from the galaxy of science there is taken away one of the last remaining standard-bearers of the old guard of the Victorian era, whose ranks are now rapidly thinning out. It was an age of giants in every field of intellectual endeavor; and, with all our boasted progress, the present age will have difficulty in matching it, either for personnel or for achievements.

Management of Tuberculosis.

BY L. HERBERT LANIER, M. D., Kansas City, Mo.

Late Clinical Assistant Royal London Ophthalmic Hospital and Central London Throat and Ear Hospital.

T HAS ALWAYS been the history of medical practice that one extreme of treatment has been followed by a swing of the pendulum to the opposite extreme, This has been well exemplified in the management of tuberculosis. The advent of the fresh air and forced-feeding method as opposed to the old regime has been pushed to such lengths as to become almost a craze; and the situation needs the injection of a little common sense. This is precisely the aim of the author in this paper, which we recommend to our readers to peruse thoughtfully. Especially we commend Dr. Lanier's sensible stand on the subject of "sending the patient away.'