The gummous syphilide is the latest manifestation of the disease, and is sometimes met with in early adult life as a congenital lesion of syphilis. Kaposi regards the characteristic symptom of hereditary syphilis a diffused infiltration of the palms and soles, the skin of which is uniformly brownish, red, dry, shiny and fissured. Prognosis. The death rate in acquired syphilis is small; it rarely causes death, but of hereditary syphilis it is murderous. It condemns the offspring to almost certain death. Intrauterine death of the fetus is the common result; this may occur at almost any period, but most commonly between the third and seventh month. The child may come to full term and be still-born. It may be born alive, but syphilitic. It may be born apparently healthy, but soon gives evidence of the disease. About one-third of all the syphilitic pregnancies die in utero; one-third born alive die in six months, and an analysis carefully compiled shows only about twenty-five per cent survive. (Prince A. Morrow.) Intrauterine death is often the result of changes occurring in the placenta, also from atheromatous inflammation and occlusion of the umbilical vessels interfering with the nutrition. The skin is often macerated, the epidermis lifted in patches, and often entirely wanting over large areas. If the fetus has reached an advanced stage of development, characteristic changes are found in the epiphyses of the long bones and in the internal organs. If there should be no manifestations during the first year, the child has probably escaped infection. 909 Seventeenth Street. [Written for the MEDICAL BRIEF.] The New Psychology. BY J. D. BUCK, M. D., It would be an anachronism to speak at the present time of the science of medicine. Science means system, order, uniformity, certainty, and definite results. True, we have something of the methods of science, something of its achievements elsewhere, utilized in, and applied to, the study of both health and disease, and in the efforts to overcome its ravages. But empiricism is still everywhere in evidence, and uncertainty, confusion and often disappointment and disaster stare us in the face. The physician who is confident he can "cure" all his cases is either an inexperienced or shallow enthusiast, or a prevaricator. The physician of long experience and deep learning is apt to be the most ready to admit his uncertainty and frequent failures. People recover without aid of the doctor, and often die after much treatment and many consultations. All the way from "Christian Science," "Faith Cure," "Metaphysical Healing," down to "Dowieism," if the patient recovers the process employed, whatever it may be, is credited with his cure, and heralded accordingly. While death in any case is an "irresistible dispensation of Providence," plain and unmistakable. Nor can the most scientific physicians or methods be altogether acquitted of this empiricism, much as they may dislike or deny it. Perhaps its frank admission may be the most hopeful and certain release. Now our ideas of disease and of health are based on the natural and inherent relation of structure and function, whether of any tissue or organ, or of the organism as a whole. Deranged organ implies deranged function, and vice versa. Histology, physiology and pathology here clasp hands. Nevertheless, we are frequently confronted by the fact that where grave disease exists, and death results, no appreciable or discoverable disorder of tissue or organ can be discovered. The theory is, however, that it must be there, whether we can locate or define it or not. This may be called the mechanical theory of disease. That it is, in a large sense, true, and that it has greatly increased our knowledge of pathology is true. But there is another side to the problem. The foregoing method has led us into endless details; into categories of symptoms and pathological changes, such as require half a lifetime to master. The patient, the man as a whole, is almost lost sight of. Detail has led to specialization, so that a man's medical attendants are like the household attendants in the old world, where caste defines and limits their duties, and they swarm like flies. I am not denying any benefit or the finest achievements that have resulted from this drift of the times, though we may presently be compelled to halt and review the ground over which we have passed. If the foregoing is true regarding our theory and treatment of disease in general, the defects are manifest in a magnified form when we come to mental diseases. Dropping for the moment recognizable diseases of the nervous mechanism, and regarding a very large number of cases of purely mental disturbance or alienation, we find our physiology, or pathology and our categories practically useless. We are driven from that view of the man of many parts-organs and functions to that other concrete view of man as a unit; a self-conscious, individualized intelligence. Our categories seem practically useless, our patient is insane, and we know little of the "mind diseased," more than a name, and we often find neither cause nor cure. Here lies the field of the new psychology. Recognizing all that our categories have taught us, and leaving this in the background, we are to study the modes and manifestations of the individual intelligence; the "Content of Consciousness." What it is, and how it acts, and the laws of its states and changes, can never be inferred or deduced from the study of the physiology and pathology of the nervous system. That the two are related goes without saying. We as yet no systematic knowledge of "the self and its states of consciousness," the purely psychological side of the problem: Not only so, but such knowledge is quite generally ignored, ridiculed or declared impossible. In other words, psychology, with the average physician today, is in the position that physiology occupied a century ago, when to name the "vital principles," was regarded as sufficient to explain all human phenomena. Hypnotism has done something, when intelligently interpreted, to add to our real knowledge of psychology. But how seldom it is correctly and intelligently interpreted. There are three recent works that, taken together, illuminate this whole subject, viz., "The Great Psychological Crime," Professor William James' "Varieties of Religious Experience," and Mr. F. W. H. Myer's "Human Personality." The new psychology is here launched in quite definite form, not on the boundless ocean of conjecture, but on a well-defined coast, with the chart of experience and the compass of experiment, fact, and law. Owing to materialistic bias, and contemptous and ignorant prejudgment, it may take twenty or fifty years for the average Sadducee among physicians to regognize the new psychology. That a very considerable portion of the activities of man are basic, physical, and proceed from below the plane of action, is quite true. That another and very large, though exceedingly subtle group of activities proceed from above the plane of action-sift down into us from above, as lust and passion arise from below-is equally true. Hence, in the new nomenclature of psychology, we have the self, the subliminal self; and the supraliminal self, already adopted by the profession of leading universities. Now, the bearing of all this new psychology on the recognition and treatment of mental diseases is already apparent. Our text books already contain the word obsession, which only a few years ago would have been simply sneered at, and our whole field of study in mental and psychic phenomena is being rapidly enlarged and illuminated as never before. Those who really care to know, need not be left in darkness, doubt or uncertainty. Fifth and Walnut Streets. [Written for the MEDICAL BRIEF.] A Plea for More Humane Treatment of Advanced Cases of Tuberculosis. BY FRANK C. WILSON, M. D., A total lack of humanity on the part of the large sanitariums toward the advanced cases of tuberculosis should be a subject of very severe criticism. Their refusal to admit these cases can only be accounted for by their fear of "injuring" the statistics of their institutions. In cipient cases are gladly received, and occasionally a moderately advanced case will be admitted, but the advanced and hopeless cases are not wanted. It is very much to be desired that our wealthy philanthropists, in the disposal of their charity for the establishment of such institutions, should make it a condition that proper provision should be made for the advanced as well as the incipient cases, irrespective of their effect upon the statistics. If necessary, they could be grouped under separate classes, but for humanity's sake they should be taken care of. If this were done the public would be better protected, for this dangerous class of cases would be taught proper sanitary requisites, and the community to that extent protected from infection. At the same time the segregation of such a large number of cases will afford an opportunity of testing the various methods of intreatment suggested. Among the hundreds of methods of treatment now being exploited some may be very valuable, many are known to be worthless, and a clinical test of the best of these treatments by large institutions for the tuberculous would be of untold benefit to the physician and to the public. If every method proposed were subjected to careful, systematic tests at the bedside of a large number of patients, and a co-operation and comparison of results between these large institutions were possible, after a sufficient length of time definite conclusions could be reached which would clearly determine the value or the worthlessness of a given remedy. No physician, however anxious he may be to properly test a method of treatment, can have the same facilities that are accorded the sanitarium observer. Much time would be saved by such a co-operation, and the public would be protected from charlatanry and imposition. It is most desirable to discover some method of destroying the tubercle, if that can be done without injury to the patient. While the natural resistant powers of the patient are not sufficient to accomplish this unaided, the trend of opinion in the professional mind in recent years has been to simply depend upon the natural powers of the patient, aided by fresh air and food. That many incipient cases can be cured in this way it must be granted, but it is certainly a rational proposition that if we can in any way, without injury to the system, destroy any portion of the germs which are causing the disease, it is a thing to be desired. In the moderately advanced, and also the more advanced cases, it seems folly to trust solely to nature's efforts, even though assisted by fresh air and food. With millions of germs multiplying so rapidly and destroying the tissues so extensively, overwhelming the system with poisonous emanations and sapping the strength of the poor victim, is it any wonder that death soon closes the scene in this unequal contest? Is it reasonable that physicians should calmly watch such a contest without at least making an effort to assist nature in her combat with these germs. The vitality of these germs can be destroyed by agents if there can be found any way of introducing them into the system in sufficient quantity to accomplish this purpose. I have, for several years, made use in a number of cases of a method of treatment employing two of our best germicides, employing as a vehicle an artificial serum, the exact counterpart of the natural blood serum, which, when introduced intravenously in the circulation without protest on the part of the system, carries with it a germicidal action which will immediately destroy every tubercle bacillus with which it comes in contact. This fluid, conveying nascent chlorine and ozone, is introduced to the amount of one pint without disturbance to the circulation, passing to the right side of the heart, thence directly to the pulmonary circulation, and if only a moderate amount of pulmonary tissue is involved in the tubercular process, it will permeate every portion of this area, destroying all, or at least a large percentage, of the germs present. If only a small area is involved in the process, I have seen a single infusion bring about a complete disappearance of the tubercle bacilli from the sputum, and the constitutional symptoms subside, and the physical signs disappear. If a large area is involved, then some bacilli may escape destruction, and begin to multiply, and the constitutional symptoms return in a few weeks. If a second infusion is made, the results are permanent in many cases. It certainly seems reasonable that if such results can be secured by this simple plan of treatment directed toward the destruction of the germs, and which does not interfere in the least with the use of fresh air and food, we should take advantage of it. Treated in this way a large percentage of incipient cases can be promptly arrested, of the moderately advanced cases many can be cured, and even some of the more advanced can, if persistently treated, either be greatly benfited or possibly cured. Can we not in this way materially aid in our fight with the Great White Plague? 405 West Chestnut Street. [Written for the MEDICAL BRIEF.] The Non-Operative Treatment of Strabismus. BY JOS. S. LICHTENBERG, M. D., Professor Ophthalmology, Medico-Chirurgical College, Now Consolidated with the School of Medicine, University of Kansas; Ophthalmologist St. Joseph's Orphan's Home, Home for Aged, Etc. Kansas City, Mo. Stimulated by a series of successful cases in the treatment of strabismus by non-operative methods, and by several recent publications by Jackson, Wurdeman, Worth and others, I deem it best that this short sketch should bring the attention of the profession to the fact that this ocular deformity is, in many instances, amenable to cure without surgical interference. In the present day furore for operations, it is the tendency to rush into surgery to the neglect of other methods. True conservatism may sometimes demand immediate and timely surgery, but in the condition under consideration in the majority of instances, in fact, nearly all instances, the need of haste is conspicuous by its absence. As a rule, I have had no difficulty with my patients, after laying the facts before them, to gain consent to use the non-operative methods. To successfully correct the deviation of the eyes by non-surgical measures, I wish to emphasize the great importance of early treatment. Worth in his recent book cites two cases of infants which he had under his care at the early age of one year and five months. In both of these cases glasses were worn, and other methods used with success. Worth also reports one case at the extremely early age of five months. So that the advice commonly given by the family physician to wait until the child is older, he may outgrow it, etc., is wrong. Many cases which could have been cured by non-operative measures require surgical intervention later, and then only a cosmetic result achieved. The present aim in the treatment of strabismus, by any method, is not only the cosmetic result, but to restore binocular vision. This is always the case where nonoperative measures are successful, which cannot be said of the operative methods, because conditions have been established by waiting, which render this impossible. As a rule, when strabismus has become established for any length of time, there is a great reduction of vision in the non-fixing eye, and this is known as amblyopia exanopsia. The exact pathology of this condition is not clearly understood, but the clinical fact remains that these eyes do not recover their visual acuity under any treatment. To this general rule, however, I have found many exceptions, especially in young subjects. It is the amblyopia combined with the loss of binocular vision that early treatment prevents, so it is positive that any case should receive proper attention as soon as the earliest symptoms are noticed. The non-operative methods of treatment may be classified as follows: First, optical or the exact correction of errors of refraction. Second, the occlusive bandage. Third, the suspension of the accommodation of the fixing eye by a reliable cycloplegic. Fourth, fusion training or orthoptic exercises. Fifth, bar reading. The exact correction of refraction errors is of first importance. The rule is that convergent cases are associated with hypermetropia, and divergent cases with myopia, so that it appeals to any logical mind that the correction of these errors is rational. The ciliary muscle must be under the control of a reliable cycloplegiac, and there is none better than atropia. As a rule I order a one per cent solution dropped into the eyes three times daily for three days, and then examine or test the refraction. In young children the strength of the solution must be modified. In young children, also, retinoscopy is the method par excellence in estimating the refraction. I know that I can measure the error within .25 D, so that we have in this an accurate method in which the observer sees for himself, and is independent of the patient. In older subjects the results by retinoscopy are proved by subjective methods as a matter of accuracy in the routine of adjusting glasses. The glasses prescribed must be a full correction or very nearly so. The occlusion bandage is applied over the fixing eye for variable periods, from a few hours daily to several days. It consists simply of a pad of gauze and cotton, held in place by a bandage or strips of plaster. The object of the bandage is to test by the usual methods, such as a red glass held over one eye, prisms, etc., and try to elicit a diplopia. If the diplopia is elicited, we know that both eyes are being used simultaneously, and then we are ready to use the fusion exercises. For this purpose we have the orthoptic picture in one form or another. These consist of two halves, which when combined, make the complete picture. For the purpose of having the picture in the act of binocular vision, stereoscopes are used, and there have been invented by Oliver and others adjustable ones, but I have found the ordinary cheap hand stereoscope to answer all purposes. However, the best instrument as yet devised, is the amblyscope of Worth (see illustration). This instrument, to follow Worth's description, consists of two halves joined by force the use of the non-fixing eye, thus exercising it, so to speak, and, in many instances, the vision comes up and the amblyopia exanopsia prevented. With the same object in view the suspension of accommodation in the fixing eye is next used. The cycloplegiac, almost always atropin, must be applied to the fixing or better eye only. It is a fact that, in many cases the eyes remain straight during the time the accommodation is suspended in both eyes, but the old habit of using one eye only is kept up. If the atropin is applied to the fixing eye only, this forces the use of the nonfixing or worse eye, especially in near vision, thus again forcing its use. After several months of this treatment the vision of the nonfixing eye usually comes up, and then we a hinge. Each half is made up of a short tube joined to a longer tube at an angle of 120 degrees. These tubes are 11⁄2 inches in diameter. At the elbow of each tube is a flat oval piece, on the inside of which is fitted a mirror. At the end of each of the long tubes is fitted carriers to hold the object slides, which are again two halves or portions of a complete picture. At the ocular end of the instrument are two lenses of five inches focal length, the distance of the reflected image, and serves to render the rays of light emanating from the pictures at the other end of the tubes parallel. An adjustable arc connects the two tubes so that their angle of separation may be varied or adjusted to each case. The advantage of this instrument is that the illumination of the two halves of the |