for the defendant to hire such experts as the size of his purse and that of his friends will allow. In this way expert testimony becomes prejudiced, illogical and is not given upon the question at issue, but as a defense or prosecution argument. Nothing need be said at this point as to the quality of the expert testimony which such a method produces. It was for the above reasons that steps were taken and an organization completed which has been in successful operation for more than a year past, and which, during that time, has forwarded courts more than thirty opinions. to the The commission as now organized is composed of three of the most prominent psychiatrists of our city. These gentlemen, actuated solely by a desire to elevate the standard of medical testimony, volunteered their services, upon the request of the writer, to assist him in determining the mental status of certain individuals charged with crime, when from their actions or upon the suggestion that such individuals were not mentally responsible for the acts for which they were charged. It is obvious that the proper time to consider the question of mental responsibility is before the trial takes place, not at the trial where the defense of insanity becomes not a medical question, but in the nature an ex parte appeal to the jury. son. It was agreed that the commission was to be at the service of the court-present their findings to the jury, or in any other way to assist the court to arrive at a just opinion in regard to the sanity or insanity of a perIt goes without saying that this body serves without compensation. As mentioned above, the commission as now constituted, which of course, has no legal status, consists of three neurologists together with the jail physician. The method of procedure is as follows: Any prisoner in the jail before he is brought to trial, and in some cases before he is arraigned, in whom is found the slightest evidence of abnormality, is examined by the commission and a report of its findings is transmitted to the circuit attorney. Depending upon the report of the commission, the prisoner is tried for his crime or is brought into court and de lunatico inquir. endo is instituted as a result of the opinion of the commission. Naturally, as it frequently occurs, in the event that the ccmmission believe the prisoner to be sane the defense introduces it own experts. In such case, the court has the privilege to see the report of the commission, or its members are put upon the stand, in rebuttal of the testimony introduced by the experts for the defense. En The practical results of the commission's work has been entirely satisfactory. couragement has been given it by many of the criminal judges, the city attorney's office and others interested. It is of great satisfaction that I can state that in no single instance has a report of the commission been rejected by the jury in those cases in which the defense has refused to accept the opinion of the commission and have brought the case to trial, and attempted to prove a condition opposite to that of the report of the commission. In a discussion of its method before one of the most advanced associations in mental conditions, it was conceded that this step was one of the most advanced that had been attempted in the United States. As was said before, the commission has no legal standing as at present constituted, and can be dissolved at a moment's notice if the judge shouid see fit. The precarious existence of the commission has been the cause of some debate as to the possibility of passing a State law constituting such a commission of experts, and giving it the proper authority and standing. We are content at present to let the work it is doing effect in as large a way as possible the procedure in the courts in respect to the employment of expert testimony, and leave the solution of the permanenoy of such a commission to other hands. In conclusion, it may be stated that the voluntary and unpaid service to the state of line with the larger view of the civic responthese experts has appealed to me as being in sibility which physicians feel bound to share, and from which until of late there has been considerable shrinking. It is a part of a widespread movement which is tending to remove the isolation which the profession holds to the community in which it is a part, and for the elevation of expert testimony to the dignity where it belongs. IN THE REALM OF SPECIALISM.-Should the general practitioner send his eye cases to the eye doctor, his ear cases to the ear doctor, his throat cases to the throat doctor, his chest cases to the chest doctor, his stomach cases to the stomach doctor, his rectal cases to the rectum doctor, his genito-urinary cases to the G. U. doctor, his skin cases to the skin doctor, his gynecological cases to the gynecological doctor, his X-ray cases to the Xray doctor, etc., and had not married rich, who will pay the bills of the generous general practitioner?-E. S. McKee, in LancetClinic. HOSPITALS OF NEW ST. LOUIS. St. Luke's Hospital, at Delmar Boulevard and Belt Ave., is conducted under the auspices of the Protestant Episcopal Church, Diocese of Missouri, by which it was organized in 1866. The present structure was completed April 23d, 1904, its cost, together with the ground and the Nurse's Home, having been $450,000. It is built to accommodate 110 patients, there being 50 private rooms and 60 ward beds. Its medical and surgical conduct is under a physician's staff, at the head of which is Dr. H. G. Mudd; its school for nurses is under the superin. tendency of Miss Ella Fligg. The hospital has a small endowment from various sources, amounting to $75000. The extent of charity is limited only by the capacity of the hospital and means ST. LUKE'S HOSPITAL. ST. LUKE'S NURSES HOME. contributed for its support. For year ending April 30, 1906, 27 per cent of the total number of days of hospital care and treatment was given free of charge, which is about the percentage of previous years. ASTHMA.-J. Madison Taylor (Monthly Cyclopedia of Practical Medicine) states that the manual treatment of asthma has proved of the greatest value in his hands. He regulates vasomotor action by alternating pressure on the erector spinal muscles, by means of the hand or by heat, cold, dry cups, electricity or specially devised machines. A sufferer from asthma should be taught in the intervals to forcefully expel all the residual air possible, to educate his diaphragm and external abdominal muscles. Gentle exercise for more than a half hour tends to equalize blood-pressure. The Hospitals of New St. Louis. A SHORT time since we heard a physician of this city bewailing the lack of modern hospitals in St. Louis, and his utterances drew our attention to the fact that during the last decade there has been as tremendous an improvement in local hospital equipment and facilities as in any one line of modern development. It is only the man who confines his attention to one institution and lives in his little circle who is blind to the fact. St. Louis has its full quota of hospitals, and they are in the main as finely housed and as well equipped as those of Eastern cities; the buildings of the City Hospital, St. Luke's, the Jewish, St. Anthony's, and the Deaconess' are among the most modern and are architecturally beautiful, being ornaments to our city; with such institutions the profession has never need to be apologetic about our hospitals. It occurs to us that our readers will be interested in seeing what St. Louis has in the way of hospital buildings, and to this end we will from time to time devote a page to various of these institutions. We hope and believe that this feature will meet with the general approval of friends of the FORTNIGHTLY and of St. Louis. DISCUSSION of the reduction of garbage and its economic value has been so voluminous Garbage Removal. during the past decade that one would expect that an ideal system would be operative in every progressive city, it has effected great improvement in many localities. Without making a study of the subject it has been our privilege to observe in four of the larger Eastern cities and in Toronto during the past summer, and the trip has left us with the impression that a deplorable condition exists in St. Louis. With us the question is not so much what disposition is made of this refuse as when and how it shall be removed so that it shall not be a menace to the community. We have a system of alleys better than that of any other city that we know, and the whole matter of handling garbage should be easier here than in cities less favored in this respect, yet his majesty of the garbage cart does not like alleys except in more favored districts and refuse left there may be collected at his pleasure, but his dripping, stinking cart soon seeks the avenue and it is nothing unusual for such reeking wagons to make their way through the downtown streets at mid-day If garbage is properly collected and conveyed the matter of receptacles used by individual householders is of minor importance, to insist on a certain receptacle and let the refuse lie therein until it is a decomposed mass and then carry it through the streets in a wagon which drips and spills considerable portions is little short of an outrage. It is our belief that we must have proper garbage removal; that this work must be done at night and with a sufficient force and such wagons as will insure prompt removal and cleanly handling. The disposition made of refuse after it has been properly removed is another question and one which concerns the householder but slightly. If it has value this should be turned to paying the expense of removal; if the question is largely one of destruction the twin genius of the one which has given us clear and healthful water should be devoted to the purpose. We have had a hot summer, and one which has emphasized the defects of our system, another summer is coming, and it is to be hoped that a better condition will prevail in this department, and that New St. Louis will be able to point to her clean alleys as well as to her well paved streets, beautiful parks and pervading prosperity. AN interesting scientific program was the feature of the meeting of the St. Louis Med Scientific and Other Work of the St. Louis Medical Society. ical Society, held at its hall on Saturday evening, September 29th. The paper of the evening was read by Dr. Rollin H. Barnes who considered Rectal Abscesses in their various Forms and Stages, emphasizing the importance of early diagnosis by the general practitioner, to whom these cases first come, and of prompt surgical treatment. He considered surgery with thorough drainage the only treatment, and thought patients should be generally educated by the physician to a realization that delay is especially conducive to unfortunate results, and to fistulas and other trying sequelae in troubles of this class. The discussion was exceedingly interesting, and brought out much which was important to the subject; Drs. Stauffer, Meisenbach, Hinchey, Funk. houser, Kirschner and Kieffer participating. Drs. Dorsett, T.A. Hopkins and Meisenbach reported their impressions of the recent meeting of the British Medical Association held in Toronto; the reports were made with a thought of comparison with the work of our own American Medical Association, the gentlemen having attended both meetings, and covered organization, scientific and social aspects. The strength of both was emphasized, there seeming to be room for criticism, but in minor points. The President, Dr. Homan, and Dr. Spooner also spoke on the subject. The society accomplished considerable routine business; elected fourteen new members and entertained six nominations for membership, which were referred to its Election Committee. The following were elected to membership: R. W. O'Bannon, Missouri Trust Building THE CZAR'S "HUMAN SIDE." In the spring of 1899 Mrs. Amalia Küssner Coudert, an American miniature painter, was called to the Winter Palace to paint miniatures of the Czar and Czarina. There she saw much of the Russian royal family and its home life. Mrs. Coudert found the Empress a woman of rare beauty and grace of person and character. Of the Emperor she says: "In dwell. ing upon the Emperor's youthful appearance and gentle bearing, there is no thought of implying any lack of strength. There could hardly be a question of physical bravery in any royal case, since personal fearlessness is a part of royal training, if not inherent in royal blood. But no one could see this young Emperor of Russia, as I saw him then, without seeing spiritual force in his direct gaze and hearing moral courage in his sincere voice. To my excited imagination he appeared fully aware of the weight of his des tiny, and to be bearing the awful burden with cheerful serenity, always looking at his great danger and without one waver of fear." Such an intimate view of so important a figure in the history of today cannot fail to be of unusual interest; and this view will be presented in an article in the October Century by Mrs. Coudert, under the title of "The Human Side of the Czar." There will also be reprcductions of Mrs. Coudert's portraits of the Russian family. THE REVIEWER'S TABLE Books, Reprints, and Instruments for this department, should be sent to the Managing Editor, Century Building, St. Louis. CHEMISTRY: GENERAL. MEDICAL AND PHARMACEUTICAL, INCLUDING THE CHEMISTRY OF THE U. S. PHARMACOPEIA. A Manual of the Science of Chemistry and its Application to Medicine and Pharmacy. By John Attfield, F.R.S., M.A.. PH.D.. F. C.S.. etc., Professor of Practical hemistry to the Pharmaceutical Society of Great Britain, etc. New (19th) edition. specially revised by the author to accord with the New U. S Pharmacopeia, edited by Leonard Dobbin. Ph. D. F.I.C., etc.. Lecturer on Chemistry in the University of Edinburgh, etc. 12mo 760 pages, illustrated Philadelphia and New York: Lea Brothers & Co., 1906. (Price, cloth, $2.50, net.) tion of Attfield's Chemistry, for it is one of It is always a pleasure to review a new edithe few text-books on the subject which make it attractive even to those who have not a profound knowledge of chemistry. It was the guide of many of us in the college days, and has since been our counselor when chemical information was needed. The revision preparatory to the nineteenth edition was confided by the author to Mr. Leonard Dobbin, of the University of Edinburgh and examiner in Chemistry on the Board of Examiners for Scotland of the Pharmaceutical Society of Great Britain. The work has been brought thoroughly up to date and to accord with the most recent pharmacopeias of the United States and of Great Britain. The original plan of the book. has been strictly adhered to, as seventeen large editions in the United States and eighteen in Great Britain are an evidence of the approval of the professions of medicine and pharmacy in the two great English-speaking nations of the world. The author's ideal has been to produce a Manual of Chemistry for medical and pharmaceutical students, one in which not only the science of chemistry is taught, but in which the chemistry of every substance having interest for the followers of medicine and pharmacy, at more or less length, and proportion to its importance and its position in relation to the leading principles of chemistry, is set forth with all attainable exactness. The long and continued popularity of the volume testifies to the author's success in this. THE TRAINING OF THE NEGRO.-Dr. Robert Bennett Bean's paper in the September Century on "The Brain of the Negro" will be followed in the October issue by a discussion of "The Training of the Negro. It is Dr. Bean's belief that the negro needs restraint, moral and physical, and that, while the blacks must work out their own salvation with fear and trembling, to solve existing difficulties the attitude of the whites must be one of restraint and control, combined with. humane interest, sympathetic and altruistic guidance, and a good example. CORRESPONDENCE BORIC ACID AND APPENDICITIS. NEW YORK, September 28th, 1906. EDITOR OF THE MEDICAL FORTNIGHTLY: If I have perused numerous articles on the pure food question and the evil effects of coloring matter and preservatives on the human system, but not until recently, however, have I perused articles written by physicians who claim that boric acid and boron compounds, which are used quite extensively for preserving food, are the cause of appendicitis. such statements were true, however, the English Nation would be wiped out of existence. They have consumed foods preserved with borax for decades, and if food preserved with boron compounds was dangerous to health, the entire medical fraternity would have learned of it years ago. I have had a great deal of experience with boric acid and have always found it a soothing, cooling, healing sedative agent. The action of boric acid on the cuticle and mu. cous membrane is to allay inflammation, not to cause it. It is recognized as the most innocent antiseptic extant. It is an antiseptic which never irritates nor inflames, and thus enables a natural healing process to take place without interruption. Its action on the organic tissues is seen by the blood. Concentrated boric acid mixed thoroughly with fresh blood only delays and cannot prevent coagulation. In spite of all that has been said against. boric acid, it is clear that its action on albuIninous bodies has no analogy with any other acid except carbonic acid gas. It has been stated that weak or diseased kidneys could not eliminate boric acid. It is a fact, however, that it forms remedies of great value in kidney diseases. If the vermiform appendix were inflamed, boric acid would have a tendency to allay the inflammation instead of exciting it. Solutions of boric acid have been used in every cavity of the human system with beneficial instead of detrimental results. That cases of appendicitis are more numerous now than they were years ago cannot be denied. Years ago, however, such cases were diagnosed differently. In the census of 1890 there are no records of any appendicitis cases. In 1900 there were 5111 cases. There is no doubt that a few cases are caused by foreign bodies entering the appendix. Coprolites are found much more frequently, however, than foreign bodies. Bryant, in his paper, published in the "Annals of Surgery," February, 1903, states, "I found in 124 cases, abnormal matter in 70 per cent of the males and 55 per cent of the females." Renvers, in the Deutsche Medicinsche Wochenschrift, 1891, found in 459 autopsies, 179 coprolites and about 16 foreign bodies. We do not as yet understand the functions of the appendix. Without doubt almost every case of inflammation in the iliac region__can be traced to a diseased appendix. Fecal matter is forced into the appendix, which is so constructed that it cannot drain itself which causes inflammation. The vermiform appendix being a weak organ, is unable. to protect itself. Constipation would have a tendency to interfere with the supply of blood by direct pressure on the single artery which supplies the blood. A great many cases can, no doubt, be attributed to our bad habits of eating too much and masticating our food too little, which causes constipation, dyspepsia and general derangement of the functions. The hurrying, restless lives we lead certainly interferes with the normal working of our digestive organs. I firmly believe that indigestion, constipation, diarrhea and other digestive disturbances velopment of appendicitis. are the prime factors which favor the de H. H. LANGDON. THE recent innovation of American maga. zines in the matter of deviating from the use of a set and often inartistic cover designs, and giving their readers an attractive exterior, together with a constantly improving in. terior, should meet with general commendation. The "Century" and "Scribner's" have been exceptionally happy in this, but we believe that the best design yet is that used by the "Century" for October. This number of the magazine need not have been dated, for its front cover says "October," and says it in a most beautiful and poetic form. LARGE doses of stimulants depress by overstimulation-i.e., over-functional activity. |