In about two weeks the patient died. Post is to "excite waves of vessel dilatation in mortem examination revealed metastatic foci the correlated area." The vessels of the in both lungs, and in the muscular tissue of drum become distended; acute congestion is the lower extremity. The right external thus established with its attendant stretching meatus was filled with a dark, tolerably thick of the sensitive and tense tissue in which it blood clot. Cutis of External Meatus swollen occurs, and so occasions the pain experienced and covered with a greasy secretion. On by the subject of these conditions. If the the posterior wall, at the point where it passes irritation be sufficiently prolonged, effusion into the bony meatus it is thickly granulated. into the tissues ensues, which, under favorBony meatus deprived of its periosteum. able circumstances, will pass on to suppuraThe lower third of lower wall, hyperæmie tion and constitute a veritable otorrhea. But, and in places rough, (commencing caries). before suppuration is fully established here, Membrana tympani gone, with the excep- there is great danger of an extension of intion of a part of the anterior edge, which flammation to the membranes of the brain. is loosened from the annulus and partially This is shown to be due to certain structural displaced toward the ostium tympanicum arrangements at the petro-squamosal fissure. tubæ. The wall of the labyrinth is deprived At this fissure in the infant the dura-mater of its periosteum. The hamnus is drawn in- dips down into the tympanic cavity, becomwards and upward. The end of the handle ing continuous with its muco-periosteal linrests on the anterior edge of the oval win- ing. This process of dura mater is richly endow. The stapes is not seen. The incus is dowed with vessels from the middle meninpreserved. The end of its long process geal artery, which also supply the drum rests on the posterior wall of the oval win- cavity. It is manifest that congestion and dow. At the point where the chorda tym- inflammation of the drum cavity may be pani leaves the facial canal there is an irregular opening about the size of a pea, through which a thick probe can be passed a short distance into the facial canal. The chorda tympani is destroyed up to near its entrance into the galasserian fissure. In the floor of the tympanic cavity is an oblique oval opening, whose long diameter is about c. m., with a transverse diameter of about half the length. This opening leads into the jugular vein, whose inner wall is infiltrated with pus and yellow, for the extent of about c. m. No sign of a fragment of stone was seen where. any directly and rapidly conveyed to the meninges of the brain in infants. Towards adult life this fissure becomes more or less obliterated, though the vascular arterial connection exists. ADENOID TUMORS IN THE NASO-PHARYN GEAL CAVITY.-Prof. Dayer (Brit. Med. AURAL DISEASES FROM REFLEX IRRITA THE DETROIT LANCET. VOL. III. DECEMBER, 1879. No. 6. Original Communications. The Enemies of our Profession. Annual Address before the Detroit Academy of Medicine, BY A. B. LYONS, M. D. L IFE means strife. Vigor implies an environment which encourages existence by constantly antagonizing it. Among the elements none is so active in undoing the constructive work of the vital energies as oxygen; yet of all the elements we single out oxygen as the one upon the presence of which vital activity is immediately conditioned. Darwin has shown how the same principle applies to the development of race and of species, and few biologists will be found today to dissent from the proposition, that no factor has greater influence in bringing to perfection the mechanism through which life manifests itself than the "struggle for existence." We need not regret, then, however inclined in our private capacity to Quaker principles, that, as members of the medical profession, we have enemies. Only let us see to it that our warfare be carried on in that manly, chivalrous spirit that shall make it truly man-ennobling. (Kediave pa.) It is true that the Detroit Academy of Medicine holds itself aloof from a certain petty sort of strife, the broils of clan and feud, bitter and fruitless, like all civil war, in which many organizations of a similar character engage. No petty questions of medical ethics are allowed to divide its ranks in internecine conflict. It holds itself a united body to engage in warfare whose ends look to the common good. What then are the foes it shall find worthy of its steel? Or is it to disband its forces because there are no longer foes to subdue? Or again, shall it turn to peaceful pursuits, finding opportunity for the exercise of its accumulated force of talent and intellect in occupations more suited to our Quaker bent? It is worth our while, on such an occasion as the present, to ask ourselves seriously whether we have a right to lay by our armor and turn to thoughts of peace-whether we have not more than ever to renew old conflicts, to engage in new ones more difficult than any in which we have hitherto tried our strength. Who then are the enemies with whom we have to cope in open warfare? and what insidious adversaries must be met by a strategy wiser than their cunning? Under what banner do we hold the field? What watchwords stir our blood and inspire us anew to deeds of valor? First then, the foe who annoys and menaces us most constantly, is none other than the prince of the powers of darkness. Against this adversary-Ignorance,—our war must be one of conquest and extermination. The hosts arrayed against us under this hostile leadership embrace disciplined warriors, over whom we deem it our highest glory to win a triumph, but also comprise a rabble of lawless malcontents drawn from the dangerous classes, who have to be punished as a disagreeable task, not conquered as a glorious achievement. What part, then, have we, members of the Detroit Academy of Medicine, individually or in our corporate capacity to play in the contest with human ignorance and superstition? A far more active one, I am bound to say to you, than many of you seem to have hitherto realized. Peculiarly to us as a profession, it belongs to point out to our fellow-men the narrow way that leads to life. Often indeed in individual cases we can but snatch from his position of imminent peril the unconscious victim of some fatal imprudence. How often, alas, is our attempted aid unavailing, about engaging in it on any plea of excessive our well directed labor lost. are re modesty. a relative term. Confessedly we are our- we as a To instruct the masses in regard to matIn the mercenary view, we may be satisfied that we have done all that can be de- ters to which we have given a lifetime of manded of us when we have attended, either study, is however, not our hardest task. to convalescence or to a termination we have "Ignorant," as applied to the people, is only striven in vain to avert, our "case" e. g. of typhoid fever. At all events we leased from further responsibility when we have at last paid the collector his ten per cent. on a bill we had given up as worthless. Yes, but where mercenary obligations end, professional ones begin. Whether or not we secure a fee, we are bound to warn other inmates of the house by the example of their comrade, to shun the penalty nature will surely exact for even an ignorant violation of her laws. As a profession, we are bound to exert ourselves to the utmost to acquaint physiology, and when we disagreed, refer the common people with the principles of sanitary science, and throw the weight of our influence on the side of every judicious measure that has for its object the salus populi. Do you say the Academy has always been interested in such matters-is doing all it can? How is it then that our efficient State board of health does not find among us a We disputed questions to our text books. long after we have admitted to ourselves It is true that the spirit and temper manifested in the discussions in our academy have been unusually free from such littleness. Perhaps it has been oftenest shown single man to volunteer aid in collecting vital statistics? How does it happen that we have not as an organization assumed, either independently or in co-operation with the State board, the labor-peculiarly our own-of studying systematically the sanitary by a reticence on the part of members who own-of studying systematically the sanitary feared to ask pertinent questions, lest it conditions and surroundings of the City of Detroit? Is it lest some one should hint that such labor is undertaken to win glory for Dr. Y., or Prof. W.? Shall then the man who sees a child in peril of some dreadful death hesitate to jeopardize his own life in the heroic act of rescue, lest forsooth some one should say we did it only to win the name of hero? No, gentlemen, when a noble work, demanding self-sacrifice presents itself, we may safely trust our generous impulses, and trouble ourselves least of all about the judg should seem a betrayal of ignorance. At all events, recognizing how antagonistic such a false pride is to scientific progress, let us in the future take care to banish it altogether. Including in our membership some who have been already for more than a score of whose professional learning is as yet chiefly years physicians in active practice, others drawn from books and the instruction of the schools, there is ample opportunity among us for an interchange of thought that shall be mutually advantageous. Those who are gathering week by week in clinical observation the facts by which all theories must be As a matter of fact, the telling work, judged, must here lay open their treasuries whether in the accumulation of statistics, or of fact for the benefit of their juniors, whose in promoting sanitary reform and securing opportunities in this direction are less ample. for the masses instruction in sanitary mat- Those on the other hand who are fresh from ters, is not likely to bring the men who do the schools, where the latest researches in it into great notoriety. None need hesitate medical science have become familiar to ments of other men. them, owe it to their seniors, too busy in interest and the value of our published proclinical study to have kept pace quite with ceedings, were such reports a constant feature the progress of these researches, to point out how their facts corroborate or discountenance the new theories. therein. Many branches of medical study require the exercise, not only of the mind in grasping statements of fact, but of the preceptive faculties themselves. This we have always recognized in the importance attached to the presentation at our meetings of clinical subjects-the exhibition of pathological specimens and of instruments; and the interest of our meetings has been greatly increased by the thoughtfulness of some of our members in giving us opportunities to augment our Such an interchange of wealth, by which all are enriched and none impoverished, we have to a certain extent realized in the past. To me it has been a matter of deep regret that of late years, so many of the older members have seemed to feel that the academy was no longer of any usefulness to them. To such I would say in behalf of the younger men, we beg you not to desert our assemblies. We need the results of your knowledge by such means. May we not exwider range of observation, the conservative influence in this revolutionary age of your maturer judgment, the sound common sense that is often better than our brilliant and possibly sophistical logic. We have little to offer you in exchange, but our thinking, if often crude and misdirected, is at least fresh and vigorous, and its aim is truth. tend and systemathize yet further this kind of object teaching? Might we not, e. g., add very largely to our knowledge of histology for example, and pathological anatomy, if we would agree together to take up these branches of study de novo as learners not very far advanced, and at stated intervals occupy an hour in comparing notes, exhibiting the results of work already accomplished in the form of mounted objects, etc., and mapping out work yet to be attempted? As a practical question, can we not in the future carry into execution some plan that shall place us more upon an equal footing as students, with many things as yet before us to learn? Such plan must be something definite, involving not a little labor and self-sacrifice which even though voluntarily assumed, enthusiasm, and hard labor-aye, and what must have more than heretofore a compulsory character. All this means work that will take time and patience, and it means enthusiasm. But what victories have ever been won without is harder yet-brave, patient waiting? It is only by this sort of labor, often with the end to be attained so distant as to be quite out of view, that we shall successfully combat the ignorance that we tolerate so easily, because it is our own-precisely for the same reason the most insidious, obstinate and deadly of our foes. We should continue to expect from the members volunteer papers, only these should be greatly increased in number, so as fairly to represent the acquisitions which individuals gain year by year through their observation and experience; but there ought to be assigned definitely to each one, some of the Close allies of ignorance, and sprung, inmany topics which are engaging the thought, deed, from the same stock are the tribes of and repaying by valuable discoveries the Bigotry and Superstition. The irregular study of those in the profession who have guerilla warfare they carry on is extremely larger opportunities than any of us for re- harrassing all the more on account of its search. It is true that the reports presented petty and purposeless character. Now, it is would embrace much that other members an assault with Chinese stink-pots, or even, had already met with in their reading, but a again in good Mongolian fashion, with absoconcise, clear statement of results definitely lutely no arms but their terror inspiring grireached would occupy but little time in read- maces, upon our most impregnable fortresses. ing, and there would be little danger but that Again, our flag of truce, covering, peron the whole the academy would be more in- chance, some errand of humanity towards terested and certainly more instructed than our pusillanimous enemy, is insulted and its by the desultory discussions into which they bearers put to barbarous slaughter. No deare apt to be led when there is no special feat seems to intimidate, no generosity to topic before them. conciliate, these Bedouin sons of Ishmael; Certainly it would add very greatly to the no treaties bind them longer than a day. To drop the metaphor--who of us has not been compelled to use all our tact, nay, to resort actually to pious deception, to induce a patient to take the dose of quinine or calomel that we know is essential to his good? How absolutely impossible do we find it often to convince the valitudinarian that she does not need any medicine at all? One patient must have something to act on his liver-though it is precious little that he can tell you about the functions of that organ. Another discharges you because you dictate too much what she shall eat and drink and wear. "It is the doctor's business to cure people when they are sick, not to be always interfering when they are well." Thus in a thousand ways are we annoyed and distracted by a foe who will not be met in the open field--who will not even make declaration of war, or accept any challenge to mortal combat. us to the drudgery that is as yet inevitable in our labor, they put perhaps wise, but certainly irksome, restraint on our activity; and again and again we are impelled to revolt and win for ourselves, at any sacrifice, freedom. Understanding by freedom, such a self-poise as shall constitute us fit masters of our own actions, must we not look forward to a time when we shall be free men? And are we not even now ready for such freedom? At present, we, as physicians and scientific men, are slaves of hypothesis. It is our own fault. It is needful, indeed, that we frame hypotheses to aid our imagination in the search for truth; and it is inevitable that a hypothesis once formed, as long as it is of service to us, must stand to us in the place of truth. It is, to use a somewhat hackneyed figure, the scaffolding, which is the only support for the workman engaged in building the walls, which are, after all, what the evanescent We may, indeed, in the main, treat him with a lofty disdain, showing a magnanimous spirit even in the punishment we are often scaffolding foreshadowed. When the walls compelled to inflict in pure self-defense, and contriving, on the whole, to come very seldom into actual collision with his organized forces. At least, so far as we are ourselves con are finished, the scaffolding, unsightly now and meaningless, is promptly removed by the very artisans who expended so much labor in constructing it. So it should be, although, strangely, so it cerned, for any glory we might hope to win is not, with scientific hypotheses. Because by victory, or any acquisition we might make their usefulness endures often through sevby conquest, such alone can be our policy. But in their petty way, and that on no small scale, these Bedouin enemies of ours are tyrants, from whose arbitrary and oppressive thraldom we are called upon, in the interests of common humanity, to emancipate our fellow creatures. And when, fired with righteous indignation, we do unsheath the sword of vengeance with all the might of truth on our side, it is not war; it is retribution, in which we may glory only as instruments of a power we ourselves adore as supreme. But the tyrannies of superstition and bigotry are not over the ignorant and weak alone. Happy the man, even among ourselves, who has escaped despoiling and servitude at the hands of some of these oppressors. Plebeian in origin, all of them, they have somehow usurped authority until they have us so completely in bondage that we have not arms nor force nor resolution to regain our independence. eral generations of men, we forget that their authority is wholly provisional, and confound them with the truth they have enabled us better to discern and comprehend. So it happens that much that is called scientific and rational in the practice of medicine is contrary, even to the dictates of common sense. See how, with a smattering of chemical knowledge, enthusiastic medical men have proposed antidotal remedies having no real relation whatever to the pathological condition present. And it is astonishing what a tenacious hold methods of treatment having such slender foundation gain from the authority of a single name. All this I say, not in disparagement of the intelligence of those who were our preceptors and immediate predecessors in medical practice, not as blaming the multitude of our contemporaries who employ remedies not empirically--would that they were sufficiently enlightened to do that-but following a routine based on the theories that Not without their usefulness in holding were framed years ago, when only half the |