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night. She has moved from one room to an- symptom of melancholia, and it may be one other and turned the bed in all directions, yet of its most troublesome manifestations, but the result is the same. If, however, she simply it is somewhat peculiar to have such marked goes across the field to the old house she sleeps insomnia, and to have it so completely rewithout the slightest trouble. She states that lieved by removal. I have, however, seen it she has lost all interest in everything, and that in a less degree. Some cannot sleep in one she feels that she is useless. She would not room, while they sleep very well in the next want to make away with herself, she says, but room. Some cannot sleep with the bed in a if it happened accidentally she would think certain position, but if it is moved the trouble that it would be very pleasant. She will not disappears. It is unusual to find the whole of her own accord leave the house, but if she spot tainted with this insomnia while all other is taken she will go, and it is necessary to localities are free from it. take her away at times in order that she may In melancholia, it is the rule to have depressleep. In that house she is absorbed in herself sion of the general health ; appetite may be and her miserable existence.
preserved, but assimilation suffers. The paThe appetite is good, the bowels regular, tient usually loses flesh and grows weak. Notand the digestive organs appear to be normal. withstanding this the patient is often able to The urine is normal. There is no evidence of take a great deal of exercise, and indeed there central disease. There is no headache, and may be, in some cases, constant restlessness, the eye-ground is normal. She has wasted such patients being with difficulty kept quiet some in flesh, and lost some strength. The sufficiently long to rest them after fatiguing skin has been growing darker since she has walks. The patient is, however, rarely able to been sick. She informs us that the menses are do connected work. This woman has not exregular, but that the quantity is decreasing, hibited this restless manifestation. She is perwhich, in connection with her age, would in- fectly content to remain in one spot, eyes lowdicate that she is in the menopause.
ered, perfectly idle, and absorbed with her As you can judge from her answers the intel- miserable feelings, and going over and over lect is perfectly preserved. There is no dis- the same unending chain of morbid notions. turbance or impairment of any of the special This case also illustrates the hereditary nasenses. It is quite common in melancholia, of ture of this affection. There is perhaps no which this is an example, to find that the pa- other form of mental derangement which is tient has perfect preservation of intellect. The more commonly the result of hereditary transsubject will be able to transact business and be mission than this. A tendency to melancholia perfectly rational on every question. We no- runs in certain families, and for several succestice, in this case, that the melancholia presents sive generations, several members of each gen. the peculiarity of association with a definite spot. eration presenting this disposition. The disIt is not very rare to find the depression of spirits ease is apt to make its appearance late in life, connected with a locality. Sometimes it is a so that, although none of her brothers and sisdread of a locality or topophobia, which is a ters have yet showed this tendency, it is not word coined to express this condition. A per- impossible that some of them may yet exhibit son may be perfectly able to go anywhere with it. In women, it is very likely to develop at the exception of on a certain street. He has an the menopause, and it is at this time that conunconquerable aversion to this street. Some-stitutional tendencies in females are most apt times it is only one side of a street. It is often to become prominent. This tendency to melthe case that where these persons cannot go, ancholia is perhaps especially apt to show they can be taken without resistance. It is more itself at this time, because even in women who unusual to have the manifestation of aversion show no tendency to true melancholia, there is to a dwelling, which is seen in this patient. depression of spirits at this period. It is,
Another interesting fact is the insomnia therefore, not strange that in those who have a which is connected with this house, and which predisposition to the affection it should deis immediately relieved by leaving it. When velop at this time. she goes to another house, she states that In her father's case the tendency to recur, she cannot get enough sleep. This is an which this affection presents, was well seen. unusual feature. Broken sleep is a common | The deep gloom which has rested over the pa
tient for months, rendering him utterably mis- be found. In this patient, the melancholia
would naturally suggest itself that she was in In some cases there are special causes which the way, and the temptation to put an end to operate to produce this trouble, such as family her existence would be very natural. This eletroubles, nervous shock, business worry, or ex ment is always to be recollected in our proghausting discharges. It is, however, very rare nosis, and it is always to be guarded against in to have the affection arise as it has in this our treatment. Further than that, these spells
of melancholia continue an indefinite time, but In speaking of hereditary influences as pre- the individual attack nearly always passes away, disposing to mental derangements, I would ask sometimes abruptly. Therefore the prognosis your careful attention in connection with the in a case lasting a long time should not be unsubject of melancholia to its relation to in- favorable as regards the particular attack. We herited gout or a disposition to lithæmia. In may, however, fear that it will return. a certain number of cases there is a very close We shall encourage this patient to fight connection between the two, and the develop- against her morbid feelings. Undoubtedly ment of the morbid depression of the melan- change of scene, travel, and distraction of the cholia is distinctly associated with mal-assimi- mind constitute most potent remedies. This lation of the food and torpidity of the stomach, patient cannot sleep in her own house, and she liver, and kidneys, or in other words with that should not be forced to remain there. If she condition which we name lithæmia. Although went away this trouble might be benefited. I this term is a vague one, it is applied to that should advise you to use drugs with a good group of nutritive disturbances usually met deal of care and only when there ‘are wellwith in the subjects of internal gout, and is marked indications. Occasionally you will be doubtless associated with impaired functional forced to use remedies, such as bromides, activity of the great digestive organs, so that hyoscyamus, assafætida, and valerian, to secure the blood is more or less altered in composio rest, but as a rule, the less you use of these tion. In such subjects various nervous mani- sedative remedies, and the more you accomfestations take place. Neuralgic conditions are plish by a change of scene, change of diet, frequent. In epilepsy the attacks are frequently change of occupation, and moral influences preceded by the development of a lithæmic the better. state, and apparently there is a spontaneously Malignant Disease of Left Lobe of Liver, generated poison which operates upon the —This woman is 66 years of
age, and has been nervous system and produces the explosion. a hard working woman. She has led a strictly In the same way, there is in many cases a correct life. For one year past she has noticed close connection between melancholia and slight jaundice. As can be seen, the skin is lithæmia. Cases of this kind are familiar in somewhat colored, the conjunctivæ are slightly history. The connection between this type of stained, and the urine is colored with bile pigmental trouble and lithæmia is well worth ment; during this time there have been no notice in considering its dietetic and thera- attacks of pain in the region of the liver. The peutic treatment
jaundice has come on gradually, and we cannot In other instances nothing of this kind is to suspect that it is due to gall-stones. The jaundice has, as is usual, been accompanied with with the left lobe of the liver and pressing upon itching of the skin, constipation, and pale some of the ducts. feces, although not absolutely clay-colored. The symptoms are not urgent, the pain is With these, there has been impaired appetite, not severe, and the digestive functions are impaired intestinal digestion, from the absence fairly well performed. The treatment of this of bile from the intestinal canal. These are condition must of course be symptomatic and the symptoms common to jaundice. There has palliative. The only thing to be done here is been for some time slight pain in the pit of the to give attention to diet, and to administer stomach, and gradual, but very positive and such remedies as will assist in perfecting the progressive, loss of flesh. When she first pre- digestive processes. For this patient, pepsin, sented herself, a hard tumor was found in the with a little muriatic acid, would be suitable. abdomen in the left side.' This appears to be For the constipation, a little prepared ox-gall connected with the left lobe of the liver. It is with pepsin and nux vomica would be of serslightly painful on pressure. It is the seat of vice. It is often necessary to associate with the pain of which she complains. For the these remedies hyoscyamus or belladonna as a past two years she has had more or less pain sedative. In the present instance, the pain is across the back.
not sufficiently severe to call for such remedies. The jaundice which she presents is undoubt- This case has already lasted over one year, edly due to gradually increasing obstruction of the jaundice being a year's standing. The the biliary ducts. The gradual and progressive case is advancing very slowly. As regards development of the jaundice excludes all such the duration of the case, it is difficult to form causes as gall-stones and attacks of acute inflam- any opinion, but I think it will continue for mation closing the duct by the swelling of the some considerable time. Although she has membrane, and by pressure and adhesion. Of lost flesh and strength, she is not much rethe causes of gradual obstruction, the most duced and is able to be about. The usual common at this age is the gradual development course of these cases is from six to eighteen of some neoplasm in connection with the liver, months, but the freedom from pain, the comand pressing upon its duct.
parative preservation of general health, the The right lobe of the liver is not materially small size of the tumor, and its limitation to enlarged. Over the left lobe there is increased the left lobe, point to the fact that this case hardness, and the liver projects below the mar- will be prolonged. gin of the ribs at least two inches. This enlargement is irregular, and justifies the sus
ORIGINAL COMMUNICATIONS. picion that there is a new growth forming in connection with the left lobe of the liver. The ON THE NECESSITY OF ORGANIdegree of jaundice is slight. The urine is
ZATION OF THE MEDICAL PROmoderately stained, but otherwise normal.
FESSION.* These facts show that the obstruction is not complete. Some of the ducts are pressed
BY F. E. DANIEL, M.D.,
Editor Daniel's Texas Medical Journal, President Travis County upon, while others are patulous.
Medical Association, Secretary to Section of Dermatology The diagnosis in this case is undoubtedly Ninth International Medical Congress, Member - American
Medical Association, and of the American Public Health Assothat there is a neoplasm forming in connection
ciation, Secretary of the Association of American Medical Ediwith the left lobe of the liver, in all proba
tors, Secretary of The Physicians' Mutual Benefit Association bility of a sarcomatous or carcinomatous nature. The age of the patient, the progressive emacia
ENT'LEMEN: I thank you for the courtion, and the local pain favor this view. The
tesy of an invitation to be with you on absence of any other satisfactory cause to ex
this interesting and important occasion. It is plain the presence of the jaundice assists in an occasion which I hope and believe will the diagnosis. It is a well-known fact that the mark a new era in the history of the mediliver is one of the most frequent seats of the cal profession of the grand old county of primary formation of these neoplasms. Con- Williamson. It will be an era of departure sidering all the facts in the case I do not think and of progress, a falling into line, as it were, that the diagnosis can be open to doubt, that
Delivered by invitation at Georgetown, Texas, on the occawe have a slowly forming growth in connection ciety, January 13, 1886.
sion of the organization of the Williamson County Medical So
of Texas, etc.
of the body of the profession of this en- Not alone in the still chamber of death, lightened community in that grand march of where, with hushed voice and stifled tread, the sanitary and medical progress which is now re- physician battles successfully with the "fell desounding throughout the length and breadth of stroyer;" not alone in the plague “beleagured this broad and beautiful land, and a preliminary city," where - pestilence walketh in darkness," to which is—as in all else of progress and re- where the death-angel flaps his wing, and the form-organization. I thank you for the honor devoted doctor cheerfully lays down his life in you have conferred upon me by an invitation the unequal struggle, does genius illuminate and to address you on this occasion, and, while I make glorious the life and character of the defeel and appreciate the courtesy as a recognition votees of this divine science, but in the crash of my humble labors in this fruitful field, I am of battle, in the shock of contending hosts, yet more sensible of my inability to enlighten where gallantly rides the proud crest of a Hood, -nay, I fear, to even interest you. Were my a Wane, a Terry, or a DeBray, leading the ability commensurate with my inclination, or victorious and impetuous Texans—there, too, were my eloquence equal to the interest, nay, the is seen the sash of a Cupples, a Beall, or a enthusiasm I feel in all that pertains to the wel. Wooten. fare of our beloved profession, I would glad- I come not here to sing of the “ grand den your hearts with a speech to-day, such as achievements of medicine," nor to recount would arouse in you, too, a desire to be “up how, step by step, it has advanced from an and doing." This hall should resound with humble calling, with its few devoted followers, stirring words, such as were wont to fall from to that proud eminence it to-day occupies, as a the lips of a Houston, and should echo an elo- grand, a sublime science, resplendent among quence worthy of a Coke or a Terrell. But, the kindred sciences of the world. Nor to realas ! “unaccustomed as I am to public speak- call the struggles of surgery, through its Parés, ing," my tongue cleaves to the roof of my mouth its Nélatons, its Grosses, and its Hamiltons, and refuses its office, while swell, like billows upward and ever onward from the dark domain on the mighty ocean, the deep thoughts within of ignorance, to which a blind and superstitious my bosom! But, I apprehend, my hearers are priesthood had relegated it, on the absurd too generous, too sensible men to expect elo dogma that “the church abhors bloodshed" quence of an editor. To write, and not to the church, which a little while later made the speak, is his province; and, to the best of my streets of Paris run red, knee-deep, with the humble ability, each month I endeavor to lay blood of the “reformers.” It is a fact in hisbefore you a translation of such thoughts as do tory well-known to you all, that Pope Gregory “swell," as just remarked.
XI. forbade the practice of surgery on the part Gentlemen, I come not here to talk, though of any of the priesthood, in whose hands at that of my "inability to do justice to the subject;" period was all the learning, on the pretext that I come not here to bandy compliments, nor to it was “sinful to shed blood.” For years all indulge in commonplace platitudes, neither do the surgery was done by the barbers, who were I come to tell of that “grandeur of medical called “leeches," as indicative of their trade, science," " the dignity of the medical profes. and, in addition to shaving and shampooing, sion,” nor to sing of the achievements of the they cupped, bled, and leeched; and to day genius of medicine or surgery, for that genius the striped pole which adorns the shop of the which God gave to man—that subtle essence of humblest “tonsorial artist” is a symbol of intellectuality by which man has, in all ages, surgery's disgrace. It is equally well-known by its exercise and development, in one way to you that the immortal Paré, who revived the and another, reached a sublimity almost di practice of surgery, and made that kind of vine, asserts itself as powerfully, as unmis bloodshed, at least, respectable, was saved at takably in the life-work of a Sims, a Gross, or bloody Bartholomew by especial protection of a Flint, as ever it did in that of a Franklin, a the weak and cruel Catharine, and the weaker Watt, or an Eads. It shines as resplendently —the Dauphin-Charles IX. in the writings and in the work of a Pepper, a But I do come here to talk of organization ; Carpenter, or a Gaillard, as in the brilliant and that great element of success in science as in bloody records of a Lee, a McClellan, or a war, and without which great things are imStonewall Jackson.
possible. Behold the vast chain of railroads and system of railroads which encircle the to-day, while ostensibly building a mythical globe with an iron band! The mighty com- temple, are, in reality, erecting one to famemerce of the world, with its fleets of steel for good, charity, and benevolence—to endure steamships begemming every water ! With when the rock-ribbed shores of the Atlantic what precision and success are they operated. and Gibraltar's granite greatness shall have It is only by a combination of means and crumbled into the sea ! minds, and thus the domination of mind over We have seen, in the harmonious working of matter, that such is possible. The grandest societies, medical and others, the accomplishworks of all ages, and in all lands, the beau- ment of much good. Not alone for the protiful charities which ennoble the order of Free-motion of science do we meet, but each assemmasons and kindred organizations, are the re-bling of our little society—a chosen brothersult and outcome of combination and system, hood, into whose charmed circle only the the handmaids of organization. And the great-worthy can come, estimated by that ideal est and most renowned military exploits that standard understood and recognized by physihave ever startled the world, the gigantic en- cians, but hard to define-enables us to renew gineering feats which have spanned an ocean that fraternity of feeling and intellect which and tunnelled a mountain, would have been ennobles and beautifies the life of the physician. disastrous failures, but for system, discipline, We meet, like harvesters, to garner up someand combination, which wait alone on organi- what of the fruit we may have reaped amid the zation. A mob, a howling mass of humanity, toils, the successes, the failures of a physician's however numerous, is powerless to cope with a daily life. They are regular recurring periods, squad of disciplined troops till touched by the devoted to retrospection and anticipation, and genius of organization, when lo! great armies are a necessity in our nature-periods when, arise, at whose measured tread the very earth pausing, we may look back upon the shadowy quakes and trembles.
fragments of the past, gathered into solemn Even so, it is the magic of organization that forms of warning, or of encouragement; or gives life and energy to scientific progress. look to the future, bright, but unformed, and
If in those days, when man was in his in- take counsel with ourselves how best we may fancy, and science yet in its swaddling clothes, shape it that coming generations may know it was found necessary to organize to accom- that we, too, have lived and struggled; that plish any desired end; if, thousands of years “ some forlorn and shipwrecked brother" may ago, for want of organization that most daring recognize our “ footprints on the sands of deed of man was doomed to failure and “a time,” and,“ seeing, take heart again." confusion of tongues" told the tale of Babel ; The profession of medicine, the legitimate is, thousands of years ago it was possible only practitioners of rational medicine, should by organization to build the great temple to organize in every nook and corner of this great Jehovah, an organization which endures till to State, and cease not the good work till every day, and which, with hands clasped around worthy practitioner is enrolled upon the records the globe, is yet intact, and ten thousand times of a grand State Association, which, in turn, more perfect, more powerful for the advance should formi an integer of a grand or national ment of science and the promotion of all the organization; like tiny tributaries, each pourvirtues, how much more necessary is it to-day, ing its wealth into a common stream of majority when men and methods, means and necessities and might. In that way, every village comhave multiplied many millions of times ? munity, every individual practitioner will be
On "general principles," therefore, I assert, brought into accord with, and subject to, the organization is a prime necessity with mankind restraints and the benefits of the central or genin every relation of life.
eral society, the meetings of which are full of I have often wondered why, in a learned pleasure and profit. Such meetings have been profession, numbering many thousands, alike aptly compared to mile-stones along the pathin all parts of the world, a brotherhood having way of life to show us how far we have travcommon interests, common sympathies, and a elled. It is ennobling to reflect that you are a common mission, a life-work of philanthropy part of that grand whole, so potent for good. of tangible reality, should never have or- The influence of association is magnetic. You ganized on such' plan as did those who, return from a convention of your Slate Associa