the result is the same. If, however, she simply goes across the field to the old house she sleeps without the slightest trouble. She states that she has lost all interest in everything, and that she feels that she is useless. She would not want to make away with herself, she says, but if it happened accidentally she would think that it would be very pleasant. She will not of her own accord leave the house, but if she is taken she will go, and it is necessary to take her away at times in order that she may sleep. In that house she is absorbed in herself and her miserable existence.

The appetite is good, the bowels regular, and the digestive organs appear to be normal. The urine is normal. There is no evidence of central disease. There is no headache, and the eye-ground is normal. She has wasted some in flesh, and lost some strength. The skin has been growing darker since she has been sick. She informs us that the menses are regular, but that the quantity is decreasing, which, in connection with her age, would indicate that she is in the menopause.

As you can judge from her answers the intellect is perfectly preserved. There is no disturbance or impairment of any of the special senses. It is quite common in melancholia, of which this is an example, to find that the patient has perfect preservation of intellect. The subject will be able to transact business and be perfectly rational on every question. We notice, in this case, that the melancholia presents the peculiarity of association with a definite spot. It is not very rare to find the depression of spirits connected with a locality. Sometimes it is a dread of a locality or topophobia, which is a word coined to express this condition. A person may be perfectly able to go anywhere with the exception of on a certain street. He has an unconquerable aversion to this street. times it is only one side of a street. It is often the case that where these persons cannot go, they can be taken without resistance. It is more unusual to have the manifestation of aversion to a dwelling, which is seen in this patient.

Some

Another interesting fact is the insomnia which is connected with this house, and which is immediately relieved by leaving it. When she goes to another house, she states that she cannot get enough sleep. This is an unusual feature. Broken sleep is a common

it is somewhat peculiar to have such marked insomnia, and to have it so completely relieved by removal. I have, however, seen it in a less degree. Some cannot sleep in one room, while they sleep very well in the next room. Some cannot sleep with the bed in a certain position, but if it is moved the trouble disappears. It is unusual to find the whole spot tainted with this insomnia while all other localities are free from it.

In melancholia, it is the rule to have depression of the general health; appetite may be preserved, but assimilation suffers. The patient usually loses flesh and grows weak. Notwithstanding this the patient is often able to take a great deal of exercise, and indeed there may be, in some cases, constant restlessness, such patients being with difficulty kept quiet sufficiently long to rest them after fatiguing walks. The patient is, however, rarely able to do connected work. This woman has not exhibited this restless manifestation. She is perfectly content to remain in one spot, eyes lowered, perfectly idle, and absorbed with her miserable feelings, and going over and over the same unending chain of morbid notions.

This case also illustrates the hereditary nature of this affection. There is perhaps no other form of mental derangement which is more commonly the result of hereditary transmission than this. A tendency to melancholia runs in certain families, and for several successive generations, several members of each generation presenting this disposition. The disease is apt to make its appearance late in life, so that, although none of her brothers and sisters have yet showed this tendency, it is not impossible that some of them may yet exhibit it. In women, it is very likely to develop at the menopause, and it is at this time that constitutional tendencies in females are most apt to become prominent. This tendency to melancholia is perhaps especially apt to show itself at this time, because even in women who show no tendency to true melancholia, there is depression of spirits at this period. It is, therefore, not strange that in those who have a predisposition to the affection it should develop at this time.

In her father's case the tendency to recur, which this affection presents, was well seen. The deep gloom which has rested over the pa

dice has, as is usual, been accompanied with itching of the skin, constipation, and pale feces, although not absolutely clay-colored. With these, there has been impaired appetite, impaired intestinal digestion, from the absence of bile from the intestinal canal. These are the symptoms common to jaundice. There has been for some time slight pain in the pit of the stomach, and gradual, but very positive and progressive, loss of flesh. When she first presented herself, a hard tumor was found in the abdormen in the left side. This appears to be connected with the left lobe of the liver. It is slightly painful on pressure. It is the seat of It is the seat of the pain of which she complains. For the past two years she has had more or less pain across the back.

The jaundice which she presents is undoubtedly due to gradually increasing obstruction of the biliary ducts. The gradual and progressive development of the jaundice excludes all such causes as gall-stones and attacks of acute inflammation closing the duct by the swelling of the membrane, and by pressure and adhesion. Of the causes of gradual obstruction, the most common at this age is the gradual development of some neoplasm in connection with the liver, and pressing upon its duct.

The right lobe of the liver is not materially enlarged. Over the left lobe there is increased hardness, and the liver projects below the margin of the ribs at least two inches. This enlargement is irregular, and justifies the suspicion that there is a new growth forming in connection with the left lobe of the liver. The degree of jaundice is slight. The urine is moderately stained, but otherwise normal. These facts show that the obstruction is not complete. Some of the ducts are pressed upon, while others are patulous.

with the left lobe of the liver and pressing upon some of the ducts.

The symptoms are not urgent, the pain is not severe, and the digestive functions are fairly well performed. The treatment of this condition must of course be symptomatic and palliative. The only thing to be done here is to give attention to diet, and to administer such remedies as will assist in perfecting the digestive processes. For this patient, pepsin, with a little muriatic acid, would be suitable. For the constipation, a little prepared ox-gall with pepsin and nux vomica would be of service. vice. It is often necessary to associate with these remedies hyoscyamus or belladonna as a sedative. In the present instance, the pain is not sufficiently severe to call for such remedies.

This case has already lasted over one year, the jaundice being a year's standing. The case is advancing very slowly. As regards the duration of the case, it is difficult to form any opinion, but I think it will continue for some considerable time. Although she has lost flesh and strength, she is not much reduced and is able to be about. The usual course of these cases is from six to eighteen months, but the freedom from pain, the comparative preservation of general health, the small size of the tumor, and its limitation to the left lobe, point to the fact that this case will be prolonged.

ORIGINAL COMMUNICATIONS.

ON THE NECESSITY OF ORGANI

ZATION OF THE MEDICAL PROFESSION.*

BY F. E. DANIEL, M.D., Editor Daniel's Texas Medical Journal, President Travis County Medical Association, Secretary to Section of Dermatology Ninth International Medical Congress, Member- American Medical Association, and of the American Public Health Association, Secretary of the Association of American Medical Editors, Secretary of The Physicians' Mutual Benefit Association of Texas, etc.

G

ENTLEMEN: I thank you for the cour tesy of an invitation to be with you on this interesting and important occasion. It is an occasion which I hope and believe will mark a new era in the history of the medical profession of the grand old county of Williamson. It will be an era of departure and of progress, a falling into line, as it were,

*Delivered by invitation at Georgetown, Texas, on the occasion of the organization of the Williamson County Medical So

of the body of the profession of this enlightened community in that grand march of sanitary and medical progress which is now resounding throughout the length and breadth of this broad and beautiful land, and a preliminary to which is as in all else of progress and reform-organization. I thank you for the honor you have conferred upon me by an invitation to address you on this occasion, and, while I feel and appreciate the courtesy as a recognition of my humble labors in this fruitful field, I am yet more sensible of my inability to enlighten -nay, I fear, to even interest you. Were my ability commensurate with my inclination, or were my eloquence equal to the interest, nay, the enthusiasm I feel in all that pertains to the welfare of our beloved profession, I would gladden your hearts with a speech to-day, such as would arouse in you, too, a desire to be "up and doing." This hall should resound with stirring words, such as were wont to fall from the lips of a Houston, and should echo an eloquence worthy of a Coke or a Terrell. But, alas! "unaccustomed as I am to public speaking," my tongue cleaves to the roof of my mouth and refuses its office, while swell, like billows on the mighty ocean, the deep thoughts within my bosom! But, I apprehend, my hearers are too generous, too sensible men to expect eloquence of an editor. To write, and not to speak, is his province; and, to the best of my humble ability, each month I endeavor to lay before you a translation of such thoughts as do "swell," as just remarked.

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Gentlemen, I come not here to talk, though of my inability to do justice to the subject ;" I come not here to bandy compliments, nor to indulge in commonplace platitudes, neither do I come to tell of that " "grandeur of medical science," the dignity of the medical profes sion," nor to sing of the achievements of the genius of medicine or surgery, for that genius which God gave to man-that subtle essence of intellectuality by which man has, in all ages, by its exercise and development, in one way and another, reached a sublimity almost di vine, asserts itself as powerfully, as unmis takably in the life-work of a Sims, a Gross, or a Flint, as ever it did in that of a Franklin, a Watt, or an Eads. It shines as resplendently in the writings and in the work of a Pepper, a Carpenter, or a Gaillard, as in the brilliant and bloody records of a Lee, a McClellan, or a Stonewall Jackson.

Not alone in the still chamber of death, where, with hushed voice and stifled tread, the physician battles successfully with the "fell destroyer;" not alone in the plague "beleagured city," where "pestilence walketh in darkness," where the death-angel flaps his wing, and the devoted doctor cheerfully lays down his life in the unequal struggle, does genius illuminate and make glorious the life and character of the devotees of this divine science, but in the crash of battle, in the shock of contending hosts, where gallantly rides the proud crest of a Hood, a Wane, a Terry, or a DeBray, leading the victorious and impetuous Texans—there, too, is seen the sash of a Cupples, a Beall, or a Wooten.

I come not here to sing of the "grand achievements of medicine," nor to recount how, step by step, it has advanced from an humble calling, with its few devoted followers, to that proud eminence it to-day occupies, as a grand, a sublime science, resplendent among the kindred sciences of the world. Nor to recall the struggles of surgery, through its Parés, its Nélatons, its Grosses, and its Hamiltons, upward and ever onward from the dark domain of ignorance, to which a blind and superstitious priesthood had relegated it, on the absurd dogma that "the church abhors bloodshed"— the church, which a little while later made the streets of Paris run red, knee-deep, with the blood of the "reformers." It is a fact in history well-known to you all, that Pope Gregory XI. forbade the practice of surgery on the part of any of the priesthood, in whose hands at that period was all the learning, on the pretext that it was "sinful to shed blood." For years all the surgery was done by the barbers, who were called "leeches," as indicative of their trade, and, in addition to shaving and shampooing, they cupped, bled, and leeched; and to day the striped pole which adorns the shop of the humblest "tonsorial artist" is a symbol of surgery's disgrace. It is equally well-known to you that the immortal Paré, who revived the practice of surgery, and made that kind of bloodshed, at least, respectable, was saved at bloody Bartholomew by especial protection of the weak and cruel Catharine, and the weaker the Dauphin-Charles IX.

But I do come here to talk of organization; that great element of success in science as in war, and without which great things are impossible. Behold the vast chain of railroads