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names that crowd faster than one can speak 'em? Pluck? Where will you mate it, in whatever form you ask it? Physical courage? What of our army surgeons, with their 'grand contempt of death, taking a cool head, a white handkerchief, a case of instruments, where other men rush, hot-blooded, with weapons'! Heroic endurance? What of, for but one instance, William Hunter, going, on his death-day to deliver his lecture on surgery, cheering those about him with the brave whisper of how easy and pleasant a thing it is to die!' Heroic facing of peril, for duty's sake? Match me the men who invite, in the midst of a hideous epidemic, for the sake of the sufferers from that epidemic, the exhaustion that makes themselves victims to it! Match me the man who, fully foreseeing the possible consequences of that act, stoops to suck a diphtheritic membrane from a strangling throat! Heroic scorn of self-interest? What other men, with such a key to riches in their grasp as the invention of a new surgical instrument, quietly give the invention a free largess to humanity's need? Abernethy, answering the great Duke of York's arrogant 'I suppose you know who I am, sir?' with a calm And suppose I do what of it?' is the type of a thousand doctors whose self-interest bows to their selfrespect. Heroic inspiration of heroism in others? Take Bowditch's splendid trumpet-words to the graduating class of Harvard medical school, in those powder-blackened days of '63, Wasn't he an old-school doctor, you ask? Douglas, if you don't want me to make remarks unfitting this season of peace and good will, don't ask me such a question as that! If there's anything that rips my amiability open at the seams, it's to have doubtfully asked of some great soul-But he was old-school?

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But he was an Englishman? Good Lord! Has America, or has homoeopathy, or has any nation or creed on earth a patent on great souls or great words, that we shouldn't joyfully and reverently welcome them, even if they don't flower from seed planted in our own back yards? Of course Bowditch was oldschool! Of course, none the less, he was a hero of medicine and the inspirer of heroes of medicine. And how many such there are, and what grand encouragement our grand old profession gives 'em to be heroes, it's good for us to remember at Christ

Eh! What is it,

mas, of all good days o' the year Robert?" - this to the man-servant, who stands apologetically in the door-way.

"Mrs. De Nerfs has a turn, sir, and if the young Doctor could come, immediate"

As Douglas rises with a groan, the Doctor says, with an affable grin, "D' you remember that remark of Mr. Squeers, about his boys spelling c-l-e-n-e, clean, w-i-n-d-e-r-s, windows, — and then they goes an' does it? Likewise, Douglas, my son, having heard something of medical heroism, you can go and do it. The thermometer isn't more than two degrees below, and she may let you off in time for a slice of the Christmas pudding!"

COMMUNICATIONS.

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ANALYSIS OF ONE HUNDRED AND TWENTY-SEVEN CASES OF ACNE VULGARIS WITH REFERENCE TO FUNCTIONAL MENSTRUAL DISORDER AS A CAUSE.

BY JOHN L. COFFIN, M.D.

[Read before the Hughes Medical Club.]

The fact that acne vulgaris occurs especially at the age of puberty, when the sexual organs are being rapidly developed and their functional power established, has led to the more or less widespread idea, both among the profession and the people, that acne must be due either to the establishment of this function or to some perversion of normal action referable to these parts. All authorities mention deficient or irregular or painful menstruation as a cause, but they do not give it equal importance. Thus Duhring says, "Uterine disorders, particularly those of a functional character, are also to be viewed as the origin and direct cause of some cases of acne." Von Harlingen says, "Uterine disorders, especially of a functional character, are often the direct cause of acne." While Jamieson in the last edition of his work published this year, puts it thus strongly; "the females' irregular menstruation as to time and quantity, is constantly found in association with acne."

In order to determine to a slight extent what place derangement of uterine function may have as an etiological factor, I invite your attention this evening to an analysis of one hundred and twenty-seven cases of acne vulgaris treated by the author, seventy-six of which are Dispensary, the remainder, fifty-one, private cases.

The analysis of these two classes of cases will be given sepa

rately, as, owing to lack of time in examination and the irregularity of attendance of Dispensary patients, their records are more meagre, and a full knowledge of the success of treatment is not always to be had. An examination of the seventy-six Dispensary patients shows that of these cases nine were males, sixty-seven were females; the average age was twenty-one years and fourteen days. Of these, 52.8 per cent. had constipation, 46.9 per cent. had indigestion, 26.7 per cent. had both; 19.3 per cent. of the female cases had menstrual functional disorder; of this number, 13.4 per cent. suffered at the same time either with constipation or indigestion, leaving only 5.9 per cent., showing uterine derangement only. Of the fifty-one private patients, seven were males, forty-four, females. Average age, 26.3 years. 39.6 per cent. had constipation; 59.4 per cent. had indigestion; 25.7 per cent. had both; 247 per cent. showed marked errors in diet; 22.7 per cent. showed menstrual derangement; of these, 11.3 per cent. suffered at the same time from either constipation or indigestion, leaving 11.4 per cent. with menstrual derangement alone, as the only discoverable exciting cause of the acne.

As far as the above statistics go then, we learn that menstrual disorders occupy a rather subordinate place in the etiological scale, inasmuch as in the Dispensary cases, while 73 per cent. had either constipation or indigestion, only 5.9 per cent. showed menstrual trouble alone, and in the private cases, 73.3 per cent. had derangements referable to the alimentary canal, and 11.4 per cent. suffered from uterine disorder only. If then functional derangements of the sexual system occupy a comparatively minor place as an etiological factor, what part does that developmental period called puberty play as a cause, or is the appearance of the disease at that time only a coincidence. Tilbury Fox, I believe, strikes the keynote to an explanation of this when he says, "Whenever a portion of the body is physiologically active, it is likely to become disordered if the general or local condition of nutrition is deranged." Both these conditions are apt to be present at this time when acne is especially apt to first present itself. At the age of puberty, the whole system is in a condition of "physiological activity" and rapid development; the sebaceous glands of the face share in this general activity, and are, therefore, "especially liable to become disordered." At this time the general condition of nutrition is very likely to be bad, for if at any period of its existence the human male may be said to be omniverous, it is at the age of from fourteen to eighteen; and not only is it omniverous as regards quantity, but as regards quality and time, and every. thing else pertaining to digestion. The average healthy boy at

this age does not know he has a stomach, except to know that it is empty. At this time, also, he is apt to essay the manly vices of tobacco and beer, and it is not long before "the general condition of nutrition is deranged" in his case, and an obstinate, and persistent, and disgusting, and, oftentimes, permanently disfiguring acne is the result.

Girls of the same age are encased in a whalebone cuirass, are told that good, healthy running and playing is hoydenish, savors of the tom-boy, and is highly improper, are allowed to keep late hours, pay no attention to much-needed rest and quiet, and freedom from nervous excitement during menstruation, are permitted to indulge in a diet of confectionery and sweets, almost ad libitum, and soon the girl, too, has "the general conditions of nutrition deranged," and the result is indelibly written on her face in the appearance of an obstinate acne.

Not puberty, then, but the pernicious ways of living in which young people are allowed to establish themselves, are, I believe, mostly responsible for the appearance of acne at this interesting period, and failure to appreciate and recognize this fact often results disastrously to the patient. The anxious youth of either sex is dismissed with the knowledge that it is his age which causes it, and with advancing years he will get over it; so he may, and with a face as badly pitted, as though he had been a victim in an epidemic of small-pox. Acne taken in its incipience is not so intractable a disease as its representation would lead one to expect, and if not absolutely curable in a short time, it can be so controlled as to prevent any permanent disfigurement.

As seventy-three per cent. of these cases suffer with symptoms referable to the alimentary canal, it may be advantageous for us to consider the character of these digestive troubles. An examination of the cases shows great uniformity in the symp toms, which may be thus enumerated: A large, broad, roundpointed, flat, slimy-coated tongue, marked by the teeth along the border; a flat, metallic or bitter taste in the morning; feeling of fullness or distress in the stomach after eating, with eructations of gas; this last symptom, whether accompanied with any distress in stomach or not, was one of the most prominent and constant; abdominal flatulence; constipation, both in regard to frequency and character of evacuations. Associated with these are quite often symptoms referable to other parts, but due to these; such as, a more or less constant headache, located across the forehead and back of the eyes, a relaxed, catarrhal condition of the throat, a feeling of malaise and general indisposition to physical exertion, or, sometimes, a state of great mental irritability. Such is the list, and it is a list as you will readily observe, such as results from chronic wrong habits

of eating and drinking and living, rather than from a sudden and temporary indiscretion; in point of fact, acute indigestion is not prominent in these cases.

A recognition of the importance of these symptoms immediately points to the line of treatment best calculated to benefit the acne patient. No matter what the especial character of the lesion, whether it is papular, vesicular or pustular, whether it is disseminate, indurated or hypertrophied, if all or any of the symptoms to which I have alluded above are present, direct your medication to their removal, and I can assure you improvment in the leisons upon the skin, in a very large majority of cases will follow. Make your male patients stop tobacco and beer, restrict meat to once a day, direct them if they take tea, coffee or soups, to take them at a moderate temperature, never very hot; to abstain from fried foods, rich gravies, and desserts; insist on regularity in their times of eating, and slowness in their manner. For the young lady, stop her candies and sweetmeats, denounce the corset or any modification thereof, insist on plenty of out-door exercise and little evening dissipation, plenty of time during the night to sleep, and plenty of soap and water on the face in the morning; regular and systematic gymnastic exercise, not too violent in character, is often of the greatest assistance in these cases.

As regards internal medication, remedies will suggest themselves to you equally as to myself. The general line of remedies used has been the mercurials, nux vom., lycopodium, carbo veg., capsicum, podophyllum, arsen. iod., ferrum iod., hepar, ferri et strych. sulph., calc. phos., calc. iod. and sulphur. The local treatment has for the most part been stimulating by soap frictions, the various sulphur preparations, resorcin, ichthyol, etc. Treatment based upon the lines above indicated has shown 50 per cent. of cures, 42 per cent. of cases showing improvement, and 8 per cent. no improvement whatever.

REFLEX NEUROSES FROM EYE-STRAIN.

BY A. B. NORTON, M.D., NEW YORK.

[Read before the Homeopathic Medical Society of the State of New York, Oct. 6, '92.] It has been my intention for some time to make a study of the various reflex conditions that may originate from certain ocular defects, but, owing to lack of time, have been unable to consider the subject now with that thoroughness which it merits. and which I shall hope to give it on some future occasion.

This, then, may be considered as merely a preliminary paper, in which I shall simply detail a few interesting cases that were relieved after correction of the eye-strain, or at least certain

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