power of the Board to prevent it from doing harm | reliability is apt to be shaken. Resort should, thereuntil the changes which experience may show to be fore, be made, whenever possible, to virus but few necessary shall have been made. removes from the calf, as being more trustworthy and reliable. ANIMAL VACCINATION. IT has been stated that the protection afforded by vaccination against small-pox is much less complete in recent years than it was in the days of Jenner. Prof. Cameron, of Dublin, has recently called attention to the fact that, in the epidemics of Rotterdam, Montpelier, and Edinburgh, occurring between 1818-23, the mortality among a large number of vaccinated persons attacked was only about 1 in 330 cases; while among the many cases treated in the London hospitals during the epidemics of 1870-79, I in every 10 of the vaccinated died. So, also, in the epidemics in the United States in the years 1871-73, the results of the operation were not as satisfactory as might have been expected, although animal vaccination was then beginning to be practised to a very considerable extent. A careful analysis, made by Prof. Cameron, of over 15,000 cases recorded in London in 1852-67, and at periods between 1871 and 1879, shows a marked falling off in the protective power of vaccination, as measured by the death-rate. This falling off in the results has been attributed by the advocates of animal vaccination to the deterioration of humanized virus by transmission through a countless number of subjects. The virus is thought to have become attenuated to a degree that has deprived it of much of its original protective influence. To remedy this assumed defect, and restore to the operation the fullest measure of efficiency, it would seem most natural and judicious to return to the original source of the virus, and substitute animal vaccination for the method hitherto almost universally employed, unless provided with virus from lymph or crusts possessing unquestionably the characteristics of true Jennerian virus. Another reason, of some weight, for the practice of animal vaccination, is to avoid all possibility of transmitting human disease, though authenticated cases of this means of infection are excessively rare. Animal vaccination is now practised very generally in the United States, but the results of the innovation are not altogether satisfactory. The fault is not with the system, but in its practical application. "Pure and unadulterated" animal virus, judiciously introduced into the system, must confer every possible protection. But the virus supplied from the numerous vaccine farms throughout the country is so often inert or impure from admixture with blood, pus, or other foreign substances, the result of careless or reckless manner of collection and preparation, or, if originally unobjectionable, the uncertainty of its activity when it arrives in the hands of the physician, is so great that confidence in its To prevent failure, and to obviate this growing distrust, it would appear incumbent upon the Government or State authorities to organize vaccine farms. under their immediate supervision, and this office might, with propriety, be assigned to the National or State Boards of Health. From these sources, a reliable and adequate supply of material could be obtained at all times. If this method were pursued, every possible objection to animal vaccination would disappear, and its advantages would be more universally recognized and applied. The danger of inoculation of human disease, though hardly possible where proper prudence and care are observed, is entirely avoided by the use of bovine virus. A more complete confidence in the operation is established, as is indicated by the greater willingness of the public to have vaccination performed when it is used. Then, again, there need never be any scarcity of supply, as so frequently happens when depending entirely upon the humanized stock. THE LESSON OF MEMPHIS. IN another column appears a letter from Dr. R. B. Maury, entitled "Memphis-its Sewers and its Health," which is of much more than local interest. It will be remembered that immediately after the end of the yellow-fever epidemic of 1879 a sanitary survey was made of the city of Memphis, under the auspices of the National Board of Health, by a Commission composed of Drs. Billings, Mitchell, and Folsom, Major Benvaurd, U. S. Engineers, and Col. George E. Waring. This Commission advised a change in the source of supply for the waterworks; the introduction of a system of sewerage to discharge into the Mississippi River; a system of subsoil drainage; the keeping the bayous free from contamination; the condemnation and destruction of certain buildings, etc. The system of sewerage has been introduced, but it does not discharge into the Mississippi; it has been turned into Wolf River a few hundred yards below the water-works. The bayous have not only not been kept free from filth, but the sewers have been allowed to overflow into them. Only such subsoil drainage has been introduced as was immediately connected with the sewers laid-an amount altogether insufficient, as Dr. | Maury remarks, to secure good drainage. And the source of the water supply has not only not been changed, but fresh sources of impurity have been brought to it by the sewers. It is not to be wondered at that the mortality has rather increased than diminished; that the deaths from dysentery have doubled, and that the death-rate from consumption is higher than it is on the bleak New England coast; | give variety. Duquesnel's napeline has been lately on the contrary, it is rather surprising that the mortality has not been greater. The system of water supply of a city, and its sewerage, are two factors which must be considered together. To bring water in large amount into a city, and make no provision for its removal by sewers after it has been fouled by use, brings on soil pollution; to provide sewerage without an adequate water supply, or without the arrangements necessary to prevent deposits, is to establish a manufactory of offensive and dangerous gases; and to so arrange matters that the sewage, after having been conducted out of the city, shall contaminate its water supply, is certain, in the long run, to produce disease. Moreover, in a city like Memphis drainage is quite as important a matter as sewerage, and we do not think that Dr. Maury puts the case too strongly when he says that "we may not reasonably look for much improvement in our death-rate until our drainage is radically improved." We would add to this that ventilation must be provided under houses. If they are built without cellars or ventilation, the floors being but a few inches above the damp earth, as is the case with many dwellings in Memphis and New Orleans, it will not be possible to reduce the deathrates from consumption and other forms of lung disease to the point which they ought to occupy in those climates. And this matter of soil-drainage is one that must be carefully considered in deciding on the merits of the small water-tight pipe system of sewers. We believe that for many places this system is an excellent one, if a drainage system is provided with it, but the case of Memphis shows that there is great danger that it will not be provided. We hope that other cities will heed the warning, and that the authorities of Memphis will go on and properly complete their work, and thus prove by actual trial the wisdom of the advice given them by their sanitary commission two years ago. NAPELINE. THE remarkable properties of aconite, as a remedy for the inflammatory state, as an anodyne, etc., are not possessed in their entirety by the alkaloid aconitine. The explanation of this variation is obvious. Aconite contains several kinds of aconitine-crystallized and amorphous, and pseudo-aconitine, which also exists in the two forms, crystallized and amorphous. The aconitine of commerce varies much in purity, the most highly esteemed being Morson's and Duquesnel's. In 1857, Hübschmann discovered in the root of aconitum napellus a new alkaloid, which he named napelline. Recently Duquesnel has isolated an alkaloid from the same source, which he designates napeline. It is probably the same as that discovered by Hübschmann, one / being omitted to studied by Laborde, who has conducted an experimental and clinical investigation. He finds that this new alkaloid differs in many respects from aconitine: it is less active, and has more decided hypnotic and calmative properties. Napeline causes quiet and profound sleep, similar to that caused by narceine. The first trial of it in man was in the case of a neuropathic individual, fifty years of age, attacked with neuralgia, which resisted all the wellknown anodynes and antineuralgics. A decided soporific effect was produced by two doses of three and four centigrammes respectively (and grains), and there were no unpleasant after-effects. M. Dumontpallier has used napelline with success at Pitie in three cases of neuralgia-one of sciatica, one of facial neuralgia, and one of wandering neuralgia. Laborde finds that this remedy is indicated in neuralgia, persistent insomnia, and in general hyperexcitability of the nervous system. If it be found on further trials to possess the virtues claimed for it by M. Laborde, it will take place amongst our most valuable remedies, and afford another conclusive reason for the belief in the utility of aconite. BEEF-TEA A STIMULANT, AND NOT A FOOD. NOTWITHSTANDING it has been repeatedly shown that beef-tea is not a food, the laity, and to a considerable extent the profession, are slow to be convinced. That patients fed on beef-tea slowly starve is a fact, which the analysis only too conclusively supports, and which is sustained by accurate clinical observation. In the Lancet for October, 1880, p. 562, Mr. G. F. Masterman publishes an analysis, which shows that beef-tea has a chemical composition similar to urine. Beef-tea, most carefully prepared, says Dr. Neale in a recent issue of the Practitioner (November, 1881), does not contain, including alkaline salts, more than from 1.5 to 2.25 per cent. of solid matters, and such matter is mainly composed of urea, kreatin, kreatinin, isolin, and decomposed hæmatin. As a stimulant, beef-tea may be, and often is, highly serviceable, but as a means of support during the exhausting drain of a long illness, it does not compare in nutritive value to milk. Dr. Lauder Brunton raises the question whether beef-tea, a product of muscular waste, may not under some circumstances be actually poisonous! THE SALICYLATES IN RHEUMATISM. STATISTICS, to show the exact value of the salicylates as remedies in rheumatism, continue to appear in the English medical periodicals. In our last issue we referred to the paper of Dr. Hood in the Lancet of December 31, 1881, in which were tabulated twelve hundred cases of rheumatism, treated with and without the salicylates, in Guy's Hospital. In the issues of the Lancet for January 7 and 14, 1882, there appears a statistical report from Dr. Sidney Coupland of cases of rheumatism treated in the Middlesex Hospital with salicylate of soda. The conclusions derived from an examination of these tables agree in the main with those heretofore published. Dr. Coupland finds that in the majority of cases salicylates speedily reduce fever and diminish the articular pains. Unless the remedy is continued for some time after the subsidence of the fever and pain, relapses will occur. All the reports agree that relapses are apt to take place even when the salicylates are kept up, and may be occasioned by indiscretions on the part of the patient. It is agreed also that these remedies do not prevent cardiac complications. Their actual value consists in the relief which they afford to the pain and fever, but they do not materially lessen the period of confinement necessary. Toxic symptoms are produced by them in a small proportion of the cases. In the same issue of the Lancet we find some remarks of Dr. Maclagan on the administration of salicin and salicylates. He is the apostle of salicin, as our readers have been informed. He maintains that this is superior to the others because it has no injurious effect—a matter of much importance since this remedy must be used in the maximum doses. "Salicin is equally powerful as an anti-rheumatic, but it produces none of the deleterious effects of the salicylates," says Dr. Maclagan. Amongst the "disastrous effects" charged to the action of the salicylates are, according to Maclagan, "delirium, insanity, prostration of the vital powers, syncope, and even death." We need now some satisfactory evidence as to the value of salicin. This is in part afforded by Dr. Maclagan, who appends a report from thirty-nine hospitals of Great Britain. In most of these salicylates are used, but in the Glasgow Royal Infirmary, Glasgow Western Infirmary, and in the Dundee Infirmary, salicin is preferred. In the first named, the report from Prof. Charteris is that salicin and salicylates are "invariably satisfactory," but "preference is given to salicin over salicylates." In the second, the report by Prof. Gairdner is, "have always favored salicin as versus salicylates. Have not found it produce any unfavorable symptoms." In the third, the report from Dr. Maclagan says, "salicylates often caused gastric and cerebral disturbance; salicin produced no unfavorable results, and was equally potent." As salicin is insoluble in water, and must be given in large doses, the question of administration becomes important. Doubtless, the best method is to enclose the powder in capsules, but it may be suspended in mucilage. ENGLISH PIRACY. In our youth we remember the story of a pious preacher who with even perspiring zeal used to give the fiercest thwacks to the ancient Jews, going even so far as to "name" not a few like Ahab and Jezebel, but he was most tender and judicious in avoiding all allusion to the wicked deeds of the merchant princes and speculators who atoned for the sins of six days on 'Change by hanging on his eloquent lips on the seventh. Our esteemed contemporary, the Lancet, seems to have somewhat of the same wise discernment in perceiving sins three thousand miles away, while it is blind to those which exist at its elbow. In the issue of January 7, it begins an article thus, "We have so often protested against the disgraceful practice of pirating English medical books by American publishers and editors, etc." Now it so happens that in the most flagrant case of English piracy of American books that we wot of, the Lancet was dumb, and further, although the attention of the editor was specifically called to the matter, he neither published the letter nor alluded to the fact. The "American Health Primers" were published two years ago in Philadelphia. Six of the twelve were republished by Ward & Lock, of London, under the new title of their "Long Life Series.” Not only was no honorarium ever offered to the authors (as respectable American publishers usually do in the case of English authors), but their names were actually erased from the title-pages. Nay, more; the text was most carefully "edited" so as to cut out everything indicative of their American origin, and the series purported to be "written and edited by distinguished members of the medical profession,' which, of course, would mean in England that they were of English origin. In our issue for December, 1880, we called attention editorially to the fraud practised on men like H. C. Wood, Burnett, Cohen, Richardson, Harlan, and White, yet the Lancet had no word of condemnation, and even a letter and a copy of one of the pirated books failed to disturb its equanimity. Not long since the Edinburgh Medical Journal exposed the piracy of Dr. G. R. Cutter's Dictionary of German Terms used in Medicine, by Dr. Fancourt Barnes, of London, yet the Lancet had no "protest," such as its present zeal would suggest would have been at least consistent as well as eminently just. THE NEW YORK STATE MEDICAL SOCIETY. THE seventy-sixth annual meeting of this Society began at Albany on Tuesday, under the Presidency of Dr. Abraham Jacobi, of New York City. In another column we give a detailed account of the interesting proceedings, including full abstracts of the scientific papers and the discussions they elicited, We received by telegraph from our special reporter. have also the pleasure of laying before our readers, in full, the valuable practical papers read at the meeting by Drs. Austin Flint and D. B. St. John Roosa. We regret to be called upon to record the adoption of the proposed Code of Ethics, which permits consultations with irregular, but licensed, practitioners ;-action which severs the affiliation of the Society with the American Medical Association, and which will prove, we fear, far-reaching in its pernicious influence. SOCIETY PROCEEDINGS. MEDICAL SOCIETY OF THE STATE OF NEW YORK. Seventy-sixth Annual Meeting, held in Albany, February 7, 8, and 9, 1882. (By Telegraph, from our Special Reporter.) TUESDAY, FEBRUARY 7.-MORNING SESSION. The Society met in the Geological and Agricultural Hall, and was called to order at 10 o'clock, by the President, Dr. ABRAHAM JACOBI, of New York, and the session was formally opened by religious exercises, by the Right Reverend Bishop DOANE, who read a portion of the Scriptures and offered a prayer. The PRESIDENT then delivered his INAUGURAL ADDRESS. Dr. JACOBI referred to the status of medical science at the time when the Society was organized, seventyfive years ago, when Bichat first thought of establishing on a sound basis a pathology of the tissues-the period of schools and systems in medicine-in contrast with the present, when cellular pathology reigns supreme, and scientific methods prevail in medical science. In the various stages of progress, this Society has participated, and occupied an honorable position. The elevation of American medicine is due largely to the attainments of the general profession. There is no country in the world but ours, in which the professor and the practitioner are so near kin; the professor, almost always a practitioner, having been selected from the ranks of the profession. After speaking of the parts played by each, he stated that it has not always been on the part of the colleges what the profession understands by progress. In regard to the colleges, it may be stated that their requirements for graduation are certainly not always equally strict. We need not inquire into the reason for the inequality of level, be they pecuniary, intellectual, or other. But the fact is recognized, and nobody is more sorry for it than the profession. In the interest of the public, medical education ought to be of the most advanced kind; health and life claim the protection of the community. That these into whose hands the most important and sacred interests of the people are given, should owe their commission to a corporation of professors, with whose very instalment the community has nothing to do, appears preposterous. Thus the profession has for many years insisted upon a change in the law which licenses practitioners of medicine, and this is growing stronger day by day. Perhaps it cannot be said that the medical schools ever opposed the establishment of a State Board of Examination, which alone would be authorized to convey the license to practise, the right of the colleges to confer diplomas, notwithstanding. If it ever did, it is not probable that any college would now oppose any such movement, which I hope will be set on foot, and result in the Legislature passing a proper law. For the good colleges would not be afraid of their graduates not passing the State Board, and no college would be willing to thwart the movement for fear lest its unwillingness to compete might be recognized as, or alleged to be, the result of incompetency. qualified, but not usually classed as regulars, was taken The question of affiliation with practitioners legally up and a favorable verdict given. It is asserted by many that the time was coming for abolishing the boundaries between the different classes of medical men. "I do not speak of schools of medical men, for modern medicine is not divided into schools. Moreover, as I have said, the homeopaths claim that they do not differ from us, do not mean to differ from us, as formerly they did, and proudly 'claimed to do. If we have reason to believe not only that medical science is one and indivisible, and based on logic and experimentation, but that we, the profession of the State of New York, are sufficiently imbued with that spirit of logic and experimental science, we may overlook differences, and meet with a spirit of reconciliation those who do not encounter us any more with the dicta of a school-a sectbut who claim that each individual man amongst them stands on his feet and does his own thinking. A crowd similia similibus' and 'no quarter,' exclude themof men, favoring the profession with a battle-cry of selves, and cannot expect kind treatment at our hands. d'esprit raises the flag of hostility, and instead of a When the ranks, however, are dissolved, and no corps fighting army under orders, men come into your camp for reconciliation and a parley, the case is different. Besides, in the effort to better the condition of the profession and the public, it is better that no part of the legally qualified practitioners should be excluded from the benefit of such efforts, or from co-operating in that direction." The question of preventible disease was taken up at some length and discussed, with especial reference to the necessity of providing hospitals for proper treatment of children suffering with contagious disorders, especially scarlatina and diphtheria, in all large cities. Such isolation and intelligent care is needed, not only for the poor, but also for the rich, in order to prevent the spread of these diseases. A letter written by the Secretary of the Society for the Prevention of Cruelty to Children, addressed to the Mayor of New York, illustrating the great need existing in that city, was quoted, and Dr. Jacobi announced that pecuniary aid had been promised for the establishment of such an institution in New York City. In In conclusion, attention was directed to the want of legislation to protect factory children in New York State, and it is recommended that (1) Children employed in factories should be under official supervision. large cities the Boards of Health could be entrusted with this task. (2) Before being admitted to factory work a child of legal age ought to undergo a medical examination, and chlorotic, anæmic, scrofulous, crippled, scoliotic, bronchitic, and phthisical children, and those under the normal size for their age should be excluded. (3) No night or Sunday work ought to be permitted. (4) Some branches of work to be forbidden entirely, such as mining, glassworks, rag-sorting, working in mercury, lead, arsenic, etc., and in match factories. (5) The earliest age at which the young ought to be admitted to manufacturing employments ought to be fourteen years. Up to the period of puberty the energies of life and mind needed in the development of the individual should not be wasted recklessly. Dr. Jacobi concluded his address with personal reminiscences, and a comparison between his position on his arrival in this country, twenty-eight years ago, upon exit from a political prison, and the position he now occupied, the honors of which had been conferred upon him unsolicited by the Society. The recommendations contained in the President's and of the sick, the following rules should be observed in conducting consultations: The examination of the patient by the consulting address were referred to a special committee to be sub-physician should be made in the presence of the attendsequently appointed. The President then announced the appointment of the following Drs. E. C. Seguin, of New York; John B. Stonehouse, Wm. Geoghegan, Theo. P. Bailey, G. B. Tefft, Lewis Balch, all of Albany; Lucius E. Felton, of Potsdam, Brayton Babcock, of Allegheny Co.; S. O. Vanderpoel, Jr., John F. Lockwood, H. R. Starkweather, S. R. Morrow, Chas. F. Huddleston, Lorenzo Hale, John Thompson, W. J. Nellis, all of Albany; Samuel Peters, of Cohoes; A. B. Huested, Otto Ritzmann, P. J. Keegan, and J. W. Gould, all of Albany. Following the report of the Business Committee, was a report from the Special Committee appointed at the last meeting, to revise the Code of Ethics. By request of this Committee the Business Committee was directed to set apart a special evening for the discussion of the report, and Tuesday was appointed. The following draft of a Code of Medical Ethics was then presented by the Committee (consisting of Drs. Wm. C. Wey, C. R. Agnew, S. Oakley Vanderpoel, Wm. S. Ely, and Henry G. Piffard). CODE OF MEDICAL ETHICS. I. The Relations of Physicians to the Public.-It is derogatory to the dignity and interests of the profession for physicians to resort to public advertisements, private cards, or handbills, inviting the attention of individuals affected with particular diseases, publicly offering advice and medicine to the poor without charge, or promising radical cures; or to publish cases or operations in the daily prints, or to suffer such publications to be made; or through the medium of reporters or interviewers, or otherwise, to permit their opinions on medical and surgical questions to appear in the newspapers; to invite laymen to be present at operations; to boast of cures and remedies; to adduce certificates of skill and success, or to perform other similar acts. It is equally derogatory to professional character, and opposed to the interests of the profession, for a physician to hold a patent for any surgical instrument or medicine, or to prescribe a secret nostrum, whether the invention or discovery or exclusive property of himself or of others. It is also reprehensible for physicians to give certificates attesting the efficacy of patented medical or surgical appliances, or of patented, copyrighted, or secret medicines, or of proprietary drugs, medicines, wines, mineral waters, health resorts, etc. II. Rules Governing Consultations.-Members of the Medical Society of the State of New York, and of the medical societies in affiliation therewith, may meet in consultation legally qualified practitioners of medicine. Emergencies may occur in which all restrictions should, in the judgment of the practitioner, yield to the demands of humanity. To promote the interests of the medical profession ing physician, and during such examination no discussion should take place, nor any remarks as to diagnosis or treatment be made. When the examination is completed, the physicians should retire to a room by themselves, and after a statement by the attending physician, of the history of the case and of his views of its diagnosis and treatment, each of the consulting physicians, beginning with the youngest, should deliver his opinion. If they arrive at an agreement, it will be the duty of the attending physician to announce the result to the patient, or to some responsible member of the family, and to carry out the plan of treatment agreed upon. If in the consultation there is found to be an essential difference of opinion as to diagnosis or treatment, the case should be presented to the patient, or some responsible member of the family, as plainly and intelligently as possible, to make such choice, or pursue such course as may be thought best. In cases of acute, dangerous, or obscure illness, the consulting physician should continue his consultationvisits at such intervals as may be deemed necessary by the patient or his friends, by him, or by the attending physician. The utmost punctuality should be observed in the visits of physicians when they are to hold consultations, but as professional engagements may interfere or delay one of the parties, the physician who first arrives should wait for his associate a reasonable period, after which the consultation should be considered as postponed to a new appointment. If it be the attending physician who is present, he will of course see the patient and prescribe, but if it be the consulting physician, he should retire, except in an emergency, or when he has been called from a considerable distance, in which latter case he may examine the patient and give his opinion in writing, and under seal, to be delivered to his associate. III. The Relations of Physicians to each other.-All practitioners of medicine, their wives, and their children while under paternal care, are entitled to the gratuitous services of any one or more of the faculty residing near them, whose assistance may be desired. Gratuitous attendance cannot, however, be expected from physicians called from a distance, nor need it be deemed obligatory when opposed by both the circumstances and the preferences of the patient. The affairs of life, the pursuit of health, and the various accidents and contingencies to which a medical man is peculiarly exposed may require him temporarily to withdraw from his duties to his patients, and to request some of his professional brethren to officiate for him. Compliance with this request is an act of courtesy which should always be performed with the utmost consideration for the interests and character of the family physician, and when exercised for a short period, all the pecuniary obligations for such service should be awarded to him. But if a member of the profession neglect his business in quest of pleasure and amusement, he cannot be considered as entitled to the advantages of the frequent and long-continued exercise of this fraternal courtesy without awarding to the physician who officiates the fees arising from the discharge of his professional duties. In obstetrical and important surgical cases, which give rise to unusual fatigue, anxiety, and responsibility, it is just that the fees accruing therefrom should be awarded to the physician who officiates. Diversity of opinion and opposition of interest may, in the medical as in other professions, occasion con |