The whole question solves itself in the creation of a strong State organization, with the county society as a unit. Every county in the State should have a live, active working branch of the State medical organization. The annual meeting should be the opportunity for reviving interest in medical society work all over the State; a time for getting together and comparing notes on the great work that should be done by the local societies. Its importance, however, should not be so magnified that the great value of the meetings of the local societies will be entirely lost sight of; for the county society is the moving force; from it must come the motive power of the whole machinery of organization. If this power is inactive or weak, little moving force can be imparted to the great machinery that must be constructed to do the work of our profession. The power of the medical profession to do good will be in direct proportion to the activity, influence and motive power of the combined local county societies. All other plans, all other efforts to place organization of the medical profession on a sure and lasting foundation are as nothing compared to the plan of keeping alive and increasing the motive power and activity of the county societies; for here, and here alone, is found the battleground upon which our foes are to be fought, and here should we concentrate our energies. In the county society all petty jealousies and dissensions will be wiped away, and hard earned merit crowned as it deserves. In the county society alone will our profession be able to fully meet and solve directly important questions affecting the public health, such as water supply, food and drink adulteration, tenement house and factory inspection, child labor, school inspecting, etc.

If we are to build at all, let us put up a substantial structure, one that will stand the test of time; that, from the compactness of its organization, will enable us to throw our forces, well-trained and disciplined, into the fray; that will present to the enemy, when necessary, a solid front; and not societies scattered here and there in the loose, unsystematic manner that at present characterizes our lack of organization. The great opportunities awaiting us from a thoroughly organized profession can hardly be appreciated. A few local societies, under the stimulus of some of our leading men, are beginning to realize what can be done by an active, well-regulated medical society; but no concerted action is being taken, no intelligently directed effort to awaken the medical profession in each county of our State to a realization of their immense responsibility. The great body of our profession is either indifferent to or ignorant of the fact that they owe a certain duty to the other doctor and to the public at large; that at present the field of their responsibility is far wider than their own personal clientele, and that the future will see from the very nature of the life they live and the training they have received, greater possibilities and duties for them.

Not half of the counties of our State have medical societies. Think of the wonderful possibilities for good the profession and the general public in these counties are being deprived of. There is no correlation of what forces we already have, and no systematic endeavor to increase our efficiency. Whatever strength and influence our local societies may have, is lost by the lack of co-operation. Each society is working with its own aims, endeavoring to accomplish whatever it can, unaided by either the State Society or its fellow local societies. Isolation means diversity of interests, or, what is more frequent, lack of interest.

Close and intimate association between county societies, and between each county society and the State Society, will bring mutual aid, co-operation, understanding and greatly increased strength and influence. If we are to accomplish any really valuable work, we must unite our forces. There must be some system in our plan of action. The machinery of organization and society work must be made, as far as possible, automatic.

Let us consider for what purpose a State society is created. Certainly not merely to gather together, annually, a select few of the members of the profession for the purpose of reading and discussing scientific papers. Such a society surely does not appreciate its function. The duty of a State society consists in doing all in its power to better the condition of every individual member of the medical profession in the entire State. A body whose sole aim and object is to benefit only those who attend its annual meetings should cease to exist, or else change its name and claim, so that a State society could be organized that would appreciate its full duty and do it. The State Society, by

building up local societies, and by encouraging them in every way, should make every effort to reach and keep in touch with those who have from their own accord, or from the exigencies of their location, separated themselves from professional association with their fellows. The State Society, representing the profession of the State, should have cognizance of all medico-political, social and financial matters affecting the entire profession, as well as sanitary affairs that affect the well-being of the people; but the greatest value of the State Society depends upon the fact that in it can be centered the power and influence of the county society, and through it the county society can be created, supported, encouraged and made most useful to its members, both for educational and general purposes.

What gain could be expected from perfecting an organization with branches in every county or section of the State? Well, in the first place, it will increase the membership, and so the influence of the State Society, every physician being brought through his local society into the fold, and, as will be readily seen, not the least advantage will be the increased revenue. This is an important consideration, as lack of money prevents the execution of important measures. And it might not be amiss to refer to another phase of this question. The Annual Transactions record the fact that a most discouraging feature is the collection of dues. This is a very vexed question. It is not an uncommon thing for a physician to join the State Society, pay his annual fee, and then, through non-attendance, let his dues lapse for one, two or three years. These will amount to such a sum that it has a great tendency to keep him away from the annual meeting and from becoming an active member again. Under the proposed method, each county secretary will collect at a certain stated time the annual dues and pay direct to the State treasurer. The dues should be that amount necessary for local purposes, plus the State per capita tax.

One of the most difficult problems our profession has to meet is that of proper medical legislation. The "Repeal of the State License Tax" has engaged our attention for some time. Much money and valuable time has been wasted. Organized on the plan mentioned, success would have been ours long ago. If senators and representatives have the unselfish principles underlying health and medical legislation explained to them in the county societies, and by their family physician, while they are candidates and in a receptive mood, practically every vote can be controlled-and needed legislation secured before they get to the Capital.

Think of the enormous power for good a thoroughly organized profession would have in educating the people in regard to public health questions. Our profession has been entirely too modest in their efforts to enlighten the public, apparently seeming to think it either beneath their dignity-an assumption on the part of the people—or perchance, the fear of overstepping the bounds of propriety and ethics. Yet the people are thirsting for such knowledge, and if not received through the proper channels, much harm will be done; for the versatile, wide-awake charlatan can be depended upon to do his share of public instruction. It will elevate the physician in the sight of the people, and increase their dependence upon him, doing away with that old yet groundless suspicion-that the physician has some ulterior motive or selfish end whenever he attempts anything for the public good.

A great incentive to the more perfect organization of our profession would be found in furthering our material welfare. Our poverty is pitiable and inexcusable. Each is afraid to collect his hard-earned fees for fear that the other will inherit some of his offended patrons. A "Medical Revival" is needed to dispel this narrowness; a strong organization to teach business methods and secure for our profession the proper remuneration for their services. A medical defense or protective feature, as well as an insurance against sickness, old age and death, could be made part of the benefits of a thorough organization, that would, from the dollars and cents involved, attract many. But, to my mind, the great reason for perfecting a strong organization is that it solves the problem of keeping alive and active the weak, local societies.

As to the plan: A local society in every county in the State, capable of sustaining an organization-else, district societies composed of all the regular physicians; all county societies united to form the State Society; the State Society, not an independent body with its interests separate and distinct from the

local societies, any more than our State is an independent body, separate and distinct from the counties. The State is merely an aggregation of the counties; so should the State Society be merely an aggregation of the county societies. The plan is simple, yet adequate, capable of local variation, but still uniform. A State organization built upon such a plan could not fail, but be perfect in its machinery. A paid organizer-preferably the State secretary-assisted in each district by the corresponding counselor, should be made responsible for the organization and continued activity of the county societies. If a flower is planted and not weeded or watered, it will soon die; organizing local medical societies and leaving them to take care of themselves, is going on a fool's errand, is travelling in a circle. They must be kept in close touch with, stimulated, encouraged and even visited personally.

(Through the medium of a wide-awake State journal all the transactions of the State Society, as well as the best papers read before the local societies, can be sent free of charge to every physician in the State. This journal should be alive to the needs of the profession, clean in its advertising pages and filled with high ideals; it should contain live articles on medical organization, encouraging each physician to be active in his local society; keeping ever alive the spark of interest in the other fellow and the profession in general, stimulating to proper activity in medical legislation, etc. Our "Transactions" costs us six or seven hundred dollars annually, and are appreciated by only a few. For my part, I would prefer that this sum be put into building up a wide-awake State journal, and I believe that the profession in general is sufficiently business-like to demand, for the money they put into society membership, something else than the mere honor of membership, “The Transactions” and the knowledge of helping a good cause.)

The plan that I have outlined and is now used by practically all the State societies, is almost perfect in its conception, scope and purposes, and entirely practical; it is worth all the time and money it will cost. As secretary of one of the local societies, and one who for three years has worked hard to make of it a success, I am forced to the conclusion that under our present system we are so sadly handicapped that a majority of the county societies will be a failure. I appeal to you in behalf of the local society, the most important part of all medical organization. I feel, within the depths of my soul that we stand on the verge of a new era, when our profession, united and ennobled, with peace and progress inscribed upon its banners, will come to occupy its rightful place.

CONCERNING MONSTERS.

By R. H. WHITEHEAD, M. D., University, Virginia.

Human monsters are doubtless almost as old as the human race, and have at all times been subjects of the greatest speculative interest. The ancients seem to have been so impressed by their unnatural appearance that they thought that monsters must be supernatural-at any rate, they represented some of their deities as monsters. For example, one well-known variety of monster presents two heads fused together; the ancient Latins, seeing the possibilities of a god with two faces and two sets of eyes, whose "foresights" might be supposed to be as good as his "hindsights," gave this form to that circumspect guard whom they placed at the gate of heaven and called Janus. Still another well-known monster is the cyclops, characterized by a single eye in the median plane of the face. This form probably served as the prototype of the Cyclops of Grecian mythology, those one-eyed demi-gods who forged the thunderbolts for Jupiter.

Among the ancient writers Aristotle seems to have been the only one who attempted to explain monsters by natural causes. To him we owe the conception of monsters as divisible into two classes-those less than, and those greater than one complete normal individual-the monstra per defectum and the monstra per excessum of later writers. Throughout the first fifteen centuries of the Christian era not a single ray of light was thrown upon the nature and origin of monsters. The teratology of those times was a mass of grossest superstition, and some of the prevalent theories were, to say the least, highly indecent. Men imagined the most grotesque forms and mixtures of forms, the like of which were never seen on sea or land, such as a man's body with an elephant's head, double monsters, one-half man, the other half dog, etc., and then firmly believed in these creations of their own imagination, even picturing them in books.

To explain such imaginary monsters, cohabitation with lower animals was invoked. To witchcraft, of course, was assigned a most prominent place in the production of monsters, and the mothers of monsters were sometimes executed as witches as if the mothering of a monster in that day and generation were not sufficient humiliation for any woman. Equally, of course, the devil was blamed as the father of many monsters. As the pseudo-science of astrology became widespread, the production of monsters was believed by many to be due to the baneful influence of the heavenly bodies, particularly the moon. Indeed, our word monster (moonster) probably owes its origin to this belief. Shakespeare's play, "The Tempest," is full of allusions to these superstitions. Thus, Prospero says that Caliban's mother was a witch, and that Caliban was "got by the devil himself." And Trinculo, while explaining to Stephano how he had sheltered himself from the rain by crawling under the cloak of the prostrate Caliban, who he supposed was dead, says, "I hid me under the dead mooncalf's gaberdine"—"misery acquaints a man with strange bedfellows."

Another superstition which originated in the middle ages was that which still goes by the name of maternal impressions. Monsters were supposed to be due to the witnessing of revolting sights by pregnant women; such a sight, it was supposed, so impressed the mother and through her the fetus, that the developing child would ape the form of the object seen, or take some other loathsome shape. This superstition-for such, of course, it is still enjoys wide popularity with the laity, and many doctors believe that "there is something in it." It is pleasant to think that this hypothesis was invented by some kind-hearted obstetrician of the olden time in order to provide the unfortunate mothers of monsters with a decent excuse. Certainly it is more comforting than the charge of being a witch or a partner of the devil. One can easily imagine the trouble produced by the arrival of a monster into the family of an honest burgher when such beliefs held sway.

And so, deified by the ancients, regarded with superstitious horror in the middle ages, monsters have been the objects of serious scientific study only in comparatively modern times. At first this study was greatly hampered by very imperfect knowledge of the basic science, embryology; little headway could be made in a study of the genesis of monsters so long as the genesis of the normal being was badly known. Accordingly, activity was largely confined to collecting, describing and classifying various types of monsters, the theories as to their nature and origin being almost purely speculative and lacking a scientific foundation. In the eyes of many, monsters were merely curiosities to be stored away in jars and exhibited occasionally to the curious. In recent years the various developmental processes have been followed so thoroughly and repeatedly that we have a very good knowledge of descriptive embryology. Moreover, a new science, experimental embryology, has appeared, and bids fair to be exceedingly fruitful. It would seem that we are approaching a time when attempts to learn the nature and origin of monsters may be made with some hope of success. Accordingly, interest in these beings has revived, and recently three large monographs on the subject have appeared, representing a great deal of study.

Before mentioning these it would be well to define what I understand by monsters. It does not seem possible to give an anatomical definition which shall be free from objections; and so I shall simply state that I mean by monsters those bilaterally symmetrical beings which are either less than or more than one normal individual.

The works to which I alluded are: First, The Morphology of Malformations, by E. Schwalbe, professor of pathology at Rostock. This is a very comprehensive monograph in three volumes, only two of which have been published. It is the work of a professional pathologist, with an uncommonly good knowledge of general morphology, and will doubtless long remain the standard text on teratology in general. It would, of course, be impossible to review this work here, and I shall merely state that he does not draw any clear distinction between monsters and malformations in general, but classes them all together; he regards them, however, as due to pathological causes.

The second is Dr. Mall's monograph, "The Causes Underlying the Production of Monsters," which occupied an entire number of the Jour. of Morphology in 1908. This is the work of a master in embryology with excellent training in pathology. He regards monsters as always due to pathological agencies, and suggests that the underlying condition is hemorrhagic endometritis, which interferes with the proper implantation of the ovum, and thus with the nutrition of the embryo.

The third monograph is by Dr. H. H. Wilder, professor of zoology in Smith College, entitled "The Morphology of Cosmobia," which appeared in a recent number of the Amer. Jour. Anat. In it there is put forward an interesting theory as to the genesis of monsters, about which I shall speak later. Enough has been said to show that monsters are a live topic among anatomists just now, and that the students of the subject are directing their activity mainly towards a determination of the causal genesis of these interesting beings.

The development of an animal from a fertilized egg is the result of the action of two forces, or rather sets of forces. The one set is internal, inherent in the organization of the germ, or, as we express it, inherited. The other is external to the germ, consisting of physical and chemical agencies which, collectively, we call the environment.

It is obvious that alterations in either of these forces may lead to the development of an abnormal being. Accordingly we will be prepared to find that there are divergent views among teratologists as to which of the two forces we shall ascribe the predominating influence in the production of the abnormal individuals we call monsters. One, like Mall, holds that they are always due to alterations in the environment, to physical or chemical agents which act upon the germ from without, and that they are, therefore, pathological in nature. Another, like Wilder, believes that they are inherent in the germs from which they develop, and, therefore, are not pathological, but are merely germinal variations. Professor Wilder finds that he can draw up a series of known types of monsters passing by regular gradations from the cyclops through the normal individual to duplicate twins, i. e., he presents a series which has the cyclops at one extreme, duplicate twins at the other, and the normal individual in the middle. Wilder was so impressed by this series, and the further fact of the orderly, bilaterally symmetrical anatomy of monsters that the thought occurred to him: "these are not pathological beings, they are merely variations from the norm." And he proposes to call the whole series, normal individual included, cosmobia, i. e., orderly living beings.

Given a monster, how shall we study it? First, of course, we should make a thorough dissection and study its structure; from such a study alone we may sometimes derive valuable hints. It is, furthermore, desirable to institute a comparison with other and similar monsters accurately described in the literature. By this method important results have sometimes been obtained; by its employment Wilder reached the hypothesis just mentioned, and Schwalbe was able to show that teratomatous epulis is of monstrous origin. We should then submit any deduction we may be inclined to draw to the well-known facts of normal embryology, after which we should usually be able to work out the formal genesis of the case with a fair degree of satisfaction. Even the negative evidence thus obtained may be important. For example, a woman in the third month of pregnancy sees a double-headed calf at the circus, and at term gives birth to a double monster. It would be a waste of time, to say the least, to try to convince that woman that there was no causal connection between the two incidents. But it is absolutely certain that nothing short of a miracle could produce a double monster out of a normal embryo in the third month of development.