ingitis, cerebral congestion, epilepsy, facial neuralgia, cervico-occipital and intercostal neuralgia, sciatica, organic infantile paralysis. The peculiar views and teachings of Prof. Hammond have already become familiar to the profession through his larger and more comprehensive treatise. CLINICAL LECTURES ON VARIOUS IMPORTANT In this second edition two new lectures have been added, one on mania a potu and chronic diseases of the brain, the other on pneumonia. THE CHICAGO JOURNAL OF NERVOUS AND The number for October, which is just issued, completes the first volume of this new quarterly. Each of the four numbers has been filled with the most valuable and im portant matter relating to this specialty. A full supply of original com munications and translations has been given, while the department of reviews and gleanings has comprised a complete epitome of all the foreign and home literature relating to this department. Altogether the complete and thorough manner in which they have carried out their enterprise re ergy and talent of the editors. it is constituted embrace the follow-flects the highest credit upon the ening topics: partial cerebral anæmia, alternate, or cross hemiplegia, congestion of the spinal cord, lead paralysis, chorea, aphasia, facial paralysis, glosso-labio laryngial paralysis, cerebral hæmorrhage, posterior spinal sclerosis, progressive muscular atrophy, convulsive tremor, chronic basilar men The editors announce that the Journal has met with favor and patronage largely exceeding their expectations, and, "that there has not been, and is not now, a thought of its discontinuance, whatever changes the future may bring." THE EXAMINATION OF THE SICK BY INSPECTION, ORAL QUESTIONS, PALPATION OR TOUCH, INSTRUMENTAL AID; THE PRINCIPLES OF DIAGNOSIS; THERAPEUTIC METHODS, ETC. A LECTURE IN THE REGULAR COURSE ON PRACTICAL MEDICINE, IN CHICAGO MEDICAL COLLEGE, BY N. S. DAVIS, M.D. Ο NE of the most delicate and important duties of the physician is to examine his patient. The object of such examination is, to ascertain the location, extent, nature, stage of progress, and coincident derangements, of whatever disease or diseases may afflict the patient; together with the causes that may have been efficient either in producing it or perpetuating its existence. Το accomplish this object fully, requires on the part of the practitioner, patience, kindness, gentleness of manipulation; close, undivided attention; the mental discipline that gives quickness of perception, and accuracy of comparison and induction; with that easy boldness which quietly assumes nothing to be immodest that is necessary for a full understanding of the nature and extent of the disease, and yet which sacredly avoids all not thus necessary. To place the patient at ease, and at the same time secure attention, it is best to commence the examination with a few leading questions, such as: How long have you been unwell? How did your sickness commence? Do you suffer much pain, and if so, where? Is it sharp, dull, burning, constant or paroxysmal ? Having thus introduced the examination far enough to allow any feeling of trepidation or embarrassment that might have been felt by the patient, to have subsided, and at the same time. to have obtained an outline of his particular suffering, you should, without apparent design, pass directly to a methodical examination, so complete as to elicit a correct knowledge of all the important functions and processes performed in the system. By simple inspection you observe the physiognomy or expression; the hue of the skin; the position or attitude; voluntary and involuntary movements; general contour or relative development of parts; and the particular appearance of the tongue, with such other parts as may be the seat of special complaint. All this, except the two last items, may be accomplished while proceeding with the oral part of the examination. After the leading introductory questions already suggested, the further prosecution of the oral examination should take such direction as to elicit as full an account of the several important functions as the patient is capable of giving. Perhaps the most natural and easy method is to interrogate consecutively concerning the organs engaged in the work of digestion, assimilation, and nutrition; those engaged in the opposite processes of disintegration and excretion; then those constituting the nervous system, both cerebro-spinal and ganglionic; and, finally, those concerned in reproduction, especially in females past the age of puberty. When the patient is too young or too sick to answer properly the necessary inquiries, the same should be directed to the nurse, or whoever has immediate care of the patient. There are some diseases, like those of a typhoid character, that always blunt, more or less, the sensibilities of the patient, and often render the manifestations of mind so inactive as to cause very im perfect or erroneous answers to be All con times acid eructations. So, too, in regard to excretions. I have seen many patients who when asked "if their bowels were regular?" answered without any hesitation, "Yes, they were all right." But when asked specifically how often they had a focal evacuation some said once in three or four days; others three or four times every day; while others said once a day. The better way is to ask directly how often the patient has an evacuation from the bowels, and what is the color and consistence of the evacuation. The same rule is still more necessary in obtaining a knowledge of the renal secretion. Unless their attention has been previously called to the subject, many patients will not be able to give a reliable statement either as to the quantity or quality of the urine, but will answer in general terms that they think it is about natural. Others will say they "make a great deal more" than natural, when they really make it very often, but only a little at a time. Patients laboring under low forms of fever and paralytic affections, not unfrequently have either partial or complete paralysis of the muscular coat. of the bladder. This is liable to cause, first, retention until a certain degree of distention of the bladder, and then dribbling, so as to keep the clothing wet, or the passage of only a few spoonfuls at a time. In all such cases, in addition to careful inquiries of the nurse, the physician should daily examine the hypogastric region sufficiently to determine whether the bladder is distended or not. I have known a neglect of this latter rule to lead to several serious mistakes. It is only a few weeks since that I was requested to see a young man reported to be very dangerously sick from disease of the brain. On calling at the house I met the attending physician, and after listening to a brief history of the case, entered the sick man's room. The patient was entirely comatose; chin dropped; pupils a little dilated; breathing irregular; skin clammy; pulse frequent and very feeble; and frequent irregular muscular twitchings. The latter, with a strong urinous odor about the bed, caused me to inquire whether the patient had passed his water regularly. The attending physician answered in the affirmative. Turning to the nurse I asked when he passed his water last? Her answer was, "He passes it every little while, and his bed is wet now." "How long has he passed his water in the bed?" I inquired, at the same time passing my hand down over the region of the bladder. "Three days," was her reply. The hand at once detected a great degree of fullness in the hypogastrium, which further examination proved to be owing to the presence of a bladder so much distended that its fundus reached the umbilicus. The introduction of a catheter gave exit to an ordinary chambervesselful of ammoniacal urine. The attending physician, not a little chagrined, excused himself by saying he had not examined the region of the bladder because the nurse had assured him every day that the patient had passed his water freely. In most cases of chronic disease presenting obscure questions in relation to their pathology, and especially if accompanied by serous or dropsical effusions, the physician should directly examine the urine, aided both by chemical tests and the microscope. Palpation or Touch.-While the acquisition of an easy, systematic, and accurate method of oral examination is of great importance to the physician, it is never sufficient to give him a full and correct knowledge of the condition of his patient, without the aid of direct contact or touch. By the latter we gain a knowledge of the temperature, and other qualities of the skin; the state of the circulation as indicated by the force, frequency, and regularity of the pulse; the fullness and regularity of respiration; the tension or flaccidity of muscles; the existence of hyperæsthesia and anææsthesia; the existence or non-existence of indurations, enlargements, tumors, abscesses, dropsical effusions, etc.; and the physical condition of the parts within the chest and the abdomen. In young children, and in patients of all ages whose mental perceptions are disordered by disease, direct physical examination, coupled with inspection, constitute our chief means for acquiring a knowledge of the morbid conditions under which they may be laboring. The Instrumental Aid.-To render this part of the examination of patients more complete, various instruments have been constructed, some of which are of great practical value. ophthalmoscope; otoscope; rhinoscope; laryngoscope; stethoscope; microscope; sphygmograph; ther mometer; urinometer; speculums; with test tubes, spirit lamp, and chemical re-agents, constitute the chief instruments which the physician of today may bring to his aid in determining the existence, nature, stage of progress, and tendencies of disease. I do not say that a physician can not acquire skill, and even superior skill, both in the diagnosis and treatment of disease, without familiarity with the use of many, and perhaps all of these instruments. And yet it must be admitted that each one of them, properly used, is capable of adding both to the extent and accuracy of our knowledge concerning the morbid conditions it is designed to aid in investigating. It is desirable, therefore, that every general practitioner should be familiar with the use of all these instruments; and as far as practicable, keep them constantly within his reach. No detailed descriptions or illustrative drawings can give you an adequate knowledge of the articles themselves, or of their practical application. Such knowledge can be obtained only by direct examination and actual clinical use. Happily for you as a class, the daily hospital and dispensary clinics which constitute a prominent part of the course of instruction in this institution, will give you ample opportunities for becoming acquainted, individually, with the practical application of every instrument and appliance that may aid in the examination and treatment of the sick. As already intimated, the primary object of all our examinations of the sick is to ascertain whether they are afflicted by disease, and if so, its nature, extent, duration, etc.-in other words, to arrive at as full and complete a diagnosis as possible. But what constitutes a complete diagnosis? Certainly not the mere classification or naming of the disease; for a very superficial examination may enable the practitioner to determine that a patient has typhoid fever, pneu |