first saw him he had 24 of these attacks, all limited to the right arm. They were not attended by any loss of consciousness. They exhausted him very greatly, especially when they were excessively severe. Several times it was necessary to give him chloroform. There was no fracture of the skull. The only physical evidence of any injury was a very slight bruise at the outer end of the left eyebrow. Had I seen this case before 1885 I would have been unable to explain why the spasms were chiefly manifested in the right arm, and from the evidence of the slow pulse, the headache, the stupor, the bruise on the left temple, etc., I would have been justified in inferring that probably the front part of the brain was injured at the site of the bruise. Had I opened his skull at that point I would have found a perfectly normal brain and have missed the clot. The young man, therefore, would have died, whether his skull had been opened or not. As a In 1902 observe the difference. result of the knowledge derived from experiments on animals which have located precisely the center for motion of the right arm on the left side of the brain near the top and a little in front of a vertical line drawn through the ear, and disregarding entirely the site of the headache and the bruise, I reached the conclusion that there had been a rupture of a blood vessel within the head, which had poured out a quantity of blood, and that the situation of the clot should correspond to the "arm center." The location of this arm center was far away (about three inches) from the location of the bruise, and its position was fixed absolutely as a result of experiments on animals, confirmed later by many operations on human beings and also by postmortems. As soon as the skull was opened at this point the clot was found, its thickest point being exactly over the arm center and nine tablespoonfuls of blood were removed, with the result that the patient's life has been saved. The blood had first been poured out over the "leg center," which is located a little higher up than that for the arm. This explained the early spasms in the right leg. The clot did not ex tend, however, further down than the arm center. This explained why the face was never convulsed, for the "face center" lies just below that for the arm. I think if you were to ask the parents of this young man how many animals they would be willing to have sacrificed in order that their son might have his life saved, there would be doubt of the answer. Indeed, had it been your own son, I can not doubt the answer. But this is only one of hundreds of cases in which a similar exact localization has been made by many surgeons, both in Europe and America. Yet, by a curious coincidence, in the very same issue of a Baltimore newspaper containing a reporter's account of the successful operation on Midshipman Aikin there is a letter signed. by an active antivivisectionist agitator, which, among other misstatements and misrepresentations usually found in such publications, asserts that "brain surgery is disregarded." If the laws which you and your friends advocate were in force, the conditions for scientific investigation in medicine in this country would be quite as deplorable as those in England. For example, when Lord Lister, who has revolutionized modern surgery, largely as a result of such experiments, wished to discover possibly some still better way of operating by further experiments, he was obliged to go Toulouse to carry them out, as the vexatious restrictions of the law in England practically made it impossible for him to continue there these pre-eminently humane experiments. Again, when Sir T. Lauder Brunton in London started a series of experiments on animals to discover an antidote for the cobra and other snake poisons of India, where every year 20,000 human lives are sacrificed by snake bites, these beneficent researches were stopped by the stringent British laws to protect animals. Meanwhile half a million of human beings have hopelessly perished. Who, I may ask, is the more humane; he who, doubtless with the best and sincerest motives of love for dumb beasts, would prohibit experiments on animals and thereby prevent the acquisition of such knowledge and so compel surgeons to stand with folded arms and see innumerable lives thus needlessly sacrificed; or he who, by properly instituted experiments, would discover such new truths and apply them to the service of humanity? The antivivisectionists have frequently denied that surgeons have learned anything from such experiments. I presume that I may be considered a competent witness as to the source, at least, of my own knowledge, and I state with the greatest positiveness that without the knowledge derived from experiments on animals which have demonstrated the facts of cerebral localization, I should never have been able to locate the clot in Mr. Aikin's head and to remove it, nor would I have been able in the last fifteen years to locate numerous tumors and other brain troubles and relieve many of them. What is true of myself is equaily true of other surgeons. In view, therefore, of the evident and positive benefit of such experiments, I trust that you will be willing to desist from further efforts at such repressive and, as I regard it, most inhumane and cruel legislation. As this matter is of vital importance to the well-being of the entire community, I shall take the liberty of giving this letter to the press as soon as you have received it. Yours very respectfully, W. W. Keen, Professor of Surgery, Jefferson Medical College. Journal A. M. A. In Lighter Vein. Prima Donna Maud Lillian Berri swallowed a small Swiss watch while asleep at Keokuk, Ia., and had quite a time with herself, says the St. Louis Post-Dispatch. Whether she swallowed it because she was asleep or because she was in Keokuk is not plain, but anyway it went down and got all mixed up with her after-theater supper. Had it been a stop-watch-but that's another story for the press agent. Just why Maud Lillian should have gone to bed with a watch in her mouth is not apparent to the layman, who usually finds the bedticking enough, but maybe she wanted to By the keep a watch on herself (or in herself) to call her early, call her early, Maudie dear, But the result was disastrous. time she arrived at Quincy, Ill., instead of having a Swiss movement, she came near having no movement at all, and she had to "face" a doctor and put herself in his "hands" for a few "minutes" before she could determine what the facts in the "case" were. One thing is certain. Maud Lillian will never sample another stomach regulator of this kind. Her husband ought to call her Crystal. Then she would be on the watch.-St. Louis Medical Review. THE NEW WOMAN. "I can't conceive," she archly cried, I can't conceive. "Now, entre nous, won't you confide, And tell me true, all jokes aside, What diefference the world can see Between your manly self and me?" "To tell you truly," he replied, "I can't conceive." TOASTING AMERICA. The late Prof. John Fiske liked to tell the story of three patriotic Americans who toasted their native land as follows: The first "Here's to the United States, bounded on the north by British America, on the south by the Gulf of Mexico, on the east by the Atlantic and on the west by the Pacific." The second-"Here's to the United States, bounded on the north by the north pole, on the south by the south pole, on the east by the rising and on the west by the setting sun." The third"Here's to the United States, bounded on the north by the aurora borealis, on the south by the precession of the equinoxes, on the east by primeval chaos and on the west by the day of judgment."-New York Press. The members of the profession of this State, whether subscribers or not, are especially invited to send their contributions to this journal. To insure prompt publication contributions must be mailed by the 15th of each month, and should not ordinarily exceed 1,500 words. Short practical articles, reports of society meetings, and medical news solicited. The editor is not responsible for the opinions of contributors. The journal is mailed on the first of each month. Subscribers who fail to receive their journal should promptly notify the publishers. All letters and communications relating to the scientific and literary departments of the journal, and all books for review, should be addressed to the editor. All communications pertaining to the business interests of the journal, or remittances for either subscriptions or advertisements, should be sent to the General Manager, Willoughby Building, Indianapolis. Greeting and Retrospect. 1902-1903. THE JOURNAL sends New Years greetings to its subscribers, its advertisers, its exchanges and its friends of every kind and degree. Within the ten years the present writer has been the editor of the INDIANA MEDICAL JOURNAL many of its most powerful friends and allies have passed away. Great progress has been made in science, in medical education, and in medical journalism. It has been our province to reflect this progress and in some degree to direct its course and outcome. Our own State has done its share nobly. The plan of organization which has secured to our Society nearly 2,000 members and Societies in nearly every county, has been adopted in the main by the American Medical Association, and this, our mother society, is now the most powerful medical association in the world. Within the ten years there has been formed in Indianapolis a medical library of several thousand volumes. The Marion County Medical Society has changed its name to "The Indianapolis Medical Society: the Medical Society of Marion County," a name which will be of Society has adopted the itinerant system, meeting in the decade at Indianapolis twice, at Fort Wayne, South Bend, Terre Haute, Lafayette, Evansville, Anderson and Richmond, and possibly next year at West Baden or French Lick. And our State Society, stimulated by Dr. F. B. Wynn, has taken the lead in establishing a Section on Pathology in the National Association. The last year has not been prolific in medical discoveries. Surgery has received emphasis along certain lines by the visit of Professor Lorenz, of Vienna, whose warm reception has shown that our profession rises superior to a false patriotism, really jingoism, which Johnson defined as the last refuge of a scoundrel. More and more has it become accepted that appendicitis is a surgical disease and to save life requires early operation. Edebohl's operation as a cure for Bright's disease has continued to grow in favor, and a somewhat similar operation for supplying a better nutrition to the sclerotic or cirrhotic liver has been attempted. A bolder surgery of the heart and pericardium has been instituted experimentally and in accident cases. Gastrostomy," early operation for intestinal obstruction and for hernia; operations for ptosis of the kidney, stomach and bowels as a cure for neurasthenia mark a surgical advance as shown by the confidence of the surgeon and the willingness of the patients; also very free surgery in various forms of bone tuberculosis and diseases of the mastoid region such are the signs of surgical activity. On the other hand, there has been a notable revulsion against the radical treatment of cancer of the breast and uterus, unless these conditions are early diagnosed. The almost pessimistic attitude of Baldy and McMurtry in recent papers; the discrediting of the earlier papers of Halsted have had their effect. They have aroused the general profession to look with suspicion on all irregular discharges and hemorrhages from the uterus as the prodromes of cancer, and requiring immediate surgical treatment. Upon the medical side, we can only note the great attention given to the sanitarium and the out-door treatment of tuberculosis, the increased interest in the suppression of the social evil and of venereal diseases; the early operative treatment in cases of intestinal perforation in typhoid fever; the large knowledge of smallpox consequent upon the universal epidemic in the United States now just closing its third year; the fact that the disease is assuming constantly a higher degree of virulence, the percentage of deaths in Pittsburg being nearly 33, and in Indianapolis between 12 and 15 per cent. during December, 1902; also that over 90 per cent. of the deaths are among those never vaccinated. To this we may add the brilliant confirmation of the fact that malaria and yellow fever are diseases disseminated by mosquitos. The fact that yellow fever is not known positively to be transferred in any other way is of immense value in disinfection and sanitation. The appearance of bubonic plague in vessels off New York, and the secreting of this disease among the Chinese of San Francisco by the aid and connivance of the local health board is evidence of the close touch we have with the world at large. Upon the whole, the medical year has been satisfactory. In the United States times have been good, the intellectual and social status of the profession has been elevated, and we may still modestly assert and prove the claim that medicine is one of the most progressive and beneficent of the sciences, and is more and more esteemed and regarded by the intelligent laity with each revolving year. The Smallpox Situation in Indianapolis. There is no doubt that Indianapolis is now suffering from a virulent type of smallpox. Eight of the patients in the pesthouse have died within two weeks, out of a total of some twenty-three or twentyfive cases. Hence the death-rate in the pesthouse has been about 30 per cent. Including those quarantined in their homes there are perhaps about 50 cases in Indianapolis, as an average for the month, with between 12 and 15 per cent. of mortalities. No one of those dead of smallpox had been vaccinated at any time. The prox imity of the pesthouse to the City Hospital, only about 200 feet distant, and the fact that the smallpox physician resides in the hospital easily enough accounts for the disease invading the hospital wards where there were quite a number of unvaccinated patients. Of these one young woman of 19 came down with the disease at the same time as her delivery; indeed, the pronounced headache and backache of smallpox preceded her delivery some 24 hours. She was delivered Saturday evening, December 13th, had a temperature of 102 Sunday morning, an erythema over her entire person December 15th, 2 A. M., and on Tuesday, P. M., was papulated from head to foot. Her baby was vaccinated 80 hours after birth, developed a good vesicle on the 10th day of its life, but also some 25 or 30 widely disseminated papules. It was jaundiced. On the 15th day it developed numerous minute scarcely visible papules and died the following day of smallpox toxæmia. The vesicles on the mother did not pustulate, or she would have been a confluent case. The vesicles darkened in their centers, the case became hemorrhagic and she died ten days after confinement. A young woman of 17 years with multiple symmetrical gangrene-the hysterical gangrene of Kaposi, developed smallpox in the hospital, which took on the semiconfluent form in the pesthouse. The gangrene, which was centripetal in progress, had commenced May, 1902, leaving a series of symmetrical keloid scars from her ankles to her neck, also on her arms and her back, but not on her neck and face. She is now rapidly recovering, and while suffering from smallpox has had no more of the eruptions of gangrene. Her case will be reported later by Dr. Hughes, of the hospital staff, who has witnessed with the present writer the development of the gangrenous sloughs in the course of an hour. It is noticeable in the present phase of the smallpox, which has been continuously prevalent in Indianapolis since January 15, 1899. (when the first case was discovered by Dr. E. Hadley in the person of a postal clerk and his three unvaccinated. children and afterwards confirmed by Dr. G. Wagner,) that we have had an unusually mild type of the disease. There has been a mortality of only one or at the most of two in a hundred cases until comparatively recently. Indeed, many cases escaped observation entirely. The cases were discrete; not infrequently less than a hundred pustules developing. Cases showed in the ordinary history of diagnosis in communities where smalipox has been seen by less than one in a hundred of the practicing physicans. They were mistaken for chickenpox of which less than half a dozen cases in persons over 15 years have been observed in our city; for syphilis, for acne, for contagious impetigo, etc. At the present time, however, there are many physicians in the city who have şeen smallpox and are capable in its diagnosis. From ten to twelve hospital internes see and handle cases every year. It is now promptly recognized by the city physicians. The cases are quarantined in their homes, as only 20 cases can be cared for in the city pesthouse, which is simply an adjunct of the City Hospital. In Indianapolis, as elsewhere, domicillary quarantine has proved expensive and inefficient. Vaccination in infected families frequently fails, even where permitted, and as a rule smallpox breaks out in the same houses and localities where it has occurred before. The only hope of subduing smallpox is by the vaccination of school children and even these escape sometimes. A white child of 9 years is in the pesthouse now with smallpox. She was in the schools three weeks ago, but was never vaccinated. The city council has bought property adjacent to the City Hospital for a pesthouse location. But if it is heated and lighted and receives its food supply from the City Hospital, the Hospital will still be endangered. The health board of Indianapolis has the power to enforce vaccination in the City Dispensary and Hospital or deprive people the privileges of these institutions. It is quite likely that the high mortality of the present month, 12 to 15 per cent., will stimulate vaccination in the city. Nearly all the cases, some 40 or 50, now affected are white people. No children have died. The eruption is thick set, semiconfluent and confluent; two cases were hemorrhagic. The death rate in Indianapolis the last month is equal to that of Knightstown last July, 15 deaths out of 85 cases. It is greater than in the epidemic in Muncie in 1893, where there were 150 cases with 22 deaths, 14 2-3 per cent. dren. The smallpox we are now "enjoying" in Indianapolis approaches in malignancy the great Montreal epidemic from June, 1885, to June, 1886, with 10,000 cases and 3,209 deaths. The only reason that smallpox is not a fatal and terrible epidemic in Indianapolis this Christmas tide is that our people are very generally vaccinated, and particularly our school chilFor we now have in this city the virulent type of smallpox, confluent and hemorrhagic, destroying from 10 to 15 per cent. of those unvaccinated in from six to twelve days and "leaving on those whose lives it spares the hideous traces of its power, turning the babe to a changeling at which its mother shudders and making the eyes and cheeks of the betrothed maiden objects of horror to her lover." If there was ever a time in the history of Indianapolis when every physician should preach and practice vaccination in his families, that time is now, so that this disease over which science has achieved so glorious and beneficent a succession of victories may not continue in our midst as it is now and as it was at Knightstown last July, the most terrible of all the ministers of death. What we need in Indianapolis is the iron hand of military power such as vaccinated a million people in Porto Rico, and the sequence has shown its people are safer from smallpox to-day than those of Woodruff Place or North Meridian street. Our health officers can only meet the problem by free and efficient vaccination; the schools should be inspected and teachers should be. discharged if the strict vaccination rules are not enforced. Health boards are "benignant autocracies," and in emergencies are always supported by the people and the courts. There should be public vaccinators to visit the jails, workhouses, police courts, bum rooms of the court house and vaccinate the inmates as Dr. Reynolds has done in Chicago until that city is to-day freer from and safer from smallpox than any other great city of the United States. Let the health board circulate the Chi |