my student days, it used to be said that he who understood the nature and treatment of inflammation had acquired half the knowledge necessary for a successful practitioner. Now it would be more correct to say that he who understands the nature and treatment of hepatic diseases has little more to learn.

On this view, gout, of course, is said to be a mere symptom of liver disorder, and the same is said of lithuria and all calculi composed of lithic acid or its salts; and the practical deduction inenlcated by Dr. Murchison, and also by Sir H. Thompson, is, that in the treatment of gout and lithuria, those remedies which are supposed to address themselves to the liver are to be preferred to those which diminish acidity and dissolve uric acid; that alkalies and alkaline waters are to be laid aside as inefficient, and, at the best, but of temporary benefit, and that saline aperients and waters of that character are alone of real use. To this I would reply, judging from ample observation, that the saline aperient waters are not proved to act specially on the liver; that they probably act chiefly on the stomach and alimentary canal; that they are not so directly capable of removing gout or lithuria as the alkaline waters; and that, when they do so act, they, like the alkaline remedies, are equally evanescent in their effect. I have the conviction that this tendency to exaggerate the influence of the liver in health and in illness displays the drawbacks of specialism in the study of disease, narrows the view to one stand-point, and encourages the old but loose habit of attributing every obscure symptom to a disordered or a torpid liver." On the whole, it is safer to attribute lithuria to dyspepsia and malassimilation, which probably concerns all the digestive organs, than to fix the fault mainly on one.

Undoubtedly, the general dyspeptic condition above mentioned, which, in the opulent classes of society, is generally caused by over-feeding and over-drinking, over-work, and deficient oxidation, and in the poorer classes by other sources of derangement, is the most fertile source of lithuria. This source, however, is common to all places and to most countries, certainly to all parts of the United Kingdom: and yet, as I have shown, there is the greatest possible variation in the tendency to lithuria in various places; and this brings me to the concluding question-What explanation can be given of this variation, and especially of the excess of lithuria in this district ?-and when I say excess, I desire to guard myself by admitting that, although there probably is excess, this is by no means proved. It may be that the abundance of stone in Norfolk is due, not to actual access, but to circumstances which merely determine the precipitation and separation of lithic acid in the urinary tract. Whether it be so or not-and I know no means of deciding that point-the question equally remains. It has often been asked, but never answered, and never argued, except in a negative manner.

One thing appears to me clear and indisputable-the abundance or rarity of the diathesis must depend mainly on local and endemic causes, aided by another agency, which, however, grows out of the endemic cause. Further, these endemic causes must be due to the physical geography of the district, by which is meant the soil, food, and climate; and, when we call to mind how powerful is the effect of the physical geography of a country on the mental character and on the civilisation even of its inhabitants, we may well appreciate, if we cannot always explain, its laws in the production and spread of various diseases. This vast field of investigation has been cultivated by many distinguished labourers of late years, chiefly in the tracing of general constitutional diseases, but its capabilities for the elucidation of particular local diseases is not even now fully recognised; and yet it seems probable that further knowledge in this direction will not only demonstrate the etiology of many local diseases, but will direct into fresh and more accurate lines the study of their pathology, and even lead to more rational means of prevention and cure.

Taking these causes seriatim, the climate of Norfolk has by many authorities been thought to be a powerful factor of lithuria. A glance at the map will show how much this county is projected, as it were, into the sea. From Yarmouth to King's Lynn is a very long coast line, not less than seventy miles. During the winter and spring months there is a great prevalence of north and east winds; and it is held that these bleak cold winds, by checking cutaneous secretion and deranging delicate digestion, cast additional work on the kidneys and liver, and so derange their function and lead to lithuria. Dr. Prout somewhat favoured this view, and the late Mr. Crosse

had a strong belief in it. Rigid investigation, however, will show that climate can have but the very smallest influence. Admitting that cold, drying winds do prevail and are keenly felt in this county to a most unpleasant extent, it is not proved that they exceed those of other places. In the north of Scotland and in many of the exposed parts of Ireland, the temperature must be as cold as it is here, and yet it has been shown that we have almost as many cases of stone as in all Ireland. Moreover, in hot climates, such as India and in some parts of China, stone is not uncommon; while in Sweden and Norway, and some other very cold countries, it is very rare. Again, although it is the fact that we pass more lithic acid in winter than in summer, this is probably due to the greater muscular activity we use in the cold season, and to the consequent greater amount of tissue-metamorphosis. The natural effect of arresting cutaneous secretion must be to increase the amount of the water of the urine by which lithic acid and other solid constituents would be better held in solution, and so the liability to calculous deposit would be diminished; and, per contra, the increased cutaneous secretion from summer heat may be supposed to lead to concentration of the urine, and consequently to the liability of lithic deposit. The effect of cold is to diminish the acidity of the urine, and prolonged immersion of the body in cold water is said to render it alkaline. Observation, based on the localisation of 1500 stone cases in Norfolk, shows that fewer have come from the villages on the coast, where the exposure to cold is greatest, than from places more inland. These and other considerations which might be adduced did time permit, prove, I think, that climate alone has but little influence in producing lithuria.

The food of the poorer classes in this district, consisting as it does chiefly of good bread, cheese, and a small modicum of meat, chiefly pork, has, however, a speciality which has attracted attention, and has been assigned by many, notably by Prout, as a helping cause of stone. It consists of dumplings made of flour, water, and yeast, which may be described as boiled bread, and are universally consumed by the poorer classes with dripping or treacle. Those who think this article of diet conduces to stone give no other reason for their opinion, than that it is apt to disagree with the stomach and lead to malassimilation. I cannot, however, admit the impeachment against the popular dumpling, for I do not believe that it is hostile to good digestion; it is never referred to by patients as a probable cause; and, when stone cases are admitted into the hospital, although in all instances remedies are prescribed of a nature likely to check lithic deposit, I never heard that the dumpling, which is a part of our hospital dietary, was forbidden. There is, however, one article of food-viz., milk, -the want of which, in my opinion, does influence the development of lithuria very largely. More than twenty years ago it attracted my attention, and I dare say the attention of others, that stone in the bladder, which in the young children of the poor is so common as to constitute more than half the whole number of cases, is seldom or never met with in the more opulent classes of society. In some hundreds of cases of stone which have passed under my own observation, I have met with but one occurring in a child under five years whose parents were well to do in the world; and this experience has been corroborated by all those surgeons of whom I have made inquiry. To what is this marked contrast due? Mr. Thomas Smith, in a paper on the subject (British Medical Journal, vol. i. 1869, p. 442), summed up the probable explanation by attributing it to "insufficient and almost arrested cutaneous excretion from imperfect clothing and uncleanliness, tending to disturb the due proportion of the normal constituents of the urine, and lead to a relative or absolute excess of some one constituent; while the digestive organs of poor children are constantly liable to disarrangement from unsuitable food or from irregularities in their mothers' diet." Agreeing in the main with this account, I would go further, and say, that the prevalence of stone amongst the children of the poor is largely due to the impossibility of their obtaining a proper and sufficient supply of sound milk. The insufficient clothing and uncleanliness referred to probably exist everywhere, in Ireland and Scotland as much as in England, and yet Ireland has but little stone as compared with England. Again, in the table of hospital cases which I have compiled, the most remarkable differences with regard to stone in children appear. In the midland counties, a large majority of the cases are in young children, while in Aberdeenshire, where stone in the adult is common, there are but very few cases in children. In

Yarmouth, a town on the east coast, fifteen out of twenty-one were under ten years of age, while in Aberdeen, which is similarly situated, there were only three cases out of fortyseven under ten years. Referring to Dr. Edward Smith's report to the Privy Council on the food of the labouring classes, it appears that, in Ireland, Wales, and Scotland, the poor obtain an abundance of milk, while in Warwickshire, Norfolk, Suffolk, Kent, and other places, very little is obtained. I am warned by time that I may not go more into particulars on this subject; but I affirm that strict inquiry shows that the abundance of stone in children of urban over rural populations, and of one district over another, will be found in strict accordance with the difficulty of procuring milk. The one exception mentioned is very corroborative of this view. A few years ago, after removing a stone from a child of well-todo parents, I was remarking to one of my assistants that this was the first instance in my practice, and that I attributed the general absence of stone to milk; the mother volunteered the statement that, in a large family, this was her only child who never could take milk, and who, therefore, never had any. this lamentable want is chiefly due not only this disease of stone, but probably a vast many of the diseases which attend the early years of childhood; which are prolonged into after years of imperfect development and early decrepitude. ever true wisdom was combined with much false political economy, it was when John Stuart Mill maintained that those who live and labour on the soil have rights in the products of the soil beyond that of mere wage. It would, indeed, be a glorious result of statecraft if, instead of the futile wrangling over the sale of fermented liquors, which has wrecked one powerful Government, and, by the disappointment of greedy expectants, has gone far to sap the popularity of its successor, if, I say, by some equitable enactment, those who possess and those who occupy the land should be held responsible for the production, in sufficient abundance for the wants of the poor, of that which is now a costly luxury, but which nature points out to be the chief, I may say the only, need of early childhood.

To

If

One other fact connected with the food and beverage of this district deserves mention. The light but fertile soil of Norfolk is peculiarly adapted to the growth of barley, and I believe I am right in assuming that this is one of the greatest maltmaking districts of the kingdom. One effect of this is, that beer is the common beverage of all classes. The labourer seldom touches spirit of any kind, but his libations of strong, sweet, new beer are liberal and often deep. The effect of malt liquor in provoking gout and lithuria is undoubtedly great, and, if we contrast the beer-drinking Norfolk peasant with the milk and whisky-drinking Irishman, we shall probably be right in attributing somewhat of the prevailing lithuria to this habit.

Associated with the soil is the geological structure. Stretching diagonally across the south-eastern part of the kingdom is the great chalk-formation, and Norfolk may be considered almost its centre. Close beneath where we now stand there is a thousand feet in thickness of chalk; it crops out on the surface, is visible in every pit, and impregnates the superjacent deposits where itself dips deep. Corresponding to this southeastern chalk-district there will be found a large amount of lithuria; both the death-rate and the hospital records combine to prove this; and I have the conviction that a more minute inquiry than I have been able to make would demonstrate even a still closer relation than I have been able to show. What reason can be assigned for this striking correspondence? The only probable cause that I can discover lies in the character of the drinking-water, and the only peculiar character of the drinking-water is its excessive hardness. That there is an excessive amount of carbonate of lime in water derived from the chalk, will probably be readily allowed. Mr. Sutton, the eminent chemist of this city, has given me the analysis of eighty different sources of water, chiefly well-water, from various villages of Norfolk, and I find that the average hardness is 33° of Clark's scale; while, from forty Government analyses of water from different towns, the average hardness is 11°, and, from sixtyfive different sources supplied to Government by Dr. Letheby, the average hardness is 9.2. I am aware that water supplied by public companies is generally less hard than that derived from wells; and I admit that we are not in possession of sufficiently detailed analyses of local sources of drinking-water to justify very close deductions. Still the broad fact remains, and I know no other peculiarity likely to act as a probable cause. The drinking of hard water has long and often been held

to influence the production and growth of stone; but I know of no explanation or argument in favour of it, except that of Prout, who says, "that hard waters, in conjunction with other favourable circumstances, have a great influence in producing stone, I have no doubt; they derange delicate stomachs very considerably, and have a tendency to produce lithic sediments, though they generally act by causing a deposit of the crystallised sediments or gravel in those disposed to them." I am not con. petent to discuss the chemical action of lime-salts in leading to lithic acid deposit; but I note the fact, that both lime and lithic acid are exceedingly insoluble; that there is no chemical affinity between them; and that, although lithate of lime has been said to exist in the mixed lithates so often seen, no calculus has ever contained it. Is it not, therefore, possible that the constant filtration of lime in excess through the system may encourage the separation and deposit of lithic acid in the urinary passages? In seeking information on this point, I inquired of all my correspondents as to the hardness of the drinking-water in the various districts, and I found very varying statements. Many were sceptical as to its having any influence; but the balance of evidence was in favour of stonecases being connected with hard drinking-water. I have seen so many instances of persons who have come to reside in Norfolk rapidly acquiring the lithic diathesis; of others who lose the tendency immediately they leave the county; and of others whose tendency varied with their residence even in the district while the habits of living have remained the same,— that I know not how to doubt the effect of the drinkingwater on them. Against this view, it has been urged that, if hard waters had any effect, they would show it in males and females equally; that hard waters prevail largely over soft in most places; and that the drinking of hard waters predisposes rather to the axalic and phosphatic than to the lithic diathesis. In reply to the first objection, it may be said that all influences act more powerfully on men than on women, and that renal, if not vesical calculus is frequent amongst women; that, although three-fourths of all drinkingwaters may be hard, the waters coming from the chalk may have some special peculiarity, and that in other places, as in Ireland, the hard waters may be counteracted by other favour able circumstances of food or drink. Moreover, in the midland districts, where, I believe, the water is very hard, I have shown that stone is also very prevalent. As to the effect of hard water in leading to the oxalic or phosphatic diathesis, as described by Dr. G. Harley and Dr. Murray, I can only say that, in my experience, it is not the fact in this district. I have now operated for stone in nearly 200 cases, and I can only call to mind three cases in which oxalate of lime calculi were removed from adults, and these cases were curious. In one the central half of the stone is pure uric acid, and the outer half oxalate of lime, and this patient left Norfolk, probably with an uric acid stone in his bladder, to reside in North Wales, and immediately the uric acid became covered with oxalate of lime; the second case was in a Norfolk man, who also had resided out of the county; and the third was a private in a Dragoon regiment, who had very recently come to live here.

I leave this question of the effect of hard waters, therefore, as an undecided one, requiring fuller investigation, and especially the tracing the absence or prevalence of stone in other counties, and connecting it with local influence or endemic

causes.

Lastly, I have to say a few words on hereditary tendency and family predisposition as a cause of stone in this county; and here I cannot help believing we have an influence acting slowly but potently. I can understand, and would maintain, that the hereditary influence must be but slight as to its immediate effects, and must probably require the other favouring influences mentioned to act at all; but with them, in the course of generations and centuries, it would probably so grow and develope as to create in part the admitted abundance. Let me put the proposition in another way. Could we remove the present population of Norfolk into Ireland, and import the same number of Irish into Norfolk, it is probable that no great change would quickly follow in the respective manifestations of the lithic diathesis; but it is most probable that, in course of time, owing to the absence of endemic influences, the Norfolk diathesis would not maintain itself in Ireland, and and the Irish substitutes here would as certainly acquire our tendency. I cannot appeal to statistics on this point, and therefore I may be excused for again referring to my own experience. I have never operated on a father and son, but I have very often traced the disease back to father and grand

father. In five instances I have operated on brothers; and in four other instances I have operated on one brother, and other surgeons on another. Mr. Clubbe, of Lowestoft, has given us a curious history of a stone family. Three brothers were cut for stone by Mr. Clubbe; a fourth passed a stone; a fifth child died, aged three months, with every symptom of stone; a female child now has vesical irritation and bloody urine; the father and mother are constantly passing large quantities of lithic acid; the grandfather passed one stone, and the grandmother seven; a great-uncle was cut for stone, and six uncles and four aunts all suffer, either with fits of gravel or from lithic deposits; and, to finish, a cousin passes calculi. (See Lancet, July, 1872.)

There is considerable historical testimony in favour of this hypothesis. We know that Montaigne and his father both died of stone in the bladder, and we remember how he moralises on the incomprehensible wonders of the hereditary transmission of mental and bodily resemblances and infirmities. The celebrated minister, Sir Robert Walpole, and his brother Horace (who once represented this city in Parliament), were both afflicted with stone, and both resided in this county; and their mother also had stone.

What we know of the genesis and growth of stone would lead us to acknowledge both constitutional and local causes; and there is surely as much inherent probability in favour of its hereditary transmission as in that of gout, of cancer, or of scrofula. The difficulties in the way of admitting this influence in one case equally, or nearly equally, exist in the others, and are principally those which beset the whole question of inherited predisposition to disease. Dr. Richardson, indeed, objects to this theory, on the ground that stone is far less frequent in females than in males; whereas the tendency, he says, from the parent should pass alike to male and female. To this it may be replied, that the same influences which govern the transmission of gout chiefly in the male issue are equally dominant in the case of stone; and these influences consist in the harder living and the harder life, the greater exposure, and the rougher work of men beyond women. Besides, although the relative proportion of vesical stone in males and females is about 25 to 1, it is far less disproportionate as regards renal stone. I cannot, of course, give the relative proportion in the latter case; but it is unquestionably the fact, that renal calculus in the female is common in this district.

Time warns me to conclude. Permit me to sum up by saying that in every part of the British Isles there is, so to say, a film of lithuria; that constitutional and individual causes act everywhere; that, in some places, local and endemic influences co-operate to thicken the film into a decided layer; in others, the constitutional tendency is counteracted by the local conditions. In this particular district, the local favouring influences consist, to a very trivial degree, in the cold climate; in the universal consumption of malt liquor; possibly, I will even say probably, in the constant daily use of exceedingly hard drinking-water; and, lastly, in the accumulated effect of hereditary predisposition.

I cannot, however, pretend, in what I have written and read to-day, that a full and complete explanation of a very interesting and important fact is to be found. The subject is so abstruse in itself, so mixed up with profound physiological and chemico-vital processes, so intimately associated with what essentially we know so little about-viz., the nutrition, the growth, and the decay, of tissues and organs-that, in the present state of knowledge, we must, I fear, admit our darkness, and search and strive for increased light. I may, however, hope that I have stimulated, if I have not satisfied, the desire for fuller information; and if, by the help of such additional facts as have been adduced, and by the exposure of some errors and vague theories, the future search for truth may be made easier, I am content to believe that towards this end I have made a slight contribution, and have not wholly wasted a golden opportunity, or overtaxed your indulgent patience.

KOUMISS IN PHTHISIS PULMONALIS.-In the Bulletin de Thérapeutique for July 30, M. Urdy gives a favourable account of some trials that have been made with this agent in Prof. Chaufford's wards at the Necker Hospital. Only eight cases have as yet been so treated, but in these considerable amelioration has been observed, effects very similar to those produced by cod-liver oil having resulted from the employment of this more palatable substance.

THE ADDRESSES AT THE BRITISH MEDICAL ASSOCIATION.

AGAIN we open our pages with great pleasure to the addresses delivered at the meeting of the British Medical Association; and, so far as the laws of space will allow, to an account of the meeting and the various work done during it. Once before-nearly thirty years ago the Association met in Norwich, and those among its members who can remember that meeting may look with legitimate pride "on that picture and on this," and point out with some exultation the growth of the Association in numbers, strength, influence, and importance since those days. Then it was a Provincial Association, now it is British; its numbers then were comparatively small, now it consists, we believe, of some six thousand members, and is an active, watchful, and powerful body; then it had no journal or "organ" of its own, but now who does not know the British Medical Journal? We will leave it to others, however, to draw out more fully, if it please them, a comparison between the Provincial Medical and Surgical Association of 1846 and the British Medical Association of 1874, and we will turn our attention to the addresses this year delivered at the meeting in the old city of Norwich.

First, in time and in place of honour, comes of course the Address by the President, Dr. Copeman. He made naturally a few remarks, with which everyone will sympathise, on the difficulty the President must feel, year by year, in finding topics on which to address his audience; for, as we have before observed, whether he be physician or surgeon, his own familiar field of practice is entrusted to some other eminent man, local or metropolitan, who gives an address in medicine or surgery, and the most familiar lines of thought and work of the President are, partly at least, closed to him. The main part of Dr. Copeman's address was on the paramount necessity of sanitary measures; and he illustrated this part of his address by some graphic and painfully telling instances of the appalling tragedies sometimes enacted when zymotic

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disease enters a household, the members of which have been exposed to the subtle influences of contaminated air or water. In connexion with these subjects the President suggested that the Association might help to enlighten and guide the Government on the best mode of selecting and appointing medical officers of health; and then he pointed out two ways in which the strength and force of the Association may be employed so as to aid the advance of medical science. "Two things," he observed, "strike me as especially needful: first, that we should attempt the elucidation of many phenomena we meet with, by earnest physiological research; and secondly, that we should endeavour, above all things, to add to the not too ample store of practical facts in the use of remedies for the cure of disease." With reference to the first, he remarked that for physiological (research men must be "free from all anxiety about the ways and means of providing for their daily wants and necessities," and from the cares and troubles of daily practice; and he expressed the hope that the Association would, ere long, find means "to supply the necessary funds to a certain number of young and healthy minds, congenial to the work, to enable them to devote their time and energies to physiology as a separate study." In order to effect the second thing needed, "the study of the effects of medicine upon the human body, when employed for the cure of disease," the President suggested the appointment of a selecting and judging committee. "Scarcely anything," he said, "could be more useful to us than an accumulation of reliable facts in physic; and if each one of us were to contribute what he knows, or may know, of a certainty in this respect, and such contributions were placed in the hands of a committee, who would collate them, and publish in our journal such of them as might, after strict and careful examination, be proved of good foundation, a great service would be done to practical medicine, and a vast boon be conferred upon the public at large." It would be ungracious to criticise the suggestions of a President; and we are not at all disposed to take up the easy rôle of a mere objector; so will only say we entirely agree with the President, that if a committee can be found who will sift out, and hand to us, proved, reliable facts of general application in therapeutics, they will render an immense service to practical medicine, and thereby to the public. Dr. Copeman concluded his interesting and instructive address by a short reference to Mr. Crosse's presidential address in 1846, some account of which will be found also in our pages last week.

To Professor Russell Reynolds the Association gave the task and honour of delivering the Address in Medicine; and his most admirable and philosophic discourse will be eagerly read and studied wherever medical journals penetrate. In style and matter alike it deserves and will command attention; and among its readers not the least eager will, we venture to say, be those who had the pleasure of hearing it-eager to bestow on it more and closer attention and thought than could be given while hearing it. We may be permitted to say that the address is in the main an eloquent and forcible defence of and appeal for belief in "life," as a special, distinct, and, as yet, uncomprehended force or property; in man as a special, distinctive being; and in individuality; and also as a defence of a belief in the specificity of disease. It would be impossible to give, in the space at our command, anything like a fair or full résumé or abstract of the address, and we find that in reading it we have marked as deserving of special notice and quotation a great deal more than we can deal with; we must be content with making a few brief notes here and there.

terms, it may still be questioned whether or no we have advanced many steps in the solution of the ultimate and real mystery of life. The tendency of the present day is to believe, and act upon the belief, that we have done so; and, as it seems to me, to push aside awkward facts as irrelevant or unreal, and to smother questionings by representing them as either solved, insoluble, or worthless. With regard to life, we have drifted into a sort of belief that it is to be decomposed, explained away, or got rid of; and that our true line of action is to be found and followed by such a belief in the future results, rather than in the present or past facts of science;" and he thinks that this state of mind affects us injuriously as physicians and surgeons, and proceeds to point out two evils which result from it. "The first is, the growing disregard of what may be termed the 'subjective symptoms of disease '; and the second is the effect which such frame of thought exerts upon therapeutics." He points out forcibly and well, and does well to point out, the danger and the loss of paying no heed or too little heed to a patient's ideas, emotions, feelings, and physical sensations. A patient's story of his illness may be made up of fears and dreads, of a "consciousness of deep unrest," of a lessened sense and consciousness of power, intellectual and physical, of a dread of impending evil, and other miseries; and because " we have physically examined thorax, abdomen, limbs, and excretions, and have found in them nothing wrong; because we have looked at the retina, examined the limbs electrically, traced on paper the beatings of the pulse, weighed the patient, and have not found him wanting," we are perhaps too apt to be content to assure the patient that there is nothing "organically wrong," and to urge him to disregard all his "nervous" feelings; while these sensations and fears may be in truth symptoms of the gravest import-symptoms of the approaching breakdown of mind or body. Again, the practical ignoring of "life"—that is, the outcome of the modern views taken of the correlation of vital and physical forces-may, and does, lead to misdirected treatment, to efforts to elicit vital action, when the object ought to be the conservation of vital force; and it leads also to the overlooking or ignoring "of many of the most important causes of disease."

Dr. Russell Reynolds next shows that, "by failing to see the speciality of the nature of Man, we underrate or ignore (a) much of the etiology of human suffering; (b) are often misled by the results of observations upon animals; and (c) are in danger of misinterpreting the facts of the most serious maladies that may afflict our fellow-creatures." We must recognise in man his true relation to the world lying round and about him-" which in many of its forms of life comes so near, but which is yet so far removed from him in his higher phases"-if we would "duly understand his sorrows, or, whence they come, in such way as to prevent them, or relieve them when they are thickly hedging him. about."

Dr. Reynolds next directed attention to the influence which the belief in "Individuality" has exerted in the past, and still exerts in the present, history of pathology; and to the effect which a disbelief in the individuality of each human being seems likely to produce on the future of our science and art. Allowing that the importance and value of a knowledge of the personal and family history of each individual patient may have heretofore often been overrated, he thinks that now there is a danger of such knowledge being underrated. He holds that "that which has conduced the most powerfully to a disregard of personality and idiosyncrasy in the study of disease, is the prevalent adoption of the statistical or numerical method in the processes of pathological investigation," and points out the danger "of overrating the value of statistics, and of being led astray by their apparent precision, which exists only with regard to masses." Daily