which form the basis of this book were delivered over fifty years ago; the book itself was published first over forty years ago, while the distinguished author has been dead more than ten years. To be a good orthopedic surgeon a man must be a mechanic, a pediatrist, a general surgeon, and, likewise, possess inventive genius. Mr. Chance was all of these and more; he was not only devoted to the science of medicine as a whole, but was broadly trained as

a man.

No one can read these lectures without absorbing knowledge. They betray anatomical knowledge, surgical skill, and artistic accomplishment. They deal with the subject differently from the way adopted by most authors, and many of the illustrations are drawn by the author's own hand. The editor, too, has performed a difficult task most admirably, in fashioning the work to meet present conditions.

A Laboratory Manual of Physiological Chemistry. By Elbert W. Rockwood, M.D., Ph.D., Professor of Chemistry and Toxicology and head of the department of Chemistry in the University of Iowa. Second edition. revised and enlarged. With one colored plate and three plates of microscopic preparations. Large 12m0, 229 pages. Philadelphia: F. A. Davis Company. (Price: $1.00 net).

The progress made in the department of biology dealt with under the name of physologic chemistry has been very considerable during the last seven years, or since the first edition of this manual was sent out. A new edition, therefore, became imperative in order to present the subject in its best light and in proper form. The same general plan has been adhered to as in the original, the changes being principally such as further experience has suggested. It is essentially a book for the student to use during his laboratory studies, but is equally useful to the general practitioner who is wont to study his cases in the light of clinical laboratory investigation. To all such we most heartily commend. it.

Transactions of the American Surgical Association for the Year 1905. Volume XXIII. Edited by Richard H. Harte. M.D., recorder of the Association. Printed by the Association. William J. Dornan, Philadelphia, 1905.

This volume contains the record of the work of the association at its San Francisco meeting held July 5-7, 1906, under the presidency of Dr. George Ben Johnston, of Richmond. The subject of the presidential address is "John Peter Mettaner," and is a biographic sketch of this distinguished and somewhat eccentric physician, who practised medicine and surgery in Prince Edward County for nearly three-quarters of the nineteenth century. The story is told in Dr. Johnston's peculiarly graceful fashion, and furnishes charming entertainment for a leisure hour.

Many papers of surgical interest and importance go to make up a valuable book, only two of which, for lack of time and space,

may we mention. Dr. George Ryerson Fowler presented the history of a case of suture of the spinal cord for gunshot injury causing complete severance of the cord. Twenty-six months after the operation the patient was living, but voluntary motion in the affected area was practically lost. Dr. Rudolph Matas gave his further experiences in the radical operation for the cure of aneurysm, by his own method of intrasaccular suture. A group of 27 cases was reported from all operators, without fatal results.

LITERARY NOTES.

"DIET AFTER WEANING" is the title of a handsome brochure issued by the Mellin's Food Company, Boston. It is a duodecimo of forty-six pages, giving useful hints for baby-feeding and is illustrated by numerous half-tones of fine healthy looking children. It is printed on heavy book paper with illuminated margins and is bound in red vellum, making a beautiful specimen of the bookmakers art. It will be sent free on application to the publishers by any mother or physician, on mentioning this Journal.

MESSRS P. Blakiston's Son and Company, Philadelphia, announce that the second edition of the treatise on Diseases of Children, by J. Madison Taylor and William H. Wells, has been translated. into Italian by Dr. Mario Flamimi, of the Pediatric Clinic of Rome, with contributions by Professor Concetti and Dr. Valagussa. This is a distinctive honor few American books have been accorded and the success of the work abroad is only second to the favor it has received at home.

MISCELLANY.

A board of officers will be convened to meet at the Bureau of Public Health and Marine Hospital Service, 3 B Street, S. E., Washington, D. C., Monday, August 6, 1906, at 10 o'clock A. M., for the purpose of examining candidates for admission to the grade. of assistant surgeon in the Public Health and Marine Hospital Service. For full information, or for invitation to appear before the board of examiners, address: The Surgcon-General, Public Health and Marine Hospital Service, Washington D. C.

THE MORSE INTERNATIONAL AGENCY OF NEW YORK AND LONDON, one of the largest advertising houses in this country, is represented in Buffalo and the west by the Macdonald-Olmsted Advertising Company, which has opened commodious and well appointed offices in the German-American bank building, Buffalo. This is one of the finest locations in the city and bespeaks the good judgment of both principal and resident agencies.

BUFFALO MEDICAL JOURNAL.

VOL. LXII.

SEPTEMBER, 1906.

ORIGINAL COMMUNICATIONS.

Etiology of Functional Nervous Diseases'

BY JAMES WRIGHT PUTNAM, M. D., Buffalo, N. Y.

No. 2

Professor of Diseases of the Nervous System in the University of Buffalo; Fellow and Ex-president of the American Neurological Association.

TH

HE subject of etiology in functional nervous diseases was chosen because in the neuroses we are sure to find either our greatest successes or our greatest failures. In these cases it is not sufficient to make a diagnosis of the disease but it is equally necessary that we should discover all the etiological factors in a given case in order to successfully treat it. I speak of factors, because in my experience, it is not the rule to find a single cause. The habits and occupation of the patient; the condition of the eyes as regards refractive errors or balance of ocular muscles; the condition of the respiratory gastrointestinal and the genitourinary tracts; the pelvic organs; the condition of the blood and the urine; mental strain; physical shock; fright; any of these may act either alone or in varying combinations to produce various clinical pictures of nervous disorders. Each of these causes may produce many symptoms widely dissimilar. We are also liable to find in a series of patients similar symptoms produced by different causes. A study of my cases shows that the various functional diseases with very different symptoms may result from a single cause; that is, one cause may produce different diseases and the reverse is true that several different causes may produce identical symptoms in different patients.

I have found that eye difficulties of various kinds will cause in one patient symptoms of a mental type, in another patient, motor or muscular symptoms will be produced, while in another the symptoms may be purely sensory in character. In a fourth we may have general constitutional disturbances. The mental symptoms will range from simple fatigue after slight mental effort, as reading or writing, to a more serious condition of confusion of thought, forgetfulness, mental irritability, inability to

1. Read at the meeting of the Medical Society of the County of Niagara held at North Tonawanda, May 1, 1906.

concentrate the mind on any subject. Motor symptoms amounting to serious disease, such as chorea, habit spasm, torticollis, have all been observed many times by different clinicians as a result of eye defects.

As to the production of epilepsy by errors of refraction I am still to be numbered among the skeptical. I am mindful of the good results claimed by Dr. Stevens and the late Dr. Ranney in a series of cases of epilepsy treated by refraction, but on the other hand I bear in mind the fact that similar results have not been reported by other observers, and further, that the claims of these gentlemen were fully investigated by a committee of the New York Neurological Society and a report made that those claims of cure were not justified. More recently, at Sonyea Colony for Epileptics in New York no case of epilepsy has been cured by the treatment of the eyes, by such eminent men as Dr. Gould, of Philadelphia and Dr. Bennett, of Buffalo. In my own experience I have frequently come across cases of epilepsy who had coincident eye defects. Some of these have been cured but I have never succeeded in curing the patient by eye treatment alone. To this experience Dr. Spratling of Sonyea, contributes the following

note:

"I desire to add a brief clinical note to the paper I published in American Medicine, April 9, 1904, 'The Nonoperative Relief of Eyestrain for the Possible Cure of Epilepsy as Tested in 68 Cases at the Craig Colony.' As a result of this test, so painstakingly made by Dr. Gould and Dr. Bennett, one patient only seemed to show a possible recovery from the use of glasses. I can best state the case by quoting from the article in question:

'One male patient (O. B., No. 3), who had 27 attacks between January and September, 1902, had 4 in September, 4 in October, and 4 in December, 12 in all, after he commenced wearing glasses on September 1, 1902. After January, 1903, he had no further attacks up to the date on which this was written, December 1, 1903, a period of 11 months.

His attacks were all grand mal, and of great severity, and were announced some time in advance by a motor aura in the form of a quick, jerking movement in one hand. After a few minutes, the hand, after being lifted higher with each movement, would be jerked straight above the head each time. As soon as the acme of this warning was reached, a similar movement commenced in the left hand, and went through the same order, the attacks appearing after both hands were simultaneously jerked above the head. The patient lives an active, outdoor life, is robust and strong in every respect, and has had epilepsy since his seventeenth year, his present age being 38 years.

He shows a slight degree of epileptic irritability at times, but nothing in the way of permanent mental enfeeblement. He is, or

was, an excellent illustration of a motor epileptic, the type in which motor manifestations are marked to the exclusion of those that involve the psychic side. The arrest in his disease now bids fair to pass into complete and lasting recovery.'

It is a matter for regret that the arrest in this patient's disease, which seemed at one time to bid fair to pass into recovery, did not fulfill such a promise. After being fitted with glasses on September 1, 1902, this man had no seizures during the remainder of that or during the following year.

In January, 1904, his glasses were broken, and while not wearing them he had several attacks, in January, 6 in March, and 4 in April. The 6 in March and the 4 in April occurred after he had again put on glasses. After April he had no more attacks during 1904, but they recommenced in January, 1905. In that month he had 1, in February, 5."

SENSORY SYMPTOMS CAUSED BY EYE STRAIN.

Headaches are of the first importance. These may be either periodical or continuous, varying or unvarying in severity; occipital, vertical, temporal or frontal in location. They may be lateral or bilateral. They can be angiospastic or angioparalytic in type. All of these different forms of headache may result from different eye difficulties. This has been brought out most prominently by Dr. Gould, in his various articles on headache and eye strain, and notably in his series of biographic clinics. Again, we have as a result of eye strain, general constitutional disturbances of digestion or we may have a symptom grouping of neurasthenia and hysteria. Of this I am certain as a result, not only of my own observation, but of the observation of others, and I have sent patients who have been unable to regain health by other means of treatment, who have made speedy recoveries when the etiological factors of uncorrected eye difficulties had been removed. If, then, uncorrected ocular difficulties will cause symptoms so widely different, surely the correct diagnosing of a disease is not the all important thing. Have we done our duty by diagnosticating neurasthenia or hysteria or migraine or epilepsy or chorea? Must we not go further and seek the cause before we are ready to undertake the cure? Of course all physicians answer "yes, the cause must be sought for and removed.” Theoretically, all agree but practically we often see only the empirical method of treatment.

For epilepsy, bromides are prescribed; for chorea, arsenic; for migraine, cannabis indica and migraine tablets. Such prescribing is indeed fruitless if there is in any of these cases a causative factor which has not been discovered, and which if discovered and removed must be the basis of successful treatment. To achieve this in ocular defects, the general practitioner labors at a