Hugh T. Patrick

THE CHOICE AND USE OF MEDICAL LITERATURE.

The choice and the use of medical literature depend first on what the physician tries to be; not on what he would like to be, not on what his ideal may be, but on what he thoughtfully, consistently, persistently strives to be. KINDS OF PHYSICIANS. Our day-dreams of attainment are much the same, but the daily walk of physicians varies greatly. Most of us have met a physician who may be called the family factotum. He hobnobs with fussy mothers and puttering fathers. He is greatly interested in grandmas cough, knows just how to wash the baby, has his special poultice, and can take off warts. Dropping in to ask about Aunt Ems backache, he stays an hour visiting with the folks. He is a gentle and kindly soul, but his mind is occupied with the trivialities of medicine and domestic chit-chat. Then, there is our old friend who in

THE SOMATIC SIGNS OF BRAIN SYPHILIS.

This paper takes no cognizance of inherited syphilis or of the degenerative diseases in some way caused by specific infection, but is limited to the signs of histologically definable specific invasion of the brain. Before entering upon the details of my subject, I beg indulgence while I enunciate half a dozen postulates relating to the clinical history and more general symptomatology of cerebral lues, which seem to me so important as to be inevitable as a preface. Brain syphilis is most frequent in the first year after infection, next most frequent in the second year, less frequent in the third year and so on, about 50 per cent. of all cases occurring within three years after the primary sore. After ten years of quiescence, therefore, the appearance of cerebral syphilis is exceptional. In reaching a diagnosis of a brain case, absence of a history of specific infection should

REMARKS ON THE TRAUMATIC NEUROSES.

I think we are agreed in understanding traumatic neuroses to mean functional disturbance of the nervous system caused by traumatism. In the present state of society this traumatism is generally accidental. We are doubtless also agreed that in the symptomatology of the traumatic neuroses there is nothing pathognomonic of injury by violence and that a case of traumatic neurosis generally presents a picture of hysteria, neurasthenia or hypochondria, or, what is more frequent, a combination of two or all three of these neuroses. A certain admixture of melancholia is far from rare. In the diagnosis of any neurosis the most essential step is not the recognition of a neurosis, but the exclusion of organic disease. For this a single examination will not always suffice, as a combination of the two is very common, and the former may so obscure the latter as to make its prompt and positive recognition impossible.