toms. The duration of the treatment at best seemed to me to require from three to six months, frequently longer; to require services of a special nurse, and isolation was essential; the patient could not be treated at home; and, above all, bed treatment was necessary during the first part of the treatment. It was about six or eight years ago that I first began attending the neurological dispensary at the Johns Hopkins Hospital, and in the beginning the idea of treating cases of neurasthenia seemed to be almost hopeless, with the preconception that I had that these cases required the rest, isolation, special nursing and all the other appurtenances which are, as a rule, so expensive. It was my first opportunity to treat neurasthenia uncomplicated by marked mental symptoms, and I was very glad to have this experience. I inherited a number of cases from my predecessor, and these I found were being treated with tonics and partial rest in bed and forced nutrition. As a rule the patient was not allowed to get up until after break fast; a cold sponge bath was usually ordered in the morning, and they were directed to eat frequently during the day.

In observing these cases I found that after a period, usually equivalent to the time required for the cure of a case of neurasthenia in a hospital-that is to say, from three to six months-they showed marked mental improvement, and this encouraged me so much that I sought for other means to extend the treatment and make it of greater value. The cases which I class as neurasthenics are those which show a morning tire, a lack of appetite, insomnia and anesthesia to fatigue-that is, signs of fatigue come on abruptly after a prolonged physical or mental exertion, during which time the patients have not been conscious of any fatigue, and these signs of fatigue usually occur abruptly and severely when they have finished the task which they have been performing. These, I think, are the cardinal symptoms of this condition, and associated with these there is frequently a feeling of anxiety or even depression, which was explained usually by the fact that the patients were wage-earners and could ill afford the time necessary for them to come to the dispensary for their medicine, so that the question of their stopping work in order to take the proper rest treatment could only meet with a negative answer. Naturally, this feeling of depression militated against the success of the treatment, and when we met with a case who was obliged to keep on with his or her daily work, working at hard manual work from 7 to 6, with an hour's rest daily, the prognosis seemed almost hopeless.

I do not claim any originality for the treatment which has been adopted, as it is the outcome of the experience of my colleagues and suggestions from them. We have all labored together for the success of treatment in the dispensary, and are glad to adopt any suggestions which we feel would be of value.

Whenever it is possible for the patient to take a rest, this has been ordered, but in only about one case in twenty has this been

possible. In such cases the patient is encouraged to remain in bed until about 10.30, after which he is to arise, take a sponge bath, which is at first given warm and the temperature decreased daily until it is that of ordinary tap water; his break fast is served to him in bed; he is to take a lunch immediately after rising, which may be of milk, with bread and butter, or sometimes bread and sugar or bread and molasses; in fact, almost anything that is palatable to the patient and will increase his nutrition. He is directed to eat his three meals daily and to take a lunch such as I have mentioned in the middle of the morning and in the middle of the afternoon and before going to bed. If the patient is a beer drinker he is encouraged to keep on taking a pint of beer at bed time, as it is felt that it is a good hypnotic to those accustomed to using it, and its withdrawal will be apt to increase any insomnia which may be present. The use of spirits, however, is condemned. absolutely, and the patient is only allowed the use of beer at bed time. As a medicine we give syrup hypophosphites, or if there is some dyspepsia we usually give the alkaline gentian mixture. Directions are given to take food slowly and see that a proper amount of fluid is taken daily. If constipation is present this is corrected by some purgative, although, of course, we try to correct this by patient's diet and by regular habits at stool. Psychotherapy plays an important part in the treatment, and we find that by encouragement and our interest in the patient's case he becomes less pessimistic and makes a greater effort to get well. Frequently the patient is told to indulge in a certain amount of social relaxation and to attend the theater once a week, avoiding emotional dramas and seeing the lighter plays or vaudeville. This is especially true in cases where there is slight depression and where the patient is apt to be given up to morbid introspection. The patient is told that he can be cured provided he co-operates in carrying out all the directions, and he is also told that if he looks at matters with a cheerful face recovery will be more rapid, and that his state of mind helps a great deal in carrying out the treatment and in attaining recovery.

The results of this treatment have been most encouraging, and there are but few cases whom it has not benefited, even in men who are at hard manual work. Its success, however, depends upon the patient's co-operation and upon his carrying out the directions. Half-way measures do not succeed.

I have been so encouraged in the dispensary treatment of neurasthenics that I have brought forward the subject tonight, hoping that I may encourage those physicians who, like myself, were pessimistic about this group of cases as not being amenable to cure unless we have an expensive armamentarium in the way of hospital treatment or isolation at home with special nursing. I believe that almost all cases of neurasthenia who undergo treatment early enough and co-operate in the therapeutic measures proposed will eventually recover, and that those who do not must be classed with the congenitally weak.

Editorial and Publishing Committee.

ALEXIUS MCGLANNAN, M.D. J. A. CHATARD, M.D.

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JOHN RUHRAH, M.D.

Secretaries of the County Societies are earnestly requested to send reports of meetings and all items of personal mention and of local or general interest for publication addressed to Dr. Alexius McGlannan. 847 North Eutaw Street, Baltimore.

ALLEGANY COUNTY MEDICAL SOCIETY, HELD APRIL 2, 1907, 2 P. M., AT MOREHEAD HALL, CUMBERLAND, MD. Dr. William R. Foard, Secretary. Dr. S. A. Boucher, President.

Regular order of business.

Papers with report of cases

PROGRAM.

Cholelithiasis-Diagnosis and treatment.-Dr. E. B. Claybrook.
Diptheria, with report of cases.-Dr. J. H. Carpenter.

Personal experiences with abortion, and treatment.-Dr. T. Griffith.

A committee was appointed to look into the feasibility of renting a house, or rooms, to be used as a permanent meeting-place for the Society, and open at all times to its members. The Society to hold a meeting each month, with a program arranged six months in advance, along the lines of post-graduate work outlined by Dr. McCormack.

One new member, Dr. M. Catherine Buell, Cumberland, was admitted.

HARFORD COUNTY MEDICAL SOCIETY.

THE Harford County Medical Society met on Wednesday, April 10. Dr. James Bordley, Jr., of Baltimore read a paper on "Throat troubles and their relation to other diseases."

Dr. Emory was unable to be present, so his paper on "The treatment of goitre by the milk of a thyroidectomised goat" was read by title.

Dr. Charles Bagley, Jr., was admitted to membership.

The secretary distributed cards for subscription to the new library building. A committee was appointed to make arrangements for a meeting in Havre de Grace in May.

DR. R. S. PAGE, Secretary.

SOMERSET COUNTY MEDICAL SOCIETY.

THE regular spring meeting of the Somerset County Medical Society was held at Crisfield, Md., on Thursday, April 4, at 3 P. M.

After reading the journal of the last meeting the president, Dr. Chas. W. Wainwright of Princess Anne, delivered his annual address, and spoke especially of professional jealousies and the evil they worked among the members of the profession.

He then introduced Dr. John S. Fulton of Baltimore, who spoke very entertainingly on typhoid fever from the standpoint of a health officer.

Dr. Chas. T. Fisher read an instructive paper on the etiology of typhoid fever, which was ably discussed by Dr. C. E. Collins of Crisfield.

He was followed by Dr. Wm. F. Hall of Crisfield, who read an interesting paper on the diagnosis of typhoid fever, which was discussed by Dr. G. E. Dickinson of Upper Fairmount, Md.

Dr. Somers closed the subject with an interesting paper on the treatment of typhoid.

The subject of life insurance was introduced by the president, who had a set of resolutions read, which were unanimously passed.

WHEREAS, recent official investigation into the management of the affairs of the three great life insurance companies of New York have developed the fact that the medical departments of these companies were among those that were not honeycombed with corruption and fraud; and

WHEREAS, in our judgment, the steps taken to cure these evils are such as would tend to lower the standing and character of the work that is done by medical departments of these companies, and work an injustice to the policyholders and to the examining physicians; and

WHEREAS, the financial condition of these companies, notwithstanding the inroads that were made upon their treasuries by an unlimited amount of mismanagement and reckless waste of their funds, have shown by an enormous accumulation of surplus that economies are not necessary; therefore, be it

Resolved, That we, the Somerset County Medical Society, unite with our brethren of this and other States in protesting against the reduction of the examining fees in these companies; and be it further

Resolved, That we pledge ourselves as a society of honorable and professional gentlemen to make no examination for any old line life insurance company operating in our several districts, or that may operate in same, requiring an urinalysis, unless said companies pay us a fee of not less than five dollars ($5) for each and every such examination; and be it further

Resolved. That a copy of these resolutions be sent to the Medical and Chirurgical Faculty for publication in the society jounal, and a copy be sent to the Journal of the American Medical Association for publication.

Signed by Drs. Lankford, Smith, C. T. and W. H. Fisher, Wainwright, Dickinson, Atkinson, Ward, Coulbourn, Hall, Simonson, Somers, Schwatka, Alexander, Windsor, Allen, Collins and Hoyt.

The various standing committees reported, after which the following officers were elected to serve for the ensuing year:

President-Dr. G. E. Dickinson, Upper Fairmount.
Vice-President-Dr. J. F. Somers, Crisfield.

Secretary and Treasurer-Dr. R. L. Hoyt, Oriole.

Member Board of Censors-Dr. Chas. T. Fisher, Princess Anne.

After adjournment the members visited the dining-room, where an enjoyable repast was partaken of.

PRESIDENT'S ADDRESS.

By Hiram Woods, M.D., Baltimore.

THE MEDICAL AND CHIRURGICAL FACULTY: ITS DEBT TO ITSELF AND THE PUBLIC.

Fellow-Members of the Medical and Chirurgical Faculty:

A year ago, when you honored me with election to your presidency, I was not only conscious of the honor, but sensible of its responsibilities. Our constitution compels the President to keep in touch with the routine work of the Faculty. But beyond constitutional requirements, a man would show his unfitness for the position if, after a little experience, he did not become intensely interested; if he failed to see the possibilities opening to us as part of the organized profession of the country; if he did not seek the comradeship and advice of his professional brethren in developing the Faculty's forces, and if this work did not become a labor of love. For the past three or four years your President has found it necessary to depart from the custom of a century in presenting at the annual meeting an address on a subject of scientific interest. The work of the year has furnished him with theme enough, and he has felt it a duty to present this work, with a forecast as to future usefulness. So I make no apology when I ask your attention to the past year's work and to some lessons which can be profitably gathered therefrom.

The first duty I assigned myself was to discover the basis of work left by my predecessor-condition of component societies and attitude of our members to our organization and its work. We have been for a few years, and still are, in a transition stage. We are passing from a period of individualism to one of co-operation, for that is what "organization" means. The old regime of county, city and State society, each under different organization, each independent of the other, each entered by a separate portal, exists no more. The change has caused regrets in some quarters, inconvenience, or possibly open individual revolt, in others; but it has been accomplished, and it has come to stay. Looking backward is useless; sulking in the tent while the procession goes by is worse; for it not only throws the individual out of line, but deranges the whole campaign. There is very little of the backward glance, while if the spirit of sulking exists it has the good sense to hide its head. This is the condition in which our former President's work left the Faculty. And let me say here, for myself, my successor and future Presidents, that the magnitude of Dr. Earle's work, its thoroughness and inspiration, have smoothed out rough places, put into the whole State organization the go-ahead spirit and indicated new lines of useful activity. If I rightly interpret the spirit of his administration, it embraced conviction that no chain is stronger than its weakest link. He worked on the links, and these links, or component societies in the counties, responded so well to his efforts that they are holding up their proportional weight of responsibility. They recognize themselves as part of