Motes and Comment.

HONOR TO DR. CARLOS F. MACDONALD.-A dinner to celebrate the 40th anniversary of the graduation in medicine of Dr. Carlos F. MacDonald, of New York City, and equally the 20th anniversary of the inauguration of State care of the insane in New York was given on the evening of February 2, 1910, at the Hotel Astor. About one hundred personal friends and professional associates were present, and many others in different parts of the country who were prevented from coming sent letters of regret. The afterdinner speeches were of more than usual ability and interest. Dr. Austin Flint spoke of the aspect of Dr. MacDonald as a "Teacher," Goodwin Brown as a "Public Officer," DeLancey Nicoll as a "Man," and W. T. Jerome as an " Expert." The latter advocated the establishment of a tribunal in the medical profession with powers similar to those of the Appellate Division of the Supreme Court in its relation to the legal profession. This tribunal should have power to suspend or disbar unworthy members of the medical profession as unprofessional lawyers are now suspended or disbarred by a similar tribunal. Such a tribunal in his opinion would prevent the scandals which had arisen in criminal trials where the defense of insanity had been interposed.

Mr. Jerome, after causing amusement by looking about the room and asserting that the gathering seemed to be "the first annual reunion of the Thaw trial experts," and that "most of the swearers were here," said:

There is no subject on which more poll parrot nonsense is uttered than the subject of medical expert testimony.

Out of the 15,000 lawyers in New York there are not more than fifty who are qualified by experience to speak with authority on this question. No man has had more experience with experts than myself during the eight years I was district attorney. And during that time I recall only one man whose testimony was radically dishonest. There were many who disagreed with me honestly. (Applause.) In only one case was there any miscarriage of justice. And in every case the judgment of the experts retained by the State was justified by subsequent clinical history.

There was only one case which attracted great public attention, and there was only one physician who was touched by the great scandals arising therefrom. And I am positive in stating that the scandals arose through judicial incompetency rather than from any corrupt medica! testimony.

I have never heard of greater nonsense than the proposal that there should be a trial of the guilt or innocence of the accused first and then that the question of insanity should be considered by the court under proper safeguards. I know of no case where insanity was interposed as a defense where it was not conceded that the killing would have been murder in the first degree if the accused had been sane. There is no more need of the abolition of expert medical testimony because it is said that some medical experts are willing to prostitute their knowledge-to lie on the stand-than to abolish lawyers because some attorneys coach witnesses in a way that amounts to subornation of perjury. I have caused the disbarment of twenty lawyers for unprofessional practices, and not in one case where I have proceeded against an attorney has he escaped disbarment or suspension.

Mr. Jerome then went on to outline his plan for a medical supervisory tribunal. He said there were hundreds of medical men, in the knowledge of those present, who through " drunkenness, the use of narcotics, or charlatanism, were a menace to the community," and that there is at present no adequate method of dealing with these cases. He believed that the supposed scandals connected with expert testimony would be abolished by the creation of this tribunal.

In closing he voiced his respect for Dr. MacDonald, by citing a recent case where he had committed on his own motion to Dr. MacDonald's custody a client pending the determination of his sanity, although the doctor had been retained by the opposition.

Dr. C. F. MacDonald is a native of Ohio and is now in his sixtyfifth year. He received his early education in Ohio and in Pittsburg. He served during the Civil War in the Sixth Ohio Cavalry. At the close of the war he engaged in the study of medicine and graduated at Bellevue Hospital Medical College in 1869. In 1873 he was appointed resident physician at Flatbush Asylum, then a municipal establishment for the insane, as a successor to Dr. E. R. Chapin, but retired the following year because of political interference. In 1876, however, he re-entered institutional service at the Auburn State Asylum for Insane Criminals where he remained until 1879 when he became superintendent of the newly organized State Hospital for the Insane at Binghamton, N. Y., established in

the former Asylum for Inebriates. In 1882 he returned to the Auburn Asylum for Insane Criminals where he remained until his appointment as president of the New York State Lunacy Commission in 1889. His work upon this commission is fresh in the minds of all readers of the JOURNAL. To his wisdom, foresight, energy and pertinacity the present standard of New York's care of her insane is largely due. Many differed with him as to his policy at first but the majority now concede that he built wisely for the future and was an efficient worker in promoting the humane and scientific treatment of the dependent insane of the State of New York. After holding this position for seven years he purchased a private hospital for the insane and retired from the service of the State. Since his retirement, in addition to the administration of his private hospital, he has been mainly engaged as an expert and has been in almost every important medico-legal case in New York during the past ten years. He has also been a teacher of psychiatry at the Albany Medical College and at the University and Bellevue Hospital Medical School. His numerous friends among the readers of the JOURNAL join in congratulations to him upon the completion of forty years of public service in the profession of medicine.

A UNIQUE EXPERIENCE WITH PELLAGRA.-Bulletins of State Boards of Health are not usually very entertaining publications, as they deal with the dry facts of statistics. An exception to this, however, is the Monthly Bulletin of Illinois, of August, 1909, which contains a preliminary contribution to the subject of pellagra as that disease has been found in Illinois. A particularly unusual series of events is narrated by Dr. George A. Zeller, the medical superintendent of the State Hospital for the Insane at Peoria. The Peoria State Hospital was opened in 1902 for the relief of the chronic insane, then held in the poor-houses of the State. Patients were received at the rate of two hundred a month and represented, of course, a deplorable and neglected lot of human beings. Into the relief of the discomfort of these patients Dr. Zeller threw an abundance of enthusiasm, and endeavored from the first to establish the highest ideals of humane care. He went to the extreme of liberality in the policy of non-restraint, and provided ample porches, air spaces and tent colonies for the attainment of the best

sanitary conditions. In the course of this development of an ideal hospital he was confronted and perplexed by some distressing incidents. There were some unexplained casualties and unexpected deaths which were attributed respectively to scalds during the baths, summer diarrhea and sunburn. These incidents may be best described in Dr. Zeller's own words:

The adoption of a universal non-restraint policy caused its accidents, which were in no sense excessive, to be very closely scrutinized. Perhaps the one causing the most bitter criticism was described as follows in the biennial report of 1906:

The rush, incident to the rapid growth of the institution was attended by a fatality in the death of Fred Weber, due to scalds received while being bathed by an incompetent attendant. The case was promptly placed in the hands of the coroner, as is every unusual death in this institution, and a searching investigation ordered. The verdict censured the attendant, but charged no criminal neglect.

Even if the public had been inclined to overlook this, a repetition the next year only intensified the suspicions that are apt to center about an insane hospital. Our second case is described as follows in the published report of 1908:

The death of George Wright who was scalded on the morning of November 25, was directly due to incompetence. He was an untidy partially paralytic epileptic.

We maintain two night nurses in our epileptic colony for men, and on the morning in question the nurse on duty while bathing him preparatory to turning him over to the day force in a presentable condition, scalded him about the feet. He lived eleven days and died from an intercurrent pneumonia, but the coroner was called as in every other fatality, and the facts placed before him.

We give three hundred and fifty thousand baths a year in this institution, and the work is performed by expert bathers, who are retained for that purpose. In the hospitals and infirmaries the untidy patients are bathed by the nurses, and this patient passed into the hands of an incompetent person who was promptly dismissed.

In both instances the attendants stoutly maintained that they did not scald the patients, that they had their own hands in the water and that it was not hot. The clinical notes of the case show that the burns were of the first degree only, and that the area involved was not in itself sufficient to cause death. In the case of Weber there was a distinct line of demarcation from a line about three inches above the ankles extending to the plantar surface of the foot.

Wright's injuries were almost identical, but Weber had in addition a distinct bleb over each of the ischia. The jury in the case of Wright very reluctantly accepted scalds as the cause of death, especially since he sur