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ATLANTA 

.viedical  and  Surgical  Journal. 

Vol.  XV.  MARCH,  1898.  No.  1. 

L.  B.  GRANDY,  M.D.,}  M.  B.  HUTCHINS,  M.D., 

DUNBAR  ROY,  M.D.,  |  "'"<"^-  bdbinesb  manaobr. 

ORIQINAL  COMMUNICATIONS. 


THE  DIAGNOSIS   AND   TREATMENT  OF   APPEN- 
DICITIS.* 

By  L0DI8  FRANK,  U.D., 
TUiting  OyoecologUt  to  the  LouJBVille  City  Uoapital,  Louiaville,  £y. 

The  papers  which  have  been  writteo  upoa  appendicitis  have  been 
almost  invariably  read  before  surgical  societies  and  discussed  by 
Burgeons.  Rarely  do  we  hear  the  ideas  ot  the  geaeral  practitiooer 
upoa  this  subject.  I  anticipate  ceusure  or  at  least  disagreement 
upon  the  part  of  many  of  the  members  in  my  consideration  of  the 
treatment  of  this  dangerous  trouble ;  but  it  is  the  experience  of  the 
doctor  that  we  are  alter.  Surgeons  want  to  know  how  many  cases 
he  has  seen  which  have  gone  through  an  attack  without  operation  ; 
we  want  to  know  how  many  cases  he  has  seen  upou  which  no 
operation  has  been  performed  that  have  had  a  reciirreuce ;  we  want 
to  know  what  has  been  the  ultimate  outcome  in  these  cases;  how 
many  of  them  were  reaUy  or  permanently  cured.  I  feel  sure  that 
shall  meet  with  opposition  when  I  speak  of  operating  upon  all 
cases  of  appendicitis.  I  might  say  here  that  I  believe  that  as  soon 
•  Bead  before  Uie  Reultickj  Mldtand  HedtcalSodetr,  KtSbelb;TlUe,Er.,  January  13, 1S98. 


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2         The  Atujtta  Medioal  and  Sueoioal  Jodrnal. 

as  the  diagnosis  of  appeDdicitia  is  made,  tbe  case  is  no  longer  a 
medical  case;  at  tbe  same  time  I  recognize  tbe  fact  that  many 
patients  positively  refuse  to  have  the  sui^eon  called  in.  To  this 
class  of  cases  I  will  also  devote  a  little  attention. 

The  diagnosis  of  appendicitis  should  be  a  comparatively  easy 
matter,  though  not  always  as  much  so  as  some  would  have  us 
believe.  There  may  be  great  difficulty  at  times  in  making  the 
diagnosis,  though  this  is  far  less  frequent  in  tbe  male  than  in  the 
female.  In  tbe  male  I  think  we  may  say  that  99  per  cent,  of  all 
cases  of  peritonitis,  not  due  to  trauma,  are  appendiceal  in  origin ; 
but  we  should  not  look  upon  all  pains  that  occur  in  the  abdomen 
or  that  are  referred  to  the  abdomen  as  due  to  peritonitis.  Appen- 
dicitis may  be  confounded  wjtb  several  affections.  For  instance, 
I  had  a  case  under  observation  which  had  been  treated  for  a  week 
for  appendicitis,  the  patient  being  a  man  aix>ut  fifty-six  or  fifty- 
eight  years  of  age ;  I  was  called  to  see  the  patient  with  the  idea  of 
operating.  I  could  not  agree  in  the  diagnosis  and  was  inclined  to 
look  upon  the  case  as  one  of  renal  colic.  The  patient  was  pnt 
upon  treatment  and  my  diagoosis  was  verified  by  bis  passing  two 
days  later  a  small  renal  calculus.  This  man  had  rigidity,  pain, 
vomiting,  constipation,  with  pulse  increased  in  rapidity,  due  how- 
ever to  pain  and  not  to  elevation  of  temperature.  There  were 
other  symptoms,  however,  which  in  connection  with  his  age  made 
me  feel  sure  his  trouble  was  not  appendiceal.  Gall-stones  have 
also  been  mistaken  for  appendicitis.  We  should  analyze  our  cases 
very  carefully.  The  tendency  now  is  to  diagnose  all  acute  ab- 
dominal troubles  as  appendicitis.  This  is  due  to  over-zealousness, 
and  careful  consideration  of  each  case  will  prevent  it.  I  think 
that  few  cases  of  appendicitis  go  undiagnosed,  and  those  that  do 
have  as  a  rule  been  improperly  treated.  This  calling  every  ab- 
dominal pain  appendicitis  has  also  done  much  to  prejudice  people 
against  operation,  and  also  physicians,  as  they  look  upon  them  as 
cured  cases.  Tbey  are  the  cases  that  have  no  recurrence.  The 
symptoms  of  appendiceal  diseases  are  so  constant  that  by  careful 
examination  differentiation  is  most  always  possible.  Among  the 
most  important  of  these  symptoms  are  pain  referable  in  almost  all 
cases  to  tbe  McBurney  point,  tenderness  and  rigidity  in  the  right 


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Diagnosis  and  Treatmest  of  Appendicitis.  3 

iliac  foBSB ;  tbe  other  symptoms  which  we  would  mention  are  vom- 
iliDg,  constipation,  distention,  tumor,  rapidity  of  pulse  and  eleva- 
tion of  temperature. 

Let  us  analyze  the  symptoms  separately:  The  first  symptom 
which  is  usually  present  is  pain.  This  pain  at  first  may  be  rather 
indefinite  in  location ;  it  may  be  present  about  the  umbilicus  ;  it 
may  be  present  in  the  epigastric  region,  or  it  may  vary  in  its  loca- 
tion, first  here  and  there ;  at  first  the  character  is  that  of  acut« 
indigestion  or  intestinal  colic.  Soon,  however,  it  becomes  localized 
io  the  right  iliac  fossa.  This  pain  is  due  to  pressure  upon  the 
branches  of  the  sympathetic  which  are  distributed  in  the  swollen 
appendix.  Pain  is  always  present  at  some  time  during  the  course 
of  the  disease.  It  is  always  present  primarily  ;  later  in  some  cases 
it  may  entirely  disappear,  for  reasons  which  will  be  given  directly. 
Tenderness  like  pain  may  always  be  elicited  by  pressure  over  the 
appendiceal  region.  Rarely  it  exists  on  the  left  side.  This  ten- 
derness, in  the  vast  majority  of  cases,  is  most  intense  and  can  be 
located  exactly  at  the  McBurney  point,  namely,  a  point  midway 
between  the  umbilicus  and  the  anterior  superior  spinous  process  of 
the  ilium.  Like  pain,  it  may  in  some  cases  disappear.  It  is  always 
present,  however,  unless  there  has  been  a  rupture  and  the  patient 
is  in  shock ;  when  rupture  occurs  both  pain  and  tenderness  may 
disappear  entirely.  These  two  symptoms,  with  rigidity  of  the 
mnacles  upon  this  side,  are  the  most  important  of  all.  If  we  com- 
pare the  right  and  the  left  side  io  an  appendicitio  patient,  that  is, 
before  peritonitis  has  become  diffuse,  while  it  is  still  localized  in 
the  right  iliac  fossa,  whether  there  is  an  abscess  or  not,  we  find  that 
nature  has  thrown  out  her  guards  in  the  form  of  a  stiff,  rigid 
muscle.  Thi?  rigidity  is  so  marked  that  it  is  absolutely  impossible 
to  do  anything  in  the  way  of  palpating  for  presence  of  a  tumor. 

Now  with  these  important  symptoms  we  have  a  change  in  the 
pulse ;  we  have  the  pulse  of  peritonitis ;  it  may  not  be  increaeed 
mnch  in  rapidity,  but  its  character  is  changed  in  a  marked  degree. 
And  just  here  I  would  say  that  it  is  not  the  rapidity  of  the  pulse 
opon  which  we  lay  stress,  but  upon  the  character  orthepulse  itself. 
We  find  the  pulse  hard,  bounding,  throbbing  as  it  were,  and  one 
that  it  is  impossible  to  compress  or  to   make  entirely  disappear. 


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4         The  Atlanta  Mbdioax  asd  Sdboical  Jodknal. 

We  feel  it  jumping  uuder  the  liDgers  as  an  unrqly  horse  pulling 
against  the  bridle.  The  pulse  rate  may  be  very  little  increased,  or 
it  may  run  up  very  rapidly, 

Now  as  to  temperature :  The  temperature  will  depend  upoo 
the  character  of  the  infection.  I  do  nut  lay  any  stress  upon  the- 
temperature  in  connection  with  appendicitic  cases  when  considered 
by  itself.  Taken  in  conjunction  with  other  symptoms  it  is  some- 
times a  valuable  means  of  diagDosis.  I  have  seen  a  most  severe 
case  of  appendicitis  where  the  temperature  range  was  not  higher 
than  100°  F.;  I  have  seen  cases  where  it  did  not  reach  100°  F. 
until  the  time  of  rupture.  I  have  seen  others  where  there  was  not 
nearly  so  much  disease  about  the  appendix,  where  the  temperature 
was  as  high  as  103°  and  104°  F.  Morris  has  said  that  with  the 
colon  bacillus  infection  we  need  not  look  for  high  temperature ; 
with  pyogenic  organisms  we  may  look  for  it. 

Vomiting  is  usually  an  early  symptom,  and  is  often  at  first, 
though  not  always  persistent ;  first  the  coutents  of  the  stomach, 
afterwards  bile.  As  the  case  becomes  more  and  more  septic  this 
vomit«d  matter  contains  little  black  particles,  not  the  coffee-ground 
vomit,  however;  but  it  is  streaked  with  black  and  contains  little 
black  specks.  The  vomiting  may  then  be  either  biliary  in  charac- 
ter, or  it  may  consist  entirely  of  mucus.  This  black  streaking  is 
due  to  hemorrhages  (petechial)  from  the  mucous  membrane  of  the 
stomach.  With  increase  in  peritonitis  the  vomitiug  may  be 
stercoraceous. 

Constipation:  Constipation  is  present  in  most  of  the  cases  of 
appendicitis,  and  usually  persists  during  the  initial  stage  of  the 
attack,  or  at  least  until  the  administration  ot  some  saline.  How- 
ever, we  may  find  diarrhea  from  the  incipiency  of  the  disease,  or  as 
a  symptom  of  sepsis.  Constipation  may  be  very  obstinate  at  times, 
refusing  to  yield  to  any  treatment;  there  is  intestinal  paralysis  due 
to  toxemia.  This  may  lead  tn  mistake  in  diagnosis  as  in  a  case  I 
now  call  to  mind,  which  was  treated  primarily  for  obstipation,, 
then  for  obstruction,  in  which  an  operation  (although  it  was  fatal) 
proved  the  case  to  be  one  of  the  worst  sort  ofap()endicitis. 

Distention:  Distention  begins  from  the  very -start.  It  may  be 
very  slight,  or  it  may  be  marked,  usually  progressing  with  the  con- 


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DlAGNOeiS   AND  TREATMENT  OP  APPENDICITIS.  5 

-tJDuatioD  of  tbe  disease.  Upon  iuspection  the  dieteutioa  may  not 
be  marked,  but  if  we  percuss  over  the  abdomen  we  will  find  there 
is  a  diffuse  tympanitic  note  which  extends  up  under  the  ribs,  and 
we  find  it  on  the  right  side  where  we  should  find  liver  duliiess. 
By  percussing  upon  either  side  over  the  floating  ribs  we  can  make 
-out  this  distention,  when  it  is  at  times  not  apparent  by  inspection 
nor  so  marked  by  percussion  over  the  lower  abdomen. 

These  are  the  most  important  symptoms,  and  the  only  ones,  I 
take  it,  that  it  is  necessary  to  dwell  upon,  and  their  importance  I 
should  say  was  in  the  order  named. 

There  is  one  symptom  to  which  a  great  deal  of  prominence  has 
been  attached,  far  more  than  it  deserves,  and  upon  its  presence  or 
absence  the  diagnosis  is  otltimes,  though  it  should  not  be,  depend- 
ent. I  refer  to  tumor.  On  account  of  the  rigidity  a  tumor  can 
not  always  be  made  out  even  when  present.  "We  may  get  over  the 
area  of  the  effusion,  or  of  the  adhesions,  or  of  tbe  abscess  sao, 
whichever  may  be  present,  upon  percussion,  a  dull  note.  In  many 
cases  there  is  no  tumor  at  all  present.  These  I  think  arc  the  most 
dangerous  of  all  the  cases,  and  are  those  where  there  have  not  been 
many  adhesions  and  where,  when  the  appendix  ruptures,  rupture  is 
into  the  free  cavity.  Those  cases  where  there  is  a  tumor,  particu- 
larly if  of  any  size,  are  really  far  less  dangerous  than  the  other 
class ;  therefore,  I  think  presence  or  absence  of  tumor  of  little  di- 
agnostic value.  With  rupture  where  there  are  adhesions  shutting 
off  the  appendix  from  the  general  cavity,  or  with  formation  of  an 
abscess,  a  tumor,  when  one  is  present,  may  rapidly  increase  in  size 
and  may  reach  apparently  enormous  proportions.  These  are  the 
cases  that  are  operated  upon  merely  by  opening  the  abscess,  wash- 
ing out  and  draining.  They  too  frequently  go  on  to  recurrences 
notwithstanding  the  evacuation  of  pus,  because  the  appendix,  tbe 
seat  of  the  original  trouble,  is  still  present. 

A  careful  consideration  of  these  symptoms  will  render  a  diagno- 
sis easy  in  the  male,  but  we  should  never  jump  to  a  conclusion;  we 
should  make  oar  diagnosis  carefully  always  by  exclusion. 

In  the  female,  while  appendicitis  is  not  nearly  so  frequent  as  in 
the  male,  this  being  due  to  the  increased  blood  supply  to  the  ap- 
pendix through  Cleido's  ligament,  the  diagnosis  may  at  times  pre- 


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6        Thx  Atlanta  Mssioal  ahd  Suboioal  Joubhal. 

sent  more  difficulties.  We  have  here  to  difiTereotiate  tubal  disease^ 
and  some  caaes  which  I  have  recently  seen  have  impressed  the  im- 
portance of  a  careful  examination  in  arriving  at  an  opinion  Of 
course  there  are  cases  where  there  is  no  difficulty,  but  we  should 
always  examine  carefully  into  the  menstrual  history  of  the  patient, 
be  she  maid,  wife  or  widow.  If  there  is  the  least  doubt  we  should 
examine  before  operation  under  anesthesia  and  exclude  abgoJutely 
the  possibility  of  disease  of  the  uterine  appendages.  We  should 
also  bear  in  mind  that  disease  of  the  appendix  and  of  the  uterine- 
appendageB  may  coexist  in  the  same  patient,  the  trouble  in  the  gen- 
erative organs  being  due  to  secondary  infection  from  the  appeodixr 
or  we  may  have  them  occurring  independently  of  each  other.  I 
do  not  believe  it  is  podsible  for  disease  of  the  appendix,  except  pos- 
sibly adhesions  due  to  extensive  inflammatory  trouble,  to  result 
from  primary  disease  of  the  tubes  or  ovaries.  By  that  I  mean  to- 
Bay  that  we  do  not  have  appendicitis  occurring  secondarily  to 
tronhles  about  the  uterine  appendages.  Those  cases  where  the 
roost  difficulty  arises  are  cases  where  there  ia  an  extremely  long 
vermiform  appendix,  one  which  hangs  down  over  the  brim  of  the 
pelvis,  thus  referring  the  pain  lower  down  than  usual,  and  showing 
by  bimanual  examination  the  presence  of  a  mass  high  up  in  the 
pelvis  upon  the  right  side.  The  mass  is,  however,  not  couoected 
with  the  uterus,  and  that  organ  ia  movable.  Careful  examination 
will  always  enable  us  to  differentiate  from  tubal  disease. 

A»  to  treatTnent :  I  have  indicated  previously,  that  this  disease,, 
as  soon  as  diagnosis  has  been  made,  is  a  surgical  one.  "We  might 
divide  the  treatment  into  medical  and  surgical."  I  do  not  mean 
by  this  that  I  think  the  treatment  of  a  case  of  appendicitis  should 
ever  be  medical  in  character,  but  I  recognize  the  fact  that  often- 
times patients  are  averse  to  having  an  operation  performed  ;  some- 
will  positively  refuse,  others  desire  to  delay  it  as  long  as  possible. 

The  very  word  "operation"  will  frighten  some  half  to  death ; 
they  dread  the  knife,  and  I  have  seen  people  who  would  prefer 
death  to  the  auigeon.  Why  ia  this  ?  It  should  not  be,  for  the  sur- 
geon is  really  in  these  cases  a  life-saver.  It  is  prejudice,  due  to 
lack  of  education  or  ignorance,  and  at  times,  I  regret  to  say,  to  the 
physician,  who  fears  either  to  lose  his  fee,  his  influence  and  prestige- 


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Diagnosis  and  TitEATMENT  of  Appesdicitis.  7 

by  calling  the  guidon,  or  by  not  being  able  to  perform  the  work 
himself;  or  he  may  fear  death  from  the  operation  and  censure  on 
account  thereof  from  the  community.  Should  this  be?  Not 
Let  us  educate  the  people  to  the  true  value  of  the  conservative  sur- 
geon. Id  other  instaDces  it  is  impossihie  to  obtain  a  surgeon  at 
once,  and  for  these  cases  there  must  he  some  treatment.  The  prao- 
dtioner  in  expected  to  do  something,  and  he  must  do  something. 
There  is  one  thing,  however,  he  should  not  do — and  upon  this  too 
much  stress  cannot  he  laid — that  is  to  administer  opium.  There  is 
never  a  time  in  the  treatment  of  appendicitis  when  opium  is  indi- 
cated. I  believe  that  lives  would  have  been  saved  bad  this  been 
borne  in  mind  in  treating  such  patients.  I  recognize  full  well 
that  it  is  at  times  difficult  to  resist  the  temptation  to  administer  a 
few  doses  of  opium,  especially  after  you  have  made  the  diagnosis, 
after  you  have  convinced  yourself,  and  therais  no  longer  any  doubt 
as  to  the  nature  of  the  trouble.  You  say  to  yourself,  here  is  a 
case  of  appendicitis,  why  not  give  the  patient  a  little  relief  by  a 
hypodermic ;  it  acts  so  nicely  and  is  so  quickly  done  ?  The  results 
are  so  perfect  that  it  is  at  times  almost  irresistible.  It  should  not, 
however,  be  yielded  to.  We  should  resist  the  temptation,  not  be- 
cause it  obscures  our  diagnosis,  it  being  already  made,  but  because 
pain  being  allayed  we  are  at  once  given  a  false  sense  of  security. 
We  may  then  think  that  our  patient  may  get  along  without  an 
operation.  We  go  on  from  day  to  day  giving  one  or  two  hypo- 
dermics, being  all  the  time  convinced  that  we  have  a  case  of  ap- 
pendicitis, but  that  the  symptoms  have  subsided,  and  our  patient 
goes  on  to  death  simply  because  we  could  not  refuse  their  plead- 
ings or  had  not  the  courage  of  our  convictions. 

To  my  mind  medical  treatment  should  consist  only  in  purgation 
with  salines,  or  an  attempt  at  purgation,  the  administration  of  ene- 
mata  to  empty  the  bowels,  and  hot  applications;  nothing  more 
unless  at  times  strychnia  as  a  stimulant.  These  things  may  relieve 
the  pain.  If  there  is  any  curative  value,  or  any  benefit  to  be  de- 
rived from  medical  treatment,  it  will  be  derived  from  purgation, 
getting  rid  of  ooxions  products,  keeping  the  bowels  open,  and  if 
there  are  any  cases  that  can  be  cured  by  medical  or  medicinal 
means,  it  will  be   these.     I  have  seen  pain  subside  very  quickly 


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S  Thb  ATLAirrA  Medical  and  Subqioal  Journal. 

after  free  pui^tioo ;  I  have  seen  the  symptoius  almost  disappear,  and 
have  seeD  cases  which  got  well,  or  at  least  which  recovered  from  the 
attack  at  the  time,  by  the  administratioo  of  salts.  True  the  attack 
sooner  or  later  recurs.  The  fact  that  I  have  seen  cases  pass  through 
an  attack  without  operation  weighs  oot  one  bit  in  the  balance  with 
me  as  compared  with  the  good  to  be  denved  from  operative  inter- 
fereuce. 

The  question  when  to  operate  has  been  a  great  deal  discussed 
ever  since  appendicitis  was  recognized  as  a  surgical  trouble.  I 
would  say  with  Morris,  operate  as  soon  as  the  diagnosis  is  made- 
"Isolate  an  infected  appendix,  from  the  peritoneal  cavity,  just  as 
you  would  isolate  a  case  of  diphtheria  in  a  healthy  community." 
One  is  as  essential  as  the  other.  There  is  only  oue  answer  to  the 
question  in  my  mind  when  to  operate,  and  that  is  at  once.  The 
presence  of  an  appendix  previously  inflamed  is  a  constant  menace 
to  health  and  to  life.  There  is  only  one  class  of  cases  upon  which 
I  would  not  operate,  and  of  late  I  am  even  at  times  inclined  to 
operate  upon  these,  and  that  is  where  the  case  is  desperate,  where 
there  is  rupture,  where  the  patient  is  on  the  brink  of  the  grave, 
as  it  were,  where  you  feel  sure  that  notwithstanding  the  operation 
recovery  is  almost  impossible.  These  are  the  cases,  however, 
where  we  are  urged  to  operate,  and  they  are  the  ones  which  have 
brought  appendiceal  surgery  into  disrepute  with  the  laity.  They 
are  the  ones  where  we  see  reported  in  the  newspapers,  "Death 
from  Appendicitis."  I  may  say  in  passing,  that  these  newspaper 
reports  have  cost  many  lives  by  giving  rise  to  prejudice  on  the 
part  of  the  laity ;  they  think  that  all  cases  of  appendicitis  operated 
upon  die.  They  never  hear  of  the  ones  that  are  cured,  and  if  we 
refuse  to  operate  upon  this  class  they  would  bear  even  less  of 
those  that  die. 

As  to  the  operation  itself:  I  take  it  that  you  are  all  familiar  with 
the  technique,  or  suflSciently  so  as  not  to  necessitate  a  description 
of  the  operation  by  me.  But  there  is  one  thing  that  I  must 
dwell  upon,  and  that  is  the  question  of  adhesions  and  their  treat- 
ment, and  the  disposition  of  the  appendix.  The  appendix  should 
be  removed  in  every  case  at  the  primary  operation,  unless  the 
patient  is  in  such  a  bad  condition  that  it  would  not  do  to  prolong 


^dbyGoogle 


DiAONoeis  AND  Tbeathent  of  Appendicitis.  9 

etherization  to  search  for  and  remove  it.  AgaiD,  ia  the  practice  of 
the  couDtiy  doctor,  where  an  operation  is  done  without  sufficient 
assistance,  and  without  sufficient  preparation  for  a  thorough  opera- 
tion, leaving  the  appendix  may  at  times  be  excusahle.  An  ap- 
pendix left  hehind  is  a  source  of  future  trouble,  and  for  that  reason 
I  think  it  is  safer  to  break  up  the  adhesions,  search  for  the  offend- 
ing organ  and  take  it  away.  It  should  be  taken  away  as  close  to 
the  bowel  as  is  possible.  I  aay  as  is  possible,  because  there  may  be 
«ases  where  we  cannot  get  the  colon  sufficiently  up,  or  where  for 
other  reasons  we  are  not  able  to  treat  the  appendix  in  this  manner. 
A  portion  of  an  infected  appendix  left. behind  may  form  a  focus 
for  abscesses  which  may  discharge  later,  either  into  the  bowel  or 
externally,  or  into  the  peritoneal  cavity.  I  have  heard  expressions 
such  as  this  in  speaking  of  appendiceal  operations:  "  I  did  not 
remove  the  appendix  because  it  had  sloughed  off."  Even  when 
the  appendix  has  sloughed  off,  it  should  be  searched  for,  the  adhe- 
sions in  which  it  lies  embedded  broken  up,  and  it  should  be  re- 
moved. We  do  not  know  that  it  has  sloughed  off,  however,  unless 
we  trace  the  colon  down  to  the  appendiceal  attachment  aud  note 
its  presence  or  absence.  This  requires  separation  of  adhesions. 
!Eveo  alter  the  appendix  is  removed  I  think  it  well  to  separate  all 
adhesions,  and  this  is  especially  true  if  there  has  been  any  pus 
formation.  All  pus  pockets  must  be  opened,  washed  out  and 
possibly  drained.  The  reasons  fur  this  are  as  evident  as  those  for 
the  removal  of  the  appendix  in  every  case. 

As  to  the  necessities  for  drainage:  Each  case  must  be  a  rule 
onto  itself,  and  the  after  treatment  will  depend  upon  the  character 
of  the  operation  and  the  condition  found.  The  general  indications 
are  about  the  same  as  in  any  other  abdominal  section. 

1S9  Wett  Oierinut  street. 


Teacher — Now,  children,  we  will  have  our  verses.  First  Small 
Ohild  (repeating  verse) — He  that  hath  ears  to  hear  let  him  bear. 
"  Very  good.  Now  the  next  little  boy."  Small  Boy  (taking  his 
■cue) — He  that  batb  a  noth  to  shmell  let  him  ehmell." — Ex. 


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The  Atlanta  Medical  Ain>  Subgical  Jocblnal. 


NATIONAL  VERSUS  STATE  QUARANTINE. 

By  W.  D.  TRAVIS,  BLD., 
CovisoTON,  Gx. 

It  has  been  wisely  said  that  the  health  of  a  oatioD  is  a  Dational 
oonsideratioQ  involviag  ioterQational  cooperation,  aad  it  should 
be  as  much  a  common  cause  for  national  defense  as  are  our  cher- 
ished liberties.  When  these  are  threateoed  by  a  foreign  foe  each 
State  feels  called  upon  to  furnish  men  and  means  to  be  eeot  when- 
ever and  wherever  the  commander-io-chief  of  our  nation  shall 
direct.  State  rights  are  held  in  abeyance,  while  soldiers  and  sail- 
ors are  rushed  wherever  common  defense  requires  it;  yet  when  "the 
pestilence  that  walketh  in  darkness  and  the  destruction  that  wasteth 
at  noonday,"  with  weapons  so  tiny  as  to  be  invisible  to  the  unaided 
eye,  but  still  so  powerful  that  armies  and  navies  vanish  away,  and 
commerce,  agriculture,  manufacture  and  all  of  the  industrial  occu- 
pations, except  that  of  the  undertaker,  are  paralyzed,  and  even 
shotgun  quarantine  can  not  call  forth  respect  for  State  lines,  peo- 
ple say  "  the  national  government  should  have  nothing  to  do  with 
it;  each  State  should  manage  its  own  quarantine." 

Suppose  during  the  Revolutionary  War  each  colony  had  estab- 
lished a  shotgun  line  of  defense  and  kept  its  forces  strictly  within 
its  own  border,  are  you  quite  sure  that  we  would  now  have  a  grand 
and  glorious  union  boasting  of  its  freedom?  In  united  and  con- 
certed action  there  is  strength,  and  this  proves  true  in  overcoming 
disease  as  well  as  other  foes.  Again,  when  an  American  citizen  is 
imprisoned  by  a  foreign  power,  nothing  is  said  about  State  rights 
or  from  what  State  he  comes.  He  is  an  American  citizen,  there- 
fore entitled  to  all  the  aid  and  protection  this  guvernmeDt  can  give; 
but  let  some  dread  epidemic  invade  a  town,  aad  the  lives  of  many 
people  be  endangered,  not  only  from  want  of  skill  iu  treatment  of 
disease,  but  also  from  ignorance  of  the  best  methods  of  extermina- 
tion, experienced  national  aid  is  not  wanted — its  acceptance  would 
be  an  infringement  of  State  rights. 

In  some  States,  our  own  for  example,  there  are  no  State  boards 


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National  VBRfins  State  Quarantine.  II 

of  health ;  in  othera  the  rules  and  regulations  are  very  meager,  aod 
are  imperfectly  carried  out.  By  the  eBtablishment  of  a  natioiial 
health  departmeot,  from  which  all  politics  are  eliminated,  we  would 
have  an  executive  authority  that  would  be  able  not  only  to  arbi- 
trate, bat  dictate  and  command,  where  public  health  and  safety 
demand  it. 

The  Bubject  of  sanitary  science  is  a  complicated  one,  and  should 
be  carefully  studied  before  any  practical  measures  are  instituted. 
Onr  sanitary  system  in  its  divisions  should  be  modeled  after  our 
American  government.  As  that  has  national,  State,  city  and  bor- 
ough legblatioD  with  executive  offices  for  each,  so  we  should 
have  legislation  in  sanitary  matters  for  the  nation.  State,  city  and 
borough,  with  executive  ofBcers  to  enforce  them.  In  ordinary 
caees  the  borough,  city  or  State  should  be  allowed  to  pass  aud  exe- 
cute their  own  sanitary  laws ;  to  proteot  their  own  local  territory 
against  the  causes  of  disease  localized  within  their  own  limits,  but 
should  not  have  the  right  to  so  regulate  or  neglect  to  regulate 
their  local  sanitation  as  to  endanger  neighboring  States  or  dis- 
tant governmeuts.  Our  border  should  be  entirely  under  the 
control  and  protection  of  a  Dational  sanitary  authority.  Our  gov- 
ernment should  establish  and  maintain  a  perfect  cordon  of  sanitary 
stations  along  our  coasts,  thoroughly  furnished  and  equipped  for 
the  health  and  comfort  of  those  under  detention,  and  well  supplied 
with  all  of  the  improved  scientific  appliances  for  fumigation  and 
sterilisation,  under  control  of  physicians  eminent  for  skill  in  diag- 
nosing and  treating  yellow  fever,  cholera,  smallpox  and  other  infec- 
tious diseases  that  are  imported  from  other  countries  to  our  own. 
These  officials  should  not  be  appointed  by  the  President  or  be 
subject  to  political  removal.  They  should  be  selected  by  medical 
associations  or  scientific  bodies,  and  their  term  of  office  conditional 
upon  their  ability,  efficiency  and  honest  and  faithful  discharge  of 
duty. 

The  State  of  Lonisiana  has  one  of  the  most  perfect  sanitary  or- 
ganieatione  in  the  world,  as  far  as  concerns  quarantine  against 
contagious  diseases ;  for  which  credit  is  largely  due  to  Dr.  Holt. 
The  whole  country  is  indebted  to  this  Slate  for  her  system  of  quar- 
antine ;  bat  is  it  just  that  Louisiana  should  bear,  unaided,  the  heavy 


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12         The  Atla.nta  Medical  akd  Sdboical  Judbnau 

fiDanclal  burden  uf  guardiog  us  agaioet  yellow  fever  ?  For  she 
asserts  that  it  is  not  a  Dative  of  her  soil,  but  is  a  foreiga  disease, 
which  an  efBcient  system  of  quarantine  will  keep  out,  and  in  the 
past  she  has  boasted  that  she  is  fully  able  to  protect  her  citizens 
from  its  ravages.  But  alas !  where  was  this  same  confident  boast- 
ing during  the  last  epidemic  of  fever  ?  She  found  herself  not  only 
unable  to  keep  it  out,  but  to  stamp  it  out  afler  it  had  entered,  and 
was  forced  to  appeal  to  the  national  government  for  aid.  How  the 
New  Orleans  quarantine  is  now  regulated  or  may  be  regulated  is 
something  that  concerns  the  whole  country,  and  the  care  of  guard- 
ing her  gateway  of  disease  should  not  be  left  to  Louisiana  alone. 
If  her  present  system  of  quarantine  can  be  improved  or  made  more 
perfect  by  national  supervision  and  aid,  the  government  owes  it  to 
our  country  to  supply  that  aid. 

"The  operation  of  a  national  department  of  health  need  no 
more  interfere  with  or  abrogate  the  rights  and  duties  of  the  State 
boards  of  health  to  attend  to  the  proper  sanitation  of  their  re- 
spective States  than  a  national  department  of  agriculture  or  a  na- 
tional code  of  laws  need  interfere  or  do  away  with  a  State  depart- 
ment of  agriculture  or  a  State  system  of  laws."  If  the  govern- 
ment has  power  to  establish  an  interstate  commerce  commission, 
and  power  to  adopt  measures  to  prevent  the  wrecking  and  robbing 
of  railway  trains,  and  thus  assume  jurisdiction  over  life  aud  prop- 
erty in  transit  through  differeDt  States,  why  has  it  not  the  right  to 
try  to  prevent  the  migration  of  disease  from  one  State  or  place  to 
another?  With  the  facilities  that  would  be  at  its  disposal,  it  should 
be  the  duty  of  the  national  board  to  be  informed  of  the  exact  san- 
itary condition  of  every  State  in  the  Union  aud  every  country  in 
the  world,  and  to  keep  all  sanitary  authorities  fully  informed  of 
the  same.  It  should  make  a  thorough  study  of  epidemic  diseases, 
and  experts  who  have  had  all  the  advantages  of  an  extended  expe- 
rience, aided  by  an  improved  medical  science,  should  be  immedi- 
ately disimiched  to  any  part  of  the  Union  to  diagnose  suspicious 
«ases  in  order  to  arrest  disease  in  its  inoipiency.  Wise  heads  should 
meet  and  formulate  a  plan  by  which  national,  State,  and  city  boards 
■of  health  could  work  together,  without  friction,  to  save  out  coun- 


sel byGoOglc 


Natiosal  Versos  State  Quarantine.  la 

try  from  scourges  that  have  destroyed  more  Jives  dariog  the  last 
thirty  years  than  the  sword  or  the  bullet  during  our  civil  war. 

Lastly,  it  is  in  the  interest  of  economy  that  we  have  a  perfect 
system  of  national  sanitation  and  quarantine.  Dr.  Albert  L. 
Gibon  says:  "As  the  enlightened  phyeictan  seeks  to  prevent  hi» 
chains  becoming  ill,  so  should  the  guardian  of  the  public  health 
be  able  to  forestall  these  emergencies,  whose  pecuniary  cost  in 
money  expended  and  wasted,  in  trade  paralyzed  and  diverted,  ia 
kbor  and  its  wages  lost  by  the  sick  and  terrified  and  dead,  in  a 
single  epidemic,  exceeds  that  of  maintaining  an  efficient  sanitary 
service  for  the  whole  country  for  a  whole  year.  The  fault  of  the 
medical  profession  has  always  been  its  tack  of  bold  assertion  of  it» 
rights;  but  it  can  no  longer  beflitate  to  declare  to  trade  and  com- 
merce  and  agriculture  and  manufacture  that  the  health  and  vigor 
which  are  essential  to  prosperity  cannot  be  secured  by  their  own 
unskilled,  uninformed  efforts."  Then  as  epidemics  rarely  occur  at 
the  same  time  except  in  narrow  limits,  a  few  experts  supplied  by 
the  general  government  would  supersede  the  necessity  of  every 
State  maintaining  its  own.  Other  expenses,  too,  could  be  saved, 
as,  for  instance,  the  government  could  easily  establish,  in  places 
where  most  needed,  plants  for  disinfection  by  meaue  of  formaliUr 
now  considered  by  the  highest  authorities  the  best  disinfectant 
known.  It  would  be  utterly  impracticable  for  each  town  to  pos- 
sess  its  own  plant.  Thousands  of  dollars  and  perhaps  as  many 
Uvea  have  been  saved  by  our  national  weather  bureau.  Who  can 
say  how  many  lives  and  how  much  money  might  be  saved  by  a 
national  health  department  free  from  fectioual  bias  and  political 
environments  whose  motto  should  be,  No  North,  no  South,  no 
East,  no  West,  but  my  country  and  her  interests. 

Fob  Chbonic  CossTiPATroN. 

B    Tr.  nnxTom 5  g  Ktt.  8. 

Tr.  belladODtiK 3  iise. 

Inf.  aennte— 3  v. 

Inf.  colnmbee ,^  viiss. 

U.  Sig.:  A  teaepoonful  before  meals. 
If  the  motions  are  drier  than  normal,  a  saline  may  be  given  at 
mealtime  in  addition  to  the  above. — Dr.  C.  B.  Kelsey. 


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The  ATI.AJITA  Medical  and  SxmQiCAL  Juubkal. 


THE  EXPERIENCES  AND  REMINISCENCES  OF 
FORTY  YEARS. 

By  G.  G.  rot.  M.D., 

Emeritus  Professor  of  Materia  MedicK  «nd  Thsrapentics  in  Soathern 

Medical  College,  Atlanta. 

In  March,  1857,  after  receiving  my  medical  education  at  the 
University  of  Virginia  and  the  Jefferson  Medical  College  of  Phil- 
adelphia, I  began  the  practice  of  medicine  in  my  native  State 
Virginia  in  connection  with  my  &tber,  who  had  been  so  engaged 
for  a  number  of  years. 

Those  were  days  when  negroes  were  slaves  and  they  received 
more  careful  medical  skill  and  nursing  than  they  ever  will  again. 
Because  then  they  were  the  legal  property  of  their  owners  and 
very  valuable. 

Though  slaves,  I  never  knew  them  treated  otherwise  than 
humanely  and  kindly,  and  there  was  a  respect  and  love  shown  by 
them  for  their  owners  that  was  thoroughly  tested  during  the  late 
civil  war,  when  in  many  instances  they  were  the  support  and  pro- 
tection of  the  women  and  children  throughout  our  Southland. 

The  negro  is  a  superstitions  being — was  so  then  and  not  less  so 
now — though  it  is  natural  to  espect  otherwise,  in  view  of  the 
large  amount  that  is  expended  upon  them  yearly  by  the  Southern 
people,  whom  they  are  now  taught  to  look  upon  as  their  enemy. 

In  those  days  to  be  "tricked"  or  "conjured"  by  some  other 
negro  at  enmity  to  them  was  an  every-day  occurrence ;  and  to  dis- 
abuse their  miuds  of  this  fallacy  by  reassuring  was  a  matter  of 
impossibility. 

I  do  not  think  Vii^nia  negroes  were  more  addicted  to  this 
BuperstitioD  than  those  of  other  Southern  States ;  but  it  is  a  fact 
that  in  those  days  numbers  of  Southern  negroes  and  some  of  the 
ignorant  whites  adhered  to  that  belief. 

My  first  patient — when  I  landed  from  the  steamboat  plying  the 
Rappahannock  river  between  Baltimore,  Md.,  and  Frederieksbui^, 
Va.,  from  Philadelphia  with  my  green  case  holding  the  then  most 
precious  legacy  I  desired,  authorizing   me  by  permission   of  the 


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ExPEBIErfCES   AND   ReHINIBCBNCES   OF   FOBTY  YEASS.      15 

facnlty  of  the  Jefferson  Medical  College  and  tbe  laws  of  the  State 
tif  PeDDsylvania,  to  go  forth  into  the  world  to  cure  or  kill — the 
first  individaal  I  met  was  old  Sam  Brown,  colored  freedmao. 
Now  Sam  Brown  was  a  noted  character  and  had  a  history.  At 
this  period  he  was  a  very  old  man.  His  owner  was  a  Frenchman 
and  the  captain  of  a  brig  plying  between  our  southern  ports  and 
lhi)se  of  the  North.  Sam  was  one  of  his  trusted  hands  and  bad 
become  an  expert  sailor.  After  accumulating  a  fortune  as  a  sea 
captain  he  located  on  the  Rappahannock  river  in  the  county  of  my 
birth,  and  in  addition  to  possessing  magnificent  lands  and  over  a 
hundred  negroes,  he  was  engaged  in  tbe  mercantile  business  on 
the  river.     Sam  was  all  this  time  his  trusted  slave  and  friend. 

In  the  war  of  1812  the  British  landed  a  company  of  marines 
and  set  lire  to  this  store.  Everybody  lelib  the  place  but  &m 
Brown.  He  secreted  himself  in  the  marsh  just  behind  the  store. 
The  British  as  soon  as  they  applied  the  torch  returned  to  their 
gunboats.  Sam,  taking  advantage  of  this,  before  the  fire  had 
reached  the  "  counting-room,"  rushed  in,  seized  his  master's 
account-book  and  a  large  sum  of  money  where  he  fortunately 
knew  it  had  been  secreted,  and  thus  saved  several  thousand  dol- 
lars. His  reward  was  his  freedom  given  him  by  bis  master.  Cap 
tain  Janney. 

Sam — as  all  worthy  men  should  have — had  a  wife,  dutiful  and 
faithful,  who  was  a  slave,  having  another  master.  Her  name  was 
Bathias.  Sam  called  her  more  endearingly,  Thia.  He  bought 
her  (rom  her  master,  paying  six  hundred  dollars,  standard  cur- 
rency. The  laws  of  Virginia  allowed  him  to  buy  and  own  her  as 
a  slave  just  as  slaves  were  bought  and  owned  by  whites.  She 
then  became  both  his  wife  and  his  slave.  They  were  now  quite 
old. 

Uncle  Sam,  I  say,  was  the  first  to  greet  me  on  landing.  He 
said,  "  Mars  Gus,  de  tell  me  you  bin  way  out  in  de  backwoods 
laming  to  be  a  doctor.  Tell  me,  did  you  laro  anything  about 
curing  'conjuration'"?  I  told  him  I  thought  I  would  make  a 
success  of  curing  that  troublesome  disease,  as  I  had  been  bending 
my  enei^es  to  that  end.  He  was  greatly  elated  and  comforted 
and  said,  "  For  de  Lord  sake,  please  come  see  Thia  soon  as  you 


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16    "    The  Atla.hta  Medical  and  Stjboioal  Jodrnal. 

git  home.  Dat  crater  dun  bin  in  bed  for  three  years,  conjured  to 
def,  and  she  gwioe  die  sbo  if  sum'ting  ain't  dun  for  her.  Your 
pa  and  Dr.  Smith  I  knows  is  good  doctors,  but  dey  won't  hab 
nothing  to  do  with  Thia  case  dey  say  dare  ain't  no  eich  ting  as 
'conjuration.'  Dat  critter  is  gwine  die,  eho'.''  I  promised  him 
to  call  next,  day  at  11  o'clock  a.m.,  and  true  to  promise  I  was 
there. 

Lying  on  a  bed  in  her  cabin  was  the  emaciated  frame  and  hag- 
gard form  of  old  Aunt  Bathiaa  Brown.  She  had  taken  little  or 
no  nourishment  for  a  long  time,  and  could  not  be  induced  to  take 
it,  unless  brought  out  of  the  neighborhood,  for  fear  her  supposed 
enemy  might  put  more  "  pizen  "  in  it.  This  was  my  visit  of  pros- 
pectioo  toascertaiu  her  condition  and  see  how  the  land  lay  before 
beginning  my  treatment. 

I  began  by  HesoribiDg  her  feelings  and  symptoms  myself,  and 
wound  up  by  telling  her  the  live  things  in  her,  rapidly  sappiog- 
her  life  away,  collected  into  a  large  lump  between  her  shoulders  at 
11  o'clock  every  day,  and  were  a  source  of  so  much  torment  that 
she  could  not  rest  and  could  barely  turn  over  for  the  lump,  and  they 
mnst  be  worms  very  much  like  fishing-worms,  and  some  of  them 
had  grown  very  large  after  being  hatched  in  her  body,  from  the 
"  pizen  "  of  the  conjurer.  She  clapped  her  bands  and  said,  "Dat 
is  de  God's  truf  and  I  does  believe  you  knows  all  'bout  con- 
juration." 

I  told  her  I  would  call  next  day  promptly  at  11  o'clock  to  try 
my  hand  at  their  extermination  and  ber  restoration. 

Before  the  hour  ot  starting  on  my  visit  to  my  patient  I  directed 
my  office  boy  t<>  go  behind  the  smoke-house  and  dig  up  eight  or 
ten  fishing-worms  and  wrap  them  in  a  piece  of  paper  and  bring 
to  me.  He  did  so.  For  the  purpose  of  somewhat  shielding  my 
conscience  and  for  the  wiser  purpose  of  telling  her  I  had  not  seen 
any  live  things  that  I  might  succeed  in  getting  from  her,  I  put  the 
package  in  my  vest  pocket,  never  for  once  looking  to  see  what  was 
in  it. 

I  reached  her  bedside  at  the  appointed  hour — told  her  she  must 
be  blindfolded  (aa  that  was  a  part  of  the  treatment  to  make  it  a 
success),  and  lay  flat  upon  her  stomach  so  that  I  could  readily  get 


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EXPEBIEHCES  AMD   REMINISCENCES   OF   FOBTY  YeaES.      17 

at  the  lump  of  live  things  between  her  shoulders.  She  consented, 
and  placing  her  in  this  position  I  proceeded  to  cup  her  over  the 
lump.  She  was  so  thin  and  emaciated  that  after  using  the  scari- 
ficator three  or  four  times,  and  a  strong  and  new  suction  pump  to 
esbaust  the  air  from  the  cupping-glasses  and  draw  out  the  blood, 
I  only,  after  considerable  effort,  succeeded  in  getting  about  a  tea- 
spoonful  of  blood.  With  this  I  barely  colored  the  water  in  the 
basin  iateoded  for  washing  my  cupping-glass  and  also  prevent  her 
seeing  the  worms  until  she  drained  off  the  water.  I  took  the 
paper  containing  the  worms  from  my  vest  pocket  and  turning  my 
head  so  as  not  to  see  them  when  emptied  into  the  basin,  and  there- 
by making  good  my  aasertion  to  her  that  I  had  not  seen  a  living 
thing,  directed  her  to  try  t4)  crawl  out  of  her  bed  and  take  the 
basin  and  go  to  the  fireplace,  drain  the  water,  and  see  for  herself 
if  there  was  anything  in  it;  that  I  had  not  seen  anything  and 
could  not  swear  there  was,  but  I  thought  I  had  gotten  something 
as  the  suction  from  the  pump  was  so  severe  as  to  make  me  think  it 
was  drawing  something  out. 

The  old  woman  hobbled  to  the  fireplace  with  the  assistance  of 
ber  cane,  took  a  seat  on  a  stool  and  began  to  drain  off  the  water. 
Getting  near  the  bottom  she  saw  the  worms  wriggling,  and,  drop- 
ping the  basin,  began  to  shout  and  clap  her  bands,  exclaiming,  "I 
knowed  them  things  was  in  me,  and  dey  done  near  eat  me  up  now, 
but  praise  God  be  done  sent  you  here,  way  from  de  backwoods,  to 
cure  poor  me." 

Her  joy  was  ecstatic.  She  put  the  worms  into  a  bottle,  corked 
it,  tJed  a  striog  around  the  neck  of  it,  and  hung  it  up  in  a  secret 
place  in  her  cabin. 

She  said  at  once  she  felt  better  and  stronger,  and  "sorter  hon- 
gry,  too,  for  God  knows  I  been  feared  to  eat  anything  for  months 
case  I  knowed  dat  nigger  would  pizen  everything  dat  was  cooked 
in  dis  house." 

I  continued  the  process  of  extracting  the  worms  once  a  week 
for  a  month  until  I  got  a  lot  of  tiny  little  worms,  and  assured  her 
that  they  were  the  last;  that  I  had  destroyed  the  eggs  and 
broken  up  the  nest. 


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18       Thb  Atlanta.  Medical  and  Subqioal  Joubnal. 

She  began  at  ouce  to  improve,  took  Doarisbmeat  (as  I  assured 
ber  it  was  safe  to  do  so  now,  aod  if  she  got  worse  I  woold  trick 
the  nigger  that  had  tricked  her;  this  delighted  her);  gained 
strength  and  flesh,  and  in  two  months  she  was  about  ber  usual 
duties,  hard  at  work,  and  lived  for  3'ears  after  that  in  perfect  health 
both  of  body  and  mind.  During  this  treatment  I  gave  no  medi- 
cine, save  the  medtcina  menlis. 

This,  my  first  case,  taught  me  the  lesson  that  it  is  sometimes 

legitimate  and  necessary  to  use  deception  to  the  cure  of  such  results 

of  ignorance  and  superstition.     It  is  an  instance  in  which  one  is 

justified  in  doing  evil  that  good  may  come. 

(To  be  conlinutd.) 


OTOMY  ASTHENIA— M  USCLE- DE  A  FNESS.* 

Bt  THOS-IP.   RUMBOLD,   M.D., 

St.  LouiH,   Mo. 

In  the  September  number  of  the  Laryngoscope  I  gave  my  views 
concerning  the  functions  of  the  tensor  tympani  and  stapedius 
•DUBcles,!  stating  that  these  functions  were  to  select  and  amplify  such 
:eounds  as  the  listener  desired  to  hear  most  distinctly.  I  have  re- 
■ceived  some  letters  since  the  publication  of  this  article  asking  me 
.to  give  the  clinical  application  of  the  deductions  contained  in  the 
Ifull  paper. 

Ih  answer  I  will  say,  in  part,  that  with  a  knowledge  of  the 
functions  of  these  ear-muscles  we  are  able  to  name,  with  a  great 
deal  of  certainty,  two  causes  of  deafness  that  are  not  geDerally 
known.  One  of  these  causes  is  due  to  a  paralysis  agitans  of  these 
muscles,  described  at  some  length  in  the  paper  above  mentioned; 
and  the  other  cause  of  deafness  is  a  debilitated  condition  of  these 
ear-muscles,  which  prevents  them  from  selecting  and  amplifying 
sounds  normally,  an  olomyaatkenia.  The  fact  that  asthenia  uf  the 
ear-muscle  or  muscles  is  a  cause  of  deafness  is  intimated  iu  the 

'Eif-Miucle  DeblliC;. 

t  The  Krtiole  wka  re&d  U  the  WeaUrn  OphtbalmologJol,  Otologloal,  Larr(]golog1c&]  and 
Bilnoloaloal  AMooiaUon,  April,  leST,  Bnd  published  in  the  TranwwtioiK. 


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OtOMY  ASTHENIA MuSCLE-DeAPNESS.  1 9 

foU  paper.      Id  this  paper  I  will  add  enough  to  enable  one  to 
easily  select  his  cases  of  middle-ear  muscle  asthenia. 

Thii?  disability  is  not  very  difficult  of  diagnosis ;  in  fact  the 
patient  himself  will  almost  invariably  indicate  the  cause  by  the  de- 
acriptioD  of  his  deafness,  as  is  plainly  shown  by  the  following  from 
an  intelligent   patieut,  aged  fifly-eight  years.     He  says  : 

"I  have  no  difficulty  in  understanding  you,  or  even  in  hearing 
my  little  grandson,  three  years  old,  when  he  is  talking  to  me  from 
the  head  of  the  stairs,  but  some  persons  talk  in  such  a  mumbling 
way  that  their  words  are  hard  to  comprehend.  When  I  am  on 
Change  I  can't  make  out  one  word,  and  I  have  great  difficulty  on 
the  care.  If  persons  would  speak  plainly  I  could  hear  them  very 
well.  I  can  prove  to  you  that  I  am  not  very  deaf.  When  I  go  to 
« lecture,  as  soon  as  all  are  seated  and  the  speaker  gets  started  so  as 
to  stop  all  whispering,  I  hear  him  very  well  while  I  am  fifty  leet 
away  from  the  platform.  Last  evening  I  was  at  a  whist  party; 
before  the  play  commenced  I  conid  scarcely  make  out  one  word, 
because  of  the  confusion  made  by  all  of  them  (sixteen  persons) 
talking  and  laughing  together.  How  they  understood  one  another 
I  diin't  know.  As  soon  as  quiet  was  restored  I  heard  those  at  the 
other  end  of  the  room  who  once  in  a  while  made  a  remark  to 
some  one  at  their  table,  and  the  room  was  at  least  twenty  feet  long.  * 
Ton  see  I  am  not  very  deaf,  but  only  so  under  certain  circum- 
stances. There  is  another  curious  thing;  while  I  am  eating  I  can't 
distinctly  hear  those  on  the  other  side  of  the  table;  the  noise  made 
in  my  mouth  while  I  am  chewing  my  food  is  so  great  as  to  drown 
the  words,  so  I  have  to  stop  eating  to  hear  them." 

In  the  light  of  what  was  said  in  the  paper  above  referred  to,  it 
will  appear  plainly  that  his  deafness  is  due  to  the  inability  of  his 
ear-muscle  or  muscles  to  select  and  amplify  the  sounds  that  he  de- 
Mres  to  bear,  this  disability  being,  in  him,  almost  if  not  quite  total; 
indeed  much  greater  than  is  usually  observed  in  this  class  of  cases. 
It  should  be  noticed  that  it  is  ouly  while  other  noises  are  being 
made  that  he  complains  of  the  mumbling  way  in  which  others 
talk.  If  the  other  noises  were  not  present,  his  hearing,  while  it  is 
not  good,  is  such  that  he  would  not  for  an  instant  thiuk  of  com- 
plaining.    If  a  person  with  normal  ears  listens  to  the  conversation 


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20       The  Atlanta  Mbdical  and  Subgical,  Jourkal. 

of  a  friend,  the  words  of  others  near  him  seem  to  be  spokea  in  a 
mumbliQg  way.  Id  this  he  resembles  exactly  the  disability  of  the 
man  enffering  from  oto  myasthenic  deafness,  for  the  simple  reason 
that  his  ear-muscle  or  muscles  are  not  endeavoring  to  select  and 
amplify  the  sounds  of  the  other  persons.  But  if  this  listener  will 
turn  his  attention  to  what  one  of  the  other  persons  is  saying,  that 
is,  selecting  that  one's  words  instead  of  bis  friends,  then  instantly 
the  words  of  his  friend  will  seem  as  though  spoken  in  a  mumbliDg 
way.  This  is  the  daily  experience  of  every  person  with  normal 
ears. 

When  there  was  no  necessity  for  selection  and  amplification, 
such  as  in  the  case  of  his  grandson's  voice,  and  in  the  quiet  lecture 
room,  he  heard  with  entire  satisfaction,  but  when  he  desired  to  hear 
certAin  selected  sounds,  as  the  words  of  one  of  the  company  in  a 
roomful  of  noisy  people,  and  not  be  bothered  with  the  undesired 
sounds,  his  ear-organs  were  unable  to  perform  the  task.  In  a 
quiet  room  no  one  would  consider  this  man  very  deaf.  His  state- 
ments of  his  ability  to  hear  when  there  was  no  noise  are  ample 
demonstrations  of  this. 

It  is  evident  that  this  variable  condition  of  his  hearing  is  not 
due  to  an  abnormal  condition  of  the  auditory  nerve,  for  this  nerve 
cannot  be  obtuse  in  a  noisy  room  and  then  acute  the  instant  the 
noise  ceases.  For  the  same  reason  it  cannot  be  due  to  tinniti  of 
either  kind.  Cases  of  this  kind  very  seldom  suffer  from  mus- 
cular tinnitus.  If  they  do,  it  is  very  weak  in  intensity,  a  signifi- 
cant fact.  Vascular  tinnitus,  in  varying  degrees  of  severity,  is 
almost  always  present  in  these  cases,  but  it  can,  obviously,  cut  no 
tigure  in  causing  variableness  of  the  hearing.  This  proves  that 
this  condition  of  the  hearing  is  due  alone  to  the  inability  of  the 
ear-muscle  or  muscles  to  select  and  amplify  the  desired  sounds,  a 
myasthenia. 

There  is  another  method  of  proving  that  asthenia  of  the  middle 
ear-muscles  is  the  cause  of  deafness  than  by  that  of  the  patient's 
history  of  his  subjective  symptoms;  this  is  by  the  employment  of 
the  tick  of  the  watch,*     These  patients  frequently  surprise  the 


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Otomyasthenia — Mdscle-Deapness.  21 

physiciao  by  the  distance  they  can  hear  the  metallic  tick  of  the 
watch  in  a  quiet  room.  This  man  heard  the  wat«h  20/96  R.  14/96  L. 
It  varied  a  very  little  each  time  in  the  four  or  five  test^  that  were 
made  at  hie  first  visit.  After  getting  his  hearing  by  elowly  bring- 
ing the  watch  up  to  hia  ear  until  he  heard  it,  I  then  slowly  carried 
it  away  from  his  ear  to  ascertain  if  he  could  hear  it  some  distance 
lartber  away,  hut  be  covM  not  do  bo  with  either  ear,  even  after 
quite  a  number  of  trials.  This,  I  consider,  proves  conclusively 
that  he  is  afflicted  with  complete  otomyasthenia. 

Many  persons  who  could  not  hear  the  watch  at  the  distance  he 
did,  namely  20/96  R.  14/96  L.,  can  bear  the  ordinary  conversation 
of  a  person  standing  alongside  of  them  with  ease  in  a  roomful 
of  laughing  and  talking  people,  for  the  reason  that  their  ear-mus- 
cles select  and  amplify  the  words  of  the  person  they  desire  to  hear. 
This  my  patient  could  not  do,  because  of  the  asthenic  condition  of 
his  ear-muscles. 

In  every  person  with  normal  ears,  and  in  all  who  are  only  par- 
tially otomyasthenic,  the  tick  of  the  watch  may  he  beard  farther 
than  it  is  heard  when  it  is  slowly  brought  up  to  the  ear;  that  is  to 
say,  if  he  hears  it  when  slowly  brought  up  to  the  ear  at  twenty- 
four  inches  (which  occurred  in  a  partially  otomyasthenic  patient), 
the  watch  may  he  slowly  taken  away  from  the  ear,  .and  he  may 
continue  to  hear  it  as  far  as  to  30  or  36  inches,  if  the  ear-muscles 
are  not  wearied  by  too  long  a  test.  It  seems  conclusive  that  the 
increased  hearing  distance  demonstrates  that  his  ear-musctes  ampli- 
fied the  sound  of  the  watch's  tick,  or  he  would  not  have  heard  it 
beyond  the  first  hearing  distance,  twenty-four  inches. 

When  these  ear-muscle  or  muscles  are  in  a  complete  asthenic  con- 
dition, the  will  of  the  listener  has  lost  the  normal  control  over 
them;  but,  says  one,  these  persons  can  hear;  yes,  but  they  are  de- 
prived of  this  extra  acnteoess  of  hearing,  especially  in  a  noisy 
place  where  the  election  of  sounds  tbey  desire  to  hear  most  plainly 
is  denied  them,  which,  with  normal  ears,  all  persons  enjoy.  The 
proof  of  this  is  the  hearing-distance  of  the  watch  cannot  be  in- 
creased even  by  an  inch  beyond  the  first  bearing  distance,  it  makes 
DO  diETerence  bow  frequent  the  trials,  or  how  slowly  the  watch  is 


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22        Thk  Atlanta  Medical,  and  Suboical  Journal. 

removed  from  tbe  ear,  or  how  much  the  listener  exerts  himself  to 
bear  it. 

After  daily  examioatioDS  of  the  heariDg-distaoce  in  this  manner 
during  the  last  five  or  six  years,  with  a  special  view  to  this  subject, 
I  fiud  that  otomyastheuia,  iu  varying  degrees,  is  by  &r  the  most 
frequent  cause  of  deafuess,  showing  tbe  importauce  of  understand- 
ing its  mechanism. 

The  following  is  a  good  method  of  making  a  differential  diagno- 
sis of  this  kind  of  deafness: 

While  in  San  Francisco  this  summer  I  chanced  to  step  into  a 
place  where  ttie  Edison  phonographs  were  on  exhibition.  I  was 
accompanied  by  a  physician  who  was  under  treatment  for  complete 
otomyasthenic  deafness.  Three  of  the  machines  were  so  arranged 
that  the  tubes  led  to  one  person's  ears.  One  machine  played  Old 
Hundred,  another  Yankee  Doodle,  the  third  Annie  Laurie- 
When  my  friend  placed  the  ear-pieces  in  his  ears,  he  heard  a  con- 
fusion of  noises.  Tbe  exhibitor  said,  "Listen  and  you  will  hear 
Annie  Laurie;"  but  he  could  not.  "Well,  can't  you  hear  Yankee 
Doodle?"  He  could  not.  "  Old  Hundred  is  there  too."  "  Xo, 
sir,  nothing  but  a  confusion  of  noises  that  would  drive  one  crazy 
if  he  listened  to  it  very  long."  He  could  not  hear  any  two  tunes 
together,  but  instantly  called  out  each  of  the  three  tunes  as  they 
were  played  singly.  I  then  listened  to  the  three  machines,  but 
could  barely  hear  Yankee  Doodle;  when  he  stopped  this  machine  I 
then  heard  Annie  Laurie  very  well,  when  this  machine  stopped  I 
heard  Old  Hundred,  of  course,  proving  plainly  that  I  also  was 
affected  with  otumyasthenia  to  a  considerable  degree,  I  took  the 
ear-piece  out  of  my  right  ear,  and  easily  selected  each  tune  with 
my  left  ear  while  all  three  machines  were  playing.  I  suffered  a 
serious  injury  of  my  right  ear  in  1869,  which  rendered  me  quite 
deaf  in  this  ear.     This  accounted  for  my  disability. 

Incidentally,  I  will  say  that  the  subjective  symptoms  of  otomy- 
asthenic deafness  prove  that  my  views  concerning  the  functions  of 
the  middle  ear-muscles  are  correct,  namely:  that  their  ofBce  is  to 
select  and  amplify  snob  sounds  as  tbe  listener  desires  to  bear  most 
distinctly,  showing  that  the  ears  have  muscles  of  accommodation 
quite  analogous  to  those  of  the  eyes. 


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SOME  REMARKS  ON  FISTULA  IN  ANO. 

Bv  WILLIAM  S.  GOLDSMITH,  M.D., 
Lectarer  od  Genito-nrinary  aud  Rectal  Diseases,  Atlanta  Medical  College- 

Id  a  paper  entitled  "Fistula  in  Ano,"  read  before  the  State 
Society  last  April,  I  endeavored  to  briefly  point  out  what  I  con- 
oidered  the  principles  of  treatment  of  this  affection.  Since  that 
time  I  have  bad  under  observation  a  case  which  presented  certain 
conditions  that  cannot  fail  to  be  of  interest,  as  it  involves  a  qnes- 
tion  of  some  surgical  importance.  But,  before  further  reference  ie 
made  to  this  case,  I  desire  to  comment  on  the  various  divisions 
and  nomenclature  employed  by  authors  of  text-books  on  rectal 
diseases,  and,  indeed,  all  contributors  on  this  subject  in  text-books 
OD  general  surgery.  These  divisions  are  misleading  to  a  medical 
Ktudeot,  and  no  doubt  also  to  the  practitioner  of  medicine. 

I  have,  in  my  humble  capacity  as  a  teacher,  explained  to  students 
the  erroneous  varieties  of  so-called  fistula  in  ano.  A  fistula,  or  as 
the  text-books  describe,  a  complete  fistula,  and  a  sinns,  are  used 
synonymously,  the  difference  being  expressed  by  a  qualifying 
adjective,  A  good  definition  of  the  two  terms  is  found  in  Park's 
Surgery,  Vol.  1,  which  is-as  follows:  "These  are  terms  applied 
to  more  or  less  tubular  channels  abnormally  connecting  various 
parts  of  the  body,  or  connecting  some  cavity   with  the  surface  of 

the  body  in  a  way  anatomically  quite  abnormal A 

more  exact  distinction  between  the  two  terms  would  imply  that  a 
sinns  connects  the  surface  with  some  deeper  portion  where  a  cavity 
is  not  normally  present,  i.  e.,  with  a  focus  of  disease;  whereas  a 
fistula  properly  refers  to  a  tubular  passage  connecting  natural  or 
pre-existing  cavities  in  an  abnormal  manner." 

There  is  no  mistaking  such  a  lucid  description,  yet  we  have 
complet«,  blind  internal,  blind  external,  and  horseshoe  fistulas. 
Blind  internal  fistulas  are  a  rare  occurrence,  or  rather  it  is  a  condition 
not  usually  suspected  until  other  grave  complications  arise.  The 
so-called   blind  external  fistulas  are  quite  frequently  seen,  and  the 


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24       The  Atlanta  Medical  and  Sdbqical  Journal. 

horseshoe  variety,  absurdly  named,  ie  usually  a  complicatioa  of  a 
fistula  and  numerous  sinuses.  I  hold  that  there  is  but  ooe  variety 
of  fistula  in  ano,  and  that  is  the  complete.  This  latter  is  well 
named,  for  to  be  a  fistula  it  must  be,  of  course,  complete.  Any- 
thing short  of  that  condition  would  necessarily  define  it  as  a 
sinus. 

Blind  external  fistulas  (for  the  moment  retaining  the  name)  are 
the  result  of  an  abscess,  either  superficial  or  ischio-rectal.  As  the 
name  implies  it  has  do  connection  with  the  rectum,  therefore  it 
cannot  be  a  fistula,  but  is  a  sinus.  This  leads  me  to  the  case  in  mind. 
In  December,  1896,  the  gentleman  affected  had  an  ischio-rectal 
abscess,  which  pointed  about  two  inches  from  the  anus.  After 
poulticing  the  part  for  a  day  or  two,  the  attending  physic! an  opened 
the  abscess,  evacuating  a  quantity  of  pus,  and  found  that  there  was 
a  cavity  which  extended  toward  the  rectum  and  out  into  the  buttock. 
This  cavity  was  at  once  cleansed  with  peroxide  of  hydrogen, 
and  irrigated  daily  with  a  bichloride  of  mercury  solution.  The 
wound  was  drained  by  means  of  a  gauze  tent,  and  fora  while  there 
was  some  evidence  of  repair.  I  was  called  in  consultation  the  latter 
part  of  March  and  concurred  in  the  opinion  that  an  operation, 
under  ether,  was  necessary.  This  was  done,  and  the  entire  lining 
membrane  was  curetted  and  dissected  out,  supplemented  by  the  free 
use  of  the  peroxide  of  hydrogen  spray.  Careful  search  &iled  to 
reveal  the  least  indication  of  a  tract  runniDg  up  alongside  the 
rectum,  other  than  the  superior  l}ouodary  of  the  abscess  cavity, 
which  had,  in  its  ramifications,  destroyed  tissue  along  the  rectal  wall 
for  perhaps  an  inch  and  one-half  The  wound  healed  kindly,  and 
led  us  to  believe  that  a  certain  cure  would  result.  A  month  after 
the  operation  I  discovered  a  suspicious  exudation  of  pus,  and  the 
probe  confirmed  my  fears.  A  tract  an  inch  and  one-half  in  depth 
was  found,  following  the  iuner  boundary  of  the  old  abscess  cavity, 
and  pointing  near  the  rectum.  All  efforts  to  heal  this  sinus  proved 
futile.  I  advised  another  operation,  which  was  deferred  from  time 
to  time  until  the  first  of  October. 

Upon  again  opening  this  tract  I  found  that,  owing  to  it«  tortuous 
course,  only  one-half  of  its  depth  was  accessible  to  the  probe,  and 
that  it  ran  up  the  rectal  wall  for  three  inches.     I  searched  for  an 


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Some  Eehakks  on  Fistcla.  is  Ano.  26 

internal  opening  and  was  not  disappointed  at  my  failure  to  find 
one.  This  circumstaDce  does  not,  of  course,  deter  us  from  con- 
vertiDg  a  sinuB  into  a  fistula  as  the  preliminary  technique  in  per- 
forming the  radical  operation.  I  then  incised  the  gut  with  all 
intervening  tissue,  including  the  sphincters.  The  last  operation 
resulted  in  complete  cure.  This  is  the  poiat  I  wish  to  make,  are 
we  justified  in  cutting  the  gut  and  the  sphincter  muscles,  incurring 
the  risk  of  imperfect  union,  in  abscesses,  where  the  cavity  extends 
to  the  rectal  wall  and  above  the  sphincters?  In  this  case  I  did  not 
feel  at  that  time,  that  I  should  undertake  such  a  procedure,  but  I 
have  made  up  my  mind  that  should  a  similar  case  come  to  me,  I 
would  have  no  hesitation  in  doing  the  radical  operation,'  that  is 
making  a  complete  section  of  all  intervening  structures. 

In  deep  rectal  abscesses  I  think  it  is  our  duty  to  inform  the 
patient  of  the  likelihood  of  a  subsequent  fistula,  and  advii^e  the 
administration  of  an  anesthetic  for  the  apparently  simple  operation 
of  opening  the  abscess.  When  this  is  done  we  are  free  to  act  as 
our  judgment  dictates,  and  have  abundant  opportunity  of  laying 
open  the  entire  circumscribed  area,  together  with  the  almost  abso- 
lute certainty  of  successfully  removing  all  morbid  tissues.  All  ab- 
scesses are  painful,  and  as  we  all  know,  every  patient  having  a 
rectal  ailment,  looks  upon  the  invasion  of  that  particular  territory, 
with  much  trepidation.  To  attempt  the  thorough  opening  of  a 
rectal  abscess  without  an  anesthetic  is  most  unsatisfactory,  and,  at 
best,  the  assistance  of  cocain,  is  often  immaterial,  as  nothing  more 
than  the  mere  skin  incision  is  permitted.  I  am  extremely 
cautions  in  the  use  of  cocain  about  the  rectum,  and  very  seldom 
resort  to  it 

If,  after  the  eradication  of  the  lining  membrane,  an  angle  of  the 
wound  in  directed  to  the  gut,  say  above  the  internal  sphincter, 
should  we  proceed  to  make  an  opening  and  incise  all  the  tissues? 
On  one  hand  we  have  the  local  and  constitutional  evidence  of  a 
violeot  inflammation,  and  on  the  other,  the  fact  of  our  patient 
already  nnder  the  influence  of  the  anesthetic,  and  also  the  improb- 
ability of  a  successful  issue,  owing,  among  other  things,  to  the 
peculiar  anatomical  construction  of  the  parts. 

My  convictions  are  that  under  these  circumstances  we  could  con- 


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26       The  Atulkta  Medical  and  Sdbgical  Joubnal. 

scieDtiouely  iocise  the  gut,  and  proceed  with  the  treatment,  indicated 
for  a  true  fietuk  in  ano.  In  closing,  permit  me  to  make  slight 
refereDce  to  the  most  pronounced  local  idiosyncrasy  to  iodoform  I 
have  ever  seen.  This  occurred  in  this  case.  I  seldom  use  iodoform 
gauze,  and  more  rarely  the  powder,  as  a  surgical  dressing,  except 
in  rectal  work,  and  aa  a  medium  of  drainage.  In  this  case,  as  is 
my  custom,  I  packed  the  wound  tightly  for  the  first  forty-eight 
hours  with  iodoform  gauze.  I  pack  these  wounds  tightly  to  stop 
what  is  sometimes  a  profuse  oozing,  and  leave  this  dressing  in 
place  for  two  days  on  account  of  the  fact  that  to  remove  it  in  a 
shorter  time  subjects  the  patient  to  much  pain  and  a  recurrence 
of  the  oozing.  When  I  dressed  the  wound  two  days  after  the 
o|>eration  I  found  that  wherever  the  iodoform  gauze  pad  touched 
the  skin,  and  even  in  a  much  larger  area  exposed  to  the  drainage 
and  blood-stains,  a  most  violent  dermatitis  was  excited.  The  irrita- 
tion was  so  intense  that  nothing  short  of  liberal  hypodermics  of 
morphine  afforded  relief.  This  experience  should  have  been  sufficient 
warning,  but  about  two  weeks  later  I  inserted  a  pledget  of  iodo- 
form gauze,  the  size  of  a  lead  pencil  and  two  inches  in  length,  into 
the  tract,  for  the  double  purpose  of  drainage  and  of  mitigating  the 
unpleasant  odor  of  the  discharge.  I  was  called  io  the  middle  of 
the  night  to  give  my  patient  some  relief  from  the  most  torturing 
irritation  and  pruritus,  the  result  of  my  indiscretion.  I  was  told 
that  the  idiosyncrasy  began  to  assert  its  peculiarity  within  an  hour, 
but  the  observance  of  my  directions  prevented  any  action  until  all 
patience  and  forbearance  was  exhausted.  I  at  once  resumed  the  use 
of  sterilized  gauze,  which  answered  my  purpose  in  a  thoroughly 
satisfactory  manner.  Bichloride  gauze  was  also  used  sparingly, 
but  having  seen  skin  irritation  arise  from  its  use,  I  abandoned  this 
dressing  also. 

S7-SS  Grant  Building. 


When  you  advise  a  patient  to  wear  a  suspensory  bandage,  tell 
him  to  get  the  kind  which  has  straps  running  from  the  posterior 
band  of  the  bag  itself,  around  the  legs  or  buttocks.  The  suspen- 
sories which  are  attached  to  the  belt  in  front  alone,  with  an  elastic 
in  the  back  edge  of  the  bag,  are  useless. — International  Journal  of 


:dbv  Google 


SOCIETY  REPORTS. 


THE  QUARANTINE  CONVENTION  OF  THE  SOUTH 
ATLANTIC  AND  GULF  STATES,  AT  MOBILE,  ALA.* 

The  coDveotioD  met  Wednesday,  February  9th,  at  10.40  a.m., 
and,  after  the  usual  formalities  of  opening,  Governor  Johnston, 
of  Alabama,  was  chosen  temporary  chairman.  The  convention 
by  vote  proceeded  to  change  the  program,  taking  up  first  the  ques- 
tions of  State  and  National  Quarantine.  Hon.  Hannis  Taylor 
then  read  a  paper  on  "Quarantine  with  Reference  to  International 
Righto  and  Interests."  The  sources  whence  we  receive  yellow 
fever  infection  are  from  Brazilian,  West  Indian,  and  Peruvian 
ports ;  mostly  from  Havana  and  Rio  de  Janeiro.  The  great  diRi- 
culty  al  once  encountered  is  that  international  law  is  defective, 
each  nation's  system  being  difTerent  and  not  to  be  interfered  with 
by  outsiders.  Only  by  interaational  courtesy  can  a  common  action 
and  remedy  be  provided.  A  Quarantine  Union,  like  that  of  the 
Postal  Union,  is  necessary,  and  an  agreement  upon  a  uniform  sys- 
tem of  rules. 

Hon.  Edward  Farrar  read  a  paper  upon  "  Federal  and  State 
Powers  as  to  Quarantine,"  which  proved  to  be  a  vigorous  argu- 
ment for  the  States'  rights  party.  Quarantine  laws,  he  said,  are 
health  laws  and  belong  to  the  police  power,  which  has  never  been 
taken  from  the  State,  and  in  which  rests  the  protection  of  the 
health,  life,  well-being,  and  prosperity  of  the  people.  He  held 
that  if  the  State  did  not  pass  laws  to  prohibit  nuisances,  the  spread 
of  disinfection,  the  punishment  of  incendiarism,  murder,  assaults, 
etc..  Congress  cannot  pass  such  laws.  He  cited  a  number  of  au- 
thorities to  show  that  the  police  powers  of  the  State  had  never  been 
delegated  to  the  general  government.  He  held  that  as  quarantine 
laws  had  been  classed  as  part  of  the  police  powers  of  the  State, 
and  that  such  police  power  had  never  been  delegated  to  the  Con- 

•Condeiued  from  Kepoct  in  PhOaildplita  Medital  Journal. 


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28       The  Atlanta  Medical  and  Surqical  Jodbnal. 

gress,  therefore  there  was  do  power,  implied  or  expressed,  in 
Congress  to  pass  quaraatine  laws.  If  quarantine  laws  control  com- 
merce between  States  and  nations,  Congress  can  deal  with  them ; 
but  if  they  simply  affect  commerce,  than  the  Congress  has  nothing 
to  do  with  them,  especially  if  they  are  bona  fide  health  laws;  I  do 
not  mean  shotgun  quarantine,  nor  those  which  prevent  a  train  from 
passing  from  one  locality  through  another.  I  believe  that  the 
enactment  of  quarantine  laws  is  therefore  reserved  to  the  States. 

Hon.  R.  H.  Clarke,  in  the  discussion,  said :  This  is  a  convention 
gathered  for  suggesting  the  best  means  of  keeping  yellow  fever  out 
of  this  country.  No  sooner  does  an  epidemic  of  yellow  fever 
break  out  than  we  begin  to  call  on  the  government  for  aid.  We 
want  money,  camps,  rations,  and  other  things,  but  still  we  say  to 
it  "hands  off."  Such  a  state  of  things  can  scarcely  exist.  There 
are  two  divisions  of  quarantine.  One  is  a  boundary  quarantine, 
and  the  question  is,  has  the  general  government  the  right  to  say  to 
a  vessel  that  it  shall  not  enter  any  port  or  proceed  up  any  river  or 
harbor.  The  government  has  the  power  to  turn  back  from  any 
harbor  of  this  country  men  and  merchandise.  He  argued  that  the 
general  government  had  the  power  to  do  these  things. 

Dr.  S.  A.  Robinson,  of  New  York,  thought  that  quarantine,  or 
disease-limiting  and  preventing  authority,  must  be  uniform  in  order 
to  be  most  effective.  Not  uniform  in  methods,  for  conditions  vary 
and  methods  must  meet  conditions,  but  uniform  in  spirit  and 
power.  The  idea  that  forty-five  systems  of  quarantine  (one  for 
each  State)  could  best  protect  the  people  of  the  United  States  seems 
pre|iosterous.  To  thoroughly  protect  our  entire  population,  such 
authority  and  regulations  must  be  national.  In  proof  of  this  he 
read  an  opinion  of  W.  B.  Hornblower,  of  New  York,  in  answer 
to  a  request  of  the  New  York  Board  of  Trade  and  fTransportation, 
the  summary  of  which  is  as  follows: 

"Conceding  the  right  of  the  government  to  interfere  with  the 
liberty  of  the  citizen  and  with  his  rights  of  property,  so  far  as  may 
be  necessary  for  the  protection  of  the  public  health,  the  only  ques- 
tion is,  whether  it  is  more  expedient  that  this  right  should  be 
exercised  by  the  local  government  or  by  the  State  government  than 
by  the  general  government?     It  seems  to  me  that  a  uniform  sys- 


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Society  Repobts.  29 

tern  adniiDietered  by  Datiooal  ofBcere  is  the  only  safe  and  ratioaal 
method  of  administeriDg  this  braocb  of  government.  Of  course, 
the  tremendous  powers  imposed  upon  quarantine  officers  are  open 
to  abase,  but  such  abuse  by  national  officers  would  have  a  wider 
publicity  and  be  subject  to  more  direct  remedial  legislation  than 
would  the  petty  tyranny  of  the  local  officers,  especially  where  the 
sufferers  from  such  tyranny  woald  usually  be  non-residents  of  the 
locality  where  the  officers  exercised  their  authority.  As  quaran- 
tine is,  of  necessity,  an  interference  with  commerce,  it  seems  to  me 
that  it  is  peculiarly  a  matter  within  tbe  province  of  Federal  legis- 
lation." 

Mr.  John  B.  Enox  of  Anniston,  also  made  a  telling  speech 
•gainst  the  States'  rights  doctrine,  and  quoted  two  cases  decided  by 
the  Supreme  Court  of  the  United  States,  proving  the  constitution- 
ality of  Federal  control. 

Hon.  P.  W.  Meldrim  of  Savannah,  Ga.,  then  read  a  paper  on 
"Quarantine  and  Commerce  from  a  Legal  Standpoint."  He  said 
the  question  could  be  divided  into  two  heads.  Has  Congress  the 
power  to  pass  an  exclusive  quarantine  law,  and,  if  so,  would  the 
passage  of  such  a  law  he  proper?  He  traced  the  history  of  quar- 
antine from  the  time  of  the  fourteenth  century,  when  Venice  quar- 
antined against  the  plague,  down  to  the  present  lime,  speaking  of 
the  enactments  of  the  Colonial  Congress.  He  admitted  that  every 
quarantine  regulation  is  a  restriction  upon  commerce;  but  even  that 
restriction  has  been  a  protection  to  the  lives  of  the  people.  He 
declared  that  quarantine  is  based  on  the  law  of  nature.  He  cited 
the  possibility  of  State  and  Federal  statutes  on  the  subject  of  quar- 
antiue-^two  laws  on  the  same  subject,  so  that  the  question  to  be 
decided  is,  which  law  shall  yield.  If  Congress  legislates  on  this 
subject,  then  the  State  law  is  abrogated.  The  public  health  comes 
within  the  strict  meaning  of  the  police  power,  and  in  this  the  State 
is  sovereign.  He  deprecated  the  drift  toward  centralization  and 
paternalism. 

The  second  day's  session  began  at  9:30  a.m.,  with  a  paper  on 
"  Quarantine  as  it  Affects  Personal  Bights,"  by  Professor  G.  D. 
Sh&odfl,  of  the  Law  Department  of  the  University  of  Mississippi. 
He  cited  opinions  that  quarantine  laws  were  constitutional  when 


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so       The  Atiaiita  Medical  akd  Sdboical  Jodbnal. 

the  necessity  for  the  enforcement  of  the  provisions  abridging  per- 
sonal rights  was  apparent  and  necessary  to  protect  the  public  health 
and  property.  One  of  these  opinions  was  by  the  Supreme  Court 
of  New  York,  in  effect  that  before  a  person's  liberty  could  be  in- 
fringed that  person  must  either  be  infected  or  have  been  exposed 
to  infection.  Another  opinion  was  that  in  all  doubtful  cases  the 
decision  of  the  court  shoufd  loan  toward  the  police  power.  He 
held  the  act  must  be  convenient  and  appropriate  to  promote  the 
public  health,  theu  the  law  will  be  upheld  by  the  courts. 

In  the  discussion,  Hon.  E.  G,  Bromberg  of  Mobile,  said  the 
remedy  for  all  the  mischievous  features  of  our  quarantine  is  to  be 
found  in  the  education  of  the  people.  Ultimately  the  United 
States  Supreme  Court  will  have  to  pass  upon  any  rule  touching  the 
commerce  laws,  and  so  the  State  Supreme  Courts  will  have  to  pass 
upon  the  local  laws.  We  need  a  department  of  health,  with  its 
great  laboratories,  to  disseminate  information  relative  to  disease, 
just  as  the  Department  of  Agriculture  disseminates  information  as 
to  the  raising  of  crops. 

Dr.  W.  H.  Sanders,  State  Health  Officer  of  Alabama,  read  a  paper 
on  "National,  State,  and  Local  Quarantines — How  Best  to  Adjust 
their  Differences."  He  said  there  are  three  monarchs  in  this  coun- 
try— the  citizen  in  his  inalienable  rights  ou  bis  own  domain;  the 
State  in  its  reserved  rights,  and  the  nation  in  its  granted  rights. 
He  urged  that  there  must  be  harmony  between  the  local,  State  and 
national  quarantine  laws,  so  that  they  might  be  enforced  with  the 
least  friction.  Make  the  State  supreme  in  her  own  borders,  and 
the  problem  is  lai^ely  solved.  The  function  of  the  general  gov- 
ernment is  to  aid  and  cooperate  with  the  State  authorities.  He 
said  the  system  of  quarantine  he  seeks  to  establish  contemplates  a 
national  bureau  of  public  health,  in  which  all  the  States  would 
have  a  voice,  and  all  the  States  having  equal  rights  in  making  the 
rules  and  regulations. 

The  plan  contemplates  in  each  county  a  health  officer,  backed  by 
a  board  of  health.  He  would  have  the  health  officer  one  in  fact, 
trained  for  his  work,  and  have  him  study  the  topography  of  his 
county,  the  railroads  and  county  roads  through  it,  and  the  manner 
of  travel  and  character  of  commerce,  and  would  have  him  study 


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Society  Repobts.  31 

the  health  laws.  He  would  have  a  State  health  officer  of  the  uame 
sort,  and  would  expect  him  to  &miliarize  himself  with  the  rail- 
road statioDfl  ID  the  State  ;  have  him  know  one  or  two  prominent 
men  at  each  station,  so  he  could  call  them  to  bis  aid  by  telegraph. 
Suppose  we  had  a  quarantinable  disease  under  such  conditions, 
within  an  hour  there  could  be  a  cordon  of  health  officers  around 
the  place  where  that  case  was  found.  He  would  have  all  public 
roads  guarded,  and  all  trains  stopped  at  the  State  line  till  they 
could  be  inspected,  and  would  have  an  officer  on  the  trains  to  in- 
spect them.  Thus  there  would  be  a  cordon  on  the  borders  of  the 
State,  and  people  inside  that  cordon  could  transact  their  business 
without disturbauce  by  quarantine  officers.  He  would  forbid  inter- 
ference with  trains  by  local  authorities  and  lodge  this  power  io  the 
State.  He  would  concede  to  local  authorities  to  decline  to  receive 
freight  which  they  feared  would  infect  their  towns,  but  beyond  this 
they  should  not  be  allowed  to  go. 

He  had  heard  many  proclaim  they  favored  national  quarantine, 
when  three  questions  would  put  them  on  the  other  side.  "  If  those 
who  urge  national  quarantine  mean  that  all  State  lines  are  to  be 
obliterated,  and  the  country  become  as  one  great  country,  with  a 
horde  of  quarantine  officers  receiving  their  power  from  a  central 
head  far  removed  from  the  seat  of  action,  I  say,  God  forbid.  ^  It 
is  unnecessary  for  me  to  say  that  we  would  find  ourselves  overrun 
with  an  ignorant,  insolent  class,  that  would  lead  to  bloodshed  and 
disorder." 

Dr.  F.  C.  Zacharie  read  a  paper  upon  the  same  subject,  advising 
that  Congress  declare  what  is  a  reasonable  quarantine,  what  a  rea- 
sonable detention,  what  goods  shall  be  disinfected,  and  then  pre- 
scribe a  penalty.  Let  the  State  pass  general  laws  for  the  regula- 
tion of  their  State  quarantine.  He  believed  such  statutes  could  be 
carried  out. 

At  the  night  session  Br.  Wingate  of  Milwaukee,  read  a  paper  on 
"A  ^National  Bureau  of  Public  Health."  He  said  that  as  &r  as 
a  cabinet  officer  of  health  is  concerned,  he  is  satisfied  that  is  out  of 
order;  but  the  national  bureau  can  he  established  without  such  a 
cabioet  officer.  He  opposed  the  enlargement  of  the  powers  of  the 
Marine  Hospital  Service  in  order  to  cover  a  national  health  bureau. 


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32       The  Atlanta  Medical  akd  Sdbqioal  Joubkal. 

The  time  is  coming  when  quarantine  will  be  a  relic  of  barbarism. 
He  referred  to  a  bill  od  the  subject,  and  said  it  would  give  a  □&- 
tional  bureau  of  health  other  powers  than  those  pertaining  to  quar- 
antine. He  believed  the  States  should  maaage  their  own  quaran- 
tines, and  the  general  government  should  assist,  and  laws  should 
be  adopted  so  that  both  would  move  smoothly. 

Dr.  C.  M.  Drake  of  Atlanta,  then  read  a  paper  on  "  National 
Quarantine."  He  expressed  his  surprise  at  the  references  he  had 
heard  against  the  Federal  government  on  the  floor  of  the  conven- 
tion. He  said  that  if  the  recent  epidemic  proved  anylhiag,  it 
proved  that  the  State  and  local  boards  of  health  were  unable  to 
prevent  the  spread  of  the  infection.  Their  methods  were  absurd, 
and  often  barbarous;  one  State  quarantined  against  another  State, 
and  one  city  against  another,  without  reason,  and  still  the  fever 
spread.  Bridges  were  burned,  mails  were  stopped,  commerce  was 
paralyzed.  He  spoke  of  Montgomery's  action  relative  to  receiv- 
ing the  mails.  The  people  are  disgusted  with  our  present  quaran- 
tine laws,  and  they  want  a  change.  The  States  along  the  Gulf  and 
Atlantic  coasts  cry  out  for  a  change,  and  that  change  ought  to  be 
known  to  every  thinking  man. 

Dr.  H.  B.  Horlbeck  of  Charleston,  on  the  same  subject,  said 
that  Congress  should  authorize  a  "Quarantine  Council,"  one  mem- 
ber from  each  State,  to  make  all  rules  and  regulations  as  to  inter- 
state quarantine,  that  such  regulation  shall  be  referred  by  the  State 
boards,  and,  in  their  &ilure,  by  the  general  government. 

The  morning  session,  February  11th,  was  taken  up  with  a  dis- 
cussion over  the  majority  report  of  the  Committee  on  Resolutions, 
and  a  substitute  offered  by  Hon.  R.  H.  Clarke  of  Mobile.  The 
final ly-reamended  Clarke  substitute,  after  a  long  discussion,  was 
passed  at  the  afternoon  session;  it  is  as  follows  ; 

Resolved,  That  it  is  the  sense  of  this  convention: 

1.  That  Congress  he  requested  to  provide  for  a  department  of 
health  as  soon  as  practicable. 

2.  That  it  is  the  sense  of  this  convention  that  Congress  should 
enact  laws  to  provide  for  an  efficient  maritime  quarantine,  to  be 
uniform  and  impartial  in  its  application  to  the  different  commercial 
ports  of  this  country,  so  as  to  give  no  one  or  more  of  them  undue 


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Society  Repoetb.  33 

oommercial  advantage  over  the  otbere,  and  to  be  enforced  by  the 
several  State  and  municipal  quarantine  or  health  boarda,  if  they 
will  uuderlake  so  to  do,  leaving  altio  to  the  States  the  power  to 
prescribe  and  enforce  additional  reasonable  Bafeguards  of  the  health 
of  their  communities,  provided  that  such  State  action  shall  not  un- 
reasonably obstnict  commerce. 

3.  That  Congress  should  aid  the  several  States  in  establishing 
and  maintaining  uniform,  reasonable,  and  efficient  quarantine  laws 
for  effecting,  but  not  regulating,  interstate  commerce,  leaving  to 
each  State  adequate  power  to  protect  as  it  shall  deem  beet  the  lives 
aud  health  of  its  people. 

4.  That  Congress  should  leave  exclusively  to  the  States  the  reg- 
ulation of  their  purely  internal  commeree  and  the  provision  of  such 
quarantine  and  sanitary  laws  and  regulations  as  they  may  deem 
advisable  to  that  end. 

5.  That  in  the  framing  of  quarantine  laws  and  regulations  and 
in  tbeir  enforcement  Congress  should  avail  itself  of  the  learning, 
experience  and  ability  of  the  medical  profession  in  the  fullest  meas- 
ure possible,  and  especially  by  way  of  an  advisory  council. 

A  paper  was  then  read  by  Dr.  S.  K.  Olliphant  on  "Sanitary  In- 
spection of  Foreign  Ports,"  and  a  number  of  papers  were  passed  to 
the  secretary  for  publication. 

An  interesting  paper  on  "Depopulating  Cities  Infected  with 
Tellow  Fever,  and  How  Best  to  Accomplish  It,"  was  read  by  Dr. 
Felix  Formento^of  New  Orleans.  The  following  were  the  con- 
clusions : 

1.  General  depopulating  of  towns  and  cities  infected  with  yellow 
fever,  however  desirable,  is  not  practicable. 

2.  Voluntary  exodus  of  individuals  and  families  is  to  be  en- 
couraged at  the  first  breaking  out  of  the  disease. 

3.  During  an  epidemic,  depopulating  should  be  carried  out  under 
special  sanitary  precautions. 

4.  Depopulating  of  houses  in  which  first  cases  occur,  by  removal 
of  the  sick  to  properly  constructed  hospitals,  and  of  the  well  to 
special  campu  of  observation,  and  thorough  disinfection  of  houses, 
we  consider  the  most  efficient  measure  for  the  stamping  out  of  the 
disease  at  its  birth. 


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34        The  Atlanta  AIbdical  Aim  Sobqical  Jourkau 

5.  Isolation  of  the  sick  and  destruction  or  disinfection  of  dis- 
charj^  Trom  bowels,  and  of  all  contaminated  material,  with  disio- 
fectioD  of  the  premises,  are  the  best  means  of  limiting  the  disease. 

6.  All  measures  of  repression  of  an  arbitrary  character  are  to  be 
applied  to  a  limited  number  of  cases  only.  If  they  fail,  they 
should  be  discontinued,  as  they  are  an  additional  burden  to  the  suf- 
ferings and  hardships  of  the  people. 


Hypodermoclysis. 


The  subjectof  subcutaneous  injection  of  salt  solution  is  discussed 
by  Dr.  George  S.  Brown,  of  Birmingham,  Ala.,  in  a  Iat«  issue  of 
the  New  York  Medical  Journal.  Alter  detailing  a  number  of 
surgical  cases,  in  which  the  treatment  apparently  saved  life,  he  says: 
"I  feel  confident  that  from  time  to  time  in  the  near  future  wesball 
have  encouraging  reports  of  the  use  of  bypodermoolysis  in  the 
treatment  of  many  diseases  in  which  it  has  not  as  yet  been  used. 
It  undoubtedly  increases  the  number  and  activity  of  the  leucocytes. 
By  increasing  the  arterial  pressure  it  also  increases  the  action  of 
the  skin  and  kidneys.  Increased  leuoocytosis  and  increased  elimina- 
tion are  the  conditions  most  to  be  desired  in  combating  toxemias. 
Keasoaing  from  the  ground  of  its  diluent  and  elimiaative  effects, 
faypodermoclysis  ought  to  give  good  results  in  the  treatment  of  cases 
of  typhoid  fever.  In  those  cases  in  which  the  active  symptoms  of 
the  disease  have  disappeared  and  the  patient  is  left  in  a  prostrated 
condition,  with  a  slight  daily  fever  which  be  seems  unable  to  throw 
off,  it  ought  to  be  of  the  greatest  value  by  its  diluent  and  eliminating 
action.  Indeed  all  through  the  active  stage  of  the  disease  it  might 
be  of  benefit  as  a  stimulant.  By  its  diluent  and  eliminative  action 
it  might  be  of  value  in  the  treatment  of  acute  rheumatism,  and, 
indeed,  in  all  that  class  of  toxemias  which  react  so  violently  on  the 
nervous  system — e.  g.,  in  the  late  stages  of  severe  cases  of  diphtheria 
and  scarlet  fever  it  might  save  life,  as  it  has  done  in  so  maay  sur- 
rioal  conditions,  septicemia,  shook,  excessive  hemorrhage,  etc. — 
Ameriean  Journal  i^  Mtdidne  and  Surgery. 


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CORRBSPONDBNCB. 


COMPENSATION  FOR  SERVICES. 

Gbeensbodo,  Ga.,  February  3,  1898. 
Editora  Atlanta  Medieal  and  Sta-gical  Journal  .- 

One  of  the  vital  questions  which  come  up  for  consideration  hy 
Ibe  doctor  in  the  rounds  of  his  every-daj  work  is  how  he  shall  be 
compensated  for  his  work.  It  has  always  been  my  custom  to  try 
and  educate  my  patrons  in  the  duty  of  paying  for  service  rendered ; 
but  in  spite  of  all  that  can  be  done,  there  is  a  lai^  class  of  people 
who  never  pay  for  medical  service.  They  change  yearly  from 
one  doctor  to  another  and  in  this  way  avoid  paying  any  one. 

The  business  of  this  country  is  larely  run  on  credit,  with  a 
mortgage  on  land,  stock,  crops,  household  goods,  any  and  every- 
thing tbat  can  possibly  be  mortg^ed;  so  when  the  doctor  is  called  in 
to  attend  them  in  sickness,  he  finds  his  patient  has  a  mortgage 
covering  everything  from  which  he  could  possibly  hope  to  derive 
any  money.  Of  course,  in  a  large  number  of  cases  the  doctor  has 
no  time  to  writeand  have  executed,  properly,  a  mortgage  or  bill  of 
Bale.  Now,  when  the  end  of  the  year  comes,  the  doctor  is  told  that 
the  merchant  and  banker  holds  a  claim  on  all  of  their  earthly 
posseeeions,  and  be  will  have  to  patiently  bide  his  time,  and  in  the 
wind  np  he  will  pay  his  "  doctor's  bill."  In  other  words  he  will 
pay  him  out  of  the  "  tail  end  of  bis  crop."  So  often,  oh !  much  too 
often  the  crop  has  no  "tail  end,"  and  the  hard-worked  doctor,  who 
bas  tenderly,  skillfully  and  attentively  looked  after  him  daring  his 
sickness,  has  to  go  unpaid,  and  his  dear  patient  and  deserving 
little  wife  without  the  comforts  and  sometimes  the  necessities  of 
life. 

Let  me  illustrate :  John  Brown  works  on  the  farm  of  Mr.  C, 
who  is  both  merchant  and  &rmer.  He  has  rented  land  to  John 
for  so  much  cotton,  and  agrees  to  furnish  him  with  the  things 
needfol  to  live  while  he  is  making  bis  oropi  for  which  he  secures 


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36       The  Atlanta  Medical  akd  tiuBOK-Ai.  ■Ioi^kxai.. 

himself  by  mortgage  on  all  of  John's  eSecia  and  his  growing  cTOyi. 
la  May  John  is  taken  sick  with  a  fever,  the  doctor,  knowing  John 
to  be  an  honest,  but  poor  man,  attends  bims,  farDisbes  medicine, 
atteadanoe  and  all  the  professional  service  to  restore  him  back  to 
health.  When  the  fall-time  cornea  and  the  doctor  presents  his  bill, 
he  is  told  that  it  took  all  of  bis  crop  to  pay  Mr.  Cs  mortgage, 
and  there  is  nothing  out  of  which  to  pay  the  doctor.  This  is  no 
imaginary  picture,  but  one  of  too  frequent  occurrence,  as  any 
country  doctor  well  knows. 

Now  what  is  the  remedy  for  all  this  ?  The  merchant,  the  banker, 
the  carpenter,  the  landlord,  all  classes  of  men  are  protected  by  law 
except  our  own  profession,  and  I  think  it  high  time  that  we  Georgia 
doctors  go  before  our  legislature  and  ask  that  we,  too,  be  protected. 
Give  go  us  a  law  creating  a  primary  lien  on  what  a  man  bas  for  a 
stated  amount — say  fifteen  dollars  for  every  case  of  sickness  attended. 
Of  course  I  do  not  mean  that  this  amount  in  full  shall  be  charged 
in  every  case,  but  we  are  to  be  paid  according  to  our  bill  this 
amount  ((16.00)  before  any  other  claim  can  be  satisfied.  By  this 
law,  if  our  bill  was  five  or  ten  dollars,  we  would  be  safe;  if  it  was 
twenty  or  twenty-five  dollars,  we  would  be  safe  for  fifteen  dollars. 
I  hope  my  meaning  is  clear,  and  as  this  is  the  year  when  our  legis- 
lature is  to  be  elected,  let  every  doctor  in  this  State  demand  a 
pledge  of  candidates  to  vote  for  some  bill  which  will  relieve  the 
financially  oppressed  doctor.  W.  E.  A.damb,  M.D. 


PAINLESS  VACCINATION.* 

Faib  Play,  8.  C,  January  28,  1898. 
.  .  .  I  will  give  you  my  experience  with  your  "new  method 
of  vaccinating,"  as  originated  by  you  and  published  in  the  Novem- 
ber issue  of  The  Joubkal.  When  I  first  read  the  report  tbe 
plan  seemed  so  feasible  that  I  determined  to  try  it.  Ab  an  exper- 
iment I  first  tried  it  on  myself  and  little  girl,  using  only  one  side 
of  tbe  point  on  her  arm  and  the  other  on  my  own,  and  I  got  beau- 

II  %  mMhod  of  pdalan  TKOdnktioD 


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COBBESPONDENCE.  37 

tiful  resalts;  and  after  that,  whea  I  could  get  two  or  |roore  to  be 
vaccinated  at  the  same  time,  I  would  only  use  one  side  of  the 
point  to  each  arm,  and  out  of  thirty-six  cases  I  have  only  had 
fiulures  in  two  of  them,  and  I  took  special  pains  tojiook  after 
them  in  order  to  find  out  and  test  its  efficacy.  I  have  seen  the 
other  method  employed,  with  ahout  fifty  per  cent,  of  failures,  so  I 
am  bound  to  think  that  yours  is  the  best  method  yet  used,  for 
several  reasons ;  as  by  the  use  of  the  liq.  pot.  you  only  take  off 
enough  of  the  epidermis,  and  do  not  have  any  bleeding  to  inter- 
fere with  its  taking,  as  yuu  are  liable  to  if  you  should  go  the  least 
bit  too  deep  with  an  instrument,  and  tbea  it  is  practically  pamless, 
which  makes  it  preferable  for  cbildrea,  as  they  naturally  have  a 
horror  of  "  cutting." 

My  little  girl,  three  and  a  half  years  old,  enjoyed  the  proceed- 
ings immensely.  After  dissolving  the  epidermis  as  you  suggest,  I 
rub  it  off  with  a  rubber,  and  just  before  applying  the  virus  I  wash 
the  denuded  surface  off  with  a  wet  rag  or  absorbent  sponge,  to  be 
sure  I  get  all  the  liq.  pot.  off,  and  then  apply  the  virus,  and  with 
the  point  of  the  ivory  I  gently  scratch  over  the  surface  and  leave 
it  to  dry.  Indeed,  the  whole  proceeding  is  so  simple  it  seems 
strange  it  was  never  thought  of  before.  For  my  part  I  thank  you 
for  the  method  which  I  believe  will  be  the  universal  one,  if  it  is 
ever  tried.     It  will  be  with  me.     Yours  fraternally, 

J.  H.  MoOHE,  M.D. 


INFORMATION  WANTED  ABOUT  COCA. 

New  Yohk,  January  17, 1898. 
Atlanta  Mediccd  and  Sargicai  Journal: 

For  some  time  I  have  been  preparing  a  work  on  Coca  which  will 
aim  to  exhaustively  present,  in  an  impartial  manner,  all  that  is 
known  of  this  remarkable  plant  and  its  application. 

The  marvelous  tales,  with  which  we  are  familiar,  of  the  wonder- 
ful sustaining  powers  of  Coca,  would  alone  indicate  some  inherent 
inestimable  value.  But  either  from  prejudice  or  neglect,  possibly 
from  the  greater  interest  directed  to  its  alkaloid.  Coca  has  been 


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38      The  Atlanta  Medical  and  Subqical  Joujikal. 

overlooked  and  baa  not  received  thatatteDtioo  to  which  through  its 
pbysiologicai  importanc«  it  is  eutilled. 

To  supptemeot  data  already  at  hand  for  this  work,  I  addressed 
many  represeotative  physicians,  asking  their  experience  with  Coca. 
While  this  collective  investigation  was  commenced  on  the  supposi- 
tion that  the  remedy  was  little  known  and  leas  understood,  the 
replies  have  impressively  emphasized  this.  They  also  have  gen- 
erally expressed  a  desire  to  more  fully  learn  the  true  properties 
of  Coca. 

I  ask  that  you  will  kindly  further  this  work  by  answering  the 
iDclosed  queries,  and  also  by  calling  the  attention  of  your  readers 
to  this  inquiry  of  common  interest,  with  a  request  to  forward  to 
me  the  result  of  personal  observation  or  experience  in  the  use  of 
Coca,  as  a  therapeutic  agent  or  as  a  food.     Very  sincerely, 

604  W.  146th  Street.  W.  Golden  Moetimee,  M.D. 

[Dr.  Mortimer  will  be  pleased  to  forward  question-blanks  to 
any  one  who  will  aid  him  in  this  investigation. — Eds.] 


The  late  Madame  Boucicault,  of  Paris,  has  left  a  large  portion 
of  her  estate  lor  the  erection  and  maintenance  of  a  hospital  for  the 
treatment  of  persons  affected  with  tuberculosis.  The  buildings, 
with  furniture,  have  cost  about  $650,000,  and  a  sum  of  $1,500,000 
was  left  for  its  maintenance.  The  new  hospital  is  isolated  and  sit- 
uated in  that  part  of  the  city  known  as  Javel,  which  is  on  the 
south  side  of  the  Seine.  The  wards  are  glass-roofed  galleries,  the 
sides  of  which  may  be  entirely  oi>eu.  This  is  for  the  air  treat- 
ment, which  is  a  method  constantly  growing  in  &vor.  The  floor- 
ing is  of  polished  hard  wood,  the  furniture  of  enameled  iron,  and 
there  is  no  drapery  or  curtain  of  any  kind.  The  object  is  to  be 
able  to  disinfect  tbe  entire  apartment  by  means  of  steam  and  hot 
water.  The  matter  of  sterilization  of  all  matter  from  the  patients' 
mouths  and  throats  is  carefully  looked  after.  Incurable  patients 
are  to  be  isolated  in  smaller  rooms  away  from  the  wards. — Medical 
Age. 


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EDITORIAL. 


Ttw  DiSce  ot  The  JomNiL  it  Sll  ud  iH  Flttea  Bulldins. 

AddroB  kll  oommnalo&tlaDs,  and  maka  all  remluaaoea  payable  to  Tbb  Ati.U<ta  Muhoai. 
n  Bmuicjki.  Jouamu  Atlanta,  Oa. 

BepnoU  of  article*  will  be  fumUhed,  wben  dnired,  at  a  small  cost.  Kequeeta  for  tbe 
UDe  (iMNikl  aJwaja  be  made  on  ihe  manuKrlpl. 


THE  MOBILE  QUARANTINE  CONVENTION. 

Id  another  place  will  be  found  a  detailed  report  of  the  prooeed- 
iDgs  of  this  Conveotion. 

Much  good  might  have  come  from  this  QuaraQtiae  OonveDtioa 
had  not  the  politicians  captured  the  meeting  and  turned  it  into  a 
forum  for  airing  "States'  rights"  doctrines  and  completely  over- 
riding all  scientific  discussion  relating  to  quarantine.  The  method 
of  selecting  delegates  was  in  itself  faulty,  and  the  charge  that  the 
Convention  was  "  packed  "  with  members  known  to  be  opposed  to 
national  quarantine  seemed  to  have  ground  when  it  was  found  that 
all  the  leading  essays,  with  a  single  exception,  were  in  the  hands  of 
advocates  of  State  and  municipal  quarantine.  If  this  was  not  con- 
vincing, little  doubt  remained  after  organization  of  the  Convention 
wasefiectcd.  This  was  purclya  "cut  aud  dried'*  aflfeir.  The  permanent 
presidingofBcer  waa^resen/ed  to  the  Convention  and  took  the  chair 
without  the  formality  of  a  vote,  and  proceeded  to  name  commit- 
tees from  a  prepared  iist.  This  at  least  saved  time,  although  Aio 
plan  was  open  to  question.  In  this  way  the  Committee  on  Resolu- 
tions was  formed.  Great  liberality  was  shown  by  the  chairman  in 
KlectJng  members  of  this  committee,  as  he  did  not  confine  himself 
to  the  South  Atlantic  and  Gulf  States  in  gathering  proper  mate- 


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40        The  Atlanta  Medical  ahd  Surgical  Joubkal. 

rial,  but  named  "members  by  invitation"  from  the  States  of  Illi- 
oois,  WisGODBin,  New  York  and  Maryland.  This  committee  pre- 
sented a  majority  report  aa  a  memorial  to  Congress  condemning 
the  CafFery  bill  and  recommending  the  passage  of  the  Spooner  bill. 
The  ink  in  this  report  was  probably  well  dried  before  the  Conven- 
tiofi  met.  The  minority  report,  signed  by  two  members  of  the 
committee,  simply  urged  Congress  to  adopt  a  national  quarantine 
system  without  favoring  in  its  report  any  of  the  several  quarantine 
bills  now  before  our  national  lawmakers.  At  this  juncture  the 
Convention  took  a  recess  for  dinner,  and  during  the  interim  a 
"compromise"  resolution  was  drawn  up,  and  when  the  Convention 
was  called  to  order  this  compromise  resolution  was  presented,  and, 
without  discussion  or  comment,  rushed  through,  the  majority  and 
minority  reports  having  been  withdrawn.  In  an  another  place 
will  be  found  the  "compromise"  or  substitute  resolution  in  full. 

A  careful  study  of  this  resolution  will  reveal  the  fact  that  the 
recommendations  of  the  Convention  are  little,  if  any,  in  advance 
of  present  national  quarantine  laws;  and  few  there  are  who,  having 
had  experience  during  the  late  epidemic  of  yellow  fever  with  local 
quarantine  regulations  and  restriction,  will  accept  with  satisfaction 
the  result  of  the  Convention's  labor.  It  may  therefore  be  fairly 
said  of  the  Mobile  Quarantine  Convention,  that,  boiled  down,  its 
net  result  is  nil.  It  was  as  one  force,  one  argument,  neutralized 
by  another,  with  perhaps  the  balance  of  credit  to  the  side  of  the 
minority. 

A  good  suggestion  came  near  the  close  of  the  Convention,  and 
from  a  gentleman  not  a  delegate,  namely:  To  call  a  convention  of 
b^lth  and  quarantine  officials  of  the  South  Atlantic  and  Gulf 
States  to  meet  in  Atlanta  in  April,  1898;  and  a  resolution  to  this 
effect  was  adopted  and  a  committee  to  arrange  the  details  of  the 
call  was  appointed.  This  Convention  will  deal  with  the  question 
of  uniform   rules  and  regulations  of  quarantine,  and  it  is  hoped 


^dbyGoOgle 


Editoriaih  41 

that  it  will  also  discuss  matters  pertaioing  to  saoitary  affairs  in  its 
broadest  sense.  As  invitations  are  to  be  extended  to  all  Central 
aod  Soutb  American  countries  to  participate  in  the  work  of  the 
CuDvention,  the  proposed  meeting  assumes  international  impor- 
tance, and  it  may  confidently  be  predicted  that  some  improvement 
in  international  quarantine  regulations  will  result. 

Hon.  C.  A.  Collier,  Mayor  of  Atlanta  and  Chairman  of  the 
Committee  on  Calling  the  Convention,  has  named  April  12,  1898, 
as  the  date  of  assembling,  and  has  Issued  invitations  to  that  eSect. 

Atlanta  will  greet  the  Convention  in  its  well-known  hospitable 
way.  c.  M.  D. 


LAW  TO  PREVENT  OPHTHALMIA  NEONATORUM. 

In  an  editorial  recently  the  Journal  of  the  American  Medical  As- 
tociation  calls  attention  to  the  law  which  has  been  passed  in  several 
States  to  compel  midwives  to  report  cases  of  purulent  ophthalmia 
of  in&ncy.  The  necessity  for  such  a  law  was  first  brought  forward 
in  New  York  State  by  Dr.  Lucien  Howe  of  Bufialo,  and  through 
hb  efforts  such  a  law  was  enacted  by  the  State  Assembly.  When 
the  American  Medical  Association  met  in  Milwaukee  in  1893, 
resolutions  were  adopted  by  the  section  of  ophthalmology  approv- 
ing of  legislation  which  would  compel  midwives  to  promptly  re- 
port cases  of  purulent  ophthalmia  of  infancy  to  some  legally  quali- 
fied practitioner.  As  a  result  of  this  movement  there  has  been  an 
active  endeavor  by  ophthalmologists  of  all  sections  to  have  passed 
by  their  States  a  law  looking  to  this  end.  As  a  result  of  this, 
laws  have  been  passed  in  the  following  States:  New  York,  Maine, 
Rhode  Island,  Connecticut,  Minnesota,  Ohio,  Maryland,  Missouri, 
Pennsylvania,  Iowa,  New  Jersey,  Illinois,  and  Michigan. 

As  many  of  our  readers  are  not  familiar  with  the  wording  of  the 


^dbyGoOgle 

J 


42       The  Atulnta  Medical  and  Subqioaij  Joubnal. 

law,  we  Rive  the  one  as  passed  in  Ohio,  which  is  about  the  same  a» 
all. 

^  BILL  rOR  TBI  PBBVmTIOll  or  BLIMDMBSS  IV  TBI  STATa  07  OHIO. 

SiCTIOM  1.  Bb  t(  enacted  by  the  General  ABiembly  of  the  State  of  Ohio,  Thkt 
■hould  one  OT  both  oyel  of  ao  infant  become  inSamed  or  Bwollea  or  show  ttaj  un- 
natural discbarge  at  any  time  witbin  ten  (10)  days  after  its  birtb,  it  tball  be  tbe 
duty  of  tbe  midwife,  nune  or  relative  baviog  charge  of  «ucb  an  infant  to  report 
in  wridng  within  »i  (0)  houn  to  the  phyBiciao  in  attendance  upon  the  family,  or, 
in  the  abience  of  an  attending  phyiician,  to  the  health  officer  of  tbe  city,  village 
or  townibip  in  whicb  the  infant  is  living  at  the  time,  or,  in  case  there  it  no  »uch 
officer,  to  tome  practitioner  of  medicine  legally  qualified  to  pracUce  in  tbe  State 
of  Ohio,  the  fact  that  such  inflammation,  snelliDg,  or  unnatural  discharge  eiista. 

8bc.  2.  Any  lliilure  to  comply  with  the  provisions  of  this  Act  shall  be  punished 
by  a  fine  of  not  less  than  tan  dollars  ($10.00)  nor  more  than  one  hundred  dollars 
(f  100.00),  or  imprisonment  for  not  leas  than  thirty  (80)  days  nor  more  than  six  (6> 
months,  or  both  fine  and  imprisonment. 

The  editorial  referred  to  further  says:  "  We  call  atteutioo  to  this 
law  for  tbe  reason  that  it  should  be  passed  also  hy  the  legislatures 
oi  other  States,  and  we  trust  that  ophthalmologists  who  most  fre- 
queutly  see  these  sad  results  of  ignorauce  and  delay  of  tnidwives^ 
will  take  the  matter  in  hand,  and  also  that  the  medical  journals  in 
States  without  this  provision  will  agitate  the  subject,  so  that  when 
their  legislatures  convene,  some  move  may  be  made  to  extend  still 
further  the  effects  of  this  beneficent  law." 

We  heartily  agree  with  the  editorial  in  commenting  upon  this 
subject.  We  have  but  to  took  in  our  bliod  asylums  to  see  the 
ravages  of  ophthalmia  neonatorum  to  realize  the  gravity  of  the 
disease.  It  is  true  that  we  may  not  have  as  many  ntidwives  in  our 
State  as  are  found  in  the  North,  yet  they  do  exist;  therefore,  the 
law  is  applicable  to  "  those  who  are  present."  It  is  very  difficult 
to  obtain  any  medical  laws  passed  by  the  Georgia  legislature,  espe- 
cially by  such  a  body  of  men  who  declare  that  "any  blacksmith 
can  pull  teeth,"  and  therefore  we  fear  that  it  will  be  some  time  be- 
fore medical  men  can  enlighten  the  understanding  of  these  legisla- 


te! byGoOglc 


EDITOBIAIi.  43 

tors  sufficiently  for  tbem  to  even  understand  for  what  the  law  is  in- 
tended. Tbe  sufferiDg  medical  profession  in  Greorgia  went  through 
It  severe  stru^Ie  in  their  three  years'  fight  to  obtain  a  recognition 
between  physician  and  quaok.  However,  we  shall  not  cease  our 
warfere,  and  will  in  time  urge  upon  the  profession  tbe  necessity 
for  the  enactment  of  such  a  law  as  will  save  the  eyes  o(  many 
who  now  fill  our  asylums  for  the  blind.  r. 


THE  PLEA  OF  INSANITY. 

The  jailer  of  our  county  jail  in  Atlanta  has  recently  made  griev- 
aaces  to  the  effect  that  the  jail  is  becoming  more  of  a  lunatic  asy- 
lum than  a  repository  for  straight-out  criminals.  This  is  a  lament; 
able  fact,  yet  nevertheless  true.  Criminals  are  criminals  before  the 
bar  of  justice,  but  ere  their  trial  is  over  they  are  raving  lunatics. 
Surety  this  age  of  ours  is  the  age  for  the  production  of  insane  per- 
sons. Certainly  would  we  conjecture  that  such  is  tbe  case  should 
we  follow  the  results  obtained  in  our  criminal  courts.  It  is  indeed 
a  sad  condition  of  afi^airs  that  atrocious  criminals  can  cover  their 
heinous  deeds  under  tbe  cloak  of  insanity  and  then  seek  the  repose 
and  comforts  of  a  well-conducted  asylum  !  We  have  no  sympathy 
with  the  justice  which  can  recognize  a  deed  of  murder  and  then 
palliate  it  as  an  act  of  an  insane  moment.  Who  would  not  become 
insane  had  he  shot  a  man  down  in  cold  blood  or  killed  a  defense- 
leas  woman  ?  Tbe  plea  of  insanity  on  the  part  of  the  lawyers  for 
a  criminal  is  becoming  too  threadbare.  If  such  a  condition  of 
iflairs  continues,  justice  will  never  have  a  victim.  It  is  said  that 
the  term  neurastfunia  is  entirely  of  American  coinage,  since  it  is 
supposed  to  represent  a  condition  of  the  nervous  system  common 
only  to  Americans.  It  will  soon  be  said  that  homicidal  insanity  is 
porely  an  American  production,  and  will  be  placed  in  our  diction- 
aries aa  "  an  American  term  representing  that  condition  of  the  ner- 


^dbyGoOgle 


44      Thb  Atlanta  Hediojx  and  Subqioai.  Jouiwal. 

V0U8  system  at  the  time  one  man  kills  another."  The  medical 
proTession  must  stop  this  lameutable  state  of  a&irs  hy  giving  cod- 
scientious  testimony  on  the  witDess-Btand.  We  believe  that  the 
plea  of  insanity  should  not  be  allowed  to  exist  unless  unimpeacha- 
ble testimony  shows  that  the  culprit  was  insane  before  the  murder- 
ous deed  was  committed.  The  very  fact  that  the  man  or  woman 
becomes  insane  when  the  act  is  committed,  or  manifests  insanity 
after  the  deed  is  done,  is  self-evident  that  he  has  enough  conscience 
to  recognize  the  enormity  of  the  crime,  or  knowledge  enough  to 
know  that  he  is  guilty  of  murder  in  the  eyes  of  the  law.  Besides, 
how  do  we  know  but  that  the  asylum  in  which  such  criminals  are 
placed  will  yet  be  the  scene  of  more  murder  enactments?  A  case 
of  this  kind  has  but  recently  occurred  in  our  own  State  asylum  at 
Milledgeville,  B.  H.  Osborne,  a  murderer,  was  adjudged  insane  (?) 
after  shooting  down  a  man  in  cold  blood,  and  as  a  result  of  the 
verdict  he  was  placed  in  the  State  asylum.  A  few  weeks  ago  the 
*'  less  insane  "  of  the  inmates,  among  which  number  was  Osborne, 
were  permitted  more  freedom  in  their  Christmas  enjoyment,  and 
were  having  an  entertainment,  when  Osborne  suddenly  bolted  by 
the  guards,  shooting  at  them  as  he  went,  and  in  a  few  moments 
^ined  his  liberty.  The  superintendent,  Dr.  Powell,  being  acci- 
dentally near  by  Osborne  in  his  flight,  narrowly  escaped  a  flying 
bullet  aimed  at  bim.  Osborne  had  sufficient  knowledge  to  make 
£0od  his  escape.  Now,  as  we  well  know,  the  asylum  at  Milledge- 
ville is  one  of  the  best-managed  in  this  country,  and  what  happened 
there  would  be  liable  to  happen  at  any  similar  institution.  In  other 
words,  there  comes  a  time  in  the  confinemeot  of  individuals  in  asy- 
lums when  they  are  thought  to  have  become  harmless,  and  in  these 
moments  they  are  given  more  liberty.  This  management  is 
rational,  but  often  serious  in  its  results.  Such  class  of  the  "  insane 
criminals"  should  be  kept  in  their  own  prison  cells,  if  the  justice 
of  the  law  has  decreed  that  our  asylum  shall  be  the  repository  for 


^dbyGoOgle 


Editobial.  45 

such  beasts.  Let  justice  be  swifter  in  its  admiuistratioD.  The 
great  agitation  about  tlie  "  lyoch  law  "  is  just  as  applicable  herC' 
Criminals  appeal  from  the  lower  to  the  higher  courts,  and  by  the 
time  the  last  one  is  reached  the  prisoner  is  "  absolutely  insane."  If 
there  is  doubt  enough  about  the  matter  to  stay  justice  in  a  human 
execution,  then  make  it  a  life-seuteQCe  and  let  the  State  and  the 
country  make  the  criminal  a  producer  and  not  an  expense  on  its 
treasury.  Above  all,  let  our  "experts"  give  testimony  according 
to  &cts  and  not  according  to  the  side  they  are  on,  and  then  will 
justice  be  properly  meted  to  criminals  and  this  &rce  play  of  insan- 
ity be  stripped  of  its  mask.  B. 


MEETING  OF  THE  SOUTHERN  SECTION  OF  THE 
AMERICAN  LARYNGOLOGICAL,  RHINOLOGICAL 
AND  OTOLOGICAL  SOCIETY,  IN  ATLANTA,  GA., 
MARCH  28.— PRELIMINARY  PROGRAM. 

1.  Address  by  the  Chairman.     Dr.  A.  W.  Calhoun,  Atlanta,  Ga. 

2.  Labyrintbioe  Verdgo.  Dr.  John  Hey  Williams,  Asheville, 
S.C. 

3.  Chromatic  Audition.     Dr.  J.  L.  Minor,  Memphis,  Tenn. 

4.  Report  of  a  Case  of  Hemorrhage  after  the  Removal  of  Ade- 
noid Vegetations.     Dr.  Boss  P.  Cox,  Rome,  Ga. 

5.  Hypertrophy  of  the  Lingual  Tonsil,  its  Symptoms  and  its 
Treatment.     Dr.  D.  A.  Kuyk,  Richmond,  Va. 

6.  Thrombosis  of  the  Lateral  Sinus,  Dependent  upon  Suppura- 
tive OtiUs  Media.     Dr.  E.  B.  Dench,  New  York. 

7.  Othematoma  and  Pericondrotis  of  the  Auricle.  Dr.  John  O. 
McBeynolds,  Dallas,  Texas. 

8.  Tracheotomy  for  Foreign  Bodies  in  the  Air  Passages ;  Report 
of  Twenty-eeven  Sncoessful  Cases.  Dr.  Willis  F.  Westmoreland, 
Atlanta,  Ga. 


^dbyGoogle 


46      The  Atlutta  Ubdicui.  Axn>  SuBGioio.  Journal. 

9.  Empyema  of  the  Aocessorj  Nasal  Cavities.  Dr.  Ruffin  A. 
Wright,  Mobile,  Ala. 

10.  The  Influence  oa  Development  of  the  Nervous  System  of 
the  Child  by  Adenoid  Vegetations  in  the  Nasopharjiiz.  Dr.  E.  P. 
Sale,  Memphis,  Teoo, 

11.  Nasal  Fibromata  with  Beport  of  Cases.  Dr.  L.  M.  Crich- 
(on,  Atlanta,  Ga. 

12.  A  Form  of  Primary  Nasal  Diphtheria.  Dr.  E.  C.  Ellett, 
Memphis,  Teno. 

13.  The  Importance  of  Examining  the  Nose  in  Troublesome 
Coughs.     Dr.  Alfred  C.  Palmer,  Richmond,  Ya. 

14.  Intubation  of  the  Larynx  for  Membranous  Stenosis.  Dr. 
.  Bernard  Wolfif,  Atlanta,  Ga. 

15.  Mouth  Breathing.  Dr.  Norburne  B.  Jenkins,  Knoxville, 
Tenn. 

16.  Mental  Disturbance  in  Turbinate  Hypertrophies  or  Nasal 
Stenosis.     Dr.  John  F.  Woodward,  Norfolk,  Ya. 

17.  A  Discovery  in  the  Physiology  of  the  Ear.  Dr.  W.  F. 
Cole,  Waco,  Texas. 

18.  Middle  Ear  Catarrh;  Some  Original  Deductions.  Dr. 
Maury  M.  Stapler,  Macon,  Ga. 

19.  Ethmoiditis  and  Report  of  Case.  Dr.  B.  F.  Travis,  Chat- 
tanooga, Tenn. 

20.  Mastoid  Inflammation,  with  a  Report  of  Two  Interesting 
Cases.     Dr.  T.  E.  Mitehell,  Columbus,  Ga. 

21.  Mouth  Breathing  in  Children,  Particularly  as  a  Result  of 
Adenoids.     Dr.  Arthur  G.  Hobba,  Atlanta,  Ga. 

22.  The  Nasopharynx  in  Laryngeal  Diseases.  Dr.  N.  C.  Steel, 
Chattanooga,  Tenn, 

23.  Cholesteatoma  of  the  Mastoid  Antrum.  Dr.  8.  L.  Led- 
better,  Birmingham,  Ala. 


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Editobial.  47 

24.  Dieeasefl  of  the  Accessory  Siouses.  Dr.  Alex.  W.  Stir- 
ling, Atlaota,  Ga. 

25.  Clinical  Miscellanies  from  Private  Praottoe.  Dr.  Frsak  M. 
Mullins,  Ft.  Worth,  Texas. 

26.  Empyema  of  the  Accessory  Sinuses  of  the  Nose.  Dr. 
Frank  M.  Hanger,  Staunton,  Ya. 

27.  A  Good  Hemostatic  after  Nasal  Operations.  Dr.  L.  B. 
Grandy,  Atlanta,  Ga. 

28.  Hypertrophic  Rhinitis  and  ita  Treatment.  Dr.  J.  F.  Hill, 
Memphis,  Tenn. 

29.  The  Serum  Treatment  of  Ozena.  Dr.  W.  E.  Campbell, 
Atlanta,  Ga. 

30.  Peritonsillar  Abscess.     Dr.  Dunbar  Roy,  Atlanta,  Go. 

All  the  hotels  have  given  reduced  rates  and  a  large  meeting  is 
expected.  The  meeting  will  be  called  to  order  at  10  a.m.  in  the 
ballroom  of  the  Kimball  House.  The  profession  is  cordially 
invited.  Dunbab  Roy, 

Secretary. 


Tbe  Atlanta  Medical  akd  Sitroical  Joubnal  is  one  of 
the  oldest  medical  journals  in  the  South  and  as  such  should  be  in 
tbe  office  of  every  Georgia  physician.  Our  State  is  known  every- 
where for  ita  progreasiveness  and  for  the  fact  that  Georgians  are 
proad  of  their  owii  State.  Then  let  the  physicians  stand  by  their 
home  joornal  by  writing  articles  for  its  p^es,  by  subscribing  and 
getting  their  friends  to  subscribe.  We  want  medical  items  from 
all  over  the  State  and  invite  our  friends  to  send  us  such,  Our  pages 
will  be  filled  with  praciiccU  medidae  and  abstracts  of  subjects  which 
will  iDtereot  tbe  busy  practitioner.  Two  dollars  a  year  is  a  small 
amount  for  the  pleasure  and  information  which  you  will  get  from 
tlte  pages  of  the  JotTBNAii, 


^dbyGoogle 


48       Thb  Atlanta  Medical  and  Subuical  Joubnai_ 

Publisb  your  communications  and  medical  writings  in  your  home 
journal,  where  they  will  be  read  by  your  professional  friends  who 
know  you.     Tbey  will  be  much  more  appreciated. 

This  number  is  the  beginning  of  our  fifteenth  volume  (new 
seriea).  We  shall  endeavor  to  make  it  and  succeeding  volumes 
more  and  more  worthy  of  iudorsement  and  support  on  the  part  of 
our  many  readers. 


The  American  Medical  Association  meets  at  Denver,  June  7th 
to  10th.  One  of  the  features  of  the  gathering  will  he  an  excursion 
from  Denver  to  Salt  Lake  City  and  return,  via  the  Denver  and 
Rio  Grande,  Colorado  MidUnd,  and  Rio  Grande  Western  Railways, 
through  the  "Heart  of  the  Rockies,"  furnishing  a  splendid  oppor- 
tunity to  view  the  most  magnificent  scenery  on  the  American  Con- 
tinent. Salt  Lake  City  is  an  ideal  summer  resort,  and  the  bathing 
at  Saltair  in  the  Great  Salt  Lake — inland  salt  sea  nearly  a  mile 
above  sea  level — is  superb  in  June.  There  are  more  attractions  in 
and  about  Salt  Lake  City  than  any  place  in  the  world.  Later 
notice  will  appear  in  this  publication  giving  rates  for  this  excursion 
and  all  details.  In  the  meantime  send  to  F.  A.  Wadlaigh,  G.  P.  A., 
Rio  Grande  Woetern  Railway,  Salt  Lake  City,  for  copy  of  pam- 
phlets on  Salt  Lake  City  and  the  Rocky  Mountains. 


One  op  The  Jouenal's  oldest  subscribers  is  Dr.  J.  J.  Devincj 
of  Tom  Bean,  Texas.  In  a  late  letter,  renewing  his  subscription, 
the  doctor  reminds  us  that  he  has  been  taking  The  Jodrnal  for 
twenty-four  years.  We  desire  to  thank  Dr.  D.  for  his  continued 
interest  and  loyalty,  which  we  trust  will  be  uninterrupted  for 
another  twenty-four  years. 


^dbyGoOgle 


MEDICAL  ITEMS. 


Dr.  Robert  Jones,  of  Rosalie,  Tesas,  is  comiDg  East  for  a 
trip  this  aprtDg. 


The  Jovbnal  had  the  pleasure  of  a  visit  recently  from  Dr. 
Jas.  T.  LovTorn,  of  Bowmen,  Ga. 


De.  Montague  L.  Botd,  of  Savannah,  died  February  15th, 
from  septic  infection  acquired  in  an  operation. 


Db.  H.  T.  Whitney,  Medical  Missionary  in  China,  is  engaged 
in  translating  Gray's  Anatomy  into  the  Chinese  language. 


Ds.  E.  C.  Seouik,  of  New  York,  the  well-known  author  and 
aathority  on  mental  and  nervous  diseases,  died  February  19th,  in 
his  fifty-fiflh  year.  The  immediate  cause  of  his  death  was  car- 
ciaoma  of  the  liver. 


It  is  said  that  one  person  out  of  eight  hundred  is  blind  to  the 
X-rays;  that  is,  when  looking  through  the  fluoroscope  they  cannot 
see  the  bones  of  the  hand,  coins  in  a  book,  etc.  This  is  no  doubt 
■□alogous  to  color-blindness. 


A  Frenchman  has  discovered  that  the  "  poison  of  tbe  hornet 
renders  one  immune  to  that  of  the  viper."  People,  however,  will 
be  slow  to  accept  tbe  conclusion  that  the  hornet  sting  offers  any 
particular  advantages  over  other  more  agreeable  and  time-honored 
remedies  for  snake-bite. 


^dbyGoogle 


50      Thb  Atlanta  Hodicai.  and  Subgioal  Journal. 

De.  Theophilds  Pabvin,  of  Philadelphia,  died  Jaouary  29th, 
from  pulmonaiy  edema  due  to  renal  diseaae.  Dr.  Parvia  was 
sixty-eight  years  of  age,  and  for  maoy  years  had  been  Professor 
of  Obstetrics  io  the  Jefferson  Medical  College.  He  was  aathor  of 
a  popular  text-book  od  obstetrics. 


In  a  late  Philadelphia  Medtoal  Journal  Dr.  Osier,  of  Baltimore, 
pays  bis  respects  to  the  Woodbridge  treatment  of  typhoid  fever. 
He  is  greatly  impressed,  he  says,  in  reading  Dr.  Woodhridge's 
articles  upon  typhoid,  with  the  "  crude,  nnsoientific  character  of 
his  work,  and  with  the  ignorance  everywhere  displayed  of  thenature 
of  typhoid  fever,  and  with  the  specific  vaunting  of  a  cure-all 
for  it."  > 


What  is  a  "Specialist  in  Practical  Medicine?"  That  is  the 
way  a  writer  signs  himself  in  a  more  or  less  esteemed  contemporary. 
This  is  a  little  more  elegant  and  not  so  commou  as  the  well-worn 
"Specialist  in  all  medical  and  surgical  diseases  of  men,  women, 
and  children,"  besides  enabling  the  proprietor  of  the  term  to  em- 
brace in  bis  comprehensive  specialty  hygiene  and  sanitary  science, 
life  insurance  examination,  railway  surgery,  drug  habits,  toxicol- 
•ogy,  and  everything  else,  from  lost  manhood  to  leprosy.  What  fur- 
ither  indignities  await  the  once  honorable  name  of  specialist  re- 
mam  to  be  seen. 


De.  F.  K.  Daniel,  editor  of  the  Texas  Medical  Jourmd  and 
late  Surgeon  C.  S.  A.,  has  written  a  hook,  "The  Recollections  of 
a  B«bel  Surgeon,"  or  "In  the  Doctor's  Sappy  Days."  It  will 
soon  be  published,  and  will  be  a  "  series  of  short  sketches,  personal 
reminiscences,  mostly  humorous,  of  life  in  camp,  field  and  hospital, 
"endurin'  of  the  war."  Dr.  Daniel  says  the  work  will  be  "real 
good,"  and,  from  our  acquaintance  with[otber  works  of  the  doctor's 
bright  and  incisive  pen,  we  are  willing  to  accept  this  short  criticism 


^dbyGoogle 


Medical  Items.  SI 

ID  advance.     We  venture  to  predict  that  there  will  not  be  a  dull 
page  in  the  book.     Lookout  for  it,  doctor;  then  get  it  and  read  it. 


Charles  Todd  Qcintabd,  M.D.,  D.D.,  LL.D.,  Bishop  of  the 
Protestant  Episcopal  Diocese  of  Tennessee,  died  Fehruary  15th, 
at  Darieo,  Ga.,  of  heart-failure.  He  was  born  in  Stamford  in 
1824.  After  leaviog  Trinity  School  he  studied  medicine  with  Dr. 
James  R.  Wood  and  Dr.  Valentine  Mott,  and  was  graduated  from 
the  University  of  the  City  of  New  York  in  1847.  He  then  re- 
moved to  Athene,  Ga.,  where  he  began  the  practice  of  medicioe. 
Id  1851  he  was  appointed  professor  of  physiology  and  pathologic 
aoatomy  in  the  medical  college  at  Memphis,  Tenn.  In  1876  he 
was  appointed  a  deacon  in  the  Protestant  Episcopal  Church,  and 
in  January,  1857,  became  rector  of  the  Calvary  Church,  Mem- 
phis.    In  1865  he  was  elected  Bishop  of  Tennessee. — Ex. 


We  imagine  that  the  editor  of  the  Paeifio  Medical  Journal  is  oft 
OD  his  vacation,  having  left  the  office  boy  in  chai^,  armed  with  a 
pair  of  shears  and  a  breezy  western  newspaper.  The  last  number 
of  oar  usually  esteemed  contemporary  conveys  (he  following  bits 
of  wonderful  misinformation: 

"  A  Missouri  girl  recently  had  a  cataract  burned  irom  her  eye  by 
the  popping  of  some  hot  grease  in  her  face  and  eye.  She  bandaged 
tile  bnm  for  a  few  days  with  tea  leaves,  and  on  removing  the 
bandage,  found  she  could  see  as  well  as  ever." 

'*  A  yonng  man  of  Rahifty,  Pa.,  whose  weight  had  decreased 
from  145  to  90  ponnds,  and  who  was  being  treated  for  consumption, 
coughed  up  a  live  frog  three  inches  long,  which  is  in  the  possession 
of  the  physician,  wlio  suspects  the  presence  of  other  batraobains 
■omewbere  about  bis  patient." 


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62       The  Atlaitta  Medical  and  Subqioal  Joubmal. 

A  "National  Society  for  the  Study  of  Epilepsy  and  the  Care 
and  Treatment  of  Epilepsy"  is  proposed  by  Dr.  W.  P.  Spratling, 
Medical  Superintendent  of  the  Craig  Colony  of  Epileptics, 
Sooyea,  N.  Y.  The  objects  of  such  a  society  would  be:  1.  The 
scientific  study  of  epilepsy.  2.  The  rational  treatment  of  the 
disease.  3.  The  best  methods  of  caring  for  dependent  epileptics, 
including,  (a)  The  construction  of  proper  homes,  based  upon  a 
study  of  the  epileptic's  needs  as  to  classification  and  environment 
(6)  The  study  of  the  utilization  of  the  epileptic's  labor,  for  eco- 
nomic, scientific  and  ethical  reasons,  (c)  The  study  of  the  best 
educational  methods  to  be  employed,  including  manual,  industrial, 
intellectual  and  moral  forms  and  forces. 

It  is  thought  that  an  effort  will  be  made  to  organize  the  society 
in  May  next. 

Am  army  medical  examining  board  will  be  In  session  at  Wash- 
ington, D.  C.|  during  the  month  of  May  for  the  examination  of 
candidates  for  appointment  to  the  Medical  Corps  of  the  United 
States  Army,  ta  fill  existing  vacancies.  Persons  desiring  to  pre- 
sent themselves  for  examination  will  make  application  to  the  Sec- 
retary of  War  before  April  15,  1898,  for  the  necessary  invitation, 
giving  the  date  and  place  of  birth,  the  place  and  State  of  perma- 
nent residence,  the  &ct  of  American  citizenship,  the  name  of  the 
medical  college  from  which  they  were  graduated,  and  a  record  of 
the  service  in  hospital,  if  any,  from  the  authorities  thereof.  The 
application  should  be  accompanied  by  certificates  based  on  per- 
sonal  acquaintance,  from  at  least  two  reputable  persons,  as  to  his 
citizenship,  character  and  habits.  The  candidate  must  be  between 
22  and  29  years  of  age,  and  a  graduate  from  a  Regular  Medical 
College,  as  evidence  of  which  his  diploma  must  be  submitted  to 
the  Board.  Fnrther  information  regarding  the  examinations  may 
be  obtained  by  addressing  the  Surgeon-General  U.  8.  Army,  Geo. 
M.  Sternberg,  Washington,  D.  0. 


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BOOK  REVIEWS. 


Lectures  on  Appehdicitis,  and  Noteb  on  Other  Subjects. 
By  Robert  T.  Morris,  A.M.,  M.D.,  Fellow  of  the  New  York 
Academy  of  Medicine,  American  AseociatioD  of  ObstetriciaDs 
aad  Qyoecologists,  American  Medical  Association,  etc.  Second 
edition,  revised  and  enlarged.  G.  F.  Putnam's  Sons,  27  West 
Twenty-third  street,  New  York.     Price  #2.00. 

This  little  book  is  written  in  the  same  concise,  dogmatical  style 
an  Dr.  Morris's  former  work  on  "  How  We  Treat  Wounds  To-day." 
It  certainly  has  the  "merit  of  brevity,"  and  of  setting  forth  the 
personal  views  of  the  author.  Many  important  points,  upon  which 
the  profession  are  laboring  earnestly  to  reach  satis&ctory  conclu- 
nooB,  the  author  has-  decided  for  himself,  and  dismisses  with  a 
wave  of  the  hand.  As  a  specimen  of  the  author's  style  and  dog- 
milism  I  quote  the  following : 

"I  speak,  then,  unequivocally,  knowing  that  some  patients  are  to 
die  and  others  are  to  suffer  unnecessarily  because  their  advisers 
will  believe  themselves  to  be  on  a  prognostic  track.  There  is  but 
one  rule  to  be  followed,  and  that  is  to  isolate  an  infected  appendix 
as  promptly  as  we  would  isolate  a  case  of  diphtheria,  and  for  prac- 
tically the  same  reasons,  viz.:  the  infected  appendix  will  probably 
infect  other  structures,  and  the  infected  throat  is  likely  to  infect 
other  throats.  An  infected  appendix  is  isolated  when  it  is  out  of 
the  patient.  All  cases  of  appendicitis  that  are  otherwise  within 
surgical  limitations,  and  that  are  within  reach  of  competent  surgi- 
cal services,  are  cases  for  prompt  isolation  of  the  appendix.  Va- 
rious periods  of  waiting  have  been  tried,  with  the  effect  of  prov- 
ing that  the  question  is  wedge-shaped,  with  the  greatest  number  of 
deaths  at  the  broad  waiting  end,  and  the  smallest  number  of  deaths 
at  the  point  of  isolating  an  appendix  while  infection  is  limited  to 
the  confines  of  the  appendix.  We  are  held  to  our  rule  by  two  car- 
dinal principles,  viz. :  (1)  Every  hour  of  progress  of  any  acute 
attack  of  appendicitis  means  increased  damage  to  the  viscera;  and 


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64       The  Atlanta  Medical  and  SimoiCAL  Joubnal. 

(2)  with  DO  iofected  appendix  the  patient  would  bave  no  complioa- 
tione  of  appendicitis,  and  therefore  the  patient  would  have  no  oom- 
piications  of  appendicitis  if  we  leave  him  with  no  infected  ap- 
pendix." 

His  etatistics  also  are  really  quite  amusing.  The  book  contains 
many  valuable  practical  suggestions,  but,  as  a  whole,  would  not,  ia 
the  opinion  of  the  reviewer,  be  a  safe  guide  to  follow,  and  must  be 
taken  cum  grano  salU.  f.  w.  m. 


Diseases  op  the  Stomach.  Their  Special  Pathology,  Diagnosis, 
and  Treatment,  with  Sections  on  Anatomy,  Physiology,  Analy- 
sis of  Stomach  Contents,  Dietetics,  Surgery  of  Stomach,  etc. 
By  John  C.  Hemmeter,  M.D.,  Ph.D.,  Clinical  Professor  of  Med- 
icine Baltimore  Medical  College,  etc.  Illustrated.  Pp.  788. 
$6.00.  P.  Blakiston,  Son  &  Co.,  J0I2  Walnut  St.,  Philadel- 
phia.    [Or  J.  F.  Meegan,  Atlanta.] 

This  scientific  and  elaborate  work,  exhibiting  thorough  and 
painstaking  research  by  the  author,  offers  to  the  profession  at  large, 
and  especially  to  the  general  practitioner,  a  volume  of  great  worth, 
from  which  one  can  cull  lessons  of  value  both  in  the  pathology 
and  therapeutics  of  stomach  and  allied  diseases.  Beginning  with 
the  anatomy  of  the  stomach,  general  and  minute,  the  author  next 
takes  up  the  physiology  of  digestion  and  the  phenomena  of  indi- 
gestion. He  next  considers  bile,  intestinal  rermentation,  putreliac- 
tion,  organized  ferments,  the  contemporaneous  action  of  the  sev- 
eral digestive  secretions,  methods  of  testing  the  motor  functions  of 
the  stomach,  method  of  testing  gastric  peristalsis,  et<^.  Chapters 
12  and  13  treat  of  stomach-washing,  test-meals  and  the  methods 
for  qualitative  and  quantitative  analysis  of  stomach  contents. 

Fart  second  deals  with  the  therapy  and  materia  medica  of  stomach 
diseases.  The  first  chapter  discusses  the  principles  of  dietetic 
treatment  of  gastric  disorders,  and  the  second  is  devoted  to  the 
diet-kitchen  and  diet-Hats.  The  latter  contains  valuable  suggea- 
tions  upon  the  proper  mode  of  preparing  foods,  soups,  fish,  meats, 
jellies,  vegetables,  milk  and  e^  dishes,  etc.  The  third  chapter 
discusses  the  dietetics  of  alcohol  and  alcoholic  beverages.  The 
author  believes  that  alcohol  is  injurious  to  the  human  organism  in 


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Book  Eetibwb,  66 

health.     Other  chapters  treat  of  the  gastric  douche  and  the  uses 
ind  abuses  of  the  natural  mineral  waters. 

This  is  ao  up-to-date  work  in  every  particular,  giving  valuable 
iororinatioD  upon  maay  heretofore  obscure  diseases  aod  conditions 
of  the  stomach  which  have  been  overlooked  or  not  fully  investi- 
gated by  writers  ou  this  subject.  It  is  worthy  of  a  place  in  every 
medical  library.  a.  a.  R. 


Spinal  Carirs  (Spondylitis  or  Pott's  Disease  of  the  Spinal  Ool- 
Dmn).  By  Noble  Smith,  F.E.C.S.,  Ed.,  L.R.C.P.,  Lond.,  Sur- 
geon to  the  City  Orthopedic  Hospital;  Surgeon  to  All  Saints' 
Children's  Hospital;  Orthopedic  Surgeon  to  the  British  Home 
for  Incurables.  Second  edition.  Smith,  Elder  &  Co.,  15  Water- 
loo Place,  London. 

No  better  exhibition  of  the  aims  of  this  little  book  could  be 
given  than  the  pre&ce  to  the  second  edition,  which  is  quoted  in 
full: 

"In  this  edition  I  have  corrected  some  errors,  supplied  an  index, 
described  a  new  fi)rm  of  head-{)iece  for  cervical  disease,  and  have 
added  some  remarks  upon  the  forced  reduction  of  the  deformity 
of  caries  under  chloroform.  I  may  add  that  since  I  wrote  the  first 
edition  I  have  met  with  further  confirmation  of  the  conclusion 
which  I  then  expressed,  that  spinal  caries  is  generally  a  curable 
disease,  but  that  success  depends,  above  all  things,  upon  accurate 
support  of  the  spine.  During  this  period  very  little  has  been  done 
by  surgeons  generally  to  overcome  the  very  unsatisfactory  custom 
of  leaving  the  construction  of  the  apparatus  entirely  in  the  hands 
uf  instrument  makers." 

The  author's  method  of  treatment  is  at  variance  with  the  prac- 
tice of  the  majority  of  orthopedic  surgeons  in  America.  They,  as 
a  rule,  use  plaster  of  Paris  jackets  and  corsets,  with  jury  masts 
where  the  disease  is  situated  in  the  upper  dorsal  or  cervical  regions; 
while  he  uses  braces  of  his  own  device. 

The  work  of  the  publishers  is  well  done,  and  the  book  contains 
many  interesting  and  original  illustrations.  f.  w.  m. 


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66       The  Atijuita  Ukdioax  a»d  Subgioai.  Joubhai- 

TUBEECDLOSIS  OP  THE   GeNITO-UeINARY   OrQANB,    MalE  AND 

Female.  By  N.  Senn,  M.D.,  Pb.I>.,  LL.D.,  Professor  of  Prac- 
tice of  Surgery  and  Clinical  Surgery,  Rueb  Medical  College; 
Attending  Surgeon  to  Preebyteriao  Hospital ;  Surgeon-in-Chief 
to  St.  Joseph's  Hospital,  Cbicago.  Illustrated.  W.  B.  Saunders, 
925  Walnut  St.,  Philadelphia.     Price  f3.00. 

Too  much  cannot  be  said  in  praise  of  this  most  excellent  work 
on  a  very  important  and  much  neglected  subject.  Dr.  Sean  ban- 
dlee  Tuberculosis  of  the  Genito-iirlDary  Organs  in  the  same  masterly 
manner  that  be  has  handled  surgical  tuberculosis  of  other  organs 
and  tissues.  The  whole  field  of  literature  of  this  subject  has  been 
thoroughly  canvassed,  cases  cited,  and  the  opinions  of  other  pathol- 
ogists and  sui^eons  freely  drawn  from,  making  the  book  quite  ex- 
haustive, though  without  tiresome  detail. 

Tuberculosis  of  the  male  genitals  is  first  considered,  theu  tuber- 
culosis of  the  female  genitals,  followed  by  tuberculosis  of  the  blad- 
der, urethra,  and  kidneys.  The  pathology  of  local  tuberculosis 
is  thoroughly  given  in  Dr.  Sinn's  most  interesting  style.  Especially 
interesting  and  valuable,  however,  are  the  details  of  the  most  ap- 
proved methods  of  treatment  of  these  affections.  Here  also  the 
author  has  drawn  freely  from  bis  own  cases,  as  well  as  quoted  lib- 
erally. His  further  experience  has  confirmed  bis  good  opinion  of 
the  emulsion  of  iodoform  in  glycerine  in   local  tuberculosis. 

The  work  of  the  publishers  has  been  well  done,  aod  the  book  is 
interesting  from  cover  to  cover.  f.  w.  m. 


A  System  of  Pbactical  Medicine.  By  American  Authors. 
Edited  by  Alfred  Lee  Loomis,  M.D.,  Late  Professor  of  Pathol- 
ogy and  Practical  Medicine  in  the  New  York  University,  and 
William  Gilman  Thompson,  M.D.,  Professor  of  Medicine  in  the 
New  York  University.  Volume  III.  Per  volume.  Cloth,  $5.00. 
Lea  Brothers  &  Co.,  Publishers,  Philadelphia  and  New  York, 
1898. 

The  subjects  discussed  io  the  third  volume  of  this  valuable 
system  are:  Diseases  of  the  Alimentary  Canal,  Diseases  of  the 
Peritoneum,  Diseases  of  the  Liver  and  Gall-Bladder,  Diseases  of 
the  Spleen,  Diseases  of  the  Pancreas,  Diseases  of  the  Thyroid 
Gland,  Infectious  Diseases  Common  to  Man  and  Animals,  Chronic 


^dbyGoogle 


Book  Reviews.  67 

Metal  Poisoning,  Aloholism,  Morphinism,  Purpura,  Beri-Beri, 
Hemophilia,  Diabetes,  and  Inaolation.  The  authors  assigned  to 
these  subjects  are  :  Drs.  R.  C.  Cabot,  Boston ;  Warren  ColeraaD, 
New  York ;  George  Dock,  Ann  Arbor  ;  F.  G.  Finley,  Montreal ; 
J.  E.  Graham,  Toronto ;  H.  A.  Hare,  Philadelphia ;  W.  B.  James, 
New  York;  W.  W.  Johnston,  Washington;  A.  A.  Jones,  BuSalo; 
F.  P.  Kinnicutt,  New  York;  Alexander  Lambert,  New  York; 
James  Law,  Ithaca;  G.  R.  Lockwood,  New  York ;  H.  M.  Lyman, 
Chicago ;  W.  F.  McNutt,  San  Francisco ;  M.  A.  Starr,  New  York; 
James  Stewart,  Montreal;  C.  G.  Stockton,  Buflalo ;  and  V.  C. 
Vaughn,  Ann  Arbor. 

The  reader  will  find  in  this  volume,  as  in  its  predecessors,  the 
same  thorough  and  scientific  handling  of  subjects  which  will  make 
this  System  when  completed  one  of  the  most  valuable  that  has 
been  added  to  out  literature  in  many  years.  The  corps  of  contrib- 
DtDrs  numbers  nineteen  able  American  authorities  and  teachers, 
and  their  articles  may  confidently  be  consulted  for  a  complete 
statement  of  each  subject  in  its  practical  bearings  according  to  the 
most  modern  knowledge.  Full  therapeutic  directions  form  a 
^tare  of  this  System  and  engravings  and  plates  are  introduced 
wherever  they  can  aid  in  elucidating  the  text. 


Text-Book  on  Surgery.  Geueral,  Operative  and  Mechanical. 
By  John  A.  Wyeth,  M.D.,  Professor  of  Surgery  in  the  New 
York  Polyclinic  Medical  School  and  Hospital ;  late  Surgeon  to 
Mount  Sinai  Hospital,  etc.  Third  Edition,  Revised  and  En- 
lai^ed.  D.  Appleton  &  Co.,  New  York.  [Southern  Agency, 
Atlanta.] 

The  preceding  edition  of  this  work,  which  was  everywhere 
accepted  as  a  standard  text-book  on  surgery,  was  published  in 
IdyO.  Since  that  time  so  many  important  advances  have  been 
made  in  surgical  science  and  the  operative  technique  that  the 
author  baa  found  it  necessary  to  revise  aud  practically  rewrite  this 
volume.  This  edition  exceeds  the  former  by  one  hundred  and 
twelve  pages. 

Many  of  our  readers  are  familiar  with  Wyeth's  Surgery.  The 
author  is  a  skilful  surgeon,  a  good  teacher  and  an  accomplished 


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58        The  Atlanta  Medical  and  Sdboical  Jodbnal. 

writer.  The  last  edition  of  his  work,  just  from  the  press,  may 
safely  be  assumed  to  be  a  complete  exposition  of  modern  surgery, 
and  a  careful  examination  of  it  will  readily  prove  this.  The 
chapters  on  Amputations,  Fractures,  Abdominal  Surgery,  Hernia,. 
Ligation  of  Arteries,  and  Deformities  are  particularly  full.  Under 
Amputations  sixty-nine  cases  of  Wyeth's  bloodless  method  of  hip- 
joint  amputation  are  tabulated,  with  the  testimony  of  many  of  the 
oi^erators  as  to  the  great  value  of  this  method.  Mention  should 
be  made  of  the  la:^,  plain  type  and  of  the  number  and  olear- 
nese  of  the  illustrations.  Tbe  present  edition  will  still  further 
enhance  the  popularity  of  this  standard  work. 


A  Manual  of  Obstethics.  By  A.  F.  A.  King,  M.D.,  Professor 
of  Obstetrics  and  Diseases  of  Women  in  tbe  Medical  De- 
partment of  the  Columbian  University,  Washington,  D.  C. 
New  (7th)  edition.  In  one  12mo  volume  of  573  pages,  with 
223  illustrations.  $2.50.  Lea  Brothers  &  Co.,  Publishers, 
Philadelphia  and  New  York. 

A  work  which  is  issued  in  a  new  edition  every  two  years 
requires  little  more  from  the  reviewer  than  tbe  statement  that  it 
contiDues  to  deserve  tbe  reader's  confidence  and  patronage  by 
keeping  closely  in  touch  with  advanced  medical  ideas.  "  In  the 
present  revision  some  errors  and  omissions  in  tbe  preceding  edition 
have  been  rectified;  some  additions  introduced;  the  chapter  on. 
Puerperal  Septicemia  has  been  rewritten  ;  and  throughout  tbe  work 
an  effort  ba'^  been  made  to  accentuate  tbe  importance  of  antiseptic 
midwifery  with  more  emphasis  than  formerly." 

This  book  has  long  enjoyed  a  well-deserved  popularity,  partic- 
ularly with  students.  Tbe  essential  principles  of  obstetrics  have 
been  nowhere  more  judiciously  selected  or  more  clearly  presented- 


Clinical  Diagnosis.  By  Dr.  G.  Klemperer,  Professor  at  the 
University  of  Berlin.  Translated  by  Nathan  Brill,  M.D.,  and 
Samuel  Briokner,  M.D.,  New  York.  Tbe  McMillan  Company, 
66  Fifth  Ave.,  New  York.     Price  |1.00. 

Afi  the  name  implies,  this  volume  of  280  pages  contains,  in  a 
very  concise  and  well  written    manner,  tbe  "elements  of  clinical 


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Book  Reviews.  '         69 

diagDoais."  It  coutains  the  diagnosis  of  acute  febrile,  acute  ia- 
fectiotis  diseases,  diseases  of  the  nervous  and  digestive  systems, 
respiratnry  tract  and  circulatory  system.  For  a  volume  of  its  size 
the  prautitionpr  will  find  it  very  useful  for  the  study  of  clinical 
diagnosis.  The  chapters  ou  the  microscopic  examinatioD  of  the 
sputum  and  blood  are  especially  interesting  and  instructive.  Chap- 
ter 8,  on  the  esamination  of  the  urine,  contains  the  practical  meth- 
ods of  arinary  analysis.  The  chapter  on  the  "diagnostic  aids  of 
the  Roentgen  myn"  is  a  new  addition  to  a  work  of  this  kind. 
The  volume  is  nicely  bound  and  well  illustrated.  w.  i»  c. 


Collier's  Weekly  has  donned  a  dress  entirely  new  and  has 
ilmoBt  doubled  its  quantity  of  illustrations.  The  current  number 
is  in  larger  type  than  its  predecessors,  and  the  three  columns  have 
been  replaced  by  two  broad  ones.  Five  of  the  pages  are  entirely 
covered  by  illustations,  besides  which  there  are  a  dozen  pictures; 
and  among  the  artiste  represented  are  John  La  Farge,  Frederic 
Remington,  A.  B.  Wenzell,  Eric  Pape  and  Peter  Newell.  The 
first  installment  of  Henry  James's  new  novel,  "Tbe  Turn  of  the 
Screw,"  appears,  as  well  as  the  beginning  of  "An  Impossible  House 
Party" — an  amusing  serial  by  Caroline  and  Alice  Duer,  Another 
new  contributor  is  Blanche  Willis  Howard,  author  of  "One  Sum- 
mer," "Guenn,"  etc.,  who  has  a  department  entitled  "Under  the 
Sao."  The  new  issue  appears  on  heavy  plated  paper,  and  is  in 
every  way  handsome  and  attractive. 


The  anesthetic  is  very  often  as  much  or  more  to  be  feared  than 
the  operation.  This  is  especially  so  in  the  case  of  old  persons  and 
those  who  suffer  from  chronic  or  acute  lung,  heart  or  kidney  dis- 
etse.  The  greatest  care  should  be  taken  that  no  more  of  the  nar- 
cotic than  is  actually  needed  should  be  used.  Ofleuer  than  is. 
admitted,  death  from  the  anesthetic  is  due  to  lack  of  care  or  expe- 
rience on  tbe  part  of  the  anesthetist.  When  you  are  about  to 
operate  upon  an  individual  who  will  probably  take  general  narcosis 
badly,  try  local  anesthesia.  You  will  often  be  surprised  at  the  ap- 
parently formidable  operations  which  may  be  done  with  the  aid  of 
oocaiue  or  encaine. — Iniemational  JoumcU  of  Surgery. 


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SELECTIONS  AND  ABSTRACTS. 


Pbogebss  op  Sebum-Therapy. 

A  committee  appointed  last  April  by  the  Kicbniond  (Virginia) 
Academy  of  MediciDe  to  investigate  and  report  upon  the  progress 
of  serum-therapy  have  juet  submitted  their  report,  of  which  the 
following  is  part: 

Diphtheria. — The  history  of  the  development  of  the  anti- 
toxin treatment  of  diphtheria  is  so  well  known,  and  its  acceptance 
now  so  universal,  that  it  would  be  uaeless,  even  if  the  limits  of 
this  report  rendered  it  possible,  to  go  fully  into  details  on  these 
points.  Even  at  the  time  that  your  committee  was  appointed  it 
could  be  said  that  a  sufficiently  extensive  trial  of  the  antitoxin 
treatment  of  diphtheria  had  been  made  to  remove  the  fears  which 
many  had  entertained  as  to  its  action,  and  to  place  the  remedy  in 
an  assured  position  as  one  of  inestimable  worth. 

During  the  past  year  statistics  from  many  and  varied  sources 
have  appeared,  all  tending  still  further  to  increase  the  confidence 
of  the  profession  in- the  remedy,  and  to  demonstrate  the  saving  of 
life  which  it  has  accomplished.  Many  who  were  sceptical  have 
been  convinced  by  the  unanswerable  argument  of  statistics  whose 
authenticity  could  not  be  questioned,  until  to-day  it  may  be  said 
that  but  few  physicians,  indeed,  who,  having  given  the  subject  care- 
ful consideration,  do  not  accord  to  the  remedy  even  more  value 
than  was  at  first  claimed  for  it  by  its  staunchest  advocates. 

Only  two  sets  of  these  statistics  will  be  referred  to,  not  because 
they  are  more  favorable  than  others,  but  on  account  of  the  large 
number  of  cases  recorded  in  them,  and  because  they  represent  such 
diversity  in  the  class  of  cases  treated. 

The  report  of  the  committee  of  the  American  Pediatric  Society, 
presented  at  its  last  meeting,  includes  1,704  eases  of  laryngeal 
diphtheria  which  occurred  in  the  practice  of  422  physicians  in  the 
United  States  and  Canada.  In  this  report  the  following  points 
are  among  the  most  prominent :    Before  the  use  of  antitoxin  it  was 


,„i,z.d  by  Google 


Selbotions  aud  Abbtbacts.  61 

estimated  that  90  per  cent,  of  laryngeal  diphtheria  cases  required 
operatioD,  whereas  now,  with  the  use  of  antitoxin,  only  39.21  per 
cent,  require  it.  The  mortality  id  the  whole  series  of  1,704  cases 
was  21.12  per  cent.  (360  deaths).  In  the  non-operated  cases  the 
mortality  was  17.18  per  cent.  (178  deaths).  The  mortality  in  the 
operated  cases  (27.24  per  cent. — 182  deaths)  shows  even  more  re- 
m&rkahle  results.  Before  the  use  of  antitoxin  only  27  per  oent. 
neovered;  now  only  27.24  per  oent.  die. 

The  other  report  to  which  reference  will  be  made  is  the  "  Second 
Report  of  Medical  Superintendents  upon  the  Use  of  Antitoxic 
Seram  in  the  Treatment  of  Diphtheria  in  the  Hospitals  of  the 
Metropolitan  Asylum's  Board  during  the  year  1896."  (London.) 
Id  these  hospitals  during  1896  antitoxin  was  used  in  71.3  percent, 
of  all  cases  of  diphtheria,  the  remedy  not  being  employed  in  mori- 
bund, mild,  or  doubtful  cases.  The  total  death-rate  during  1896 
(nader  antitoxin)  was  20.8  per  cent.;  that  of  1894  (without  anti- 
toxin), although  then  considered  remarkably  low,  was  29.6  per 
cent.  This  represented  a  saving  of  365  lives.  It  is  well  known, 
however,  that  only  during  the  early  days  of  the  disease  does  anti- 
toxin exert  its  full  beneficial  effect ;  and  hence,  while  the  above 
figures  show  a  difference  in  the  total  death-rate  of  only  8.8  per 
cent.,  the  difference  in  cases  treated  on  the  first  day  was  17.8  per 
cent.;  on  the  second  day,  14.2  per  cent;  on  the  third  day,  11.7 
per  cent.;  on  the  fourth  day,  9.1  per  cent.,  and  on  the  fifth  day  or 
liter,  6.2  per  cent.  Laryngeal  cases  were  attended  with  a  mor- 
tality of  62  per  (%nt.  in  1894 ;  29.6  per  cent,  in  1896.  Operated 
laryngeal  cases  had  a  death-rate  of  70.4  per  cent,  in  1864 ;  41  per 
cent,  in  1896.  It  is  the  opinion  of  the  superintendents  that  there 
has  been  no  reduction  in  the  frequency  of  complications  of  the 
disease  as  a  result  of  antitoxin  treatment,  except  in  the  case  of 
nephritis,  which  occurs  less  often.  In  fact,  it  would  seem  as  if  the 
other  complications  occur  even  more  frequently  than  formerly. 
This,  however,  is  only  apparent,  and  is  due  to  the  closer  observa- 
tions which  are  now  made,  and,  even  more,  to  the  &ct  that  many 
•evere  caeee,  which  would  have  died  under  other  treatment,  now 
raeover,  and  these  are  natorally  more  prone  to  develop  compli- 
cations. 


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62       The  Atlasta  Medical  ahd  Sdbqioal  JouBNAih 

Id  this  report  the  general  results  of  antitoxin  treatment  are 
summecl  up  as  follows:  1.  DimiautioD  of  faucial  swelling;  2. 
Lessening  of  irritating  and  ofiensive  dischai^  from  the  nose ; 
3.  Limitation  of  exten»on  of  membrane ;  4.  Earlier  separation  of 
exudate ;  6.  Limitation  and  earlier  separation  of  membrane  in 
laryngeal  cases;  6.  TiDprovemeat  in  general  condition  and  aspect 
of  patients;  7.  Prolongation  of  life,  in  &tal  cases,  to  an  extent 
not  obtained  with  former  methods  of  treatment. 

It  has  been  claimed  by  those  who  refuse  to  recognize  the  value 
of  diphtheria  antitoxin,  that  the  fevorahle  results  shown  tn  the 
statistics  of  the  past  few  years  are  due  to  other  factors  than  the  em- 
ployment of  antitoxin.  By  some  it  is  held  that  the  type  of  the 
disease  has  become  milder ;  others  that  since  the  wide-spread  appli- 
cation of  bacteriologic  diagnosis,  cases  are  now  called  diphtheria 
which  were  formerly  not  so  classified;  or,  again,  that  moribund 
cases  and  cases  treated  after  the  fifth  day  of  the  disease  are  excluded 
in  many  of  the  statistics.  The  first  report  to  which  reference  has 
been  mode  above  answers  fully  the  first  objection,  since  it  deals 
with  only  laryngeal  cases,  and  laryngeal  diphtheria  can  never  be 
considered  mild.  In  the  report  of  the  Metropolitan  Asylum's 
Board  Hospitals  mild  as  well  as  moribund  cases  were  not  injected. 
As  r^ards  the  influence  of  bacteriologic  diagnosts,  it  is  a  fact 
which  no  one  acquainted  with  the  subject  will  dispute,  that  the  num- 
ber of  cases  which  would  formerly  have  been  considered  diphtheria, 
but  which  are  now  excluded  from  the  statistics  by  bacteriolo^c 
investigations,  &r  exceed  those  in  which  the  reverse  is  true. 

While  the  above  are  strong  replies  to  the  criticisms  of  the  oppo- 
nents of  antitoxia,  we  are  indebted  to  Park*  for  a  table  of  statistics 
against  which  none  of  the  usual  objections  can  be  urged.  This 
table,  compiled  from  the  official  records  of  Berlin,  Paris  and  New 
York,  shows  the  absolute  death-rate  per  100,000  inhabitants  in 
these  cities  from  diphtheria  and  croup  from  1886  to  1897  inclusive. 
There  is  here  no  room  for  asserting  that  the  statistics  have  been 
twisted  to  &vor  any  plan  of  treatment,  that  any  special  class  of 
cases  has  been  excluded  or  included,  and  yet  the  reduction  in  mer- 
it BMtsriolocT  to  ThenpvnttOi.    Wwler  U.  Oupeotar, 


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Selections  and  Abstbacts.  63 

tality  ia  all  tbree  of  these  citieB  sioce  the  iotroduction  of  antitoxin 
is  remarkable  and  too  uDiform  to  be  tbe  result  of  mere  coincidence. 
This  table  is  of  sucb  interest  that  it  is  here  appended  : 


^LCT.  D.ATH-RATB  FBO«  DIPHTHERIA  AKD  CBOUP  P«  lOO.OOO  POPULATIOK. 

YB4R- 

BBHLIN. 

PAEia. 

NRW  YOSK. 

126.7 

100.7 
76.1 
85.6 

102.0 
67.6 
92.9 

100.8 
M.7 

t59.7 
80.9 
26.4 

73.3 
76.9 
83.7 
79.9 
77.5 
«3,0 
68.6 
61.4 
40.7 
17.7 
17.6 
17.2 

1890 — 

1891 

110  6 
118.7 
123.3 

189S  , 

1896 

•1897 

105.2 
91.3 

86.4 

As  regards  actual  advances  in  the  antitoxin  treatment  of  diph- 
theria, the  chief  of  these  seems  to  be  the  production  of  more  potent 
and  trustworthy  serums  and  the  attention  to  details  in  its  manu- 
facture, whereby  its  efScacj  has  been  increased  and  maoy  of  its  ob- 
jectionable features  diminished.  Kashes  and  joint  symptoms  fol- 
lowing its  use  are  now  somewhat  less  frequent  than  formerly. 

Tbe  preparation  of  dried  serum  has  not  yet  been  brought  to  a 
safficieot  degree  of  perfection 'to  supplant  the  ordinary  product, 
while  "we  have  no  more  hope  than  we  bad  five  years  ago  of  sepa- 
rating antitoxin  completely  from  the  horse  serum."     (Park. ) 

Daring  the  past  few  months  tbe  Health  Department  of  New 
Tork  city  has  been  testing  tbe  comparative  frequency  of  rashes 
after  the  nse  of  filtered  and  unfiltered  serums.  Tour  committee  is 
indebted  to  Dr.  Wm.  !•.  Sommerset,  Resident  Physician  Willard 
Parker  Hospital,  for  the  following  statement,  which  is  an  approxi- 
mate one,  of  the  results  obtained  :  Previous  to  the  employment  of 
filtered  sernm,  rashes  occurred  at  the  Willard  Parker  Hospital  in 
from  25  to  SO  per  cent,  of  all  cases;  since  the  use  of  filtered  and 
nnfiltered  serum  in  parallel  cases,  tbe  percentage  of  rashes  where 


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64       The  ATi.AirrA  Medical  and  Suboigal  Joubnal. 

filtered  Beruoi  was  injected  has  been  reduced  to  about  15  per  ccDt., 
while  it  has  risen  to  about  40  per  cent,  where  the  uafiltered  product 
WB3  employed.  The  higher  percentage  of  rashes  in  the  latter  class 
of  cases  than  formerly  is  due  to  the  fact  that  the  unfiltered  serum 
used  ia  these  cases  contained  the  residue  from  the  filtered  portion. 
It  would  thus  appear  that  the  production  of  rashes  is  caused  largely 
by  some  constituent  of  the  serum  which  is  incapable  of  passing,  or 
passes  only  in  small  amounts,  through  unglazed  porcelain. 

The  use  of  antitoxin  as  a  prophylactic  measure  has  been  steadily 
gaining  ground,  and  with  the  production  of  a  serum  from  which  all 
objectionable  features  have  been  eliminated,  its  use  in  this  direction 
will  doubtless  become  even  more  popular;  though,  from  the  tem- 
porary nature  of  the  immunity  affected,  it  must  remain  a  measure 
to  be  adopted  only  in  the  presence  of  epidemics  or  in  cases  where 
exposure  has  undoubtedly  occurred. 

Yellow  Fever. — In  1854  and  1855,  inoculaUon,  as  a  preven- 
tive meaauret  was  made  use  of  in  Havana  during  an  epidemic  of 
yellow  fever.  In  1887,  this  idea  was  again  introduced  and  followed 
up  very  thoroughly  in  Brazil.  But  in  neither  instance  were  the 
results  satisfactory.  In  1892,  Domingo  Freire  introduced  a  diluted 
virus  derived  from  the  micrococcus  xanthogenicus,  which  he  held 
to  be  the  etiological  factor  in  the  development  of  yellow  fever. 
This  diluted  virus  was  advocated  as  a  preventive  inoculation  by 
Dr.  Belinger,  of  San  Francisco,  Dr.  J.  McFadden  Gaston,  of 
Atlanta,  and  others  during  1893  and  1894;  but  the  results  have 
been  disappointing.  About  the  same  time,  1893,  Dr.  A.  S.  Ash- 
mead  recommended  "  Murray's  immunizing  method"  as  follows  : 
Inoculate  with  the  blood  serum  of  a  partially  immune  subject 
(negro),  and  inoculate  a  second  time  with  perfectly  immune  blood 
serum  of  a  white  subject  who  has  had  yellow  fever.  Before  inoc- 
ulation, however,  as  frost  always  modifies  the  virus,  let  the  infected 
serum  be  first  exposed  to  frost.  Follow  at  once  with  a  second  in- 
oculation of  immune  blood  serum."  Disappointments  likewise 
followed  the  use  of  this  method. 

In  July,  1897,  Prof.  Q-.  Sanarelli,  of  the  University  of  Monte- 
video, isolated  and  cultivated  a  bacillus  which  he  considers  to  be 
the  specific  organism  of  yellow  fever.     Probably  it  is  the  same 


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^ELBUtlOlia  AND  ABStEACft.  6S 

bacillus  as  that  formerly  described  by  Surgeon-OeDeral  Sternberg. 
Possibly  both  may  ultimately  be  proven  to  be  eecoDdary  invaders. 
However,  Sanarelli  has  been  occupying  himself  since  last  summer 
in  the  secnring  of  a  protective  or  curative  serum,  about  which  most 
encouraging  reports  have  been  already  made.  And  yet  scarcely  is 
the  hope  boro  that  at  length  we  have  a  protective  or  curative  agent 
with  which  to  meet  yellow  fever  before  adverse  reports  are  coming 
in  to  indicate  that  we  must  wait  and  see. 

TdbebcuijOSIS. — The  medical  world  was  startled  in  1890  by  the 
announcement  that  Eoch  had  discovered  a  remedial  agent  for 
phthisis.  This  announcement  was  hailed  with  joy,  and  it  was  im- 
mediately put  to  the  clinical  test,  but  its  virtues,  so  ably  set  forth 
by  its  discoverer,  soon  began  to  minimize,  and  finally  it  fell  into 
disrepute  as  a  curative  remedy.  Since  the  introduction  of  tuber- 
culin, several  serums  have  been  bronght  forward,  and  have  been 
tried  with  varying  success  by  many  physicians. 

Among  the  most  popular  of  these  preparations  is  the  serum  of 
Prof.  E.  Maragliano  of  Genoa,  obtained  from  the  dog,  the  ass,  and 
the  serum.  When  treatment  was  begnn  as  late  as  the  formation  of 
cavities  in  the  lungs,  he  claims  a  cure  of  7.76  per  cent.  In  non- 
febrile  tuberculosis,  his  successes  have  amounted  to  nearly  100  per 
cent,  of  recoveries.  He  recommends  that  1  o.  m.  of  the  serum 
should  be  the  dose  injected  aubcutaneously  every  second  day.  In 
febrile  forms  the  dose  may  be  increased  for  several  days — 5  to  8 
days — to  6  and  even  10  c.  m.  Such  are  the  contradictory  reports 
as  regards  successful  use  of  MaragUano's  serum  by  different  doctors 
that  it  is  difficult  to  come  to  a  fixed  opinion  on  the  subject. 

What  has  been  said  in  general  of  Maragliano  serum  applies  in 
the  DUUD  to  the  published  results  of  the  use  of  -  the  antituberole 
serum  introduced  in  1896  by  Dr.  Paul  Paquin  of  St.  Louis.  That 
it  is  useful  when  administered  with  other  remedies  is  more  than 
probable. 

Early  in  1896,  Eocb  introduced  what  he  called  T.  R.  Tuber- 
culin, and  this  was  followed  by  encouraging  reports  of  its  use.  But 
it  was  not  long  before  the  process  of  its  manufacture  was  found  to 
be  faulty  in  that,  notwithstanding  the  centrifugation,  it  was  dis- 
covered that  in  a  lai^  number  of  the   preparations  on  the  market 


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66       fHE  Atlahta.  Medical  and  Subqical  JoubkaL. 

tubercle  bacilli  remamed  ia  the  fluid.  This  being  recognized  aa  an 
error  of  manutacture,  it  has  been  withdrawn  from  market — cer- 
tainly until  the  fault  of  its  manufacture  can  be  remedied. 

Antiphthisin  is  a  sozalbumin,  introduced  some  years  ago  by 
Elebs,  which  he  regards  as  the  germicidal  part  of  tubereulin. 
Yon  Ruck  "attests  its  absolute  safety,  and  oonsiders  that  it  has 
curative  properties." 

But  the  early  disappointments  in  practice  of  the  semm  treat- 
ment of  tuberculosis  have  made  the  professtoo  skeptical  as  to  the 
remunerative  value  of  any  and  all  such  methods  of  treatment;  and 
yet  it  is  evident  to  the  non-skeptical,  who  reviews  the  experience 
of  unbiased  practitioners,  that  it  is  probable  that  whatever  may  be 
found  curative  of  tuberculosis,  one  of  the  measures  to  be  used  will  be 
perfection  of  some  of  the  antitoxins  so  called.  It  is  the  opinion 
of  many  that  the  scientific  worker  is  getting  in  the  neighborhood 
of  the  real  remedy,  and  is  probably  knocking  at  a  door  of  the 
house  in  which  the  truth  is  to  be  found. 

Typhoid  Fever. — Chautemesse  and  Widal  found,  in  1888,  that 
susceptible  animals  could  be  rendered  immune  by  inoculating  them 
with  a  culture  of  the  typhoid  organisms  which  had  been  rendered 
sterile  by  heat. 

Following  this  line  of  investigation,  serum-therapy  has  been 
employed  in  typhoid  fever.  However,  with  the  most  persistent 
use  of  this  substance,  the  results  in  this  disease  have  been  unsat- 
isfactory. 

SCAKLET  Feveb. — An  antistreptococcic  serum  has  been  em- 
ployed in  this  affection,  and  while  it  does  not  seem  to  have  any 
efficacy  in  the  scarlet  fever  itself,  yet,  from  a  certain  number  of  ob- 
servaljons  made  by  Roux,  it  appears  to  have  a  favorable  influence 
on  the  complications  due  to  the  streptococcus,  and  which  are  so 
common  in  this  malady, 

Typhds  Fevee. — In  a  prison  at  Bougie,  from  November  25th 
to  December  12th,  forty  cases  occurred,  with  two  deaths.  Serum- 
therapy  was  commenced  December  12th,  the  serum  being  obtained 
from  patients  who  had  recovered.  From  2  to  6  c.c.  were  injected 
into  each  of  39  c,  and  only  one  died.     Legrain  noted  fall  of  tem- 


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Selections  and  AssrcBACia.  67 

perature,  improvement  in  pulse,  disappearance  of  fever,  and  that 
severe  cases  soon  became  mild  in  type. 

Although  this  disease  is  rare,  owing  to  improved  hygienic 
measures,  yet,  from  the  fevorable  report  of  serum  in  its  treatmenti 
it  is  to  be  hoped  that  the  rate  of  mortality  will  be  kept  lowered  in 
those  instances  where  disease  gains  a  foothold. 

R&BTE8. — Ttzzoni  and  Cattani  reported  that  seram  of  animals 
rendered  immune  to  hydrophobia  has  the  power  of  conferring  im- 
munity and  arresting  the  disease  when  already  developed.  So  far 
no  trial  has  been  made  in  man.  If  successful  here,  its  value  will 
surpass  the  treatment  of  Pasteur,  in  that  the  latter  may  produce 
immunity,  bnt  cannot  cure  the  disease  if  once  developed. 

Leprosy. — Carrasqnilla  treated  a  number  of  cases  of  leprosy 
with  aerum,  and  in  fifteen  oases  of  the  anesthetic  type  secured  a 
remarkable  d^ree  of  success.  Medina,  commenting  on  this  treat- 
ment. Bums  up  as  follows  : 

"  The  sensation  is  restored  more  or  less  rapidly  according  to  the 
extent  and  gravity  of  the  lesions  of  the  peripheral  nervous  system. 
Distinct  patches  lose  their  abdominal  color  without  disappearing 
entirely.  Edema  subsides  rapidly  in  some  cases,  slowly  in  others. 
The  skin  shrinks  and  resumes  its  physiological  condition  after  the 
absorption  of  the  edema.  The  tubercular  variety  shrinks,  breaks 
down,  and  disappears  by  absorption,. desquamation,  or  suppuration, 
lea^-ing  traces  of  their  existence  at  the  affected  spots.  Ulcers,  after 
having  presented  copious  pmulent  secretions,  rapidly  clear  off  and 
are  covered  with  healthy  skin  ;  scars  from  former  suppurative  lep- 
romata  &de  and  lend  to  assume  the  same  level  as  the  surrounding 
skin.  Ulcerated  mucous  membranes  ftde  like  the  skin  and  recover 
sensibility,  while  the  tuberoules  break  down.  The  face  loses  its 
leonine  appearance.  I^istly,  the  patient  recovers  his  appetite,  the 
ability  to  sleep,  and  the  mental  state  improves." 

S&BCOHA  AND  Carcinoua. — Varying  success  has  attended  the 
use  of  bacterial  products  in  inoperable  malignant  disease.  Coley, 
who  has  done  a  great  deal  of  work  in  this  class  of  cases,  secured 
greater  success  with  the  (reatmenl  in  sarcoma  than  in  carcinoma. 
The  conclusions  of  the  Kew  York  Sui^ical  Society,  which  may  be 
considered  as  a  conservative  survey  of  the  efficacy  of  this  treatment 


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68      The  Atlamta  Medical  and  Subgical  Johekal. 

in  malignaat  dieease,  are  wi  follows  (AnruUa  of  Surgery,  Julj, 
1896) : 

"  (1)  The  danger  to  the  patient  from  the  treatment  is  great. 

"  (2)  The  alleged  successes  are  so  few  and  doubtful,  the  most 
that  can  be  said  for  the  treatment  is  that  it  may  offer  a  slight 
chance  of  improvement. 

"(3)  Valuable  time  has  been  lost  in  operable  cases  by  giving 
the  treatment  a  trial  before  operating. 

"  (4)  The  method  should  be  absolutely  confined  to  inoperable 
cases." 

Syphilis. — Richet  and  Haricoart  were  the  first  to  try  injections 
of  serum  in  the  treatment  of  syphilis.  They  report  two  cases,  one 
resulting  in  a  cure;  the  other  showed  marked  signs  of  improve- 
ment— the  ulcerated  surface  decreasing  four-fiftbein  size.  Pelliz- 
zari  and  Neu  man  have  employed  blood  in  its  treatment,  but  no 
satisfactory  resulte  were  obtained. 

Streptococcic  Infections. — In  eryaipelaa  Marmoreek  used  the 
antistreptococcic  serum  in  413  cases  in  which  the  mortality  was 
3.87  per  cent,  against  6  per  cent,  prior  to  the  use  of  serum.  In 
165  cases  of  erysipelas  alone  the  mortality  was  1.2  per  cent.  As 
a  result  of  the  use  of  the  serum  he  noticed  an  improvement  in  the 
general  condition,  &11  of  temperature,  and  local  improvement. 

Puerperal  fever  has  been  treated  by  this  plan  with  a  certain  de- 
gree of  success.  It  has  not  proven  as  useful  in  this  disease  as  there 
was  reason  to  expect  at  the  first  mentioning  of  the  subject. 

The  semm  has  also  been  used  with  success  in  acute  hemorrhagic 
septicemia,  erydpelas  neonatorum,  acute  genital  septic  peritonitis, 
purulent  cellulitis  of  the  face,  cerebro-spinal  meningitis. 

FNEnHONiA. — Klemperer,  in  1892  and  1893,  published  his  re- 
searches as  to  the  treatment  of  serum-therapy  in  six  cases  with  good 
results.  Mosny,  Bonone,  Emmerich,  and  Pansint,  following  np 
this  idea,  obtained  practically  the  same  results  as  Klemperer.  On 
the  other  hand,  Hughes  and  Carter,  in  1894,  reported  the  injection 
of  the  serum  of  patients  just  recovered  from  pneumonia  in  ten  cases 
of  this  disease,  and  they  had  no  reason  to  consider  the  treatment 
efficacious. 

Cholera. — Mauy    experiments   have   been   made    in    cholera, 


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Selsotions  akd  Absteacts.  6d 

chiefly  as  iDoouIatioDs,  and  these  mostly  in  animals  until  nicently. 
During  an  epidemic  of  this  dread  malady  in  Spain,  50  per  cent,  of 
those  attacked  died.  After  inoculation  was  used,  the  rate  of  mor- 
tality was  reduced  to  25  per  cent. 

Influenza. — The  bacteria  of  influenza  was  discovered  in  1892. 
Babbits  were  inoculated  with  cultures,  aud  after  they  had  been 
proven  immune,  the  blood  serum  was  used  on  men  suffering  from 
influenza  with  varying  success. 

The  serum  treatment  has  been  extended  considerably  in  its  scope, 
BO  that  at  the  present  time  there  are  but  few  of  the  more  infec- 
tions diseases,  to  which  mankind  is  liable,  that  have  not  been 
considered  by  the  experimental  bacteriologist.  In  addition  to  the 
diseases  above  referred  to  may  be  mentioned  the  Imbonia  plague, 
anthrax,  alcoholism,  acute  delirious  mania,  glanders,  pleuro-pneu- 
monia,  foot  and  mouth  disease,  chicken  cholera,  hog  cholera  and 
bites  of  reptiles,  as  other  diseases  in  which  serum-therapy  has  been 
employed. 

TETAK178. — Behring  and  Kitasato  were  the  first  to  produce  in 
the  blood  of  animals  a  distinctly  potent  and  valuable  antitoxic  sub- 
stance. In  1892  Dr.  Budolpb  Schwarz  reported  the  first  success 
with  tetanus  antitoxin  in  mau.  Cases  of  cure  have  been  reported 
from  time  to  time  which  gradually  increase  the  per  cent,  of  recov- 
eries. It  may  be  very  properly  asked  why  the  success  with  serum 
in  this  disease  is  not  so  favorable  as  that  in  diphtheria — the  two 
antitoxins  being  so  nearly  identical  in  their  efficacy  as  agents  for 
immunization?  The  answer  may  be  found  "in  the  manner"  in 
which  "  the  two  infections  begin  and  progress,"  *  The  tetanus 
affection  advances  for  from  five  to  ten  days  undetected  in  the 
wound,  the  toxins  develop  unnoticed,  cause  their  deleterious  effect, 
and  only  after  general  poisoning  has  occurred  is  the  disease 
detected. 

The  diphtheria  infection  starts  on  the  sur&ce,  and  before  its  tox- 
ins are  folly  developed  and  absorbed,  it  is  diagnosticated  by  the 
appearance  of  its  exudate,  the  husky  voice,  or  the  nasal  obstruction. 
At  this  time  we  could  also  arrest  the  tetanus  infection.  If  we  allow 
this  time  to  pass  by,  then,  as  in  tetanus,  after  the  constitutional 
poisoning  has  taken  place,  the  antitoxin  is  usually  of  no  avail. 

'TbaWalefH.  CupenterLeetarerorian.   B;  Wm.  H.  Park,  H.D. 


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70       The  Atlanta  Medical  and  Suboical  Journal. 

Ad  improvcmeDt  id  the  form  of  tetaaus  antitoxin  is  the  solid 
variety.  It  18  olaimed  that  thin  preparation  cao  be  kept  indefi- 
nitely, and  is  ready  for  ase  at  any  time  by  simply  diBsolviug  it  in 
water. — Drb.  Akthub  Jordan,  Landox  Edwabds  and  E.  C. 
Levy,  Committee. 


The  Treatment  op  Pulmonary  Tuberculosis  by  the  Hypo- 
dermic USE  OF  a  Compound  Solution  of  Iodine. 

Dr.  Chas,  W.  Ingraham,  of  BingbamtoD,  New  York,  believeB 
{N.  Y.  Medical  Journal,  October  23,  1897)  that  "in  iodine  we 
have  a  powerful  antitubercular  remedy,  though,  unfortunately,  on 
account  of  ita  tendency  to  irritate  the  mucous  membranes  of  the 
stomach,  its  continued  use  cannot  be  tolerated  by  the  average  con- 
sumptive invalid.  It  is  customary  to  find  the  stomach  of  the  pul- 
monary invalid  already  weakened  by  the  effect  of  the  tuberculous 
disease,  and  when  we  attempt  to  administer  a  remedy  which  tends 
to  increase  the  existing  irritation,  disastrous  results  must  ensue. 
Hence,  though  the  effect  of  iodine  might  be  strongly  indicated, 
the  administration  of  the  drug  by  the  stomach  is  out-of  the  ques- 
tion in  nine  cases  out  of  ten. 

"The  formula  of  my  compound  solution  of  iodine  was  perfected 
in  the  tatter  part  of  1892,  and  now,  after  five  years'  use  in  the 
treatment  of  all  forms  of  phthisis,  it  has  proved  so  thoroughly 
satisbctory  and  generally  applicable  that  I  have  made  no  altera- 
tions or  additions  to  the  original  formula.  I  should  state  that  the 
compound  is  prepared  for  hypodermic  use  only,  sterilized  oil  being 
the  solvent  used.  Each  drachm  of  the  compound  represents 
approximately  the  following: 

Itfdine  (chemicsUjr  pur«).> Kr-  }■ 

Bromide  (ehemiolly  pure) gr.  ^. 

Fhoipboru*  (chemically  pure) fr-rhr- 

Tbymol  (chemically  pure) gr,  J. 

Menthol  (chemically  pure) gr.  }. 

"It  must  be  borne  in  mind  that  the  compound  is  not  a  simple 
mixture  of  the  ingredients  herein  mentioned,  but  that  the  properly 
prepared  product  is  the  result  of  a  series  of  definite  chemi<»l  reac- 


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SELECtlONa  AND   AbstracIS.  71 

tioDB.  The  characteristics  of  the  compouDd  are  as  follows:  It  is 
of  a  bright  cherry  color,  distiDctly  transpareot,  and  of  a  slight 
aromatic  odor.  It  will  keep  indeBaitely  without  uadergoiag  any 
change  if  kept  protected  from  light  and  beat. 

"My  report  io  the  £u^in  two  years  and  a  half  ago  shows  nearly 
ninety  per  cent,  of  cures  of  all  cases  of  pulmonary  tuberculosis 
treated  in  the  first  stages  of  the  disease,  while  the  percentage  of 
recoveries  in  the  second  stage  of  the  disease  was  nearly  fifty. 
These  percentages  were  based  upon  twenty-one  cases  treated  in  the 
first  stage  and  fourteen  cases  treated  in  the  second  stage — «  total 
of  thirty-five." 


Some  "Dok'ts"  ABonx  Heart  Disease. 

Don't  feel  called  upon  to  give  digitalis  as  soon  as  you  hear  a 
murmur  over  the  heart.  Stndj  and  treat  the  patient  not  the 
murmur. 

Don't  conclude  that  every  murmur  indicates  disease  of  the 
heart. 

Don't  forget  that  the  pulse  and  general  appearance  of  the  patient 
often  t«ll  more  than  auscultation. 

Don't  neglect  to  note  the  character  of  the  pulse  when  yon  feel 
it.  Posnbly  you  may  look  at  the  tongue  to  satisfy  the  patient; 
feet  the  poise  to  instruct  yourself. 

Don't  think  every  systolic  murmur  at  the  apex  indicates  mitral 
regnrgitation ;  every  systolic  murmur  at  the  aortic  interspace,  aortic 
stenosis.  The  former  may  be  trivial;  the  latter  may  be  dne  to 
atheroma  of  the  arch  of  the  aorta. 

Don't  Bay  every  sudden  death  is  due  to  heart  disease. 

Don't  fi>rget  that  the  most  serious  diseases  of  the  heart  may 
occasion  no  murmur.     A  bad  muscle  is  worse  than  a  leaky  valve. 

Don't  examine  the  heart  through  heavy  clothing. 

Don't  give  positive  opinions  after  one  examination. — Philadelphia 
Medical  Journal. 


According  to  the  Baltimore  Sun,  smallpox  this  winter  appears 
to  have  been  most  prevalent  in  the  vicinity  of  Birmingham,  Ala., 
where  many  thonsand  negro  coal-miners  are  employed,  and  from 


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1i       The  Atlanta  Medical  Ain>  Surgical  JoubnaL. 

theace  diseeminated  elsewhere.  The  great  difficulty  id  the  way  of 
preventiDg  the  spread  of  the  disease  was  the  refusal  of  the  negroes 
to  be  vaccinated.  Fiaally,  the  local  authorities  appealed  to  the 
supervising  Surgeon-General  of  the  Marine  Hospital  Service.  Dr. 
Wyman  immediately  dispatched  Assistant-Surgeon  Magrader,  with 
thirty-odd  assistants,  to  the  infected  territory  near  Birmingham. 
At  the  Bu^estion  of  the  United  States  officials,  the  mine-owners 
and  superintendents  joined  in  a  notice  to  the  miners  that  employ- 
ment would  no  longer  be  given  unless  they  consented  to  be  vac- 
cinated. The  Surgeon -General  has  just  received  a  report  from 
Dr.  Magruder  that  in  a  little  over  two  weeks  more  than  25,000 
had  been  vaccinated  by  hia  assistants,  over  14,000  bouses  in- 
spected, and  the  disease  is  being  rapidly  stamped  out.  When  Ala- 
bama is  through  with  Dr.  Magruder  and  his  corps,  by  request  of 
the  State  Board  of  Health  he  will  proceed  to  Teunessee  and  make 
a  wholesale  vaccioatioo  in  all  infected  places  in  that  State. — Phtla. 
Med.  Joarnal. 


Geay'8  Glycebin  Tosic. 

K    Fluid  extract  ot  cinchooft 3  8. 

Diluted  photphoric  uid 3  10. 

Glycerin 3   4. 

Sherry  irine 5  lOi- 

The  above  was  the  formula  of  the  "glycerin  tonic"  used  so 
much  by  the  late  Dr.  John  P.  Gray,  of  the  New  York  State  Luna- 
tic Asylum. — DruggiaW  CHreiUar. 


A  Fill  fob  Miobainb. 
The  Journal  des  practieiem  for  January  29th  gives  the  follomng 
formula : 

B    QuiDlae  Tslerianate ligr. 

Caffeine  citrate jgr. 

Bitract  of  Indian  hemp fii>  S'- 

H.    Two  or  three  luch  pilU  to  be  taken  dally. 

— N.  Y.  Med.  Jowmal. 


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ATLANTA 

Medical  and  Surgical  Journal. 

Vol.  XV.  APRIL,  1898.  No.  2. 

M.  B.  HUTCHINS,  M.D., 


ORIGINAL  COMMUNICATIONS. 


THE  PATHOLOGY  AND  DIAGNOSTIC  VALUE  OF 
PAIN. 

By  J.  CLARENCE  JOHNSON,  M.D., 

Atlanta,  Ga. 

Id  the  crowdiDg  cares  of  a  doctor's  life  he  has  little  time  for 
Mady  of  many  questiooe  that  vitally  coDcern  the  exactness  of 
bis  work.  We  are  therefore  incliued  to  accept  the  relics  n(  o»r 
predecessor's  faith,  and  follow  beaten  paths  that  lead  to  oft.-repeated 
disappoiotments.  Made  restless  by  defeat,  we  turn  with  exagger- 
ated zeal  to  new  remedies  and  methods  that  promise  improved  re- 
sults, and  with  devotion  thus  misplaced,  neglect  the  material  ele- 
ments of  scientific  progress  and  success. 

The  topic  which  I  have  chosen  for  discussion  may  seem  out  of 
date;  but  faces  never  grow  so  familiar  that  some  feature  may  not 
1>e  lost  to  memory  or  dimmed  beyond  the  probability  of  prompt 
and  perfect  recognition.  So,  there  is  do  principle  in  medicine  so 
well  established  that  it  may  not  be  controverted,  no  fact  that  may 
not  be  modified  by  eager  search  for  truth.     It  is  not  amiss  to  take 


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74         The  Atlanta  Medical  and  Surgical  Journal. 


lal  inveatory  of  our  knowledge,  and  circumspectly  watch 
our  wayj  though  apparently  not  in  need  of  thought  or  care. 

There  are  many  physicians  who  have  never  seen  a  case  of  cholera, 
but  therf  is  not  one  who  fails  to  witness  suffering  every  day.  It 
is  such  a  common  attendant  of  disease  that  we  are  apt  to  regard  it 
an  essential  part,  worthy  only  of  that  consideration  which  the  pa- 
tient has  a  right  to  expect  or  demands  towards  its  relief. 

The  highest  office  of  a  physician  is  embodied  in  the  well-known 
maxim,  "  Curare  cito,  into  et  jucunde."  Especially  is  it  our  duly 
to  accomplish  the  last  when  consistent  with  a  safe  and  rapid  cure. 
But  the  ready  means  at  our  command  are  too  often  abused  in  our 
haste  to  respond  (o  the  solicitude  of  sympathizing  friends,  or  the 
urgency  of  the  sufferer  himself,  thereby  obscuring  an  important 
factor  in  accurate  diagnosis. 

Pain  is  the  natural  language  of  an  organ  diseased,  as  is  the  cry 
of  a  babe  its  speed)  for  hunger,  or  indication  of  distress;  and  its 
character,  like  the  character  of  the  cry,  points  to  the  seat  and  na- 
ture of  the  cause. 

You  are  all  too  ^miliar  with  the  various  forms  of  pain  for  me 
to  dwell  upon  them  here.  It  is  enough  to  say  that  they  differ  with 
the  structure  of  the  jttirt  diseased,  its  relation  to  other  parts,  aud 
the  degree  and  extent  of  morbid  action  which  produces  them. 
Unfortunately,  the  description  of  {>ain  must  l>e  vague  at  best,  be- 
cause it  cannot  be  seen,  nor  can  its  intensity  be  measured  or  ex- 
pressed. It  can  only  be  felt  and  estimated  by  the  patient  himself. 
To  him  exactness  is  impossible,  for  it  so  engages  his  power  of  re- 
sistance that  the  departure  from  the  normal  state  of  conscious 
sensation  is  roagnitied.  While  its  manner  is  obvious,  and  more  or 
less  consistent,  it  is  influenced  by  the  habit  of  the  subject  and 
mental  agitation.  So  that,  pain  of  the  same  degree  aod  character, 
arising  from  a  similar  cause  and  condition,  appears  more  violent  in 
one  individual  than  another,  or  seems  to  exist  where  it  is  not  pres- 
ent, or  an  actual  part  of  the  disease. 

Yet,  when  brought  to  the  last  analysis,  we  roust  admit  that  so- 
called  imaginary  ills  are  practically  real,  though  the  nature  of 
their  reality  may  escape  our  detection  or  bafBe  our  comprehension. 
We  cannot  state  positively  that  a  patient  has  or  has  not  pain.     We 


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The  Pathology  and  Diagnostic  Value  of  Pain.        75 

can  only  know  by  scientitic  reasoo  that  it  is  a  natural  sequence  or 
attendant  of  certain  morbid  actions,  and  apply  the  evidence  ad- 
duced to  the  determination  of  its  presence,  severity,  and  character. 

Hence  the  ignorance  that  veils  the  pathology  of  diseases  in  which 
pain  is  the  predominant  or  exclusive  symptom — bearing  a  name 
that  only  indicates  its  seat  and  existence. 

Pain  is  not  an  entity,  not  a  disease,  but  a  part  and  product  of  a 
pathological  process,  the  physiology  of  abnormal  sensation,  the 
.symbol  of  perverted  function;  as  delirium  is  of  disordered  intel- 
lection, and  convulsions  of  incoordinate  muscular  contraction. 

Therefore,  ia  seeking  to  ascertain  the  cause  of  pain  and  the  man- 
ner of  its  production,  we  must  look  to  the  source  and  conduct  of 
normal  sensation.  It  is  thus  rendered  easily  apparent  that  it  arises 
from  perverse  generation  or  distribution  of  sensory  impressions,  in 
any  event  involving  a  material  change  in  the  jiart  or  parts  affected. 

Engorgement  of  the  meninges  may  excite  central  or  peripheral 
pain,  but  preceding  or  attending  the  engorgement  is  an  alteration 
of  metabolic,  cardiac,  or  vascular  action. 

Normal  sensation  consists  in  the  reception  by  a  sensory  ganglion, 
or  cell,  of  an  impression  made  upon  a  tactile,  Pacinian,  or  Veta's 
•corpuscle,  or  an  end  bulb,  conveyed  thither  by  a  centripetal  fila- 
ment. It  becomes  a  conscious  sensation  when  it  reaches  the  cere- 
brum. While  reflex  action  from  peripheral  irritation  may  give 
rise  to  the  sensation  of  pain  at  the  point  of  irritation,  there  is  in 
reality  do  pain  without  intelligent  reception — as  there  is  no  sound 
from  coDCussion  of  the  air  without  an  ear  to  bear  it. 

The  relation,  then,  which  any  part  or  organ  of  the  body  sus- 
tains to  other  parts  is  rendered  conscious  and  appreciable  by  the 
■exercise  of  the  sensory  functions,  as  exhibited  in  the  phenomena  of 
health  and  disease.  Anything  that  increases  the  impressionability 
of  the  sensory  corpuscles  or  receptivity  of  the  sensory  ganglia, 
lessens  to  the  same  extent  the  general  power  of  resistauce  and  fa- 
vors the  production  of  pain. 

The  normal  action  of  the  sensory  corpuscles  or  ganglion,  like 
the  function  of  any  oi^n,  depends  upon  a  normal  state  of  nutrition, 
which  in  turn  depends  upon  the  quantity  and  quality  of  its  blood 
supply,  and  the  elective  and  appropriative  capacity  of  its  constitu- 


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76         The  Atlanta  Medical  and  Surgical  Journal. 

eat  cells.  So,  their  susceptibility  may  be  increased  or  dimiDisheiJ 
by  a  perverted  nutrition — the  result  of  direct  interference  with  their 
metabolism,  as  from  violeace  or  pressure,  or  a  vitiated  pabulum- 
Direct  irritation  of  a  sensory  ganglion  does  not  cause  pain.  A 
ganglion  can  only  receive  the  impression,  and  by  reference  to  other 
parts,  through  jn  e^rent  filament,  transform  it  into  a  sensation. 
The  ultimate  effect  of  the  impressiou  is  governed  by  the  manner 
of  reception  and  transmission  to  a  cooscious  center,  and  the  toler- 
ance of  the  general  system,  the  power  of  resistance  which  is  or  can 
be  exercised.  The  nature  of  the  tolerance  and  extent  of  resist- 
ance is  inversely  proportionate  to  the  susceptibility  of  the  individ- 
ual; the  more  highly  organized,  being  more  susceptible,  have  less, 
and  tftee  versa.  By  the  same  associative  action  are  the  reflex  mani- 
festations controlled. 

If,  then,  from  any  cause,  the  function  of  a  corpuscle  or  ganglion 
is  exalted,  the  intensity  of  the  sensation  will  be  exaggerated,  as 
emotion  inflames  a  mind  diseased,  or  light  affects  an  irritated  eye. 
The  converse  is  true.  If  the  function  is  restrained,  the  intensity 
of  the  sensation  will  be  lessened,  as  is  demoustrated  by  the  action 
of  anesthetics  and  anodynes. 

So,  in  organic  changes  thus  affecting  the  sensory  surface  and 
centers,  impressions  that  would  create  no  pain  or  awaken  no  con- 
scious sense  may  induce  severe  discomfort.  The  habit  of  conduc- 
tion, the  relation  of  the  sensory,  motor,  and  trophic  systems  is  em- 
phasized, and,  in  consequence,  the  functional  activity  of  the  parts^ 
which  they  iu  common  supply  is  deranged. 

It  thus  appears,  that  in  the  pathology  of  pain  not  only  the  cor- 
puscles and  the  ganglia,  but  the  whole  economy,  is  involved;  that 
each  oi^D  contributes  to  the  general  power  of  resistance,  and  iu 
so  doing  surrenders  a  proportionate  degree  of  its  vital  capacity  and 
official  esercise.  The  expression  of  pain  is  the  result  of  this  con- 
certed action. 

By  applving  these  observations  to  the  various  forms  of  pain,  and 
the  conditions  from  which  they  arise,  we  will  he  able  to  estimate 
their  diagnostic  value  and  importance. 

For  convenience,  pain  may  be  divided  into  three  classes: 


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The  Pathology  and  Diasnostic  Value  op  Pain.        77 

1.  That  occurring  in  the  abseuce  of  appreciable  organic  change 
in  the  tissues  involved,  being  the  chief  or  exclusive  symptom. 

2.  That  occurring  without  appreciable  oi^nic  change,  attended 
by  other  symptoms. 

3.  That  accompanied  by  organic  change,  and  obviously  depend- 
ent upon  it. 

We  are  all  familiar  with  the  nature  of  pain  as  it  occurs  in  the 
process  of  inflammation,  and  know  that  it  is  the  result  of  irritation 
of  the  end  filaments  of  the  nerves  by  the  products  of  the  morbid 
actioD,  in  which  the  filaments  themselves  participate.  We  know 
that  the  character  of  the  pain  is  governed  by  the  abundance  of  the 
nerves  and  the  presence-or  absence  of  elastic  tissue  in  the  part  dis- 
eased. Thus  we  are  enabled  to  distinguish  the  pains  of  pleurisy 
and  pneumonia,  of  cellulitis  and  whitlow. 

Our  task  is  not  so  easy  when  we  attempt  to  comprehend  the 
meaniug  and  explain  the  value  of  pain  in  the  absence  of  oi^anic 
chauge. 

A  man  eats  heartily;  soon  thereafter  he  is  seized  with  gastric 
pain,  or  pain  between  the  shoulder  blades,  or  in  the  dorsal  region 
of  the  spine.  We  know  that  indigestion  is  the  cause,  but  bow? 
There  was  no  previous  engorgement  of  the  capillaries  beyond  the 
normal.  There  is  no  excess  or  lack  of  acid  suEBcient  to  so  irritate 
the  sentient  surface.  It  is  not  produced  by  mecbanieal  pressure  of 
the  food,  because  at  another  time  he  eats  more  heartily  without  the 
least  discomfort.  Besides,  if  this  were  so,  pain  would  follow  nor- 
mal distension  of  the  bladder,  or  ordinary  active  thought.  The 
explanation  rests  in  the  fact  that  the  whole  anatomy  of  the  stom- 
ach is  engaged  in  the  eflbrt  to  discharge  its  function,  each  constit- 
uent part  contributing  more  than  its  usual  share,  each  thus  becom- 
ing more  sensible  of  impressions  and  disposed  to  perversion.  The 
nerves,  with  susceptibilities  increased,  exaggerate  the  impression 
they  receive  and  direct  them  to  their  centers,  whence  abnormal 
force  is  discbai^ed  to  the  muscular  coats,  and  spasm  is  the  result. 
Irritation  is  intensified.  The  impressions  are  conveyed  to  the 
spinal  ganglia  by  the  splanchnic  nerves,  and  here  are  formed  sen- 
sations  which  are  reflected  to  the  back  and  stomach,  recognized 
as  aches  and  pains. 


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78         The  Atlanta  Medical  and  Suroical  Journal. 

The  same  process  substaDtially  obtains  in  astigraatic  paios,  aii<{ 
in  myalgia  from  muscular  exbaustiou,  and  id  neuralgia  from  any 
cause  that  similarly  affects  the  activity  or  integrity  of  the  nerve 
supply,  as  anemia  or  malaria.  It  likewise  follows  inordinate  men- 
tal exercise,  worry,  or  overwork. 

But  it  is  that  form  which  attends  febrile  and  other  diseases  of 
idiopathic  nature  that  is  most  difficult  of  comprehension. 

Fever  affects  every  part  and  function  of  the  tiody.  Pain  is  ao- 
initiatory  symptom.  Does  the  elevated  temperature  cause  the  pain, 
or  is  the  pain  associated  in  the  production  of  the  fever  ?  The 
solution  of  this  question  will  throw  important  light  upon  the  ex- 
pediency of  agents  which  at  the  same  time  reduce  the  fever  and 
allay  the  pain,aa  the  coal-tar  preparations. 

There  are  remedies  that  will  relieve  the  pain  and  not  reduce  the 
fever.  There  are  also  those  which  will  reduce  the  fever  and  not 
remove  the  pain.  Besides,  the  intensity  of  the  pain  is  not  always- 
measured  by  the  degree  of  fever.  It  is  true  that  the  centers  which 
control  the  generation  of  heat  and  preside  over  common  sensations 
are  intimately  related,  so  that  one  can  hardly  be  affected  without 
disorder  of  the  other.  Yet  it  is  in  the  general  departure  from  the 
healthy  state  alone  that  both  can  have  their  source,  and  in  the  op- 
eration of  the  exciting  cause  must  we  find  the  answer  to  our  ques- 
tion. 

In  the  action  and  reaction  of  the  febrile  process,  the  sensory,  mo- 
tor, and  trophic  systems  are  all  involved.  Compensatory  functions 
are  engaged  to  supply  the  needs  ot  organic  life.  Voluntary  action  is 
economized.  Every  power  is  enlisted  to  thwart  the  insidious  de- 
cay. Yet  waste  exceeds  repair.  Vitality  is  lowered,  conduction 
of  impressions  is  opposed,  sensation  is  obtunded,  and  pain  is  lost 
to  consciousness,  or  disappears.  But  the  fever  rises  higher,  and 
continues  until  nature  is  subdued  or  reasserts  her  sway. 

It  is  not  within  the  province  of  this  paper  to  consider  at  length 
special  pains  or  pains  attending  special  diseases.  A.  iew  examples- 
will  suffice  to  illustrate  the  principles  I  have  undertaken  to  estab- 
lish. 

An  arm  is  amputated.  Months  or  years  subsequent  to  the  ope- 
ration pain  is  felt  in  the  part  removed.     The  spinal  meninges  are 


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The  Pathology  and  Diagnostic  Value  op  Pain.        79 

inflamed,  the  patient  suffers  pain  throughout  the  thorax,  abdomen, 
aad  eitremities  at  points  and  in  directions  of  the  nerves  which  are 
impreesed. 

Disease  of  the  bip-joiat  causes  pain  in  the  knee,  and  dislocation 
of  the  humerus  pain  in  the  hand,  demonstrating  the  fact  that  sensa- 
tion is  referred  to  the  extremity  of  a  nerve.  But  pain  is  not  always 
tiius  disposed.  According  to  its  intensity  it  is  local,  symmetrical  or 
generalized;  and  a  knowledge  of  its  source  and  meaning  only  re- 
quires careful  tracing  of  the  filaments — through  which  it  is  re- 
flected— to  their  ganglionic  centers,  and  the  distribution  of  other 
filaments  having  the  most  intimate  anatomical  and  physiological 
relation  to  them. 

Pain  in  the  ear  is  a  common  symptom  of  a  carious  tooth,  which 
is  easily  explained  by  the  fact  that  both  are  supplied  with  sensation 
by  the  trigeminal  nerve.  So  it  is  with  neuralgia  of  the  eye  and 
other  parts  of  the  face. 

The  frequency  of  pain  in  the  head  is  due  to  constant  exercise  of 
(be  functions  by  which  directive  agency  is  maintained  over  other 
oi^ans  of  the  body.  The  causes  are  manifold,  but  the  pathology 
is  essentially  the  same. 

One  of  the  most  interesting  forms  of  pain  is  that  attending 
Iibor,  Labor  is  ordinarily  a  physiological  process.  The  pain  is 
consonant  with  uterine  contraction,  and  is  supposed  to  be  caused 
by  pressure  on  the  nerves.  Be  that  as  it  may,  it  is  obvious  that 
there  are  other  factors  in  its  pioduction.  First,  an  impression 
most  be  made  upon  the  sensory  supply,  which  being  conveyed  to 
the  sacral  ganglia,  originates  ao  impulse  that  is  sent  to  the  mus- 
cular fibers  of  the  womb,  and  they  contract.  New  impressions 
thus  arise,  with  similar  results,  and  these  successive  acts,  favored 
by  the  susceptibility  of  the  pregnant  state,  and  the  general  contri- 
bution to  the  expulsive  efibrts,  intensify  the  pain.  Whether  we 
should  class  this  as  pathological  will  depend  upon  our  construction 
of  the  divine  injunction,  "In  sorrow  shalt  thou  bring  forth  chil- 
dren." 

Finally,  what  is  the  pathology  of  hysterical  pain  ?  We  have  a 
patient  who  complains  that  ^he  has  pains  of  this  or  that  kind, 
here  or  there.     There  is  no  acceleration  of  the  pulse,  perhaps,  no 


^dbyGoOgle 


80         The  Atlanta  Medical  and  Surgical  Jodrnal. 

rise  of  temperature,  no  objective  symptoms  that  confirm  the  truth 
of  her  assertion.  We  have  no  doubt  that  she  is  suffering,  or  be- 
lieves it  strongly.  We  have  no  doubt  there  is  a  cause  for  ibis  effect, 
and  we  term  it  diseased  imagination.     But  has  she  really  pain? 

There  are  other  symptoms  of  hysteria  that  will  aid  in  our  de- 
cision. Ko  one  doubts  a  phantom  tumor,  or  the  occurrence  of 
eclampsia.  We  all  know  that  these  phenomeDa  are  possible  only 
by  diseased  fasciculi,  abnormal  generation  or  distribution  of  motor 
force.  What  is  delirium  tremens  but  disordered  intellection  and 
reception  of  diseased  impressions — the  natural  sequence  of  meta- 
bolic inhibition  or  perversion.  Truly  does  the  drunkard's  eye,  in 
fiery  frenzy  rolling,  body  forth  the  forms  of  things  unseen,  and 
give  to  airy  nothing  a  menacing  presence  and  a  name.  But  to 
his  tortured  brain  the  snakes  and  devils  are  as  real  as  if  be  felt 
their  poisonous  fangs,  or  stifled  iu  their  ruthless  clutch. 

Fain  is  consciousness  diseased,  or  knowledge  of  diseased  sensa- 
tion. The  mind  cannot  form  impressions;  it  can  create  thought 
and  govern  their  relatiou.  All  ideas  in  a  healthful  mental  state 
are  consistent  with  the  natural  sense.  Therefore,  if  pain  appa- 
rently exists,  it  must  have  reality  and  a  cause  somewhere. 

So  is  ])ain  produced.  So  are  its  secret  ways  made  manifest,  and 
by  its  character  and  conduct  is  its  value  known.  Though  intangi- 
ble and  unseen,  it  betrays  its  habitation  and  source  of  power,  and 
enables  us  to  offer  open  combat  to  man's  most  potent  and  relent- 
less foe. 


SOME  CASES  OF  DRUG  HABIT.* 

By  0.  C.  'BTOCKA.ED,  M.D., 

Atlanta,  Ga. 

I  feel  that  I  ought  to  apologize  to  those  present  for  presenting  a 
subject  in  which  so  few  of  us,  apparently,  are  interested.  It  is 
because  of  the  fact  that  I  think  the  profession  needs  arousing  te 
the  importaoce  of  drug  habituation,  for  the  benefit  of  society  in 
general,  and  also  that  such  a  large  number  among  our  own  ranks 

•ftoad  belan  Uie  AtUnU  Bocletf  of  Hedlcloe,  Febnur;  3,  ISSe. 


^dbyGoogle 


Some  Cases  of  Druq  Habit.  81 

are  lalliDg  victims  to  morphia,  cocain,  etc.,  that  I  call  your  atteii- 
tioD  to  the  steady  increase  id  the  number  of  drug  habitues,  and  the 
fearful  cousequences  to  all  connected  with  the  victims.  Since  the 
invention  of  the  hypodermatic  syringe  these  cases  have  rapidly 
increased,  as  shown  by  the  numerous  advertised  cures  and  institu- 
tions for  the  treatmeot  of  them,  iu  both  the  lay  and  medical  press. 

There  seems  to  be  a  fascioatioD  about  tbe  syringe  which  causei^ 
the  patient  to  more  rapidly  increase  tbe  doses  taken  than  when  used  by 
the  stomach,  and  the  evil  consequences  are  proportionately  greater. 
I  have  on  hand  now  a  patient  who,  after  twenty  years  as  an  opium 
habitu^,  came  to  me  taking  one  drachm  of  laudanum  three  times  a 
day.  On  the  other  band,  in  a  recent  letter  from  a  lady  in  regard 
to  her  brother  ahe  stated  that  he  had  used  morphia  hypodermatic- 
ally  twelve  years  and  cocaio  four,  and  that  last  year  he  had  run  tbe 
cocain  up  to  three  drachms  per  day,  and  she  didn't  know  bow  much 
morphia. 

I  heard  recently  of  a  morphinist,  himself  treating  the  habit,  who 
took  within  forty-eight  hours  ten  drachms.  It  is  only  a  matter  of 
wonder  that  this  sort  of  drugging  does  not  kill  more  rapidly  than 
it  does. 

The  treatment  of  drug  habitues  fails  of  success  in  a  large  pro- 
portion of  cases  because  few  of  tbem  are  able  to  pay  for  treatment 
sufficiently  long  to  insure  permanent  results.  The  customary 
method  is  to  send  tbe  patient  home — or,  rather,  for  him  to  go 
home  for  want  of  money — after  remaining  four  to  eight  weeks  in 
an  institution,  and  the  too  frequent  consequence  is  that,  owing  to 
sleeplessness  or  some  slight  ailment,  he  returns  to  his  syringe, 
when  a  few  months  more  of  huilding-up  treatment  and  proper 
moral  support  would  have  been  sufficient  to  enable  him  to  resist  in 
the  future. 

It  seems  that  the  time  is  not  far  off  when  it  will  he  necessary  for 
legislatures  to  make  provision  for  tbe  oare  of  these  people,  as  is 
done  for  the  insane;  and  also  more  rigid  laws  governing  the  sale 
of  drugs  likely  to  be  bought  by  babitu^s. 

I  give  below  brief  histories  of  a  few  cases  I  have  treated  in  tbe 
past  two  years: 

Case  1. — Dr.  ,  aged  about  fifty,  a   man  of  fine  physique. 


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82         The  Atlanta  Mbdical  and  Surgical  Journal. 

highly  educated  aod  iotelligent;  had  been  a  successful  specialist  in 
a  Nurtbern  city.  He  had  beeu  using  morphia  hypodermatically 
for  twenty  years,  having  contracted  the  habit  while  reeident  physi- 
cian of  a  Boston  hospital.  He  stated  that  he  had  been  broken  of 
the  habit  once  or  twice.  He  was  taking  twenty  grains  per  day  in 
four  or  five  doses.  Had  at  one  time  taken  coeain;  had  been  a 
heavy  drinker  of  beer  and  whisky,  and  frequently  put  himself  to 
sleep  inhaling  chloroform.  I  followed  with  him  the  Mattison  plan, 
taking  away  the  morphia  in  about  ten  days;  but  at  the  end  of  five 
weeks,  at  which  time  be  left,  he  was  still  taking  two  or  three  grains 
of  codeine  phosphate  per  day,  and  though  he  repeatedly  told  me 
that  he  left  off  the  codeine  and  took  no  morphia  until  about  four 
months  after,  wben  he  had  an  inflammation  of  tbe  knee  which  has 
laid  him  up  the  past  eighteen  montbSj  still  X  always  believed  that 
he  went  back  to  his  morphia  immediately  after  leaving  me.  Dur- 
ing and  after  the  withdrawal  of  the  drug  be  suffered  from  cramps, 
vomiting,  diarrhea  and  sleeplessness.  He  was  continually  threat- 
ening to  kill  himself  and  made  several  attempts — one  time  remov- 
ing tbe  tube  from  a  small  gas  stove,  turning  on  the  gas,  and  going 
to  bed  with  the  tube  in  his  mouth. 

Case  2. — Dr. ,  four  years  before  coming  to  me,  had  begun 

the  use  of  morphia  while  suffering  from  an  infected  finger.  He 
had  at  times  combined  coeain  with  morphia,  and  when  he  came  to 
me  had  been  using  coeain  for  a  week  or  two.  This  was  immediately 
withdrawn,  and  the  morphia  rapidly,  so  that  iu  four  weeks  he  was 
in  very  good  condition  and  insisted  on  returning  to  work.  About 
two  months  later  he  returued,  stating  that  for  a  cold  he  had  taken 
antikamnia  and  codeine,  and  tbe  next  morning  a  bypodermic  of 
morphia.  This  occurred  about  three  weeks  after  leaving  me,  and 
on  his  return  he  was  using  about  three  grains  per  day.  At  this 
time  (just  a  short  while  before  moving  into  the  Atlanta  Retreat)  I 
was  not  prepared  to  care  for  such  a  case  properly,  but,  as  he  had 
gotten  on  eo  nicely  before,  I  anticipated  no  trouble  and  undertook 
tbe  case.  Things  weut  very  well  till  hts  dose  of  morphia  was  getting 
pretty  small,  wben,  one  night,  though  I  had  taken  tbe  precaution 
to  take  his  shoes  from  tbe  room,  he  went  out  shod  with  slippers, 
filled  up  on  whisky,  and  also  supplied  himself  with  coeain.     After 


^dbyGoogle 


Some  Cases  of  Drdq  Habit.  fiS- 

a  few  days  lie  began  to  write  voluminous  letters  and  poetry,  and 
then  a  few  days  later  hallucinations  developed.  He  thought  the 
people  in  the  house  were  watching  his  actions  and  were  talking 
about  and  planning  against  him.  These  hallucinations  grew  stead- 
ily worse  until  the  sparrows  singing  in  tbestreets  were  talking  about 
him,  the  ticking  clock  was  a  telegraph  machine  of  some  sort,  through 
which  people  were  communicating  about  and  plotting  against 
him.  After  his  worst  day,  and  when  I  feared  I  should  have  to 
send  him  to  Milledgeville,  I  gave  bim  at  bedtime  fifty  grains  of 
sudinm  bromide  and  thirty  of  trional.  He  went  to  sleep  promptly 
and  slept  soundly  until  half-past  five  next  morning,  when  he  sprang 
from  his  bed  yelling,  "What  does  this  mean?"  I  went  in  and 
8[Kike  to  him,  when  he  said,  "Thank  God!  it  isn't  done,  but  you 
didn't  keep  it  from  being  done."  I  asked,  "  What  are  you  talking 
about?"  when  he  replied,  "Those  men  were  trying  to  castrate  me 
by  electricity."  I  had  the  night  previous  arranged  it,  and  imme- 
diately telephoned  for  a  policeman,  who  took  him  to  the  police  sta- 
tion to  keep  him  until  I  could  arrange  for  sending  him  to  the- 
asylum.  Here  he  soon  began  to  sober  up,  and  told  me  that  he  had 
been  taking  cocain.  He  got  no  more,  and  in  forty-eight  hours  bad 
sii£Bciently  recovered  his  reason  for  me  to  take  him  back  borne. 
At  evening,  for  a  few  days,  there  would  be  some  return  of  ballu- 
noations,  but  he  improved  steadily  and  in  a  few  weeks  returned  to 
bis  home,  and  is  now  doing  well  at  practice,  having  gone  about  a 
fear  without  relapse. 

Case  3. — Dr. .     This  case  I  relate  to  illustrate  how  one  who 

is  not  of  the  temperament,  or  has  nof  inherited  neurotic  tendencies- 
predisposing  to  this  sort  of  thing,  can  take  morphia  a  long  time 
without  carrying  it  to  the  escess  common  to  habitu^.  For  six 
years  this  man  has  suffered  from  myelitis,  produced  by  accident,, 
being  completely  paralyzed  from  the  waist  down,  with  inability  to 
void  feces  or  urine,  vomiting  during  nearly  all  these  years  from  one- 
to  Gftytimes  a  day,  and  feeling  all  the  time  as  though  a  log  were  lying 
across  his  body,  crushing  it;  and  yet  was  taking  only  two  and  a 
half  grains  of  morphia  per  day.  In  this  condition  he  does  con- 
siderable practice,  performing  a  good  many  surgical  operations.  A 
man  of  remarkable  courage  and  nerve  he  is.     He  thought  bis  gen- 


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S4         The  Atlanta  Medical  and  Surgical  Journal. 

•erai  health  bad  improved  latterly,  and  that  if  be  could  leave  off  his 
morphia  be  would  be  better,  but  after  a  few  weeks'  trial  I  advised 
him  not  to  go  further  with  it,  believing  that  there  was  Dotbiug  else 
Avhich  would  give  him  any  relief  from  hie  paio  with  as  little  inju- 
rious effect. 

Case  4, — Mrs. ,  aged  about  thirty,  had  uaed  morphia  hypo- 

^ermatically  tor  five  years,  and  was  taking  twenty-five  graiue  per 
day.  Had  twice  been  treated  by  a  guarantee  cure  establish  ment, 
but  was  given  up  because  &he  had  an  inflamed  external  hemorrhoid, 
which  the  man  in  charge,  not  a  physician,  did  not  know  how  to 
relieve,  and  hence  advised  her  that  she  could  not  stand  tt  without 
morphia.  I  had  less  trouble  with  her  than  with  any  case  I  have 
•ever  treated,  getting  her  entirely  off  in  four  weeks.  Though  her 
general  health  is  not  good,  up  to  a  tew  weeks  ago  she  was  still  hold- 
ing out,  though,  living  in  the  house,  as  she  does,  with  two  habitues, 
it  will  be  remarkable  if  she  does  not  go  back  to  it. 

CaseS. — Dr. f&gfid  about  forty-five,  was  struck  by  lightning 

About  two  years  ago,  and  afterward  had  typhoid  fever.  These  were 
followed  by  the  development  of  attacks  resembling  angina  pectoris!. 
He  would  be  taken  suddenly  with  violent  pain  in  the  cardiac 
region,  which  he  described  as  feeling  like  a  red-hot  knitting  nee- 
dle was  thrust  through  the  heart  and  withdrawn.  With  these 
attacks  were  spasms  of  various  muscles,  half-purposive  movements, 
and  I  promptly  told  him  that  he  had  a  good  case  of  hysteria.  Drs. 
Finckney  and  Hagan  both  saw  him  and  agreed  with  my  diagnosis, 
the  latter  suggesting  a  trial  of  hypnotism,  for  which  he  proved  to 
be  an  unusually  ready  subject.  After  Dr.  Hagan  had  hypnotized 
him  I  repeated  it  a  number  of  times.  While  hypnotized  be  was 
given  the  suggestion  that  he  would  have  do  more  of  the  spells  aod 
would  want  no  morphia.  The  first  day  he  had  no  morphia 
he  complained  some  of  his  knees,  and  said  that  if  I  would  brace 
them  he  would  be  all  right.  They  were  braced  by  hypnotic  sug- 
gestion, and  that  was  the  last  of  it.  There  was  never  a  spell  after 
the  first  hypnotism,  and  now,  afler  three  months,  h«  is  perfectly 
well — no  spells,  no  desire  for  morphia.  He  has  been  gaining  about 
iialf  a  pound  a  day. 


^dbyGoOgle 


Some  Cases  of  Drco  Habit.  85- 

I  believe  with  Dr.  Howard,  of  Baltimore,  that  in  proper  Bub- 
jecte  hypDOtism  will  give  better  results  ia  drug  habits  thau  any 
other  method  or  treatmeot. 

Case  6. — Dr. ,  aged  thirty-one,  a  man  with  do  family  history 

or  Deurolic  predispositioQ,  about  four  years  ago  had  his  druggist 
give  bim  a  souff-powder,  for  cold,  which  he  was  io  the  habit  of 
prescribing.  From  this  start  he  had  cootioued  and  soon  used  the 
pure  hydrochlorate  of  cocain,  always  snuffing  it  up  the  nostrils. 
Two  mouths  before  comiug  to  rae  he  had  left  off  the  cocain  and. 
took,  for  nervousness  and  sleeplessness,  bromodine,  and  was  taking 
at  the  time  of  coming  to  me  two  ounces  per  day.  So  he  was  tak- 
ing half  an  ounce  each  of  chloral  and  potassium  bromide,  besides 
cannabis  indica,  byosciamus,  etc.  I  put  him  on  tonic  treatment,, 
gave  trional  for  a  few  nights,  and  letl;  off  bromide  at  once.  He 
improved  rapidly  and  went  home  at  the  end  of  three  weeks.  In  a 
letter  recently  received  he  says  he  is  well.  Not  being  of  neurotic 
disposition,  I  think  be  got  into  this  habit  purely  by  accident,  and 
I  do  not  apprehend  any  relapse  in  his  case. 

It  will  be  seen  that  live  out  of  these  six  cases  reported  are  doc- 
tors. This  does  not  represent  the  proportion  of  doctors  among  all 
the  cases  I  have  treated;  still,  the  proportion  is  very  large — sixty- 
six  per  cent.  This  large  proportion  of  doctors  ia  accounted  for  by 
the  fact  that  doctors  are  less  disposed  to  go  to  the  advertising 
quacks,  but  still  there  are  a  larger  proportion  of  doctors  addicted 
to  drug  habits  than  any  other  class  of  our  citizens,  and  I  would  par- 
ticularly waru  my  professional  brothers  to  be  cautious  about  taking 
any  of  these  drugs,  and  especially  by  the  hypodermatic  method. 


Codeine  as  Analgesic. 
The  following  solution  of  codeine  is  recommended  by  Dr.  I.  J. 
Jones,  of  Austin,  Texas,  as  a  good  analgesic   mixture  in   place  of 
morphine. — (^Texaa  Med.  News. ) 

B    Codeine  sol ph gr.  s»ii. 

Spir.  amm.  ar. 3vi. 

Sp.  rect S  i> 

Syr.aurant.  cott q.  b.  J  iv. 

Sig. :    One  to  three  teaspooofuls  once  or  twice  daily. 


^dbyGoOgle 


The  Atlanta  Medical  and  Sdroical  Journal. 


SOME  OF  THE  EARLY  EXPERIENCES  OF  AN 
OLD  PHYSICIAN. 

Bt  G.  G.  rot,  M.D., 
Atlanta,  Oa. 

In  the  March  number  of  The  Journal  I  gave  a  history  of  my 
first  patient,  in  1857.  It  caoDot  be  so  well  appreciated  by  the 
young  physicians  of  this  day  as  by  those  who  began  practice  in 
the  South  when  negroes  were  the  property  of  their  owners,  and 
very  valuable  property,  the  care  and  preservation  of  which,  sepa- 
rate and  apart  from  the  standpoint  of  the  humanitarian,  was  en- 
hanced by  the  more  sordid  motive  of  self-interest.  It  was  losing 
money  to  lose  a  negro  by  death,  and  it  was  saving  money  to  save 
the  life  of  one  when  ill.  Consequently,  in  those  days  the  negro 
when  sick  received  the  moat  skilful  medical  attention,  the  very 
best  nursing,  and  every  comfort  was  added  to  these  that  could 
increase  the  chances  of  recovery. 

The  young  physician  who  was  fortunate  enough  to  get  the  prac- 
tice of  two  or  three  large  plantations  had  a  bonanza.  Bills  then  were 
more  easily  collected  and  they  were  paid  more  readily  and  cheer- 
fully than  our  bills  are  at  this  progressive  age  of  American  free- 
■dom. 

Negroes  were  then  superstitious,  very;  believed  in  "cunjnra- 
tion,"  being  "tricked,"  and  in  ghosts,  hobgoblins,  jack-o'-lanterns, 
etc.  Nor  are  they  now,  with  the  millions  of  dollars  expended  yearly 
for  their  education,  in  these  respects  very  far  removed  from  those 
innate  conditions  of  the  old  Southern  slave.  Superstition  is  an 
instinct  or  intuition  of  the  uegro,  and  it  will  not  down  by  educa- 
tion, and  it  will  not  desert  the  race  until  every  vestige  of  the  char- 
acter of  the  old-time  Southern  darky  is  purged  from  the  world. 
Aud  when  that  is  done  the  race  will  be  extinct  in  the  land. 

But  I  began  to  tell  of  my  second  patient  when  I  started  out  as  a 
full-fledged  doctor.  I  was  called  t«  see  a  man  with  whom  I  grew 
up  from  a  boy.  He  had  developed  into  an  oysterman  and  fisher- 
man, a  very  lucrative  business  in  those  days.     He  lived  near  the 


^dbyGoOgle 


SoMB  Early  Experiences  of  an  Old  Physician.        87 

RappahaDDock  river  Id  tidewater  Virginia,  noted  the  world  over 
for  itB  fine  oysters  and  fish — especially  the  former.  Tom  was 
expert  at  both,  and  bad  been  very  successful,  not  only  in  this  busi- 
ness, but  more  so  as  a  dram-drinker.  The  shores  of  tbe  river  in 
that  section  of  the  State  were  studded  with  little  groceries,  all  of 
which  dispensed  liquors.  This,  too,  was  a  profitable  business; 
they  were  tbe  catch-nets  for  the  money  ot  the  oystermen  and  fish- 
ermen. Toni  began  moderately,  and  kept  this  up  for  several  years ; 
finally  the  habit  grew  and  he  became  a  sot,  and  by  this  time  he  had 
produced  what  the  doctors  know  as  an  alcoholic  or  whisky  liver. 
Tbe  inevitable  result  soon  followed — general  dropsy.  And  Ibis  was 
his  condition  when  I  was  called  to  see  him.  On  my  road  to  hia 
house  I  bad  to  pass  tbe  farm  of  an  old  friend  who  had  known  me 
from  my  babyhood.  He  was  sitting  on  the  fence  watching,  or,  as 
we  called  it  in  those  days,  overseeing  bis  negroes  at  work  in  his 
cornfield.  He  had  not  seen  me  before  since  I  had  gotten  home 
with  my  sheepskin,  aod  of  course  stopped  me  for  a  chat.  "  Well, 
GuB,"  be  said,  "  you  have  come  home  a  full-fiedged  doctor,  and  are 
going  out  to  kill  or  cure,  the  former  of  which  you  will  be  very  sure 
10  do.  I  want  to  tell  you  right  here  and  now,  you  will  never 
make  the  doctor  your  father  is."  This  was  very  galling  to  my 
pride  and  vanity,  and  I  thought  he  was  very  impertiuent.  I  cer- 
tainly was  very  much  disgusted.     But  he  did  not  stop  at  this.    Said 

he:  "You  are  going  to  see  Tom  McK .     He  has  the  dropsy, 

and  I  can  cure  him  now  quicker  than  you  can.  I  have  a  remedy 
that  never  fails."  By  this  time  patience  bad  ceased  to  be  a  virtue, 
and,  without  making  a  reply  or  bidding  him  good-bye,  I  spurred 
my  horse  in  tbe  direction  of  my  patieut's  home. 

Reaching  it,  I  found  poor  Tom  swollen  until  every  feature  of 
himself  a-s  I  knew  him  was  obliterated.  Face  swollen  until  his 
eyes  were  tightly  closed;  be  could  not  see  me,  but  recognizing  my 
voice  he  said,  "Is  that  you,  Gus?"  (Now,  do  you  know  of  any- 
thing that  will  make  a  right  young  doctor  madder  than  to  call  bim 
by  his  first  name,  or  Mr.?)  But,  poor  boy,  he  was  so  disfig- 
ured, and  seemed  to  me  to  be  so  nearly  dead,  I  quickly  forgave 
him.  Hie  abdomen  was  swelled  till  about  the  size  of  a  keg  of 
beer,  bis  legs  and  feet  looked  like  those  of  an  elephant,     I  felt  so 


^dbyGoOgle 


88         The  Atlanta  Medical  and  Suroical  Journal. 

sorry  for  Tom,  because  he  had  a  big  heart  and  was  kind  to  every- 
body but  himeelf. 

1  went  vigorously  to  work ;  read  all  the  books  on  dropsy  in  mine 
aud  my  father's  libraries;  laid  awake  at  uight  thinkiog  about  his 
case;  would  dream  of  a  new  remedy  I  had  forgotten;  would  get 
up,  light  the  candle,  get  my  books  and  reread  all  I  had  read  look- 
iog  for  it,  and  to  find  out  what  the  books  said  about  it;  I  would 
then  get  my  college  note-books  to  see  if  the  professors  bad  not 
mentioned  something  about  such  a  case  that  I  could  not  find  in  the 
books. 

I  began  my  treatment,  visited  him  every  day  for  a  week ;  but 
poor  Tom  did  not  get  any  smaller.  I  was  becoming  very  misera- 
ble myself,  to  say  nothing  of  Tom's  feelings.  At  my  next  visit  I 
chanced  to  find  my  old  friend  sitting  on  the  same  fence,  but  in  an- 
other place.  He  stopped  me  as  before,  and  said,  "  Welt,  Gus,  how 
is  Tom  getting  on  ? "  I  summoned  all  the  courage  I  had  ( my 
heart  was  then  in  my  hoots),  and  said,  "Oh,  doing  very  well." 

I  said  to  him,  "You  spoke  of  having  a  good  remedy — what  U 
it?"  Now,  he  was  one  of  these  farmer-doctors  (no  quack)  who 
took  great  pleasure  in  telling  bis  remedies  and  his  successes  with 
tbem.  He  said,  with  a  confidence  born  of  self-reliance  if  not 
knowledge:  "You  take  two  teaspoonfuls  of  nicely  powdered  cop- 
peras and  four  tablespoonfuls  of  Epsom  salts;  mix  tbem  well  to- 
gether; put  into  a  quart  bottle  and  fill  it  with  water  nearly  hot 
(don't  use  boiling  water,  if  you  do  you  will  bust  the  bottle).  Shake 
it  well  every  time  you  give  it,  and  give  from  one  to  two  tablespoon- 
fuls every  three  or  four  hours,  till  you  make  his  bowels  act  like 
lightning.  Do  this  for  two  or  three  days,  and  when  the  swelling 
begins  to  go  down  give  it  three  times  a  day,  and  I'll  be  darned  if 
you  don't  have  him  as  thin  as  a  whippoorwill  in  a  week." 

My  remedies  having  failed,  I  accepted  that  of  my  farmer-doctor. 
(But  I  did  not  tell  him  so.  This  is  a  point  it  is  well  for  the  young 
doctor  to  remember.)  I  gave  him  the  salts  and  copperas  as  directed, 
and  it  had  just  the  effect  the  old  farmer  claimed  for  it.  In  a  week's 
time  all  of  poor  Tom's  swelling  was  gone  and  he  was  able  to  sit 
around,  though,  as  you  may  readily  imagine,  very  weak. 

Dropsy  is  a  symptom,  not  a  disease,  per  se.     There  are   three 


^dbyGoOgle 


Some  Early  Espb&iences  op  an  Old  Physician.        89 

kinds  of  Jropsy  ordinarily  met  with ;  the  liver,  heart,  and  kidney 
dropey.  The  first  is  most  common  in  abusers  of  alcoholic  drinks 
and  ID  malarial  districts,  and  is  more  amenable  to  treatment  than 
eitJier  of  the  other  two.  When  we  have  a  dropsy  from  organic 
disease  of  the  heart  or  kidneys,  you  can  only  give  temporary  relief. 
It  may  not  be  difBcult  in  either  case  at  the  first  two  or  three  attacks 
to  reduce  the  swelling  by  active  drastic  purgation,  alternated  with 
those  medicines  which  will  produce  active  and  profuse  diuresis. 
But  in  heart  and  kidney  dropsies  the  effusion  quickly  returns,  and 
your  remedies  for  its  removal  will  all  fail ;  then  you  resort  to  para- 
centesis, which  will  relieve  the  urgent  and  distressful  symptoms 
for  awhile,  then  they  all  fail,  and  death  ensues. 

Dropsy  produced  from  obstruction  of  the  portal  circulation  is 
sometimes  permanently  relieved,  because  the  condition  which  pro- 
duces it  is  amenable  to  radical  cure  by  proper  medication  and  at- 
tention to  diet  and  drink.  But  it  must  be  remembered  that  re- 
ducing the  swelling  is  not  euring  the  dropsy.  This  is  just  what 
and  just  all  the  quack  dropsy  doctors  do — relieve  the  swelling — and 
every  time  they  do  this  they  claim  a  cure,  and  the  next  time  it  is  a 
new  bill  for  a  new  case.  They  all  depend  upon  Epsom  salts,  giving 
from  one-half  to  one  pound  a  day ;  but  they  haven't  the  sense  my  far- 
mer friend  had  of  adding  the  iron,  so  as  to  strengthen  the  blood, 
and  thereby  increase  nutrition  while  getting  rid  of  the  effusion. 
This  is  the  secret  of  curing  curable  cases  of  dropsy :  begin  with 
some  soluble  ferruginous  preparation  just  as  soon  as  you  see  the 
swelling  begin  to  go  down. 

The  salts  and  copperas — or,  as  be  called  it,  his  ferro-saline — was 
a  favorite  remedy  of  Professor  Robley  Dunglison,  when  he  occa- 
sionally held  clinics  at  the  Jefiferson  Medical  College,  forty  years 
ago,  and  I  have  used  it  in  various  forms  in  different  conditions  of 
general  anemia  ever  since,  and  have  found  no  better. 
llh  be  eontinutd.) 


A  Baltihobe  judge  has  decided  that  faith-cure  doctors  are  not 
legally  entitled  to  remuneration  for  their  services.  He  takes  the 
ground  that  the  faith-cure  physician  renders  no  apparent  service 
to  the  «ok. — Exchange. 


^dbyGoOgle 


The  Atlanta  Medical  and  SuagicAL  Journal. 


SOME  CASES  OF  DRUG  ERUPTIONS. 

Bt  W.  H.  HUDSON,  M.D., 
LitFiYBTTB,  Ala. 

In  1889  Mrs,  T.,  white,  aged  thirty  years,  was  under  my  care 
for  the  treatment  of  a  cough  which  had  remained  from  an  attack 
of  pleurisy.  Sulphate  of  codeine  was  given  in  one-half  grain 
quantities.  After  the  third  doee  wae  taken  she  sent  for  me  in  great 
alarm  on  account  of  an  eruption  which  implicated  most  of  the 
body.  Itching  was  very  intenae,  and  in  many  pJaces  large  wheals 
had  developed,  presenting  the  appearance  of  usual  urticaria.  The 
codeine  was  stopped  and  the  eruptioc  disappeared  in  a  short  time. 

During  the  autumn  of  1887  we  had  an  epidemic  of  typhoid  fever, 
most  of  the  cases  beginning  with  the  characteristic  symptoms.  Mr. 
A.,  aged  nineteen  years,  was  taken  sick  with  chill  and  high  fever. 
I  saw  him  a  few  hours  after  the  onset  of  his  sickness.  This  was 
before  my  day  of  esamining  the  blood  for  the  malarial  organism, 
and  I  gave  him  twenty  grains  of  quinine  in  two  doses.  A  severe 
articaria  developed,  which  he  informed  me  came  from  the  quinine, 
which  he  said  always  produced  such  an  eruption  on  him.  The 
quinine  was  stopped  and  the  eruption  disappeared  promptly.  The 
case  developed  into  typical  typhoid  fever  which  lasted  about  a 
month.  This  was,  perhaps,  a  case  of  typhoid  of  sudden  onset. 
Since  that  time  I  have  seen  many  cases  of  typhoid  which  began 
suddenly.  Some  of  them  being  differentiated  from  appendicitis 
with  difScuIty. 

For  some  years  a  prominent  Alabamian  consulted  me  frequently 
for  minor  ailments.  During  the  spring  of  1893  he  was  returning 
home  after  an  absence  of  several  days,  and  on  his  way  to  his  resi- 
dence from  the  train  stopped  in  my  office  to  get  a  simple  tonic,  as 
he  said  he  felt  run  down.  I  gave  him  a  prescription  for  the  elixir 
of  oalisaya.  This  was  on  Friday  afternoon.  On  Sunday  morning 
I  met  him  on  bis  way  to  church;  he  said  be  felt  all  right,  but  said 
to  me:  "Why  did  you  give  me  that  quinine?"  I  answered  that 
I  did  not  give  him  quinine,  forgetting  for  a  moment  that  the  oali- 


DiclizedbyGoOgle    _ 


SOHB    Ca3BS    of    DrCS    ERUPTIONS.  91 

saya  contained  quioine.  He  replied:  "1  know  you  have  given 
me  quinioe,  for  it  has  done  me  as  quinioe  always  does."  Then  I  re- 
membered the  efiectthat  quinine  bad  on  bim,  for  be  had  frequently 
told  me  of  hie  idiosyncrasy  towards  quinine. 

His  brother,  also  a  prominent  Alabamian,  was  affected  the  same 
way  by  qninine.  Some  hours  after  taking  the  smallest  dose  of 
qninine,  two  or  three  grains  or  less,  an  itching  would  begin  on  the 
entire  sar&ce  of  the  glans  penis  after  a  few  hours  an  intense  red- 
ness would  appear,  then  after  about  ten  hours  the  epithelium  of  the 
glans  wonid  begin  to  exfoliate ;  this  would  leave  a  raw  and  painful 
surface  which  would  last  two  or  three  days  before  the  epithelium 
would  begin  to  be  restored.  Quinine  affected  him  in  no  other  way 
peculiarly.  Latterly  this  gentleman  has  found  that  the  addition  of 
gum  camphor  to  the  quinine  prevents  the  peculiar  effect. 

In  the  spring  of  18^7,  Mr.  A.,  aged  seventy-eight  years,  con- 
sulted me  for  a  difiBculty  in  passing  his  urine.  He  was  suffering 
from  an  enlarged  prostate  gland;  his  urine  was  purulent  and  highly 
ammoDtacal.  With  the  exception  of  the  bladder  trouble  he  was  a 
man  wonderfully  well  preserved  for  one  of  bis  age.  His  arteries, 
heart,  brain,  and  everything  except  bis  prostate  gland  were  much 
younger  than  is  usually  seen  in  men  of  even  seventy  years.  I  was 
never  able  to  catheterize  his  bladder,  so  I  could  not  wash  his  blad- 
der out.  Among  other  things  which  I  did  for  him,  I  gave  boracic 
acid  in  10-grain  and  salol  in  5-grain  doses  combined  in  one  powder 
three  times  a  day.  He  improved  rapidly,  the  urine  soon  becoming 
clear,  and  be  regained  much  control  of  bis  bladder.  After  a  few 
days  I  reduced  the  boracic  acid  to  6  grains  and  the  salol  to  2J 
grains  to  the  powder.  His  bladder  continued  to  get  better,  and  I 
did  not  see  him  again  for  about  a  month.  At  this  time  I  was  sent 
for  OD  account  of  the  strange  condition  he  was  in.  His  face  was 
swollen  and  somewhat  indurated,  and  of  a  dull,  red  color ;  bis  up- 
per lids  were  so  much  swollen  that  he  could  open  bis  eyes  only  with 
difficulty ;  there  was  an  intense  erythema  over  his  entire  body,  the 
itching  was  so  severe  that  he  conld  not  sleep,  and  the  skin  every- 
where— more  marked  on  bis  body — was  swollen,  making  the  ap- 
peaniDce  of  a  most  exaggerated  scarlet  fever.  There  were  a  few 
superficial  sores  on  his  hands  and  arms  and  on  his  feet  and  legs. 


^dbyGoOgle 


92         The  Atlanta  Medical  and  Sdkgical  Journal. 

Some  of  these  sorea  were  weeke  id  faealiag.  I  suspended  the  boracic 
acid  and  salol,  and  very  soon  the  symptoms  began  to  ameliorate, 
the  redness  and  swelling  in  the  skin  disappeared,  and  after  a  few 
days  such  desquamation  began,  the  like  of  which  I  bad  never  seen 
before.  The  skin  of  the  soles  of  the  feet  and  palms  of  the  hands 
came  off  in  great  strips,  leaving  very  sensitive,  delicate  skin  un- 
derneath. Several  of  the  finger-  and  toe-nails  were  also  shed.  With 
the  exception  of  the  ulcers  on  the  arms,  bands  and  legs  he  rapidly 
recovered  from  the  effects  of  the  drugs,  but  bis  urine  soon  became 
clouded  again,  and  he  insisted  on  having  more  of  tlie  powders. 
I  gave  bim  a  powder  containing  2  grains  of  boracic  acid  and  1 
grain  of  ealol,  wat«bing  the  time  for  the  ill  effects  should  they  re- 
cur. In  about  three  days  his  hands  began  to  itch,  his  upper  eye- 
lids to  itch  and  swell,  and  his  entire  skin  to  feel  a  little  unnatural — 
the  old  trouble  was  beginning  again,  although  the  medicines  were 
given  in  such  small  quantities.  I  stopped  the  drugs  and  the  symp- 
toms disappeared  entirely  in  a  few  days.  This  patient  was  hardly 
willing  for  a  radical  surgical  procedure  so  long  as  he  was  in  such 
good  condition,  and  is  still,  without  further  treatment,  in  fair 
health. 

In  another  case  of  a  woman  with  cystitis,  I  gave  boracic  acid  and 
salolintbeusualquautitles;  an  eruption,  probablyofabullous  nature, 
was  produced,  but  the  cystitis  was  greatly  improved.  This  woman 
lived  some  distance  from  me,  and  I  was  not  informed  of  the  erup- 
tion until  the  medicine  had  been  all  taken.  Her  husband  came  to 
see  me  for  further  treatment  and  told  me  of  the  condition  of  her 
skin.  He  thought  it  was  the  disease  "  coming  out "  and  was  very 
much  pleased.  I  had  the  woman  brought  to  me,  and  much  of  her 
body  was  covered  with  small  healing  sores.  She  bad  had  no  med- 
icine for  some  days  and  the  skin  was  rapidly  returning  to  a  natural 
condition. 

The  eruption  in  these  cases  was  no  doubt  due  to  the  boracic  acid 
and  not  to  the  salol,  but  what  surprised  me  was  the  very  small 
quantities  of  the  drug  which  produced  the  disturbanoe  in  the  skin 
of  the  first  case,  and  the  very  severe  eruption  in  the  second  case, 
which  was  produced  by  the  moderate  doses. 

Frequently,  previous  to  my  experience  with  boracic  acid  in  these 


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Remarks  on  Gdde's  Pepto-Mangan.  98 

casett,  I  had  used  this  drug  as  a  harmless  one,  giving  it  internally 
Id  large  doses,  udng  it  ia  water  as  an  injection  in  the  bowels  of  in- 
gots, and  in  many  other  ways.  But  it  appears  that  harm  may 
come  of  it,  and  we  should  use  it  knowing  that  it  is  not  an  entirely 
«afe  drug  in  all  oases. 


REMARKS  ON  GUDE'S  PEPTO-MANGAN. 

By  T.  V.  HUBBARD,  M.D., 
Atlanta,  Oa. 

The  result  to  be  accomplished  in  the  administration  of  any  prep- 
intioD  of  iron  is  primarily  an  increase  in  the  number  and  quality 
of  red  blood  corpuscles,  and  notably  the  hemoglobin,  and  seconda- 
rily an  improvement  in  the  general  health  which  follows  the  in- 
cTeased  oxygen-carrying  power  of  the  red  cells.  How  to  obtain 
this  desirable  end  quickly  and  pleasantly  with  least  inconvenience 
to  the  patient  has  been  the  constant  aim  of  the  physician.  While 
we  have  numerous  preparations  of  iron,  they  are  practically  all 
open  to  the  same  objection,  that  is,  their  astringent  effect,  though 
varying,  of  course,  in  degree.  They  most  all  produce  more  or 
less  constipation,  headache  and  derangement  of  the  digestive  or- 
gans. As  a  very  small  proportion  of  the  inorganic  iron  is  ab- 
sorbed, it  ie  probable  that  better  results  would  be  obtained  in 
giving  it  in  small  doses,  unless  we  admit  the  correctness  of  the 
theory  of  Bunge:  that  is,  that  in  anemia  there  is  frequently  an 
excess  of  suphur  or  sulphureted  hydrogen  in  the  bowels,  which 
Doites  with  the  medicinal  iron  administered,  forming  the  sulphide 
of  iron,  and  excreted  with  the  feces,  and  thus  allowing  the  organic 
iron  of  the  food  to  be  absorbed,  and  acting  indirectly  as  a  blood 
tonic.  Though  this  theory  may  be  true  in  part,  it  cannot  be 
wholly  so,  because  there  is  nu  evidence  to  show  that  food-iron  is 
ibeorbed  in  preference  to  inoi^nic  preparations  when  they  are 
both  ID  the  intestines,  and  Stohman  has  cured  anemia  by  giving 
iron  bypodermically,  and  thus  proven  that  inorganic  iron  does  pro- 
note  blood  manufacture,  and  also  disproving  to  a  certain  extent 
at  least  the  correctness  of  Bunge's  theory  by  showing  that  the  in- 


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94         The  Atlanta  Medical  and  Surgical  Journal. 


orgaDJo  irOD  does  not  necessarily  act  by  unitiDg  with  the  sulphur 
ID  the  bowels.  The  truth  probably  is  that  the  inot^anic  iron  acts 
both  ways  to  a  certain  extent,  by  being  absorbed  and  furnishing 
material  for  the  blood-making  glands,  and  indirectly  by  uniting 
with  the  sulphur  in  the  bowels,  thus  allowing  absorption  of  all  the 
food-iron. 

In  the  administration  of  Pepto-mangan  (which  is  an  organic 
peptonate  of  iron  and  manganese)  we  have  usually  gotten  more  de- 
cided results  and  in  a  shorter  time  than  with  any  other  preparation 
of  iron.  Whether  the  superiority  of  this  preparation  is  due  to  the 
special  chemical  form  of  the  iron  or  to  the  manganese  which  exists 
in  combination  with  it,  or  both,  we  are  unable  to  say;  but  the 
practical  results  obtained  from  the  administration  of  Pepto-maogaa 
speak  for  themselves.  We  are  aware  of  the  fact,  of  course,  that 
manganese  itself  exists  in  the  blood  in  small  quantities,  and  it  is 
claimed  by  some  that  manganese  possesses  greater  ozonizing  power 
in  the  red  blood  corpuscles  than  iron;  consequently  the  superior 
results  obtained  from  this  preparation  over  that  of  other  prepara- 
tions of  iron  is  probably  due  to  the  manganese  present,  for  the 
physician,  in  prescribiog  the  ordinary  preparation  of  iron,  rarely 
ever  combines  manganese  with  it.  Pepto-mangan  is  also  very 
pleasant  to  the  taste,  neutral  in  reaction,  does  uot  injure  the  teeth, 
and  is  devoid  of  astringency,  and  is  easily  assimilated.  It  is 
claimed  that  this  preparation  of  iron  does  not  undergo  any  chemi- 
cal change  iu  the  stomach  before  being  absorbed,  as  does  the  inor- 
ganic salts  of  iron. 

As  an  illustration  of  the  prompt  results  obtained  by  this  prep- 
aration, we  will  report  a  few  cases  in  which  it  was  used : 

Case  I. — Mrs.  G.,  aged  28,  six  months  in  her  second  pregnancy, 
was  very  much  emaciated,  anemic,  and  unable  to  exercise  much  for 
want  of  muscular  strength.  She  also  suffered  much  loss  of  appetite, 
was  very  nervous  at  night,  so  much  so  that  she  was  unable  to  sleep, 
and  had  the  general  appearance  of  a  profound  anemia.  After  taking 
Pepto-mangan  for  two  or  three  weeks  she  was  practically  restored 
to  her  normal  condition  of  health;  her  color  returned  to  Hps  and 
cheeks,  her  nervous  symptoms  disappeared,  and  she  was  able  to 
sleep  comfortably. 


,„i,z.d  by  Google 


Remarks  on  Qtjde's  Pepto-Mangan.  95 

Case  2. — Boy,  aged  8 ;  had  the  mumps,  ulcerated  throat,  accom- 
paoied  by  a  general  glandular  enlargement  to  the  neck;  was  very 
anemic  and  somewhat  of  a  scrofulous  tendency.  After  the  acute 
symptoms  of  mumps  had  subsided,  Pepto-mangan  was  administered 
in  drachm  doses  three  times  a  day  after  meals.  The  throat  symptoms 
improved,  the  enlarged  glands  disappeared,  color  was  restored,  and 
there  was  general  improvement  in  the  nutrition  after  two  weeks' 
adminifitratioD. 

Numerous  other  cases  could  be  mentioned  in  this  connection 
confirming  the  above,  but  we  think  the  beneficial  results  to  be  ob- 
.  tained  from  Gude's  Pepto-maogao  are  too  well  known  by  the  medi- 
cal fraternity  to  need  any  further  comment 


Mammaby  Cancer — Prognosis. 
The  prognosis  after  operation  for  mammary  cancer  is  thus 
summed  up  by  Dr.  Bennett  May  in  hie  lectures,  just  published: 
"So  far  as  is  at  present  known,  our  only  hope  for  advancement 
ties  in  the  direction  .of  more  thorough  and  more  early  operation. 
The  limit  of  what  is  possible  in  the  former  direction  will  soon  be, 
if  it  is  not  already  reached.  The  result  must  carry  conviction 
that  we  may  hopefully  anticipate  a  real  cure  in  at  least  30  or  40, 
or  some  would  say  50,  per  cent,  of  our  cases.  I  would  not  like  to 
place  30  as  a  limit,  but  it  is  with  somewhat  chastened  hope  that  I  look 
for  anything  beyond.  Longer  observation  is  required,  particularly 
as  to  the  future  development  of  those  cases  who  pass  the  three-year 
limit.  Even  now,  however,  the  operation  in  too  many  cases  is  not 
practiced  to  the  beat  advantage,  and  is  not  used  for  all  it  is  worth. 
Certainly  some  of  the  disrepute  and  prejudice  which  have  sur- 
rounded it  may  fairly  be  ascribed  to  the  incomplete  and  inadequate 
manner  in  which  it  is  too  often  done  by  men  who  have  had  no 
proper  sargical  training,  and  whose  ill  results  serve  to  injure  the 
caose  as  a  whole,  and  to  reflect  prejudicially  on  the  work  of  others. 
The  fact  is  it  has  been  every  one's  operation  because  it  is  thought 
to  be  easy,  but  now  that  surgery  is  specialized  to  such  an  extent 
these  happy-gO'Iucky  methods  should  be  abolished  in  this  as  in 
other  branches  of  surgery." — Am.  Jour,  Surg,  and  Qyn. 


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SOCIETY  REPORTS. 


ATLANTA  SOCIETY   OF  MEDICINE. 

Atlanta,  Ga.,  February  17,  1898. 

Regular  meetiog  of  the  Atlanta  Society  of  Medicine. 

The  Society  waa  called  to  order  by  the  President  at  8  p.v.,  and 
upon  call  of  the  roll  the  following  members  were  present:  Drs. 
Champion,  Childe,  Collins,  Duncan,  Felder,  Hancock,  Hoke,  and 
Hurt. 

The  President  then  announced  thnt  the  regular  paper  for  the 
night  was  by  Dr.  £&therine  Collins,  on  "Mentally  Deficient  ChiU 
dieo."     (To  be  published  in  this  Journal.) 

Dr.  Collius  read  the  paper,  and  the  following  discussion  was  bad : 

The  Preaiderti:  You  have  heard  this  interesting  paper  by  Dr. 
Collins.  Dr.  Duncan,  we  will  be  glad  for  you  to  open  the  discus- 
sion. 

Dr.  Duncan:  It  is  one  of  the  most  interesting  papers  I  have 
had  the  pleaaure  of  hearing  in  this  Society,  bearing  upon  a  most 
important  subject,  and  Dr.  Collins  has  shown  that  she  has  given 
the  subject  a  great  deal  of  thought,  care  and  investigation.  I  do  not 
know  that  I  shall  be  able  to  say  anything  that  will  add  to  the  inter- 
est of  the  subject.  In  the  treatment  of  these  cases  the  management 
of  them,  I  think,  should  be  commenced  in  early  childhood,  and 
especially  so  with  the  girls.  I  think  they,  at  least,  could  he  man- 
aged even  in  early  life  so  as  to  be  better  prepared  for  living,  and 
in  later  life,  when  girls  are  grown  up  and  become  married,  during 
pregnancy  they  ought  to  receive  the  most  careful  attention.  I 
think  a  great  deal  depends  upon  their  impressiotis,  upon  what  is 
brought  to  bear  upon  the  mind  of  the  mother  during  pregnancy. 
I  think  a  great  deal  depends  upon  the  acts  and  associations  of  the 
mothers.  This,  I  think,  is  one  cause  why  there  are  so  many  weak- 
minded  children,  the  condition  of  the  mothers  during  pregnancy, 
and  I  think  this  condition  begins  away  back  in  girlhood  in  many 


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SociBTY  Reports.  97 

cases — more  especially  in  later  life.  I  really  believe  that  our  edu- 
cational syEtem  is  a  fraud  in  many  respects.  I  believe  that  we  tiave 
children  in  Atlanta  who  are  suffering  with  literaiy  dyspepsia, 
trying  to  crowd  too  many  things  into  their  minds  in  the  public 
schools  here.  Take  up  any  class  in  the  schools  and  you  will  find 
that  in  one  bandred  pupils  they  are  not  all  of  the  same  ability,  but 
they  all  have  the  same  lessons.  One-half  of  the  pupils,  perhaps, 
will  learn  the  lesson  well  and  may  digest  it  well;  consequently 
their  minds  grow  stronger  every  day.  The  other  half  will  not 
digest  the  lesson,  and  they  have  as  much  literary  dyspepsia  as  a 
man  wonld  have  dyspepsia  if  he  overloaded  his  stomach  with  indi- 
gestible food.  What  we  eat  and  digest  gives  us  physical  strength  ;- 
what  we  eat  and  fail  to  digest  injures  us.  Consequently  I  think 
there  ought  to  he  a  different  plan  of  education  for  the  children. 
Take  the  kind  of  child  that  Dr.  Collins  mentions,  a  feeble-minded 
child  who  learns  some  things  very  well.  I  think  if  the  child  can- 
not get  the  lesson  in  a  certain  study  that  it  ought  not  to  be  crowded. 
I  don't  believe  that  a  child  ought  to  be  required  to  try  to  digest 
what  it  cannot  digest.  Consequently  I  do  not  think  the  educa- 
tional system  is  as  good  here  as  if  we  had  all  these  various  classes 
recognized,  and  not  try  to  crowd  them  in  early  life. 

Dr.  Hurt:  I  most  compliment  Dr.  Collins  upon  tbe  well-written 
paper.  The  statistics  and  the  various  points  involved  in  the  paper 
are  of  material  importaoce  at  this  present  age  of  science  in  medi- 
cine, and,  if  I  may  be  allowed  to  say  so,  science  in  society  life  or 
in  social  life.  The  question  of  weak  minds,  putting  it  in  tbe  most 
conservative  and  charitable  light,  and  giving  it  that  nomenclature, 
is  affected  by  various  influences.  The  influences  that  are  brought 
to  bear  upon  persons  begin,  in  the  judgment  of  some,  from  concep- 
tion; and  while  in  utero,  aud  during  early  infancy  and  childhood, 
and  OD  up  during  life,  these  influences  are  as  varied  as  the  sur- 
roundings and  conditions  under  which  life  exists  in  such  creatures. 
In  ut«ro,  in  my  opinion,  they  are  largely  influenced  by  the  state  of 
the  maternal  mind  during  the  period  of  gestation,  and  by  tbe  state 
of  the  physical  motherhood  as  well.  We  all  know  that  a  sound 
and  healthy  female  is  prepared  naturally  for  a  healthy  gestation  and 
development  of  the  fetus.     We  know  equally  as  well  that  a  feeble. 


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The  Atlanta  Medical  and  Surgical  Jocknal. 

,  sensitive,  weakened  physical  coQctition  is  very  much 
in  the  way  of  the  development  of  the  fetus  physically.  The  same 
evil  ia  very  often  transmitted  to  the  nervous  system  and  the  mental 
functions  or  the  mind,  so  we  find  children  not  infrequently  coming 
into  the  world  at  the  end  of  gestation  who  are  under  the  ban  of 
maternal  infiuences  which  could  not  be  avoided  while  in  the  state 
of  health  in  which  the  mother  was  then  existing.  Again,  it  comes 
into  life  the  victim  of  maternal  impressions  which  doubtless  might 
have  been  avoided  and  which  ought  to  have  been  avoided.  A 
physician  is  frequently  handicapped  in  his  efforts  to  take  care  of  a 
female  who  has  engaged  him  to  attend  her  during  parturition  while 
•he  looks  after  her  during  gestation,  because,  while  it  is  possible  for 
him  always  to  take  cognizance  of  her  surroundings,  it  is  frequently 
impossible  for  him  to  get  knowledge  of  all  the  conditons  which 
attend  her  physically  and  mentally.  Therefore,  while  be  makes 
every  efibrt,  and  well  realizes  that  it  is  his  duty  to  make  every  effort, 
to  so  control  the  mother  in  mind  and  body  as  to  bring  about  a  full 
development  of  the  new-born  at  parturition,  his  efforts  in  this  con- 
nection are  often  overcome  by  circumstances  surrounding  her  which 
are  beyond  his  control.  Just  this  point  occurred  to  me  while  lis- 
tening to  Dr.  Collins  on  this  subject,  that  the  legislation  looking 
to  the  care  of  these  weak-minded  and  otherwise  enfeebled  persons, 
while  the  call  for  this  has  been  so  active,  and  very  justly  so,  and  it 
ought  to  be  very  much  encouraged,  there  ought  to  be  coupled  with 
it  legislation  which  will  place  as  far  as  possible  such  environments 
around  the  mother,  or  the  female  expecting  to  become  a  mother,  as 
will  prevent  such  influences  as  are  known  or  believed  by  many  of 
us  to  be  of  irreparable  damage  to  the  fetus  during  the  early 
months  of  gestation.  To  speak  more  plainly,  the  maternal  impres- 
sions influencing  the  child  in  utero,  in  my  mind,  are  unquestiona- 
bly capable,  not  only  of  producing  physical  deformity,  physical 
monstrosity,  but  of  destroying  all  mental  power,  so  that  when  the 
child  is  horn,  although  it  may  have  enough  of  nervous  capacity  to 
take  charge  of  its  physical  part,  it  has  no  mental  capacity  of  be- 
coming really  a  citizen  and  occupying  its  place  in  the  world.  I 
believe  that  many  of  these  imbeciles  and  weak-minded  children  are 
the  direct  results  of  maternal    impressions.     When   we  come  to 


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Society  Reports.  99 

Bpeak  of  materDal  impressions,  it  is  very  uecesaary,  if  hard  some- 
times to  do,  to  distinguish  between  materoal  impresaiooB  which  are 
calculated  to  be  transmitted  to  the  developing  fetus  and  maternal 
impressions  which  go  no  further  than  simply  to  affect  the  woman 
herself.  Now,  if  you  will  observe,  or  recall  if  you  have  had  any 
experience  in  obstetrics,  it  is  almost  universally  true  that  when  a 
female  is  delivered  one  of  the  first  questions  is,  "Doctor,  is  it  all 
right?"  This  question  goes  to  show  that  every  woman  hearing 
children  has  more  or  less  dread  or  suspicion  of  some  evil  befalling 
the  child  in  utero,  and  manifests  her  anxiety  as  soon  as  it  is  born 
by  tliat  question.  The  exaggerated  impressions  or  exaggerated 
fear  of  such  impressions  is  not  always  an  index  to  what  is  going 
on  to  the  damage  of  the  child,  but  there  are  certain  other  influ- 
ences, when  closely  inquired  into,  so  convincing  that  no  intelli- 
gent, thoughtful  physician  van  for  a  moment  doubt  the  certainty  of 
such  influences  in  utero.  I  think,  if  legislation  could  be  had  pre- 
venting the  .frequent  exhibition  upon  our  streets  and  over  the 
country  at  large  of  the  unfortunates — and  among  the  unfortunates 
are  just  these  classes  that  Dr.  Collins  has  been  talking  about  to- 
night, and  along  with  these  are  those  who  are  so  physically  deformed 
that  their  deformities  become  terrorizing  to  a  woman  in  a  delicate 
condition ;  and  if  such  a  woman  passes  along  the  street  and  comes 
in  contact  with  such  an  object,  she  is  first  shocked,  and  the  fright 
and  shock  are  calculated  to  make  impressions  upon  her  mind  so 
that  the  impressions  are  transmitted  to  the  fetus  or  child  in  utero. 
Again,  if  she  sees  such  an  object  frequently,  or  several  times,  she 
sometimes  reports  that  at  each  successive  time  her  fear  and  distress 
of  mind  has  increased.  I  have  known  one  woman  so  say,  and 
voluntarily,  too,  that  it  oppressed  her,  took  away  her  appetite,  gave 
her  a  headache,  made  her  sick  and  put  her  to  bed.  I  have  seen 
reports  of  other  cases  where  abortion  follows  such  a  shock.  There- 
fore, if  the  physical  shock  of  such  a  thing  could  produce  abortion^ 
there  is  no  reason  why  maternal  impression  should  not  obstruct  or 
deform  the  developing  fetus  while  growing  in  the  uteras. 

-Dr.  Otampion:  I  don't  know  that  I  could  add  anything  to 
what  has  already  been  said  on  this  subject.  I  am  satisfied  that  the 
Society  appreciates  Br.  Collins  coming  out  to  night  and  reading 


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100        The  Atlanta  Medical  and  Surgical  Jodrnal, 

the  paper.  It  is  certainly  a  very  interesting  paper,  and  I  am  sat- 
isfied that  this  subject  should  be  looked  into  more  fully  and  care- 
fully than  it  is.  In  all  the  schools  in  this  country  there  are 
children  who  are  mentally  deficient,  and  not  capable  of  keeping 
up  with  the  classes.  1  think  there  ought  to  be  schools  especially 
for  children  oi  this  kind.  We  have  penitentiaries  for  criminals, 
we  have  lunatic  asylums  for  the  insane,  and  we  have  reformatories 
for  criminals;  but  children  of  this  class  are  placed  in  schools 
where  they  are  not  capable  of  competing  with  the  other  children. 
As  Dr.  Collins  says,  if  they  had  a  school  or  reformatory  of  some 
kind  where  they  could  be  specially  trained,  they  would  amount  to 
a  great  deal  more  io  future  life  than  they  will  otherwise.  I  am 
sorry  that  we  have  had  such  a  bad  night,  so  that  we  could  not  have 
more  members  out  and  have  a  full  discussion. 

Dr.  CoUina :  I  am  glad  that  the  doctor  mentioned  the  education 
of  the  future  mother.  That  is  a  very  imporlant  subject,  and  I 
think  the  time  will  come  when  it  will  be  a  part  of  every  girl's 
education,  that  it  will  be  a  part  of  the  school  system.  In  regard 
to  the  school  system,  I  think  the  fundamental  wrong  is  that  there 
is  too  much  work  given  to  one  teacher.  When  a  teacher  has  fifty 
pupils  to  teach,  she  cannot  study  the  individual  capacity  and  in- 
dividual traits  of  each  child.  Until  the  number  is  lessened,  iudi- 
vidual  work  cannot  be  done,  and  until  it  is  done  we  canuot  get  the 
best  results.  Children  are  not  so  much  taught  too  much,  as  they 
are  taught  in  the  wrong  way.  The  doctor  spoke  of  maternal  im- 
pressions. I  think  that  anything  that  will  produce  a  shock  will 
interfere  to  a  certain  extent  with  the  general  system,  more  especially 
with  the  nervous  system.  To  what  extent  this  will  cause  arrested 
development  in  the  fcetus  it  is  hard  to  say,  but  that  it  does  cause  a 
certain  amount,  I  think  is  without  doubt.  I  would  not  favor  a 
reformatory  for  these  children.  We  have  had  reformatories,  and 
they  mean  punishment.  These  mentally  deficients  should  be  taken 
just  as  normal  children  are  taken,  except  that  we  must  begin  with 
them  a  step  lower.  Teach  them  as  a  normal  child  is  taught,  on 
the  same  lines,  only  take  a  small  amount  of  education  at  a  time. 

Dr.  Hurt:  Mr.  President,  I  thought  it  might  interest  the 
Society  to  present  this  case.     It  is  one  that  you  do  not  see  every 


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Society  Reports.  101 

day  or  aoytbiag  like  it,  nor  are  we  agreed  as  to  tbe  causes  of  such 
troables  or  the  remedies  for  such  troubles.  My  object  was  more 
(o  illustrate  and  briog  out  a  discussion  upon  tbe  subject,  looking 
to  the  benefit  of  the  human  race  and  the  coming  generations 
especially,  and  if  I  can  eo  develop  this  idea  as  to  bring  forward 
into  our  legislative  bodies  at  some  future  time  tbe  idea  of  tbe  pro- 
tection of  females  during  gestation,  I  shall  feel  that  my  efforts 
have  been  well  rewarded.  I  conscientiously  feel  like  such  things 
can  be  done  and  ought  to  be  done,  and  that  we  are  derelict  in  our 
duty  until  it  is  done.  This  is  the  case  that  I  intend  to  present  to- 
night. I  was  called,  about  the  third  of  this  month,  I  believe  it 
was,  to  attend  a  lady  twenty-five  years  old,  who  had  been  for  over 
nve  years  in  tbe  enjoyment  of  good  health,  and  was  well  developed. 
Her  husband  was  about  thirty  years  old,  the  very  picture  of  health, 
and  a  man  of  good  size.  This  lady  had  miscarried  at  a  period  of 
some  two  or  three  years  ago,  I  don't  know  exactly  how  long  ago 
it  was.  That  is  the  history  that  she  gave  me.  Following  the 
abortion  she  had  an  attack  of  abortive  fever,  which  went  into 
sepsia,  and  she  bad  rather  a  severe  spell,  but  that  she  bad  enjoyed 
very  good  health  ever  since  she  had  got  up  from  this  sepsis.  In 
making  calculation  as  to  her  last  menstrual  period,  she  told  me 
that  the  flow  ceased  on  the  6tb  of  June  last.  Having  this  data  to 
calculate  from  as  to  tbe  last  menstrual  period,  my  being  called  on 
tbe  third. of  February  shows  that  it  must  have  been  at  least  thirty 
days  ahead  of  time.  And  from  all  the  features  of  the  case,  I  am 
prepared  to  say  that  she  was  delivered  in  the  eighth  month  of  ges- 
tation. The  condition  of  the  patient  when  I  was  called  to  see  her 
was  that  of  discomfort.  Sbe  had  a  little  headache,  a  little  albu- 
men in  her  uriue,  constipation  and  annoying,  severe  and  irregular 
pains.  I  was  summoned  about  eight  o'clock  in  the  morning  with 
the  announcement  that  she  bad  been  in  labor  all  night.  I  was 
busy  all  day  and  didn't  reach  tbe  bouse  until  about  two  o'clock  in 
tbe  aft«rooon.  I  made  a  digital  examination,  and  directed  that  she 
be  given  an  ounce  of  sulphate  of  magnesia,  and  told  her  that  I 
would  return  at  night  unless  I  was  summoned  sooner.  I  returned 
^ot  eight  o'clock  in  the  evening  and  found  that  very  shortly 
aAer  I  bad  left  the  bonse  the  sac  had  ruptured,     I  found  the  os 


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102       The  Atlanta  Medical  and  Surqical  Joubnal. 

dilated  to  the  size  of  a  silver  balf  dollar,  and  thought  I  detected 
what  I  was  able  to  make  out  a  vertex  presentatioD,  aod  I  rested 
somewhat  eatiefied.  But  seeiog  that  she  was  getting  along  slowly, 
aod  egtimating  that  she  would  probably  be  in  labor  all  night,  I  called 
in  Dr.  Corput,  a  young  man  who  assists  me  sometimes,  and  told 
him  to  watch  while  I  went  and  had  some  sleep.  About  two  o'clock 
I  was  waked  up.  She  was  still  having  pains  every  few  minutes. 
The  pains  were  then  every  seven  minutes.  She  complained  of  a 
nauseating  headache,  aii(j  her  pulse  was  very  high.  I  suggested 
to  him  to  give  her  a  hypodermic  injection  of  five  drops  of  Nor- 
wood's tincture  of  veratrum  and  this  he  did,  and  it  had  the  result 
of  removing  the  headache  that  she  complained  of.  In  two  hours 
she  was  delivered,  the  pains  recurring  every  seven  minutes  up  to 
the  time  of  delivery.  They  had  not  come  any  nearer  together 
than  seven  minutes.  At  this  buur,  2:30,  I  made  a  digital  exam- 
ination. There  was  some  trouble  with  the  presentation,  and  when 
I  endeavored  to  relieve  the  matter  of  doubt,  I  found  myself  puzzled. 
I  could  not  make  out  a  satisfactory  diagnosis  of  the  presentation. 
Taking  one  view  of  it,  I  made  it  out  a  breech  presentation,  and 
taking  another  view  of  it,  I  thought  that  it  was  a  brow  presenta- 
tion, hut  I  made  no  satisfactory  diagnosis.  SufBcient  to  say,  I 
found  in  the  delivery,  when  the  part  presenting  came  down  upon 
the  penneum,  it  had  in  front  of  it  a  hard,  spear-pointed  substance 
tending  to  go  directly  into  the  perineum,  immediately  on  the  in- 
side of  which  the  point  threatened  laceration.  To  prevent  this,  I 
insert«d  my  two  fingers  and  held  them  under  this  point  until  it  had 
passed  through  the  vulva.  Afler  being  passed  through  I  an-  ' 
nounced  to  the  mother  that  it  was  deformed,  and  while  I  was  pre- 
paring to  sever  the  cord,  she  told  me  that  she  had  seen  a  man 
fi^uently  on  the  streets  during  the  early  months  of  her  pregnancy 
who  had  a  large,  red  tumor  on  the  back  of  his  head,  that  extended 
down  his  neck  and  between  his  shoulders,  with  some  long,  red 
hairs  on  the  sides  of  the  tumor.  If  you  will  pay  attention  to  ber 
description  of  this  man,  and  notice  these  pictures  which  I  have 
brought  here,  you  will  see  that  that  description  fits  this  picture, 
except  that  this  was  bone  tissue  covered  with  a  thin  tissue  of  fi- 
brous consistence  enough  to  give  it  a  red  color,  or  scarlet  color. 


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Society  Reports.  103 

The  straacls  of  long,  red  hair  are  here  identically  as  she  described 
seeing  tbem  on  the  man  on  the  streets.  She  said  that  each  time 
she  had  seen  him  it  bad  a  terrible  efiect  upon  her,  disturbing  her 
sleep,  loss  of  appetite,  headache,  and  sick  so  that  she  would  have 
to  go  to  bed.  I  intended  to  bring  the  specimen  with  me  and  ei- 
hihit  it  to  the  Society,  but  the  inclement  weather  prevented  my 
getting  it  to  the  hall.  It  ie  in  my  office,  and  I  shall  be  glad  to 
show  it  to  any  of  you  if  you  care  to  call.  This  bony  plate  broadeus 
until  it  is  as  wide  as  your  two  fingers  and  passes  down  over  the 
neck  and  between  the  shoulders.  The  strands  of  hair  are  of  a 
brown  coJor,  few  and  long,  passing  down  on  either  side  of  this 
bony  growth.  Just  as  she  described  the  hair  on  each  side  of  the 
tumor.  Then  there  is  another  story  given  by  her  hunbaud.  The 
iront  view,  you  see,  is  not  at  all  normal,  resembling  a  frog.  You 
might  say  it  resembles  a  frog  or  an  ape  or  a  brownie.  He  says 
that  he  and  his  wife  were  sitting  down  looking  at  some  pictures  of 
brownies,  etc.,  on  the  back  of  a  patent  medicine  sheet.  And  the 
discussion  of  these  distorted  brownies  that  they  fouud  there  seemed 
to  disturb  her.  While  she  herself  made  do  mention  of  this,  he 
called  my  attention  to  it  at  once,  and  I  thought  at  the  time,  and 
now  believe  more  fully,  that  this  occurred  and  affected  the  fetus. 
So  1  am  inclined  to  believe  that  this  deformity  of  the  fetus  was 
caused  from  these  compound  maternal  impressions,  from  seeing 
this  man  on  the  streets,  and  from  the  discussion  of  these  pictures 
of  brownies  on  the  advertising  sheet.  The  child  was  alive,  at  least 
she  said  she  felt  movement  at  the  time  the  waters  were  discharging. 
When  I  reached  her  there  was  no  sign  of  life.  It  was  born  dead. 
I  am  disposed  to  think,  though  I  have  never  made  a  dissection  of 
the  subject,  and  I  intend  to  make  a  thorough  dissection  and  exam- 
ination, bat  until  I  make  the  dissection  and  find  out  I  am  disposed 
to  think  that  there  was  not  enough  development  of  the  nervous 
system  to  bring  about  action  of  the  heart  and  lungs. 

Ih.  CSiUda;  Dr.  Hurt,  did  she  describe  those  facts  before  she 
saw  it? 

Dr.  Hart  .*  She  never  has  seen  it.  I  told  her  husband  that  it 
was  deformed  and  dead,  and  that  I  could  not  afford  to  let  her  see 
it,  and  asked  him  to  let  me  take  it  away.     She  described  the  man 


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104       Tbb  Atlanta  Medical  and  Scrqical  Journal. 

she  had  seen  on  the  streets  of  her  own  motion.  As  soon  as  she 
was  delivered,  I  took  it  away  into  another  room,  and  she  never 
has  seen  it  or  any  description  of  it. 

Ih.  Collins :  I  would  like  to  know  if  you  have  had  anything  of 
her  &mily  history. 

Br.  Hurt :  I  inquired  into  the  family  history  on  both  aides  as  to 
whether  there  was  any  insanity,  imbecility,  neurotic  tendencies,  or 
anything  departing  from  the  normal,  and  I  could  not  find  any- 
thing in  the  history  leading  to  any  serious  trouble  in  the  family 
on  either  side. 


Schleich's  Anesthetic  Mixture. 

Dr.  Willy  Meyer,  in  a  letter  to  the  New  York  Medieai  Becord 
(December  4, 1897),  recommends  this  anesthetic,  after  considerable 
experience  with  it  at  the  German  Hospital,  New  York.  He  re- 
gards it  as  safe.  Schleich  experimented  with  it  on  a  physical  and  not 
on  a  chemical  basis,  adapting  the  boiling-point  of  the  narcotic  t« 
the  temperature  of  the  body.  He  uses  a  mixture  of  three  drugs, 
chloroform,  ether,  and  petroleum  ether  (benzin — boiling-point  60° 
to  65°  C.  [140°— 148°  F.]). 

Formula  1.  Boiling  point  ^100.4°  F. — Chloroform,  IJ  oz,; 
petroleum  ether,  ^  oz.;  dulphuric  ether,  6  oz.  Used  in  short  op- 
erations. 

Formula  2.  Boiling  point  =  104°  F. — Chloroform,  IJ  oz.; 
petroleum  ether,  ^  oz.;  sulphuric  ether,  6  oz.  For  medium  length 
operation. 

Formulas.  Boiling  point  =  107.6°  F. — Chloroform,  1  oz.; 
petroleum  ether  ^  oz. ;  sulphuric  ether,  2§  oz.  Used  for  major 
operations. 

The  measurement  is  made  by  volume,  not  by  weight.  It  is  a 
real  solution,  chemically. 

He  has  used  this  mixture  with  the  ordinary  ether  cone — paper 
and  towel.  The  advanti^s  of  this  anesthesia  are :  Ko  cyanosis, 
salivation,  or  superabundant  tracheal  mucus;  no  bronchitis  or 
broDoho-pnenmonia  afterward.  ESect  on  the  heart  less  marked 
than  that  of  chloroform. — Am.  Med.  Surg.  BtUldin, 


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CORRBSPONDBNCB. 


NEW  YORK  LETTER. 

New  Yobk,  March  15,  1898. 
Editors  Atlanta  MedtccU  and  Surgical  Journal: 

Od  the  closing  day  of  1897,  the  Board  of  Health  made  the  aa- 
Donncemenl— cheering  or  depressing,  depending  upon  the  point  of 
view — that  the  city  of  New  York  had  never  been  so  healthy  as 
during  the  year  just  past.  The  records  show  that  the  death-rate 
was  only  19.62.  Although  we  may  infer  from  this  that  the  "busi- 
ness" of  the  medical  practitioner  here  haB  not  been  as  good  as  he 
might  desire,  there  is  nothing  to  indicate  that  he  has  lost  any  of 
hia  old-time  iutereet  in  medicine  as  a  atiidy.  True,  the  once  famil- 
iar figure  of  the  "  &mily  doctor"  has  become  a  rare  bird  iu  these 
parts,  but  the  activity — I  had  almost  said  the  "  pernicious  activ- 
ity"— of  the  specialists  serves  to  keep  alive  a  proper  interest  in 
our  medical  gatherings. 

The  following  method  of  performing  taxis  in  oases  of  strangu- 
lated hernia  is  offered  by  Dr.  William  B.  De  Garmo,  who  claims 
for  it  a  very  large  proportion  of  successful  reductions.  His  very 
large  experience  with  this  class  of  cases  should  give  such  a  recom- 
mendation great  weight.  The  instructions  are,  to  take  bold  of  the 
tumor  and  draw  it  down,  in  this  way  lengthening  the  part  in  the 
canal  at  the  point  of  constriction.  Then,  without  attempting 
to  push  it  up,  steady  pressure  is  to  be  made  on  the  tumor  with  the 
idea  of  forcing  out  its  contents.  If  the  patient  is  a  child,  it  is 
also  well  to  suspend  the  little  one  by  one  leg  while  taxis  is  being 
made. 

Another  surgical  wrinkle  that  should  be  included  in  the  next 
list  of  "  Surgical  Dont's  "  is  in  regard  to  the  danger  of  using  plain 
water,  without  salt,  for  intravenous  injections.  It  is  not  difficult 
to  suppose  that  in  an  emergency,  a  stock  of  normal  saline  solution 


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106       The  Atlanta  'Medical  and  Sorgical  Jodrnal. 

not  having  been  previously  made  ready,  a  aui^on  might  think 
that  time  was  too  precious  to  waste  any  of  it  in  making  op  salt  so- 
lution, and  would  accordingly  use  plain  hot  water.  Dr.  R.  H.  M. 
Dawbarn  assures  us  that  such  a  procedure  is  not  only  unwise,  but 
exceedingly  dangerous.  As  far  back  as  1890,  in  some  experiments 
on  animals,  he  accidentally  discovered  that  an  intravenous  iujection 
of  non-saline  solution  would  prove  very  rapidly  &tal,  and  then 
he  was  told  by  the.  physiologists  that  this  result  was  due  to  the 
rapid  solvent  action  of  non-saline  water  on  the  blood  corpuscles- 
Speaking  of  saline  injections,  reminds  me  of  a  method  of  treat- 
ment for  various  diseased  conditions,  which  has  become  so  popular 
here  of  late  that  it  would  deserve  to  be  dubbed  a  "fad,"  were  it 
not  that  such  an  appellation  would  give  a  wrong  impression  as  to 
its  value.  I  refer  to  continuous  irrigation  of  the  bowel.  It  has 
been  the  subject  of  papers,  discussious  and  various  demonstrations 
this  winter.  This  is  largely  owing  to  the  enthusiastic  advocacy 
of  the  method  by  Dr.  Robert  Coleman  Kemp,  the  inventor  of  sev- 
eral varieties  of  double-current  rectal  tubes.  Dr.  Kemp  has  not 
been  satisfied  with  the  rapidly  accumulating  clinical  data  in  favor  of 
the  method,  but  has  subjected  it  to  critical  tests  in  the  physiological 
laboratory.  Both  the  observations  in  the  laboratory  and  those  at 
the  bedside  seem  to  show  conclusively  that  it  is  a  convenient  and 
potent  method  of  preventing  and  combating  shock,  and  of  treating 
oases  of  suppression  of  urine,  to  say  uothing  of  its  beneficial 
action  in  certain  diseased  conditions  found  in  both  the  male  and 
female  pelvis.  A  number  of  our  surgeons  make  use  of  this  form 
of  rectal  irrigation,  as  a  routine  measure,  during  all  operations  in 
which  there  is  reason  to  believe  shock  will  be  produced,  and  enme 
of  them  go  so  far  as  to  say  that  it  is  equal,  if  not  superior,  to  saline 
infusion  in  cases  of  profuse  hemorrhage.  There  is,  moreover,  great 
unanimity  of  opinion  regarding  its  power  to  arouse  the  kidneys  to 
functional  activity.  Dr.  E.  H.  Grandin  says  that  he  knows  of  no 
other  method  of  treatment  for  cases  of  urinary  toxemia,  with  im- 
pending eclampsia,  that  is  equal  to  irrigation  of  the  bowel  with 
water  at  a  temperature  of  115°  to  120°  F.  In  one  case  of  anuria 
that  had  lasted  thirty -six  hours,  he  succeeded  in  saving  the  woman's 
life  by  nsing  in  this  way  fifteen  gallons  of  hot  water. 


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Correspondence.  107 

While  speaking  of  matters  of  surgical  interest,  it  is  bot  right 
to  refer  to  the  work  of  Dr.  Willy  Meyer  with  Schleich's  new 
method  of  inducing  general  anesthesia.  The  fundamental  princi- 
ple of  the  method  is,  that  the  absorption  of  the  anesthetic  agent  is 
regulated  chiefly  by  the  relation  existing  between  the  body  tem- 
perature of  the  patient  and  the  boiling  point  of  the  anesthetic.  If, 
as  in  the  case  of  chloroform,  the  boiling  point  is  much  higher  than 
the  body-temperature,  the  anesthetic  will  be  absorbed  in  unneces- 
sarily large  quantity,  and  will  overtax  all  the  parenchymatous  or- 
gans. Schleich's  solutions  are  composed  of  varying  proportions  of 
chloroform,  petroleum  ether  and  sulphuric  ether,  thus  giving  con- 
trol of  the  boiling  point  of  the  anesthetic  agent.  Dr.  Meyer's  ex- 
perience with  this  new  method  comprises  about  one  hundred  cases, 
so  that  he  is  entitled  to  speak  with  more  assurance  than  a  number 
of  others  here  who  have  tried  it  in  a  few  instances  only,  but  it 
mtiBt  always  be  remembered  that,  in  studying  the  effects  of  a  gen- 
«ral  anesthetic,  very  positive  conclusions  should  only  be  drawn 
from  an  experience,  not  of  two  or  three  hundred,  but  of  several 
thousand  cases.  Dr.  Meyer  has  found  that  the  pulse  remains  of 
good  quality,  that  there  is  no  hypersecretion  of  mucus,  that  vom- 
iting occurs  in  about  44  per  cent,  of  the  cases,  and  albuminura  in 
4  per  cent.,  and  that  the  return  to  consciousness  has  been  more 
rapid  than  afler  either  chloroform  or  ether.  There  has  also  been 
«  notable  A-eedom  from  consecutive  bronchitis  and  pneumonia. 
Experience  has  shown  that  the  best  mode  of  administering  the 
Schleich  anesthetic  solutions  is  by  the  use  of  an  Esmarch  mask 
covered  with  flannel  and  oil-silk,  with  a  funnel  so  adapted  to  it 
that  the  solution  may  be  made  to  drop  on  the  mask  at  a  given  rate. 
The  usual  rate  is  one  drop  every  four  or  five  seconds,  but  it  should 
be  rather  more  rapid  at  the  commencement.  The  chief  difficulty 
experienced  has  been  in  securing  in  the  market  a  specimen  of  pe- 
troleum ether  having  the  requisite  boiling  point. 

We  have  all  heard  a  great  deal  about  the  injurious  effects  some- 
times observed  after  the  use  of  the  X-rays,  but  I  believe  that  Dr. 
James  P.  Tuttle,  of  New  York,  has  the  distinction  of  being  the 
first  who  has  been  caUed  upon  to  amputate  a  limb  because  of  such 
an  injury.     It  happened  in  this  way.    The  patient  was  an  old 


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108       The  Atlanta  Medical  and  Scrqical  Journal. 

soldier  who  had  long  suffered  from  disease  of  the  knee-joiot. 
About  three  years  ago,  an  operation,  largely  ex  peri  mental,  wa» 
done  on  him.  It  showed  the  presence  of  some  floating  bodies  in 
the  joint,  but  failed  to  reveal  the  exact  nature  of  the  painful  affec- 
tion from  which  he  suffered.  It  did,  however,  give  him  compute 
relief  for  nearly  three  years.  On  the  recurrence  of  the  pain,  hi» 
attending  physician  submitted  the  part  to  a  long  and  searching  ex- 
amination with  the  X-rays.  This  caused  no  discomfort  at  the 
time,  but  at  the  end  of  about  three  weeks  the  part  heoame  red  and 
painful,  and  in  the  course  of  two  or  three  days  very  extensive 
sloughs  had  formed.  Skin-grafting  was  resorted  to,  at  first  with 
a  very  gratifying  result,  but  after  five  weeks  the  whole  grafted  area, 
broke  down.  From  this  time  on,  the  man's  health  failed  rapidly, 
and  he  became  addicted  to  the  use  of  morphine.  A  consultation 
was  held,  and,  as  a  result,  the  thigh  was  amputated.  At  the  last 
report  the  patient  was  doing  well. 

This  case  is  full  of  interest,  not  alone  as  showing  the  postiible 
gravity  of  such  accidents,  but  because  of  the  importaut  points- 
brought  out  regarding  the  nature  of  these  so-called  burns.  Dr. 
E.  B.  Brouson  says  that  it  is  far  from  accurate  to  speak  of  these 
injuries  as  *'  burns,"  because  unlike  true  burns,  there  are  no  imme- 
diate effects  observable,  there  is  a  distinct  and  rather  long  interval 
between  the  exposure  to  the  X-rays  and  the  development  of  the 
local  lesions,  and  the  pathological  process  spreads  from  within  out- 
ward. It  should  be  noted  also  that  these  "  burns"  are  not  amen- 
able to  the  same  treatment  as  ordinary  burns.  Thus,  Dr.  Tuttle 
found  that  the  external  applications  usually  relied  on  to  mitigate 
the  patient's  suffering,  seem  to  actually  increase  the  pain  experi- 
enced ill  connection  with  X-ray  burns. 

T!i()Be  who  use  this  important  adjunct  of  modern  surgery  will 
do  well  to  remember  that  it  is  claimed  that  no  such  accidents  have 
followed  exposure  to  X-rays  generated  by  a  static  machine,  and 
that  they  have  all  been  produced  in  connection  with  the  Rhumkorff 
coil  apparatus.  It  is  also  will  to  bear  iu  mind  that  exjwricnce  has 
shown  that  but  few  of  tlic-^o  "  burns"  heal  in  less  than  nine  monthi^, 
and  that  the  healing  process  often  cfivers  a  period  two  or  tlwee 
times  as  long.     The  (juickcst  cures  in  these  cases,  I  believe,  have 


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Correspondence.  109 

beea  efiected  by  Dr.  Seneca  D.  Powell,  who  has  observed  healing 
occur  in  six  or  eight  weekB  in  cases  in  which  he  had  promptly  ez- 
cieed  the  affected  area.  I  infer  that  in  neglected  cases  it  is  neces- 
eiry  to  excise  very  deeply,  although  I  have  no  specific  information 
on  this  point.  It  is  noteworthy  that  in  the  case  of  amputation  of 
the  thigh,  examination  of  the  knee-joint  after  the  operation  showed 
that  the  pathological  process  set  up  by  the  X-rays  had  extended 
down  even  to  the  capsular  ligament  of  the  joint. 

As  a  result  of  a  clinical  study  of  the  effects  of  diphtheria  on  the 
heart  actioD,  Dr.  Henry  Dwight  Chapin  has  called  special  atten- 
tion to  a  sudden  and  peculiar  slowing  of  the  pulse  which  is  of  con- 
siderable prognostic  importance.  He  finds  that  this  retardation  is 
observed  chiefly  in  the  grave  septic  cases,  irrespective  of  whether 
the  pulse  has  previously  been  slow  or  rapid.  A  slow  pulse,  with- 
out other  symptoms,  is  not  necessarily  of  grave  omen,  but  when 
the  slowing  is  sudden  and  extreme,  death  invariably  occurs.  In 
floe  case,  which  he  reports,  that  of  a  boy  of  five  years,  the  pulse 
suddenly  dropped  to  28  per  minute,  and  in  spite  of  free  stimula- 
tion the  child  died  in  two  days.  Dr.  J.  E.  Winters  contends  that 
a  slow  pulse  in  diphtheria  has  been  considered  by  all  authorities 
on  that  disease  to  be  of  very  rare  occurrence,  and  from  its  more 
frequent  occurrence  at  the  present  time,  and  especially  among  cases 
receiving  the  antitoxin  treatment,  be  is  disposed  to  infer  that  there 
is  some  direct  connection  between  the  two.  Dr.  H.  W.  Berg,  on 
the  other  hand,  asserts  that  he  met  with  this  peculiar  symptom 
many  years  before  diphtheria  antitoxin  was  known  or  thought  of. 

A  question  which  almost  daily  confronts  the  medical  practitioner 
is,  What  importance  is  to  be  attached  to  the  finding  of  albumin 
and  casts  in  the  urine?  The  answers  vary  greatly,  but  it  is  prob- 
able that  in  the  great  majority  of  instances,  the  tendency  is  to  take 
too  gloomy  and  absolute  a  view.  Dr.  William  Henry  Porter  claims 
that  hyaline  casts  are  not  uncommonly  found  in  the  urine  of  gross 
feeders,  and  in  those  who  exhibit  a  tendency  to  the  over-production 
of  uric  acid;  and  he  explains  their  presence  in  the  urine  by  saying 
that  they  mean  little  more  than  that  an  isomeric  albumin  has  been 
excreted  through  the  renal  cells  and  has  been  precipitated  by  the 
aric  acid.     But  if  epithelial  or  nucleated  casts  are  present  there  is 


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110       The  Atlanta  Medical  and  Surgical  Journal. 

good  reason  for  believing  that  the  kidneys  are  really  diseased. 
Regarding  albuminuria,  the  same  observer  maintains  that  its  sig- 
nificance depends  very  largely  on  the  habits  of  the  individual.  If 
the  patient  is  an  auimaUfeeder,  he  looks  upon  the  prognosis  a» 
much  more  &vorable  than  where  the  individual  ie  largely  vegeta- 
rian, or  partakes  freely  of  frnits.  Odgen  C.  Ludlow,  M.D. 
S309  Seventh  Avenue. 


HYPODERMIC  NEEDLES. 

Richland,  Ga.,  March  23,  1898. 
AOanta  Medical  and  Surgioai  Journal: 

I  enclose  a  little  item  that  may  be  of  intereet  and  some  value 
to  many  physicians  who  have  hypodermic  needles  to  buy. 

When  the  hypodermic  needle  becomes  plugged  up  by  a  particle  of 
rust,  or  any  substance  whatsoever,  and  which  cannot  be  removed 
by  the  little  wire  that  accompanies  every  syringe,  fill  the  syringe 
with  water,  screw  on  needle,  press  down  upon  obstacle  by  piston- 
rod,  then  hold  needle  at  the  point  of  obstruction  in  the  flame  of  an 
alcohol  lamp,  or  any  lamp  as  to  that  matter,  and  the  steam  pro- 
duced thereby  will  expel  the  obstructing  substance  at  once. 

This  does  not  materially  injure  the  needle,  as  I  have  used  them 
for  months  afterward.  It  is  not  necessary  to  hold  the  needle  in 
the  flame  but  a  moment,  and  then  by  expelling  water  immediately 
the  needle  is  cooled. 

By  this  simple  procedure  many  an  old  needle  long  thrown  aside 
■  may  again  be  brought  into   use,  and  the   price  of  many  needles 
saved  in  the  oourse  of  a  physician's  experience. 

Yours  truly,  R.  E.  L.  Barnom,  M.D. 


Is  sepsis  everything?  Is  traumatism  nothing?  What  causes 
the  death  of  the  woman  who  perishes  on  the  operating-table  or  in 
the  obstetric  bed  twenty-four  hours  afler  labor  ?  Does  any  one 
mean  to  say  that  within  twenty-four  hours  germs  have  entered  that 
woman's  system  and  killed  her?  No!  It  is  traumatism  which 
has  killed  her  and  this  traumatism  we  must  avoid. — Malcolm- 
McLean. 


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BDITORIAU 


TtM  offlce  o(  Tn  JoOBBii.  ia  111  ud  SIS  FIlMn  BulldluK- 
Iddnn  »I1  oommanlaliaDi,  kad  make  all  remlttanoea  payable  I 

mSmaiojiT.  Joukhal,  AUanta,  Ga. 

Bapnolsot  aitieletwUl  be  furnUhed.wben  desired, at   a  small 

MIH  •bOBld  alwar*  be  made  on  Uie  mamaeripl. 


THE  MEDICAL  ASSOCIATION  OF  GEORGIA. 


The  forty-DiDth  aoDual  seRsion  of  the  State  AssociatioD  will  be 
held  at  CumberlaDd  Island  April  20th,  21st  anB  22d.  It  ia  hoped 
that  all  who  caa  do  ao  will  malce  it  a  point  to  be  preseot.  Fol- 
lowing is  a  partial  list  of  papers  that  have  been  promised  : 

1.  Treatment  of  Typhoid  Fever.  Wm.  J.  Cox,  M.D.,  Barnes- 
ville. 

2.  A  Report  of  Surgical  Cases,  Hunter  P.  Cooper,  M.D., 
AtlanU. 

3.  Malarial  Asthenopia.     J.  Lawton  Hiers,  M.D.,  Savannah. 

4.  Diphtheria  Antitoxin  with  Report  of  Cases.  Henry  R.  Slack, 
M.D.,  LaGrange. 

5.  Solid  Tumora  of  the  Ovary.  Virgil  O.  Harden,  M.D., 
Atlanta. 

(j.  Puerperal  Eclampsia  and  some  Probable  Causes  of  It.  J.  I. 
Qriffeth,  M.D.,  Danielsville. 

7.  Hysteria.     A.  A.  Davidson,  M.D.,  Angusta. 

8.  Femoral  Hernia,  with  Report  of  Cases.  Floyd  W,  McRae, 
H.D.,  Atlanta. 


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112       The  Atlanta  Medical  and  Surgical  Journal. 

9.  Primary  Sarcoma  of  the  Orbit,  with  Cases.  Alex.  W.  Stic- 
liog,  M.D.,  AtlaDta. 

10.  Mushrooms,  a  Food  and  a  Poison.  W.  H.  Elliott,  M.D., 
SayaDnah. 

11.  The  Indication  for  and  Antiseptic  Technique  of  Uterine 
Drainage  after  Lahor  and  Abortion.     R.  R,  Kime,  M.D.,  Atlanta. 

12.  A  Rare  Form  of  Bone  Atrophy  following  au  Unuuited 
Fracture,  as  seen  by  the  X-Ray.  Eugene  R.  Corson,  M.D.,  Sa- 
vannah. 

13.  Surgical  Treatment  of  Hemorrhoids.  Wm.  S.  Goldsmith, 
M.D.,  Atlanta. 

14.  A  few  Cases  from  my  Note-Book.  J.  G.  Hopkins,  M.D., 
Thomasville. 

15.  The  Possibilities  of  a  Perfect  Aseptic  Surgical  Technique. 
E.  C.  Davis,  M.D.,,  Atlanta. 

16.  Diphtheria,  its  Present  Status  and  Treatment.  B.  C.  Powell, 
M.D.,  Villa  Rica. 

17.  Shall  Georgia  have  a  Medical  Law  Pertaining  to  Marriage 
Contracts?     J.  Chestnut  King,  M.D.,  Newnan. 

18.  Tonsillotomy,  Wheu  and  How  to  Make  It.  J.  M.  Craw- 
ford, M.D.,  Atlanta. 

19.  A  Georgia  Incubator.     W.  P.  Williams,  M.D.,  Blackshear. 

20.  Some  Remarks  on  (a)  Appendicitis,  (6)  Hernia.  W.  F. 
Westmoreland,  M.D.,  Atlanta. 

21.  Chronic  Diarrhea  as  an  Entity,  with  Report  of  Cases.  T.  M. 
Greenwood,  M.D.,  Mineral  Bluff. 

22.  A  Few  Remarks  on  the  Treatment  of  Post-Nasal  Adenitis. 
M.  F.  Carson,  M.D.,  G(iffin. 

23.  The  Physician.     J.  S.  Wimberly,  M.D.,  Sunlight. 

24.  The  "Endoscopic  Treatment  of  Chronic  Urethritis,  with 
Report  of  Cases.     W.  L.  Champion,  M.D.,  Atlanta. 


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Editorial.  118 

25.  AotitoxiD  in  the  TreatmeDt  of  Diphtheria.  B.  L.  Bridges,. 
M.D.,  Ellaville. 

26.  Adenoids  in  the  Pharyngeal  Vault  and  Their  Influence  upon 
the  Ear.     A.  W.  Calhoun,  M.D.,  Atlanta. 

27.  The  Deadbeat  vs.  The  Doctor.     W.  J.  Rowe,  M.D.,  Buford. 

28.  Report  of  a  Case  of  Poliomyelitia.  W.  L.  Patten,  M.D., 
Milltown. 

29.  Some  Patholofpcal  Investigations.  Chas.  M.  Blackford, 
M.D.,  Augusta. 

30.  (Title  to  be  ftirnished.)  S.  Latimer  Phillips,  M.D.,  Sa- 
vannah. 

31.  Alcoholic  Irrigation  in  Puerperal  Sepsis.  Geo.  H.  Noble, 
M.D.,  Atlanta. 

32.  The  Importance  of  Careful  Chemical  Analysis  in  Gastric 
Disorder.     Wm.  Clifton  Lyie,  M.D.,  Augusta. 

The  Cumberland  Island  Hotel  will  be  headquarters  for  members 
of  the  Association,  and  the  place  of  meeting  will  he  the  Georgia 
Teachers'  Auditorium  adjacent  to  the  hotel. 

The  committee  in  charge  of  transportation  will  secure  low  rail- 
^)ad  rates,  perhaps  lower  than  have  heretofore  been  granted  the 
Association.  Several  pleasant  excursions  from  Brunswick  have  been 
arranged  for  the  social  entertainment  of  the  visiting  members,  and 
*^'«ry  effort  will  be  made  to  make  this  meeting  profilahle  and  enjoy- 
<ble,  in  both  scientific  and  social  senses.  The  Committee  of  Ar- 
"ngements  wants  all  U>  come. 

On  Tuesday  the  19tb,  the  day  before  the  assembling  of  the  As- 
woialion,  the  eighth  annual  meeting  of  the  Central  of  Georgia 
•wilffay  Surgeons  Ae^ociatioD  will  be  held  in  the  parlors  of  the 
Cumberland  Island  Hotel.  An  interesting  program  has  been  pre- 
pared and  a  pleasant  meeting  is  expected. 


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114       The  Atlanta  Medical  and  Surgical  Journal, 


MEETING  OF  THE  SOUTHERN  SECTION  OF  THE 
AMERICAN  LA  RYNGOLOGICAL,  BHINOLOGICAL 
AND  OTOLOGICAL  SOCIETY. 

The  second  annual  meeting  of  the  Southern  section  of  the 
above  society  has  just  been  held  in  Atlanta,  under  the  chairman- 
ship  of  Dr.  A.  W.  Calhoun.  This  society  is  comparatively  a  new 
organization,  but  even  in  its  short  career  has  already  reached  a 
high  standard  of  success,  as  has  been  shown  by  the  able  contribu- 
tions of  its  members  in  the  special  fields  of  Laryngology,  Rbi- 
nology  and  Otology. 

The  society  is  distinctively  national  in  ita  aims  and  membei^ 
ship,  and  in  the  latter  its  endeavor  has  been  to  represent  the  beet 
talent  from  all  sections  of  the  Union.  In  order  to  foster  this 
idea,  the  society  has  been  divided  into  sections,  representing  the 
various  parts  of  the  country,  and  these  meet  two  or  three  months 
prior  to  the  national  meeting  of  the  whole  society.  There  are 
four  sections:  Eastern,  Middle,  Western,  and  Southern,  each 
having  its  own  chairman.  Last  year  was  the  first  occasion  of  the 
meeting  of  the  various  sections,  and  the  Southern  section  met  in 
New  Orleans  under  the  chairmanship  of  Dr.  W.  ScheppegreU  of 
that  city,  and  this  year  it  met  in  Atlanta. 

If  this  last  meeting  of  the  Southern  section  can  be  an  index  to 
the  success  of  its  future  meetings,  then  this  latter  has  certainly 
been  attained.  The  meeting  was  held  in  the  ballroom  of  the 
Kimball  House,  and  the  program,  which  has  already  been  printed 
in  the  previous  issue  of  The  Journal,  was  fully  carried  out  with 
several  additional  papers.  The  papers  were  all  practical  in  char> 
acter,  and  all  showed  the  original  work  of  its  author.  The  rep- 
resentation from  the  South  was  large,  and  the  program  showed  the 
following  States  represented:     Texas,  Louisiana,  Mississippi,  Ala- 


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Editorial.  llfr 

bama,  Georgia,  South  Carolina,  Yirgiaia,  TeoDeesee,  Keotuoky, 
ArkaDsas,  and  New  York. 

This  meetiDg  developed  one  fact  and  that  was  the  excellency  of 
the  papers  irom  the  Southern  men,  ehowing  as  it  did  that  they  ar& 
JDSt  as  progresHve  in  their  work  as  our  Northern  confrirea. 

For  some  time,  we  think,  it  has  been  unjustly  held  that  the- 
Southern  men  are  a  little  backward  in  their  profession  and  not 
strictly  up  to  date.  The  program  of  the  recent  meeting  certainly 
refutes  this  idea,  and  it  but  exemplified  the  fact  that  future  meet- 
ings in  the  South  will  rank  equally  in  prominence  as  those  in 
other  portions  of  the  country. 


COMMENCEMENTS. 


Atlanta  Medical  College. — The  fortieth  annual  commencement  of 
this  college  was  held  at  the  Grand  Opera  House  on  the  evening  of 
March  28,  1898.     Forty-six  graduates  were  given  diplomas. 

Dr.  T.  P.  Bell  made  the  opening  prayer.  Dr.  W.  S.  Kendrick, 
Dean,  then  read  the  faculty  report. 

Hon.  N.  J.  Hammond,  President  of  Board  of  Trustees,  conferred 
the  degrees,  in  Latin. 

Rev.  Henry  McDonald,  D.D.,  delivered  the  oration. 

Col.  Hammond  delivered  the  honor  medals.  Dr.  D.  Kios- 
Zertuoche,  of  Mexico,  received  first  honor ;  Dr.  J.  Jones,  of  South 
Carolina,  second  honor,  and  Dr.  J.  H.  Johns,  of  South  Carolina, 
third  honor. 

"Honorable  mention"  was  received  by  Dr.  LeRoy  Napier  of 
Georgia;  Dr.  W.  K.  Johnson  of  Georgia;  Dr.  J.  M.  Smith  of 
Georgia,  and  Dr.  A.  J.  Mooney  of  Geoi^ia. 

Munc  as  usual. 


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116       The  Atlanta  Medical  and  Surgical  Journal. 

Southern  Medical  College, — This  college  cloeed  ite  ntDeteeoth 
seaeiuD  with  ioleresting  exercises  id  the  Grand  Opera  Houee  od  the 
«veiiiDg  of  March  30th.  After  prayer  by  Bishop  C.  K.  Nelson, 
the  Dean,  Dr.  J.  B.  Baird,  made  a  gratifyiog  report  of  the  condi- 
tion of  the  college. 

Diplomas  were  conferred  upon  twenty-seven  graduates  by  Hon. 
Howard  Yan  Epps,  President  of  the  Board  of  Trustees. 

The  address  of  the  evening  was  then  delivered  by  Judge  John 
W.  Akin,  President  of  the  Georgia  Bar  Association. 

The  first-honor  medal  was  awarded  to  Dr.  Xf.  S.  Hardin,  of  South 
-Carolina;  the  secood-bonor  medal  to  Dr.  W.  A.  Tillet,  of  Geoi^ia. 
Drs.  A.  Harper  and  C.  A.  Smith,  both  of  Geoi^a,  tied  for  third 
honor,  and  both  received  a  prize.  Drs.  Joseph  Goodwin  of  Ten- 
nessee, James  Weddinglon  of  Georgia,  Victor  Lagerson  ot  Maine, 
and  George  Turner  of  Geni^ia  received  honorable  roentioD. 

The  music  rendered  by  the  United  States  Fifth  Infantry  band 
was  a  delightful  feature  of  the  evening. 


The  Southern  Quarantine  Couveniion,  called  for  Atlanta  on 
April  12th,  promises  to  be  euccesslul  in  pniut  of  attendance  and  in 
the  work  outlined  for  the  convention.  Some  of  the  most  promi- 
nent health  ofRcere  and  quarantine  officials  in  the  South  have  sig- 
nified their  intention  of  coming  to  Atlanta  to  attend  the  conven- 
tion, and  arrangemento  are  being  made  tor  their  reception. 

Mayor  Collier,  chairman  of  the  Arrangements  Committee,  has 
sent  out  a  great  many  invitations  to  officials  of  the  health  and 
quarantine  departmenU  of  the  Southern  States,  and  a  number  of 
responses  have  been  received  indicating  that  the  convention  will 
be  well  attended. 

Surgeon-General  Wyman,  of  the  United  States  Marine  hospital 
aervice,  has  stated  that   he  will  attend   the  convention,  and  other 


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Editorial.  117 

vell-koowD  officials  will  be  here.  The  Oommittee  od  Arrange- 
OKata  has  been  at  work  and  the  coiiveotion  will  be  made  an  inter- 
esting and  infitrnctive  one. 

Uajor  Collier  has  sent  out  iovitatioDa  to  the  executive  offi- 
cers of  the  Southern  railroads  and  requested  them  to  be  present  or 
send  representatives  to  the  convention,  and  this  will  bring  a 
namber  of  delegates.  The  roads  in  the  Soutbeastern,  Gulf,  and 
Southwestern  States  will  be  invited  to  nend  representatives. 

The  principal  object  of  the  convention  is  to  formulate  roles  for 
the  enforcement  of  quarantine  regulations  and  the  conduct  of 
baodliDg  the  epidemics  of  contagious  diseases.  Other  questions 
will  be  considered,  principal  among  them  that  of  national  quar* 
antine.  Health  ofBcers  from  all  the  States  interested  are  expected 
to  be  present.     Many  interesting  papers  will  be  read. 

Among  those  expected  to  attend  the  convention  are  the  fol- 
lowing : 

Surgeon-General  Wy man  of  Washington;  Dr.  C.  P.  Wilkinson 
of  Louisiana;  Dr.  H.  B.  Horlbeck  of  Charleston,  S.  C;  Dr.  W.  H. 
Sanders  of  Mobile,  Ala.;  Dr.  T.  S.  Scales  of  Mobile;  Dr.  F.  G. 
Ranshaw  of  Peosacola;  Professor  J.  L.  Ludlow  of  Winstoo,  >J.  C, ; 
Dr.  Felix  Formento  of  New  Orleans;  Dr.  E.  P.  Griffin  of  Pen- 
wcola,  Miss.;  Dr.  W.  T.  Oppenheimer  of  Virginia;  Mr.  J.  S.  B. 
Thompson,  representing  the  Virginia  health  department;  Dr. 
Allen  Stewart  of  Port  Royal,  S.  C,  aud  many  others. 


The  Chair  of  Diseases  of  the  Kye,  liir,  aud  Throat  at  the  Medical 
College  of  Virginia,  made  vacant  by  the  death  of  Professor  Charles 
M.  Shields,  will  be  filled  at  the  annual  meeting  of  the  board  of  vis- 
itors of  the  college  April  21st.  All  applications,  accompanied  by 
credeolials,  should  be  forwarded  to  Christopher  Tompkins,  M.D., 
Dean,  Richmond,  Va. 


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MEDICAL  ITEMS. 


Mathews  Quarlerly  Journal  of  ReaUd  OaaCro-TniesHnal  Dis' 
^asea  will  hereafter  appear  as  a  mODthlj  under  tbe  name  of  the 
LouiaviUe  Journal  of  Surgery  and  Medicine. 


To  STOP  an  epistaxis,  it  is  suggested  in  ao  article  before  us  to  in- 
-sert  a  rubber  condom  well  back  in  the  narea  and  fill  it  up  with 
fiaely  cracked  ice.     fiecondom  artem,  isn't  it? 


What's  the  matter  with  Keokuk,  Iowa?  Under  the  "Change  of 
Address"  heading  in  the  last  Journal  of  the  American  Medical 
Association,  we  notice  that  ten  doctors  have  just  left  that  town 
for  other  more  promising  fields.  As  a  good  place  to  get  away 
from  Keokuk  seems  to  be  quite  a  success. 


It  is  reported  that  over  forty  victims  of  the  cocain  babit,  in- 
duced largely  by  the  use  of  popular  preparations  as  catarrh  cures, 
appeared  in  the  police  courts,  etc.,  of  Chicago  within  two  or  three 
mootbs  of  last  year.  The  evil  was  so  noticeable  as  to  cause  the  in- 
troduction of  an  ordinance  prohibiting  the  sale  of  these  dangerous 
remedies. — Ex. 


Dh.  a.  G.  Hobbb  has  (removed  hie  office  from  14^  Whitehall 
«treet  to  elegant  new  offices  in  tbe  English-American  Trust  Co.'s 
building  on  Peachtree  street.  Dr.  Hobbs  was  in  his  old  offices  for 
sixteen  years,  and  we  trust  that  he  will  enjoy  the  same  good  health 
and  prosperity,  now  that  he  has  moved  to  a  more  modern  building. 
He  is  beautifully  fitted  up  on  tbe  seveutb  floor. 


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Medical  Iteus.  119 

The  reorgacizatioD  of  the  old  Savaooab  Medical  College  (which 
has  been  dead  for  thirty  years)  is  being  discussed.  What  imagi- 
nary reasoDS  any  persoos  can  have  for  creating  another  medical  col- 
lege is  past  our  uoderstandiDg.  There  is  no  need  for  a  new  col- 
lege in  Savannah  or  anywhere  else  in  this  country.  The  over- 
supply  which  we  already  have  is  one  of  the  evils  which  afflict  the 
medical  profession  to-day,  and  to  those  who  contemplate  adding  still 
further  to  this  excess  we  sincerely  ui^e,  Don't,  for  heaven's  sake, 
Don't. 


Mestion  was  made  in  onr  last  issue  of  Dr.  J.  J.  Devine,  of 
Texas,  as  one  of  our  oldest  subscribers.  Probably  the  oldest  on 
oor  boohs  is  Dr.  T,  J.  Mitchell,  of  Locust  Grove,  Georgia.  Dr. 
Mitchell  first  became  a  subscriber  in  1869,  and  when  the  Joubnal 
was  revived  aAer  the  war  he  again  subscribed,  and  through  all  the 
varying  fortunes  of  the  Journal  since  that  date  he  bas  not  for- 
gotten UB.  Dr.  Mitchell  has  had  a  long  and  useful  medical  expe- 
rience, and  we  would  be  pleased  if  he  would  give  us  some  of  his 
professional  reminisceDces  for  publication. 


An  important  innovation  in  the  plan  of  Sajous'  Annual  of  the 
UnivertfU  Medical  Seieiiceg  is  announced  by  the  editor.  Beginning 
with  1898  a  new  clasaificatioa  and  arrangement,  more  adapted  to 
the  use  of  the  general  practitioner  and  yet  of  no  l^s  value  to  the 
medical  author,  will  be  adopted.  Instead  of  presenting  the  ex- 
cerpts from  the  year's  literature  arranged  in  order  under  a  general 
head  as  before,  each  disease  is  described  m  extenao  and  the  new 
features  of  the  past  year  properly  noted.  The  work  therefore  be- 
comes a  complete  reference  text-book  of  medical  science  revised 
each  year.  The  volumes  are  awaited  with  interest,  as  the  new 
plan  promises  largely  increased  usefulness. — Ex. 


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120       The  Atlanta  Medical  and  Surgical  Journal. 

The  New  York  Skin  and  Cancer  Hospital  has  moved  out  of  its 
old  quarters  on  Thirty-fourth  street  into  its  baadsome  new  build- 
ing on  Nineteenth  street  and  Second  avenue.  The  new  building 
la  a  modern  fire-proof  structure  of  four  stories  and  basement,  con- 
taining about  sixty  beds  for  patients ;  of  these  seven  are  in  private 
rooms.  On  the  top  floor  is  a  modern  operating-room,  well  equipped, 
the  Worden  ward  for  children,  and  most  of  the  private  rooms.  On 
the  next  two  floors  are  four  wards  for  male  and  female  patients 
with  diseases  of  the  skin  and  cancer.  On  the  ground  floor  is  the 
large  out-patient  room,  with  consulting  rooms,  pathological  labo- 
ratory, drug  room,  office,  reception  room,  etc.  In  the  basement 
there  is  a  complete  set  of  baths,  includiDg  Turkish,  Russian,  needle, 
and  plunge,  besides  the  kitchen,  laundry,  dining-room,  etc.  The 
lighting,  heating  and  ventilation  are  of  the  most  approved  kind. 


The  late  death  of  Dr.  Hugh  Hagan  was  indeed  a  grievous  loss 
to  the  profession  of  this  city,  and  no  one  has  gone  to  his  grave 
whose  absence  will  be  more  deeply  felt  by  surviving  friends.  Dr. 
Hagan  was  born  iu  Richmond,  Virginia,  in  i863.  He  graduated 
in  Medicine  at  the  College  of  Physicians  and  Surgeons,  New  York, 
in  1888,  and  after  a  year's  study. abroad  he  began  to  practice  his 
profession  iu  Atlanta.  In  his  professional  work  he  was  eminently 
successful.  His  rise  was  rapid,  and  by  innate  merit  and  an  agreea- 
ble personality  he  steadily  acquired  a  large  and  lucrative  practice. 
He  was  a  constant  Hludeut  of  medicine,  and  when  not  occupied  with 
the  demands  of  his  busy  prolesfiioual  life,  he  could  u-iually  be  found 
in  his  library  among  his  books  and  journals.  As  a  physician  he  was 
seieutific  but  conservative;  he  was  patient  and  accurate;  he  pos- 
sessed a  keen  and  discriminating  jndginent  iu  diagnosis,  and  he  was 
careful  and  faithful  in  the  management  aud  treatment  of  his  pa- 
tients.    Dr.  Hagan  was   in   the   prime  nf  an  apparently  vigorous 


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Medical  Itbms.  121 

manhood,  and  his  sudden  death  from  apoplexy  will  be  sincerelj 
and  genaiaely  mouroed  by  a  host  of  friends,  lay  and  profeBsional. 
As  a  man  he  possessed  the  noble  traits  of  a  bigb  personal  cbsi^ 
acler;  he  was  kind,  generous,  conscientious,  honest,  unassuming, 
and  warm-hearted,  and  he  wore  "  without  abuse  the  grand  old 
name  of  gentleman."     "  He  should  have  died  hereaAer." 


The  third  annual  meeting  of  the  Assr>ciation  of  Surgeons  of 
the  Southern  Railway  Company  will  convene  at  the  Hygeia  Hotel, 
Old  Point  Comfort,  Vii^inia,  Tuesday  and  Wednesday,  June  21 
and  22,  1898. 

At  the  same  time  and  place  it  is  proposed  to  hold  a  conference 
of  chief  surgeons  or  other  medical  representatives  of  the  principal 
railroads  operating  in  Virginia,  West  Virginia,  North  and  South 
Carolina,  Georgia,  Florida,  Alabama,  Mississippi,  Louisiana,  Texas, 
Arkansas,  Tennessee,  and  Kentucky,  for  the  purpose  of  determtn- 
iog  the  advisability  of  forming  an  organization  to  be  known  as  the 
"Southern  Association  of  Railway  Sui^ous,"  or  some  other 
equally  comprehensive  name.  The  following  distinguished  surgeons 
have  promised  to  be  present  and  to  deliver  addresses  on  subjects 
pertaining  to  railway  surgery :  Dr  John  A.  Wyeth,  New  York;  Drs. 
W.W.  Keen  and  Joseph  Price,  Philadelphia;  Dr.  Hunter  McGuire, 
Richmond;  Dr.  Walter  Wyman,  Sui^on-General  U.  S.  Marine 
Hospital  Service;  Dr.  Joseph  Ransohoff,  Cincinnati;  Dr.  Willis 
F.  Westmoreland,  Atlanta,  and  Dr.  J.  J.  Kiuyouu,  Past  Assistant 
Surgeon,  U.  8.  Marine  Hospital  Service.  (C.  M.  Drake,  M.D., 
President;  T.  H.  Hancock,  M.D.,  Secretary,  6J  Whitehall  St., 
Atlanta,  Ga.) 


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BOOK  REVIEWS. 


American  Year-book  of  Medicine  akd  Suhqery.  Being 
a  Yearly  Digest  ol  the  Scientific  Progress  and  Authoritative 
OpiuioD  in  all  BrancheR  of  Medicine  and  Surgery,  drawn  from 
Journals,  Mouographa  and  Text-Bui)ks  of  the  leading  Aniericaa 
and  Foreign  Authors  and  In vei^ti gators.  Under  the  General 
Editorial  Charge  of  George  M.  Gould,  M.D.  Published  by 
W.  B.  Saunders,  925  Walnut  street,  Philadelphia.    Price  f6.50. 

This  work  is  well  known  to  the  profestiiou,  and  therefore  needs 
no  introduction.  The  work  certainly  keeps  abreast  of  the  times, 
and  is  therefore  very  valuable  in  giving  to  the  prolession  the  ad- 
vancements made  in  medicine  and  surgery  during  the  year  1897. 
It  embraces  all  departments  of  medicine,  and  is  therefore  a  ready 
reference  book  for  every  physician.  To  add  to  the  value  of  this 
work  the  collaborators  are  men  of  known  ability  and  prominence. 
Sueb  a  book  fills  a  long-felt  want,  as  by  it  the  physician  can  readily 
bunt  up  all  the  advances  made  during  the  year  in  anyone  particu- 
lar  subject,  and  therefore  not  be  obliged  to  go  through  a  whole 
mass  ot  medical  journals  in  order  to  obtain  what  he  wishes.  Be- 
sides, if  he  wishes  to  know  more  of  the  reference  made,  there  is  the 
reference  also  to  the  journal  from  which  it  comes  and  also  the  date. 
This  work  is  unique,  and  no  other  journal  takes  its  place.  Every 
progressive  physician  should  yearly  add  this  book  to  his  library. 


Diseases  op  Women.  By  Alexander  J.  C.  Skene,  M.D.,  LL.D., 
Professor  of  Gynecology  Long  Island  Hospital  Medical  College. 
Third  Edition.  D.  Appleton  &  Co ,  Publishers,  New  York. 
(Southern  agency,  Atlanta.) 

To  those  in  search  of  an  extremely  conservative  text-uook  upon 
Gynecology  this  offers  an  excellent  opportunity  for  securing  such 
a  book,  but    to    those  who  wish  to  study  the    subject  from   the 


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Book  Reviews,  128 

most  advaoced  methods  this  is  not  the  book  for  them  to  select. 
Id  the  revisioD  of  this  book  it  does  seem  that  the  author  would 
have  omitted  the  prolix  details  of  illustrative  cases  which  conclude 
so  raaoy  of  the  chapters,  as  they  cousume  space  and  could  only  be 
appreciated  if  they  were  seen  and  studied  from  a  clinical  standpoint. 

Again,  it  seems  a  little  straDge  to  find  in  a  text-boot  on  Diseases  uf 
Women  a  detailed  description  of  Mr.  B.,  whose  bladder  contained 
«  foreign  body,  and  at  another  place  attention  is  called  to  one  of 
the  illustrative  cases  having  bis  pulse  accelerated  to  106  degrees. 

The  illustrations  and  descriptionfl  of  plastic  operations  are  ex- 
cellent, and  tend  to  show  with  a  great  deal  of  clearness  just  how 
these  operations  should  be  performed.  There  is  an  omission  to  a 
great  extent  ot  any  very  comprehensive  description  of  the  prepara- 
tion of  patients  for  operations,  and  the  care  necessary  to  secure 
cleanliness  on  the  part  of  the  operator  and  assistants. 

The  free  use  of  opium  iu  pelvic  peritonitis  and  cellulitis  is 
strongly  advocated,  although  most  gynecologists  believe  this  to  be 
a  most  pernicious  practice. 

This  book,  taken  throughout,  is  not  such  a  book  as  should  be 
generally  adopted  as  a  text-book,  but  is  one  which  will  need  a  re- 
vision again  within  a  very  short  period  of  lime.  e.  c.  d. 


The  Care  and  Feeding  of  Children.  By  L.  Emmett  Holt, 
Professor  of  Diseases  of  Children,  New  York  Polyclinic.  D. 
Appleton  &  Co.,  Publishers,  New  York.  (Southern  agency, 
Atlanta.) 

This  little  book,  arranged  in  the  form  of  a  catechism,  contains 
many  very  valuable  and  practical  questions  with  the  answers  in  a 
very  concise  style.  This  was  first  written  for  training-school  for 
nursery  maids,  but  its  practical  nature  was  early  recognized  by  the 
members  of  the  profession  who  have  the  care  of  children,  and  a  de- 
mand has  been  made  by  them  for  it.  It  is  a  little  book  which 
those  who  treat  many  children  would  do  well  to  read  and  to  place 
within  the  reach  of  nurses  who  care  for  infants,  especially  during 
the  early  months  of  their  lives.  e.  c.  d. 


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124       The  Atlanta  Medical  and  Surgical  Jocrnal. 

The  Yeah-Book  op  Tbeatmekt  for  1898.  A  Critical  Review 
for  Practitioners  of  Medicioe  aod  Surgery.  488  pages.  Clotb, 
*1.B0.     Lea  Brothers  &  Co.,  Philadelphia  aod  New  York. 

Id  this,  the  fourteenth  aDoual  issue  of  the  "Year- Book  of 
TreBtnuent,"  the  aim  has  been,  as  heretofore,  to  present  the  busy 
practitioner  with  a  readable  digest  made  of  the  progress  in  the 
domain  of  therapeutics  during  the  past  year.  The  entire  domain 
of  practical  medicine  is  covered  iu  a  series  of  twenty-five  chapters, 
each  being  assigned  to  a  recognized  authority,  who  gives  all  that  is 
new,  tried  and  true,  with  a  critical  statement  of  the  comparative 
value  and  applicability  of  the  various  drugs,  Ibrmulee  and  methods 
of  treatment.  The  work  as  a  whole  presents  an  exceedingly  useful 
r^sum4  of  medical  and  surgical  progress  for  the  past  year. 


International  Medical  Annual.  A  Work  of  Reference  for 
Medical  Practitioners.  Sixteenth  year,  1898.  K.  B.  Treat  & 
Co.,  Publishers,  241  West  23d  street,  New  Y.>rk.  [Price  J3.00.] 

Id  preparing  the  sixteenth  annual  issue  of  this  work  the  editors 
and  contributors  have  continued  along  the  lines  of  previous  editions, 
and  they  have  presented  a  compact  review  of  the  progress  of  med- 
ical science  (in  1897)  as  recorded  iu  curient  medical  literature. 
Those  of  our  readers  who  are  already  familiar  with  this  work  will 
find  this  issue  fully  the  equal  of  its  predecessors.  To  our  practi- 
tioners who  wish  to  keep  in  touch  with  medical  progress  it  is  an 
exceedingly  valuable  book  of  reference. 


Messrs.  Lea  Brothers  &  Co.,  of  Philadelphia,  announce  for 
early  publication  the  following  books  by  eminent  authorities: 

"A  Manual  of  Otology."  By  Gorham  Bacou,  A.M.,  M.D., 
Professor  of  Otology  iu  University  Medical  College,  New  York. 
With  an  Introductory  Chapter  by  Clarence  J.  Blake,  M.D.,  Pro- 
fessor of  Otology  in  the  Harvard  Medical  School,  Boston,  Mass. 

"  The  Treatment  of  Surgical  Patients  before  and  alter  Opera- 


nd byGoOglc 


Book  Reviews.  126 

tioD."  By  Samuel  M.  Brickner,  M.D.,  Yisiting  Surgeon  of  the 
Mt.  Sinai  Hospital,  New  York. 

"  The  Principles  of  Treatment."  By  J.  Mitchell  Bruce,  M.D., 
F.R.C.P.,  Fhyeician  and  Lecturer  on  Materia  Medica  and  Thera- 
peutics at  Chariog-CrosB  Honpital,  London. 

"Diseases  of  the  Nose,  Throat,  Naso-Pharyoz  and  Trachea:  A 
Manual  for  Students  and  Practiliouere ."  By  Cornelius  G.  Coakley, 
M.D.,  Professor  of  Laryngology  in  University  Medical  College, 
New  York. 

"  Diseases  of  Women :  A  Maoual  of  Non-Sui^cal  Gynecology, 
designed  especially  for  the  use  of  Students  and  General  Practi- 
tioners." By  Francis  H.  Davenport,  M.D.,  Instructor  in  Gyoe- 
eology  in  the  Medical  Department  of  Harvard  University,  Boston. 

"A  Treatise  on  Gynecology,"  By  E.  C.  Dudley,  A.M.,  M.D., 
Professor  of  Gynecology  in  the  Chicago  Medical  College,  Chicago. 

"  A  Text-Book  of  Anatomy."  By  American  Authors.  Edited 
by  Frederick  Henry  Gerrish,  M.D.,  Professor  of  Anatomy  in  the 
Medical  School  of  Maine. 

"  Manual  of  Skin  Diseases."  By  W.  A.  Hardaway,  M.D.,  Pro- 
fessor of  Skin  Diseases  in  the  Missouri  Medical  College. 

"  The  Principles  and  Practice  of  Obstetrics."  By  American 
Anthore.  Edited  by  Charles  Jewett,  M.D.,  Professor  of  Obstet- 
rics in  the  Long  Island  College  Hospital,  Brooklyn,  N.  Y. 


No  ONE  who  is  interested  in  the  beet  contemporary  French  lit- 
erature can  afford  to  miss  the  series  of  sketches  and  stories  by 
Paol  Bourget,  which  will  begin  in  The  laving  Age  for  April  2. 
These  sketches  have  been  but  recently  published  in  France,  and 
this  is  their  first  appearance  in  English  dress.  They  are  trans- 
lated for  The  Living  Age  by  William  Marchaot.  They  are  ex- 
tremely clever  and  characteristic. 


A  Thoughtful  Answer. — "  What's  the  first  step  toward  the 
digestion  of  the  food?"  asked  the  teacher.  Up  went  the  hand  of  a 
black-haired  little  fellow,  who  exclaimed,  with  eagerness,  "Bite  it 
off!" — American  Ziehen. 


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SELECTIONS  AND  ABSTRACTS. 


How  TO  Avoid  Catching  Consumption  and  How  to  Avoii> 
Giving  it  to  Others.* 

Tuberculosis,  or  ooDsumption,  is  an  JDfectious  disease  wbicb  de- 
pends for  its  origin  aad  continuation  upon  a  minute  oi^nism 
known  as  the  tubercle  bacillus.  Tbis  is  no  longer  denied  by  per- 
sons of  intelligence. 

^  it  is  an  infecttovs  or  contaffious  disease,  it  is  evident  that  each 
new  case  must  depend  for  itsorigin  upon  a  preceding  one.  Tbis  self- 
evident  truth  is  of  the  greatest  importance  and  must  be  borne  in 
mind  io  order  to  appreciate  tbe  force  of  tbe  following  statements: 

The  cure  of  this  disease  is  so  difficult  and  uncertain,  that  up  to 
the  present  time,  we  are  forced  to  say  that  no  absolute  cure  is 
known. 

It  is  the  purpose  of  the  State  Medical  Society  of  Washington  to 
alleviate  the  lot  of  those  afflicted,  and  to  reduce  the  large  mor- 
tality from  a  disease  which  has  increased  at  a  regular  ratio  in  this 
State  from  9.8  per  cent,  of  all  deaths  in  1892  to  about  13  per  cent, 
in  1896,  There  are  more  deaths  in  the  Northwestern  States  from, 
tuberculosis  than  from  all  the  reported  infectious  diseases  combined. 

It  being  granted  that  consumption  is  an  infectious  disease,  and 
that  each  case  results  from  a  preceding  one,  the  lessening  of  this 
high  death-rate  simply  resolves  itself  into  preventing  contagion, 
and  this  is,  fortunately,  much  easier  than  curing  the  disease. 

It  must  be  understood  that  tuberculosis  is  not  only  a  disease  of 
tbe  lungs,  but  attacks  almost  every  part  of  tbe  body.  It  is  known 
under  the  following  namej:  Consumption,  scrofula,  marasmus, 
some  forms  of  meningitis,  wasting  diseases,  white  swelling  and 
lupus  (a  disease  of  tbe  surface  of  the  body  characterized  by  rapid 
destruction  of  the  tissues,  and  so-called  from  a  Latin  word  mean- 
ing a  wolf). 

f   the  WMhlugton  Bute  UedlcaL 


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Selections  and  Abstracts.  127 

The  source  of  iofectioD  in  this  disease  lies  solely  in  the  pus,  or 
matter,  set  free  by  the  sputum  wheo  the  lung  is  affected,  the  dis- 
cb&i^e  from  the  bowels  when  the  disease  is  iu  the  abdomen,  or  the 
BecretioD  of  abscesses  nr  lupus  surfaces. 

Its  entrance  to  the  healthy  body  is  by  three  avenues :  First, 
the  lungs;  second,  the  storoach  ;  third,  the  skin. 

Knowing  the  source  of  the  disease  and  its  methods  of  iofectioD, 
ve  have  the  means  in  our  own  hands  of  controlling  and  practically 
eradicatiog  it,  and  that,  too,  without  working  hardships  upon  loved 
ones,  but  in  reality  making  life  pleasanter  and  the  chances  of  their 
recovery  many  fold  greater. 

The  most  fertile  sonrce  of  infection  is  from  the  sputum,  which, 
when  dried,  finds  an  entrance  iuto  the  body.  Therefore,  uU  pattenta 
mmt  destroy  the  gputum  before  it  passes  from  their  control.  The  fol- 
lowiog  suggestions  will  be  helpful : 

1.  At  home,  expectorate  into  a  cup  kept  for  that  purpose.  This 
cup  should  be  half  or  three-quarters  filled  with  a  solution  consist- 
ing of  one  part  of  carbolic  acid  to  twenty  oT  water.  A  solution 
can  be  made  up  and  kept  on  baud.  The  commercial  carbolic  acid 
is  as  good  as  the  refined  and  is  much  cheaper.  Burn  contents  and 
boil  cup. 

2.  Never  expefdorate  into  a  pocket  handkerchief  or  cloth  which  will 
ht  aUoiDed  to  dry.  Keep  sputum  wet,  and  best  with  the  above  so- 
lulJoo.  Soak  handkerchiefs  in  the  same,  and  immerse  them  in 
boiling  water  bffore  storing  them  with  the  soiled  linen. 

3.  For  use  upon  streets,  or  when  away  from  home,  let  patient  be 
provided  with  thin  Japanese  napkins.  After  using,  fold  up  with 
BpDtnm  inside  and  burn  at  the  first  opportunity.  A  special  pocket 
lined  with  waterproof  material  should  be  provided  for  these  used 
napkins,  and  these  pockets  should  be  frequently  sponged  with  the 
above  mentioned  solution.  Napkins  can  be  bad  at  a  low  price, 
abont  one  dollar  per  thousand. 

4.  Do  not  spit  where  domestic  animals  can  have  access  to  this 
matter.  Cattle  and  fowls  are  very  susceptible  and  become  in  turn 
wurces  of  infection.  In  fact,  do  not  spit  at  all  where  sputum  is 
not  destroyed  before  it  can  dry 

5.  Do  not  spit  on  streets,  and  never  swallow  the  sputum. 


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128       The  Atlanta  Medical  and  Sdrqical  Journal. 

6.  No  tuberculous  persoD  should  kiss  tmy  one  on  the  mouth. 

7.  Tuberculous  patients  should  be  smooth  shaven.  It  is  impos- 
sible to  keep  a  beard  clean  and  from  being  infected. 

8.  The  tuberculons  must  always  sleep  alone. 

9.  All  bed  clothing  shonld  be  chauged  often  (every  day  when 
the  case  is  far  advanced),  and  should  be  at  once  immersed  in  boil- 
ing water  for  five  minutes. 

10.  Have  separate  table  utensils  and  cause  them  to  be  scalded 
as  soon  as  used,  and  washed  separately. 

11.  Do  not  permit  others  to  use  patient's  personal  property. 

12.  A  tuberculous  mother  must  not  nurse  her  baby,  nor  kiss  it 
on  the  mouth,  and  in  preparing  its  food  must  observe  special  care. 

13.  Tuberculous  persons  should  not  engage  in  occupations  where 
they  are  compelled  to  handle  food  supplies.  If  this  is  unavoid- 
able, use  every  precaution  to  prevent  infection. 

14.  Be  careful  not  to  infect  the  sleeping  berths  when  traveling. 
There  is  no  need  of  isolating  patients,  nor  of  depriving  them  of 

a  single  home  comfort. 

Next,  a  few  directions  to  those  who  would  avoid  contracting  the 
disease. 

Eemember  the  sources  of  infection;  sputum,  bowel  discbarges 
and  pus  from  abscesses  or  tuberculous  sur&ces. 

1.  Avoid  resorts  devoted  to  the  treatment  ol  the  tuberculous. 

2.  Summer  and  winter,  women  must  wear  skirts  that  clear  the 
walks  by  not  less  than  four  inches,  and  five  or  six  would  be  better. 
Avoid  all  kinds  of  fur  or  other  soft  trimmings  around  the  lower 
border  of  dresses.  Americans  are  expectorating  animals,  and  all 
the  laws  in  the  world  and  all  the  good  advice  that  may  be  offered, 
will  serve  only  to  diminish,  but  not  eradicate  this  nuisance.  Note 
the  filth,  especially  the  sputum  on  the  sidewalks.  Skirts  draped 
through  this  are  taken  home,  dried,  brushed  and  cleaned,  and  thus 
infection  is  introduced  into  the  household. 

3.  Do  not  move  into  a  bouse  where  your  predecessor  was  tuber- 
culous, without  an  efficient  disinfection  of  the  premises.  To  secure 
such  disinfection,  have  the  walls  cleaned  of  old  paper  and  washed 
with  a  solution  of  mercuric  chloride  (bichloride  of  mercury)  one 
to  one  thousand.     The  woodwork  should  be  painted,  after  cleaning 


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Selections  and  Abstracts.  129 

with  this  solution,  aod  all  floors  thoroughly  saturated  with  the 
aame.    The  solution  is  a  poison. 

4.  Do  not  share  a  consumptive's  bed,  nor  use  the  personal  prop- 
erty, including  dishes,  belonging  to  one. 

5.  Avoid  tuberculous  food.  Fowls  and  cattle  are  found  to  be 
especially  susceptible  to  tuberculous  infections.  However,  when 
food  is  thoroughly  cooked  infection  is  destroyed.  Milk,  especially 
that  for  children,  must  be  from  cattle  free  from  infection.  By 
heating  it  to  ISO  degrees  F.  for  half  an  hour,  it  becomes  non-in- 
tectioug, 

6.  Never  pot  coins  or  other  money  into  the  mouth. 

7.  ^ever  use  a  pipe  or  wind  instrument  belonging  to  a  con- 
sumptive. 

8.  Probably  most  important  of  all ;  see  that  the  digestive  func- 
tions are  kept  in  perfect  order.  Dyspepsia  is  more  often  a  fore- 
runner of  tuberculosis  than  any  other  disease.  The  secretions  of 
a  healthy  stomach  will  dispose  of  a  large  amount  of  infected 
material,  but  when  diseased,  the  stomach  is  the  principal  avenue 
of  infection. 

9.  Spend  as  much  time  in  the  sunlight  aud  open  air  as  possible. 
Keep  sleeping  and  living  rooms  well  aired  and  filled  with  snolight. 
The  sunlight  acts  as  a  powerful  destroyer  of  the  germ. 

10.  If  possible  to  choose  the  site  of  your  home,  locate  it  on  por- 
ous soil.     If  not,  see  that  the  drainings  are  perfect. 

11.  Protect  all  raw  or  wounded  surfaces  from  any  possible  tu- 
berculous infection. 

12.  Do  not  forget  that  every  new  case  of  consumption  comes 
from  a  preceding  one. 

All  individuals  are  not  equally  apt  to  acquire  tuberculosis.  Some 
are  peculiarly  predisposed  and  must  be  especially  careful  to  follow 
the  above  instructions.     Such  are, 

1.  Persons  bom  of  tuberculous  parents,  or  having  several  rela- 
tives who  suffer  with  tuberculosis  in  any  of  its  forms. 

2.  Persons  who  are  enfeebled  by  privations  or  excesses.  Alco- 
holic excesses  are  peculiarly  dangerous  in  this  respect. 

3.  The  following   may   be  termed    predisposed:     All  persons 


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130       The  Atlanta  Medical  and  Surgical  Journal. 

Bufiering  or  Just  recoveriDg  from  measles,  whooping-cougb,  small- 
pox, loflueDza. 

Those  predisposed  must  not  associate  with  persoos  afflicted  with 
the  disease. 

Id  closing,  to  quote  from  a  publication  of  the  PeDDsylvaoia 
Society  for  the  Preveution  of  Tuberculosis,  "  Impress  indelibly 
upon  your  mind  that  do  new  case  of  tuberculosis  can  ari^  without 
an  old  one.  If  you  cao  therefore  absolutely  avoid  cases  and  every 
source  of  infection,  you  are  safe  whatever  predisposing  cause  you 
may  labor  under.  With  the  present  prevalence  of  the  disease, 
however,  no  one  can  avoid  every  source  of  infection,  and  it  there- 
fore becomes  important  that  predisposing  causes  as  well  a 
of  infection  should  be  avoided." 


The  Objects  and  Limits  of  Opbhation  for  Cancer. 

In  discussing  this  subject  Cheyne  (British  Medical  Journal) 
says :  "  The  primary  object  of  operation  in  cancer  is,  of  course, 
the  prolongation  of  the  patient's  life  and  tbe  alleviation  of  his 
local  trouble;  aud  what  I  propose  to  assert  id  these  lectures  ie 
that  these  results  are,  iu  most  cases,]  best  attained  by  aiming, 
whenever  it  is  possible,  at  the  cure  of  tbe  disease.  Until  re- 
cently, and  even  now,  many  surgeons  approach  operation  in  these 
cases  impressed  with  tbe  view  that  real  cure  is  practically  hopeless, 
and  that  with  few  rare  exceptions  the  most  that  can  be  expected  is 
prolongation  of  life  for  a  variable  length  of  time.  I  therefore 
hold,  and  would  strongly  urge  the  view,  that  the  first  question  to 
be  kept  before  us  in  investigating  a  case  of  cancer  is  whether  there 
is  a  possibility  of  curing  the  disease  or  not.  Such  a  point  of  view 
makes  a  great  difference  in  the  operation,  for  it  is  not  then  suffi- 
cient to  remove  only  the  noticeable  disease,  but  it  is  necessary  to 
take  away  as  far  as  possible  the  parts  in  which  the  disease  may 
have  become  disseminated,  although  still  unrecognizable — iu  other 
words,  possibly  infected  lymph-areas.  Hence  it  is  necessary  in  all 
cases  where  the  disease  has  lasted  any  time,  or  extended  at  all 
deeply,  not  only  to  remove  the  primary  mass  freely,  but  also  to 
takeaway  the  whole  lymphatic  area  ap  to  and  including  tbe  nearest 


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Selections  and  Abstracts.  131 

lymphatic  glands.  Thus  the  operatiou  performed  with  the  object 
of  cnriog  the  disease  becomes  a  much  more  extensive  one,  and  coo- 
Mqneiitly  muoh  more  serious  than  that  which  simply  aims  at  getting 
rid  of  the  main  trouble  for  a  time  and  prolonging  the  patient's- 
life.  The  first  question  to  be  considered,  then,  with  regard  to  a 
case  of  cancer  is  the  anatomical  one,  namely,  whether  it  is  ana- 
loiQically  possible  to  remove  all  the  local  disease  and  the  probably 
infected  lymphatic  area  so  thoroughly  as  to  give  a  fair  chance  of 
noD -recurrence.  If  this  is  anatomically  possible,  the  next  ques- 
tions are,  What  are  the  chances  of  death  as  the  result  of  the  ope- 
ration? aad  What  will  be  the  subsequent  functional  result? 

"The  primary  object  of  operatiou  in  these  cases  being,  there- 
fore, cure,  the  limit  of  the  radical  operation  is  where  there  is  no 
reasonable  prospect  of  removing  the  whole  disea^-e,  or  where,  along 
with  a  very  poor  prospect  of  success,  there  is  a  very  high  mortality- 
from  the  attempt.  In  such  cases  I  do  not  think  the  operation 
shoald  be  mentioned  at  all,  for  even  when  the  patient  recovers  from 
ii,  and  has  presumably  two  or  three  months  added  to  bis  life,  few 
woald,  I  think,  tbank  one  for  it,  seeing  that  these  two  or  three 
months  have  been  spent  in  convalescing  from  a  serious,  and,  in  the 
end,  useless  operation. 

"But  even  in  cases  where  hope  of  cure  or  imarked  prolongation 
of  life  by  radical  operation  is  out  of  the  question,  operation  may 
sometimes  he  advisable  with  the  object  of  removing  symptoms 
which  are  immediately  threatening  to  life — such  operations  as  trach- 
eotomy, colotomy,  etc.^-or,  in  the  second  place,  with  the  idea  of 
taking  the  primary  disease  from  a  part — such  as  the  mouth  or 
throat — where  its  continued  development  means  intense  pain  and 
trouble,  and  thus  of  substituting  for  these  troubles  an  easier  death 
from  exhaustion.  A  »ine  qua  non  of  such  operations  must,  how- 
ever, be  that  they  are  reasonably  free  from  immediate  risk;  and 
with  regard  to  the  second  class,  tbat  there  is  a  prospect  of  attain- 
ing the  object  of  the  operation,  namely,  the  entire  removal  of  the  , 
duease  from  the  part  operated  upon.  I  do  not  think  a  dangerous 
operation  is  allowable  for  the  relief  of  symptoms,  however  proper 
it  may  be  if  a  cure  may  be  hoped  for. 

"There  are,  then,  two  different  objects  to  be  held  in  view  and 


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132       The  Atlanta  Medical  and  Sdrgical  Jodrnal. 

two  diSereut  questions  as  regards  operation  whicb  we  must  bear  in 
mind  io  treating  a  case  of  cancer,  namely,  Can  we  reasonably  hope 
for  a  cure?  for  if  we  can,  a  serious  or  dangerous  operation  is  per- 
missible; or,  cure  not  being  possible.  Can  we  decidedly  ameliorate 
the  patient's  condition  by  operation,  such  operation,  however,  not 
involving  any  great  danger  to  life  ?" 

In  operations  for  cancer  of  the  breast  the  author  details  and  ad- 
vocates the  thorough  radical  operation,  with  the  removal  of  the 
entire  breast  in  all  cases,  the  pectoral  fascia,  the  lymphatic  chan- 
nels, and  all  the  lymph-glands  iu  the  nearest  groups,  including  the 
thorough  dissection  and  clearing  out  of  the  axillary  glands. 

As  regards  the  limita  of  operation  for  cure  of  breast  cancer, 
therefore,  he  would  exclude  from  operation: 

1.  Cases  of  cancer  en  cuiraaee. 

%  Cases  where  there  is  a  large  mass  in  the  axilla,  involving  the 
nerves. 

3.  Cases  where  large  masses  can  be  felt  above  the  clavicle. 

4.  All  cases  where  secondary  cancer  exists  elsewhere. 

In  any  cases  short  of  these  he  believes  the  patient  should  be  al- 
lowed to  choose.  Even  when  the  operation  fails  to  cure,  the  pro- 
longation of  life  is  often  marked,  much  more  so  after  the  thorough 
operations  than  after  the  ordinary  imperfect  procedure. 

As  regards  cures — that  is,  freedom  from  recurrence  for  over  three 
jears — the  author's  statistics  show  that  by  the  radical  method  of 
operating  which  he  advocates  the  number  of  cures  far  outoiimber, 
even  in  the  comparatively  few  cases  he  has  operated  upon,  the 
'Cures  recorded  by  the  older  operators,  which  goes  to  show  that  this 
radical  form  of  operation  gives  not  only  the  best  results  as  regards 
prolongation  of  life,  but  also  the  greatest  proportion  of  cures.  Of 
his  21  cases  there  were  no  deaths;  12,  or  57  per  cent,  cures;  9,  or 
42.7  per  cent.,  cases  recurring  externally  or  internally.  This  is 
the  result  obtained  in  all  operable  oases,  and  not  in  a  selected  series 
■of  favorable  cases. 

While  the  results  are  steadily  improving,  the  proportion  of  cases 
which  succumb  to  cancer  is  still  considerable,  and  will  not,  he  thinks, 
be  much  reduced  till  patients  and  doctors  understand  that  there  is 
a  good  chance  of  radical  cure  from  early  and  thorough  operation 


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Selections  and  Abstracts.  135 

in  mammary  cflDcer,  and  that  a  susi>iciou8  lump  in  the  breast,  es- 
pecially ia  elderly  women,  is  Dot  a  thing  to  be  watched,  for  over 
90  per  cent,  of  the  swelliogs  of  the  breasl  iu  elderly  womcD  are 
cancerouB. 

Contrary  to  the  usual  dictum,  it  is  now  found  that  the  most  fa- 
vorable of  all  cases  for  operation  are  those  of  atrophic  scirrhus, 
aod  the  more  nearly  a  cancer  approaches  the  atrophic  form  the 
grcnier  is  the  chance  of  permanent  cure.  The  author  believes  that 
the  malignancy  of  cancer  in  the  individual  case  has  a  great  deal 
to  do  with  the  favorable  result  of  the  operation,  more  than  the 
early  period  of  the  operation. — Am.  Jour.  Med.  Scienees. 


PoRULENT  Ophthalmia  of  the  New-Born. 

The  following  editorial  {Med.  Record)  presents  this  important 
subject  so  succinctly  and  well  that  it  is  reproduced  entire : 

Of  the  many  dangers  attending  the  newly-born  infant,  ophthal- 
mia neonatorum  is  the  most  to  he  dreaded.  It  is  staled  that  one- 
third  of  all  the  blind  in  Europe  become  so  from  this  cause.  Its 
early  recognition  and  unremitting  treatment  are  of  the  utmost  im- 
gwrtance.  In  every  obstetric  case  the  physician  should  gently  sep- 
arate the  lids  of  the  infant,  to  assure  himself  definitely  of  the  pres- 
ence or  absence  of  any  eye-discharge.  Infection  from  the  maternal 
passages  manifests  itself  almost  invariably  by  discharge  on  the  third 
day,  both  eyes  being  affected,  as  a  rule.  Dischargesappearing  ata 
later  period  usually  arise  from  soiled  hands,  towels,  sponges;  and 
only  one  eye  may  be  primarily  attacked.  This  conjunctivitis  is 
never  due  to  strong  light  or  cold,  as  is  popularly  supposed,  but  has 
adefinile  specific  origin. 

Following  a  discussion  of  the  Medical  Society  of  Breslau  con- 
cerning Crede's  method  of  treating  such  cases  with  the  aqueous 
solution  of  nitrate  of  silver  (one  grain  to  a  dram  of  distilled  water), 
twelve  thousand  question  blanks  were  sent  out  to  physicians,  with 
results  that  form  an  important  contribution  to  the  subject.  These 
blanks  were  distributed  throughout  Germany,  Switzerland,  Austria, 
Belgium  and  Holland.  Reports  were  returned  giving  statistics  of 
eye  disease  in  302,971  new-born  infants.     Of  these  1,938  suffered 


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134       The  Atlanta  Medical  and  Surgical  Journal. 

from  ophthalmia  neoDatorum.  Id  GermaDy  sixty  per  cent,  ot  eye 
disease  was  of  tbie  nature;  in  Austria,  eighty  per  cent.;  and  in 
Switzerland,  Belgium  and  Holland  combined,  ninety  per  cent.  In 
all  these  cases  the  characteristic  condition  appeared  within  five  days 
in  seventy-six  per  cent,  of  the  infants  under  observation.  The 
-discharge  began  alter  the  fifth  day  in  twenty-fonr  per  cent.  In 
one-fourth  of  the  entire  number  of  cases  one  eye  was  attacked  pri- 
marily ;  in  three- fourths,  both  were  affected  simultaneously.  Sev- 
■enty-one  per  cent,  were  completely  cured.  Nine  per  cent,  discon- 
tinued treatment.  Twenty  per  cent.,  or  one-fifth  of  the  1,938  cases, 
retained  permanent  lesions  of  more  or  less  severity. 

This  twenty  per  cent,  with  permanent  ocular  delects  presented 
-corneal  scars,  monocular  or  binocular;  and  one-half  of  these  per- 
manently damaged  infants  became  totally  blind.  It  was  consid- 
■ered  they  were  brought  too  late  Jor  cure;  fifty  per  cent,  of  the 
blind  babies  were  not  seen  until  the  ninth  day  of  their  disease,  and 
twenty-five  per  cent,  until  the  fourteenth  day. 

Out  of  one  hundred  representative  ophthalmologists  consulted, 
seventy-nine  were  in  favor  of  making  Crede's  method  obligatory 
in  routine  obstetric  practice.  It  is  not  difficult,  does  no  harm,  and 
may  avert  dreadful  catastrophe.  The  eyes  are  first  carefully  washed 
with  tepid  water,  and  the  lids  thoroughly  cleanted  by  means  of 
absorbent  cotton.  A  few  drops  of  the  two-per-cent.  solution  ol 
nitrate  of  silver  are  then  instilled  into  each  eye.  Materials  used 
to  wipe  away  the  discharge  must  be  burnt  or  otherwise  destroyed. 
Twice  daily  some  simple  ointment  should  be  applied  to  the  margin 
of  the  lids,  to  prevent  them  from  sticking  together.  In  severe 
forms,  when  there  is  much  swelling  and  a  thick  discharge  gushing 
from  between  the  lids,  the  foregoing  nitrate  of  silver  solution  may 
be  used  every  six  hours.  When  the  inflammatory  reaction  sub- 
sides, Muskett  recommends  that  weak  solutions  of  alum,  sulphate 
of  zinc  and  perchloride  of  mercury  be  substituted.  The  astrin- 
gent lotion  may  consist  of  from  tour  to  ten  grains  of  alum  or 
from  one  to  two  grains  of  sulphate  of  zinc  to  the  ounce  of  wat«r. 
Either  of  these  may  be  used  with  freedom  and  safety.  T,he  mer- 
cury solution  gives  excellent  results — one-half  grain  of  the  per- 


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Selections  and  Abstracts.  135 

chloride  to  six  ounces  of  distilled  water,     CoId-wat«r  compresses 
give  great  relief  after  active  treatment. 

Should  ulceration  of  the  cornea  ensue,  in  spite  of  active  and 
earnest  measures,  the  eserine  treatment  introduced  by  De  Wecker 
may  prevent  perforation  in  even  the  worst  cases.  Four  grains  of 
ewriue  in  one  ounce  of  distilled  water  is  the  strength  usually  em- 
ployed, though  sometimes  one  grain  to  the  ounce  is  better  borne. 
A  few  drops  are  instilled  into  the  eyes  six  times  a  day.  This  treat- 
ment is  also  of  value  in  a  form  of  corneal  affection  peculiar  to 
infantile  purulent  ophthalmia,  mentioned  by  Nettleship,  in  which 
the  cornea  becomes  rapidly  and  almost  entirely  opaque.  Whatever 
the  degree  of  ulceration,  marginal  ulcers  are  not  so  serious  as  those 
centrally  situated,  and  sight  may  be  preserved.  More  than  in  any 
other  disease.  Dr.  J.  hems  Smith  urges  the  necessity  of  employing 
fiuthful  am)  attentive  nurses,  who  will  carry  out  punctually  the 
directions  given.  Two  nurses  are  required,  one  for  day  and  the 
oiher  fornigfat  duty,  since  it  is  essential  that  the  eyes  be  frequently 
cleansed  and  the  secretion  washed  away. — 3£ed.  Standard. 


Treatment  op  Gout. 


Dr.  H.  C.  Wood  has  recently,  in  bis  characteristic  manner,  dis- 
cussed this  subject  in  the  Journal  of  the  American  Medical  Associa- 
tion. He  says  that  with  regard  to  drugs  there  are  a  great  many 
people  who  tell  us  that  salicylates  do  no  good.  Men  do  not  get 
good  out  of  salicylates  because  they  do  not  use  them  properly. 
The  author  does  not  believe  that  salicylates  cure  gout  or  rheuma- 
tism, any  more  than  that  bromides  cure  epilepsy.  They  simply  aid 
in  keeping  down  the  diathesis.  If  there  be  any  cure,  it  is  exer- 
cise. If  we  use  our  salicylates  on  a  case  properly,  and  get  no 
response,  we  have  something  more  than  ordinary  gout  or  rheuma- 
tism to  deal  with.  There  are  certaiu  cases  which  approach  typical 
gout,  aucb  as  we  rarely  see  in  America,  in  which  colchicum  does 
good,  much  more  good  than  salicylates.  He  has  seen  two  cases  of 
typical  English  gout  corresponding  to  Sydenham's  description,  and 
only  two.  We  do  not  have  it  in  this  country.  These  cases  colchi- 
cum suits  better  than  salicylates  do.     Sometimes,  when  the  case  is 


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136       The  Atlanta  Medical  and  Surgical  Journal. 

oa  the  border  line,  we  will  get  the  best  results  by  a  combiDatioo  of 
colchicum  with  salicylates.  If  we  have  a  stroDg,  robust  man,  be 
will  staud  it.  Give  him  knock-dowu  doses  in  additioo  to  purging 
him,  and  we  will  bring  him  through.  But  that  treatment  may  be 
worse  than  the  disease,  aud  has  to  be  used  with  caution. 

In  using  salicylates  the  profession  almost  universally  choose  the 
worst  salt  they  can  find,  and  that  is  sodium  salicylate.  It  is,  per- 
haps, not  so  bad  as  salicylic  acid,  but  it  is  much  more  apt  to  turn 
the  stomach,  and  is  less  effective  and  more  depressing  than  the 
other  salts  of  salicylic  acid .  The  two  salts  which  are  truly  useful 
are  the  ammonium  salt  and  the  strontium  salt.  The  ammonium 
salt  acts  immediately  and  severely;  the  strontium  salt  acts  slowly. 
If  we  have  an  acute  case  we  should  use  salicylate  of  strontium,  or 
use  tbe  two  combined.  The  strontium  salt  has  this  advantage,  that 
it  does  not  derange  digestiou  anythiug  like  the  other  preparations, 
and  many  a  time  the  author  has  seen  the  best  effects  on  the  intes- 
tinal condition  from  the  use  of  the  strontium  salt. 

In  a  large  majority  of  cases  we  will  find  that  salicylates  produce 
depression,  perhaps  a  little  nausea,  and  general  wretchedness,  and 
the  patient  refuses  them.  Nine  times  out  of  ten  we  can  overcome 
these  effects  by  combining  our  salicylate  with  digitalis  and  strych- 
nine in  the  same  prescription. 

As  to  baths,  we  cannot  cure  a  diathesis  by  such  means.  But 
baths  are  useful — hot  baths,  steam  baths,  Turkish  baths.  Any  man 
who  values  his  own  life,  who  has  had  a  gouty  grandfather,  ought  to 
take  a  Turkish  bath  once  a  week.  We  cannot  wash  out  ancestral 
traces  in  any  other  way.  Tbe  kidney  disease  and  the  atheroma 
would  be  far  less  rife  if  we  used  the  hot  bath  more  than  we  do. 
The  baths  eliminate,  give  a  temporary  result,  and  are  very  useful 
when  employed  with  the  understanding  that  they  do  not  cure  the 
disease  but  relieve  the  symptoms. —  Therapeutic  OazeUe. 


Thu  first  patent  medicine  is  said  to  have  been  called  "  Tusca- 
rora  Rice,"  sold  as  a  "  consumption  cure,"  by  Mrs.  Masters  in  1711. 
She  erected  a  large  factory  in  New  Jersey,  and  probably  inaugu- 
rated the  patent  medicine  trade  in  the  United  States. —  Oscar  Herz' 
'  berg,  in  January  LippincofCe. 


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Selbctionb  and  Abstracts.  137 

Hydrozone  and  Glycozone  in  the  Teeatmeht  op 
gonobrbea.. 

Sib  :  My  attentioo  has  beeo  attracted  to  aa  article  pnblisbed  in 
jom  journal  for  July  3,  hy  Dr.  J.  A.  Silverman,  of  Butte,  Mont. 
The  writer  states  that  no  antiseptic  has  been  discovered  that  will 
destroy  the  gonococcus  without  doing  injury  to  the  mucous  mem- 
brane. As  I  presume  that  he  Is  open  to  conviction,  I  submit  to 
yon  for  publication  the  following  report  of  three  cases  which  I 
have  successfully  treated  duriag  the  last  few  months  with  hydro- 
rone  and  glyoozoue,  which  I  consider  not  only  harmless  but  the 
most  powerful  healing  agents  that  I  have  ever  used  in  my  practice 
of  thirty-five  years. 

Case  1. — A  man  called  on  me  on  June  20,  with  gonorrhea  of 
four  weeks'  duraUon,  with  profuse  discharge,  micturition  painful, 
and  an  acute  burning  sensation  along  the  entire  urethral  tract. 
Pus  sacs  had  formed  in  the  canal,  the  meatus  was  inflamed,  and  the 
gonococcus  was  active,  as  determined  by  microscopical  examination, 
I  prescribed  injections  of  one  part  of  hydrozone  aod  ten  parte  of 
sterilized  lukewarm  water,  an  ounce  for  each  injection,  four  times 
daily.  After  two  days  I  reduced  the  proportion  to  one  part  of 
kydrosoue  and  fifteen  parts  of  lukewarm  water,  and  I  directed  gly- 
Gotone  mixed  with  an  equal  amount  of  glycerin  pure  to  be  injected 
on  his  going  to  bed.  The  diet  was  not  restricted,  but  no  stimulants 
were  permitted.  In  two  days  no  gonococcus  could  be  detected. 
The  discharge  was  lessened,  the  pain  and  difficulty  in  micturition 
bad  ceased,  and  in  twelve  days  the  patient  was  well.  Continence 
was  imposed  for  two  weeks.  Doses  of  bromide  of  potassium  and 
bicarbonate  of  sodium  were  administered  from  time  to  time  in 
order  to  make  the  urine  alkaline  and  quiet  the  patient. 

Case  2. — A  married  man  had  contracted  blennorrhea  from  a 
woman  who  had  the  whites.  The  same  treatment  was  ordered,  and 
with  snch  satisfaction  that  the  woman  also  was  brought  for  exami- 
nation and  treatment.  Result,  a  cure  in  each  case  within  three 
weeks. 

Case  3. — A  man,  fifty  years  old,  contracted  gonorrhea  from  a 
woman  of  the  town.     As  the  patient  lived  in  the  country,  twenty 


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138       The  Atlanta  Medical  and  Surqical  Journal. 

miles  out,  no  treatment  was  given  until  tea  days  afler  infection. 
Aggravated  symptoms  of  gonorrhea  were  present,  and  there  was 
chordee  every  night;  the  patient,  to  use  his  own  expression,  was 
"plumb  wild."  The  hydrozone  injections  were  ordered,  one  part 
to  twenty,  owing  to  the  great  seositiveness  of  the  urethra  and  the 
possibility  of  orchitis  if  a  stronfrer  injection  was  used,  as  there  was 
a  slight  swelling  of  the  testicles.  The  glycozone,  diluted  with 
equal  parts  of  pure  glycerin,  was  ordered  at  night.  I  also  gave 
glycozone  internally  in  medicinal  doses,  to  allay  a  gastric  disturb- 
ance due  to  nervousness.  In  this  case  the  treatment  was  continued 
for  twenty-five  days.  I  sent  my  patient  to  his  cattle  ranch  happy. — 
Warren  E.  Day,  M.D.,  Prescott,  Arizona,  in  the  New  York  Medicai 
Jowmal, 


The  Tonsil  and  the  Carotid  Arteby. 
At  the  last  meeting  of  the  Laryngological  and  Rhinological  sec- 
tion of  the  Academy  of  Medicine,  Dr.  Robert  C.  Myles  presented 
an  anatomical  wet  specimen,  showing  the  relations  of  the  carotid 
and  ascending  pharyngeal  artery  to  the  tonsils.  A  section  was  made 
on  each  side  through  the  posterior  lateral  wall  of  the  oro-pharynx, 
and  a  string  was  placed  around  the  artery  to  bring  them  into  view. 
It  demonstrated  a  very  interesting  fact — that  the  artery  in  its  nor- 
mal position  was  situated  1^  to  1^  inches  posterior  to  that  part  of 
the  palate  which  was  usually  selected  for  the  incision  in  peri-ton- 
sillar  abscesses.  It  was  also  noted  that  the  artery  was  situated 
from  one-eighth  to  one-third  of  an  inch  external  to  a  line  of  inci- 
sion when  made  antero- posteriorly.  The  tonsil  was  dissected  from 
its  basic  capsule,  which  brought  into  view  the  peri-tonsillar  space, 
and  a  rather  extensive  area  in  which  pus  might  accumulate  anterior 
to  the  superior  constrictor  muscle,  and  also  was  so  shown  the  avenue 
through  which  pus  might  burrow  uuder  the  anterior  inferior  edge 
of  the  superior  constrictor  muscle.  This  wet  specimen  showed 
that  the  much  feared  danger  of  wounding  the  carotid  artery  did 
not  really  exist.  We  ofteu  find  that  there  is  expressed  a  fear  on 
the  part  of  those  who  operate  on  the  tonsils,  that  the  carotid  artery 
may  be  wounded,  but  there  are  by  no  means  many  reported  cases 
of  this  accident.     Schmiegelow  reports  a  case  occurring  in  the 


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Sblections  and  Abstracts.  139 

practice  of  a  surgeon  where  followed  a  fatal  betnorrhage  after  the 
removal  of  adenoid  vegetations.  The  operation  wae  done  without 
anesthesia,  and  the  ordinary  Gottstein  angular  knife  was  used. 
Without  any  warning  a  sudden  gush  of  blood  issued  from  the 
mouth  aad  nose.  Id  spite  of  prompt  tamponing  and  subcutaneous 
and  intravenous  injections  of  saline  solutions  the  patient  died  within 
a  few  minutes.  The  internal  carotid  artery  was  found  to  have 
been  opened  just  in  front  of  its  point  of  entrance  iuto  the  carotid 
canal  of  the  pars  petrossaossis  temporis.  The  author  supposed  that 
swollen  glands  had  pushed  the  vessel  forward,  so  that  the  pressure 
of  the  knife  caused  its  rupture,  for  it  was  not  cut. — Medical 
Fortnightly. 


Should  Cities  go  into  the  Dritg  Business? 

This  is  the  burning  question  to-day,  and  the  medical  press  is 
taking  up  the  question  in  a  manner  that  leaves  no  doubt.  It  is 
well  known  that  Boards  of  Health,  municipal  and  State,  have  sent 
circulars  broadcast  to  the  profession  offering  antitoxin  free  to  any 
oae  who  may  need  it.  This  is  not  particularly  reprehensible  when 
taken  aloue.  But  when  these  same  boards  go  into  the  manufactur- 
ing business,  making  antitoxin  at  a  cost  to  a  municipality  or  State 
which  is  greater  than  it  could  be  obtained  irom  legitimate  manu- 
feeturers,  it  is  simply  a  fraud  and   an  imposition  on  the  taxpayers. 

This  is  not  the  only  question,  however.  A.  board  has  no  right 
to  enter  into  commercial  enterprises,  and  this  is  certainly  one  of 
them.  It  might  just  as  well  start  a  vaccine  farm  or  go  into  the  busi- 
ness of  furnishing  pure  foods  and  supply  the  poor  with  pure  milk. 
The  manufacture  of  antitoxin  has  been  gone  iuto  extensively  by 
the  New  York  Board  of  Health,  and,  as  a  natural  result,  the  entire 
pharmaceutical  and  a  large  proportion  of  the  medical  profession 
has  expressed  its  disapproval  of  this  action. 

It  is  unnecessary  to  go  into  this  question  at  length.  Were  it 
purely  from  economical  grounds  alone,  antitoxin  should  be  bought 
from  legitimate  manufacturers  of  pharmaceutical  goods.  From 
the  standpoint  of  fairness  and  justice,  no  municipality  should  ever 
try  to  be  a  rival  of  a  legitimate  manu&cturing  concern;  aud  from 


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140       The  Atlanta  Medical  add  Sbrqical  Journal. 

the  standpoint  of  trade  honor,  it  has  no  right  whatever  to  do  such 
a  thing. — 8t.  Louia  Med.  and  Surg.  Journal. 


Morphine  Anesthesia. 
Dr.  John  A.  Wyeth,  in  speaking  of  anesthetics,  says :  "  The  use 
oT  morphine  as  an  anesthetic  agent  has  not  received  the  attention 
it  deserves.  I  removed  a  larynx  on  one  occasiua  without  th(t  use 
uf  a  trachea  tube,  and  with  complete  anesthesia,  by  producing  a 
profound  narcosis  by  the  hypodermic  use  of  morphine.  I  gave 
the  patient  two  ounces  of  whisky  half  an  hour  before,  and  repeated 
this  five  minutes  before  operation ;  twenty  minutes  before  opera- 
tion one-quarter  of  a  grain  of  morphine  hypodermically,  and  an 
additional  one-quarter  of  a  grain  was  administered  five  minutes 
before  the  operation  was  begun.  During  the  course  of  the  opera- 
tion, which  lasted  one  hour  and  forty  minutes,  an  additional  eighth 
of  a  grain  was  given.  The  patient  was  entirely  free  from  pain 
throughout.  The  antidotes  to  morphine  poisoning  (atropine  sul- 
phate, gr.  Y^,  strychnine  sulphate  gr.  ^)  should  be  in  hypo- 
dermic syringes  ready  for  use,  and  strong  co^e  for  rectal  injec- 
tion."— Med,  Remew  of  ReviacB. 


The  Questiok  op  the  Tbahbfobhatiun  op  Calomel  ihto 
CoEHoeiVE  Sublimate  in  the  Ohqanibm. 
Xyon  midical  for  February  20th  says  that  this  question  was  raised 
not  long  ago  in  the  Paris  Therapeutical  Society.  M.  Patein  stated 
that  such  transformation  in  the  presence  of  sodium  chloride, 
accepted  by  Mailhe,  was  a  fable ;  it  was  not  true  that  calomel  was 
changed  into  corrosive  sublimate  on  contact  with  the  alkaline  chlo- 
rides or  with  the  gastric  juice.  M,  Pouchet  added  that  the  bro- 
mides and  the  chlorides  were  powerless  to  convert  calomel  into  coiv 
rosive  sublimate ;  such  a  change  took  place  only  on  contact  with 
the  alkaline  iodides.  If  it  did  take  place  in  the  presence  of  chlo- 
rides, he  said,  it  could  not  be  avoided  by  the  patient's  simply  abstain- 
ing from  salted  articles  of  food ;  it  would  be  necessary  to  remove  all 
the  chlorides  from  the  organism, — N.  Y.  Med.  Jour, 


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Selbctions  and  Ab8TEACTS.  141 

The  Medical  Eicuhsion  ih  Juke  to  Dekver  asd  Salt 
Lake  City. 
The  American  Medical  AssociatioD  meets  at  Denver  June  7tti  to 
10th.  One  of  the  features  of  the  gathering  will  be  an  excursion 
from  Denver  to  Salt  Lake  City  and  return  via  the  D.  &  R.  G.,  Col- 
orado Midland  and  Bio  Grande  railways,  through  the  "heart  of 
the  Rockies,"  fumisbing  a  splendid  opportunity  to  view  the  most 
magnificent  scenery  on  the  American  continent.  Salt  Lake  City 
is  an  ideal  summer  resort,  and  the  bathing  at  Saltair  in  the  great 
Salt  Lake — iulaad  salt  sea  nearly  a  mile  above  sea-level — is  superb 
in  June.  There  are  more  attractions  in  and  about  Salt  Lake  City 
than  any  place  in  the  world.  Later  notice  will  appear  in  this  pub- 
lication giving  rates  for  this  excursion  aud  all  details.  In  the 
meantime  send  to  F.  A.  Wadleigh,  G.  P.  A,  Rio  Grande  Western 
Ry.,  Salt  Lake  City,  for  copy  of  pamphlets  on  Salt  Lake  City  and 
the  Bocky  Mountains. 


Injections  op  Alcohol  ik  Carcinoma. 
Hassel  says  {ffedicai  Record,  January  15,  1898): 
"Alcohol  favors  cicatrization  in  all  growths  like  struma,  angi- 
oma, oysta,  lymphatic-gland  tumors,  sarcoma,  carcinoma,  and  espe- 
cially carcinoma  of  the  breast  and  cervix  uteri.  Under  its  use,  in 
fifteen  out  of  eighteen  cases  of  carcinoma  of  the  breast  the  growth 
gradually  dwindled  away,  until  in  a  year  there  was  nothing  Ie(t  but 
the  connective-tissue  stroma,  and  there  has  been  no  return.  Five 
cases  of  carcinoma  of  the  cervix  also  recovered  completely,  and  the 
patients  are  still  living  and  lu  good  health.  The  effect  on  the  gen- 
eral health  is  even  more  surprising.  The  pains  and  uneasiness  pass 
away,  and  sleep,  appetite,  assimilation  and  strength  return  in  a  most 
remarkable  manner. — Med,  Bevt&o  of  Bemewa, 


The  Hand  in  Obstetrics. 

The  band  as  a  dilating  agent  is  the  best  obstetrical  instrument 

at  our  disposal — better  than   Barnes's   bags  and  the  instruments 

which  have  come  to  us  from  the  French  school.     Asaresultof  ex- 


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142       The  Atlanta  Medical  and  Surgical  Journal." 

tended  experieoce,  I  am  still  able  to  say  that  la  ninety-eight  per 
cent,  of  all  claBses,  the  woman  being  within  six  weeks  of  full  term, 
and  ander  surgical  aneBthesia,  any  man  can  dilate  the  cervix  with 
hb  hand  sufficiently  to  euter  the  uterus  and  extract  the  child. — 
Egbert  H,  Grnndin. 

How  TO  Make  a  Mdbtard  Plaster. 

Never  place  a  cold  mustard  plaster  on  a  patient.  The  shock  is 
like  a  sudden  plunge  into  cold  water.  Before  you  commeuce  to 
mix  the  paste  be  sure  you  have  all  the  necessary  material  at  hand. 
First  put  a  large  plate  where  it  can  get  warm,  uot  hot.  Then  stir 
the  mustard  and  flour  thoroughly  together  before  you  add  the 
water,  which  should  be  tepid  ;  stir  in  enough  water  to  make  a  paste 
about  the  consistency  of  French  muatard.  Place  your  cloth  (an  old 
handkerchief  is  best)  on  the  warm  plate,  spreading  the  paste  in  the 
middle  of  it,  leaving  &  margin  wide  enough  to  lap  well  over  on  all 
sides.  Do  not  remove  paste  from  the  plate  until  ready  to  apply. 
Place  a  folded  cloth  between  paste  and  patient's  clothiug. — Ex. 


Delicate  Test  fob  Sdqab. 

R    Capric  sulphate gr.zxvii. 

GlfceriD 3  iii. 

Aqua „  5  iiSB. 

Liq.  potaasa ad.  ^iv. 

Dissolve  the  cupric  sulphate  in  glycerine  and  heat.  When  cold 
add  the  liquor  )>otassa.  Pour  a  drachm  of  the  solution  in  a  test 
tube  with  two  or  three  drops  of  a  saturated  solution  of  pure  tartaric 
acid,  and  boil.  Now  add,  drop  by  drop,  eight  drops  of  urine.  If 
there  is  no  reaction  there  ia  no  sugar.  Sugar  is  present  if  the  re- 
action yields  a  yellowish,  reddish,  or  greenish  gray  deposit. — Sci- 
entific ATnerioan. 

The  scourge  of  syphilis  has  been  the  most  deadly  enemy  to  the 
upward  progress  of  the  human  race  the  world  has  ever  seen.  Its 
disintegrating  power  in  destroying  human  life  has  been  greater 
than  even  j>estilence  or  the  sword.  Millions  upon  millions  of  the 
human  family  who  have  never  seen  the  light  of  day  have  been 


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Selections  and  Abstracts,  143 

sacrificed  in  lUero  by  embryonic  infection  to  gratify  this  insatiate 
molocli  of  death.  Acquired  in  one  generation  it  insidiously  prop- 
agates itself  to  future  generations,  until  who  can  tell  where  its 
baneful  influence  begins  or  ends?  It  masquerades  under  so  many 
assumed  names  and  in  so  many  uuexpected  guises  that  it  often 
baffles  and  eludes  the  skill  of  the  most  careful  diagnostician  to 
locate  it.  Its  peculiar  affinity  for  attacking  the  braiu  and  nervous 
system  is  one  of  the  marked  features  of  its  history,  and  yet  it  was 
long  before  neurologists  discovered  its  potency  as  a  factor  in  pro- 
ducing insanity.  That  &tal  form  of  insanity  known  as  general 
paresis,  or  as  it  is  now  called  general  paralysis  of  the  insane,  is 
now  recognized  by  high  authority  as  in  every  case  due  to  this 
virulent  poison.  All  authorities  are  agreed  that  it  is  the  most 
common  cause  iu  producing  this  and  other  kindred  diseases  affect- 
ing the  braiu  and  nervous  system. — Rvsaell  on  the  "  ReUtion  of 
Insanity  to  the  State."     Brit.  Med.  Aaaociation,  1897. 

Anti-Neuhalgia  Pills. 

B    StrycbniDfe  Butph gr.  i. 

QoiniDK  flolpb 3  i. 

Feni  redact! -. f^.  xv. 

Ext.  GentiaDs 3  bb. 

H.  et  ft.  pil.  No.  60.    Sig.— One  tbree  times  a  day. 
This  is  especially  good   for   facial  and   stomach  neuralgias.     If 
there  is  a  marked  malarial  element  present,  add  arsenious  acid,  Sve 
grains,  to  the  formula. — Ruff,  Med.  Rec. 

"  Wk  have  seut  forlh  a  good  deal  of  Seidlitz  powder  literature — 
literature  which,  read  by  the  surgical  aspirant,  is  as  fuel  to  the  fires 
of  surgical  aggression.  While  I  have  the  utmost  admiration  for 
the  bold  surgeon,  and  think  the  very  acme  of  the  world's  heroism 
was  attained  when  Mrs.  Crawford  clasped  hands  with  McDowell 
and  made  her  leap  for  life,  my  admiration  for  the  bold  surgeon 
warms  into  fervent  flame  of  love  when  I  learn  that  his  boldness  is 
always  tempered  by  wisdom,  and  his  conscience  holds  him  firmly 
to  the  golden  rule,  'Whatsoever  ye  would  that  men  should  do  unto 
you,  do  ye  even  so  unt«  them.'" — Dr.  Joseph  Eabthak,  Id  Am. 
Gyn.  and  Obs.  Jour.,  Feb. 


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144       The  Atlanta  Medical  and  Surgical  Journal. 

COOGH   MlSTURE. 

A  cough  mixture  much  employed  in  the  Booaevelt  Hospital, 
New  York  CSty,  ia  the  followiag : 

K    Codeioe 4gr. 

Dil.  hydrocyanic  acid 46  drops. 

AmmODinm  chloride 46  gr. 

Symp  wild  cherry  to  make lifl.oz. 

Teaspoonfal  every  three  or  four  hoan. 

— Medico  Surgical  BuSettn. 

It  matters  not  whether  it  be  the  collar,  the  waisthand  or  the 
garter,  all  ooastrictiag  bands  are  iojarious;  anything  that  com- 
presses  the  hlood-vessela  and  interferes  with  the  free  circulation  of 
the  blood  should  not  be  tolerated.  Headache,  chronic  digestion  of 
the  brain,  even  apoplexy  will  be  fevored  and  rendered  more  pos- 
sible by  the  use  of  tight  collars;  while  varicose  veins  are  com- 
monly caused  by  tight  garters.  Anything  coDstricting  the  waist  is 
evidently  and  obviously  injurious  to  the  vital  o^ans  within,  all  of 
which  require  plenty  of  room  that  they  may  fanctionate  properly. 
We  think  it  barbarous  for  Chinese  women  to  constrict  their  leet ; 
Li  Hung  Chang  thinks  it  more  barbarous  for  Americans  to  cou- 
strict  their  necks,  waists  and  legs.  The  old  man  is  right ;  there 
are  no  vital  organs  in  the  feet, — Annah  of  Hygiene. 

To  Make  a  Normal  Salt  Solution  for  Transpubion. 

B    Sodiicsrb^ gr.  xT. 

Sodii  cblor. 3  jea. 

Aqu«e_ Oij. 

— Med.  Remew. 

Sahsaparilla  Sam. — "What  you  got  dat  razor  fur?" 

Pokeberry  Pete. — "  Yer  know  dat  eddicated  nigger  wat's  teach- 
ing school  at  de  big  forks?  Well,  yer  see,  I  owed  him  a  little 
bill,  and  he  done  writ  me,  be  did,  dat  he  gwine  ter  draw  on  me 
at  sight." 

SarEaparillft  Sam. — "  Well,  what  ob  dat?" 

Pokeberry  Pete. — ^"Nuttin,  'cept  dere  ain'  no  nigger  gwine  ter 
git  de  drap  on  Pete." — AtiarUa  Consiilvtion. 


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ATLANTA 

Medical  and  Surgical  Journal. 


Vol  XV. 

MAT, 

1898. 

No. 

3. 

L.  B.  GRANDT, 
DUNBAB  BOY, 

M.D. 
M.D., 

•}' 

„™„. 

M. 

B.  HUTCHINS,  M.D. 

ORIGINAL  COMMUNICATIONS. 


EMPYEMA  OF   THE    ACCESSORY  SINUSES    OF 
THE  NOSE  * 

Br  FBANE  H.  HAHQER,  H.D.,  Staunton,  Va., 
Omlitt  tad  Aarut  totbe  State  Deftf,  Dumb  and  Blind  Institution,  Staunton,  Ta, 

Much  has  been  written  coDcerDiDg  these  affectioDs,  and  we  feel 
IS  if  the  field  has  already  been  exhaasted.  But  after  reviewing 
the  literature  on  the  subjeot  and  noting  the  diversity  of  opinion 
expressed  and  the  contradictory  conclusions  that  have  been  formed 
by  rhinologistB  of  equal  prominence,  we  are  at  a  loss  to  know 
whom  to  Follow  and  what  creed  to  adopt.  Owing  to  this  fact,  we 
believe  we  should  be  guided  more  by  oar  own  experience  and 
obeervation  than  by  the  dogmas  of  any  man,  however  eminent ; 
and  we  shall  make  effort  to  observe  this  principle  in  our  remarks, 
trnsting  our  views  will  at  least  merit  the  approval  of  some,  while 
at  the  same  time  we  incur  the  criticism  of  many. 

Before  presenting  our  subject  in  detail,  there  are  a  few  general 
remarks  common  to  all  the  accessory  sinuses  of  the  nose. 

,a  Otoloclcal,  Rfalnologlc&I  and  Laiyn- 


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146       The  Atlanta  Medical  and  Surgical  Jocrhal. 

They  all  communicate  with  the  oasal  fosse  hy  small  openings, 
are  alike  filled  with  air,  lined  with  the  same  mucous  membrane, 
and  therefore  liable  to  be  invaded  by  any  of  the  iofiammatione 
that  may  affect  these  passages. 

In  view  of  these  facts,  we  think  we  can  safely  claim  that  hy  far 
the  largest  percentage  of  empyemas  is  caused  by  influeuza  and 
coryza.  As  a  rule  the  sinuses  escape  these  inflatumations,  but  at 
times  they  are  undoubtedly  involved.  The  inflamed  cavity  be- 
comes filled  with  mucus  which,  finding  no  outlet  on  account  of  the 
swollen  and  occluded  condition  of  the  natural  opening,  undergoes 
decomposition,  and  the  mucous  lining  becomes  reiufected  and  con- 
verted into  a  pyogenic  membrane.  Now  unless  the  natural  open- 
ing is  soon  restored,  the  periosteum  may  become  diseased  by  con- 
tiguity of  structure,  or  its  function  interfered  with  by  the  pressure 
of  the  accumulating  fluid ;  thus,  necrosis  of  the  bone  is  the  inev- 
itable result. 

It  is  thus  possible  to  explain  the  presence  of  granulations, 
polypi,  and  myxomatous  degeneration,  so  frequently  associated 
with  purulent  affections  of  these  cavities.  However,  empyema 
may  be  caused  primarily  by  lesions  in  the  walls  of  the  sinuses 
themselves,  such  as  trauma,  syphilis,  tuberculosis,  metastasis  of 
pyiemia,  and  various  depressing  diseases  which  are  apt  to  be 
accompanied  or  followed  by  suppuration.  Atrophic  rhinitis  is  a 
factor  which  must  not  be  forgotten. 

In  addition  to  the  above  causes,  empyema  of  the  maxillary 
sinus  alone  enjoys  the  distinction  of  dental  origin. 

These  affections  are  distinctively  of  adult  life.  Seldom  do  we 
meet  with  cases  under  twenty  years  of  age,  and  most  of  them 
range  between  twenty-five  and  sixty.  The  reason  of  this  pecu- 
liarity, we  think,  is  apparent:  As  we  grow  old,  repeated  colds 
and  influenzas  generally  leave  the  mucous  membrane  of  the  Dose 
more  thickened  and  cougested,  resolution  less  complete  with  each 
attack,  and  the  openings  of  the  sinuses  less  patulous,  so  that  accu- 
mulated fluids  find  more  difficulty  of  egress  aud  consequently 
remain  in  the  cavities  longer  thau  in  youth,  and  thus  the  chance 
of  infection  is  increased. 

Then,  agfUD,  as  we  grow  old  the  carious  condition  of  our  teeth 


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Emptema  of  the  Accessory  Sinuses  op  the  Nose.     14T 

is  respooeible  for  many  casee  of  maxillary  sinusitis.  We  are 
seldom  called  on  to  treat  these  affectious  in  the  aoute  stage.  As  a 
rnle,  vis  medicairix  naturcE  is  sufficient,  and  as  the  rhinitis  which 
produces  them  subsides,  the  cavities  are  emptied  and  a  spontaneous 
cure  results.  We  have  on  more  than  one  occasion  successfully 
emptied  the  antrum  of  Highmore  of  a  muco-purulent  collection, 
the  result  of  aoute  coryza,  by  alteroately  lowering  the  head  and 
holding  it  to  the  opposite  side,  at  the  same  time  blowing  the  nose. 

After  the  empyemas  have  lasted  some  weeks  or  months,  the 
discharge  becomes  more  purulent  and  creamy  in  appearance,  at 
times  caseous  aud  mealy,  with  a  marked  fetid  odor;  and  it  is 
asDally  this  odor  which  drives  our  patients  to  seek  relief,  after 
they  have  become  a  nuisance  to  themselves  and  their  friends. 

One  or  more  of  the  sinuses  may  be  affected  at  the  same  time, 
00  the  same  side,  or  may  he  bilateral.  It  is  possible  for  one  sinus 
to  be  infected  by  pus  arising  from  another,  and  on  several  ocoa- 
sioDs  we  have  witnessed  violent  purulent  otitis  media  as  a  result 
of  pus  infection  from  the  maxillary  antrum. 

Furthermore,  empyema  of  those  cavities  which  lie  at  the  base 
of  the  brain  are  at  times  responsible  for  meningitb  and  cerebral 
abscess. 

Successful  diagnosis  and  treatment  is  what  concerns  us  most, 
and  we  will  now  consider  the  best  means  of  reaching  this  end,  in 
each  one  of  the  accessory  sinuses,  and  wjU  beg  your  indulgence 
while  we  present,  first — 

£UPY£UA   OP  THE   ANTRUM   UF    HIQHHORE. 

This  cavity,  as  well  as  the  sphenoidal  sinus,  is  specially  prone 
to  become  filled  with  accumulated  fluids  because  its  natural  open- 
ing is  near  the  top. 

Our  patient  comes  to  us  complaining  of  a  fetid,  pus-like  dis- 
cfaatge,  usually  from  one  nostril,  which  has  lasted  for  some  weeks 
or  perhaps  years,  dating  from  an  attack  of  influenza  or  eold.  In 
the  morning  his  throat  is  filled  with  the  dischai^e,  and  at  inter- 
vals daring  the  day,  on  stooping  over,  it  runs  out  of  the  nose. 
He  may  or  may  not  complain  of  a  sense  of  fullness  under  the 
corresponding  eye,  and  at  times  pain  and   tenderness  along  the 


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148       The  Atlanta  Medical  and  Sxtrsical  Journal. 

malar  bone  and  extending  back  to  the  temple.  This  pain  and 
sense  of  disteneion  is  very  pronounced  in  the  acute  stage,  bat  as 
the  disease  becomes  chronic,  onr  patients  are  remarkably  free 
from  discomfort  and  reflex  pains.  On  examination  we  asually  find 
pus  in  the  upper  middle  part  of  the  middle  meatus  and  slowly 
trickling  down  over  the  inferior  turbinated  bone.  The  &ct  that  the 
pus  is  not  found  higher  up  in  the  nasal  passage  points  to  the  non- 
involvement  of  the  sphenoidal  sinus  and  the  ethmoidal  cells. 

Now  spray  the  nose  with  some  alkaline  wash  and  follow  with  a 
4  per  cent,  solution  of  cocain.  This  makes  maDipalatioD  painless 
and  opens  up  the  nasal  pa8s^;es  to  better  inspection.  With  a 
piece  of  cotton  on  the  end  of  a  probe,  mop  all  pus  from  the  site 
ol  the  hiatus  semilunaris  and  wait.  It  will  not  be  long  before  a 
drop  of  pus  will  ooze  from  the  opening.  Then  direct  the  patient 
to  hang  the  head  down  and  shake  it  back  and  forth,  and  from  side 
to  side.  On  looking  into  the  nose  again,  you  will  usually  find  the 
passage  filled  with  a  creamy  pus  in  such  quantity  as  to  exclude  the 
possibility  of  its  origin  from  any  of  the  other  sinuses. 

At  times  the  character  of  the  pus  varies.  It  may  be  sero-pu- 
rulent,  muco-purulent,  caseous,  mealy,  or  muco-gelatinous.  The 
last  named  is  seldom  dislodged  from  the  cavity  without  irrigation ; 
it  comes  away  en  viatae  and  is  of  such  consistency  as  not  to  be 
even  broken  up  with  a  spray  of  water. 

The  teeth  should  now  be  examined  to  see  if  any  are  carious  or 
offending  sufficiently  to  be  responsible.  If  there  is  still  any  room 
for  doubt  as  to  a  diagnosis,  because  of  the  failure  to  get  pus,  the 
antrum  should,  if  possible,  be  irrigated  after  first  locating  and 
testing  the  size  of  the  ostium  with  a  probe-pointed  sound.  If 
this  is  practicable,  we  are  able  to  evacuate  the  pus  at  once  and  the 
case  is  made  clear.  Should  we  fail,  we  can  use  the  electric  trans- 
illumination test  after  the  method  of  Heryng  or  Voltolini,  Should 
there  be  pus  in  the  antrum,  we  should  expect  the  corresponding 
cheek  to  be  less  illuminated  than  its  fellow  and  a  dark  orescent 
appear  just  below  the  lower  eyelid,  and  also  the  subjective  lumi- 
nous perception  be  less  in  the  corresponding  eye. 

This  test  is  merely  corroborative,  and  is  often  misleading  or 
negative.     Should  we  have  a  tumor  in   the  antrum,  we  get  all  of 


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Empyema  of  the  Accessory  Sindsbs  of  the  Nose.     149 

these  signs,  only  iptensifieij.  As  the  extraction  of  pus  is  the  only 
infallible  sigD  of  empyema,  we  much  prefer  exploratioD  with  the 
trocar  through  the  middle  or  inferior  meatus,  or  eveu  the  canine 
fossa.  The  inferior  meatus  Is  safer  than  the  middle,  as  there  ia 
less  likelihood  of  wounding  the  orbit. 

We  have  been  able  to  cure  more  than  half  of  our  cases,  by  irri- 
gation through  the  natural  opening,  and  give  this  method  the  pref- 
erence, not  only  in  every  case  of  antral  empyema,  but  in  all  the 
other  sinuses.  If  you  &il  to  cure  by  this  method,  you  will  seldom 
succeed  by  irrigating  through  an  artificial  opening  of  whatever 
selection.  Catheterizing  the  hiatus  semilunaris  is  by  no  means  aa 
easy  task;  still,  it  is  not  only  possible,  but  a  practicable  procedure, 
and  is  more  easily  accomplished  than  a  like  result  in  any  of  the 
other  natural  openings. 

Telling  how  these  catheterizations  are  done,  and  putting  them 
into  efTect,  are  two  entirely  different  things.  It  requires  a  delicate 
hand  and  the  most  skilful  manipulation,  and,  even  then,  we  fail  in 
many  cases.  Afler  we  have  learned  the  contour  of  the  nose,  in 
each  special  case,  it  becomes  comparatively  easy. 

Tbe  canula  for  irrigating  the  antrum  should  be  of  sufficient 
length  and  bent,  at  a  right  angle,  one-third  of  an  inch  from  the 
extremity,  and  connected  with  an  india-rubber  bulb-syringe  that 
will  hold  aboat  an  ounce  of  fluid.  The  caaula  is  introduced  into 
the  nasal  passage  with  the  beak  upward,  and  then  rotated  outward 
into  the  ostium. 

When  in  position,  and  the  syringe  already  filled  with  the  irri- 
gating fluid,  direct  the  patient  to  inhale  deeply  and  hold  the  breath, 
at  tbe  same  time  bend  the  head  forward.  When  the  syringe  is 
nearly  emptied,  direct  the  patient  to  exhale  through  the  nose. 
This  simple  precaution  will  prevent  the  terrible  strangling  we  have 
often  witnessed.  For  irrigatiou,  there  is  nothing  better  than  a 
two  or  three  per  cent,  solution  of  boric  acid.  In  obstinate  cases, 
a  one  per  cent,  solution  of  nitrate  of  silver,  or  peroxide  of  hydro- 
gen, pure  or  diluted,  may  be  used  with  advantage,  after  first  cleans- 
ing the  cavity  with  the  boric  acid  solution,  and  following  with  a 
second  irrigation  of  the  same.  Treatment,  by  this  method,  usually 
lasts  from  one  to  eight  weeks,  daily  irrigations  being  used.     The 


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150       The  Atlanta  Medical  ahd  Surgical  Journal. 

time  required  to  effect  a  cure,  bears  no  regular  proportino  to  the 
period  the  empyema  has  existed.  We  have  eeea  a  case  of  thirty- 
two  years'  standiog  cured  in  two  weeks,  and  one  of  two  weeks' 
standing  require  as  many  months  of  treatment. 

Should  the  hiatus  semilunaris  not  be  accessible  or  patulous 
enough  for  irrigation,  our  next  preference  is  an  opening  made 
through  the  alveolar  process,  at  a  point  where  a  bicuspid  or  a  first 
or  second  molar  tooth  has  already  been  extracted,  or  should  oue  of 
said  teeth  be  so  carious  as  to  require  extraction,  or  be  the  probable 
cause  of  the  empyema.  Under  no  circumstances  should  a  sound 
tooth  be  sacrificed.  For  making  the  opening,  a  baud  drill  and 
mastoid  curette  are  all  that  is  needed. 

The  point  of  the  drill  should  be  directed  upward  and  a  little  in- 
ward. A.  drainage-tube  has  little  advantage  over  a  plug,  and  either 
can  be  used  with  good  results.  The  former  permits  irrigation 
while  in  situ,  hut  little  drainage  takes  place  from  it  after  a  few 
days,  and  has  the  disadvantage  of  permitting  extraneous  matter 
entering  the  cavity,  unless  provided  ypith  a  suitable  obturator 
during  meals.  The  tube  or  plug  should  be  removed  as  soon  as 
possible  afler  discharge  has  ceased,  but  the  irrigation  should  be 
continued  as  long  as  the  wound  remains  open. 

Some  object  to  the  alveolar  opening  because  it  is  so  long  clos- 
ing. We  have  never  noticed  this  difficulty  in  the  least,  and  it 
usually  has  a  marked  tendency  to  close  before  we  are  ready.  The 
patient  himself  can  perform  the  irrigation  much  better  than  through 
an  opening  made  in  the  inferior  or  middle  meatus. 

Our  next  preference  is  an  opening  through  the  inferior  meatus, 
made  with  the  drill  and  curette.  This  can  also  be  made  with  the 
electric  cautery. 

This  method  has  the  advantage  of  permitting  no  pus  dripping 
into  the  patient's  mouth  or  particles  of  food  entering  the  cavity. 
Besides,  the  patient  can  he  taught  how  to  irrigate.  It  has  the  dis- 
advantage of  being  more  difficult  to  perform,  and  at  times  impos- 
sible, on  account  of  the  interference  of  the  inferior  turbinated, 
and  the  excessive  thickness  of  the  bone.  There  is  little  danger  of 
wounding  the  orbit  if  due  care  is  used. 

y/e  have,  on  two  occasions,  enlarged  the  natural  opening,  in  the 


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Emptbma  of  the  Accessory  Sinuses  of  thb  Nose.     151 

middle  meatofi,  in  an  anterior  direction,  witli  the  electric  drill,  ob- 
aerviDg  the  precaution  of  pressing  the  drill  downward  and  out- 
ward for  fear  of  entering  the  obit.  Should  irrigation  fail  to  cure 
in  tvo  months,  and  the  discbarge  remain  purulent,  with  a  caseous 
or  mealy  tendency,  an  opening  should  be  made  in  the  canine  fossa, 
la^  enough  to  permit  free  inspection  and  manipulation.  Should 
we  discover  granulations,  polypi,  or  uecrosed  bone,  the  cavity 
Bbould  be  thoroughly  curetted,  irrigated  and  packed  with  iodoform 
gauze,  and  changed  each  day  until  the  pyogenic  character  of  the 
membrane  has  been  destroyed. 

We  are  opposed  to  the  iocliscriminate  use  of  the  curette,  and 
think  it  should  be  reserved  for  special  cases,  and  thus  prevent,  as 
&r  as  possible,  the  formation  of  cicatricial  tissue. 

In  most  cases  the  medicated  gauze  will  effect  as  good  result  and 
leave  the  mucosa  in  a  natural  condition.  A  soft  rubber  drainage- 
tube  should  be  introduced  and  daily  irrigations  practiced. 

For  oar  opening  we  prefer  the  canine  fossa  to  the  lower  border 
of  the  molar  ridge  at  the  Eoot  of  the  first  molar  tooth.  The  bone 
is  thinner  in  the  canine  fossa  and  it  is  .a  better  site  for  curetting 
and  reaching  all  parts  of  the  antrum,  although  not  quite  as  de- 
pendent. Both  are  equally  inaccessible  for  operation  and  after- 
treatment. 

EMPYEMA   OP  THE   FRONTAL  8INUB. 

Diagnosis  in  these  oases  is  not  always  easy,  and  is  often  mis- 
taken for,  and  associated  with,  purulent  troubles  of  the  anterior 
ethmoidal  cells;  for,  by  meaas  of  the  iufundibulum,  the  middle 
meatus  communicates  with  the  cells,  and,  through  them,  with  the 
frontal  sinus. 

Oar  patient  complains  of  purulent  dischai^  from  the  uostril, 
and  the  flow  is  not  increased  on  stooping  over,  but  a  sense  of 
frontal  fullness  and  interorbital  pain  is  generally  manifest  and  in- 
creased by  this  posture.  If  the  iufundibulum  is  patulous,  in  all 
probability  we  will  observe  no  external  swelliag  at  the  inner  angle 
of  the  orbit  and  over  the  superciliary  ridges. 

Should  the  natural  opening  close,  or  the  pus  flow  be  too  great 
to  escape,  this  will  occur  and  the  pus  will  point,  usually,  toward 


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152       The  Atlanta  Medical  and  Surgical  Journal. 

the  orbit  at  its  iaaer  angle.  On  looking  into  the  nose  we  will  find 
the  anterior  part  of  the  middle  meatus  bathed  in  pus,  coming 
from  the  region  of  the  infnndibulam  and  too  anterior  for  the 
ostium  mazillare.  If  we  are  not  now  able  to  detect  dead  bone 
with  a  probe,  we  are  certain  the  ethmoid  bone  is  involved,  but  the 
frontal  sinus  may  or  may  nut  be ;  and,  in  some  cases,  it  is  impossi- 
ble to  make  a  differential  diagnosis  without  invading  the  sinus  from 
the  front.  If,  however,  we  find  no  dead  bone  in  the  ethmoid,  and 
can  succeed  in  irrigating  through  the  infundibulum  and  get  pus, 
and  the  pus  flow  ceases  for  half  an  hour  or  more,  we  are  certain  we 
are  dealing  with  a  frontal  sinusitis  alone.  If  the  pas  flow  begins 
almost  immediately,  after  a  successful  irrigation,  there  is  ethmoidal 
complication.  If  we  have  a  nasal  flow  of  pus  and  external  swelling 
of  the  walls  of  the  sinus,  there  is  no  longer  any  room  for  doubt 
as  to  the  diagnosis.  This  trouble  may  be  mistaken  for  orbital  ab- 
scess or  phlegmonous  abscess  of  the  lachrymal  sac.  In  the  for- 
mer ptosis  is  usually  in  proportion  to  the  swelling  of  the  lids, 
while  in  frontal  empyma  the  ptosis  is  marked  at  first  and  out  of 
proportion  to  the  swelling; 

In  lachrymal  abscess  the  swelling  is  too  low,  and  pns  points 
below  the  tendon  of  the  orbicular  muscle.  We  should  always 
attempt  irrigation  through  the  infundibulum,  using  preferably  a 
boric  acid  solution.  The  canula  should  be  bent  at  a  right  angle 
about  one-third  of  an  inch  from  the  end,  and  care  should  be  used 
not  to  woand  the  mucous  membrane  in  its  introduction.  It 
should  be  directed  forward  and  upward  and  its  beak  rotated  a 
little  outward  as  it  becomes  engaged  in  the  narrow  portion  of  the 
infuodihulum.  GeneraiUy  it  is  best  to  first  remove  the  anterior 
extremity  of  the  middle  turbinated,  in  order  to  facilitate  the  ope- 
ration. Should  we  fail  to  catbeterize  and  external  perforation 
threaten,  we  should  open  the  sinus  from  the  front,  preserving  the 
periosteum  either  with  the  trephine  or  gouge  and  mallet,  and  a 
free  communication  established  with  the  nose,  using  a  probe  as  a 
guide. 

If  necessary  the  cavi^  should  be  carefully  curetted  and  packed 
with  gauze  until  it  is  deemed  safe  to  close  the  wound.  A  drainage- 
tube  should  be  kept  in  the  nasal  opening  all  the  while.     As  soon 


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Ehptema  of  tee  Accessory  Sinuses  of  the  Nose.     153 

asthewonnd  is  cloBed  irrigation  should  be  begun  through  the 
nose,  which  is  now  easily  accomplished. 

Zaabl  recommeDde  the  daily  evacuation  of  the  pus,  with  the  air 
douche,  through  a  fine  india-rubber  tube,  after  laying  bare  tbe 
eotranoe  of  the  infundibulum. 

Fuchs  has  dissected  out  the  entire  mucous  membraae  of  the 
sinus,  with  its  anterior  bony  wall,  with  good  result.  Some  rhinol- 
(^sts  leave  the  cases  to  nature,  and  when  pus  points  on  the  inner 
orbital  wall,  evacuate  it  there.  The  possible  fistula  and  the  result- 
ing contraction  and  deformity  of  the  eyelid  condemn  this  let- 
alone  procedure. 

EMPYEMA   OF  THE   ETHMOIDAL   CELI£. 

Some  of  the  remarks  made  on  the  differential  diagnosis  of 
frontal  empyema  from  involvement  of  the  anterior  ethmoidal  cells 
are  applicable  here.  Pus  arising  from  the  posterior  ethmoidal 
cells  may  be  confounded  with  sphenoidal  empyema  and  is  often 
associated  with  it.  This  is  specially  true  when  a  natural  commu- 
nication exists  between  these  cells  and  the  sphenoidal  sinus,  as  is 
sometimes  the  case. 

The  natural  opening  into  the  posterior  celte  is  found  in  the 
superior  meatus  at  the  front  part  of  the  upper  wall,  and  pus  pro- 
ceeding from  that  point  has  too  high  an  origin  to  be  mistaken  for 
that  which  flows  from  the  maxillary  ostium. 

If  we  are  fortunate  enough  to  irrigate  the  sphenoidal  sinus, 
which  is  generally  impossible,  it  will  greatly  assist  in  reaching  a 
correct  diagnosis,  for  if  this  cavity  aloue  be  involved,  the  pus  flow 
will  cease  for  a  while,  whereas  if  the  ethmoidal  cells  be  affected, 
the  pus  flow  will  reappear  almost  at  once.  As  an  almost  inva- 
riable rule  the  probe  reveals  necrosed  bone.  This  necrosis  may 
be  primary  in  some  cases,  the  result  of  syphilis,  tuberculosis,  etc.; 
bot  we  cling  to  tbe  opinion  that  it  is,  as  a  rule,  secondary  and 
produced  by  suppurative  intra-cellular  pressure  and  faulty  drainage. 

Owing  to  the  labyrinthine  and  extensive  structure  of  tbe  eth- 
moidal cells,  it  is  a  physical  impossibility  to  efTect  their  proper 
irrigation.  Frequently  associated  with  ethmoidal  empyema  are 
polypi  and   myxomatous  degeneration  of  the  middle  turbinated 


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154       Tee  Atlanta  Medical  and  Surgical  Journal. 

bone.  This  bone  is  fouod  eolarged,  firmly  wedged  id  between  the 
septum  and  outer  wall  of  the  Dose  and  bathed  id  a  creamy  pus. 
It  is  this  conditioD  which  is  frequently  responsible  for  asthmatic 
complications  and  other  reflex  neuroses.  Our  patients  complain  of 
the  fetid  discharge  accumulating  in  the  throat  during  sleep,  loss 
of  memory,  and  deep  frontal  and  interorbital  pains  which  are 
increased  on  lowering  the  head. 

There  is  no  disease  of  the  nose,  save  atrophic  rhinitis,  which  is 
so  intractable  to  treatment.  This  is  not  to  be  wondered  at  when 
we  consider  the  anatomical  structure  of  the  bone.  There  is  noth- 
ing 80  essential  to  the  relief  and  cure  of  these  cases  as  draivagef 
and  this  can  only  be  accomiilished  by  thoroughly  opening  up  the 
cells  with  a  sharp  curette,  or  better  perhaps,  the  drill.  All  dead 
bone  should  be  carefully  scraped.  Care  should  be  taken  not  to 
wound  the  orbit  or  enter  the  brain.  Until  the  cells  are  opened  up 
irrigation  is  useless.  We  have  never  seen  a  hemorrhage  sufficient 
to  justify  a  tampon,  and  oppose  it  because  it  interferes  with  drain- 
age and  might  dam  up  pus  and  cause  mischief.  Polypi  or  a  myx- 
omatous middle  turbinated  should  be  removed  at  a  prior  operation. 

Woakes  is  a  strong  advocate  of  the  use  of  chromic  acid  applied 
with  a  fenestrated  platinum  probe,  wherever  dead  bone  is  dis- 
covered. The  method  is  too  slow,  does  not  reach  the  site  of  the 
trouble,  and  in  our  hands  has  produced  no  good  result.  After  the 
cells  have  been  once  opened,  daily  irrigations,  with  an  occasional 
use  of  the  curette,  will  do  much  toward  ejecting  a  cure.  How- 
ever, we  must  confess  our  failures  in  this  malady  far  exceed  our 
successes. 

EMPYEMA    OF    THE    BPHENOIDAL   SINUS. 

The  size  and  exteht  of  the  sphenoidal  sinuses  vary,  and  at 
times  communicate  with  the  posterior  ethmoidal  ceils  in  front  and 
extend  into  the  basilar  process  of  the  occipital  bone  as  far  as  the 
foramen  maguum.  Empyema  of  these  cavities,  we  believe,  is  less 
oilen  diagnosed  than  the  same  trouble  in  any  of  the  other  acces- 
sory sinuses.  It  is  most  frequently  mistaken  for  purulent  auc- 
tion of  the  posterior  ethmoidal  cells,  and  the  remarks  on  that 
subject  apply  here.     The  natural  opening  of  the  sphenoidal  cavity 


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Mentally  Deficient  Childres.  165 

lies  io  the  extreme  upper  back  part  of  the  nasal  fossa,  near  the 
septum  and  behind  the  posterior  extremity  of  the  superior  tur- 
binated bone.  It  is  e^ctremely  difficult  to  catheterize.  Before 
this  can  be  successfully  accomplished  it  is  generally  necessary  to 
remove  the  posterior  end  of  the  middle  turbinated  body,  which 
greatly  obstructs  manipulation.  A.  long  straight  canula  ia  used. 
We  are  of  the  opinion  that  primary  empyema,  without  necrosis  of 
the  aaterior  &ce  of  the  sphenoidal  body,  is  seldom  diagnosed  and 
treated  through  the  ostium.  As  a  rule  our  attention  is  directed 
to  fungous  granulations  in  this  region,  and  on  ioyestigatiou 
necrosis  is  discovered  near  the  natural  opening.  Our  patients 
commonly  complain  of  little  else  than  post  nasal  dripping  of  pus, 
which  accumulates  in  the  throat  during  the  night,  and  a  deep 
Dasal  or  post-nasal  pain.  Opening  the  cavity  and  irrigation  is 
the  proper  treatment.  The  only  two  cases  we  have  met  with  were 
discoverd  atler  removing  the  middle  turbinated  bone,  for  myxom- 
titoQS  degeneration,  in  the  treatment  of  ethmoiditis.  The  anterior 
&ce  of  the  sphenoidal  body  was  carious  in  both  and  fungi  marked 
the  site  of  the  diseased  bone.  With  a  strong,  sharp  curette  the 
oecrosed  bone  was  scraped  and  an  opening  made  into  the  sinus,  in 
both  cases.  Irrigation  was  then  daily  practiced,  which  effected  a 
cure  in  one  case,  afler  several  months  of  constant  treatment.  The 
other  passed  from  our  bands  before  a  cure  resulted,  though  some- 
what improved. 


MENTALLY  DEFICIENT  CHILDREN. 

Bt  KATHEBINE  COLLINS,  M.D., 
Atlanta,  Ga. 

The  subject  which  I  bring  before  you  for  consideration  is  not  a 
new  one  to  you,  and  my  excuse  for  presenting,  is  that  I  believe  the 
mentally  deficient  child  has,  hitherto,  not  engaged  the  attention  of 
the  general  practitioner  to  the  extent  warraoted  by  the  needs  of  the 
case;  and  while  it  is  to  the  specialist  such  cases  must  ultimately  be 
referred,  it  still  remains  for  the  family  physician  to  point  the  way. 

My  own  personal  contact  with  many  children  from  all  grades  of 


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156       The  Atlanta  Medical  and  Surgical  Journal. 

society  lias  led  me  to  realize  that  a  closer  line  should  be  drawn  be- 
tween the  normal  and  abnormal  mind  and  special  attention  directed 
toward  the  latter,  and  such  disposition  made  of  tbem  as  to  best 
promote  individual  happiness  and  insure  public  safety. 

For  the  etiology  and  classification  of  these  cases,  I  have  drawn 
largely  from  the  writings  of  those  who  have  spent  years  among  the 
defective  class  and  studied  it  in  all  its  phases. 

For  the  possibilities  in  the  lines  of  improvement  I  give  you  the 
experience  of  others,  and  my  own  observations. 

The  earliest  efforts  to  instruct  an  idiot  were  made  by  Itard,  of 
France,  in  1800,  on  a  boy  found  running  wild  in  the  woods.  Essays, 
also,  upon  the  subject  were  written  by  Voisin  and  E^quirol,  but  it 
remained  for  Seguin,  a  pupil  of  Itard  and  Esquirol,  to  make  sys- 
tematic and  serious  efforts  to  improve  the  condition  of  mentally 
deficient  children. 

His  first  experiments,  in  1837,  were  with  the  inmates  of  the 
Hospital  for  the  Incurables-  Later  he  was  appointed  to  apply  his 
method  to  the  children  of  the  Bic^tre. 

Simultaneously  with  Seguin's  work  tn  France,  Dr.  Saegert,  in 
Berlin,  and  Guggenbiihl,  in  Switzerland,  were  making  experiments 
along  the  same  lines,  but  it  was  Seguin's  great  work,  entitled 
^'Traitement  moral.  Hygiene  et  Education  des  Idiots  et  des  autres 
Enfant  Arrifer^s,"  that  laid  the  foundation  for  the  emancipation  of 
the  imbecile  class. 

A  few  years  later,  in  England,  a  small  school  for  imbeciles  was 
started,  others  soon  followed,  while  in  the  United  States  efforts  were 
being  made  to  benefit  the  idiots  by  training  them  in  connection 
with  special  schools  for  the  deaf  and  blind. 

Massachusetts  was  the  first  State  to  make  specific  provision  for 
this  class  by  appointing  a  commission  to  investigate  the  number  and 
condition  of  idiots  in  the  State.  Dr.  Howe,  instructor  of  Laura 
Bridgeman,  was  chairman,  and  the  report  of  this  commission  led  to 
an  appropriation  of  $2,500  for  the  establishment  of  a  school. 

Other  States  soon  followed  the  example  set  by  Massachusetts,  and 
at  the  close  of  1 895  sixteen  States  made  special  provision  for  6,000 
mentally  deficient  children.  The  census  of  1890  gives  a  total  of 
95,571  idiots  and  imbeciles,  leaving  89,571  unprovided  for. 


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Mentally  Dbpicieht  CHiiDaBN.  157 

Eoglaod  provides  for  2,700,  and  estimates  a  total  of  4,600. 

GermaD7  supports  2d  iastitations,  together  witb  tbe  auxiliary 
schools  or  "Half  KlUsse,"  that  are  in  ooDaection  with  the  pnblio 
schools  proper. 

Switzerland,  Korway  and  Denmark  also  recognize  and  make  pro- 
vifflon  for  these  unfortunates. 

Such  in  brief  is  the  historical  outline  of  this  work  as  it  has  pro- 
gressed in  the  countries  mentioned. 

The  term  "idiocy"  is  misleading  as  it  is  so  variously  applied  by 
different  writers.  Landon  Carter  Gray  defines  it  as  "a  congenital 
condition  of  mental  defect  that  ts  technically  distinguished  from 
that  mental  defect  of  later  years  which  is  known  as  dementia.  The 
symptoms  are  those  of  lack  of  development,  and  this  lack  of  mental 
development  may  vary  very  much  in  degree." 

The  term  "idiot"  seems  in  this  definition  to  include  all  classes 
of  mental  deficiency,  and  to  make  it  always  congenital  in  its  ori^u. 

Chas.  K.  Mills  gives  three  divisions  of  thb  chtss :  "Idiots,  im- 
beciles and  cretins."  He  considers  idiocy  as  congenital  or  acquired 
in  early  life  previous  to  the  evolation  of  tbe  mental  &colties. 

While  the  division  into  the  above  classes  is  often  confusing,  tbe 
division  as  to  time  of  acquisition  is  verydefinite,3eparating  it  entirely 
from  those  oases  occurring  in  later  life,  such  as  dementia.  Mills 
uses  the  terms  imbecility  and  feeble-mindedness  interchangeably. 

Shuttleworth,  of  England,  includes  all  grades  under  the  term 
"mentally  deficient,"  and  groups  them  according  to  time  of  acquisi- 
tion witb  a  pathological  subdivision.  Like  all  chisaifications,  it  is 
more  or  less  imperfect,  but  it  gives  a  convenient  working  outline 
and  is  adopted  by  many  institutions. 

The  first  division  is  that  of  congenUal  origin,  under  which  head 
we  have  the  microcephalous,  hydrocephalous,  mongol,  scrofulous 
birth  palsies,  cretinism  and  primarily  neurotics. 

These  forms  may  exhibit  any  degree  of  mental  defect  from  the 
low  grade  idiot  to  tbe  merely  backward  child,  according  to  the  ex- 
tent to  which  the  primary  cause  acts. 

To  enable  you  to  understand  the  table  better  I  will  call  your 
attention  to  a  few  points  in  each  case,  but  for  a  fuller  description 
will  leave  you  to  refer  to  any  good  text-book  upon  tbe  subject. 


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158       The  Atlanta  Medical  ahd  Surgical  Jodrnal. 

Tlie  microcephalic  in  its  extreme  form  is  characteristic  of  low 
grade  idiocy.  An  attempt  was  made  at  one  time  to  establish,  in 
these  cases,  seventeeD  inches  as  a  limit  of  circumferential  measure- 
ment ;  such  a  limitation  seems  not  to  be  wholly  satisfactory,  thoagh 
Fletcher  Beach  states  that  heads  measuring  less  than  this  never 
show  any  signs  of  intelligence.  The  diagnosis,  however,  of  this 
condition  is  not  based  upon  measurement  alone;  the  characteristic 
receding  forehead,  pointed  vertex,  flattened  occiput,  with  the  bodily 
peculiarities,  will  not  leave  one  long  in  doubt  as  to  which  class  the 
subject  belongs, 

Hydrocepbalous  is  occasionally  congenital  and  does  not  always 
produce  mental  enfeeblement.  Distinction  must  be  made  between 
this  condition  and  nckets;  in  the  latter  the  fontanelle  is  depressed 
and  the  head  elongated  in  the  antero-posterior  diameter,  while  in 
the  former  the  fontanelle  is  raised  and  the  crossed  diameters  more 
nearly  approximate. 

In  the  Mongol  or  Kalmuo  type,  so  named  from  a  strong  resem- 
blance to  these  races,  the  skull  is  short,  the  transverse  and 
longitudinal  diameters  nearly  equal,  the  frontal  and  occipital 
planes  are  almost  parallel ;  the  tongue  is  transversely  Assured  and 
has  hypertropbied  papillte ;  the  eyes  are  frequently  set  obliquely. 
Antopeies  in  these  oases  show  the  brain  to  be  made  up  of  coarse 
convolutions. 

Shuttleworth  and  Beach  agree  that  the  Mongol  variety  is  often 
the  last  born  of  a  long  family  with  a  tubercular  iamily  history,  and 
it  is  not  unusual  for  them  to  die  in  early  life  of  tubercular  aEfections. 

Cretinism,  which  is  characterized  both  by  the  lack  of  physical 
and  mental  development,  when  it  occurs  in  wiero  results  in  death  to 
the  fetus,  but  in  some  cases  the  congenital  taint  is  developed  after 
birth.  These  cases  are  recognized  by  the  low  stature,  large  head 
in  proportion  to  the  body,  flat  on  top,  narrow  in  front  and  spread- 
ing out  toward  the  sides,  the  hair  is  coarse  and  bristle-like,  the  fore- 
head low,  the  skin  loose  and  rough. 

The  thyroid  gland  is  absent  and  fatty  tumors  are  formed  in  the 
supra-clavicular  region.  The  Cretin  is  usually  of  a  low  grade  of 
mentality  but  not  vicious ;  they  have  rather  an  afiectiouate  dispo- 


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Mbntallt  Deficient  Children.  159 

Bition,  can  recognize  their  frieads,  and  seem  in  some  cases  to  under- 
stand a  little  of  what  is  goinj;  on  about  them. 

According  to  the  experiments  of  Dr.  Telford  Telford-Smith  of 
EBgland.improvementhasfollowedtheadministratioa  of  the  thyroid 
extract  in  cases  of  sporadic  cretinism,  and  reversion  to  the  former 
condition  occurs  upon  withdrawal  of  the  remedy.  Bemoval  from 
the  low  valleys,  where  these  cases  occur,  to  higher  altitudes  seems 
to  have  a  modifying  influence. 

Birth  palsies  will  be  considered  under  traumatic  injuries  to  the 
new-born. 

Of  the  next  division  little  need  be  said,  as  it  is  a  familiar  con- 
dition. 

Dr.  Ireland  claims  that  two-thirds  of  the  idiots  show  scrofulous 
diathesis ;  strumous  glands,  tubercular  disease  of  the  joints  and 
eeroos  membranes  are  frequentaccompanimentof  mental  defection. 

The  next  division  is  the  primarily  neurotics.  I  am  rather 
inclined  to  take  issue  with  some  authors  u^Kin  this  point.  My 
experience  leads  me  to  believe  that  while  mental  enfeeblement  may 
show  itself  in  the  child  where  parents  are  neurotica,  yet  there  is 
ofteoer  a  condition  of  instability  of  the  general  nervous  system 
aocompanied  by  a  high  grade  of  mental  development.  Should, 
however,  this  neurotic  state  be  grafted  upon  an  epileptic, 
tubercular  and  other  depraved  condition,  then  mental  enfeeble- 
ment of  any  degree  may  result. 

The  second  general  class,  Developmental,  is  where  a  latent  or 
unstable  condition  of  the  central  nervous  system  exists,  congen- 
ital in  origin,  but  not  exhibited  until  precipitated  by  some  crises. 

Convulsions  during  the  first  or  second  dentition  and  the  chang- 
ing conditions  of  puberty  often  mark  the  downward  path  of  an 
already  tottering  mind.  Epileptic  seizures  frequently  do  not  begin 
Qutil  the  sixth  or  seventh  year,  and  up  to  that  age  the  child  may 
seem  as  bright  as  other  children. 

In  those  cases  of  inherited  syphilis  the  characteristic  lesions 
may  occur  early,  but  mental  deterioration  rarely  begins  before 
the  second  dentition. 

The  third  general  class  consists  t)f  those  cases  which  are  non- 


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160       The  Atlanta  Medical  and  Sdroical  Journal. 

eongenital,  aod  under  tbis  head  we  have  traumatic,  post-febrile- 
sboek,  aod  toxic  cases. 

Traumatism  ma^  act  at  the  time  of  birth  or  later.  A  severe  tall 
in  early  infancy,  producing  injuries  resulting  in  pressure  upon 
the  brun  or  causing  meningeal  hemorrhage,  may  result  in  degen- 
eration of  the  brain  substance. 

As  to  traumatism  at  the  time  of  birth,  much  has  been  said  and 
written.  Dr.  J.  Madison  Taylor,  of  Philadelphia,  several  years  ago 
carefully  collected  the  opinions  of  many  specialists  regarding  the 
number  and  exteot  of  cerebral  injuries  due  to  forceps  deliveries. 
I  will  give  briefly  some  of  the  replies  he  received : 

Jacobi  writes  as  follows:  "That  while  forceps  may  do  injury 
by  the  fact  that  the  very  preseuce  of  the  blade  narrows  the  canal, 
but  the  greater  danger  arises  from  the  prolonged  labors." 

Drs.  Sarah  McNutt  of  New  York,  Fullerton  of  the  Woman's 
Hospital,  Philadelphia,  Martin  of  Ann  Arbor,  Davis,  Sinkler,  and 
Hirst  of  Philadelphia,  look  upon  prolonged  labors  as  the  more 
fruitful  source  of  these  cerebral  injuries  in  the  new-born. 

Dr.  Wm.  Goodell,  however,  is  quoted  as  follows :  "  My  experience 
would  lead  me  to  the  belief  that  the  great  majority  of  cases  of 
cerebral  palsies  are  due  to  acute  unequally  distributed  pressure 
of  the  forceps  upon  the  child's  bead,  rather  than  the  prolonged 
but  equally  distributed  pressure  in  an  unaided  labor." 

Dr.  Joseph  Price  states  that  during  his  stay  at  Preston  Retreat 
he  did  not  have  a  direct  or  remote  cerebral  sequela  of  parturition 
in  in&nts,  though  there  were  many  complicated  labors,  some  with 
contracted  pelvis.  Dr.  Price  fiercely  denouooes  the  promiscuous 
and  unskilled  use  of  the  forceps. 

Post-febrile  conditions  producing  meningeal  inflammation  may 
cause  more  or  less  deterioration  or  arrest  of  development.  Shock 
in  the  form  of  fright  is  sometimes  assigned  as  the  origin  of  mental 
defect,  and  where  it  is  prolonged  may,  by  interference  with  nutri- 
tion of  the  nerve  centers,  bring  about  trophic  changes  more  or 
less  permanent  in  character. 

Toxic  cases  are  seen  in  very  young  children  that  are  subjected 
to  long-continued  use  of  alcohol  or  narcotics. 

Instead  of  going  into  a  long  discussion  of  the  etiology  of  mental 


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Mestally  Bepicient  Children,  161 

deterioratioD,  I  will  run  over  a  few  tables  that  will,  I  thiak,  give 
you  a  better  idea  of  the  subject  thau  aay  words  of  mine. 

The  first  is 

Beach  and  Shuttleworth. — Royal  Albert  Asylum,  1200  cases. 

I.    CAUSES    ACTING    BEFORE   BIRTH. 

PhtbUiB „ 291      Intemperanc* 169 

MenUUlraio  191      Syphilia  18 

InaftDity 182      Illegitimacy 28 


II.   CAUBES   ACTING   AT   BIRTH. 


Primogeaitura 

Protracted  pressure.... 


III.   CAUSES   ACTING   AFTER   BIRTH. 

Inrantile  convulsione. 891       Head  injury 99 

Acute  infectious  fevers 119       Epilepiy  and  cerebral  aOections  57 

Dr.  Pearce,  of  Philadelphia,  has,  from  the  statistics  of  many  iosti- 
tatioDs  compiled  several  very  valuable  tables.  I  will  only  quote 
theoDe  giviDg  the  causes  assigned  for  the  mental  eufeeblemeut. 

COJ<aiHITl.L.  ACqUIRID. 

Pater.  Haler. 

Imbecility 16  21         Accident 76 

iMbriety 10  11         Abuse  and  neglect 10 

SenrwuneM _ 17  —        iDfantile  d<«ease „ 96 

*l"l»p«r 3  80        Sunstroke 5 

Hj'tsris .,,.—         6        In  Btrumantal  delivery 26 

Shock _  25 

lauDity —  7 

(^•ntrainlDg  during  gestation —  40 

Syphilii —         7 

Pl'hisiiand  consanguinity —  17 


The  incoDgruity  between  the  number  ascribed  to  imbecility, 
alcoholism,  or  auy  other  cause  that  would  reflect  discredit  to  the 
parents,  and  the  number  ascribed  to  overstraining,  shock,  and  in- 
jury is  always  very  marked  in  these  tables,  and  allowance  must  be 
made  accordingly. 

A  few  words  as  to  the  moral  imbecile  before  taking  up  the  dis- 
position of  the  mentally  deficient:  He  belongs  to  a  class  apart 
from  the  others.  Frequently  the  mental  powers  are  good,  but 
totally  lacking  in  moral  sense  and  not  amenable  to  any  teaching  in 

t 

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162       Thb  Atlanta  Medical  and  Sorgical  Jouenal. 

this  direolioD.  Puaishment  and  persuasion  alike  fail  and  he  has 
DO  moral  sense  to  appeal  to.  He  is  the  despair  of  his  parents  and 
teachers,  and  bis  influence  among  other  children  is  bad.  Lifelong 
detention  is  at  present  the  only  disposition  that  can  be  made  of 
such  cases. 

We  will  now  take  up  the  mauagement  of  the  mentally  deficient 
as  it  is  exhibited  by  the  special  institution.  The  late  Dr.  Kerlin 
was  very  active  in  initiating  the  work  in  this  country  that  has 
proven  m  beneficial  tu  the  public  at  large  as  well  as  the  individ- 
uals. In  olden  times  the  Greeks  destroyed  their  "fools,"  but  in 
this  Christian  age  we  are  not  permitted  to  resort  to  such  extreme 
measures,  so  it  remains  for  us  to  protect  the  people  and  promote 
the  happiness  and  usefulness  of  the  individual  by  educational 
means. 

In  the  many  instittitious  provided  for  this  class,  the  school  sys- 
tem takes  precedence  over  the  custodial.  In  fact  the  entire  insti- 
tution might  be  considered  a  school,  inasmuch  as  some  degree  of 
training  is  (with  few  exceptions)  resorted  to  in  all  cases.  The 
faintest  ray  of  intelligence  is  carefully  looked  for,  and  when  found 
acts  as  a  lever  to  open  the  mind  to  other  impressions. 

The  hand  is  generally  the  first  to  receive  attention.  The  useless 
band  of  the  idiot  is  familiar  to  all.  The  simple  act  of  raising  a 
cup  of  water  to  the  lips  is  often  denied  it;  but,  after  training, 
many  of  these  children  can  make  beds,  sweep,  and  perform  other 
domestic  duties.  Every  possible  means  is  resorted  to,  to  at  least 
raise  the  independence  of  these  children,  who  cannot  perrorm  the 
simple  acts  of  daily  life  that  the  normal  child  does  continually, 
unconscious  that  it  ever  bad  to  learn  to  do  just  that  one  thing. 

Sometimes  a  child  is  labored  with  for  years  in  this  simple  way 
until  be  has  reached  a  point  of  development  where  he  can  eut^r 
into  the  kindergarten  work;  from  there  take  up  the  sluyd  or  man- 
ual arts,  on  into  what  corresponds  to  the  primary  and  intermediate 
grades  of  our  public  schools.  Here  at  the  age  of  twenty  years 
you  wilt  find  him  with  a  fair  amount  of  knowledge  of  geography, 
arithmetic,  spelling,  etc.,  able  to  perform  in  a  very  intelligent  way 
rough  carpentering  work,  gardening,  etc.  It  is  possible  now  for  bim 
to  be  sent  out  to  earn  his  own  livelihood,  providing  he  be  placed 


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Mentally  Deficient  Children.  163 

under  proper  supervioioD  and  not  eiibjected  to  teoiptatioa.  Mao^ 
«f  these  cases  are  not  primarily  vicious,  but  often  show  a  sweet, 
lovable  nature,  capable  ot  much  good  or  evil,  according  to  the 
influence  that  surrounds  them.  The  will  is  weak,  and  they  become 
«n  easy  tool  to  ibeir  more  evil  companions. 

Institution  work  is  organized  upon  a  broad  scale  to  meet  every 
requirement.  Military  drill  and  calisthenics  receive  special  atten- 
tion, and  together  with  all  manual  work,  prove  important  factors, 
for  mental  specialists  generally  agree  that  the  education  of  the 
body  helps  to  develop  the  mind. 

A.  band  is  usually  formed  from  the  inmates.  Entertainments 
are  given  at  intervals  wherein  the  children  take  active  part. 
Sewing  and  all  domestic  duties  are  taught,  together  with  garden- 
ing, carpentering  and  the  general  care  of  the  premises.  As  a  con- 
sequence the  number  who  are  absolutely  helpless  is  greatly 
reduced. 

How  much  better  this  condition  than  the  retaining  of  such  a 
child  in  the  home  where  it  degenerates  instead  of  improves,  bring- 
ing trouble  and  ansiety  to  all  about  him. 

Many  parents  would  send  such  children  to  special  institutions, 
but  are  debarred  from  doing  so  through  financial  reasons,  and  as 
yet  comparatively  few  States  make  provision  for  them.  Others 
are  deterred  from  doing  so  through  a  false  sentiment ;  this  would 
be  overcome  if  the  institutions  were  considered  more  in  the  light 
of  schools  than  asylums. 

There  is  a  class  of  the  mentally  deTective  found  in  our  schools 
which  represent  the  borderline  cases,  recognized  oftener  by  the 
teacher  than  the  physician.  Such  cases  exhibit  incapacity  in  one 
or  more  directions,  being  normal  in  other  respects  and  often  excel 
in  some  one  line.  These  children,  while  capable  of  receiving  an 
education,  cannot  he  treated  as  the  normal  child.  School  author- 
ities realizing  this,  are  making  elforta  to  provide  special  instruc- 
tion (as  is  done  in  Germany)  for  them  in  connection  with  the  city 
schools. 

Every  city  should  have  an  "auxiliary  school"  centrally  located, 
where  these  children  can  receive  individual  training  without  being 
sent  away  from  home.     In  some  instances  after  a  year  or  two  of 


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164       The  Atlanta  Medical  and  Sdkqical  Jodrnal. 

special  traioiDg  a  child  may  be  permitted  to  take  iia  place  in  tbe 
regular  school  work. 

These  childreD'e  miode  are  like  some  plaate;  they  need  more 
tender  care  to  start  them  growing,  bat  when  once  a  fouodatioa  i» 
laid,  become  vigorous  and  hardj;  but  if  deprived  of  this  initial 
oare,  grow  up  weak  and  distorted. 

Tbe  anemia  child  must  not  be  coafniiDded  with  actual  mental 
defect,  for  in  the  former  tbe  elriggiebnese  of  mental  activity  is  a 
general  condition  dependent  upon  improper  nutrition,  and  such  a. 
child  should  not  be  in  school  at  all,  but  given  proper  food  and  out- 
door life  UDtil  the  anemic  condition  is  overcome. 

In  closing  I  would  say  a  few  words  concerning  State  economics- 
as  related  to  this  subject.  The  providing  for  these  cases  by 
the  establishment  of  State  institutions  for  the  severer  cases  and 
auxiliary  schools  for  the  milder  ones  means,  of  course,  a  large  ex- 
penditure of  money,  but  one  function  of  tbe  State  is  to  protect  and 
care  for  its  own,  and  afler  alt  is  it  not  better  and  more  economical 
to  support,  such  institutions  for  the  improvement  of  a  class  than 
penitentiaries  and  poorhuuses  for  the  detention  of  the  criminal 
and  disabled?  Sooner  or  later  a  large  proportion  of  the  mentally 
deficient  become  wards  of  the  State  in  one  capacity  or  another. 


MASTOID  INFLAMMATION  WITH  A  REPORT  OF  TWO 
INTERESTING  OASES.* 

Bt  T.  £.  UlTCHELL,  H.D., 
CoLUMBtrs,  Ga. 

As  an  apology  for  my  remarks  on  mastoid  inflammation  I  desire 
to  say  that  it  is  a  subject  which  merits  our  careful  consideration 
for  the  reason  that  it  is  always  a  grave  disease,  and  though  rela- 
tively infrequent,  when  present  demands  prompt  and  rational  ther- 
apeutic ageuts.  In  medico-surgical  parlance  the  mastoid  process 
consists  of  that  part  of  the  temporal  bone  immediately  posterior 
to  tbe  attachment  of  the  auricle.  Ordinarily  it  contains  a  honey- 
ion  or  the  Aiaerlaui  Otologlcail,  RhlnologicaJ  and 


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Mastoid  Inflammation.  165 

«ombed  structure  of  bone  with  cells  variable  in  size,  shape  aud 
Dumber  id  diSereot  individuals,  aod  id  the  two  mastoids  of  tbe 
same  iodividual.  Ooe  of  these,  the  mastoid  antrum,  is  always 
present  and  sometimes,  though  rarely,  exists  alone.  These  mas- 
toid cells  are  lined  by  a  contiouation  of  the  tympanic  mucous 
membraDC.  They  intercom muuicate  with  each  otber  and  by  way 
of  the  antrum  with  tbe  tympanum,  and,  like  tbe  latter  cavity,  con- 
tain air,  hence  the  name  pneumatic  cells.  This  osseous  structure 
is  in  relation  with  the  middle  cranial  fossa  above  and  the  external 
auditory  canal  in  front,  from  which  it  is  separated  by  thin  layers 
of  bone.  The  sigmoid  portion  of  the  groove  for  the  lateral  sinus 
lies  internal  to  the  cells  and  usually  to  their  posterior,  though  it  is 
Dot  constant  in  this  respect.  The  depth  of  the  antrum  from  the 
cortical  layer  varies  from  one-half  to  seven-eighths  of  an  inch. 

Except  in  rare  instances  mastoid  inflammation  is  secondary  to  a 
suppurative  inflammation  of  the  middle  ear.  Because  of  the  very 
intimate  anatomical  relation  between  the  tympanum  and  mastoid 
cells  it  is  difBcult  to  understand  how  an  inflammation  of  any  mag- 
nitude can  exist  in  the  former  without  there  being  at  tbe  same 
time  a  similar  pathological  condition  in  the  latter;  and  yet  in  the 
vast  majority  of  instances  in  which  there  is  a  discharge  of  pus 
from  tbe  middle  ear  no  coexistent  symptoms  referable  to  the  mas- 
toid are  present. 

Mastoiditis  may  exist  in  various  degrees  of  intensity,  from  a 
mere  congestion  of  the  mucous  membrane  lining  the  cells  to  a 
condition  in  which  the  trabeculie  as  well  as  the  interspaces  are 
obliterated  and  replaced  by  a  homogeneous  mass  of  pus  and  in- 
flammatory debris. 

Probably  no  two  cases  of  mastoid  disease  are  exactly  alike,  and 
yet  in  tbe  vast  majority  of  instances  the  course  and  symptoms  are 
sufficiently  characteristic  to  enable  one  to  make  a  reasonably  cer- 
tain  diagnosis.  Tbe  earliest,  most  constant  and  characteristic 
symptoms  are  pain  in  the  post-auricular  region  and  tenderness  on 
deep  pressure  over  the  antrum.  More  rarely  these  are  accom- 
panied by  coDStitutional  disturbances,  local  edema  and  redness. 
If  an  early  diagnosis  be  followed  by  judicious  treatment,  the 
inflammatiou   may  be   checked   in  its  early  stages  and  tbe  parts 


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166       Thb  Atlanta  Medical  and  BttROiCAL  Journal. 

restored  to  their  normal  oooditioa.  Tbis  is  more  often  trne  whea 
the  disease  complicates  an  acnte  middle  ear  ioflammatiuD.  On  the 
other  hand,  one  stage  of  the  pathological  process  may  follow 
another  to  the  death  of  the  parts  and  the  formation  of  pus. 

A  pouting,  sacculated  condition  of  the  postero-superior  cuta- 
neous lining  of  the  external  auditory  canal  close  to  the  drum 
membraue,  together  with  redness  and  teoderness  over  the  mastoid 
antrum,  are  patbognomonic  signs  of  pus  in  the  cells. 

So  soon  as  symptoms  of  mastoid  congestion  are  manifest,  abso- 
lute rest  in  bed  should  be  ordered,  together  with  a  saline  cathartic 
and  liquid  diet.  Cold  in  the  form  of  the  Irfiter  coil  or  aural  ice- 
bag  should  be  kept  on  the  mastoid,  and  the  ear  Trequeotly  syringed 
with  hut  water  from  a  fountain  syringe.  At  the  same  time  free 
drainage  through  an  artificial  opening  in  tbe  drum-head  should  be 
encouraged.  This  line  of  practice  will  ameliorate  the  symptonis 
in  the  majority  of  cases,  and  in  a  lair  per  ceut.  will,  if  applied 
early  and  efficiently,  abort  the  trouble.  If,  however,  marked  im- 
provement is  not  had  in  forty-eight  to  seventy-two  hours  the 
probabilities  are  that  symptoms  demanding  an  operation  will  be 
manifest.  The  cells  should  be  opened  by  way  of  the  cortex  and 
all  detritus  removed  as  soon  as  possible  after  the  formation  of  pus 
which,  if  not  removed,  will  seek  an  outlet  in  the  way  of  least 
resistance,  and  should  this  be  in  the  direction  of  the  middle  cra- 
nial fossa  or  backward  towards  the  lateral  sinus,  a  fatal  meningitis 
or  thrombosis  would  likely  result.  Fortunately  the  pus  usually 
burrows  its  way  through  tbe  cortex  along  the  tract  of  a  mastoid 
emissary  vein. 

Since  the  time  of  Sir  William  Wilde  an  operation  bearing  his 
name  has  been  more  or  less  practiced  for  aborting  mastoid  inflam- 
mation. It  consists  of  a  vertical  incision  parallel  to  tbe  attach- 
ment of  the  auricle  down  to  and  through  tbe  mastoid  periosteum. 
When  we  call  to  mind  that  the  beginning  of  a  mastoid  inflamma- 
tion is  in  the  antrum  with  an  overlying  dense  layer  of  bone,  vari- 
able in  thickness  from  one-fourth  to  seven-eighths  of  an  inch,  the 
Wilde  incision  to  my  mind  is  as  unwise  and  unsurgical  as  it  is  in- 
efficient as  a  therapeutic  agent.  With  free  drainage  through  the 
drum,  frequent  syringing  with  hot  water,  together  with  the  anodyne 


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Mastoid  Inflahhation.  167 

effect  of  cold  to  the  mastoid  aod  absolute  rest  in  bed,  mao^  <»ise8 
will  recover. 

A  case  in  point :  A.  M.  C,  aged  forty-six,  bridge-builder, 
while  sleeping  under  a  tent  contracted  a  severe  cold  followed  by 
acute  inflammation  of  both  middle  ears.  When  first  seen  by  me 
both  drums  were  very  red  aud  bulging.  Both  mastoids  were  red, 
slightly  swollen,  exquisitely  tender  with  characteristic  pains  and 
oouBiderable  oonetitutiooat  disturbance.  Incieioo  of  drums  was 
refused.  Ordered  the  patient  to  bed  and  prescribed  as  indicated 
above.  Id  twenty-four  hours  the  patient  was  fairly  comfortable, 
bat  the  right  drum  had  ruptured.  Symptoms  continued  to  im- 
|m>ve  and  on  the  fourth  day  applications  to  the  mastoid  were 
discontinued.  Hot  water  from  a  fountain  syringe  and  inflatioDS 
constituted  the  remaining  treatment.  The  perforation  healed  in 
two  weeks,  and  although  the  patient  passed  from  under  my  obser- 
vation before  the  hearing  was  entirely  restored,  it  was  practically 
80  when  I  last  saw  him. 

I  believe  that  pus  beneath  the  6oh  parts  overlying  the  mastoid 
cortex  during  a  mastoiditis  always  forms  in  the  cells  within  and 
makes  its  way  out  either  by  way  of  the  tympanum  along  the 
superior  canal  wall  or  through  a  fistulous  tract  in  the  cortex.  It 
is  only  in  these  cases  that  the  Wilde  incisiou  is  indicated,  and 
unce  the  seat  of  trouble  is  within  the  mastoid,  good  surgery  would 
suggest  that  the  use  of  the  knife  be  only  preliminary  to  a  resort 
to  the  chisel.  The  operation  per  ae,  is  not  a  dangerous  one,  and 
when  properly  done  the  patient's  prospects  for  a  speedy  recovery 
are  infinitely  better  than  when  drainage  is  so  imperfect  as  is  the 
case  after  the  incision  alone. 

Case  I. — Mr.  M.  B.,  aged  thirty-three,  of  robust  physique  with- 
out any  history  of  a  previous  ear  trouble,  contracted  cold  from  ex- 
posure to  rain  July  7,  1896.  As  a  result  he  had  an  acute  suppura- 
tive inflammation  of  the  right  ear.  A  spontaneous  rupture  of  the 
drum-bead  and  consequent  discharge  of  pus  stopped  under  treat- 
ment in  twelve  days.  Hearing  at  this  time  equaled  watch  in  con- 
tact, which  was  increased  to  two  inches  after  inflation.  Patient 
resumed  bis  vocation  as  traveling  salesman,  reporting  at  my  office 
once  a  week  with  the  uniform  statement  that  he  suflered  with  pain 


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168       The  Atlanta  Medical  and  Surgical  Journal. 

of  a  oeuralgic  type  in  the  occi  pi  to- parietal  region  of  the  affected 
side.  This  state  of  affairs  continued  for  nearly  six  mooths  till 
January  3,  1897,  during  which  time  there  was  absolutely  no  pain, 
redness,  sw_elliug  or  tenderoess  over  the  mastoid.  Dr.  A.  W. 
CalhouD,  of  Atlanta,  saw  the  patient  at  intervals  during  this  time, 
and  agreed  with  me  that  the  mastoid  was  not  diseased  and  that 
the  pains  were  neuralgic  with  an  obscure  origin,  probably  mala- 
rial; but  the  negative  results  of  our  therapeutics  and  the  sub- 
sequent history  of  the  case  proved  the  fallacy  of  our  diagnosis. 

January  3,  1897. — A  circumscribed  swelling  over  the  antrum 
has  made  its  appearance  during  the  past  forty-eight  hours  and 
with  it  considerable  tenderness  on  pressure.  Under  local  anes- 
thesia an  incision  was  made  in  the  swelling,  evacuating  more  or 
less  pus,  and  drainage  kept  up  for  two  weeks. 

On  January  19,  very  little  or  no  relief  having  followed  the  less 
radical  operatiou,  I  advised  an  opening  of  the  cells,  which  I  did 
under  ether.  A  fistulous  tract  was  enlarged  and  the  cells  were 
found  to  be  one  large  cavity  filled  with  creamy  pus  and  inflam- 
matory debris,  the  trabeculce  having  been  obliterated.  This  was 
all  removed  and  the  bone  well  curetted,  not,  however,  without  an 
unavoidable  opening  of  the  lateral  sinus ;  but  since  this  occurred 
just  at  the  close  of  the  operation,  the  hemorrhage  was  stopped 
with  an  iodoform  tam)}on  followed  by  the  usual  toilet,  alter  which 
the  patient  was  put  to  bed  in  good  condition. 

January  20,  9  a.m. — Patient  reacted  well,  no  paiu,  temperature 
normal,  pulse  78.  At  2  p.m.  pulse  92,  temperature  102,  which 
reached  103  by  10  o'clock. 

January  21,  9  a.m. — Patient  resting  well,  no  pain,  pulse  80, 
temperature  101.  At  10  p.m.  general  condition  the  same,  pulse 
86,  temperature  102. 

January  22,  9  a.m. — Resting  well,  pulse  86,  temperature  102. 
Original  dressing  removed.  At  2  p.m.  pulse  94,  temperature 
103i,  which  fell  to  102  by  10  o'clock. 

January  23,  9  a.m. — Patieut  comfortable,  pulse  75,  tempera- 
ture 994.  At  7  P.M  pulse  was  85  and  temperature  101^.  Appe- 
tite, which  has  been  poor  since  the  o|»eration,  is  now  good. 

January  24,  9  a.m. — Pulse  75,  temperature  99. 


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Mastoid  Inflahhation.  169 

January  25. — Patieat  comfortable,  no  paio,  appetite  good,  pulse 
aoti  temperature  normal.  Further  history  of  the  case  was  une- 
veotful,  and  on  February  28th,  forty  days  afler  the  operation,  the 
wound  was  entirely  healed,  the  patient  was  dismissed  well,  with 
his  hearing  quite  as  acute  as  it  ever  was.  The  interesting  fea- 
tures iu  this  case  are: 

(1)  The  entire  abseuce  of  auy  symptoms  indicative  of  mastoid- 
itis during  tbe  suppurative  stage  of  the  middle  ear  inflammation. 
(2)  The  lapse  of  time  between  the  active  middle  ear  inflammation 
and  the  manifestation  of  pus  in  the  cells.  (3)  Tbe  entire  absenue 
of  any  and  all  symptoms  referable  to  tbe  mastoid  region  during 
the  formation  of  pus  therein.  (4)  The  remote  situation  of  tbe 
pain  in  the  occipito- parietal  region. 

Case  II. — Mr.  S.  P.,  aged  thirty-two,  bookkeeper,  when  a 
child  had  frequent  attacks  of  earache,  but  does  not  remember 
that  there  was  ever  a  discharge  from  the  canal.  In  August  of 
1897  he  had  malarial  fever  from  which  he  recovered  in  two  weeks. 
AbouE  the  time  of  convalescence  he  developed  an  earache  and 
a  coincident  mastoid  tenderness  on  the  left  side.  This  continued 
for  about  ten  days,  when  all  pain  and  tenderness  disappeared  leav- 
ing only  a  stuffy  feeling  in  tbe  ear  with  impaired  function.  At  no 
time  was  tbe  pain  in  tbe  ear  or  mastoid  severe  enough  to  interfere 
either  with  his  work  by  day  or  rest  at  night.  On  the  6th  of  De- 
cember following,  the  mastoid  became  again  tender  and  paiaful. 
This  continued  to  an  exteut  not  sufBcieut  to  interfen'  with  his 
daties  or  rest  for  twelve  days,  wlieo,  on  December  17th,  he  cou- 
Eulted  me  for  tbe  first  time.  Upon  examination  I  found  the  drum 
intact,  the  mastoid  red,  swollen  and  tender  on  pressure,  with  no 
great  amount  ot  pain  and  no  constitutional  disturbance.  I  ordered 
the  patient  to  bed,  gave  a  cathartic  and  kept  applications  of  ice  to 
the  mastoid  for  forty -eight  hours.  During  tliis  time  the  patient 
*as  entirely  comfortable,  but  tbe  condition  of  the  soft  parts  over 
the  mastoid  suggested  pus  within,  consequently  a  radical  operation 
was  advised.  This,  however,  was  refused  till  the  23d  when,  under 
ether  narcosis,  the  cells  were  ojiened.  A  long  incision  was  made 
extending  from  the  tip  of  the  mastoid  below  to  a  point  above  the 
auricle  down  to  and  through  the  periosteum,  which  being  scraped 


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170       The  Atlanta  Medical  and  Surgical  Journal. 

aside  dinclosed  a  fistulnus  opeoing  leading  to  the  aotrum.  Tbe 
entire  cortex  down  to  the  tip  being  soft  from  decay  waa  easily 
chiseled  away,  exposing  the  interior  of  the  mastoid,  which  was  one 
large  cavity  filled  with  thick  pus  and  granulation  tisane.  This 
was  all  removed  and  tbe  bone  well  scraped  with  a  sharp  spoon  till 
it  appeared  clean  and  glistening,  afWr  which  an  iodoform  dress- 
ing was  applied  and  the  patient  put  to  bed. 

December  24,  9  a.m. — Patient  reacted  nicely,  ate  supper,  slept 
well  during  the  night  and  is  entirely  comfortable  with  the  pulse  70 
and  temperature  normal.  From  this  date  the  patient  made  an 
uninterrupted  recovery,  there  being  at  no  time  any  pain,  fever  or 
acceleration  of  pulse.  The  hearing  rapidly  improved  from  a  watch 
in  contact  before  the  ojieration,  to  its  original  acuteness.  The 
patient  was  dismissed  in  seventy  days  with  tbe  opening  entirely 
closed  and  a  scar  satisfactorily  small. 

The  interesting  features  of  the  latter  case  are:  (1)  The  remission 
of  all  symptoms  except  the  impaired  hearing,  from  September  to 
December,  (2)  The  development  of  a  mastoid  abscess  with  an 
intact  drum  and  no  evidence  of  suppuration  in  the  middle  ear. 
(3)  The  entire  absence  of  any  eonetitufional  disturbance  and  the 
very  mild  character  of  the  pain  during  the  inflammatory  pro- 
cess that  eventuated  in  so  much  destruction  of  tissue  and  pus 
formation. 


HEMORRHAGE  FOLLOWING    REMOVAL  OF  THE 
THIRD  TONSIL.* 

Bt  buss  F.  cox,  M.D., 
BoHi,  Ga. 

In  the  centers  of  medical  progress  removal  of  adenoid  vegeta- 
tions from  the  nasopharynx  is  now  one  of  the  commonest  and 
most  beneficent  of  surgical  operations.  In  view  of  it«  importance, 
knowledge  of  this  subject  has  come  late.  Specialism  bad  first  to 
illumine  this  dark  cavern  and  explore  it  with  educated  touch.     To 

•Raaaberoreibe  BoulherD  Sscllonor  (he  American  Otoloelaal,  RhlnD]t>sic«l  uitt  htryo- 
galoffiCBl  A«>DClatloii.  AlJsnU,  jUaivb  38,  ISM. 


idb,Googlc 


Hemorrhage  Followinq  Removal  of  Tonsil.        171 

^e  great  body  of  tbe  profession  to-day  this  region  remains,  so  to- 
speak,  an  unknown  land.  With  blade  and  scissors,  fire  and  caus- 
tic, the  average  doctor  will  attack  tbe  faucial  tonsils,  but  shrinks 
before  tbe  hidden  mysteries  of  tbe  nasopharynx.  He  has  read  of 
Luscbka'e  wayward  tonsil,  but  his  eye  has  not  seen  nor  bis  finger 
felt  it.  He  orders  mild  gai^les  and  gentle  sprays.  If  he  be  over 
bold,  he  makes  timid  passes  with  weak  iodine  behind  tbe  sofl 
palate.  This  timidity  about  working  in  the  nasopharynx  is  not 
confined  to  ordinary  practitioners.  The  author  of  a  recent  and 
most  excellent  "Dictionary  of  Treatment"  and  professor  in  a  great 
university,  gravely  offers  the  following  advice  about  so  trivial  an 
operation  as  pluming  the  posterior  nares:  "This,"  says  he,  "is 
one  of  the  simplest  and  least  painful  operations,  in  tbe  eye  of  the 
surgeon,  until  he  has  tried  it.  Having  once  tried  it  be  will  hesi- 
tate to  repeat  or  recommend  it."  However  amusing  such  opinions 
Biay  he,  I  think  there  are  few  even  among  specialists  who  would 
not  regard  free  and  obstinate  bleeding  from  the  pharyngeal  vault 
more  seriously  than  from  any  other  region  of  their  specially, 
likely  to  be  so  affected.  We  can  astringe,  cauterize,  compress  or 
even  ligatc  the  visible  faucial  bleeding  poiut ;  we  can  tightly  pack 
the  Dostrils,  fore  and  af^,  but  I  believe  some  of  us  are  not  pre- 
pared to  apply  any  one  of  these  agencies  with  certainty  and  readi- 
ness to  tbe  upper  pharynx.  I  know  that  dangerous  loss  of  blood 
from  any  cause  in  this  region  is  very  rare.  Perhaps  for  this  very 
reason  one  is  the  more  apt  to  be  caught  unprepared,  both  in  pre- 
vious experience  and  ready  means. 

In  two  thousand  consecutive  operations  on  pharyngeal  adenoids 
in  B.  Fraukel's  clinic  at  Berlin  only  two  required  tamponing  for 
hemorrhage.  I  witnessed  several  hundred  of  these  operatious  at 
this  clinic  and  those  of  Jansen,  Politzer,  Chiari  and  others,  without 
one  severe  primary  bleeding.  Most  of  these  cases  were  operated 
with  rather  dull  Gottstein  curettes,  rarely  assisted  by  some  biting 
forceps.  Chiari  prefers  a  snare,  operated  through  tbe  nostrils. 
Tet  almost  every  recent  text-hook  mentions  excessive  or  fatal 
hemorrhage  from  this  cause,  and  we  hear  of  other  cases  rumored 
around.     It  is  probable  that   no  man  who  is  much  occupied  with 


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172        The  Atlanta  Medical  and  Scboical  Journal. 


this  work  can  escape  an  occasiooal  more  or  less  awkward  esperi- 
«iice,  fraugbt  with  sleeplessness,  grey  hair  aod  bUiod. 

Id  my  limited  experieoce  of  Dine  such  operatious,  my  seveDlh 
gave  me  the  greatest  trouble  aDd  aDxiety,  though  fiaally  making  a 
good  recovery  ia  all  respects.  The  patieut  was  white,  female,  aged 
thirteeo  years.  The  hemorrhage  was  secoDdary,  like  that  ot  the 
fatal  case  reported  by  Newcomb.  It  occurred  four  days  and  two 
hours  subsequent  to  operation  and  under  exceedingly  predisposing 
circumstances.  The  growth  wa^  large.  There  was  middle  ear 
■catarrh  at  least  on  one  side.  She  was  a  mouth-breather  and  had 
beeu  so  as  iar  back  as  she  could  remember.  The  hypertrophy 
■could  be  seen  through  the  nostrils.  There  was  chronic  nawi- 
pharyngeal  catarrh,  but  no  obstruction  in  the  nose  itself.  A  younger 
brother  is  similarly  affected.  The  faucial  tonsils  were  moderately 
enlarged.  The  constantly  opened  mouth  detracted  much  from  an 
otherwise  attractive  face.  Cosmetic  considerations,  I  think,  weighed 
much  in  gaining  consent  to  operation.  There  was  uo  acute  inflam- 
mation. 

I  operated  without  anesthesia,  using  an  aseptic  Gotlsteiu  curette 
jind  also  a  biting  forceps.  A  considerable  mass  was  removed. 
The  primary  flow  of  blood  was  only  about  the  average.  Proper 
directions  as  to  antiseptics,  food  and  exercise  were  given.  Recov- 
■ery  progressed  with  perfect  satisfaction  for  four  days.  The  patient 
felt  as  well  or  better  than  usual.  She  forgot  her  precautionta. 
With  body  bent  forward  and  head  low,  she  turned  a  heavy  and 
difflcult  ice-cream  freezer.  Suddenly  blood  began  to  ooze  from  the 
nostrils  and  api>eared  in  the  mouth.  Moderate  nose-bleed  was  not 
unusual  with  her.  Light  bleeding  recurred  at  intervals  during  the 
afternoon.  I  was  not  notified.  One-half  hour  afler  retiring, 
eight  hours  after  first  bleeding,'  and  four  and  a  half  days  after 
o|>eration  an  alarmingly  free  and  ))ersistent  hemorrhage  took  place. 

Two  physicians  who  preceded  me  tri  the  case  had  plugged  both 
nostrils  with  cotton.  Alter  an  hour's  delay  I  arrived.  Parents 
stated  that  she  had  lost  over  half  a  tin  wash-basin  of  blood. 
Bleeding  continued,  but  nut  so  freely  as  at  first.  I  removed  the 
«otton  and  hastily  directed  a  stream  of  ice-cold  solution  of  alum 
and  tanniu  through  an  Eustachian  catheter  against  the  pharyngeal 


^dbyGoOgle 


Hemorrhage  Following  Removai,  of  Tonsil.         173^ 

vaalt.  Thia  helped,  but  bleediag  persisted.  Using  a  retractor,  I 
then  tried  packing  ossopbaryDX  with  a  strip  of  iodoform  gauze. 
SooD  a  fold  of  tliis  fell  down,  ga|^d  tbe  patieot,  and  had  lo  he- 
removed.  Before  I  could  proceed  to  pack  again  the  bleedings 
latsened  so  much  that  it  finally  ceased  under  the  u.'^e  of  cold  and 
astringents.  Tbe  patient  remained  with  bead  and  shoulders  well 
elevated.  Morphine  was  adminbtered  by  the  needle  for  shock  and 
to  secure  rest. 

Thirty-six  hours  later  there  was  a  second  hemorrhage,  but  some- 
thing less  than  oue-half  the  first.  It  ceased  before  I  could  iuter- 
fere,  under  the  use  of  cold  and  astringeuts  by  a  colleague. 

Two  days,  later,  tbe  patient  still  remaining  in  bed  with  elevated 
head  and  shoulders,  there  occurred  a  third  and  very  severe  loss  of 
blond.  Tbe  bleeding  was  progressing  when  I  arrived.  Cold  aud 
astringents  did  not  control  it.  The  patient  was  greatly  reduced. 
I  was  seriously  alarmed  for  her  life.  But  meantime,  I  had  devised 
a  tampoD  for  the  nasopharynx,  which  worked  so  easily,  quickly 
and  effectively,  that  it  is  my  chief  excuse  for  mentioning  this  case 
at  all.  Its  advantages  are  that  it  can  be  hastily  prepared,  can  be 
used  by  the  comparatively  inexperienced  and  that  it  is  effective. 

It  consists,  as  you  will  see,  of  three  cords  and  a  strip  of  gauze, 
suited  to  the  space  to  be  packed.  The  first  end  is  introduced  by 
one  cord,  as  ordinarily,  and  is  so  anchored  at  tbe  post-oares.  At 
the  other  end  of  the  gauze,  two  threads  are  attached.  One  serve:^ 
merely  as  a  tactor,  as  ordinarily,  for  removing  tbe  gauze.  The 
other  thread,  after  being  secured  at  the  lower  eud  of  the  strip, 
doubly  transfixes  the  gauze  at  proper  intervals  and  finally  emerges 
at  the  first  end  to  hang  free  along  with  the  first  mentioned  thread. 
The  working  is  simplicity  itself.  Having  applied  vaseline  freely 
to  your  prepared  iodoform  gauze  and  having  anchored  the  first  end 
at  the  posterior  nares,  precisely  as  in  post-nasal  tamponing,  you 
easily  feed  up  tbe  rest  oE  tbe  gauze,  partly  by  drawing  ou  tbe  guid- 
ing puckering  string  and  partly  with  finger  or  instrument  behind 
the  soft  palate;  finally  ramming  it  home  tightly  with  the  finger 
■nd  a  smart  pull  on  tbe  cord  that  fixes  each  separate  fold  and  tbe 
last  end  of  the  tampon  iu  the  nasopharynx.  The  two  fixation 
threads  are  tbeu  tied  over  a  plug  at  the  anterior  nares. 


^dbyGoOgle 


174       The  Atlanta  Medical  and  Sdrqical  Journal. 

The  vaseline,  or  other  lubncant,  ta  to  be  recommended  tor  the 
followiDg  reasons:  It  facilitates  the  introductioti  of  the  packing; 
it  renders  the  plug  more  impervious  to  blood;  by  giving  a  smoother 
surface,  there  ia  less  pressure  reaction,  but  chiefly  because  it  pre- 
vents such  cohesion  between  the  raw  sur&ce  and  tampon  that 
bleeding  would  be  renewed  when  the  gauze  is  withdrawn, 

I  think  the  ideal  device  for  the  hemorrhage  in  questioD  is  a 
suitably  shaped  rubber  bag,  to  be  anchored  and  inflated  by  a  con- 
nected tube,  passing  out  at  the  anterior  nares. 

From  six  to  twenty-four  hours  should  be  long  enough  for  such 
:a  packing  to  remain  in  place. 

In  the  presence  of  any  hemorrhage  above  the  clavicle,  one  must 
not  overlook  a  possible  constriction  by  olothing,  which  obstructs 
the  return  circulation,  I  know  of  one  obstinate  bleeding  that 
-ceased  immediately  on  loosening  a  tight  collar,  and  that,  too,  after 
all  applied  means  bad  failed. 


A  CASE  OF  PRESUMABLE  HERM APHRODISM. 

Bt  EDWARD  NICHOLAS  LIELL,  Jackbohvillb,  Fla. 
Late  Lecturer  on  Gynecologj',  New  York  Polyclinic 

At  the  December  meeting  of  the  Duval  County  Medical  Society 
I  referred  to  the  following  interesting  case  of  presumable  herma- 
phrodism,  the  individual  being  a  negro,  at  work  in  a  convict 
camp  in  South  Florida.  The  following  is  a  description  of  the  con- 
ditions pre8enting,accompanied  by  a  photograph  of  the  same.  Age, 
twenty-two  years;  has  always  dressed  in  male  attire,  but  has  never 
been  accustomed  to  hard  work ;  has  been  a  cook  and  waiter.  Has 
a  well  developed  penis  in  natural  position,  though  rather  small  in 
■size,  being  about  the  size  of  two  joints  of  a  man's  finger.  There 
is  an  opening,  as  of  urethra,  in  the  glans  penis,  but  there  is  ap- 
parently no  canal,  the  urine  being  voided  through  an  opening  at 
the  base  of  the  penis;  the  urine,  when  voided,  takes  a  direction 
from  the  body  just  as  if  from  the  normal  male  urethra.  About  an 
inch  below  the  base  of  the  penis  is  a  vaginal  opening,  which  ia 


^dbyGoogle 


A  Case  of  FREgcuABLB  Hbrhaphrodism. 


176 


quite  small  aod  short,  barely  admitting  the  tip  of  one's  little 
finger.  There  is  no  scrotum  present.  The  lahia  majors  are,  how- 
ever, prominent,  and  are  well  shown  on  the  accompanying  illus- 
IntioD.  Just  to  the  right  of  the  base  of  what  may  be  called  the 
penis,  at  the  upper  portion  of  the  right  labia  majors,  can  be  felt, 
freely  movable,  a  email  glandular  body  about  the  size  of  a  pecan 
Dut,  aJid  which,  from  its  position  in  the  immediate  region  of  the 


inguinal  opening,  may  be  regarded  as  either  an  undeveloped  testi- 
cle or  an  ovary  in  an  abnormal  situation.  The  individual  claims 
to  have  fek  sexual  passion,  with  erection  of  the  penis  at  such  times, 
although  intercourse  has  never  been  bad.  Slight  "signs"  of  men- 
etnution  have  also  been  claimed  as  having  occurred  at  irregular 
intervals. 

Afl  shown  by  the  history  as  above  recorded,  and  made  more  evi- 
dent by  the  illustration,  the  characteristics  of  both  the  male  and 
Ibe  female  sez  are  evidently  united  in  this  individual,  those  of  the 
feniale  predominating.     I  regret  the  fact  that  no  examination  was 


^dbyGoOgle 


176       The  Atlanta  Medical  and  Bobgical  Jodrkal. 

made  as  to  the  mammary  glaods.  If  possible,  a  more  thorough 
examinatioD  will  be  made  subsequent  to  release  from  State  cootrol. 
Id  the  American  Journal  of  Obstetrics,  February,  1876,  is  recorded 
by  Muude,  with  several  illuatratious  accompauying  aud  bearing 
upon  the  text,  a  rare  case  of  presumptive  true  lateral  hermaphro- 
dism,  the  iudividual  possessing  also  the  characteristics  of  both  the 
male  and  female  sex  united  in  his  person.  The  individual  was  ex- 
hibited before  the  New  York  Obstetrical  Society,  October  5,  1875. 
Under  the  name  of  Cathariae  Hohmaun,  she  spent  the  first  forty- 
six  years  of  her  life  as  a  female,  dressing  in  female  attire;  her  sex- 
ual propensities  up  to  this  time  were  directed  entirely  towards  the 
male  sex,  though  there  was  do  vagina  present.  After  her  forty- 
sixth  year,  a  distiuct  appreciation  of  sexual  propensities  for  the 
female  sex  came  to  her,  she  then  dressing  in  male  attire  and  assum- 
ing the  name  of  Carl. 


According  to  Nature,  Professor  George  M.  StrattOD,  of  the 
University  of  California,  recently  made  an  experiment  upon  him- 
self hy  wearing  for  eight  days  a  mask  fitted  with  lenses  which  in- 
vert the  visual  image,  thus  projecting  it  upon  the  retina  in  an  erect 
instead  of  the  normal  inverted  position.  He  soon  learned  to  refer 
all  objects  to  their  correct  positions — in  other  words,  to  see  them 
right  side  up;  but,  on  removing  the  apparatus  at  the  expiration  of 
eight  days,  everything  appeared  to  be  upside  down  at  first.  He 
therefore  concludes  that  the  seeing  of  objects  right  side  up  is  due 
to  B  mental  rectification  of  the  visual  image  actually  projected  upon 
the  retina. — PkU.  Med.  Journal. 


When  a  patient  comes  to  you  with  enlarged  lymph  nodes  of  the 
neck,  he  sure  to  examine  the  throat  most  careTuIly.  If  the  patient 
is  a  child,  remember  that  a  very  common  cause  of  lymph  node  in- 
flammatiou  is  the  presence  of  hypertrophied  tonsils  or  of  adenoid 
vegetations.  In  an  individual  of  middle  age,  examine  any  hyper- 
trophy critically,  bearing  in  mind  the  possibility  of  neoplasm. — 
Inlemational  Journal  of  Surgery. 


^dbyGoOgle 


SOCIETY  REPORTS. 


MEDICAL  ASSOCIATION  OF  GEORGIA. 

Proceedings  of  the  Forty-Ninth  Annual  Meeting,  Held  at   Cumber' 
land  Island  April  M,  21  and  m,  1898. 

The  Association  met  at  2  p.  m,  iu  the  auditorium  of  the  Georgia 
Teachers'  Association,  and  io  the  absence  of  the  President,  Dr. 
James  B.  Morgan  of  Augusia,  the  meeting  was  called  to  order  by 
the  First  Vice-President,  Dr.  L,  G.  Hardman  of  Harmony  Grove. 

Col.  K.  E.  Park  was  then  introduced,  and  delivered  an  address 
uf  welcome  on  part  of  the  Cumberland  Island  Club. 

Dr.  J.  A.  Butte,  of  Brunswick,  welcomed  the  Association  on 
part  of  the  local  profession. 

The  response  to  these  addresses,  in  behalf  of  the  Association,  was 
made  by  Dr.  Hardman. 

Dr.  J.  G.  Hopkins,  of  Thomasville,  read  a  paper  entitled  "A 
Few  Cases  from  My  Note-book." 

Case  1  was  that  of  a  man,  thirty  years  of  age,  who  complained 
ofhaving  "a  chafe  which  would  not  heal."  Upon  examination 
the  doctor  found  two  fistulie  centrally  located  over  the  lower  end 
of  the  sacrum,  one  inch  apart,  and  about  one-twelfth  of  an  inch  Id 
diameter.  He  converted  the  two  openings  into  one  and  found  a 
bunch  of  curly  blonde  hair  about  two  to  two  and  a  half  inches  long, 
and  in  amount  sufficient  to  fill  a  No.  10  thimble.  After  scarifica- 
tion and  cauterization,  he  left  the  wound  to  heal  by  granulation. 
A  month  later  patient  returned,  saying  that  the  wound  had  never 
healed.  On  examination  the  cavity  was  found  well  filled  with  new 
tissue,  but  there  were  several  small  fistulous  openings  instead  of 
the  two,  as  before.  From  each  of  these  openings  he  drew  several 
strands  of  hair  similar  to  those  first  removed.  He  cut  down  again 
to  the  bone,  drew  a  lot  of  hair  out  of  the  flesh  from  diflereut  direc- 
tions and  packed  the  wound.     He  again  allowed  the  cavity  to  fill, 


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178       The  Atlanta  Medical  and  Sukqical  Journal. 

and  the  same  result  was  obtaiaed.  He  again  cut  down  and  re- 
sorted to  the  same  procedure,  and  the  wound  is  now  open  and  the 
same  condition  esiets. 

He  said  a  dermoid  cyst  was  not  a  very  uncommon  thing,  but 
the  sex,  situation  and  constant  recurrence  of  the  hair  in  this  case 
rendered  it  rather  unique. 

Another  ease  was  that  of  a  mulatto,  aged  twenty-eight;  personal 
history  good;  was  never  sick  except  with  a  elight  attack  of  influ- 
enza in  December,  18»6.  Was  seen  first  on  September  20,  1897. 
Had  had  fever  about  twenty-four  hours;  temperature  102°  and 
pulse  128.  Had  a  few  bullte  on  lips,  face,  wrists  and  shins.  A 
diagnosis  of  pemphigus  was  made,  and  quinine  and  arsenic  treat- 
ment begun.  Local  applications  of  dry  boracic  acid  were  resorted 
to.  The  bullie  appeared  thick  and  fast,  varying  in  dimensions 
from  the  size  of  a  filbert  to  that  of  a  walnut,  and  required  but  a  few 
hours  to  reach  full  growth.  They  were  punctured  at  each  visit, 
giving  exit  to  the  fluid  contents  at  the  most  dependent  point,  leav- 
ing the  cuticle  otherwise  intact  for  protection.  In  a  few  days 
almost  the  entire  cuticle  had  been  separated  from  the  cutis;  the 
scalp,  palms,  and  the  mucous  membrane  of  the  nose,  mouth  and 
throat  were  extensively  involved.  The  treatment  while  in  the  hos- 
pital was  mercurial  cathartics,  followed  by  salines  and  liquor  potass! 
arseoitia  in  increasing  doses;  also  large  doses  of  the  sulphate  of 
quinia.  The  local  treatment  consisted  of  alkaline  baths,  and  a  paste 
compound  of  aristol,  bismuth,  oxide  of  zinc  and  vaseline.  Patient 
was  enveloped  in  absorbent  cotton  from  bead  to  foot,  the  same  be- 
ing held  in  place  by  rolled  bandages.  His  mouth  and  nose  were 
kept  clean  with  peroxide  of  hydrogen,  and  he  was  subjected  to  for- 
maldehyde fumigation.  The  skin  remained  pigmented  for  three 
months  aAer.     Patient  was  discharged  cured  October  27,  1897. 

Dr.  William  C.  Lyie,  of  Augusta,  followed  with  a  paper  entitled 
"The  Importance  of  Careful  Chemical  Analysis  in  Gastric  Dis- 
orders," in  which  he  showed  that  the  technique  of  chemical  analy- 
sis of  the  gastric  contents  was  by  no  means  dlfiicult,  and  that  in  the 
determination  of  a  correct  diagnosis  it  was  of  the  utmost  value. 
The  skill  to  obtain  and  analyze  the  contents  of  the  stomach  did  not 
lie  beyond  the  dexterity  and  ability  which  every  physician  ought 


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Society  Repoets.  179 

to  possess,  and  it  certainly  should  be  utilized,  whea  we  consider 
that  the  diaguoees  of  diseases  of  the  stomach  are  based  as  much 
upon  the  results  of  our  own  investigations  as  upon  the  statements 
of  the  patients  themselves.  The  author  coutented  himself  by  re- 
ferring to  only  a  few  of  the  more  important  tests — tests  requiring 
00  apjiaratus  nor  reagents  that  the  average  practitiouer  does  not 
possess.  He  first  spoke  of  the  test  meal,  then  stomach  contents, 
lactic  acid,  pepsin,  and  absorbent  tests,  after  which  he  reported  cases 
that  had  recently  occurred  in  his  practice,  where  a  positive  diagno- 
sis would  have  been  very  difficult  without  frequent  chemical  tests. 

The  next  paper,  entitled  "Germs  of  Health  and  Disease,"  was 
read  by  Dr.  J.  W.  Duncan  of  Atlanta. 

The  author  said  that  much  attention  had  been  given  to  the  germ 
theory  of  disease  for  a  numberof  years,  and  much  had  been  learned 
through  patient  and  faithful  bacteriological  research. 

How  can  we  most  successfully  limit  the  spread  of  contagious  dis- 
eases? In  the  operating-room  extensive  major  operations  are  being 
done  daily  under  aseptic  and  antiseptic  regime,  and,  notwithstand- 
ing the  extensive  field  explored,  not  a  microbe  or  bacteria  can  gain 
a  foothold.  Much  is  being  done  in  private  practice  to  limit  the 
spread  of  the  disease,  but  very  much  mure  should  be  done.  The 
excreta  from  the  sick,  whether  from  the  bowels,  kidneys,  lungs  or 
skin,  should  be  disinfected,  and  as  soon  as  possible  the  house  should 
be  fumigated.  It  has  been  said  that  "cleanliness  is  next  to  Godli- 
ness," and  therefore  our  sanitary  boards  should  be  vi^^ilant  in  keep- 
ing everything  clean — that  is,  in  their  province.  There  should  be 
more  attention  given  to  the  matter  of  the  milk  we  drink,  that 
there  be  no  sources  of  contagion  from  them.  Meats  and  vegetables 
demand  investigation.  Each  individual  should  observe  the  laws 
of  sanitation  and  hygiene  relative  to  his  own  person  and  premises. 
By  so  doing  he  will  be  the  better  able  to  resist  contagion  should 
he  be  exposed. 

Dr.  \V.  H.  Elliott,  of  Savannah,  read  a  paper  eotilled  "  Mush- 
rooms— A  Food  and  a  Poison."  He  stated  that  the  number  of 
mushroom-eaters  in  this  country  was  steadily  growing  larger,  and 
it  was  incumbent  upon  physicians  to  know  how  to  recognize  and 
treat  cases  of  mushroom  poisoning.     Mushrooms  belong  to  that 


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180       The  Atlanta  Medical  and  Sdrgical  Journal. 

order  of  plants  known  botanically  as  fungi.  There  are  many- 
thousand  species.  By  far  the  larger  aumber  are  microscopic,  sucb 
as  the  mildew,  the  smut  on  grain,  and  the  mold  that  forms  on  cooked 
frnit,  etc.  The  larger  forms  of  fungi  are  known  indifferently  as- 
toadstoola  or  mushrooms.  These  number  about  one  thousand  species. 
While  mushrooms  grow  iu  many  different  forms,  the  commonest 
and  best  known  is  the  campestris,  or  mushroom  of  commerce. 
This  belongs  to  the  class  of  agarics,  or  gilled  mushrooms. 

He  spoke  of  three  classes  of  mushrooms  ordinarily  used  for  food  z 
agarics,  boleti  and  puff-balls,  and  described  their  structures. 

He  said  in  the  United  States  food  was  so  abundant  and  mush- 
rooms so  little  known  that  tons  of  delicious  food  were  allowed  to 
go  to  waste  for  the  want  of  the  gathering.  Their  use  in  this  country 
waa  limited  to  a  few  botanists,  and  others,  members  of  rausbroonk 
clubs  of  Boston,  New  York,  Philadelphia  and  Washingtou.  Iiv 
Europe  mushrooms  were  in  general  use  as  food.  They  were  gathered 
in  the  woods  and  fields,  regularly  sold  in  the  markets,  and  in  Paris- 
miles  of  cellars  were  maintained  for  the  artificial  cultivation  of  the- 
mushroom  of  commerce.  The  essayist  had  found  an  interesting  study 
in  mushrooms.  He  had  iu  the  past  two  seasons  tried  about  one  hun- 
dred varieties  of  mushrooms  without  any  unpleasant  consequences. 
To  the  beginner  he  would  say,  avoid  all  mushrooms  with  a  cup, 
or  the  suggestion  of  a  cup,  especially  if  the  mushroom  has  white  gills. 
Reject  all  that  are  not  perfectly  fresh,  or  that  are  worm-eaten.  Id 
short,  mushrooms  should  be  gathered  with  care  and  studied  well. 

Dr.  Howard  J.  Williams,  of  Macon,  read  a  paper  entitled  "  A 
Supernumerary  Cervical  Rib  ;  a  Deception  of  Skiagraphy." 

The  author  said  that  while  the  discovery  of  Roentgen  was  a 
material  advance  iu  surgical  diagnosis,  it  was  not  an  infallible  aid. 
Mistakes  in  its  interpretation  could  lead  to  mistakes  in  operating, 
and  its  value  as  medico-legal  evidence  was  doubtful.  Three  timea 
during  the  past  year  the  speaker  had  been  misled  by  X-ray  pho- 
tography ;  twice  iuto  performing  useless  operations  for  lesions  sup- 
posed to  be  dependent  upon  apparent  bone  injury,  and  in  one  case 
a  supposed  tumor  proved  to  be  au  anomalous  rib.  Fortunately, 
the  operation  was  necessary,  and  the  results  were  as  satisfactory  as- 
they  would  have  been  had  a  tumor  existed.     The  speaker  thought 


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SociETT  Reports.  181 

that  either  of  the  two  photographs  of  the  booe  injury  exhibited  in 
a  court-room  would  have  beeu  damagiDg  evideace  in  a  malpractice 
«uit,  had  oot  the  operation  disclosed  the  fallacy  of  the  skiagraph. 
Dr.  Williams  then  detailed  the  case  of  supernamerary  cervical  rib. 

The  patient  pursued  the  usual  normal  course  after  aseptic  opera- 
tions, had  primary  union,  and  was  restored  to  health  without  pain 
or  interference  with  the  functions  of  the  parts  involved. 

Dr.  Samuel  Lloyd,  of  New  York,  said  the  use  of  the  X-ray  in 
medico-legal  work,  without  careful  preparation  for  that  work  on 
part  of  the  sui^eoo,  would  do  great  harm.  To  leave  a  skiagraph 
to  a  single  individual  who  might  be  interested  in  the  case  and  go 
into  court  would  be  a  grave  error,  for  the  deformity  might  be  accen- 
tuated very  decidedly  by  placing  the  tube  in  an  improper  position, 
and  consequently  in  every  case  that  has  to  appear  in  court  the  X-ray 
picture  should  be  taken  before  witnesses  who  can  swear  to  the  posi- 
tion of  the  photographic  plate,  the  position  of  the  patient  on  the 
plate,  and  the  position  of  the  tube,  and  at  the  same  time,  who  can 
swear  to  the  distance  at  which  the  tube  was  placed  from  the  patient, 
so  that  allowances  may  be  made  for  any  distortion  that  may  appear 
in  the  picture,  and  as  far  as  possible  to  avoid  distortion. 

Dr.  T.  S.  Hopkins,  of  Tbomasville,  read  a  paper  entitled  "  Dis- 
location of  the  Sixth  and  Seventh  Cervical  Vertebrse,  with  General 
Paralysis." 

On  the  3d  of  March,  1897,  Col.  H.  sustained  an  injury,  the 
results  of  which  made  the  case  not  only  interesting,  but  remarkable. 
The  history  of  the  accident  is  as  follows:  Patient  while  riding  on 
«  crank-car,  the  car  collided  with  a  wood  cart  The  shafts  of  the 
wood  cart  were  elevated  and  one  of  them  struck  him  on  the  forehead, 
knocking  him  over  backwards,  his  neck  falling  across  a  thin  iron 
bar.  He  was  lifted  from  this  position  unconscious.  At  the  end  of 
an  hour  consciousness  was  restored.  He  was  taken  to  the  house  of 
a  friend,  placed  in  bed,  and  medical  aid  called.  Diagnosis  of  shock 
was  made.  Kext  morning  a  consultation  was  held,  and  the  condi- 
tion of  the  patient  pronounced  serious.  On  lifting  him  it  was  dis- 
covered that  his  bead  would  fall  over  on  his  chest.  It  was  also  found 
that  with  the  exception  of  the  respiratory  muscles,  every  muscle 
below  the  cervical   part  was  paralyzed.     Patient  was  then  trans- 


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182       The  Atlanta  Medical  and  Surgical  Journal. 

ferred  to  a  Savaonab  hospital,  where  he  recived  the  best  medical 
skill,  and  three  or  four  dajs  afler  admisdoD  the  neck  trouble  dis- 
appeared suddeQly.  The  oeck  became  the  only  unparalyzed  portion 
of  the  patient.  The  diagnosis  made  by  Dr.  Boyd,  the  surgeon  ia 
charge,  was  dislocation  of  the  sixth  and  seventh  cervical  vertebrfe^ 
with  crushing  of  the  cord,  and  sponstaoeous  reduction  by  muscular 
contraction.  After  three  months  of  hospital  treatment  the  patient 
was  sent  home  as  a  hopeless  case,  the  only  improvement  being  a 
slight  ability  to  move  the  right  leg. 

During  the  months  of  June  and  July  last  Dr.  Hopkins  frequently 
visited  and  examined  the  patient.  He  was  on  a  very  restricted 
diet,  and  there  was  much  muscular  waste  and  atrophy.  He  feared 
patient  would  never  walk  again.  As  he  knew  of  no  curative  plaster 
to  apply  to  a  crushed  cord,  he  advised  that  the  restricted  diet  be 
abandoned,  that  physic  be  thrown  to  the  dogs,  and  he  be  allowed 
to  indulge  in  every  article' of  food  he  could  relish.  This  advice 
was  carried  out.  Very  soou  the  patient's  dyspepsia  disappeared  ^ 
his  appetite  and  digestion  improved.  He  bad  l>eef,  steak,  ham, 
eggs,  oysters,  shrimps,  crabs,  fish,  and  every  variety  of  vegetables 
and  fruits.  Under  this  treatment  be  gained  flesh  and  strength. 
When  he  left  him  about  the  first  of  October  last  he  had  entire  con- 
trol of  the  right  leg  and  arm.  The  index  and  middle  fingers  of 
the  right  hand  were  contracted.  He  could  lift  the  left  arm  and 
hold  it  io  any  position  except  a  perpendicular  one,  but  the  baud  fell 
over  on  the  wrist.  This  was  not  the  result  of  contraction  of  the 
flexors,  but  the  powerless  condition  of  the  exteusor  muscles.  The 
bed  sores  had  healed.  The  catheter  and  syringe  which  he  had 
used  for  months  were  dispensed  with,  being  no  longer  needed.  The 
lefl  leg  was  stilt  paralyzed.  Although  the  patellar  reflex  and  motor 
power  was  absentia  this  leg,  sensory  power  was  present.  Time  and 
again  he  would  say  to  the  patient,  "Lilt  this  leg;  yon  can  if  you 
will,"  but  be  always  declared  that  it  was  impossible.  Having  ob- 
served in  cases  of  locomotor  ataxia  that  though  the  patient  could 
hobble  about  with  bis  eyes  open,  when  he  closed  them  he  would  AH, 
Br.  Hopkins  determined  to  aid  the  muscular  power  with  the  visual 
power.     He   therefore  uncovered   the  paralyzed   limb  so  that  the 


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Society  Reports.  183 

patient  could  see  it,  and  commanded  him  to  lift  it,  aod  instantly 
the  leg  was  lifted,  but  fell  again. 

Some  two  weeks  later  patient's  tben  condition  was  compare<t 
with  bia  condition  six  months  prior,  and  there  was  found  to  be 
decided  improvement  in  tbe  case.  Patient  was  able  to  draw  up 
both  of  his  legs  and  extend  tbem  with  perfect  ease^  has  gained 
flesh  and  strength,  and  is  looking  much  better.  If  be  continues 
to  improve  in  tbe  next  sis  mouths  as  be  has  during  the  past  six 
months,  be  will  be  able  to  walk. 

Dr.  Samuel  Lloyd,  of  New  York,  said  that  i.ome  ten  years  ago 
he  published  tbe  statistics  of  over  two  hundred  cases  of  opera- 
tions upon  the  spine  for  injuries,  and  for  Pott's  disease,  and  since 
then  be  had  operated  on  a  considerable  number  of  cases.  In  Dr. 
Hopkins's  case  be  thought  that  one  part  of  the  diagnosis  must 
have  been  in  error,  and  that  was  with  regard  to  crushing  of  tbe 
oord.  A  patient  who  has  a  crushed  cord  never  recovers.  Tbe 
probabilities  were  that  the  cord  was  compressed,  and  from  the 
progress  of  tbe  case  Dr.  Lloyd  suspected  that  tbe  compression 
was  a  hemorrhage,  and  the  absorplion  of  tbe  clot  accounted  for 
the  recurrent  power  in  the  cord  itself.  Most  assuredly  there 
was  uo  injury  at  the  time  of  tbe  receipt  of  the  trauma  that  de- 
stroyed the  elements  of  the  cord  itself,  for  had  it  been,  the  patient 
would  have  bad  an  ascending  and  descending  myelitis,  and  a  con- 
sequent increase  in  the  area  of  paralysis. 

Dr.  Hunter  P.  Cooper,  of  Atlanta,  read  a  paper  entitled  '*  A 
Report  of  Surgical  Cases."     (To  be  published  in  this  Journal.) 

Dr.  Dunbar  Roy,  of  Atlanta,  contributed  a  paper  on  "  Periton- 
sillar Abscess."     (To  be  published  in  this  Journai..) 

Dr.  Willis  F.  Westmoreland,  of  Atlanta,  reported  twenty-nine 
successful  cases  of  tracheotomy  for  foreign  bodies  in  tbe  air  pas- 
sages, and  exhibited  specimens. 

Dr.  M.  F.  Carson,  of  GrifSn,  followed  with  a  paper  entitled 
"Tbe  Condition  of  Imperfect  Septum  between  the  Mouth  and 
Nasopharynx,  Usually  Termed  Cleft  Palate,"  in  which  be  advo- 
cated early  operation  for  tbe  closure  of  the  clefl. 

Dr.  J.  H.  Shorter,  of  Macon,  read  a  paper  on  "  Suppurative 
Diseases  of  tbe  Middle  Ear,  and  their  Sequelte." 


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184       Thb  Atlanta  Medical  and  Surgical  Journal. 

The  author  said  that  otitis  media  puruleuta  may  be  acute  or 
chronic,  the  latter  often  a  sequence  of  the  6rst;  the  former,  as  is 
the  case  in  most  afTectioos,  yields  the  more  promptly  to  treatment, 
with  altogether  a  better  prognosis  both  as  to  cure  of  the  suppura- 
tive process  and  restoration  of  the  function  in  the  diseased  ear, 
Trbile  at  the  same  time  the  risk  of  serious  secondary  com[}lication3 
was  much  less.  The  exciting  cause  of  an  otitis  media  acuta  may 
he  an  influenza  and  acute  pharyngitis,  improper  use  of  the  nasal 
douche,  sea-bathing,  diphtheria,  etc.  It  was  particularly  liable  to 
occur  in  the  course  of  exanthemata,  es|)ecially  scarlatina  and  some- 
times is  a  complication  of  the  other  fevers,  as  pneumonia  and 
typhoid.  It  may  be  traumatic,  as  from  injury  to  the  drumhead  or 
injection  of  irrilant  liquids  through  the  eustachian  tube,  a  mode 
of  treatmeut  for  chronic  middle-ear  catarrh  favored  by  some  men 
of  eminence,  but  which  he  had  quite  abandoned  on  accouut  of 
having  seen  so  many  cases  of  violent  middle-ear  reaction,  and 
even  suppuration  set  up  by  it,  not  alone  in  his  personal  practice, 
but  in  that  of  other  surgeons,  some  of  them  of  noted  skill  and 
experience.  In  New  York  there  were  always  a  large  number  of 
acute  middle-ear  inflammations  during  the  season  for  surf-bathing. 
This  he  attributes,  not  as  he  first  thought,  to  the  impact  of  the 
sea  waves  on  the  side  of  the  head,  or  the  canal  over  the  drum- 
membrane  itself,  hut  to  the  spasm  accompanying  the  sneezing, 
swallowing  and  gagging  caused  by  water  entering  tbe  nostril, 
driving  the  liquid  up  the  eustachiau  tubes  into  the  tympanum. 
Among  traumatic  causes  may  be  mentioned  picking  the  ear  with  a 
sharp  instrument  for  the  removal  of  wax  or  a  sapposed  foreign 
body.  Not  a  few  times  he  had  known  the  drumhead  to  be  lac- 
erated by  this  foolish  performance,  and  had  a  case  on  record  where 
most  of  the  membrane  was  removed,  and  with  it  the  malleus  and 
incus,  done  by  a  machinist  who  used  a  long  awl  in  attempting  to 
remove  a  supposed  foreign  body  from  tbe  ear  of  a  fellow  work- 
man. Predisposing  causes  are  important  factors  in  otitis  media, 
both  acute  and  chronic,  and  chief  among  them  being  obstruction 
in  the  nasal  cavities  or  nasopharynx,  adenoid  or  lymphoid  tissue 
in  the  fold  of  the  pharynx,  bypcrtrophied  faucial  or  pharyngeal 
tonsil,  etc. 


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Society  Reports.  185 

Dr.  James  M.  Crawford,  of  Atlaota,  read  a  paper  on  "Tonsil- 
lotomy; When  and  How  to  Make  It." 

ToDsillotoDiy  should  be  resorted  to  when  the  tonsils  extend  much 
beyond  the  pillars,  not  waiting  until  they  touch  each  other,  espe- 
cially when  oral  catarrh  exists.  It  is  indicated  eveu  when  the 
tonsil  is  slightly  hypertrophied  if  the  lucunee  are  inclined  to  in- 
flammation from  collections  of  caseous  secretions.  Shaving  the 
tonsil  destroys  these  lucante,  thereby  preveoting  frequent  and  pain- 
ful inflammation.  Not  even  the  most  timid  operator  would  hesi- 
tate to  make  the  operation  when  the  tonsils  are  no  large  as  to  reach 
the  uvula,  thereby  making  it  laborioua  to  breathe,  especially  when 
the  patient  is  asleep,  and  these  diseased  conditioos  often  prevent 
respiration. 

Below  the  age  of  Gfleen  the  tousil  is  usually  soft,  and  when  cut 
with  the  tonsillotome  the  cut  edges  are  more  or  less  mashed  or 
pressed  together,  thereby  stopping  the  hemorrhage.  In  older  per- 
sons, however,  the  tonsil  is  more  fibrous.  The  watts  of  (he  cut 
vessels  are  pulled  apart,  as  it  were,  by  the  firmness  of  the  tonsil 
itself.  The  speaker  would  not  hesitate  to  make  the  operation  when 
it  was  needed,  even  in  the  oldest.  Fortunately,  aller  a  certain  age 
the  tonsils  atrophy,  and  require  to  be  removed  rarely.  Fewer  cases 
of  hemorrhage  occur  when  the  operation  is  made  with  the  ton- 
sillotome instead  of  the  vulsellum  forceps  and  bistoury.  When 
Qsing  the  forceps  and  bistoury  the  operator  is  apt  to  pull  the  ton- 
sil with  his  forceps  too  much.  In  such  a  case  he  knows  not  where 
he  is  cutting.  On  completing  the  operation  and  looking  into  the 
mouth  of  the  patient,  he  sees  a  sulcus  where  a  portion  of  the  ton- 
sil should  have  been  left.  A  sulcus,  besides  endangering  the  life 
of  the  patient  by  hemorrhage,  is  the  source  of  constant  annoyance 
io  that  it  is  a  lodging  place  for  food.  The  author  prefers  McKen- 
zie's  tODsillutome,  or  some  of  its  modifications,  to  all  others,  for 
the  reason  that  it  is  more  simple,  more  easily  managed  and  less 
cumbersome.  There  need  be  no  fear  of  the  tonsil  falling  into  the 
larynx,  as  it  nearly  always  adheres  to  the  instrument.  Where  it 
does  not  adhere  to  the  iostrnmeut  it  falls  in  the  mouth  and  is  ex- 
pelled.    By  applying  a  little  cocaine,  Bay  a  6  per  cent,  solution,  to 


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186       The  Atlanta  Medical  ako  Sdroical  Journal. 

the  toueils  and  fauces,  sensibility  of  the  throat  is  allayed,  which  is 
a  great  aid  in  the  operation. 

While  acting  as  assistant  to  Dr.  Calhoun,  he  could  recall  five  or 
six  eases  of  frightful  hemorrhage  from  tonsillotomy  made  by  him 
with  the  knife  and  forceps.  lu  each  case  the  hemorrhage  v&s 
stopped  by  Dr.  Crawford  putting  a  wet  sponge  or  pledget  of  cot- 
ton on  the  cut  surface  and  applying  pressure.  In  each  of  these 
cases  a  sulcus  existed,  making  it  impossible  for  bim  to  see  the  bleed- 
ing artery,  and  forcing  him  to  resort  to  the  only  safe  method  in  such 
cases,  namely,  pressure.  The  first  time  he  used  this  method  for 
controlling  hemorrhage  was  in  the  fall  of  1889.  The  two  means 
for  arresting  hemorrhage  in  connection  with  tonsillotomy  were  the 
cautery,  when  the  bleeding  point  could  be  seen,  and  in  other  cases 
the  application  of  pressure. 

Dr.  W.  Z.  Holliday,  of  Augusta,  read  a  paper  on  "The  Use  of 
Ethyl  Chloride  as  a  Ijoc&I  Anesthetic,"  in  which  he  recommended 
this  agent  very  highly  for  local  anesthesia. 

Dr.  R.  M.  Harbin  had  used  ethyl  chloride,  and  agreed  with  the 
author  as  to  its  efficacy.  In  selected  cases  it  was  an  ideal  local 
anesthetic. 

Dr.  J.  G.  Hopkins  asked  as  to  the  danger  in  handling  the  tubes, 
to  which  Dr.  Holliday  replied  that  there  was  very  little  danger 
from  explosion  if  the  physician  was  careful. 

Dr.  Graham,  of  Savannah,  had  used  with  satisfaction  the  com- 
bined method  of  anesthesia,  namely,  ethyl  chloride  and  the  infil- 
tration method  of  Schleich. 

Dr.  J.  T.  Ross,  of  Macon,  reported  an  interesting  case  of  "Os- 
sific  and  Calcified  Ovarian  Fibroma,"  and  exhibited  the  specimen. 
The  specimen  had  very  much  the  appearance  of  a  fetal  head.  On 
one  side  a  portion  of  the  broad  ligament,  the  Fallopian  tube,  and 
ovary  were  seen.  Almost,  if  not  all,  of  the  fibroid  entailment 
was  encrusted  by  an  osseous  deposit  about  one-sixteenth  of  an  inch 
in  diameter.  The  interior  of  the  tumor  was  more  firm  and  studded 
with  calcareous  deposits.  Strife  could  be  seen  running  down  into 
the  tumor  from  that  portion  of  the  ovary  which  formed  the  growth- 
Authorities  are  agreed  that  only  three  to  five  per  cent,  of  all  tu- 
mors of  the  ovary  are  solid,  and  that  a  fibroid  of  the  ovary  is  very 


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Society  Reports.  1ST 

rare.  The  couditioD  presented  in  the  case  of  Dr.  Ross  was  still 
more  rare.  In  fact,  the  speaker  does  oot  remember  to  have  seen 
a  record  of  an  ovary  which  had  undergone  both  osseous  and  calca- 
reous degeneration. 

Dr.  K.  P.  Moore,  of  Macon,  read  a  paper  entitled  "A  very  In- 
teresting and  Unusual  Monstrosity  in  the  Form  of  Twins,"  and< 
exhibited  the  feti. 

Dr.  £.  R.  Corson,  of  Savannah,  contributed  a  paper,  "A  Rare- 
Form  of  Bone  Atrophy  Following  an  Ununited  Fracture,  as  Seen- 
by  the  X-ray." 

Dr.  J.  I.  Griffith,  of  DauielsviUc,  read  a  paper  on  "Puerperal' 
Eclampsia,  and  Some  Probable  Causes  of  It."  He  had  been  stim- 
ulated tu  present  a  paper  of  the  number  of  cases  of  puerperal 
eclampsia  which  had  recently  come  under  his  observation. 

In  order  to  arrive  at  an  intelligent  treatment  there  must  be  a  clear- 
understanding  of  the  condition  the  physician  is  called  upon  to  treat. 
The  treatment  should  be  classified  as  preventive  and  curative.  The 
preventive  may  be  subdivided  into  medicinal  aud  hygienic,  and  tbe- 
curative  into  medicinal  and  obstetric.  These  forms  of  treatmeut 
were  then  dwelt  upon  at  some  length.  The  author  reported  four- 
cases.  Some  probable  causes  of  eclam{)sia  he  mentioned  as  albu- 
minuria, toxemia,  uremia,  pyelitis  and  pyelo- nephritis.  He  thinks 
albumin  is  one  of  the  causes  of  puerperal  eclampsia,  for  it  is  lound 
in  the  urine  of  pregnant  women. 

Dr.  George  H.  Noble,  of  Atlanta,  made  some  remarks  on  "Al- 
coholic Irrigation  in  Puerperal  Sepsis."  He  pointed  out  the  dif- 
ference between  the  ordinary  method  of  removing  the  secundines- 
with  douches  and  the  alcoholic  treatment.  He  said  that  the  alco- 
holic treatment  was  gradually  forcing  itself  upon  the  profession.. 
When  his  attention  was  first  called  to  it  he  had  little  or  no  confi- 
dence in  it,  (or  Ihe  reason  that  he  did  not  believe  in  the  antiseptic- 
properties  of  alcohol,  but  the  more  he  studied  it  the  greater  was- 
its  need  of  application  in  certain  directions.  The  successful  treat- 
ment of  puerperal  infection  depended  upon  the  selection  of  cases. 
The  practitioner  who  failed  to  properly  select  his  cases  and  prop- 
erly apply  treatment  would  be  the  man  who  would  lose  patients. 
No  treatment  applied  to  the  cavity  of  the  uterus  could  be  expected 


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188       The  Atlanta  Medical  and  Surgical  Journal. 

to  save  a  case  of  puerperal  infection  that  bad  gone  beyond  the  ea- 
iiometrium  to  any  extent.  Therefore  it  waa  oecessary  to  exclude 
-diseases  of  the  appendages,  as  pus  tubes,  abscesses,  etc.  The  treat- 
ment of  the  cavity  of  the  uterus  where  there  was  a  pus  collection 
in  the  appendages  was  futile.  Again,  the  practitioner  might  think 
the  appendages  were  absolutely  healthy,  that  there  was  no  infec- 
tion in  the  uterine  cavity  that  could  be  detected,  and  yet  the  pa- 
tient waa  in  a  hopeless  condition,  whereas  the  trouble  may  be  an 
-abscet'S  in  the  uterus  proper,  or  its  parenchymatous  structure.  The 
practitioner  should  bear  in  mind  that  if  he  has  a  case  in  which 
appendages  and  peritooeum  are  not  involved,  and  in  which  there 
is  no  material  discharge  from  the  cavity  of  the  uterus,  where  the 
uterus  is  shrunken  iu  size,  the  os  non-patulous,  he  is  likely  to 
have  uterine  abscess,  but  it  is  a  rare  condition.  There  may  be 
•one  abwiese  or  two.  He  had  previously  reported  four  such  cases 
in  which  he  made  an  incision  into  the  abscess,  curetted,  cauterized 
^nd  drained  through  the  abdominal  cavity. 

He  said  that  alcoholic  irrigation  could  be  done  by  the  general 
practitioner.  The  practitioner  should  use  a  rubber  catheter,  thor- 
oughly sterilized;  take  two  yards  of  small  gauze,  the  width  of  the 
finger,  stitch  it  to  the  end  of  the  catheter,  introduce  it  carefully 
into  the  uterus,  atler  it  is  cleansed,  and  loosely  insert  the  gauze 
■around  it.  The  object  of  the  gauze  is  to  hold  the  alcohol.  The 
■alcohol  is  renewed  through  the  end  of  the  catheter  at  variable  in- 
tervals. Alcohol  possesses  considerable  antiseptic  properties,  and 
iias  some  inhibitory  eEfect  upon  the  spores  of  the  virulent  strepto- 
-cocci.  Alcohol  acts  more  powerfully  where  there  is  a  good  deal 
of  water  in  the  tissues.  He  believes  it  is  the  simplest  method  that 
he  knows  of  for  treating  puerperal  infection  confined  to  the  cavity 
of  the  uterus.  It  must  be  remembered,  however,  that  all  local 
treatment  must  be  confined  to  those  cases  in  which  the  infection  is 
limited  to  the  uterine  cavity. 

Dr.  W.  E.  Fitch,  of  Savannah,  contributed  a  paper  on  "Tight 
Lacing — Its  Relation  to  Uterine  Development  and  the  Diseases  of 
the  Female  Organs  of  Generation,"  in  which  he  called  attention  to 
the  evil  effects  of  tight  lacing.  The  corset  was  so  constructed  that 
■when  worn  it  exerts  its  greatest  influence  (pressure)  from  above  the 


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Society  Reports.  18^ 

brim  of  the  pelvis  downward,  constricting  the  abdominal  walls,  tb& 
lower  part  of  the  thorax,  and  pushing  ioward  the  costal  cartilages^ 
and  often  the  seventh  and  eighth  overlapping.  The  greatest  con- 
striction occurs  in  the  immediate  neighborhood  of  the  stomachy 
which,  when  distended  as  a^er  a  hearty  meal,  produces  the  hour- 
glass stomach  fonnd  at  times  in  this  class  of  patients.  Compression 
is  so  great  in  most  cases  as  to  interfere  with  the  normal  peristaltic- 
action  of  the  intestines,  thereby  producing  constipation.  Compres- 
sion in  any  part  interfered  with  physiological  functions,  and  there~ 
lore  the  author  arrived  at  the  following  conclusions: 

1 .  The  normal  breathing  of  woman  is  like  that  of  man — abdom- 
inal.    Tight  lacing  changes  the  type  to  costal. 

2.  The  pelvic  organs  normally  make  a  considerable  excursion 
with  each  respiration.  Tight  lacing  in  the  upright  position  checks- 
this  motion  almost  entirely. 

3.  Sitting  or  leaning  forward  lessens  intra-abdominal  pressure- 
Tight  lacing  in  these  positions  greatly  increases  iotra-abdominaL 
pressure. 

4.  The  uterus  is  displaced  downward  by  tight  lacing  from  one- 
(o  two  and  a  half  inches.  The  pelvic  floor  is  bulged  downward 
and  the  circulation  rendered  sluggish. 

5.  Uterine  development  is  greatest  from  the  twelfth  to  the  six- 
teenth years.  Tight  lacing  is  usually  commenced  at  this,  the  pe- 
riod of  the  beginning  of  uterine  development. 

Dr.  J.  L.  Hiers,  of  Savannah,  read  a  paper  on  "  Malarial  As- 
thenopia." 

Dr.  A.  A.  Davidson,  of  Augusta,  read  a  paper  on  "  Hysteria."' 
Hysteria,  he  said,  was  a  disease  wherein  the  emotional  is  in  th& 
ascendancy  over  the  volitional,  and  characterized  by  marked  and 
marvelous  expressions  of  the  propensities  of  the  idiosyncrasy  of 
the  person  afiected,  and  was  not  hysteria  necessarily  because  of  any 
abnormal  condition  of  the  uterus,  but  was  a  manifestation  of  a 
morbid  and  incoordinate  activity  of  brain  and  nerve  forces,  voli- 
tion being  subordinated,  characterized  by  symptoms  motor,  sensory 
and  sympathetic,  abnormal  in  nature.  In  expression  it  frequently 
simulated  symptoms  of  various  pathological   and   diseased   states,, 


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190       The  Atlanta  Medical  and  Surgical  Journal. 

such  as  hyperestbesia,  anesthesia,  paralysis,  codvuIsiods,  general  or 
'local  suspension  of  runctions,  secretory  and  excretory,  etc. 

The  causes  of  this  condition  are  predisposing  and  immediate  or 
■exciting.  Heredity  stands  among  the  first  of  the  former.  Family 
history  of  phthisical,  strumous  or  neurotic  antecedents  may  confi- 
-dently  be  sought;  many  conditions  of  unsatisfied  nature,  long 
mental  worry  and  physical  strain  and  protracted  suspense. 

In  the  treatment  of  hysteria  the  thing  of  first  importance  is  to 
■obtain  the  confidence  of  tfae  patient  that  bis  or  ber  symptoms  have 
been  carefully  sought  out  and  weighed,  that  the  promise  of  com- 
plete recovery  may  be  held  out  as  the  result  of  careful  study  of 
•tbe  case,  else  little  can  be  effected.  lo  seeking  the  mode  of  mao- 
^agemeot  of  this  disorder  we  look  away  from  drugs  except  in  case 
of  complicatiog  intercurrent  diseases.  This  is  the  rule  and  prin- 
■ciple,  but  there  arise  conditions  at  times  which  must  be  met  by  the 
■energetic  use  of  active  medicinal  agents.  ■  One  cannot  in  ^very  in- 
stance douae  a  pail  of  ice-water  in  the  face  of  a  patient  if  con- 
vulsions be  present,  though  they  be  hysterical.  The  patient  is  a 
lady  of  social  standing,  of  integrity  andof  delicate  constitution, 
-what  is  to  be  done?  Power  of  moral  suasion  is  not  applicable  by 
'reason  of  the  patient  being  in  a  semi-comatose, -if  not  pseudo-com- 
atose state,  and  will  not  be  thus  reached.  Eminent  writers  would 
-eschew  such  antispasmodics  as  bromides  or  chlorals.  Experience 
leads  him  to  the  conclusion  that  where  sleep  can  be  induced  and 
.maintained  for  some  hours  a  great  advantage  is  gained.  This  can 
■be  effected  by  using  chloroform  to  offset  the  paroxysm,  continuing 
■the  sleep  by  the  use  of  chloral  per  rectum.  Tbe  subject  wants  to 
'be  taking  medicine,  and  so  reconstructives,  tonics,  etc.,  may  very 
well  be  administered,  since  malnutrition,  debility  and  anemia  are 
favorable  to  the  development  and  aggravation  of  hysterical  symp- 
itoms. 

A  plan  of  treatment  given  by  the  author  is  that  adopted  by  Dr. 
Weir  Mitchell,  of  Philadelphia,  introduced  into  this  country  by 
Dr.  Playfair,  which  consists  of  complete  isolation  of  the  patient 
-and  maintenance  in  bed,  milk  being  given  in  increasing  quantities. 
Massage  is  used  in  lien  of  exercise.  Brilliant  results  have  thus 
.been  secured.     However,  the  plan  is  rarely  practicable.     If  it  be 


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Society  Reports.  191 

impossible  to  place  the  patient  among  uou-apprehensive  aod  un- 
sympathetic attendants,  for  patieut'e  sake  and  theirs,  the  family  or 
those  immediately  interested  should  be  acquainted  with  the  true 
condition  and  educated  to  deal  intelligently  with  hysterical  attacks 
and  phases.  Parents  should  know  what  their  impressionable  chil- 
dren read;  unlimited  open  air  exercise  should  he  encouraged.  The 
miad  should  be  engaged  and  kept  off  the  imagined  condition  of 
self.  The  cardinal  motive  in  the  treatment  should  be  to  so  envi- 
ron the  patient  as  to  call  forth  no  expressions  of  an  emotional  Da- 
ture,  but  rather  <*onduce  to  exercise  of  reason  and  will. 

"Indications  for  and  Antiseptic  Technique  of  Uterine  Drainage 
after  I^bor  and  Abortion."  This  was  the  title  of  a  paper  by  Dr. 
B.  R.  Kime,  of  Atlanta. 

In  the  treatment  of  puerperal  infection,  the  practitioner  must 
consider  the  anatomical  retatioos  and  physiological  functions  of 
the  female  generative  organs.  The  author  does  not  believe  that  all 
cases  of  puerperal  infeclion  are  due  to  contamination  by  physician 
or  nurse,  nor  that  the  physician  can  always  prevent  such  infection. 
We  have  sufficient  clinical  evidence  to  prove  that  where  a  uterus 
bils  to  properly  drain  itself,  remaining  large  and  flabby,  a  blood 
clot,  portions  of  placenta,  or  a  cotyledon  is  retained,  infection  oc* 
curs  from  putrefaction  sud  absorption  of  uterine  contents.  Such 
cases  are  usually  sapremia  or  putrid  infeclion,  but  may  be  a  mixed 
or  true  septic  infection,  due  to  the  presence  of  septic  germs  in  the 
genital  tract  previous  to  confinement.  In  cases  of  septic  infection 
the  author  believes  that  the  curette  and  gauze  tampon  have  killed 
more  patients  than  they  have  saved.  Wheu  an  active  puerperal 
septic  condition  exists  long  enough  to  produce  constitutional  and 
local  symptoms  and  signs  sufficient  to  establish  a  diagnosis,  the 
«urette  cannot  reach  the  diseased  parts  on  account  of  the  germs 
baviug  extended  beyond  the  endometrium  iuto  the  uterine  walls, 
blood-vessels  and  lymphatics,  and,  iu  rapid  septic  cases,  has  ex- 
tended so  far  that  even  hysterectomy  is  not  justifiable  iu  but  few 
instances.  He  cares  not  if  small  portions  of  adherent  placenta  or 
-cotyledon  be  present,  efficient  drainage  will  eliminate  the  toxins 
sufficient  to  wait  for  nature  to  separate  these  structures  far  more 
efficiently  than  the  curette,  when  they  can  easily  be  removed  by 


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192       The  Atlanta  Medical  and  Surgical  Journal. 

forceps  without  traumatism  of  tbe  parts  aud  with  greater  safety  to 
the  patieut.  The  gauze  tampon  should  never  be  used  in  a  puer- 
peral septic  uterus  except  to  check  hemorrhage.  So  far  as  the 
present  treatment  in  concerned,  he  considers  uterine  and  alimentary 
drainage  and  elirainatioD  the  most  potent  factors  at  our  command. 
Uterine  drainage  is  secured  by  use  of  drainage-tubes  and  strips  of 
gauze  or  wicking.  The  tube  should  be  removed  and  uterus  irri- 
gated once  or  twice  in  twenty-four  hours  in  severe  cases,  being- 
governed  by  pulse  and  temperature.  If  they  rise  it  is  an  indica- 
tion for  irrigation  or  that  tbe  drainage  is  obstructed. 

As  to  drainage  in  cases  of  incomplete  abortion,  there  are  differ- 
ent conditions  to  deal  with.  The  author  limits  tbe  term  abor- 
tion to  interruption  of  gestation  at  any  time  prior  to  the  complete 
formation  of  placenta.  At  least  ninety  per  cent,  or  more  of  case* 
of  infection  occurring  during  or  after  abortion  are  putrid  infec- 
tion, hence  easier  controlled  and  less  demand  for  drainage.  If  an 
active  septic  infection  occurs,  then  drainage  is  demanded  in  cases 
of  abortion.  Tbe  dangers  and  contraindications  to  tbe  use  of  the 
curette  and  tampon  in  septic  cases  increase  in  proportion  to  the 
advance  in  pregnancy  and  tbe  increase  in  size  and  vascularity  of 
the  pelvic  oi^ns.  While  the  author  advocates  an  antiseptic  gauze 
uteriue  tampon  after  curetting  the  uterus  in  cases  of  abortion,  it  is- 
to  act  as  surgical  dressing,  prevent  further  infection,  check  hem- 
orrhage, stimulate  uterine  contractiona,  aud  not  for  the  purpose  of 
drainage.  The  tampon  should  be  removed  in  twenty-four  to  forty- 
eight  hours,  and  not  repeated.  If  af\er  gauze  is  removed  there  is 
elevation  of  pulse  and  temperature  with  coustitntional  and  pelvic 
disturbances,  then  drainage  and  elimination  are  indicated. 

The  Ibllowing  officers  were  elected  lor  the  ensuing  year:  Presi- 
dent— Dr.  Howard  J.  Williams,  Macon;  First  Vice-Preaident — Dr- 
J.  G,  Hopkins,  Thomasville;  Second  Vice- President — Dr.  I.  H. 
Goss,  Athens. 

Place  of  meeting — Macou;  time,  third  Tuesday  in  April,  1899. 


Olelimer — Is  your  married  life  one  grand  sweet  song? 
Newlywed — Well,  since  I  got  a  baby  it's   more   like  a  grand 
opera,  with  loud  calls  for  the  author  every  night. — Puek. 


^dbyGoOgle 


EDITORIAL. 


Tba  otBoa  of  Thb  JouWi*i.  !■  311  uid  SIX  FliteD  Building. 
addrcM  ftll  oommunloatloni,  and  makB  all  remltuinces  payable  t 

.MD  SOBOKUL  JOOBKAI.,  AUliQUt.  QS. 


THE  ATLANTA  QUARANTINE  CONVENTION. 

The  Couveotiou  of  quaraDtlne  and  health  ofBcers  of  the  Suulh 
Atlantic  and  Gulf  States,  which  convened  in  Atlanta  ou  the  t2tli 
ultimo,  performed  its  work  in  a  maoner  conspicuous  for  prompt- 
ness aud  harmouy.  The  meeting  lasted  only  one  day,  with  three 
sessions.  All  of  the  South  Atlantic  and  Uulf  Stales,  with  the 
>ingle  exception  of  Texas,  were  represented. 

Dr.  H.  B.  Horlbeck,  of  Charleston,  S.  C,  was  chosen  president, 
and  prompt  organization  was  effected.  A  Committee  on  Resolu- 
tions and  Plans  was  appointed,  with  Dr.  Edmond  Sotichon,  of  New 
Orleans,  as  chairman.  The  committee  reported  to  the  Convention 
a  reaolulion  favoring  the  appointment  hy  the  Federal  Qovernment 
of  meilii^l  inspectors  to  be  attached  to  consulates  where  yellow 
fever  and  cholera  are  epidemic,  and  urging  Congress  to  agipiopri- 
ale  neeessary  funds  to  carry  the  plan  into  effecl,  and  also  a  resolu- 
tion expressing  the  opinion  "that  it  is  the  duty  of  all  nations  to 
take  measures  to  eradicate  auy  plague  centers  from  their  territory," 
and  requesting  our  State  Department  to  convey,  through  pmper 
diplomatic  channels  to  all  nations  so  affected  the  sense  of  this 
resolution.     Both  resolutions  were  adopted. 

The  committee  offered  an  extensive  series  of  rules  and  regula- 


,„i,z.d  by  Google 


194      The  Atlanta  Medical  and  Surgical  Jodbnal. 

tioDS  goveroiog  quarantine,  detention  camps,  disinfection,  ship- 
ment of  merchandise  and  general  trausportatiou  by  rail  and  water 
during  tbe  prevalence  of  yellow  fever,  and  after  discussion  and 
modificalioD,  tbe  report  as  amended  was  adopted.  Other  infec- 
tious and  contagious  diseases  were  not  provided  for,  nor  did  tlie 
scope  of  discussion  embrace  the  important  subject  of  sanitation. 

The  rules  and  regulations  adopted  are  based  largely  on  those 
formulated  by  the  Marine  Hospital  Service,  but  they  fall  short  of 
that  clearness  and  conciseness  which  distinguish  the  rules  and  reg- 
ulations now  in  force  by  that  bureau.  Tbe  verbiage  of  tbe  Coa- 
vention  rules  and  regulations  and  the  minutiee  of  detail  might  have 
been  curtailed  with  advantage.  In  some  places  tbe  instructions 
are  vague  au^l  fii)parently  contradictory,  and  olten  extensive  and 
implied  redundancy.  The  pr»priety  of  enforcement  is  in  too  many 
instances  left  optimial  with  snb  >rdioate  local  officials. 

The  rules  and  regulations  are  to  be  put  in  operation  and  all  ap- 
pliances apparatus  and  equipment,  furnished  by  the  Marine  Hospi- 
tal Service  at  Federal  expense,  but  under  the  jurisdiction  and 
su|>ervision  of  local  health  and  quaruutine  officers,  in  order  that 
the  local  officers  may  be  satisfied  that  they  are  properly  executed 
and  enfitrced.  Ju'^t  bow  conflict  au<]  conftision  of  authority  is  to 
be  avoided,  and  whether  or  not  the  United  Stales  Treasury  De- 
partment will  accept  dictation  from  Stale  and  municipal  health 
boards  is  not  stated. 

If  the  Caffery  quarantine  bill  now  pending  before  Congress  i* 
enacted  into  law,  as  it  is  believed  it  will  be,  the  work  of  the  Con- 
vention in  formulating  the  rules  and  regulations  will,  in  all  proba- 
bility, c.iunt  for  little. 

A  form  of  health  certificate  to  be  used  by  all  boards  of  health  in 
the  South  Atlantic  and  Gulf  States,  and  also  the  States  of  Tennes- 
see, Arkansas,  and  Kentucky,  and  to  be  accepted  as  interstate  pass- 


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Editorial.  195 

ports  by  health  aod  sanitary  officers  and  inspectors  of  those  Staten, 
was  adopted. 

The  President  was  authorized  to  appoint  a  committee  on  the 
permaneDt orgauizatioa  of  the  "Southern  Health  Association,"  and 
to  call  a  meeting  of  the  same  at  such  place  and  time  as  may  seem 
expedient.  Such  an  organization  will  do  much  tv  stimulate  invea- 
ttgation  and  diseeminate  useful  iDformation  pertaining  to  the  do 
main  of  sanitary  and  quarantine  matters.  c.  H.  D. 


THE  GEORGIA  MEDICAL  ASSOCIATION. 

The  forty-ninth  annual  meeting  of  the  Georgia  State  Medical 
Association  was  held  ou  Cumberland  Island,  April  20,  21,  22. 
The  meeting,  we  are  sorry  to  say,  was  not  up  to  the  usual  stand- 
ard of  this  Association,  especially  in  the  attendance.  Cumberland 
Island  is  a  delightful  pleasure  resort  during  the  latter  part  of  May 
or  first  of  June,  but  as  a  meeting-place  for  the  State  Association 
in  April,  we  must  say  that  it  proved  a  failure.  In  the  first  place, 
it  was  too  far  away  from  the  center  of  the  State,  and  therefore  in- 
accessible to  a  good  proportion  of  the  members  of  the  Association. 
It  took  too  long  to  reach  the  place,  and  its  distance  necessarily 
made  it  expensive.  The  trip  tu  Bninswick  might  have  answered, 
had  the  meeting  been  held  iu  that  city,  but  the  reaching  of  Cum- 
berland Island  by  means  of  ihe  water  schedule,  necessitated  the 
loss  of  nearly  a  whole  day  on  the  water.  Besides,  we  do  not  think 
that  a  meeting  of  this  kind  should  he  held  purely  for  the  sake  of 
pleasure,  but  accurate  scientific  and  strictly  profeiuional  labor 
should  be  the  aim  of  the  State  Medical  Assottiation,  A  great 
many  of  the  members  enjoyed  the  sailing  and  fishing,  which 
amusement  unfortunately  proved  too  much  of  a  drawing  card  to 
the  detriment  of  the  real  work  of  the   meeting.     However,  we 


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196       The  Atlanta  Medical  and  Sproical  JoniujAL. 

think  tliat  th«  lesson  has  been  taught  to  consider  more  seriously  io 
the  future  the  place  of  the  annual  meeting. 

The  final  program  as  printed  showed  many  excellent  feature;", 
but  unfortunately  the  majority  of  the  papers  had  to  be  read  by  title. 
The  first  vice-presidenl,  Dr.  Hardeman,  presided  over  the  meet- 
ing with  grace  and  ease.  There  was  a  notable  absence  of  the 
Committee  on  Arrangements,  so  that  each  individual  had  to  seek 
out  his  own  information.  Yet  we  cannot  attribute  the  seemingly 
non-success  of  the  meeting  entirely  to  local  causes,  for  our  country 
being  deeply  stirred  by  the  war  measures  which  have  been  inaugu- 
rated, these  have  affected  the  professional  man  as  well  as  the  mer- 
chant, and  there  is  uo  doubt  but  that  this  one  factor  kept  many  of 
the  members  away.  However,  those  papers  which  were  read  were 
good  and  provoked  interesting  discussion.  The  weather  was  per- 
fect, and  the  city  physicians,  especially,  seemed  to  enjoy  the  out- 
ing on  the  island.  Tbe  next/  meeting  will  be  held  in  Macou, 
mainly  for  tbe  reason  that  the  Association  will  celebrate  its  semi- 
oentennial  anniversary  and  in  that  Macon  was  the  home  of  its  in- 
auguration. Some  new  resolutions  were  introduced  and  acted 
upon  which  will  he  seeu  in  the  Transactions. 


Dr.  William  H.  Johnston,  one  ol  the  founders  and  the  Dean 
uf  the  Birmingham  Medical  College  at  Birmingham,  Ala.,  died  of 
apoplexy  on  April  3,  in  his  eightieth  year.  He  was  boru  in  Lin- 
coln county,  N.  C,  educated  in  the  State  Univer:iity,  and  served 
gallantly  in  the  Twenty-third  North  Carolina  Regiment,  Confed- 
erate Army,  After  the  war  he  was  gnidualed  in  medicine  at  the 
University  of  the  City  of  New  York,  and  served  eighteen  months 
at  Bellevue  Hospital,  New  York.  For  a  short  time  be  practiced 
medicine  in  the  latter  city,  moved  to  Selma,  Ala.,  in  1872,  and  to 
Birmingham  in  188G. 


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MEDICAL  ITEMS, 


Dr.  James  H.  Bryant,  of  Talbotton,  Ga.,  died  April  14. 


Married. — Dr.  O.  N.  Pendergrase  and  Miss  Metie  Connor,  of 
Social  Circle,  April  28. 


Colleges. — Our  readers  should  notice  the  college  advertise- 
ments in  this  and  succeeding  iseiues  in  order  to  know  where  to  send 
their  students. 


There  are  three  men  in  our  social  eyutem  who  cannot  respect  or 
value  the  world — the  physician,  the  lawyer,  and  the  priest.  They 
wear  black;  perhaps  in  mourning  for  all  virtues  and  all  illusious. — 
Balzae. 


Dr.  0.  S.  Harris,  of  Rome,  died  April  18,  in  his  seventy>sec- 
ond  year.  He  had  been  a  resident  of  Rome  for  forty  years,  and 
was  a  respected  and  successful  practitioner.  During  the  civil  war 
he  waH  a  surgeon  in  Hood's  army. 


The  InUmaiional  Magazine  is  responsible  for  the  statement  that 
of  217,000  prescriptions  written  in  Chicago,  New  York,  Boston, 
Washington,  Baltimore,  Denver,  San  Francisco,  New  Orleans,  and 
St.  Louis,  11.25  per  cent,  called  for  proprietary  articles. — Ex. 


Dr.  Chas.  Brighau,  of  San  Francisco,  has  lately  luccessfully 
performed  esophago-enterostomy,  after  Schlatter's  method.  The  pa- 
tient was  a  woman,  sixty-six  years  of  age,  the  date  of  the  operation 
being  about  two  months  ago.  She  has  made  a  good  recovery,  and 
her  digestive  functions  do  not  appear  at  all  disturbed. 


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198       The  Atlanta  Mbdical  and  Surgical  Journal. 

Arthur  Orton,  better  Udowd  to  fame  as  the  fiilse  "  Sir  Roger 
Tichborae,"  has  just  died  Id  London.  It  will  be  remembered  that 
Eoglisb  courts  were  occupied  five  years  with  tbis  very  remarkable 
case  of  cODfused  identity.  Finally  tbe  claimant  wae  exposed  and 
condemned  to  fourteen  years  of  penal  servitude. 


Dr.  Geo,  Hesry  Fox,  Professor  of  Dermatology  in  the  College 
of  Physicians  and  Surgeons,  New  York,  gave  the  Atlanta  Society 
of  Medicine  a  talk  upon  syphilitic  eruptions  at  the  meeting  of 
April  7.  His  remarks  were  illustrated  with  stereopticon  views  "I 
tbe  various  syphilitic  mabifestations.  Tbe  doctor's  comments  were 
eminently  instructive  and  the  pictures  were  excellent. 


For  the  Denver  meeting  of  the  American  Medical  Association  tbe 
Western  Passenger  Associatinu  has  granted  a  rate  to  Denver  and 
return  of  one-half  fare,  plus  f2,00,  thirty-day  limit,  for  business 
from  Chicago,  St.  Louis  and  iotermediale  points.  Tickets  im  sale 
June  2d,  4lfa  and  .^th  eant  of  the  Missouri  River;  5th  and  6ih 
west  of  the  Missouri  River.  A  round  trip  rate  of  JJ20.00,  thirty- 
day  limit,  from  Ogden  and  Salt  Lake,  is  also  announced.  Appli- 
cation for  similar  rates  has  been  made  to  all  other  passenger  asso- 
ciations aud  to  railroads  not  controlled  by  them. 


The  regular  Board  of  Medical  Examiners  met  in  annual  session 
in  Atlanta,  March  31et.  Sixty-four  applicants  were  examined  for 
liccuse-  Four  failed — two  from  the  Atlanta  Medical  College,  one 
from  the  Southern  Medical  College,  and  one  from  the  Tennessee 
Medical  College.  Dr.  J.  B.  S.  Holmes,  of  Atlanta,  was  elected 
President,  and  Dr.  E.  R.  Anthony,  of  Griffin,  Secretary  and  Treas- 
urer for  the  ensuing  year. 

The  board  also  met  in  Augusta  April  2.  Twenty-nine  appli- 
cants were  examined.  Two  failed— one  from  the  Medical  College 
of  Georgia  (Augusta),  and  one  from  Meharry  Medical  College 
(Nashville). 


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Medical  Items.  199 

It  will  be  remembered  tbat  wbeo  youDg  Oammoa  was  killed  id 
*  footb&Il  game  id  Atlanta  last  fall  aod  bills  were  afterwards  in- 
troduced in  (be  Legislature  prohibiting  further  match-games  in 
the  State,  the  young  mau's  mother,  id  a  public  letter,  requested 
that  "  the  death  of  her  son  should  uot  serve  us  an  argument  against 
the  development  of  an  athletic  education  in  the  university."  Tbte 
letter,  it  is  said,  has  l)eeD  widely  published  iu  this  country,  and  the 
Progrig  Medical,  of  Paris,  says  that  it  has  been  translated  id  the 
press  of  continental  Europe.  The  last  named  journal  says:  "That's 
the  kind  of  mothers  they  have  in  America.  Such  mothers  are  the 
makers  of  true  men.'* 


The  medical  excursion  in  June  will  leave  Denver  for  Salt  Lake 
Oty — the  Zion  of  the  new  world — on  the  last  day  of  the  meeting, 
and  the  two  successive  days  via  the  Rio  Grande  Western  Railway 
iu  connection  with  the  D.  &  R.  G.  and  Colorado  Midland  lines. 
The  rate  will  be  but  $18.00  for  the  round  trip,  offering  a  trip  of 
1,500  miles  through  the  Rocky  and  Wasatcb  Mountains.  No 
European  trip  of  equal  length  can  compare  with  it  in  grandeur  or 
wealth  of  novel  interest.  Salt  Lake  City  and  vicinity  are  one 
grand  sanitarium.  The  Great  Salt  Lake  or  Dead  Sea  of  America, 
with  its  magnificent  bathing  resort,  the  hot  and  warm  springs, 
drives,  parks,  caoyoos  aod  reserves  are  all  located  in  or  about  the 
■city.  Send  two  cents  to  F.  A.  Wadleigh,  Salt  Lake  City,  for  copy 
of  pamphlet. 


The  oineteenth  annual  report  of  the  Atlanta  Board  of  Health 
(for  1897)  is  before  us.  It  shows,  among  other  things,  an  annual 
death-rate  of  18.26  per  thousand,  the  population  consisting  of  60,- 
OOO  whites  and  40,000  colored.  There  were  806  deaths  among 
the  whites  and  1,020  among  the  colored.  Annual  death-rate  for 
the  whites,  13.43;  for  the  blacks,  25.50  per  thousand.     There 


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200       Thb  Atlanta  Medical  and  Surgical  Journal. 

were  214  deaths  from  coDsumptioD,  or  11.71  per  cent,  of  the  total 
number  of  deaths.  There  were  64  deaths  from  typhoid  fever,  con- 
fined practically  to  those  persons  who  habitually  drink  well-water. 
Within  the  year  there  were  247  cases  of  smallpox,  with  thre& 
deaths.  Of  the  214  deaths  from  tuberculosis,  66  were  white  aod 
148  colored. 

The  report  displays  a  lack  of  proof-reading  skill  which  is  any- 
thing but  creditable  to  both  compiler  and  printer.  Under  "Causes- 
of  Death"  we  learn,  for  instance,  that  one  person  died  of  "(ragiiitis 
ossimo";  another  had  "multiper  scolisis";  another,  "maltruition"; 
one  died  from  eolai^d  "protestate";  another  from  "intussus  cap- 
tion," and  another  from  rupture  of  the  "  Gaul  Bladder."  "  Pu- 
turis"  and  "inflammation  of  the  setamus,"  whatever  those  dis- 
eases may  he,  also  destroyed  a  victim  each. 


The  third  annual  meeting  of  the  Western  Ophthalmologic  an<l 
Oto-Laryngologio  Association  was  held  in  Chicago  April  7  and  8,. 
1898.  The  address  of  welcome  was  made  by  Dr.  F.  Heorotiu, 
President  of  the  Chicago  Medical  Society,  who,  in  a  felicitous 
speech,  extended  to  the  members  the  hospitalities  of  the  city  of 
Chicago.  Dr.  A.  Alt,  of  St.  Louis,  Mo.,  responded  for  the  Asso- 
ciation. The  annual  address  was  then  read  by  President  B.  £. 
Friar,  of  Kansas  City,  Mo.  After  the  usual  routine  business  had 
been  concluded,  a  scientific  communication  was  read  by  Dr.  Her- 
man Knapp,  of  New  York  City. 

The  Ophthalmologic  and  Oto-Laryngo logic  sections  have  each 
held  five  separate  and  two  joint  sessions,  many  articles  of  interest 
being  read  and  discussed.  The  last  joint  session  was  occupied  with 
the  exhibition  of  ctioioal  cases. 

The  Committee  of  Arrangeuents,  of  which  Dr.  J,  E.  Colhurn, 
of  Chicago,  was  chairman,  was  unremitting  in  its  attention  to  the 
guests,  and  nothing  was  spared  that  would  contribute  to  the  enter- 


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Medical  Items.  201 

tainmeDt  of  the  visitors.  Thursday  eveaing  the  members  were  io- 
vited  to  the  ball  of  the  Chicago  Athletic  Club,  where  a  special 
program  had  been  arraDged  for  theeDtertainmeut  of  the  members. 

The  following  officers  were  elected  for  the  ensuing  year:  Presi- 
dent, Dr.  J.  Elliott  Culburo,  of  Chicago ;  first  vice- president,  Dr. 
W. Scbeppegrell,  of  Kew  Orleans;  second  vice-president,  Dr.  Casey 
A.Wood,  of  Chicago;  third  vice-president,  Dr.  H.  Gifford,  of 
Omaha,  Neb.;  treasurer,  Dr.  W,  L.  Dayton,  of  Lincoln,  Neb,; 
secretary.  Dr.  F.  M.  Rumbold,  of  St.  Louis,  Mo. 

New  Orleans  was  unaDimously  selected  for  the  next  meeting, 
which  will  take  place  just  before  the  Mardi  Gras  of  1899,  thus 
allowing  the  members  to  conclude  their  scientific  session  with  the 
pieties  of  the  carnival  season. 


MoBT  elaborate  preparations  are  being  made  in  Denver  to  enter- 
tain the  next  meeting  of  tbe  American  Medical  Association  which 
will  be  held  there  June  7th  to  10th.  All  indications  point  to  a 
pleasant  and  successful  meeting,  and  those  who  can  attend  will 
not  fail  to  enjoy  it. 

On  Saturday,  June  4th,  the  American  Academy  of  Medicine  be- 
gins its  session,  Monday,  June  6tb,  the  Academy  continues  its 
meeting,  and  on  tbe  same  day  tbe  Medical  Editors  Association 
meets,  followed  by  a  final  session  and  banquet  at  night.  On  Tues- 
day, June  7tb,  the  general  session  of  the  American  Medical  Asso- 
ciation will  convene  in  the  Broadway  Theater,  and  in  the  afternoon 
the  various  sections  will  meet  in  places  provided  for  them.  Tues- 
day evening  the  several  section  banquets  will  be  held. 

"Co  Wednesday  there  will  be  another  general  meeting  of  the 
Association  and  the  sections  will  do  bard  work.  On  Wednesday 
evening  a  theater  party  will  probably  be  held  at  Mauhattau  Beach. 

"On  Thursday  the  regular  Association  work  will  close  with  the 
election  of  officers  and  the  sections  will  finish  their  work.     In  tbe 


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'202       The  Atlanta  Medical  and  Surgical  Journal. 

-evening  a  number  of  receptions  will  be  given  at  the  magnificent 
homes  of  some  of  Denver's  wealthy  citizens. 

"During  the  three  days'  sessions  the  visiting  ladies  will  be  cared 
for  in  various  and  divers,  ways.  Rides,  excursions,  sightseeing 
^nd  receptions  will  constitute  the  program.  It  will  be  a  merry 
merry  time. 

"On  Friday,  a  complimentary  excursion  will  be  given  aruund 
the  loop  and  then  our  visitors  will  be  sent  to  Colorado  Springs  as 
guests  of  the  local  committee  of  arrangements  there.  A  ride 
through  the  Garden  of  the  Gods,  a  visit  to  Manitou,  to  Cascade 
■Canon,  to  William's  Canon,  and  to  Glen  Eyre  will  make  a  day  of 
the  most  delightful  pleasure.  It  will  be  a  rare  treat.  Special  ar- 
Tangements  for  a  trip  to  tbe  top  of  Pike's  Peak  will  probably  be 
made. 

"After  this  the  members  of  the  Association  have  the  choice  of 
a  dozen  delightful  trips  at  greatly  reduced  rates.  There  will  be  a 
great  scattering.  Salt  Lake  City  is  bidding  bard  for  a  big  portion 
of  the  crowd." 

Following  are  the  officers  of  the  Association :  President,  Dr. 
Geo.  M.  Sternberg,  Surgeon -General  United  Stat«s  Army;  First 
Vice-President,  Dr.  J.  M.  Mathews,  Louisville,  Ky.;  Second  Vice- 
President,  Dr.  J.  L.  Thompson,  ludianapolis;  Treasurer,  Dr.  H.  P. 
Newman,  Chicago,  111.;  Secretary,  Dr.  W.  B.  Atkinson,  Phila- 
delphia; Assistant  Secretary,  Dr.  W.  A.  Jayne,  Denver;  Chairman 
■of  Committee  of  Arrangements,  Dr.  J.  W.  Graham,  Denver. 

The  Address  on  Medicine  will  be  delivered  by  Dr.  J,  H.  Muaser 
■of  Philadelphia.  The  Address  on  Surgery  will  be  delivered  by 
Dr.  J.  B.  Murphy  of  Chicago.  Dr.  8.  C.  Busey  of  Washington, 
was  appointed  to  deliver  the  Address  on  State  Medicine,  but  will 
not  be  able  to  serve.  The  speaker  on  this  subject  has  not  yet  been 
eelected. 


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BOOK  REVIEWS. 


Annual  and  Analytical  Cyclopedia  op  Practical  Medi- 
ciKE.  By  Charles  E.  de  M.  Sajous,  M.D.,  and  One  Hundred 
Associate  Editors,  assisted  by  Corresponding  Editors  and  Col- 
laborators. Volume  I.  The  F.  A.  Davis  Company,  Publishers, 
Philadelphia. 

Thio  work,  which  is  the  successor  to  the  Annual  of  the  Unh'eraal 
Medical  StAeneea,  is  intended  to  correct  Rome  of  the  deficieuces  in 
the  latter  and  to  supply  the  practitioner  with  a  Cyclopedia  cover- 
ing the  entire  field  of  Medicine.  "Instead  of  presenting  the  ex- 
cerpts from  the  year's  literature  arranged  under  a  general  head  as 
before,  each  disease  (including  its  subdivisions,  etiology,  pathology, 
treatment,  etc.)  is  described  in  extenao,  and  the  new  features  that 
the  year  has  brought  forth  are  inserted  in  their  respective  places 
in  the  text.  Id  this  manner  the  reader  is  saved  [much]  the  fatiguing 
study.  .  .  The  work,  when  completed,  will  present  all  the  gen-- 
eral  diseases  described  in  text-books  on  practical  subjects,  medicine, 
surgery,  therapeutics,  obstetrics,  etc.,  and,  inserted  in  their  logical 
order  in  the  text,  are  the  progressive  features  of  value  presented 
during  the  last  decade." 

There  will  be  six  volumes  in  the  completed  work.  The  first 
volume  includes  a  compact,  but  full,  discuEsiun  (in  alphabetical 
order)  of  subjects  from  "Abdominal  Injuries"  to  "  Brigbt's  Dis- 
ease," embracing,  therefore,  such  important  subjects  as  abdomen, 
abortion,  abscess,  acne,  acromegaly,  Addison's  disease,  albuminuria, 
alcoholism,  anemia,  aneurism,  animal  extracts,  aphasia,  appendicitis, 
atiJana,  Bright's  disease,  etc.  Brief  abstracts  are  given  of  the  most 
important  articles  beanng  upon  each  subject.  The  volume  gives 
evidence  of  much  labor  in  its  preparation  and  of  an  earnest  effort 
on  the  part  of  editor  and  collaborators  to  place  before  the  practi- 
tioner a  valuable  general  reference  book  in  medicine  which  will 
be  an  ever-present  help  in  time  of  need. 


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204       The  Atlanta  Medical  and  Surgical  Journal. 

Ati,A8  op  Clinical  Investigation.  With  sd  Epitome  of  Clin- 
ical Diagnoeis  and  of  Special  Patbolof^  and  Treatmeot  of  Id- 
ternal  Diseases.  By  Dr.  Cbriatfried  Jakob.  Edited  by  Augus- 
tus A.  Eshner.M.D.',  Philadelphia.  W.  B.  Sauudere,  Publisher, 
Philadelphia. 

As  is  truly  stated  in  the  traaslator's  note,  "The  beauty,  the 
clearness,  and  the  accuracy  of  the  illustrations  .  .  .  seemed 
to  be  a  sufficient  justificatiou  for  adapting  the  work  to  the  needs  of 
Americaa  medical  students  and  practitioners."  The  general  scope 
of  the  work  may  be  divided  into  two  parts,  the  first  treating  of  the 
microscopic  appearances  and  chemical  reactions  of  the  blood,  the 
stomach  contents  and  the  secretions  and  escretions  of  the  body,  the 
second  part  of  the  physical  signs  as  found  by  the  various  methods 
of  investigation.  ,  In  conclusion,  243  pages  of  text  are  devoted  to 
a  concise  r^sum^  of  physical  diagnosis. 

If  the  work  ooutained  uo  more  than  the  first  twenty-two  plates,, 
it  would  be  worthy  of  a  prominent  place  iu  tlie  library  of  every 
physician  who  avails  himself  of  microscopical  and  chemical  aids 
in  diagnosis.  The  plates,  especially  those  on  urinary  examinations, 
are  the  best  we  have  yet  seen,  and  hardly  need  the  accompanying- 
text  to  elucidate  them. 

The  remaining  forty-six  plates  are  beautifully  executed,  and 
clearly  illustrate  the  physical  signs  of  as  many  pathological  con- 
ditions. Ekch  one  illustrates  an  actual  case  iu  the  author's  expe- 
rience, and  is  accompanied  by  a  short  history,  the  results  of  the 
physical  examination,  the  diagnosis  and  treatment,  and  in  many 
cases  the  results  of  the  post-mortem  examination. 

The  work  is  a  valuable  one  and  should  meet  with  hearty  ap* 
proval.  F.  8.  B. 

The    Surgical    Complication's    and  Sequels  op    Typhoid 
Fever.     By  W.  W.  Keen,  M.D..  LL.D,  Professor  ot  Surgery 
in  the  .Jefferson   Medical  College,  Philadelphia      Published  by 
W.  B.  Saunders,  Philadelphia.     Price  ?3.00  net. 
This  elaborate  work   consists  of  a  book   of  three  hundred  and 

eighty-six  pages,  containing  in  addition  to  the  observations  of  the 

writer  and  his  assistants  since  1876,  his  Toner  Lecture,  which  wafr 

printed  by  the  Smithsonian  Institute  at  that  time. 


^dbyGoOgle 


Book  Reviews.  205  ■ 

The  first  portion  of  the  book  is  devoted  to  a  cooeideratioa  of 
the  pathology  of  the  complications  and  sequels  of  typhoid  fever, 
with  especial  refereace  to  the  viability  and  diffusion  of  typhoid 
bacilluR.  Cliapter  III.  is  devoted  to  gangrene,  which  occurs  with 
this  disease.  Other  chapters  enter  upon  the  cousideration  of  the 
varions  manifestations  of  the  disease  in  the  various  tissues  through- 
out the  body.  One  of  the  most  interesting  chapters  is  the  one  on 
intestinal  perforation,  with  the  results  of  treatment  from  a  surgical 
standpoint,  when  the  perforation  is  recognized  early  and  when 
late.  In  speaking  of  the  time  when  an  operation  should  be  per- 
formed, he  says:  "The  earliest  moment  at  which  the  operation 
can  be  done  after  the  immediate  shock  of  the  perforation,  pro- 
vided, of  course,  there  has  been  any,  as  is  sometimes  not  the  case, 
the  better  it  will  be  for  the  patient."  This  is  a  very  comprehen- 
sive book  and  treats  of  this  subject  in  a  scientific  and  iuteresling 
style.  The  wide  diffusion  of  the  typhoid  bacillus  is  especially 
interesting  and  its  possible  active  part  which  it  plays  in  the  mul- 
titude of  complications  of  this  disease.  E.  c.  d. 


Day-dreams  op  a  Doctor.    By  C.  Barlow,  M.D.     Pp.  251.    The 
I'eterPaul  Book  Company,  Buffalo,  New  York. 

The  author  of  this  liook  tell  us  that  he  took  his  cue  from  the 
remark  of  Dr.  Wier  Mitchell,  "I  think  there  remains  to  be  written 
the  simple,  honest,  dutiful  story  of  an  intelligent,  thoughtful  every- 
day doctor,  such  as  will  pleasantly  and  fitly  open  to  laytneu  some 
true  conception  of  the  life  he  leads — its  cares,  its  trials,  its  influ- 
ences on  himself  and  others,  and  its  varied  rewards";  and  Dr. 
Barlow  believes  he  has  presented  a  "fair  conception  of  tlio  real  life 
of  the  plain,  hard-working,  every-day  doctor." 

A  reading  of  the  volume  satisfies  one  that  the  writer  has  very 
well  sustained  his  purpose.  His  descriptions  are  exceedingly  real, 
and  many  of  the  representative  incidents  which  he  choo.ses  to  de- 
scribe can  be  more  or  less  duplicated  in  the  experiences  of  every 
"  busy  practitioner."  The  writer  believes  in  the  female  physician, 
one  of  whom  comes  in  for  due  attention,  and  the  male  representa- 
ti%'e  of  the  general  practitioner  marries  her  in  the  end;  so  it  ap- 


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206       The  Atlanta  Medical  and  Surgical  Journal. 

pears  that  the  simple  annals  of  busy,  hard-worked  "every-day  doc- 
tors" are  not  without  some  romance.  The  chapter  od  "  IX>ctor 
Crook  "  IS  as  felicitous  as  it  is  lifelike.  The  author  writes  in  a  nat- 
ural and  easy  style,  which  adds  much  to  the  interest  of  the  volume. 


An  American  Text-Book  op  Gesito-Ueinaey  Diseases, 
Syphilis,  and  Diseases  op  the  Skin.  Edited  by  L.  Bolton 
Bangs,  M.D.,  Consulting  Surgeon  to  St.  Iiuke's  Hospital  and  the 
City  Hospital,  New  York,  etc.;  and  W.  A.  Hardaway,  A.M., 
M.D.,  Professor  of  Diseases  of  the  Skin  and  Syphilis  in  the 
Missouri  Medical  College,  St.  Louis.  Illustrated  with  300  en- 
gravings and  20  full-page  colored  plates.  W.  B.  Saunders,  923 
Walnut  St.,  Philadelphia.  Price,  cloth,  $7.00;  half  morocco, 
{8.00. 

This  is  a  "collaborated"  book  of  about  twelve  hundred  pages. 
The  writ«rs  of  the  various  parts  are  mostly  well  known  authori- 
ties, but  there  are  some  new  ones.  Nearly  every  medical  center  in 
the  country  seems  represented,  as  is  Canada.  The  diseases  coming 
under  the  title  are  very  fully  discussed,  and  the  subjects  appear 
thoroughly  covered.  Individual  views  crop  out  here  and  there, 
but  quotations  from  the  general  literature  abound.  The  colored 
plates  are  not  the  best.  The  cuts  are  better.  One  should  be  able 
to  get  along  \a  the  specialties  treated  with  this  book  alone- 


A  Compendium  of  Insanity.     By  John  B.  Chapin,  M.D.,  I1L.D. 
Published  by  W.  B.  Saunder*,  Philadelphia.     Price  $1.26  net. 

This  little  book  may  truly  be  called  a  compendium,  fur  it  con- 
tains in  a  condensed  form  the  essentials  of  diagnosis  and  treatment 
of  the  various  forms  of  insanity.  It  is  written  in  an  extremely 
simple  style  and  arranged  so  as  to  prove  unusually  interesting,  not 
only  to  the  physician  but  the  lawyer  who  cannot  devote  considera- 
ble time  to  the  more  technical  books  on  insanity.  It  is  en  attrac- 
tive book  in  appearance  and  the  arrangement  of  the  various  sub- 
jects bandied  is  such  as  to  make  it  well  worth  a  careful  reading. 

E.   C.   D. 


^dbyGoogle 


SELECTIONS  AND  ABSTRACTS. 


SKIN  DISEASES  AND  SYPHILIS. 
Suited  bv  Dr.  M.  B.  Hotciiikb. 
Diffuse  Sclerudebma. 

Dr.  Wm.  Osier,  of  Baltimore,  has  aa  article  upon  this  "harden- 
ing, stiffening,  contracting"  disease  of  tlie  skin,  in  tbe  February 
iQil  March,  1898,  Journal  of  Cutaneous  and  G enito- Urinary  IHs— 
cages.  He  dwells  upon  the  diagnosis,  gives  some  case  historiex, 
and  discusses  the  treatment  of  the  disease  with  thyroid  gland  ex- 
tract. Thyroid  extract  first  came  into  use  in  the  treatment  of 
myxedema — in  the  absence  of  normality  in  the  thyroid  gland  of 
the  patient.  Tbe  substance  was  useful  iu  that  condition.  Dr. 
Oiler's  experience  with  the  drug  was  that  which  was  to  have  been 
ex|>ected — the  treatment  was  of  no  benefit.  The  extract  has  been 
used  in  various  conditions,  empirically,  and,  fur  the  most  part,  un- 
successfully. 

Cases  of  Addison's  disease — a  bronzing  of  the  skin,  supposedly 
due,  in  the  majority  of  cases,  to  disease  of  tbe  supra-venal  capsules — 
have  been  treated  with  extract  of  tbe  supra-venals  of  animals,  and 
probably  were  benefited. 

In  cases  due  to  deficiency  of  certain  glands  in  the  body,  it  is 
reasonable  to  suppose  that  extracts  from  the  same  glands  in  tbe 
lower  animals  would  be  of  benefit ;  but  it  does  not  follow  that  tbe 
purely  empirical  use  of  these  extracts  in  different  conditions  would 
do  good. 

Mebcurial  Ebuptioks  and  Eeuptioks  from  Mercurial. 
Inunction. 
The  Joum<U  of  Cutaneoug  and  Genito-  Urinary  Diseases,  Febru- 
ary-, 1898,  quotes  Rosenthal  (Wien  Med.  Wockenschr.,  1897)  and 
Stopford  Taylor  {Brit.  Joum.  Derm.,  1897,  p.  346).  Symptoms 
vary  from  a  never  suppurating  follioulitia   to   various  urticarial,. 


^dbyGoOgle 


208       The  Atlanta  Medical  and  Surgical  Journal. 

«rythe(natous  and  even  hemorrhagic  eruptions.  Eczema,  purpura 
and  other  skin  symptoms  may  occur.  Severe  general  symptoms 
and  death  may  follow.  Eruption  may  spread  from  the  point  of 
Application  of  the  mercury  or  it  may  result,  in  various  places,  from 
the  internal  use  of  the  drug  in  any  form.  Even  inhalation  may  be 
followed  by  an  eruption,  with  great  scaling.  Idiosyncrasy  does  not 
play  so  important  a  part  as  does  the  kind  of  drug,  the  condition  ol 
the  kidneys,  mental  disorders  and  change  to  a  tropical  climat«. 

The  list  of  drugs  capable  of  producing  skin  eruptions  would 
-almost  index  the  pharmacopceia.  Those  which  produce  a  charac- 
teristic eruption  are  few.  It  is  a  toxic  action  referred  to  the  skiu, 
und  is  to  be  compared  to  that  of  various  other  substances  which 
produce  some  form  of  skin  eruption.  The  internal  use  of  mercurj' 
is  less  likely  to  produce  skiu  manifestations  than  the  external, 
owing  to  its  elimiuation  through  the  intestines. 


A  Case  op  Disseminated  Carcinoma  op  the  Trunk. 

Dr.  Clias.  W.  Allen  presented  this  ease  before  the  New  York 
Dermatological  Society,  Nov.,  1897  {Journ.  Cat.  and  0.  U.  Dis., 
March,  1898);  In  1891  Dr.  Allen  amputated  the  right  breast  of 
the  patient,  an  old  lady,  including  the  axillary  tissues  and  parts  of 
the  pectoral  muscles.  The  patient  remained  well  for  about  four 
jearH.  Then  a  nodule  appeared  in  the  line  of  incision.  When 
shown,  the  anterior,  lateral  and  posterior  a.=i|)ecls  of  the  right  chest 
wall  and  the  left  breast  were  involved.  Nodules  had  abo  devel- 
oped over  the  lumbar  region. 

This  case  demonstrates  the  uncertainty  as  to  progn'jsis  in  cancer 
of  the  breast.  This  |>atient  either  had  the  carcinomatous  tendency, 
ihe  disease  redeveloping  de  novo  in  the  sear,  or  some  cells  were  left 
ill  the  operation,  or  implanted  from  elsewhere,  and  then  remained 
quiescent  fur  soiiie  years.  It  is  questionable  if  the  first  of  these 
suppositions  is  not  the  more  nearly  correct. 


Arsenical  Pigmentation. 

Dr.  W.  A,  Hardaway,  of  St.  Louis,  has  a  report  of  two  cases,  and 

some  remarks  upon   this  condition,  in  the  April,  1898,  Journ.  of 


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Selections  and  Abstracts.  209 

Oulan.  and  G.  U.  IHteatet.  PigmentatioD  of  the  skin  after  pro- 
longed use — ioterDallj — of  areeDio  is  well  knowu.  Coogestive  or 
inflammatory  coDditioDs  of  the  skin  followed  hy  the  pigmentation, 
due  to  aTsenic,  i8  not  so  commooly  recognized.  The  doctor  has 
sortie  donbt  whether  this  pigmentation  is  ever  the  first  symptom. 
The  discoloration  is  Dot  comparable  to  argysia,  which  is  due  to  the 
alver  deposit  in  the  skin.  His  cases  showed  the  erythematous 
symptoms  first,  and  the  pigmentation  which  followed  was  limited 
to  the  previoosly  affected  spots. 

£veD  temporary  congestion  or  inflammation  of  the  skin  is  often 
followed  by  an  increased  deposition  of  pigment.  The  site  of  the 
local  use  of  a  sinapism  often  remains  clearly  defined,  through  pig- 
mentation, for  a  long  time,  and  erythema  or  inflammation  from  an 
interoal  cause  can  act  in  the  same  way. 


Cancee  op  the  Urbthba. 
The  above  Journal  also  quotes  cases  of  Drs.  Binaud  and  Chav- 
annaz,  reported  to  the  Freoch  Association  of  Genito-Urinary  Sur- 
geons in  October.  It  was  a  "curious  form."  Patient  was  a  man  of 
forty-four.  The  penis  was  deformed.  The  posterior  was  indurated 
and  appeared  as  if  in  erection  ;  the  anterior  portion,  with  the  glans, 
was  normal.  The  patient  died,  and  autopsy  disclosed  encephaloid 
cancer  of  the  hack  part  of  the  anterior  urethra,  a  part  of  one  cor- 
pus cavernosum,  prostate  and  deep  urethra. 


MISCELLANEOUS. 

Liquid  Air. 


Oneof  the  latest  achivements  of  physics  to  excite  wide-spread  in- 
terest is  the  liquefaction  of  air  on  an  extensive  scale.  Air  had 
been  liquefied  as  early  as  1880  by  Dewar,  of  the  Royal  Institution, 
and,  indeed,  as  far  back  as  1777,  Pictet,  of  Geneva,  succeeded  in 
liquefying  oxygen.  In  both  cases  the  liquefaction  was  accom- 
plished by  the  use  of  an  auxiliary  liquefied  gas,  the  evaporation  of 
which  produced  a  degree  of  cold  sufficient  to  liquefy  the  air  or  gas. 
lo  1890  Mr.  Tripler,  of  New  York,  discovered  a  process  not  alone 

s 

DiclzedbyGoOgle 


210       The  Atlanta  Medical  and  Surgical  Journal. 

superior  to  that  pi-evioualy  employed,  but  also  less  expensive.  He 
secured  tbe  liqueTactioD  of  air  eutirely  by>its  own  expausioD,  after 
subjectiag  it  to  a  pressure  of  2,000  pouods.  The  sudden  expaa- 
sioD  of  the  compressed  air  produces  such  a  degree  of  cold  that  a 
part  of  tbe  air — about  one-third — is  rendered  liquid.  Liquid'air 
atatmospbericpressurehasa  temperature  of  191°  C.  (about  ^12°  F.); 
it  is  a  slightly  opalescent  liquid,  and  can  be  poured  from  one  vessel 
to  auother  just  as  any  other  liquid  substance. 

Professor  Barker,  of  tbe  University  of  Pennsylvaoia,  who  has 
been  chiefly  instrumental  in  bringing  Mr.  Tripler's  discovery  be- 
fore the  scientific  public,  has  made  an  extensive  series  of  experi- 
ments vith  the  liquid  air,  which,  by  the  new  process,  is  obtainable 
in  large  quantities.  Some  of  these  experiments  border  almost  on 
the  magical,  and  fascinated  his  hearers. 

Exposed  to  the  atmosphere,  liquid  air  boils  and  steams  like  boil- 
ing water.  The  degree  of  cold  engendered  is  so  intense  that  almost 
everything  brought  in  contact  with  the  liquid  air  is  instantly  frozen. 
Mercury  becomes  solid  ;  soil  rubber-tubing  is  rendered  so  brittle 
that  it  breaks  into  fragments ;  a  piece  of  beefsteak  placed  in  it  be- 
comes stouy  hard  and  can  be  broken  with  a  hammer  like  glass. 
Upon  pure  metals,  such  as  gold,  silver  and  copper,  liquid  air  has 
no  eflect.  It  supports  combustion,  though  it  itself,  like  ordinary  air, 
is  not  inflammable.  Oo  account  of  the  unequal  boiling  points  of 
liquid  oxygen  and  liquid  nitrogen,  that  of  the  latter  being  much 
higher,  tbe  nitrogen  is  given  off  more  rapidly,  and  the  liquid  be- 
comes progressively  richer  in  oxygen,  Tbe  slight  opalescence  of 
the  liquid  is  due  to  frozen  water  and  carbon  dioxide. 

It  need  bardly  be  said  that  the  intense  cold  is  destructive  to  tbe 
skin  and  produces  painful  blisters.  Professor  Barker  told  the 
writer  that  he  had  a  burn  from  a  hot  plate  on  one  thumb  and  a 
blister  from  liquid  air  on  the  other,  and  remarked  that  he  could 
scarcely  tell  tbe  difference. 

Regarding  the  possible  uses  of  liquid  air,  it  seems  that  Mr. 
Tripler  hopes  to  employ  it  as  a  motive  power  and  for  purposes  of 
refrigeration.  Tbe  latter  can,  it  is  said,  be  accomplished  at  leas 
expense  than  by  tbe  ordinary  freezing  process. 

To  science,  liquid  air  offers  a  profitable  field  for  experiroeotation. 


^dbyGoOgle 


Selections  and  Abstracts.  211 

Most  Biibstaaces,  when  exposed  to  a  low  temperature,  change  their 
nature  more  or  less;  and  being  able  to  produce  by  means  of  liquid 
air  a  temperature  as  low  nearly  as  200°  C,  science  will  have  a  val- 
uable opportunity  for  studies  in  this  direction.  It  has  been  showu 
that  the  electric  resistauce  of  metals  is  diminished  by  cold;  if  the 
resistance  cau  he  entirely  nulliRed,  it  will  be  possible  to  transmit 
powerful  currents  of  electricity  to  great  distances  without  loss. 
And  it  has,  indeed,  been  suggested  to  surround  conductors  with  an 
envelope  of  liquid  air  to  reduce  the  resistance  to  a  minimum. 

As  far  as  our  own  science  is  concerned,  Professor  Barker  gave 
utterance  to  the  hope  that  liquid  air  might  find  in  it  many  uses.  As 
a  germicide  and  preservative  it  would  be  far  more  efficient  than 
freezing — as  Professor  Barker  qaaintly  remarked  in  conversation, 
"a  quart  of  liquid  air  could  be  left  at  the  house  every  morning 
and  placed  iu  the  refrigerator."  An  additional  advantage  in  this 
respect  is  that  it  gives  off  no  moisture,  but  yields  up  oxygen,  which 
purifies  the  air.  In  the  sick-room  it  could  be  employed  as  a  cooling 
agent,  as  well  as  for  purifying  the  atmosphere.  Whether  it  will  be 
useful  as  a  local  auesthetic  is  questionable,  as  the  degree  of  cold  is 
too  great;  yet  a  means  of  regulating  this  may  be  found.  For 
freezing  tissue  for  histologic  purposes  it  probably  possesses  no  su- 
periority over  compre3.'<ed  carbon  dioxid. — Philadelphia  Polydinie. 

The  Possibilities  of  Amtitoxin  in  Diphtheria. 

There  is  no  difierence  of  opinion  now  among  medical  men  re- 
garding the  efficiency  of  diphtheria  antitoxin.  Statistics  have 
abundantly  proved  the  decreased  death-rate  resulting  from  its  use, 
although  there  may  be  found  an  occasional  doubter  who  refuses  to 
believe  any  kind  of  evidence  regarding  this  new  remedy. 

Having  had  something  to  do  with  the  introduction  of  antitoxin 
for  the  use  of  the  Contagious  Department  of  Harper  Hospital  of 
this  city,  and  having  watched  its  administration  Irom  the  begin- 
ning, the  writer  believes  that  a  very  much  better  i>ercentage  of 
result  is  attained  with  the  early  use  of  antitoxin  in  situations  where 
hygienic  conditions  prevail,  such  as  are  found  in  a  well-conducted 
hospital  or  even  in  the  average  private  practice. 


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212       The  Atlanta  Medical  and  Surgical  Joubnal. 

Antitoxin  was  first  used  in  Harper  Hospital  in  the  fall  and  win- 
ter of  1894  in  a  sporadic  tentative  way.  Forty-four  cases  of  diph- 
theria were  treated  with  the  Aronaon  and  Bebring'a  serum,  with 
four  deaths  (exclusive  of  three  moribund  on  admission),  and  a 
death-rat«  accordingly  of  9.1  per  cent.,  when  it  happened  that  the 
supply  of  these  became  exhausted.  At  this  juncture  Parke,  Davis 
&  Co.'s  diphtheria  antitoxin  was  employed  and  found  to  be  folly 
equal  to  any  of  the  serums  which  had  been  previously  employed; 
indeed,  this  is  putting  it  too  mildly,  for  not  only  did  fewer  disa- 
greeable sequein  follow  its  hypodermic  administration,  but  cases 
progressed  manifestly  better  under  it.  Thus  in  the  remaining  pe- 
riod of  1895  there  were  25  cases,  all  of  whom  were  treated  with 
this  sernm  (with  the  exclusion  of  one  moribund  on  admission). 
There  was  one  death  among  these,  dealb-rate  accordingly  being 
4.1  per  cent.     Four  were  tracheotomy  cases  with  four  recoveries. 

In  1896  there  were  112  cases  admitted  to  the  diphtheria  ward 
of  the  Contagious  Hospital,  12  being  subjected  to  intubation,  €  to 
tracheotomy,  with  only  five  deaths,  "three  of  these  being  moribund 
cases  when  brought  to  (be  hospital,  dying  within  a  few  hours  of  their 
arrival."     There  was,  therefore,  a  mortality  of  1.8  percent. 

For  the  present  year,  1897,  up  to  December,  there  have  been 
treated  90  cases  of  diphtheria  in  the  hospital,  with  6  deaths.  One 
case  was  certainly  moribund  on  admission,  another  may  be  called 
doubtfully  so,  but  without  excluding  the  latter,  the  death-rate  was 
5.tj  per  cent.     The  antitoxin  used  was  the  same. 

The  notable  diminution  in  the  death-rate  as  above  given  led  the 
Detroit  Board  of  Health  to  decide  to  furnish  diphtheria  antitoxin 
gratuitously  to  persons  too  jioor  to  pay  for  it,  this  also  including 
patients  under  the  charge  of  the  city  physicians,  poor  patients  at 
Harper  Hospital  sent  there  by  the  Board  of  Health,  at  the  Women's 
Hospital  and  at  the  Protestant  Orphan  Asylum.  This  was  done 
from  May  1,  1896,  and  the  number  of  patients  so  treated  up  to 
February  28,  1897,  close  of  the  official  year,  was  as  follows : 

HorUlity 
Gun.        DeUbt.  lUte. 

Wilh  Antlloiin 874  47  12.66  per  cmL 

Without  Antitoxin^ 4K7  163  M.BO  per  cant. 


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Selections  and  Abstracts.  213 

Id  oontinuatioD  of  this  serieB  of  obaervations  are  the  following 
results  from  figures  not  yet  made  public,  but  kiudiy  furuisbed  me 
by  the  Board  of  Health.  From  March  1,  1897,  up  to  December, 
the  following  cases  came  either  under  the  notice  or  care  of  the 
Board: 

HorUlitj 
Cases.        Deatbi.  Bate. 

With  ADtitoxin._ 806  82  10.49  per  cent. 

Without  Antitoxin 6$2  102  S0.S9  per  cent. 

The  antitoxin  employed  by  the  Detroit  Board  of  Health  has 
been  from  the  first  that  of  Parke,  Davis  &  Co. 

These  figures  go  to  show  that  as  experience  in  its  use  accumu- 
lates, and  as  both  medical  men  and  the  public  at  large  see  the  ad- 
vantage arising  from  the  use  of  antitoxin  early  in  the  diphtheritic 
invasion,  there  is  attained  a  continued  and  steady  improvement  in 
reenlts. 

With  patients  in  comfortable  circumstances,  assured  of  careful 
nursing,  conscientious  isolation,  and  the  administration  of  a- relia- 
ble antitoxin,  there  is  very  much  to  encourage  the  profession  to 
expect  a  very  close  approach  to  the  Harper  Hospital  figures — that 
is  to  say,  a  percentage  of  deaths  not  to  exceed  6  or  7.  This  would 
certainly  lift  diphtheria  out  of  the  bad  repute  it  has  had  hitherto 
of  being  one  of  our  most  fatal  diseases. — Dr.  George  Suttie,  of 
Detroit,  in  LouiamlU  Med.  Mordhly,  Feb.,  1898. 


Silkworm  Gut. 


Dr.  R.  T.  Morris,  of  New  York,  in  the  Kan»a«  GUy  MedieaC 
Index,  says: 

Silkworm  gut  is  an  instrument  of  the  devil  wheu  used  for  buried 
permanent  sutures.  About  three  years  ago  I  read  an  article  on 
the  use  of  silkworm  gut  by  a  su^eou  whom  I  knew  to  be  a  care- 
ful observer,  and  I  was  tempted  to  give  up  my  good-enongh  cat- 
gut for  something  better.  Id  the  course  of  six  weeks  I  employed 
buried  silkworm  gut  sutures  in  some  twenty  abdominal  operations 
for  patients  who  had  put  confidence  in  me  and  had  entrusted  their 
lives  to  my  care.  At  the  end  of  the  six  weeks  I  found  that  some 
of  these  buried  silk  knots  were  coming  out  in  strange  places,  and 


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214       The  Atlanta  Medical  and  Surgical  Journal. 

some  are  coming  out  yet — three  years  elapsed.  One  patient  died 
as  the  result  of  the  biirrowing  of  a  eilkworm  gut  knot  in  the  pel- 
vis several  months  nft&r  operation.  Nearly  all  of  the  patients  suf- 
fered in  one  way  or  another.  The  surgeon  who  wrote  the  paper 
advocating  the  use  of  the  buried  silkworm  gut  knot  has  written 
another  jmper  saying  that  he  is  sorry.  Meanwhile  other  surgeons 
are  bringing  discredit  upon  surgery  by  taking  up  tins  innocent 
looking  suture  material,  which  is  so  smooth  and  nice,  but  which 
refuses  to  liecome  encapsulated  in  the  tissues,  and  which  comes  out 
of  the  bladder  or  iliac  vein  just  after  the  surgeon  has  written  his 
paper.  A  recent  advocate  of  the  buried  silkworm  gut  suture  inti- 
mates that  some  of  us  did  not  use  aseptic  precaution,  and  that  we 
did  not  choose  the  right  sort  of  silkworm  gut.  To  this  I  will 
reply  that  most  oi  my  wounds  healed  completely  by  primary  union 
and  the  knots  came  out  months  or  years  afterward. 

To  those  who  say  they  have  had  no  trouble  with 'the  buried  silk- 
worm gut  knots,  I  wish  to  say  that  they  have  not  taken  the  trouble 
to  find  out.  The  trouble  is  all  on  the  part  of  the  patients.  The 
patient  goes  to  otie  surgeon  for  operation,  and  to  another  one  to 
complain.  S  >  it  requires  two  surgeons  to  write  the  history  of 
buried  silkworm  guts. 


The  Negro  Problem. 


Some  one  has  written  very  entertainingly  in  an  editorial  in  the 
,Vcto  York  Sfedical  Record  upon  "The  Physical  Degeneracy  of  the 
Negro."  He  solves  the  "  race  problem,"  which  has  puzzled  so 
many  brains  and  been  the  cause  of  so  much  thought  and  words,  in 
very  short  metre  and  very  effectually.  He  claims  that  physical 
degeneracy  will  soon  lead  to  the  entire  oblivion  of  the  race.  Those 
whom  tul)erculo6is  will  not  claim  for  its  own  will  be  carried  away 
by  venereal  diseases,  the  latter  having  become  so  prevalent  among 
them  that  it  has  rendered  the  female  negro  sterile  to  a  lai^  extent. 
And  the  ^''^ater  the  admixture  of  white  blood,  the  smaller  the 
negro's  resislance  to  disease. 

"  The  'negro  problem'  is  being  slowly  solved  by  busy  little  bacteria, 
working  a  slow  but  sure  decay.     Unless  the  negro  becomes  the 


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Selections  and  Abstracts.  215 

ward  of  this  great  and  good  f^vernmeut,  or  is  transported  to  some 
primitive  country  beyond  tlie  pale  of  civilization  and  its  vices  and 
allowed  to  recuperate,  his  doom  is  sure  and  certain.  Tlie  negro 
problem  will  be  solved  by  the  forces  of  nature,  and  not  by  leather- 
lunged  fanatics  who  shout  themselves  hoarse  over  effete  theories  of 
social  equality, —  Colorado  Med.  Journal, 


Cancer  of  the  Bbeast. 

Dr.  W.  L.  Bodroan  states  that  the  results  of  Keen,  Bui),  Dennis, 
Weir,  Halsted,  and  Powers,  sis  Ameriean  surgeons,  who  have 
withia  the  year  published  tbeir  statistics  in  operations  for  cancer 
of  the  breast,  show  a  mortality  of  less  than  one  per  cent.  (656 
operatioos  and  six  deaths).  He  concludes  his  paper  with  the  fol- 
lowing propositions : 

1.  AH  mammary  growths  should  be  removed  at  once,  for  inno- 
cent tumors,  carried  fur  a  long  time,  become  a  menace. 

2.  The  complete  operation  should  always  be  done  in  case  of  ma- 
lignant disease. 

3.  In  nearly  every  case  it  is  simply  impossible  to  detect  enlarged 
glands  until  the  axilla  is  opened.  Keen  says  he  cannot  do  so  once 
in  tea  times. 

4.  The  mortality  should  be,  with  average  operators,  about  three 
per  cent. 

5.  A  radical  operation  should  promise  from  25  to  50  per  cent, 
of  permanent  cures,  according  to  the  time  when  patients  apply- 

6.  When  in  donbt operate;  never  wait  for  symptoms. — Charlotte 
Medical  Observer. 


"Knock-Odt  Drops." 


By  this  term  is  understood  among  the  criminal  classes  the  use  of 
some  potent  drug  which  is  introduced  into  a  beverage  without  ihe 
victim's  knowledge. 

G.  W.  Henry  {Medical  World,  February,  1898)  invesligated  this 
subject  while  acting  as  coroner.  He  found  that  the  drops  were 
composed  of  hydrate  of  chloral  and  water,  the  high  solubility  of 
chloral  making  it  peculiarly  effective  iu  this  way,  as  a  drachm  of 


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216       The  Atlanta  Medical  and  Surgical  Journal. 

water  will  readily  dissolve  sixty  grains  of  chloral.  Gonsequeatly 
a  two-drachm  vial,  which  could  be  easily  carried  in  the  vest  pocket, 
could  be  made  to  contain  about  120  grains  of  chloral,  and  could 
be  readily  manipulated  in  the  band  without  attracting  attention. 
He  thinks  it  can  be  poured  into  a  glass  of  whisky,  wine,  beer,  or 
other  drink,  without  noticeably  affecting  the  taste  or  color.  Chlo- 
ral is  also  easily  procured  upon  various  pretexts,  and  is  sold  much 
more  readily  than  some  of  the  less  potent  poisons. — Medicine. 


General  Tonic. 

B    Strychninse  salphatifl... gr.  1-60. 

Acidt  phoaphorici  diluti m.  v. 

Ferri  phoephatis. gr.  i. 

Quininee  bisulphatis gr.  i. 

Glfcerini gsa. 

Ehr.  aurantii,  q.  b 3  sa. 

H.  et  ft-  solutio.    Sig.— Take  before  each  meal. 

—  Winslow  Anderson, 


Mercurial  stomatitis  is  in  many  instances  due  to  a  dirty  coudi* 
tion  of  the  mouth,  and  this,  frequently  among  those  who  ought  to 
know  better.  If  you  will  order  your  patient  to  clean  his  teeth 
every  three  hours,  and  oftener  if  he  should  eat  anything  between 
times,  he  will  be  far  less  Hable-to  the  pain  and  auDoyaoce  of  stom- 
atitis than  if  this  simple  rule  is  not  observed.  A  soft  tooth  brush 
and  a  mildly  alkaline  lotion  should  be  used. — Iniemaiional  Jour- 
nal of  Surgery. 


DiDRETIC  PfLL. 


The  following  pill  is  highly  recommended  in  cases  of  dropsy  of 
cardiac  origiu : 

B     Scilln,  pulv., 

IHgiUlis,  pulv., 

CafTeinn  citratis   .  .: U  gn.  zzi. 

Hydrarg.  cbloT.mitU gre.  t. 

H.     Ft.  pil.  DO.  XXX.    Sig. — Odb  pill  three  timeE  dally,  alter  maala. 

N.  A.  Practitioner. 


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ATLANTA 

Medical  and  Surgical  Journal. 

Vol.  XV.  JUNE,  1898.  No.  4. 

M.  B.  HUTCHINS,  M.D., 


ORIGINAL  COMMUNICATIONS. 


MOUTH-BREATHING  IN  CHILDREN,  PARTICULARLY 
AS  A  RESULT  OF  ADENOIDS.* 

By  ARTHUR  G.  HOBBS,  M.D., 
Atlanta,  Ga. 

That  the  nose  was  intended  by  nature  only  as  an  olfactory  orgao 
is  the  accepted  belief  of  the  laity.  But,  that  ao  maoy  of  the  pro- 
fession should  yet  eotertaiD  the  same  idea  is  more  to  be  won- 
dered at.  It  would  seem  that  many  doctors  have  never  taken  the 
time  to  allow  it  to  occur  to  them  that  olfaction  is  ooly  a  secondary 
function  of  the  nose,  aud  that  the  space  allotted  to  this  least  im- 
portant of  the  senses  is  confined  to  a  very  small  part  of  this  prom- 
inent feature. 

The  nose  is  intended  for  breathing  through  and  because  of  this 
very  important  function  and  on  account  of  its  possible  closure  from 
aondent,  or  otherwise,  the  mouth  may  be  brought  into  service  as 
an  auxiliary  in  time  of  need,  but  only  temporarily — indeed  only 
asan  auxiliary  to  respiration.     As  an  automatic  organ,  there  are  but 

•  aMdMUMSoutberaSocUoDor  tba  Amerloui  Otoloslcal.  Rhlaologlcal  and  Larja^log- 
kal  AModMloo,  AlUaU,  Nuch  ISth. 


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218       The  Atlanta  Medical  and  Surgical  Journal. 

few  in  the  body  to  compare  with  the  work  performed  by  the  lioing 
membrane  of  a  healthy  and  Dfttural  nasal  muooua  membrane.  It 
suppliee  the  proper  moisture  to  adapt  the  air  to  the  langs  by 
secreting  an  immense  amount  of  fluid  for  dry  air  to  pass  over,  or 
a  much  less  amount  when  the  air  ia  moist,  thus  automatically 
adapting  itself  to  the  humidity  of  the  inspired  air.  As  in  the  gills 
of  a  fish,  nature  has  supplied  a  large  superficial  area  of  mucous 
membrane  surface  to  this  upper  part  of  the  respiratory  tract — about 
thirty-six  square  inches  as  computed  by  Br.  Onodi.  And  Binz, 
Onodi  and  others  have  estimated  that  as  much  as  two  pints 
of  fluid  are  secreted  daily  by  this  large  sur&ce  when  the  air 
is  devoid  of  humidity,  in  order  to  supply  it  with  sufficient 
moisture  to  make  it  suitable  to  the  parts  below,  where  the 
mucous  membrane  is  less  active  in  its  secretory  function,  and 
hence,  less  automatic  in  its  response  to  the  necessities  of  a 
uniform  degree  of  humidity  of  the  inspired  air.  The  ciliated 
epithelium  of  the  mucous  snr&ce  of  the  lower  air  passages  per- 
forms another  function  than  that  of  active  secretion,  which  is 
generally  the  office  of  a  membrane  with  a  squamous  epithelium, 
such  as  we  find  the  nasal  and  pharyngeal  mucous  membrane  sup- 
plied with. 

In  mouth-breathing  the  inhaled  air  cannot  pass  over  more  than 
one-bair  of  the  moist  sur&ce  that  it  does  when  inhaled  through  the 
nose,  and  this  small  surface  is  insufficient  to  impart  the  necessary 
moisture.  Hence — and  how  natural — the  parehed  mouth  and  dry 
throat  of  one  who  has  breathed,  during  sleep,  through  nature's 
auxiliary,  the  mouth  only.  It  would  not  be  a  stretch  of  the  im- 
agination should  we  reason  by  inference  alone,  without  pausing  to 
consider  the  many  well-known  and  easily  demonstrable  results, 
bow  disastrous  to  the  lower  air  passages  a  constant  and  continuous 
mouth-breathing  would  necessarily  be  to  a  growing  child.  But 
this  is  not  all.  The  other  one  of  the  principal  functions  of  the 
nasal  membrane  seems  even  more  wonderful  in  its  automatic  action. 
It  warms  the  inspired  air  when  it  is  too  cold  for  the  lower  air 
passages.  The  arterial  circulation  of  the  membrane  becomes  greatly 
accelerated  by  the  inhalation  of  cold  air,  without  reference  to  its 
secretory  function,  and  automatically   regulates  its  surface  heat  ac- 


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Movth-Bksathino  in  Children.  219 

«ordiog  to  the  temperature  of  the  iaepired  air.  When  the  air  is 
dry  and  warm,  ite  secretioD  alone  is  accelerated,  aod  when  it  is 
«old  and  not  devoid  of  humidity,  the  increased  activity  of  the  arte- 
rial circulation  supplies  more  heat  than  fluid. 

It  would  then  be  unnatural  to  expect  au  organ  so  delicately 
poiaed  not  to  easily  become  unbalanced  when  it  is  eo  constantly 
and  directly  subjected  to  the  many  sudden  cfaaDges  of  temperature 
and  humidity.  And  how  much  more  so  when  we  remember  that 
it  has  to  hear  the  brunt,  indirectly,  of  so  many  of  nature's  traversed 
laws  through 'Other,  and  even  the  most  distant,  parts  of  the  body. 
Particularly  should  we  be  impressed  with  this  fact  when  we 
remember  that  this  organ  is  called  upon  to  perform  these  automatic 
functions  even  in  our  climate  with  its  almost  daily  changes  of 
humidity  and  its  great  ranges  of  temperature. 

It  is  not  necessary  to  follow  up  the  pathological  results  of  this 
constant  battle  that  never  ceases,  where  in  so  many  cases  it  finally 
fitils,  to  preserve  its  physiological  condition.  Each  recurrent  attack 
adds  to  the  effect  produced  before,  ere  nature  has  had  the  time  or 
the  opportunity  to  bring  about  the  proper  resolution.  Hence  the 
result  is  nasal  stenosis  from  au  hyperplasia  or  au  hypertrophy  of 
the  turbinal  membrane.  Mouth-breathing  naturally  results,  and  it 
is  fortunate  that  nature  has  provided  this  auxiliary  in  such  cases  of 
need.  Yet  this  substitute  may,  on  the  other  hand,  be  considered  a 
misfortune  to  the  growing  child,  when  we  think  of  the  many  results 
of  a  chronic  stenosis.  The  circulation  of  the  blood  is  interfered 
with,  and  hence  the  development  of  the  child  is  perverted  and  re- 
tarded, the  fecial  expression  becomes  unnatural,  the  palate  becomes 
more  arched,  and  the  nose  more  flattened,  together  with  many  more 
results  so  well  known  to  all  who  see  these  cases  daily. 

After  childhood,  and  especially  when  adult  life  is  reached,  the 
space  between  the  opposing  mucous  sur&ces  is  so  much  greater 
that  a  stenosis  from  turbinal  thickening  alone  rarely  results  in 
moutb-breatbiog  during  the  waking  hours,  although  the  voice  tone 
may  be  so  much  muffled  as  to  suggest  an  adenoid  or  a  polypus. 

In  children,  the  nasal  stenosis  which  results  from  turbinal  thick- 
ening has  the  additional  factor  of  the  undislodged  secretions  which 
can  result  only  in  moutb-breathing.     But  when  due  to  this  cause 


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220       The  Atlanta  Medical  and  Suboical  Joorbal. 

alone  tbe  history  usually  shows  a  short  duration,  since  nature's 
efforts,  assisted  or  not,  are  as  a  rule  equal  to  the  emergency  of 
bringing  about  tbe  proper  restoration  unless  the  recurrent  attacks 
become  too  frequent. 

But  how  different  is  the  picture  when  adenoid  growths  fill  this 
cavity  and  necessitate  breathing  through  the  mouth,  Tbe  history 
of  the  case  does  not  then  tell  of  an  acute,  or  a  transitory  condition. 
The  child's  pinched  face,  open  mouib,  voice  tone,  and  general  ap- 
pearance of  malnutritiun  would  belie  such  a  statement. 

There  are  many  cases  that  present  themselves  to  ns  for  relief,  and 
too  often  with  tbe  vain  hope  of  obtaining  it.  We  occasionally 
have  cases  that  we  may  selfishly  wish  bad  gone  to  some  one  else, 
knowing  full  well  that  neither  could  accomplinh  tbe  end  desired. 
A  few  of  us  have  learned  that  we  can  assist  nature  to  cure  some  of 
the  cases  sometimes,  many  of  un  think  we  can  do  so  in  some  of  tbe 
cases  all  of  the  time ;  but  the  majority  of  us  have  learned  enough 
to  know  that  we  cannot  cure  all  tbe  cases  all  tbe  time.  But  for- 
tunately, when  mouth-breatbing  in  a  child  is  caused  by  an  adenoid, 
stenosis  or  a  polypus,  we  know  as  confidently  what  tbe  result  of 
proper  treatment  will  be  in  all  such  cases  as  we  could  know  any- 
thing in  surgery  positively. 

I  will  quote  some  lines  from  my  paper  describing  a  new  instru- 
ment for  the  excision  of  adenoids :  "A  post-pbaryngeai  adenoid  is 
as  truly  an  overgrowth  of  Luscka's  tonsil  as  is  a  wart  an  ovei^rowth 
of  a  papilla  of  tbe  epidermis.  The  two  differ  in  all  respects  only 
as  the  corium  of  tbe  skin  differs  from  the  lymphoid  cushion  in  the 
pharynx,  whence  each  has  its  respective  origin.  The  resemblance 
between  them  may  be  seen  in  the  different  degrees  of  consistency 
that  each  presents,  due  in  both  cases  to  the  rapidity  of  growth,  the 
age,  and  the  peculiar  condition  of  irritation  to  which  either  may 
have  been  subjected.  While  it  is  so-called  hypertrophy,  it  is  but 
little  like  the  hypertrophies  that  we  encounter  elsewhere,  par- 
ticularly in  children." 

Nothing  is  definitely  known  as  to  the  cause  of  adenoid  growths, 
unless  an  hereditary  tendency,  as  a  predisposing  cause,  together 
with  often- recurring  colds  as  the  excitant,  can  be  regarded  as  a  sat- 
isfactory etiology.     They  occur  most  frequently  in  children,  and 


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Mouth-Breatbinq  in  Children.  221 

msy  disappear  epontaneouely  when  the  subject  has  nearly  or  quite 
reached  maturity,  still  it  is  not  a  rare  occurrence  to  Sad  them  in 
youDg  adult«  or  even  in  those  who  have  reached  middle  age. 

The  diagnosis  is  not  difficult;  indeed,  by  exclusion,  the  nature 
and  character  of  the  growth  can  be  determiued  by  digital  examina- 
tion as  tbe  surest  means  in  cbildreu.  The  finger  finds  a  mass  id 
the  superior  pharynx  that  is  yielding  and  gelatinous,  with  a  fur- 
rowed surface  that  imparts  a  wormy  feeling. 

A  glance  at  tbe  child  or  even  to  bear  bis  muffled  tone  is 
often  all  that  is  necessary  to  form  a  diagnosis.  But  the  age  should 
be  considered  and  also  the  extent  and  character  of  the  deafness  if 
any;  the  open  mouth  with  the  vacant  expression;  tbe  imperfect 
chest  development ;  the  ill-shaped  nose  with  its  small  alse;  the  in- 
ability to  blow  the  nose,  together  with  the  history  of  snoring  or 
difficult  sleep-breathing.  On  the  other  hand  it  does  not  always 
follow  that  tbe  child  has  adenoids  because  be  snores  and  keeps 
bis  mouth  open  and  is  constantly  enjoined  by  the  mother  and 
nurse  to  blow  his  nose,  since  a  catarrbal  tumefaction  of  the  tur- 
binals,  enlarged  tonsils  or  foreign  bodies  such  au  buttons,  beans, 
etc.,  deliberately  thrust  into  the  nose  by  the  child  may  have  been 
the  cause.  In  children  it  is  not  so  necessary  to  exclude  polypi  or 
poet-nasal  abscesses,  or  bony  growths,  as  these  are  rarely  found  at 
this  time  of  life. 

It  would  not  be  apropos  in  this  paper  to  discuss  the  sequelie  of 
nasal  stenosis  in  children  farther-  than  to  mention  the  not  unfre- 
qnent  middle  ear  inflammation  with  its  natural  result?  of  a  rupture 
of  the  drum  membrane,  which  in  scorbutic  children  usually  ends 
in  chronic  suppuration. 

In  any  case  tbe  treatment  that  succeeds  in  restoring  an  opening 
to  nature's  normal  breathing  space  which  will  enable  the  nose  to 
perform  its  double  function  of  supplying  moisture  and  warmth  to 
the  inspired  air  accomplishes  many  good  results  that  are  oftentimes 
unexpected.  The  use  of  tbe  finger-nail,  or  the  gouge-shaped  thim- 
ble is  advocated  by  some,  but  should  be  resorted  to  only  in  urgent 
cases.  Meyer,  who  has  tbe  honor  of  first  having  described  adenoid 
vegetations,  still  resorts  to  the  post-nasal  curette  in  children.  Vol- 
tolini  seems  to  prefer  the  wire  loop  inserted  beneath  the  palate,  a 


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222       The  Atlanta  Medical  and  Subgical  Journal. 

very  qnestiooable  procedure  in  children.  The  bullet  forcepa  of 
Loenburg  and  Michael  may  be  resorted  to  and  safely  used  in  many 
cases.  Gleitzman  and  Elsburg's  forceps  are  much  more  frequently 
used  in  England  and  on  the  continent  than  in  this  country.  In  most 
cases  requiring  an  operation  in  little  fellowa  who  have  to  he  held,  as 
well  as  in  many  of  those  who  are  reasonable  enough  to  accept  the 
inevitable,  I  uee  my  own  forceps  which  have  large  fenestrce  and 
email  shanks.  These  large  openings  in  the  blades  allow  the  soft 
mass  to  pass  through  which  enables  the  operator  to  very  rapidly 
make  a  number  of  grasps  on  the  mass  without  having  to  withdraw 
the  instrument.  These  forceps  are  equally  as  adaptable  to  operat- 
ing when  anesthesia  is  considered  necessary. 

I  will  not  mention  the  many  other  instruments  that  have  been 
and  are  now  being  used  for  the  excision  of  adenoids.  Notwith- 
standing their  large  number  and  variety  no  one  instrument,  or  no 
one  means  of  operating,  has  seemed  to  have  gained  any  decided  pre- 
ponderance of  favor.  The  very  nature  of  these  cases,  as  we  find 
them  in  children,  affording  as  they  do  so  many  ways  of  being 
reached,  and  capable  of  such  brilliant  results  when  succeBsfully 
reached,  is  calculated  to  develop  an  individuality  in  the  operator. 
I  realize  that  I  do  not  agree  with  most  operators  when  I  say  that 
I  have  not  found  it  necessary  to  extricate  the  whole  mass,  although 
I  would  consider  it  de^rable.  It  has  been  my  observation  that  a 
complete  extirpation  is  rarely  necessary  since  any  remaining  part 
of  the  growth  atrophies  when  its  greater  portion  has  been  removed 
and  nasal-breathing  has  been  reestablished. 

A  proper  course  of  constitutional  treatment  is  almost  as  essenUal 
as  the  surgical  in  a  pale,  anemic,  mouth-breathing  child  with  his 
ill-shaped  nose  and  open  mouth,  pathetic  expression  of  the  eyes, 
muffled  tone  of  the  voice,  etc.  Such  alteratives  as  the  syrup  of 
the  iodide  of  iron,  or  iodine  in  some  other  acceptable  form;  the 
chlorides  alone,  or  combined  with  cinchona  in  some  form,  or  with 
the  now  generally  known  succus  alterans,  will  produce  as  decided 
a  tonic  effect  as  the  iodides  and  mercury  do  in  syphilis.  No  class 
of  patients  is  more  satis&ctory  when  we  consider  the  almost  certain 
good  results  that  follow  the  proper  surgical  and  constitutional 
treatment  for  mouth-breathing  in  children. 


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SOME  REMARKS  UPON  SYPHILITIC  MANIFESTA- 
TIONS IN  THE  LARYNX. » 

B«  PAUL  TOBNEB  TAUOHAN,  M..D, 
Hot  Sprinqs,  Abkamias. 

ConuDg  from  a  health  resort  where  syphilis  in  its  various  mani- 
festatioDs  is  seen  cODstaotly,  and  where  innumerable  opportunities 
are  presented  for  studying  this  disease,  I  have  taken  for  my  sub- 
ject of  discussion  to-day  Laryngeal  Syphilis. 

Hot  Springs,  on  account  of  its  wonderfully  beneficial  thermal 
waters,  has  become  the  city  toward  which,  yearly,  tbousauds  of  in- 
valids suffering  with  syphilis  travel,  and  in  no  other  city  that  I 
am  familiar  with,  except  perhaps  Vienna,  is  it  possible  to  study 
this  disease  in  eo  many  interesting  and  varied  phases. 

I  shall  lay  before  you  to-day  some  &ct8  coming  front  several 
years  of  close  study  and  observation  upon  this  subjeot,  and  while 
they  are  not  new  facts  to  such  a  body  of  physicians  as  this  is,  still 
tbey  are  facts  which  will  bear  repetition,  for  in  dealing  with  this 
disease  we  are  dealing  with  one  insidious  in  its  approaches  and  &r- 
reachingin  its  ravages  upon  the  human  body,  if  its  course  be  not 
checked  early  by  appropriate  treatment. 

Syphilitic  manifestations  in  the  larynx  are  met  with  rather  fre- 
quently, and,  like  the  manifestations  of  syphilis  in  any  other  por- 
tion of  the  body,  may  be  divided  arbitrarily  into  three  stages,  pri- 
mary, secondary  and  tertiary. 

I  do  not  think  that  the  division  of  syphilitic  manifestations  into 
secondary  and  tertiary  is  a  good  division,  because  we  constantly  see 
secondary  manifestations  occurring  in  what  is  regarded  the  tertiary 
stage,  and  vice  versa,  tertiary  manifestations  often  occurring  in  a  few 
months  after  the  initial  lesion,  and  in  the  period  which  some  would 
designate  secondary. 

I  have  often   seen   mucous  patches  occur  in  the  throat  fifteen 


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224       The  Atlanta  Medical  and  Scroical  Journal. 

years  after  the  initial  lesion,  and  conversely,  I  have  seen  ginnmata 
uccur  within  six  months  after  the  primary  sore. 

However,  in  lieu  of  some  better  classification,  I  shall  speak  of 
the  symptoms  as  beiog  primary,  secondary  aad  tertiary. 

Personally,  I  have  never  seen  a  primary  syphilitic  sore  situated 
in  the  larynx,  and  in  my  reading  upon  the  subject  have  only  found 
reference  to  one  such  case,  but  the  erythema,  mucous  patch,  ulcer- 
ative process  and  gumma,  followed  later  by  breaking  down  of  the 
gummy  tumor,  and  the  subsequent  formation  of  cicatricial  tissue, 
and  the  occurrence  of  stenosis  of  the  larynx  in  varying  degrees,  are, 
with  the  possible  exception  of  the  mucous  patch,  rather  common 
pictures  to  the  laryngologist. 

Mucous  patches  are  considered  a  rather  characteristic  symptom 
of  syphilis,  and  although  of  rare  occurrence,  they  do  sometimes 
exist  in  the  larynx. 

When  found  present  in  this  locality  they  appear  by  preference  to 
locate  upon  the  upper  surface  and  free  margin  of  the  epiglottis  on 
the  false  vocal  cords,  and  sometimes  are  found  on  the  inter-aryt- 
enoid  commissure. 

A  quite  marked  symptom  in  a  great  many  cases  of  syphilis  in  its 
early  stage  is  the  appearance  of  laryngeal  catarrh,  and  only  in  one 
particular  does  this  differ  from  an  ordinary  catarrh,  the  last  named 
variety  being  usually  relieved  by  topical  applications  while  they 
are  only  of  limited  value  in  the  specific  type,  one  being  compelled 
to  resort  to  antisyphilitic  treatment  in  order  to  relieve  the  condition. 

The  erythema  observed  in  the  larynx  is  not  so  marked  and  is 
not  so  characteristic  as  is  the  erythema  so  often  found  present  in 
syphilis  of  the  larynx,  but  it  is  sufficiently  noticeable,  particularly 
when  associated  with  alternating  patches  of  red  and  white  situated 
upon  the  vocal  cords  to  lead  one  to  suspect  its  specific  origin. 

Pain  is  generally  absent,  and  the  condition  may  last  a  long  time 
showing  no  tendency  to  pass  into  one  of  the  graver  tnanifestations 
of  syphilis.  There  are  no  markedly  uncomfortable  symptoms  pro- 
duced by  the  erythema  unless  the  vocal  cords  become  involved.  If 
the  vocal  cords  become  involved  there  may  result  much  impair- 
ment of  the  voice ;  in  fact,  I  have  observed  some  cases  in  which 
the  voice  was  completely  lost. 


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Syphilitic  Manifestations  in  the  Larynx.  22& 

Probably  the  most  cominon  manifestation  of  syphilis  in  the  ter- 
tiary form  in  the  larynx  is  ulceration.  This  is  preceded  by  an  in- 
filtration of  the  mucous  membrane  with  inflammatory  products 
and  is  usually  diSuse  in  character. 

Gumraata  are  commonly  situated  near  the  posterioi  commissure, 
apon  the  arytenoid  cartilages  and  upon  the  epiglottis.  At  first 
they  are  small,  of  the  same  color  as  the  contiguous  mucous  mem- 
brane and  often  passed  unnoticed  for  some  time,  but  gradually 
they  enlarge,  soften,  a  small  yellow  spot  appears  in  the  center  of 
each  gumma,  and  finally  a  destructive  ulcerative  jtrocess  begins. 

This  ulcerative  process  may  be  either  superficial  or  deep,  the 
super6cial  variety  occurring  in  what  is  generally  called  the  secon- 
dary stage.  From  the  cases  coming  under  my  observation  I  am 
inclined  to  the  belief  that  both  varieties  of  ulceration  are  the  re- 
sult of  the  disintegration  of  gummy  tumors,  the  superficial  variety 
occurring  when  the  tumor  is  situated  just  beneath  the  mucous 
membrane,  and  the  deep  variety  occurring  when  the  tumor  is  more 
deeply  situated  ;  hence,  I  speak  of  both  varieties  as  occurring  in 
the  tertiary  stage  of  the  disease.  Ulceration,  when  once  estab- 
lished, progresses  very  rapidly,  and  frequently  large  areas  are  com- 
pletely destroyed. 

When  ulceration  occurs  on  the  epiglottis,  entire  destruction  of 
the  valve  may  take  place  before  the  patient  can  be  brought  under 
the  influence  of  medicine.  When  much  tissue  has  been  destroyed 
there  will,  of  course,  after  healing  begins,  be  a  formation  of  cica- 
trices with  resulting  stenosis,  and  sometimes  great  distortion  of  the 
larynx. 

When  this  occurs  the  voice  is  permanently  much  altered  in 
character. 

On  account  of  the  clinical  history  of  the  case  there  is  generally 
no  trouble  in  making  a  diagnosis  of  laryngeal  syphilis,  but  some- 
timesa  case  ia  met  with  in  which  the  diagnosis  is  exceedingly  diffi- 
cult to  make. 

Syphilitic  ulcers  in  the  larynx  have  sharply  defined  borders, 
are  excavated,  have  a  dirty,  purulent  slough  upon  their  floors,  and 
are  surrounded  by  angry  looking,  very  much  indamed  mucous 
membrane,  and  in  addition  there  is  comparative  absence  of  pain. 


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226       Tea  Atlanta  Medical  ahd  Surgical  Jocrkai. 

Tnberculous  ulcers  present  an  entirely  different  clinical  picture, 
faaving  ragged,  illy-defined  borders,  are  superficially  situated,  are 
ratber  grayish  looking  in  appearance,  are  not  surrounded  by  in- 
flamed mucous  membrane,  and  tbe  pain  is  severe  and  almost  con- 
fltast.  In  doubtful  cases  an  examination  of  the  lungs  and  of  the 
spntam  will  usually  aid  in  establishing  a  diagnosis. 

The  most  difficult  cases  I  have  had  any  experience  with  in  estab- 
lishing a  diagnosis  have  been  in  cases  of  malignant  disease  of  the 
larynx.  In  carcinoma,  after  ulceration  begins,  the  differential 
diagnosis  is  very  bard  to  make,  and  I  confess  it  has  been  my  expe- 
rience that  only  treatment  with  tbe  iodide  will  establish  a  <3iag- 
oosis. 

With  lupus  of  tbe  larynx  I  have  had  no  experience,  having  only 
observed  one  case,  and  consequently  cannot  speak  from  personal 
observation  upon  this  point,  but  it  is  said  that  lupus  is  rarely,  if 
«ver,  primarily  seen  in  the  larynx. 

Before  proceeding  to  the  subject  of  treatment  I  shall  refer  to 
several  bodily  conditions  which  influence  seriously  both  the  course 
«nd  treatment  of  this  disease. 

Anemia  and  general  malnutrition,  when  present,  necessarily 
■allow  the  syphilitic  infection  to  become  general  earlier,  and  to  pass 
through  its  various  stages  in  a  much  shorter  period  than  when  the 
patient  is  in  good  bodily  condition. 

One  of  tbe  most  serious  complications  possible  in  a  patient  suf- 
fering with  syphilis  is  for  the  patient  to  develop  tuberculosis. 

A  patient  in  whom  syphilis  is  present,  owing  to  the  necessarily 
weakened  condition  of  bis  system  and  consequently  its  inability  to 
resist  infection,  offers  a  peculiarly  fertile  soil  for  the  active  and 
rapid  development  of  tuberculosis. 

Another  condition  which  exerts  an  unfavorable  action  upon  the 
course  of  syphilis  is  the  presence  of  a  chronic  nephritis. 

Both  mercury  and  the  iodide  are  to  a  great  extent  eliminated  by 
tbe  kidneys,  and  wbeu  these  organs  are  diseased  the  administration 
of  both  drugs,  in  sufficient  quantity  to  accomplish  benefit,  is  se- 
riously interfered  with. 

Arterial  disease,  or  arterio-sclerosis,  is  another  condition  occur- 
ring in  elderly  people,  which  may  infiuenoe  tbe  course  of  tbe  dis- 


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Syphilitic  Manifestations  in  the  Larymx.  227 

ease,  specially  as  the  blood-vessels  seem  to  be  particular  objects  of 
attack  hj  the  sjrphilitic  virus. 

Malaria  appears  also,  when  present,  to  cause  an  increase  in  the 
severity  of  syphilitic  symptoms,  especially  an  increase  in  the  neu- 
ralgic symptoms. 

Novr  the  treatment  of  syphilis  when  present  in  the  larynx  varies 
little  from  the  treatment  of  syphilis  in  any  other  portion  of  the 
body,  except  that  skill  in  making  applications  to  the  larynx  is 
essential. 

It  ie  generally  considered,  I  know,  that  to  wait  the  development 
of  secondary  symptoms,  and  then  begin  constitutional  treatment,  is 
the  better  course  to  pursue,  but  it  appears,  to  me  that  more  favor- 
able results  are  obtained  when  the  patient  ie  put  upon  some  one  of 
the  mercurial'salts  as  soon  as  the  diagnosis  of  syphilitic  infection  is 
positively  decided  upon.  Should  a  primary  sore  be  encountered  in 
the  larynx,  the  treatment  of  it  would  not  differ  materially  from  one 
found  in  any  other  portion  of  the  body. 

It  should  be  cleaned,  and  dusted  with  some  dried  antiseptic  pow- 
der, as  iodol,  europhen,  calomel,  or  with  iodoform.  This  latter 
powder  is  most  efBcient  in  syphilitic  sores,  but  at  the  same  time  is 
■very  disagreeable  to  the  JMitient. 

Upon  the  appearance  of  secondary  symptoms,  either  inunctions 
with  mercurial  ointment  or  the  internal  administration  of  some  salt 
of  mercury  will  cause  subsidence  of  the  symptoms.  The  mucous 
patch,  when  found  in  the  larynx,  is,  as  elsewhere  in  the  body, 
resifitant  to  treatment,  and  is  very  likely  to  recur,  but  daily  touch- 
ing with  tincture  of  iodine  will  usually  cause  its  disappearance. 
Catarrh  of  speci6o  origin  requires,  in  addition  to  constitutional 
treatment,  the  administration  of  ferruginous  preparations,  and  the 
spraying  of  the  naso-pharynx  with  mild  antiseptic  and  alkaline 
mliitioDS. 

Upon  the  appearance  of  tertiary  manifestations,  the  administra- 
tion of  the  iodid  of  potassium  or  sodium  is  indicated,  be^uniog  with 
small  doses  of  from  ten  to  twenty  grains  three  times  a  day,  and 
increasing  the  dose  several  grains  daily  until  the  progress  of  the 
disease  is  checked. 

In  Hot  Springs  lai^r  doses  of  the  iodide  can  be  given  and  will 


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228       The  Atlanta  Medical  and  Surgical  Journal, 

be  tolerated  better,  on  account  of  the  hot  baths  and  their  diapho- 
retic action,  than  can  apparently,  with  comfort  to  the  patient,  be 
given  elsewhere. 

The  batbs  are  of  great  benefit  in  that  they  keep  the  skin  in  a 
thoroughly  healthy  condition,  and  thus  aid  wonderfully  in  elimi- 
nating poisonous  principles  from  the  body. 

In  some  obstinate  cases  of  severe  ulceration,  and  also  in  those 
cases  where  impending  disintegration  of  guramata  is  present,  and  a 
quick  effect  is  desired  from  medicine,  it  is  best  to  combine  mercu- 
rial inunction  with  the  iodide.  With  treatment  by  means  of  hypo- 
dermic injections  of  the  insoluble  salts  of  mercury,  I  have  had  no 
experience,  and  heace  cannot  speak  on  this  subject  knowingly;  but 
in  the  bands  of  other  men  I  have  seen  consequences  follow  this 
mode  of  treatment  which  could  have  been  obviated  by  employing 
the  inunction  method. 

When  cicatricial  stenosis  ensues  from  ulceration  in  the  larynx, 
the  use  of  instruments  for  dilating  the  stricture  becomes  necessary. 
Probably  the  best  instrument  for  this  purpose  is  a  three-bladed 
dilator  described  by  Schroetter. 

When  the  larynx  is  not  too  much  distorted,  an  intubation  tube 
can  be  used  with  advantage.  The  use  of  iodid  of  potassium  la,  I 
think,  uncalled  for  in  these  cases,  producing  a  variety  of  iodic 
laryngitis  which  is  very  distressing  to  the  patient. 


PHTHISIS,  OR  PULMONARY  TUBERCULOSIS. 

Bv  J.  L.  CAMPBELL,  M.D.,  Atlanta,  Ga., 
DemoDBtrator  of  Anatomy  and  Bacteriology,  Atlanta  Medical  College. 

Tuberculosis  is  an  infectious  disease  caused  by  Koch's  bacillus 
tuberculosis.  Authorities  differ  in  their  classification  of  the  clinical 
form.  The  classification  of  Tyson  and  Osier  seems  to  be  best. 
They  arrange  it  in  three  forms,  viz.:  1st.  Acute  pneumonic  phthisis. 
2d.  Chrouic  ulcerative  phthisis.     3d.  Fibroid  phthisis. 

Etiology. — The  disease  is  caused  by  the  bacillus  tuberculosis,  first 
demonstrated  by  Koch  in  1882.    He  found  the  bacillus  in  the  sputum 


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Phthisis,  or  Pulmonary  Tuberculosis.  229 

of  tubercular  patients  and  was  able  to  reproduce  the  disease  in  suscep- 
tible animals  by  iuoculatioD  witb  pure  culture.  Heredity  plays  an 
important  part.  Some  autborities  claim,  among  them  Mr.  Jonathan 
Rutcbinson,  that  the  bacillus  is  conveyed  directly  from  the  parent 
to  the  child,  and  in  tbe  tissues  of  tbe  child  remains  latent  until 
some  favorable  opportunity  presents  for  its  development.  A 
better  theory,  however,  is  that  children  of  tubercular  parents  in- 
herit lungs  that  are  better  suited  for  the  growth  of  tubercle  bacillus. 
The  bacilli,  tiudiDg  in  these  a  suitable  soil,  develop,  while  in  others 
they  are  thrown  off  in  tbe  expectoration.  Phthisis  also  develops 
ts  one  of  the  eequelee  of  typhoid  fever,  pneumonia,  influenza,  and 
other  acute  febrile  diseases. 

This  is  the  most  wide-spread  disease  known  to  mankind.  No 
nation,  class  or  clime  is  exempt.  It  attacks  all  alike.  It  is  more 
prevalent  in  the  "slums"  and  poorer  districts  of  our  large  cities 
than  in  the  country.  Here,  as  is  the  case  with  other  infectious 
diseases,  the  surroundings  are  more  suitable  for  its  development. 
There  are  two  modes  of  infection,  one  by  the  blood-vessels  and 
lymphatics,  and  the  other  by  inhalation.  The  sputum  which  con- 
tains tbe  bacilli  is  dried  and  powdered  into  dust;  in  this  the  bacilli 
retain  their  vitality  for  weeks.  This  is  a  probable  explanation  of 
tbe  &ct  that  chambermaids  and  porters  are  so  frequently  infected 
witb  tuberculosis. 

We  will  only  consider  chronic  ulcerative  phthisis.  To  this  class 
belongs  the  great  majority  of  cases  of  consumption.  At  first  there 
may  be  a  pure  tubercular  infection,  but  later  the  infection  becomes 
mixed,  and  many  of  tbe  most  prominent  symptoms  are  due  to  this 
septic  infection.     (Osier.) 

Morbid  Anatomy. — The  disease  may  be  divided  into  three  stages, 
asin  pneumonia,  except  in  tbe  third  stage,  instead  of  resolution  and 
return  to  the  normal,  we  have  caseation  and  ulceration  of  the  in- 
'  volved  area.  Lesions  are  located  at  the  apices  nearer  to  the  poste- 
rior surface  of  tbe  lung,  or  about  an  inch  or  a  little  more  below 
the  extreme  apex,  so  that  the  first  physical  signs  are  obtained  in 
tbe  suprascapular  fossa,  or  just  below  tbe  middle  of  the  clavicle. 
Tbe  extension  is  downward,  probably  due  to  tbe  inhalation  of  tbe 


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230       Th£  Atlanta  Medical  and  tJUBOiCAL  Journal. 

viru8.  Of  tbe  primary  leHions  in  427  apex  oases  collected  by  Osler^ 
172  were  in  the  right  apex,  130  in  the  left,  11 1  in  both. 

The  lesion  does  not  always  occar  at  the  apex.  Dr.  Percy  Kidd, 
of  the  London  Hospital,  found  th«  primary  lesion  occurred  at  th« 
base  in  about  one  to  five  hundred  cases.  In  Osier's  cases  the  pro- 
portion was  somewhat  greater. 

If  the  bacilli  enter  the  lungs  by  inhalation  they  are  carried  to 
the  smallest  bronchial  tubes,  where  they  lodge,  and  as  they  begin 
to  multiply  they  cause  a  proliferation  of  the  connective  tissue  cells 
and  epithelium;  this  continues  until  a  nodule  is  formed.  This  is 
surrounded  for  a  variable  distance  by  an  area  of  tubercular  broncho- 
pneumonia. These  nodules  begin  to  caseate  in  the  center;  this 
caseous  material  liquefies  and  may  break  through  into  a  bronchial 
tube.  This  pus  or  liquid  is  carried  by  the  respiration  into  other 
parts  of  the  lungs  and  new  areas  of  infection  result.  At  the  point 
of  the  primary  nodule  a  process  of  ulceration  begins,  which  becomes 
infected  with  septic  cocci.  These  nodules  may  caseate  and  become 
encysted  and  remain  in  the  lung  as  caseous  nodules.  Calcification 
from  deposit  of  lime  salts  may  result  in  the  "lung  stone"  frequently 
found  at  autopsies. 

Cavities  which  have  been  rapidly  formed  will  have  soft,  yielding 
walls.  These  are  usually  situated  near  the  surface,  and  are  most 
likely  to  break  externally  and  give  pneumothorax.  Where  thecavity 
Tesults  from  caseation  of  a  group  of  nodules,  the  walls  aie  hard  and 
well  formed  before  the  rupture  takes  place.  There  is  little  ten- 
dency for  such  cavities  to  increase  in  size.  Cavities  rarely  heal. 
Scars  are  sometimes  seen  which  are  thought  to  be  healed  cavities, 
but  we  are  not  sure  that  this  is  the  case. 

There  is  usually  a  pleurisy  over  the  affected  area,  the  bronchial 
glands  may  be  involved,  the  larynx  is  frequently  the  seat  of  tuber- 
cular ulcers,  the  vocal  cords  and  epiglottis  may  be  more  or  less  af- 
fected. The  tongue,  gums  and  roof  of  the  mouth  were  so  involved 
in  a  case  I  saw,  that  it  was  with  the  utmost  difficulty  that  the  patient 
was  able  to  take  food.  Other  organs,  the  spleen,  liver,  kidneys  and 
mesenteric  glauds,  intestines  and  brains  may  be  also  affected.  Fre- 
quently we  find  amyloid  changes  taking  place  in  the  liver,  kidneys, 
and  spleen.     Fatty    infiltration    is  not  infrequent.     To   intestinal 


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Phthibis,  or  Pulmonary  Tdbebculosis.  231 

tuberculosis  is  due  the  diarrhea  that  is  frequently  the  closiug  scene' 
in  a  case  of  phthisis. 

Symptoms. — -The  mode  of  onset  varies;  there  may  be  symptoms 
of  dyspepsia  with  loss  of  appetite,  loss  of  flesh  and  general  anemic 
appearance.  It  may  simulate  malaria  and  be  mistaken  for  it. 
Hemorrhage  may  be  the  first  indicatioD  of  the  diseased  lung  or  a 
slight  huskiness  of  the  voice  may  be  the  first  thing  noticed.  The 
patient  however  generally  comes  to  us  with  a  slight  cough,  dating 
from  some  culd  which  he  imagines  was  neglected;  the  cough  grows 
worse,  appetite  diminishes,  he  is  losing  flesh  and  probably  has 
night  sweats. 

Pain  in  the  chest  is  due  to  the  accompanying  pleuritis.  The 
paio  may  be  a  troublesome  symptom  or  may  occur  during  par- 
oxysms of  coughing.  It  is  usually  felt  beneath  the  scapolte  or  at 
the  apex  of  the  lung. 

A  cough  is  nearly  always  present,  at  first  dry  and  hacking.  As 
the  disease  progresses  there  is  a  glairy  muoo-purulent  expectora- 
tion. When  cavities  exist  there  is  spasmodic  coughing  occurring 
more  frequently  in  the  early  morning  or  after  a  rest  in  bed  during 
the  day.  The  sputum  may  vary  in  amount  even  in  cases  where  there 
is  extensive  involvement.  There  may  bo  scarcely  any  expectora- 
tion. At  first  the  sputum  is  catarrhal  in  character  and  glairy  in 
appearaoce;  later,  when  breaking  dowu  occurs,  it  is  more  of  a  pur- 
ulent character  and  small  grayish  or  greenish  masses  are  seen ; 
these  are  almost  pathognomonic.  In  them  we  should  find  the 
bacilli.  The  bacilli  are  not  found  as  a  rule  in  the  early  stages,  as 
there  ie  generally  no  destruction  of  tissue  and  the  sputum  is  only 
mucous  in  character. 

To  examine  the  sputum  pour  it  oat  in  a  large  dish  and  select 
one  of  the  whitish  masses  and  spread  it  evenly  on  a  well  cleaned 
cover-slip,  dry  slowly  over  the  flame  of  a  Bunsen  burner,  then  fix 
it  by  passing  it  three  limes  slowly  through  the  flame.  Stain  with 
carbol  fuchsin  or  aniline  water  gentian  violet.  To  stain  with 
either  of  these  pour  a  few  drops  on  the  cover-slip  and  hold  it  over 
the  flame  until  it  begins  to  boil,  taking  care  that  the  cover-slip 
does  not  dry.  Then  wash  with  water,  decolorize  with  twenty-five 
per  cent,  sulphuric  acid,  wash  again  with  water  and  counter-stain 


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232       Thb  Atlanta  Medical  and  Surgical  Journal. 

with  methylin  blue.  The  bacilli  will  be  seen  as  red  rods  three  or 
four  mm.  in  length  aad  from  three-tenths  to  five-tenths  mm. 
in  diameter.  They  may  be  slightly  curved  or  take  the  stain  irreg- 
ularly. The  clear  spots  are  Riipposed  to  be  spores.  The  bacilli 
may  appear  singly  or  iu  clumps  of  three  or  four.  When  found  it 
is  proof  positive  that  the  patient  has  tuberculosis.  Other  micro- 
oi^nisms,  especially  the  pus  cocci,  are  constantly  present ;  blood 
may  also  be  present  in  variable  amouats  as  well  as  the  bronchial 
elastic  tissue.  Hemoptysis  may  be  present  early  from  the  erosion 
of  a  vessel  by  an  ulcer,  or  it  may  occur  later  from  the  rupture  of 
an  aneurism  into  a  cavity.  There  is  not  as  a  usual  thing  any 
marked  dyspnea  or  rapidity  of  breathing,  although  considerable 
amount  of  lung  tissue  may  be  involved. 

General  Symptoms. — Fever  is  the  most  important  and  is  one  of 
the  most  valuable  diagnostic  points ;  there  is  nearly  always  arise 
of  from  one-hair  to  one  and  one-half  degrees  in  the  alternoon, 
which  usually  occurs  between  two  and  six  o'clock.  As  the  disease 
progresses  the  temperature  may  increase  three  or  four  degrees  in 
the  afternoon  and  one  or  two  in  the  morning  ;  this  is  partly  due 
to  mixed  infection.  The  types  vary;  it  may  be  entirely  remittent 
even  when  there  is  great  involvement  of  the  lung  and  iu  rare  cases 
is  absent.  There  may  be  a  subnormal  temperature  in  the  morning 
with  an  afternoon  rise  to  104  and  105.  Sweating  is  most  trouble- 
some and  extremely  exhausting. 

Pulse  is  increased  in  frequency  and  Page  says  it  is  a  most  im- 
portant symptom  for  early  diagnosis.  The  pulse  is  usually  full, 
soft  and  easily  compressible.  The  superficial  veins  are  distinct, 
owing  to  absorption  of  adipose  tissue  beneath  the  skin.  Com- 
plexion is  sallow,  skin  is  waxy  in  appearance  and  there  may  be 
some  jaundice  in  advanced  cases. 

Physical  Signs. — On  inspection  there  may  be  some  peculiar 
appearance  about  the  chest  of  tubercular  patients  ;  the  wing-like 
appearance  of  the  scapulte  has  often  been  described,  as  is  also  the 
antero-posterior  narrowing  of  the  chest.  So  far  as  expansion  is 
concerned  there  is  no  marked  change  in  the  first  stage,  but  as  the 
disease  progresses  there  is  flattening  and  loss  of  expansion  over 
the  affected  part.     In  cases  where  there  is  much  thickening  of  the 


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Phthisis,  oe  Pulmonary  Tdberculosis.  233 

pleura  ooe  shoulder  may  be  lower  than  the  other.  Over  cavities 
of  considerable  size  there  will  be  marked  flattening. 

PeUpation. — The  tactile  fremitus  will  be  exa^erated  over  the 
affected  part  in  the  first  stage,  markedly  increased  as  consolidation 
takes  place ;  over  cavities  it  will  be  increased  if  there  is  free  com- 
munication with  the  trachea,  but  if  the  bronchus  leading  into  the 
cavity  be  plugged  with  mucus  it  will  be  diminished. 

Percum<m. — The  diseased  area  will  give  dullness  varying  with 
the  amount  of  exudation  from  normal  resonance  to  complete  dull- 
ness where  there  is  consolidation.  Where  cavities  exist  the  per- 
cussion note  varies  with  the  depth  of  the  cavity,  elasticity  or  ine- 
lasticity of  its  walls. 

AtuoiUtation  is  by  far  the  most  important  step  in  making  a 
diagnosis;  in  the  beginaingof  tbe  disease  even  before  there  is  dull- 
ness or  increased  tactile  fremitus,  you  will  be  able  to  hear  barsh, 
pnilooged  expiration,  with  a  few  fine  moist  rftles;  when  this  i» 
heard  in  one  or  the  other  apex  we  should  suspect  phthisis.  It 
must  be  borne  in  mind  that  in  the  right  apex  the  respiratory 
murmur  is  more  pronounced,  and  expiration  is  prolonged  even  in< 
health.  As  the  disease  progresses  these  signs  become  more- 
marked.  Tbe  r&les  increase  in  number  and  the  breathing- 
Approaches  more  and  more  a  bronchial  character  until  when  con- 
sulidatioD  has  taken  place  there  is  pure  bronchial  breathing.  Over 
cavities  tbe  breath-sounds  differ  according  to  the  size,  the  elasticity 
of  the  walls  and  tbe  amount  of  fluid  contained  in  tbe  cavities. 
Vocal  resonance  is  increased  as  the  disease  progresses  and  is  one  of 
the  best  means  of  locating  the  diseased  area.  Vocal  resonance  is  best 
appreciated  when  tbe  patient  whispers.  We  can  distinctly  hear 
the  whispered  word  over  the  inflamed  lung  unless  there  is  some 
plugging  up  of  the  bronchial  tubes,  while  over  the  healthy  lung 
tbe  sound  is  more  difTused. 

DiagnoBM. — Phthisis  is  usually  located  in  the  apex  of  one  luug, 
while  bronchitis  is  bilateral  and  has  no  tendency  to  consolidation. 
Pleurisy  with  an  effusion  may  be  mistaken  for  phthisis,  but  the 
line  of  dullness  will  be  changed  with  the  position  of  the  patient. 
The  tactile  fremitus  and  tbe  respiratory  murmurs  will  be  dimin- 
ished or  entirely  absent. 


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234       The  Atlanta  Medical  and  Surgical  Journal. 

As  we  have  already  stated,  the  bacilli  are  frequently  ahseot  id 
the  early  stage;  but  for  a  sure  and  comparatively  safe  plan  ot 
diagDosis;  the  use  of  Eoch'a  tuberculin  ae  recommended  by  Hr.  J. 
Petruschky,  of  Dantzic,  first  the  hypodermic  injection  of  euch 
quantities,  one  mg.  of  the  tuberculin,  as  will  give  a  moderate  but 
sure  reaction  ;  then  to  be  sure  that  the  fever  did  not  arise  from 
some  other  cause,  a  second  and  third  injection  of  a  latter  dose  is 
to  be  given.  If  the  reaction  occurs  afler  these  injections  the 
diagnosis  is  sure,  as  healthy  individuals  can  take  without  the 
slightest  reaction  as  much  as  ten  to  fifteen  mg.  of  the  lymph. 

Treaiment. — Place  your  patients  where  they  can  have  the  best 
hygienic  surroundings  possible,  with  plenty  of  sunlight  and  fresh 
air,  moderate  exercise  and  frequent  baths,  warm  but  nut  heavy 
clothing.  Give  them  a  good  recoostitueut  tonic,  light  stimulants, 
aud  above  all  good  food.  Cough  mixtures  and  expectorants  do 
more  harm  than  good.  If  the  cough  is  troublesome  we  give  tr. 
opii  deod.  ten  drops,  spts.  ammon.  arom.  q.B.  one  dram.  Give 
every  four  to  six  hours.  Cod-liver  oil  is  excellent  when  it  is  well 
borne. 

If  the  case  is  fevorable — i.  e.  were  the  amount  of  lung  tissue 
involved  is  limited  and  the  evening  temperature  does  not  exceed 
100°  F. — Koch's  tuberculin  is  the  ideal  treatment,  given  in  one- 
tenth  mg.  doses  every  alternate  day.  This  may  at  first  give  a 
slight  reaction.  If  on  the  following  day  the  temperature  is  more 
than  one  degree  above  the  normal,  do  not  repeat  the  dose  until  the 
temperature  has  subsided.  In  only  one  of  the  cases  I  have  treated 
in  this  manner  did  I  get  any  troublesome  reaction.  On  the  second 
day  after  the  first  injection  the  patient  had  a  slight  chill,  with  a 
temperature  of  102.  Increased  cough  and  profuse  expectoration- 
This  subsided  in  about  two  or  three  days  and  the  treatment  was 
continued. 

At  this  time  the  patient  is  improving,  hia  cough  and  expectora- 
tion has  almost  disappeared,  he  has  no  afternoon  temperature  and 
is  gaining  some  flesh. 

34i  Peachlree  Si. 


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TWO  CASES  FROM  MY  NOTE-BOOK.* 

By  W.  C.  galloway,  M.D., 

WlLUINOTON,    N.  0. 

FOLLICULOUS   PHABYNGITI8. 

A  gentleman,  school-teacher,  twenty-two  years  old,  of  healthy 
ancestry,  visited  my  office  from  the  country,  September  29,  1896, 
with  the  following  history:  Last  Christmas,  nine  months  ago,  throat 
became  sore  and  tonsils  swelled  and  were  painful.  During  child- 
hood throat  gave  him  a  good  deal  of  trouble,  hut  got  well  and  had 
not  bothered  him  until  last  Christmas.  The  attack  then,  he  thinks, 
was  brought  on  by  going  tu  bed  with  cold  feet  after  playing  in  the 
snow.  Throat  grew  gradually  worse;  felt  raw  and  like  it  was  filled 
np.  Hawking  and  coughing,  which  were  moderate  at  first,  became 
frequent  and  annoying  and  sometimes  distressing,  tough,  glairy 
mucus  being  freely  expectorated.  As  the  disease  progressed 
deglutition  was  troublesome  aud  difficult.  There  was  some  drip- 
ping at  the  back  of  the  throat,  and  the  nose  discharged  more  than 
usual.  Voice  husky  and  lacking  in  timbre;  appetite  &iled,  weight 
diminished;  palms  of  the  bands  were  moist,  face  pale,  eyes  luster- 
les-s  mind  inactive;  felt  languid,  no,  disposition  to  exercise;  was 
nervous  and  fretful ;  nocturnal  emissions  frequent  aud  depressing  ; 
and  finally  had  to  abandon  his  school.  He  was  certainly  a  woe- 
begone looking  specimen,  and  not  being  whole,  needed  a  pbysi- 
cian.  Came  for  treatment  and  wanted  my  advice  about  the  pro- 
priety of  bis  seeking  a  warmer  southern  climate,  as  though  Xorth 
Caroliaa  were  not  a  real,  tangible  Utopia  between  the  first  and 
third  heavens,  in  a  fertile  valley,  sheltered  by  mountains  and 
fanned  by  the  sea.  His  was  the  worst  type  of  the  disease  I  had 
seen,  and  T  feared  tubercular  complications  had  already  marked 
him  for  that  undiscovered  country.  He  was  five  feet  eleven  inches 
in  height  and  did  not  weigh  exceeding  110  pounds. 

•Bead  b7  UUe  bafore  the  Sautbern  EeoiloD  of  the  AmericMi  Geological,  Rblnologlcal  sod 
Larrngcdoclckl  AhooIMIod.  AtlanU,  March  If,  IMS. 


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236        The  Atlanta  Medical  and  Surgical  Journal. 

ExaniinatioD  revealed  both  toaeila  cousiderably  eolarged  aod 
diseased — foUiculous  tODsillitia,  the  twelve  or  fifteen  orifices  being^ 
filled  with  an  offeosive  cheeay  deposit.  The  pharyageal  wall  was- 
vascular,  very  much  engorged,  and  studded  with  numerous  hyper- 
trophied  follicles,  some  crowned  with  a  spot  of  white  and  others- 
filled  with  caseous  material,  which  partly  protruded  out  of  the 
orifices  of  the  crypts.  They  were  as  thick  and  shiny  as  white  seed 
in  the  pulp  of  a  red-meated  melon.  I  make  the  comparison  be- 
cause it  is  true,  and  it  has  the  merit  of  originality;  and  it  is  an 
opportune  time  to  make  the  mouth  begin  to  water  in  anticipation 
of  the  luscious  Geoi^ia  rattlesnakes.  The  back  of  the  tongue  was- 
typical  of  the  pharynx,  and  so  much  swollen  as  largely  to  hide  the- 
epiglottis.  Larynx  and  vocal  cards  somewhat  congested  from  con- 
stant coughing,  otherwise  normal ;  and  the  nasal  cavities  were  con- 
gested and  slightly  infiamed  posteriorly.  Having  been  a  general 
practitioner  for  a  number  of  years,  I  took  the  precaution  to  aus- 
cultate and  percuss  (be  longs,  but  found  them  in  good  condition. 
Amputated  both  tonsils  with  Mathieu's  tonsillotome,  first  applying- 
a  four  percent,  cocain  solution;  hemorrhage  insignificant.  Wailed 
a  week  and  began  treating  nose  aud  throat,  using  for  the  former 
the  following: 

B    Zinci  sulphocarbolate gr.    x 

Cocain  muriat fix.  iv 

Borolyptolf       i 

AquEe  mentb.  pip.  q.a S  iv 

M.     Sin.:  spray  tf  in  die. 

Same  spray  was  also  used  for  the  throat,  it  being  bland,  antisep- 
tic  aud  healing.  Topiched  a  number  of  the  follicles  with  the  gal- 
vano-cantery  and  used  argent,  nitrat.,  40  grs.  to  oz.  of  water,  twice 
a  week  for  awhile,  and  afterwards  once  weekly.  Gave  tonics,  di- 
rected him  to  remain  out  of  doors  a  good  deal,  a  part  of  the  time 
in  the  sunshine,  take  gentle  exercise,  and,  as  his  appetite  improved, 
to  eat  the  best  tissue-building  food  he  could  command. 

He  has  steadily  improved,  but  is  not  thoroughly  well  yet,  though 
neatly  so.  Cough  gone,  pharynx  about  healed,  tongue  almost  so, 
rhinitis  cured,  appetite  vigorous,  digestion  good,  sleeps  well,  emis- 
sions ceased,  general  health  fine,  weighs  150  pounds,  looks  almost 


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Two  Cases  prom  My  Note-Book.  237 

ruddy,  works  tea  or  twelve  hours  a  day  as  a  steaograpber — more 
tlian  he  ought  to  do — and  is  a  good  candidate  for  matrimony,  a 
long  iiTe,  and  heaven. 

FOREIGN   BODY   IN   THE   LARYNX. 

A  white  boy  eleven  years  of  age  came  to  the  office  ill  great  dis- 
tress the  night  of  July  31,  1897.  Said  while  picking  bis  teeth 
with  a  saodspur  (a  novel  instrument  for  that  purpose)  it  got  caught 
between  bis  teeth,  and  in  an  endeavor  to  extract  it  with  a  pin  it 
suddenly  became  dislodged  and  felt  iuto  his  windpipe.  A  feeling 
■of  suffocation  immediately  followed,  he  breathed  with  great  diffi- 
■culty,  coughed  violently,  and  whenever  he  coughed  or  made  an 
-effort  to  swallow  the  spur  pricked  him  and  gave  him  considerable 
pain.  When  he  reached  me  two  hours  after  the  accident  (he  came 
by  direction  of  his  physician)  bis  face  wore  an  anxious  expression, 
tears  trickled  from  his  eyes,  and  bis  breathing,  though  more  quiet, 
was  labored,  and  he  could  only  talk  in  a  whisper.  Found  the 
iipper  part  of  the  larynx  unduly  red  and  congested,  and  the  sand- 
«pur  impinged  upon  and  partly  sticking  into  the  vocal  cords  exter- 
nally and  at  their  anterior  attachment,  covering  nearly  one-half  of 
the  opening.  Had  it  not  been  attached  by  one  of  the  spears  it 
doubtless  would  have  gone  tartber  down  the  larynx,  or  might  have 
been  expelled. 

Applied  a  four  per  cent,  cocain  spray  freely,  but  bad  some 
trouble  in  using  the  laryngeal  forceps,  due  to  retching  and  gag- 
ging, the  larynx  being  peculiarly  susceptible,  but  finally  grasped  it, 
and  as  I  did  so  the  patient  vomited  and  I  lost  the  spur,  but  ez- 
.tracted  it  from  the  larynx,  and  relief  was  instantaneous.  The 
voice,  however,  was  not  immediately  restored,  due  to  the  conges- 
Uon  of  the  cords  and  adjacent  tissues.  It  gradually  returned  and 
by  the  next  day  he  talked  very  well. 

I  think  this  ia  the  first  record  of  a  sandspur  lodging  in  the 
larynx,  and  only  in  that  respect  is  the  case  novel. 

Nun.— Tbe  Modcpor  U  what  I  Uke  U>  be  tbe  trait  of  a  (peclea  of  pvinlnD,  vblab  KTOWB 
Abundaiitly  In  tblikiid  poaslbly  all  irarm  sectloni  near  UiacoMt,  and  durlnc  summer  aad  tall 
«  a  terror  to  barefootad  hayt  auU  huatlag  dag». 


idb,Googlc 


SOCIETY  REPORTS. 


ATLANTA  SOCIETY  OF  MEDICINE. 

Atlanta,  Ga.,  April  7, 1898. 

The  Society  was  called  to  order  by  th«  Preaident  at  8  o'clock 
p.  M.,  and  on  call  of  the  roll  by  the  secretary,  the  following  mem- 
bers answered  :  Drs.  Amster,  Blalock,  Campbell,  J.  L.,  Cham- 
pioD,  Childs,  Divine,  Duncan,  Qoldsmith,  Hancock,  HutcbinSf 
Kendrick,  McDaniel,  Smith,  C.  E.  J.,  Yisanska,  and  Felder. 

The  President:  I  am  glad  to  be  able  to  state,  gentlemen,  that  we 
have  with  us  to-night  Dr.  Geoi^  H.  Fox,  of  New  York,  who  wil! 
give  us  an  address  on  "Syphilitic  Eruptions,"  and  demonstrate  his 
lecture  with  etereopticon  pictures. 

Dr.  Fox;  Allow  me  to  express  the  pleasure  it  has  given  me  of 
being  to-day,  for  the  first  time  in  my  life,  in  the  city  of  Atlanta. 
I  have  enjoyed  your  busy  streets,  fine  buildings  and  delightful 
weather,  and  that  one  attraction  which  we  certainly  cannot  equal 
in  New  York,  the  delightful  winding  bicycle  track  out  ou  the  out- 
skirts, and  that  delightful  hospitality  which  I  cannot  say  is  pecu- 
liar to  Atlanta,  as  I  have  often  beard  it  spoken  of  as  aboundtug  ia 
all  Southern  cities. 

I  am  here  to-night,  not  with  an  original  address,  but  rather  in 
the  capacity  of  a  showman,  and  the  pictures  I  will  show  will  speak 
probably  more  eloquently  and  certainly  more  instructively  than  I 
could. 

The  science  of  dermatology,  like  botany,  is  considered  very 
difficult  to  acquire.  These  must  be  learned  by  a  careful  study  of 
the  cases  themselves,  because,  although  well  prepared  paintings  may 
be  of  great  service  in  learning  it,  we  must  learn  to  recognize 
certain  traits  that  are  peculiar  to  different  species.  We  can  dis- 
tinguish a  maple  from  an  elm,  and  perhaps  some  of  you  could 
distinguish  a  chestnut  from  a  hickory,  though  I  doubt  if  I  could, 


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BociBTT  Reports.  2S9 

becaose  we  have  seen  trees  of  these  kinds  again  and  again  and  can 
recognize  perhaps  iostiDCtively  the  individual  characteristics  of 
them.  Yet  if  we  were  asked  a  quarter  of  a  mile  oET  why  we  knew 
a  certain  tree  to  be  an  elm,  perhaps  it  would  be  hard  for  us  to 
define  the  reason.  In  the  same  way  we  recognize  the  nationality 
of  men  ;  we  say  that  this  one  is  an  Irishman,  another  a  Freucb- 
man,  another  a  German.  Perhaps  we  caunot  say  exactly  why  we 
know  this,  but  we  have  trained  ourselves  to  unconsciously  observe 
certain  peculiarities,  certain  characteristics,  which  tell  at  once  the 
nationality.  So  it  is  with  diseases  of  the  skin.  Each  one  is 
marked  with  certain  peculiarities  which  are  very  perceptible  when- 
ever we  have  a  sufficient  amount  of  experience  to  distinguish  tbem. 
I  am  glad  to  say  that  syphilitic  eruptions  are  so  peculiar  that  in 
nearly  every  cose  tbey  tell  what  they  are  as  plainly  as  if  it  were 
written  on  the  skin.  It  is  not  often  necessary  to  ask  a  man 
whether  he  ever  had  a  chancre  of  ever  had  syphilis  or  not.  The 
characteristics  of  syphilitic  eruption  are  often  so  plainly  shown  on 
the  skin  that  you  can  recognize  it  at  the  first  glance,  and  certainly 
after  a  careful  study,  except  in  very  rare  cases  where  it  is  difficult 
to  distinguish  certain  forms  of  it  from  certain  forms  of  psoriasis; 
and  I  have  seen  occasional  special  cases  that  have  been  modified 
in  appearance  by  treatment  where  the  diagnosis  is  not  easily  made. 
But  the  point  1  wish  to  make  is  this :  The  diagnosis  can  be  made 
better  by  what  we  see  than  by  what  the  patient  tells  us.  The  man 
who  begins  bis  diagnosis  by  asking  questions  is  certain  in  many 
cases  to  be  led  off  the  track.  We  must  remember  that  there  are 
some  patients  who  have  had  syphilis  and  have  something  el^e. 
The  man  who  has  had  syphilis  is  not  exempt  from  psoriasis  or  a 
multitude  of  other  things.  On  the  other  hand  you  will  find  a 
man  who  has  a  well-marked  syphilitic  eruption  who  will  teU  you 
that  be  has  never  been  exposed.  You  have  often  heard  the  remark 
that  any  syphilitic  patient  will  lie.  Now  I  don't  believe  this 
generally,  but  there  are  many  men  who  have  had  an  initial  lesion 
and  have  been  unaware  of  it,  or  have  forgotten  it — have  never 
been  treated — ten  or  twenty  years  ago;  tbey  have  a  plainly  marked 
syphilitic  eruption,  and  yet  if  the  physician  depends  upon  the 
patients  be  will  certainly  be  misled. 


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240       The  Atlanta  Medical  and  SuRaioAL  Journal. 

Id  a  vast  majority  of  the  cases  the  diagaosis  is  written  on  the 
skin  60  plaioly  that  he  who  runs  may  read.  Now  this  is  not 
always  true,  ibough  nearly  always.  In  a  case  of  locomotor  ataxia 
you  must  depend  upon  the  history  of  the  case.  So  you  cannot 
distinguish  perhaps  between  iritis  the  result  of  syphilis  and  iritis 
the  result  of  some  other  cause.  But  syphilitic  skin  diseases  have 
certain  peculiarities  which  tell  distinctly  what  they  are,  and  it  is 
some  of  these  peculiarities  that  I  wish  to  present  to  you  to-night, 
in  one  case  after  another,  so  that  they  will  be  impressed  upon  your 
mindB. 

Dr.  Fox  then  proceeded  with  the  exhibition  of  the  stereopticon 
views,  explaining  each  one  as  it  was  present«d. 

Mr.  Fretident :  You  have  heard  this  interesting  talk  by  Dr. 
Fox.  We  would  like  to  hear  it  discussed.  Dr.  Hutchins,  we 
would  like  to  hear  from  you. 

Dr.  HvickiTia:  I  have  long  had  an  idea,  and  I  think  a  correct 
one,  that  the  majority  of  eruptions  cannot  be  pictured,  and  that  in 
pictures,  whether  colored  or  not,  skin  diseases,  or  skin  manifesta- 
tioBS  of  disease,  if  you  take  the  label  off  or  take  away  the  man 
who  knows  what  they  are  to  tell  you,  you  cannot  make  a  diagnosis 
from  the  pictures.  But  I  am  sure  that  Dr.  Fox's  illustrations, 
photographs,  come  nearer  enabling  us  to  make  a  diagnosis  than  any 
pictures  I  have  ever  seen.  Of  course  in  some  of  the  pictures  you 
can  get  nothing  but  the  configuration  and  distribution  of  the 
disease ;  yet  in  the  great  majority  of  these  pictures  you  can  tell 
from  the  arrangement  and  grouping  that  it  is  syphilitic.  In  some 
of  the  others  of  course  you  cannot. 

There  is  nothing  to  say  except  that  Dr.  Fox  has  shown  that  be 
is  an  expert  photographer  as  well  as  good  in  his  diagnostic  work, 
and  I  feel  as  much  obliged  to  him  as  anybody  could  for  these  pic- 
tures. As  regards  his  treatment,  he  follows  rather  broad  lines.  I 
am  inclined  to  think  he  is  right.  There  are  cases  of  chronic 
malaria  that  cannot  be  cured  with  quinine,  and  there  are  many 
other  like  cases.  If  you  can  get  the  patient  up  to  where  be  is  in 
proper  condition  it  will  do  more  than  the  drugs.  Sometimes  the 
best  thing  yon  can  do  for  a  syphilitic  patient  is  to  stop  the  treat- 


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Society  Reports.  241 

^eot  eotirelj,  ^ve  them  no  treatment  and  put  them  on  good  diet, 
-or  give  them  an  absolute  change. 

The  President:  Is  there  any  other  miscellaneous  buBineas  before 
the  Society? 

Dr.  Amater:  I  have  a  communication  here  from  Br.  Howard  A. 
Kelly,  of  Baltimore.  He  writes  regarding  some  pernioioue  legis- 
lation which  the  anti- vivisection  society  is  trying  to  pass  in  Waeb- 
ingtoD.  I  would  like  for  you  to  have  this  read  before  the  Society, 
and  if  the  Society  thinks  proper  communicate  with  our  senators 
and  ask  them  not  to  support  any  measure  of  that  kind. 

The  Secretary  then  read  Dr.  Kelly's  letter  to  the  Society. 

The  Preaidefd:  You  have  heard  this  letter,  gentlemen.  What 
shall  we  do  with  it,  if  yon  desire  to  take  any  action  in  regard 
to  it? 

Dr.  Amster:  Not  having  any  personal  acquaintance  with  either 
of  our  senators,  I  thought  this  would  be  the  proper  channel  for  it 
to  go  through,  so  that  if  any  of  the  gentlemen  here  personally 
know  Senator  Clay  or  Senator  Bacon  they  can  communicate  with 
them. 

Upon  motion  the  following  resolution  was  adopted,  and  the 
Secretary  was  instructed  to  forward  copies  of  the  same  to  each 
«enator  and  representative  in  Congress  from  Georgia : 

"Resolved,  That  the  Atlanta  Society  of  Medicine,  being  opposed 
to  the  passage  of  the  anti-vivisection  bill  now  pending  before  Con- 
gress, as  being  a  measure  calculated  to  do  great  harm  to  the  prog- 
ress of  the  science  and  practice  of  medicine,  and  consequently  be 
of  great  damage  to  the  people  of  the  United  Slates  and  of  the 
world ;  the  senators  and  members  of  Congress  from  Georgia  are 
respectfully  asked  to  use  their  efforts  towards  the  defeat  of  the 
bill."  ■  L.  A.  Felder,  M.D.,  Secretary. 


"  Bilionsnees"  is  a  contraindication  to  the  exhibition  of  iron- 
"  So  long  as  there  is  foul  tongue,  a  bad  taste  in  the  mouth  (as  if  it 
could  be  any  place  else),  and  fullness  of  the  liver,  with  disturbance 
of  the  alimentary  canal,  iron  is  to  be  prohibited;  it  is  not  only 
that  it  ia  of  no  service,  it  positively  does  barm." — Medioal  Age, 


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CORRBSPONDBNCB. 


SPINAL  CURVATURE  AND  GYMNASTICS. 

Atlanta,  Ga.,  May  10,  1898. 

It  is  very  important  that  maD  should  aim  to  have  a  symmet- 
rically-formed body.  To  do  justice  to  his  life,  bis  accomplishments 
and  his  social  connection  with  society,  it  is  one  of  the  necessities 
to  develop  personal  pride  and  character.  It  is  therefore  of  the 
utmost  importance  that  parents  and  teachers  should  pay  close  atten- 
tion to  the  physical  development  of  the  child,  thereby  avoiding- 
bodily  deformities  like  the  frequently  occurring  lateral  curvatures. 

Insignificant  appearances  which  mark  the  beginning  of  this  evil 
are  very  seldom  noticed  by  the  child's  parents;  very  often,  merely 
by  chance  is  the  parents'  attention  attracted  to  the  rapidly  pro- 
gressing disease.  It  therefore  becomes  the  duty  of  every  parent 
to  watch  the  development  of  the  child's  body  closely,  and  at  the 
discovery  of  a  suspicious  sign  of  a  possible  deformity,  employ- 
medical  assistance. 

One  of  the  most  frequently  occurring  curvatures  of  the  spinal 
column  is  scoliosis,  or  lateral  cur\'ature.  It  is,  in  the  majority  of 
cases,  the  result  of  faulty  carriage  of  the  trunk  while  walking  and 
the  wrong  posture  during  sitting.  The  latter  can  in  a  great  num- 
ber of  cases  be  traced  back  to  the  schoolroom,  where,  on  accouut 
of  the  exorbitant  demand  for  mental  work,  very  little  attention  is 
paid  to  the  physical  development  of  the  child.  Statistics  prove 
that  of  one  thousand  school  children,  at  the  ages  from  seven  to 
eleven  years,  not  less  than  Gfly-six  per  cent,  were  afflicted  with 
scoliosis. 

Scoliosis  is  the  result  of  a  one-sided  position  of  the  truuk,  the 
position  beiogassumed  involuntarily.  A  frequent  repetition  of  this 
one-sided  attitude  of  the  trunk  will  cause  the  intervertebral  carti- 
lage to  diminish  on  the  side  of  the  concavity  and  increase  on  the 
side  of  the  convexity.     The  same  difference  will  be  noticed  in  the 


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Correspondence.  24$ 

development  of  the  mneoles.  A  rotation  of  the  vertebre  very 
often  acoompiiDies  the  lateral  curvaturea;  this  is  very  notioeable  in 
the  so-called  hij;h  shoulders  and  high  hips. 

Symptoms  like  narrow  chest,  difficulty  in  breathing,  indigestion,. 
and  general  debility  of  the  whole  system  are  very  often  found  in 
scoliotic  people.  A  cure  is  only  then  possible  if  the  disease  is 
attended  to  during  its  first  stage.  I  can  conscientiously  say  that 
gymnastic  exercise  is  one  of  the  main  factors  for  the  cure  of  this 
kind  of  deformity.  General  weakness,  improper  nourishment,, 
especially  undeveloped  muscles,  weak  bones  and  ligaments,  are  in- 
variably the  fundamental  causes  of  scoliosis,  and  aid  remarkably 
in  the  progress  of  this  disease.  It  is  a  well  known  fact  that  gym- 
nastic exercise  is  the  best  medicine  to  increase  the  appetite,  thut^ 
stimulating  and  strengthening  the  tissues  of  the  body. 

A  slight  lateral  curvature  of  the  spinal  column  can  easily  be 
remedied  by  properly  selected  exercises,  thereby  improving  the 
more  or  less  faulty  carriage.  These  exercises  will  loosen  the  ver- 
tebrae OD  the  concave  side;  also  stretching  the  muscleij,  thereby 
applying  pressure  on  the  convex  side. 

If  the  person  that  is  to  be  treated  has  reached  an  age  where  it 
is  impossible  to  correct  the  existing  curvature,  exercises  should  be 
prescribed  that  will  prevent  the  delormity  from  affecting  the  func- 
tions of  the  different  ot^ns.  In  such  an  instance  I  would  recom- 
mend the  following  exercise:  Free-hand  hanging  from  a  bar  (feet 
must  not  touch  the  floor),  upper  grip,  arms  extended,  feet  and  knee& 
together,  ankles  extended,  chest  arched  and  head  erect;  in  this  po- 
sition practice  forced  respiration. 

But  alt  light  deformities  can  be  cured  by  gymnastic  exercise.  Of 
coarse  it  becomes  more  difficult  if  the  disease  is  of  an  orthopedic 
natnre  ;  mechanical  and  surgical  treatment  then  becomes  necessary. 
No  deformity,  however,  is  so  severe  that  properly  applied  exercise- 
would  not  be  of  some  benefit. 

The  first  principle  in  this,  as  in  any  other  sickness,  is  to  prevent 
the  development  of  the  disease  in  its  first  stage.  Parents  and  teachers 
should  therefore  watch  with  the  greatest  care  over  the  physical  devel- 
opment of  the  child, and,  if  necessary,  with  severity  insist  npon  a  good 
carriage  and  correct  posture.  Inaddition,practicelotsot  gymnasticsr- 


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244       The  Atlanta  Medical  and  Surgical  Journal. 

exercise  od  the  horizootal  bar,  on  theriDgs,eto.;  also exercieee  with 
dumb-bells  aod  wands  are  excelleot  means  to  avoid  any  kind  of 
spiaal  curvature,  thus  giving  the  child  the  foiiodation  for  a  symmet- 
rically formed  body.  It  is  a  oaturaland  rational  development  of  all 
its  muscles,  which  will  produce  strength  and  beauty,  thereby  relieving 
tbe  parents  of  worry  and  continued  anxiety  about  their  otherwise 
sickly  children.  Theodore  Toepel, 

Student  Atlanta  Medical  College. 


Yellow  Fever  in  Cuba. 
Dr.  John  Quiteras  recently  spoke  {Press)  of  the  danger  neces- 
earily  arising  from  the  occupation  of  Cuba  by  the  United  States 
troops.  A  great  deal  bae  been  recently  said  of  what  is  termed 
"  individual  precautions"  against  yellow  fever  while  in  an  infected 
district,  which  Dr.  Guitcras  thinks  is  almost  useless  in  time  of  war. 
He  said  that  tbe  disease  ought  not  to  be  treated  from  the  stand- 
point of  the  individual  but  from  the  standpoint  of  the  mass. 
Possibly  the  moat  important  measure  to  be  exercised  by  tbe 
army  would  be  general  measures  aBectiog  the  disiribution  of 
troops,  the  manner  and  place  of  landing,  the  location  of  dis- 
tributing centers  of  supplies,  and  the  selection  of  sites  for  the 
-establishment  of  camps.  The  Island  of  Cuba  is  usually  free 
from  the  disease  till  the  middle  of  June,  when  it  continues  until 
the  middle  of  October,  being  worse  during  the  months  ol 
August,  September  and  October.  Outside  of  the  large  seaport 
■cities  the  climate  is  most  pleasant,  malarial  fevers  and  dysentery 
not  being  more  prevalent  than  during  the  civil  war.  The  interior 
of  the  island  is  free  from  the  disease,  while  Havana  and  other  sea- 
port cities  are  tbe  danger  spots  of  the  disease  and  always  infected. 
Another  imp  irtant  factor  in  the  proper  protection  of  the  troops  is 
the  shipping  of  all  food  supplies  from  the  United  States.  Dr. 
Cruiteras  holds  to  the  belief  that  the  whole  island  could  be  kept 
free  from  the  disease  the  year  round  by  means  of  proper  sanitary 
measures,  and  that  the  island  has  always  been  a  menace  to  the 
United  States  owing  to  tbe  lack  of  proper  precautions  maintained . 
binder  Spanish  misrule. — Journal  American  Medical  Association. 


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EDITORIAL. 


TheoflleeotTHB  JounKiLli  111  ^adSll  Fjiten  Building. 

Addrea  all  commoDioatlODi,  and  make  all  remlCUuioes  payable  U>  Ths  ATLaMTi  Midioil. 
nSDBBicii.  JoDBKU,,  Atlanta,  Qa. 

Bepiinta  of  article!  will  be  fumlahed,  wbeD  desired,  M  a  amall  coat.  Requests  For  the 
kme  should  alwafi  be  made  on  (A«  manuwrfpl. 


CONSERVATIVE  GYNECOLOGY. 

Only  a  few  years  ago  the  medical  press  was  lately  interested  iq' 
what  it  styled  conservative  gynecology  and  vigorous  articles  were 
written  endeavoring  to  show  that  womea  were  on«n  subjected  to 
needless  operations,  or  when  operations  were  performed  tissues 
were  oRea  sacrificed  which  could  be  saved,  and  the  normal  func- 
tioDs  of  organs  often  destroyed  which  could  be  preserved.  A  suffi- 
ciency of  lime  has  now  elapsed  for  us  to  begin  to  view  this  sub- 
ject from  a  retrospective  standpoint  and  to  judge  from  results  as  to 
whether  we  were  then  directing  our  energies  in  the  right  channels 
or  whether  many  operators  of  to-day  who  remove  only  such  tissues 
as  appear  macroscopically  pathological,  are  coming  closer  to  the 
true  plan  of  treatment,  viz.:  the  complete  restoration  to  health 
with  a  preeervation  of  functions.  These  writers  were  iucliued  to 
divide  the  gynecologists  into  two  classes,  the  first  comprising  those 
who  believed  that  when  ovaries  and  tubes  were  sufficiently  diseased 
to  justify  an  exposure  by  operative  measures,  they  were  also  patho- 
logic enough  to  warrant  removal,  or  if  there  be  distinct  disease  of 
both  tubes  and  ovaries  there  was  no  need  to  leave  a  uterus  which 
io  all  likelihood,  under  microscopic  examination,  would  prove 
markedly  diseased,  and  would  become  an  organ  without  function- 


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246       The  Atlanta  Medical  and  Surgical  Journal. 

«2posed  to  pathological  iovasioa  and  liable  to  uudergo  maligDant 
degeneration,  in  fact,  only  a  menaoe  to  health  or  longevity.  This 
«las8  was  styled  the  radtcalists,  while  the  second,  which  will  now 
be  described,  were  self-styled  conservatives,  including  those  who 
often  made  exploring  operations,  and  on  finding  extensive  ad- 
hesions would  close  the  abdomen  without  removing  anything,  or 
on  finding  adhesions  easily  broken  up  would  do  this  either  by  ab- 
dominal or  vagiinal  route,  or  on  exposing  an  ovary,  if  any  part  of 
its  tissue  appeared  healthy,  it  was  left,  or  the  removal  of  one  organ 
alone  in  order  that  meustruation  and  often  ovulation  be  preserved, 
small  cysts  of  the  ovaries  drained,  tubes  that  were  disturbed  were 
drained  through  the  vagina,  the  uterus  not  removed  except  where 
markedly  diseased.  So  often  has  it  become  necessary  to  subject 
women  who  have  been  in  the  hands  of  the  extremists  in  this  field 
to  second  operations  before  any  relief  is  afforded  their  sufferings, 
that  viewed  from  the  present  results  the  tendency  seems  to  point 
rather  toward  a  medium  between  these  extremes.  The  leaving  oi 
a  piece  of  a  pathological  ovary  has  never  seemed  logical,  aa  it 
usually  becomes  imbedded  in  a  mass  of  adhesions  produced  by  the 
diseased  conditions,  and  the  trauma  necessary  to  remove  the  part 
which  appears  diseased  renders  it  in  a  great  measure  funotionless 
and  capable  of  producing  decided  nervous  disturbances.  Hence, 
these,  when  suGGciently  diseased  to  require  removal  of  part,  would 
lead  to  better  results  if  the  entire  ovary  was  removed.  But  in 
such  cases  as  present  a  decided  disuse  of  one  aide  we  can  occasion- 
ally leave  the  other  ovary,  provided  it  be  in  a  healthy  condition, 
and  thus  preserve  the  function  of  the  generative  organs.  The 
uterus  too  can  often  be  saved  when  both  tubes  and  ovaries 
are  removed  in  order  that  the  support  for  the  abdominal  viscera 
be  preserved.  If,  however,  there  be  a  history  pointing  toward 
malignancy  it  becomes  the  most  conservative  method  to  remove 
this  along  with  the  nduesee.     Hysterectomies  have  been  so  much 


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Editobial.  247 

simplified  that  it  is  but  little  more  difficult  to  remove  the  uterus 
DOW  than  the  appendages  alone,  and  some  operators  are  inclined 
to  be  a  little  extreme  in  this  direction. 

The  nervous  disturbances  which  are  attributed  to  a  superinduced 
menopauBe  open  an  interesting  field  for  investigation,  as  these  are 
attributed  by  some  to  the  preexisting  disease  and  not  to  the  changes 
which  follow  the  removal  of  diseased  oi^ns.  This  will,  how- 
ever, long  continue  a  subject  for  discussion,  as  evidence  is  based 
upon  these  changes  taking  place  in  women  suffering  from  disease 
capable  of  producing  nervous  manifestations,  and  the  lower  animals 
with  inferior  nervous  organization  would  not  respond  to  experi- 
mental research  on  such  lines.  True  conservative  gynecology  often 
means  the  complete  removal  of  diseased  tissues  when  this  conduces 
to  the  health  and  comfort  of  the  patient  or  the  preservation  of  as 
much  of  the  tisane  as  will  conserve  the  greatest  degree  of  health 
and  comfort  to  the  patient. 


THE  DEADLY(?)  CIGARETTE. 

The  evils  of  the  little  cigarette  have  been  told  over  and  over 
again  so  often,  and  have  been  pictured  so  vividly  under  terrifying 
head-lines  in  the  lay  press,  that  the  public  almost  believes  it  to  be 
capable  of  producing  all  diseases  and  instigating  all  crimes.  It  is 
thought  to  contain  a  large  host  of  captivating  and  death-dealing 
poisons  and  to  promote  all  inordinate  and  sinful  affections.  We 
believe  that  these  ideas  have  existed  and  do  now  exist  principally, 
if  not  entirely,  among  the  uninformed,  and  we  are  pleased  to  see 
that  there  are  not  wanting  capable  men  who  are  willing,  for  truth's 
sate,  to  say  an  honest  word  in  the  cigarette's  defense.  The  chief 
charges  against  the  cigarette  have  been  that  they  contain  harmful 
ingredients  (other  than  tobacco)  and  that  excessive  indulgence  causes 
insanity  and  other  mental  diseases. 


^dbyGoOgle 


A 


248       The  Atlanta  Medical  and  Surgical  Journal. 

In  (he  December  Dumber  of  the  Medico-Legal  Journal  (New- 
York)  appeared  a  paper  entitled  "A  Brief  for  the  Cigarette,"  by 
William  H.  Giarrison,  Eeq.,  which  combated  in  a  conclusive  man- 
ner the  "prevalent  popular  prejudice  against  the  cigarette."  He 
showed  (1)  that  the  domestic  cigarette  ia  composed  of  paper  and 
tobacco,  and  of  notbiug  else;  and  (2)  that  there  is  no  good  reason 
to  believe  that  the  cigarette  ever  caused  a  case  of  insanity.  The 
author  quoted  a  number  of  reports  from  expert  chemists  as  to  the 
quality  of  the  tobacco  and  paper,  and  these  unanimously  testified 
to  the  "entire  absence  of  foreign  matter,  deleterious  or  otherwise." 
(To  the  same  effect  we  remember  to  have  read  an  interesting  paper 
some  months  ago  by  Br.  A.  R.  Ledoux,  a  distinguished  chemist  of 
New  Jersey.) 

As  the  paper  of  Mr.  Garrison  was  somewhat  incomplete  touching 
the  alleged  relations  of  the  cigarette  to  insanity  and  allied  disor- 
ders, the  editor  of  the  Medico-Legal  Journal  collected  opinious  from 
asylum  superintendents  and  other  medical  men  having  large  experi- 
ence with  the  insane ;  the  greater  part  of  these  opinions  are  published 
in  the  March  number  of  the  above  named  journal.  In  the  letters  of 
these  doctors  (who  must  be  accepted  as  best  qualified  to  speak  on 
this  matter)  we  find  such  thoughts  as  these: 

"  The  popular  prejudice  against  the  cigarette,  I  am  sure,  is  false." 

"  I  have  long  entertained  the  conviction  that  tobacco  in  various 
forms  has  been  unjustly  charged  with  many  undeserved  malign  in- 
fluences. During  the  past  twenty  years,  the  term  of  my  devotion 
to  the  care  of  the  insane,  I  have  known  over  4,000  insane  patients, 
and  so  far  as  I  can  at  present  remember,  in  no  single  case  was  to- 
bacco in  any  form  answerable,  directly  or  indirectly,  for  the  mental 
disease." 

"  I  have  had  an  experience  of  fourteen  years  in  the  care  of  the 
insane,  and  several  thousand  cases  of  insanity  have  passed  under 


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Editorial.  249 

my  obaervatioD  in  that  time.     I  have  never  yet  seen  a  case  of  in- 
sanity that  I  believed  was  caused  by  cigarette  smoking." 

"There  is  no  foundation  of  facts  for  the  popular  prejudice 
against  the  cigarette.  From  personal  analysis  and  examination  of 
the  constitueots  of  the  cigarette,  as  welt  as  a  knowledge  of  the  re- 
sults experienced  by  expert  chemists  throughout  the  country,  I  am 
satisfied  that  only  tobacco  is  used  for  filling,  and  the  wrappers  are 
made  of  the  finest  quality  of  paper  possible  to  manu&cture.  After 
an  observation  [eztending  over  twenty  years]  of  many  thousand 
cases  of  insanity,  in  persons  of  all  ages,  I  can  recall  none  caused 
by  the  use  of  the  cigarette,  or,  I  might  add,  tobacco  in  any  form." 


SOUTHERN   ASSOCIATION  OF  RAILWAY   SURGEONS. 

A  movement  is  now  on  foot  for  the  formation  of  a  "Southern 
Association  of  Railway  Surgeons."  This,  we  believe,  is  a  much- 
needed  oi^nization.  The  movement  is  being  put  forward  by  the 
members  of  the  Association  of  the  Southern  Railway  Surgeons,  and 
especially  by  its  President,  Dr.  C.  M.  Drake.  The  annual  meeting 
of  this  latter  association  is  to  be  held  at  Old  Point  Comfort  June  21 
and  22.  An  invitation  has  been  extended  to  the  surgeons  connected 
with  other  Southern  railways,  and  it  is  hoped  that  such  an  organi- 
zation will  be  effected.  The  meeting  at  Old  Point  Comfort  prom- 
ibes  to  be  one  of  great  interest,  and  a  most  excellent  program  is 
already  assured. 

The  following  circular  has  been  sent  out  by  Dr.  Drake : 

"I  beg  to  inclose  herewith  an  announcement  of  the  third  annual 
meeting  of  the  Association  of  Surgeons  of  the  Southern  Railway 
Company,  at  the  Hygeia  Hotel,  Old  Point  Comforl,  Va.,  June  21 
and  22,  1898,  and  to  extend  an  invitation  to  you  to  be  present  and 
to  particijiate  in  the  proceedings. 

"At  the  same  time  and  place  it  is  proposed  to  bold  a  conference 


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250       The  Atlanta  Medical  and  Surgical  Journal. 

of  chief  aurgeoils  or  other  medical  representatives  of  the  priocipal 
railroads  operating  in  Virginia,  West  Virginia,  North  and  South 
Carolina,  Greorgia,  Florida,  Alabama,  Mississippi,  Louisiana,  Tesas, 
Arkansas,  Tenness^  and  Kentucky,  for  the  purpose  of  determin- 
ing the  advisability  of  forming  an  ot^nizalion  to  be  known  as  the 
"Southern  Association  of  Railway  Surgeons,"  or  some  other  equally 
comprehensive  name. 

"There  are  many  good  reasouB  for  such  an  organization.  The 
National  Association  of  Railway  Surgeons  is  too  large  to  do  effec- 
tive work;  its  places  of  meeting  are  often  too  far  remove]  for  the 
annual  attendance  of  the  majority  of  Southern  members,  and  of 
late  many  of  the  large  systems  have  tacitly  discouraged  the  attend- 
ance of  their  surgeons,  and  have  declined  to  issue  or  request  trans- 
portation  on  account  of  its  meetings. 

"It  is  hoped  that  you  will  attend  the  Old  Point  meeting." 

Invitations  have  been  extended  to  the  surgeons  of  the  Norfolk 
and  Western  Eailroad,  Chesapeake  and  Ohio  Railroad,  Atlantic 
Coast  Line,  Seaboard  Air  Line,  New  York,  Philadelphia  and  Nor- 
folk Railroad,  Atlantic  and  Danville  Railroad,  and  Norfolk  and 
Southern  Railroad  to  attend  the  meeting  and  participate  in  the 
deliberations  of  the  Association,  and  doubtless  these  roads  will  be 
well  represented. 

The  following  distinguished  sui^eons  have  promised  to  be  pres- 
ent and  to  deliver  addresses  on  subjects  pertaining  to  railway  sur- 
gery: Dr.  John  A.  Wyeth,  New  York;  Drs.  W.  W.  Keen  and 
Joseph  Price,  Philadelphia;  Dr.  Hunter  McGuire,  Richmond;  Dr. 
Walter  Wyman,  Surgeon -General,  U.  S.  Marine  Hospital  Service; 
Dr.  Joseph  Rausahoff,  Cincinnati;  Dr.  Willis  F.  Westmoreland, 
Atlanta,  and  Dr.  J.  J.  Kinyoun,  Past  Assistant  Surgeon,  U.  S. 
Marine  Hospital  Service. 

Altogether,  a  most  interesting  meeting  is  promised.  The  place 
and  the  occasion  will  be  well  worth  a  visit  from  all  railway  sur- 
geons. 

DiclzedbyGoOgle 


CONSOLIDATION  OF  THE  ATLANTA   MEDICAL 

COLLEGE    AND   THE   SOUTHERN 

MEDICAL  COLLEGE. 

At  tbU  writing  there  is  every  iDdication  that  these  well-knowD 
medical  schools  will  be  united.  While  the  announcement  of  the 
consolidation  has  not  been  officially  made  and  while  the  details  of 
the  uoioD  remaio  to  be  arranged,  favorable  Degotiations  are  id 
progresti  which  encourage  the  friends  of  medical  education  Id 
general  and  of  these  institutions  iu  particular  to  hope  that  amal- 
gamation is  iu  sight. 

This  is  as  it  should  be,  and  The  Journal  takes  pleasure  in 
congratulating  those  who  have  conceived  and  executed  this  wise 
and  excellent  movement. 

It  is  likely  that  a  new  name  will  be  selected  for  the  consol- 
idated college,  and  the  new  faculty  will  he  composed  of  judicious 
selections  from  both  the  late  faculties. 

At  present  we  are  not  able  lo  make  more  than  this  preliminary 
announcement.  By  the  next  issue  we  hope  to  be  able  to  report 
the  final  success  of  the  plan  and  to  present  all  the  details  of  the 
consolidation. 


The  business  manager.  Dr.  Hutchius,  attended  the  twenty-sec- 
ond annual  meeting  of  the  American  Dermato logical  Association 
at  Princeton,  New  Jersey,  May  3Ist  and  June  1st.  He  also  made 
a  short  visit  to  New  York.  Owing  to  his  absence  this  issue  of  The 
JouicxAi.  is  mailed  a  lew  days  late. 

Dr.  Frank  S.  Bourns,  of  Atlanta,  has  been  appointed  Chief 
Surgeon  on  the  staff  of  General  Merritt  and  will  accompany  the 
latter's  army  of  occupation  to  the  Philippine  Islands.  The  doctor 
lived  in  the  Philippines  a  number  of  years  ago. 


^dbyGoOgle 


MEDICAL  ITEMS. 


How  about  thia?     "The  health  of  a  young  widow  always  im- 
proves when  her  physician  marries." — Ex. 


It  is  said  that  an  ioveutive  genius  of  Kentucky  has  constructed 
a  sewing-machine  for  the  use  of  surgeons  in  sewing  up  wounds. 


Dr.  Mabion  Hull,  of  Athens,  Ga.,  has  located  in  Atlanta.  He 
will  be  associated  with  Dr.  J.  8.  Todd  at  the  latter's  oflSce  on  Ma- 
rietta street. 


Dr.  MichaelHoke  has  removed  his  office  from  the  Grand  Opera 
House  to  the  residence  office  of  the  late  Dr.  Hugh  Hagan  on  Peach- 
tree  street. 

The  following  physicians  are  occupying  beautiful  new  quarters 
in  the  English- American  building:  Drs.  L.  H.  Jones,  R.  B.  Bid- 
ley,  M.  A.  Purse,  A.  G.  Hobbs. 


Now  is  the  time  for  medical  colleges  to  advertise.  The  Jodrsal 
has  a  large  circulation  and  it  will  pay  any  college  to  put  an  adver- 
tisement in  our  pages.     Send  for  rates. 


Dr.  \Vm.  Owens  has  just  returned  to  Atlanta  from  a  trip  abroad. 
While  away  he  devoted  himself  to  the  study  of  the  eye,  ear,  nose 
and  throat.     The  doctor  will  make  Atlauta  his  home. 


We  would  call  attention  to  the  progressive  character  of  our  At- 
lanta medical  institutions,  whose  advertisements  can  be  seen  on  the 
pages  of  this  journal.  All  of  them  are  well  equipped  and  modern 
in  every  respect. 


^dbyGoOgle 


Medical  Items.  25ft 

Again  it  is  announced  that  the  University  Medical  College  and 
Bellevue  Medical  College,  New  York,  have  united.  An  effort  wb8 
made  to  combine  these  schools  a  year  ago,  But  without  success. 
We  trust  that  the  present  plans  for  coDSolidfttion  will  be  carried 
out. 


The  Proper  Spirit. — Convalescent  (dictating) :  "  Please  say- 
to  Mrs.  Jackson  that  I  thank  her,  not  alone  for  the  brandy 
peaches  that  she  so  kindly  sent  me,  but  also  for  the  spirit  in  which 
they  were  sent." — He. 


A  If  AM  in  the  car  was  telling  bow  good  bis  doctor  was.  "Clever?" 
said  be.  "Well,  I  should  say  he  was.  The  other  day  I  called  him 
in  when  I  bad  swallowed  five  cents.  He  said  if  the  coin  was  not 
couDterfeit  it  would  pass,  and  made  me  cough  up  two  dollars." — 
Slaiical  Age. 

Db.  M.  B.  Hutchins.— At  the  end  of  the  session  of  1897-8 
Dr.  M.  B.  Hutchins  resigned  bis  position  as  Clinical  Lecturer  on 
Skin  Diseases  and  Syphilis  in  the  Atlanta  Medical  College,  for 
reasons  satisfactory  to  himself.  This  resignation  was  accepted  at 
his  "  own  request." 

We  extend  our  heartfelt  sympathy  to  Dr.  Y.  O.  Hardon  in  the 
loss  of  his  most  estimable  wife.  In  the  bloom  of  womanhood 
death  chose  her  as  its  victim.  She  was  a  woman  beloved  and  ad- 
mired by  all  who  knew  her,  and  many  charitable  institutions  will 
miss  her  ever-ready  aid. 


Mrs.  licLubberiy — Here's  some  pills,  Murty,  that  Mrs.  Hogan 
was  afther  sindin'  over  for  yez.  She  says  dey'll  aither  kill  or 
cure  yez. 

McLubberfy  (who  is  ill) — Begnrra,  did  she  say  which  dey  would 
do  foorst? — Puck. 


^dbyGoOgle 


^64       The  Atlanta  Medical  akd  Sdhqigal  Journal. 

A  Bbooklyx  landlord  offers  a  house  and  lot  rent  free  to  the  Srefr 
family  among  his  tenants  in  which  twins  are  born.  To  the  first 
family  in  which  triplets  are  bora  he  will  present  «  bouse  bim]  Lot. 
—Sx. 

It  was  Mark  Twain,  we  believe,  who  said  that  twins  in  a  honse- 
hold  were  equal  to  a  riot  and  triplets  equivalent  to  an  insurrcctiou. 
If  this  is  true  our  enterprising  Brooklyn  friend  deems  to  be  hunt- 
■ing  trouble. 

Tub  one  sign  of  malignant  disease  of  the  uterus  which  should 
always  be  investigated,  and  especially  so  when  it  occurs  at  or  near 
the  menopause,  is  hemorrhage.  We  may  say,  I  think,  that  in  all 
eases  in  which  the  menstrual  period  becomes  prolonged,  the  flow 
more  profuse,  or  the  iuterval  shortened,  the  most  rigid  esamina- 
tion,  no  matter  what  the  condition  or  age  of  the  patient  may  be,  is 
demanded.  In  all  cases  which  I  have  observed  bleeding  has  been 
the  earliest  symptom. — L.  G.  Baldidn. 


There  has  been  much  discussiou  as  to  the  best  time  of  the  day 
for  the  performance  or  operations.  In  all  cases  in  which  much 
fear  is  present,  the  early  morning  hours  should  be  selected,  as, 
since  the  patient  has  slept,  he  will  not  be  compelled  to  spend  a 
great  part  of  the  day  hungry  and  alarmed,  with  each  succeeding 
hour  increasing  his  dread.  Operations  late  in  the  afternoon  pos- 
sess the  advantage  that,  as  night  soon  comes  on,  the  patients  are 
more  likely  to  fall  asleep  and  spend  a  quiet  night,  yet  we  kuow 
that  this  result  is  often  a  problematic  one,  as  post-operative  rest- 
lessness and  sometimes  jactitation  often  prevent  sleep  for  hours 
after  operations. — International  Journal  of  Surgery. 


A  PHYSICIAN  should  not  presume  upon  the  lime  and  patieuce 
of  bis  colleagues  by  reading  a  paper  composed  of  truisms,  some 
facts  borrowed  from  text-books,  and  much  padding.     Such  exbi- 


^dbyGoogle 


Medical  Items.  255 

bitioDs  coatribute  to  interDational  ill-feeling  and  to  persooal  dis- 
dainment.  No  more  ehould  be  report  procedures  based  on  alleged 
chemic  or  physiologic  esperiments  whiob  he  19  not  ready  and  able 
to  demonstrate  by  cbemic  or  physiologic  tests.  Above  all,  he 
assiduoasly  should  refrain  from  annoiincing  papers  that  he  does 
not  anticipate  being  able  to  present.  This  latter  procedure  has 
already  been  done  to  death.  If  he  will  take  the  results  of  his 
honest  work  and  intelligent  thought,  it  matters  not  whether  they 
be  based  on  experimentation  or  observation,  be  may  be  assured  of 
kindly  reception  and  courteous  attention. — Medical  Recortt. 


If  you  were  to  take  an  eminently  practical  boy  and  school  kim 
into  the  superficial,  sentimental,  emotional  and  dependent  habits 
of  the  average  girl,  with  the  ordinary  attendants  of  a  corset,  tight 
and  bigh-beeled  shoes  and  indoor  training,  and  insufficient  cloth- 
ing, and  let  him  live  on  deoxygenated  air,  with  no  hope  except  to 
get  married,  and  not  allow  him  to  purchase  even  as  much  as  a  rail- 
road ticket  for  himself,  never  have  a  pocket  in  his  clothes,  spend 
hours  daily  cnrliug  his  hair  and  preparing  to  speud  a  Irivolous 
evening,  etc.,  he  would  develop  into  a  veritable  hysterical  non- 
entity, capable  of  producing  only  bis  kind. — Dr.  Lucinda  H.  Corr- 


The  St.  Louis  Medical  and  Surgical  Journal  of  December,  1897, 
contains  an  article  on  appendicitis  by  Dr.  A.  C  Bernays,  of  St. 
Louts,  in  which  he  reporbi  a  series  of  seventy  cases  without  a  death 
— all  but  two  or  three  operated  upon  quite  early  in  the  course  of 
the  disease.  He  concludes :  "  I  believe  that  when  it  comes  squarely 
to  the  consciousness  of  the  general  practitiouer  that  modern  sur- 
gery, in  the  hands  of  experienced  operators,  can  cure  seventy  acute 
cases  of  suppurative  appendicitis  in  succession,  without  selection  of 
cases,  all  other  methods  of  treatment  must  be  abandoned.  And 
when  it  is  further  stated  that  the  average  time  of  confinement  to 
the  bed  is  less  than  three  weeks,  all  room  for  discussion  seems  to 
vanish." — Am.  Jour,  of  Surg,  and  Gynecol. 


,„i,z.dby.GoogIe 


256       The  Atlanta  Mbdical  and  Buegical  Journal. 

At  the  recent  meetinfc  of  the  Alabama  State  Medical  Aesocia- 
tiun,  it  was  deterraiaed  to  have  a  Jerome  Cochran  lecture  delivered 
at  the  annual  meetio^  by  some  prominent  medical  man  to  memory 
of  the  physician  of  that  name.  It  was  further  determined  to  erect 
the  proposed  monument  to  Jerome  Cocbran  at  Montgomery  instead 
of  at  Selma.  In  addition,  it  was  agreed  to  aek  ibe  State  legisla- 
ture to  make  vaccination  compulsory ;  that  a  law  should  be 
enacted  giving  Stat«  quaraatioe  laws  precedence  over  county  laws, 
and  that  the  State  Board  of  Health  should  have  charge  of  the 
movement  of  trains  in  the  event  of  epidemics  of  contagious  dis- 
eases. The  following  officers  were  elected:  President,  H.  A. 
Moody,  of  Baily  Springs;  orator,  G.  0.  Chapman,  of  Mobile; 
senior  vice-president,  S.  G.  Gay,  of  Selma;  junior  vice-president, 
S.  H.  Lowry,  of  Huntsville  ;  secretary,  G.  R.  Waller,  of  Mont- 
gomery; treasurer,  H.  G.  Perry,  cf  Greenville.  Mobile  was 
choeeu  as  the  next  place  of  meeting. — Phila.  Med.  Journal, 

Db,  David  W.  Yandbll,  of  Louisville,  Kentucky,  died  May 
3.  Dr.  Yandell  was  born  in  Tennessee  in  1826.  He  was  not  only 
preeminent  as  a  surgeon,  but  a^  a  speaker  and  raconteur  was  un- 
surpassed. Dr.  Yandell  was  the  surgeon  who  attended  Albert 
Sidney  Johnston  at  Shiloh,  and  many  a  time  bad  Dr.  Yandell  been 
heard  to  tell  how  he  importuned  the  great  Confederate  leader, 
who  was  regarded  by  many  as  the  military  genius  of  the  war, 
to  submit  to  treatment  and  to  allow  others  to  look  after  tUe 
fighting  for  the  time  Iwing.  Those  who  knew  David  \V.  Yandell 
in  his  prime  can  hardly  realize  that  for  the  past  five  years  be  bad 
been  mentally  and  physically  a  wreck.  First  his  health  declined, 
and  then  his  mental  faculties  weakened,  and  ever  since,  until  death, 
he  was  a  confirmed  invalid.  He  was  tall  of  stature,  with  massive 
frame  and  magnificent  presence.  Whether  seen  in  an  ordinary 
crowd  or  in  an  assembly  of  great  men,  David  W.  Yandell  was 
always  easily  recognized  as  a  man  cast  in  no  ordinary  mould.     He 


^dbyGoOgle 


Medical  Items.  257 

was  great  as  a  aurgeon,  useful  as  a  citizen,  and  deligbtful  ae  a 
friend ;  and  well  may  his  profession,  his  country,  and  the  wide  circle 
of  friends  whom  he  had  drawn  about  him  mourn  the  death  of  this 
princely  character. — NashviUe  American. 


Db.  Juhs  GniTERAS,  professor  of  patliology  in  the  University 
of  Pennsylvania  and  an  eminent  yellow  fever  expert,  has  been  in- 
structed by  the  Surgeon-Geneml  of  the  United  States  Army  to 
proceed  to  Tampa,  Florida,  to  act  as  medical  adviser  to  the  com- 
mander ol  the  army  which  it  is  expected  will  invade  Cuba.  Rela- 
tive to  the  dangers  which  may  beset  troops  in  Cuba,  and  the  pre- 
cautions which  should  be  adopted,  the  following  statement  is  at- 
tributed to  Dr.  Guiteras:  "It  is  possible  to  prevent  the  infection  of 
military  garrisons,  though  whether  it  can  be  done  in  a  campaign 
remains  to  be  seen.  Yellow  fever  is  circumscribed  within  certain 
areas,  and  if  it  is  possible  to  keep  the  troops  away  from  those  areas 
there  will  be  little  danger  of  infection.  Contrary  to  the  prevail- 
ing idea,  altitude  does  not  govern  the  disease.  There  are  no  ex- 
tremely high  altitudes  in  Cuba,  and  yet  there  are  places  where 
there  is  no  yellow  fever.  In  some  places  on  the  coast  the  disease 
is  not  to  l>e  found.  As  a  general  rule,  the  more  important  the 
town,  tbe  greater  its  commercial  activity,  the  more  infected  it  is. 
Yet  a  congregation  of  people  in  the  interior  could  not  originate 
yellow  fever.  The  cities  where  the  disease  prevails  are  infected 
because  they  are  permanently  inhabited  by  a  crowd.  Still,  the  dis- 
ease may  be  carried  to  a  garrison  from  an  infected  town.  To  guard 
against  tbis  the  troops  must  be  placed  by  themselves,  in  uninfected 
places,  and  they  must  not  commuuicate  with  infected  places.  Then, 
too,  no  depot  of  suppplies  should  be  placed  in  an  infected  port. 
This  is,  of  course,  a  desideratum  that  it  may  be  difficult  to  obtain, 
for  strategic  reasons.  Ideal  conditions  are  not  always  possible  in 
a  military  campaign.  Whether  or  not  yellow  fever  can  be  kept 
from  tbe  troops  depends  entirely  upon  whether  these  plans  can  he 
carried  out." — PhUa.  Med.  Journal. 


^dbyGoOgle 


BOOK  REVIEWS. 


Prompt  Aid  to  the  Injured.  Designed  for  Military  and  Civil 
Use.  By  Alvab  H.  Doty,  M.D.,  Late  Attending  Surgeon  to 
Bellevue  Hospital  Dispensary,  Late  Major  and  Surgeon  Ninth 
Regimeot,  New  York,  Second  Edition,  Revised  and  Enlat^d. 
Price  ll.SO.  D.  Appleton  &  Co.,  New  York.  [Southern 
Agency,  Atlanta.] 

"The  object  of  this  manual  is  to  instruct  those  who  are  desirous 
of  knowing  what  course  to  pursue  in  emergencies,  in  order  that 
sick  or  injured  may  be  temporarily  relieved.  Special  effort  has 
been  made  to  so  arrange  the  matter  and  introduce  such  points  as 
will  be  of  use  to  the  ambulance  corps  connected  with  military 
organizations." 

The  first  seven  chapters  are  devoted  to  the  essentials  of  anatomy 
■and  physiology.  Then  come  chapters  on  bandages  and  dressing!!, 
antiseptics,  disinfectants  and  deodorants.  The  next  chapters  con- 
tain practical  suggestions  upon  rendering  prompt  and  intelligent 
aid  in  cases  of  contusions  and  wounds,  hemorrhage,  fractures, 
sprains  and  dislocations,  burns,  scalds  and  frost-bite,  shock  and 
syncope,  concussion  of  the  brain,  apoplexy,  iutoxication,  epilepsy, 
asphyxia  and  drowning,  poisoning,  etc.  A  chapter  is  devoted  to 
the  hygiene  of  baths,  clothiug,  food,  water,  air  and  exercise.  The 
last  chapter  describes  the  proper  methods  of  transporting  the 
wounded,  and  includes  the  "  Drill  Regulations  for  the  Hospital 
■Corps,  U.  S.  Army."  The  latter  is  particularly  useful  just  at  this 
lime. 

Brief  I^ays  on  Orthopedic  Surgery.  By  Newton  M. 
Shaffer,  M.D.,  Sui^onin-Chief  to  the  New  York  Orthopedic 
Dispensary  and  Hospital,  etc.  D.  Appleton  &  Co.,  Publishers, 
72  Filth  ave.,  New  York. 

This  little  book  of  eighty-one  pages  is  a  collective  republication 
of  a  number  of  essays  which  this  author  has  written  for  various 
medical  journals  in  the  last  fourteen  years.     These  separate  titles 


^dbyGoOgle 


Book  Reviews.  259 

are:  "The  Present  Status  of  Orthopedic  Surgery;"  "What  ia 
Orthopedic  Surgery?";  *'  The  BeSnitioo  and  Scope  of  Orthopedic 
Surgery ; "  "  The  Relation  of  Orthopedic  Sui^ery  to  General 
Surgery;"  "  The  Present  Needs  and  Future  Demauds  of  Ortho- 
pedic Surgery ;  "  "  The  Operative  Side  of  Orthopedic  Surgery  ;  " 
"Is  Orthopedic  Surgery  to  become  ao  Obsoleie  Specialty,  with 
Remarks  on  Specialism."  Those  interested  in  orthopedic  litera- 
ture will  find  these  essays  quite  interesting  and  instructive. 


Collier's  Weekly,  May  28th, 

Sixty-nine  pictures  appear  in  the  current  number  of  Collier's 
Wc'lUy;  eight  of  them  are  portraits  of  Gladstone  at  different  pe- 
riods of  his  life,  and  four  have  other  subjects,  but  more  than  fifty 
are  objects,  scenes  and  individuals  made  specially  prominent  and 
interesting  by  the  war  with  Spain.  More  than  a  month  ago  Mr. 
Hare,  of  the  Weekly's  photographic  stafiF,  went,  with  two  other 
journalists,  to  the  camp  of  the  insurgent  general  Gomez  with  the 
first  nevTs  of  American  intervention  in  Cuba.  Mr,  Hare  wrote  a 
description  of  the  trip  and  took  scores  of  photographs ;  the  first 
instalment  o(  his  narrative,  with  about  twenty  of  bis  pictures,  ap- 
pears Id  the  current  number;  a  double-page  picture  of  Gomez,  in 
his  baromock,  chatting  with  his  American  visitors,  is  from  a  paint- 
ing by  Gilbert  Gaul,  after  one  of  Mr.  Hare's  photographs.  For 
frontispiece  the  paper  displays  the  conning-tower  of  the  torpedo 
boat  "  AVinslow,"  showing  the  results  of  Spanish  shots  at  Cardenas. 
This  battle  itself  is  the  subject  of  a  full-page  picture,  after  a  paint- 
ing by  Kitscbel ;  the  funeral  of  the  "Winslow's"  dead,  and  por- 
trails  of  the  survivors,  are  the  subjects  of  several  pictures.  There 
are  camp  scenes  from  New  Orleans,  Chattanooga  and  Tampa,  as 
well  as  from  some  State  camps.  A  good  map  of  the  scene  of  naval 
maneuvers,  fine  portraits  of  Admiral  Cervera  of  the  Spanish  fleet, 
Commodore  Watson  (who  fought  with  Farragut  on  the  "Hartford"), 
Captains  Barker,  Philip,  Lamberton  and  Dickens  of  tbe  navy. 
Ensign  Bagley,  who  was  killed  on  the  "  Winslow,"  Cadet  Petten- 
gili,  who  fired  the  first  abot  of  the  war,  Col.  Fred  Grant,  Governor 
Black  of  New  York,  and  pictures  of  several  vessels  that  have 
achieved  distinction  in  one  way  or  other,  add  to  the  value  of  tbe 
number. 


^dbyGoOgle 


SELECTIONS  AND  ABSTRACTS, 


The  Modification  op  Cow's  Milk. 

The  first  object  to  be  attained  id  the  modificatioa  of  cow's  milk 
is  to  secure  the  proper  quantities  of  the  albumiooids,  fat,  and 
sugar,  so  that  wheD  combined  it  shall  be  similar  to  human  milk. 
The  ingredients  used  are  milk,  cream,  sugar  of  milk,  water,  and 
lime  water.  A  misapprehension  exists  as  to  what  cream  really  is. 
It  is  simply  a  milk  rich  id  fats,  containing  about  16  per  cent,  of" 
fat,  4  of  albuminoids,  4  of  sugar.  This  is  gravity,  or  skimmed, 
cream  taken  from  milk  that  ha'^  stood  at  least  twelve  hourij.  It  is- 
always  better  to  procure  the  milk  and  skim  the  cream  rather  than 
to  buy  the  cream,  because  cream  that  is  16  per  cent,  fat  is  very 
much  richer  than  that  procured  in  the  market.  Sugar  of  milk 
can  now  be  purchased  at  a  very  reasonable  rale,  in  quantities  of 
one  pound  or  more.  One  pound  of  sugar  of  milk  is  sufficient  for 
sixteen  pints  of  prepared  food.  Allowing  two  pints  for  each, 
twenty-four  hours,  which  is  the  average  for  a  baby  of  six  months,, 
it  will  be  seen  that  this  does  not  make  an  expensive  food.  Indeed, 
the  expense  is  less  tliau  where  patent  foods  are  used.  It  should  be 
understood  that  the  milk  used  in  preparing  the  food  is  fresh  un- 
skimmed milk,  and  during  the  summer  season  the  food  should  be 
prepared  twice  each  day,  so  that  each  time  fresh  milk  is  used  aud 
the  cream  from  milk  that  has  stood  for  twelve  hours.  Id  mixing 
this  food  certain  articles  are  necessary:  A  graduated  glass  of  a 
capacity  of  six  or  eight  ounces,  a  measure  for  the  milk  sugar. 
This  measure  should  hold  about  one  ounce,  by  weight,  of  milk 
sugar.  It  may  be  of  glass,  china,  or  tin,  and  by  getting  a  sample 
package  of  one  ounce  of  milk  sugar  and  placing  it  in  the  recepta- 
cle and  marking  it,  it  may  be  used  for  each  subsequent  time.  A. 
glass  jar  of  the  capacity  of  one  pint,  in  which  all  the  ingredients 
are  mixed.  The  following  formula  will  be  found  suitable  in  the 
majority  of  case: 


^dbyGoOgle 


Sblbctioms  and  Abstracts.  261 

Milk 2g 

CrMm 8| 

Hilk  lugtr 1  3 

Wator 10  I 

Id  preparing  this  it  is  better  to  measure  the  10  ounces  of  water 
into  the  glaea  jar,  add  the  milk  sugar  and  stir  until  the  solution  ie 
made,  theu  add  the  cream  and  milk  and  stir  gently.  When  all  the 
ingredients  are  placed  in  the  jar  and  it  ia  agitated  until  the  sugar 
is  in  a  state  of  solution,  the  cream  is  very  likely  to  be  more  or  less 
churned  and  the  fat  globules  separated.  Having  properly  com- 
bined these  elements,  the  first  indication — that  is,  a  food  similar  to 
human  milk — has  been  met,  with  the  exception  of  the  lime  water, 
which  should  not  be  added  until  after  the  food  is  sterilized,  the 
reason  for  this  being  that  some  chemical  change  probably  takes 
place  in  the  process  of  heating.  This  food  may  now  be  sterilized 
either  in  bulk  or  in  individual  nursing- bottles,  as  the  case  may  be. 
The  latter  method  is  the  better  in  that  it  avoids  the  contamination 
of  the  food  in  emptying  it  from  the  large  vessel  into  the  nursing- 
bottle,  but  with  care  it  may  be  sterilized  in  pint  quantities  with 
comparative  safety.  The  food  is  sterilized,  not  to  make  it  more 
digestible,  but  to  destroy  pathogenic  bacteria.  Were  it  possible  to 
get  a  pure  milk  supply  and  keep  it  so  until  ready  for  use,  it  would 
probably  be  better  if  it  were  never  sterilized  at  all;  but  as  that  is 
out  of  the  question,  and  as  the  danger  of  infectiou  is  so  great,  we 
choose  the  lesser  of  two  evils  and  sterilize.  Experience  has  taught 
that  the  prolonged  heating  of  the  milk  at  a  high  temperature, 
while  destroying  pathogenic  organisms,  is  objectionable  in  that  it 
renders  the  milk  less  digestible  and  more  constipatiug.  The  more 
recent  practice  of  pasteuriziug  is  lees  objectionable,  and,  at  the 
same  time,  may  be  safely  depended  upon  to  destrny  most  of  the 
pathogenic  germs  found  in  milk. 

By  pasteurization  we  mean  the  heating  of  it  to  about  170°  and 
maintaining  that  heat  for  twenty  minutes.  In  private  practice 
where  people  cannot  be  supplied  with  ex{)ensive  apparatus,  ther- 
mometers, etc.,  we  can  only  approximate  the  degree  of  heat. 
Where  the  Arnold  sterilizer  can  be  procured  it  is  a  very  simple 
matter,  as  the  bottles  are  contained  iu  a  steam  chamber  which  is 
probably  always  below  the  boiling  point.     Where  this  cannot  be 


^dbyGoOgle 


262       The  Atlanta  Medical  and  Surgical  Journal. 

procured,  it  is  better  tq  direct  the  mother  to  place  the  bottle  or 
botlles  JD  a  tio  bucket  haviog  a  false  bottom,  beneath  which  a  small 
quaDtity  ot  water  is  placed  and  allowed  to  boil,  so  that  the  milk 
coiitaiued  is  in  an  atmosphere  of  gteam.  We  probably  rely  tuo 
much  upon  jiasteurization  of  milk  and  too  little  upoo  a  pure  milk 
supply.  Evidence  is  accumulating  to  demonstrate  that  impure 
milk  Ycheu  pasteurized  is  not  safe;  that  while  the  germs  may  be 
destroyed,  the  activity  of  the  ptomaines  already  generated  are  not 
destroyed  by  heating,  and  that  certain  cases  of  acute  sickness  are 
probably  due  to  ptomaines  in  the  milk  rather  than  to  ptomaines  de- 
veloped in  the  body.  This  dislinction  should  be  borne  in  mind  in 
our  investigation  of  the  cause  of  acute  sickness  in  bottle  babies. 

After  the  milk  is  pasteurized  Hme  water  can  be  added,  either  to 
the  fooJ  in  bulk  or  to  the  individual  nursing- bottles.  One  ounce 
of  lime  water  to  the  pint  is  sufficient  to  render  the  milk  alkaline 
in  reaction. 

Having  procured  a  milk  containing  the  proper  chemical  constit- 
uents and  having  it  pasteurized,  the  next  problem  is  that  it  may 
be  conveyed  to  the  stomach  of  the  child  in  Ibis  sterilized  condititm. 
We  should  never  forget  that  the  nursing-bottle  aud  nipples  may 
themselves  be  sources  of  infection.  Too  much  care  cannot  be  ex- 
ercised in  the  washing  of  the  bottles  and  nipples.  Simple  wash- 
ing of  the  bottles  is  not  sufBcient.  They  should,  especially  in  the 
summer,  after  being  thoroughly  washed,  be  placed  in  a  vessel  of 
water  and  thus  boiled  for  twenty  minutes  or  more,  in  order  that 
the  botles  themselves  may  be  completely  sterilized.  The  nipples 
should  be  carefully  cleansed  inside  and  out,  and  when  not  in  use 
kept  in  an  alkaline  solution  of  either  bora'x  or  soda.  The  nipples 
with  rubber  tubes  are  an  abomination  and  should  be  discarded. 
In  young  infanls  it  is  im|>nrtaut  that  the  food  should  be  of  the 
proper  temperature,  neither  too  hot  nor  too  cold.  Probably  the 
most  convenient  way  is  to  pbice  the  nursing- bottle  containing  the 
proper  quantity  of  milk  for  oue  feeding  in  a  pan  of  water  as  hot 
as  can  be  borne  by  the  hand,  and  permit  it  to  remain  there  until 
the   bottle  is  healed  through. 

The  formula  given  will  not  suit  all  cases,  but  the  advantages  are 
that  the  percentages  of  the  various  elements  can  be  easily  changed. 


^dbyGoOgle 


Selections  and  Abstracts.  26S 

e.  g.,  where  a  child  vomits  thin  milk  in  bard  curds  we  may  reduce 
the  amount  of  albumiooids  by  entirely  witbdrawio^  the  mtllc  and 
by  slightly  increasing  the  cream;  e.  g.,  4  ounces  of  cream,  12: 
ounces  of  water,  and  1  ounce  of  milk  sugar.  This  makes  a  nour- 
ishing foud,  and  yet  more  easy  of  digestion.  The  greatest  diffi- 
culty will  be  found  in  giving  to  children  that  have  been  badly 
fed  for  several  months,  especially  where  they  have  had  a  food 
deficient  in  fats  and  proteid:^  and  where,  as  a  result,  they  have 
taken  large  (juantities.  It  will  usually  be  found  that  a  child 
upon  condensed  milk  will  take  live  or  six  ounces  when  it  should, 
be  taking  two  or  three  ounces,  aod  when  placed  upon  (bis  mixture 
it  will  still  take  excessive  quantities  and  an  indigestion  result,  not 
from  the  fault  of  the  food,  but  from  the  abnormal  condition  of  the 
child.  lu  cases  of  this  kind  it  is  better  to  still  further  dilute  the 
food;  e.  g.,  take  four  ounces  of  this  food  aod  add  two  ouuccs  of 
sterilized  water,  and  then  attempt  gradually  to  reduce  the  quantity 
of  food  and  withdraw  the  surplus  of  water. 

JUgulurity  of  Feeding. — Much  depends  upon  this,  and  with  a 
little  care  a  child  can  be  trained  to  nurse  from  the  bottle  at  regular 
intervals.  During  the  first  three  mouths  of  life  an  infant  should 
nurse  every  two  hours  during  the  day  and  once  in  the  middle  ol 
the  night,  or  about  ten  nursings  in  twenty-four  hours,  and  the 
quantity  of  milk  at  each  nursing  should  not  exceed  three  ounces. 
From  three  to  six  mouths  the  child  should  nurse  about  every  three 
hours  during  the  day,  or  seven  nursings  during  the  twenty-four 
hours,  and  should  take  four  or  five  ounces  at  each  nursing.  From 
six  to  ten  months  the  child  should  nurse  about  every  four  hours 
and  take  six  to  eight  ounces  at  each  feeding.  The  tests  of  a  lood 
are,  first,  whether  or  not  it  agrees  with  the  patient,  and,  second, 
whether  or  not  the  patient  gains  in  weight.  A  steady  gain  in 
weight  in  the  most  important  iudex  as  to  whether  the  food  is  agree- 
ing with  the  child  and  whether  the  child  is  thriving  properly. 
During  the  first  six  months  of  life  infants  should  gain  ou  an  aver- 
age of  half  a  pound  a  week.  Bottle-fed  babies  are  more  prone  In 
attacks  of  indigestion  than  nursed  babies,  and  these  attacks  are 
very  frequently  due  to  some  fault  with  the  feeding,  either  too  large 
a  quantity  of  food  or  too  rich  a  food,  or  food  given  too  hot  or  too 


^dbyGoOgle 


264       The  Atlanta  Medical  and  Surgical  Journal. 

cold.  Rather  than  prescribe  medioiiies  it  would  be  better  for  the 
patient  if  the  phyeiciaa  would  carefully  look  into  the  methoda  of 
feeding  for  the  cause,  and  it  will  usually  be  found  that  by  chang- 
ing tfae  proportion  of  the  elements  this  difficulty  can  be  overcome. 
Constipation  is  one  of  the  most  annoying  conditions  and  the  most 
difficult  to  correct.  Frequently,  by  increasing  the  cream  we  will 
aid  in  overcoming  the  constipation.  Auotber  simple  method  is  to 
give  water  freely  between  nursings.  Where  the  various  modifica- 
tions of  cow's  milk  fail,  as  is  sometimes  the  case,  owing  to  the  in- 
.  herent  differences  in  the  albuminoids  of  human  and  cow's  milk, 
we  may  then  prcdigest  the  cow's  milk.  By  this  process  the  albu- 
minoids are  converted  into  soluble  peptones. 

In  the  following  I  quote  from  Professor  Albert  R.  Leeds:  "Take 
of  milk  half  pint,  water  half  pint,  cream  four  tablespoonfuls,  pep- 
togenic  milk  powder  one  measure.  This  mixture  is  heated  on  a 
hot  range  or  gas  stove,  with  constant  stirring,  the  heating  being 
80  conducted  that  at  the  end  of  ten  minutes  it  is  brought  to  the 
boiling  point.  This  is  put  in  a  clean  bottle,  corked,  and  placed  on 
ice  or  in  cold  water  until  ready  for  use."  Peptogenic  milk  pow- 
der contains  pancreatic  extract,  lactose,  and  alkalies,  and  the 
"measure"  is  fouud  with  every  package. — Dr.  McClanahan  in 
Western  Med.  Review. 


Some  Points  in  the  Examination  fob  Life  Imsubance. 

At  first  the  physique  and  general  appearance  should  be  noted. 

Are  the  eyes  bright;  is  the  complexion  a  healthy  cue;  is  there 

any  puffiness  uuder  the  eyes  or  on  back  of  hands;  or  swelling  of 

feet  or  ankles;  is  there  any  lameness  in  walking. 

In  making  a  physical  examination  of  the  lungs  and  heart  the 
outer  shirt  should  be  removed,  for  if  it  contaius  starch,  on  a 
deep  inspiration  it  produces  a  crackling  sound  simulating  crepitant 
or  subcrepitaut  r&les.  Inspection  should  be  made  of  the  chest 
with  reference  to  fulness  of  intercosial  spaces,  and  undue  promi- 
nence of  chest  or  contraction,  or  depression  under  the  clavicle — anv 
of  these  may  be  significant  of  an  old  pleurisy,  emphysema,  phthisis 
and  pericarditis.    Auscultation,  as  a  rule,  should  be  made  with  the 


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Sblections  axd  Abbteacts.  265 

ear  applied  to  the  chest  walls  with  a  thin  covering,  as  a  towel. 
The  examiDatioD  should  cover  supra-  and  infra-clavicular  regioa, 
supra-  and  iDfra-azillary  region,  and  posterioF  over  inter-  and 
intra-scapular  region.  Inspection  is  of  importance  in  examination 
of  the  heart;  from  it  we  determine  the  apex  heat,  force  of  beat,  or 
change  of  beat.  Palpitation  is  of  great  importance;  by  it  we  de- 
termine the  force  of  the  cardiac  pulsation,  the  frequency  or  slow- 
ness of  the  heart's  action  and  the  irregularity  of  its  movements. 
In  auscultation,  we  place  the  ear  over  different  valves  of  the  heart 
and  listen  to  the  heart  sounds  while  applicant  is  holding  his  breath, 
then  direct  him  to  breathe  naturally,  and  finally  tell  him  to  take 
a  few  forced  inspirations.  By  this  method,  if  there  be  a  murmur, 
it  can  he  easily  detected ;  in  cases  of  doubt,  the  stethoscope  may  he 
used.  The  examination  of  the  pulse  is  of  great  importance,  and 
should  he  taken  two  or  three  times  during  an  examination,  and  at 
4>ach  time  for  a  minute.  The  following  conditions  should  be  noted: 

Frequency  of  beats  in  a  given  time,  regularity,  iotermittence, 
strength  and  force  of  the  heats,  is  it  compressible,  or  is  it  small 
and  thready?  With  a  pulse  of  high  arterial  tension  the  vessels 
are  contracted  and  the  blood  escapes  with  difficulty  from  the  arteries 
into  the  veins;  the  artery  is  cord-like  and  can  be  traced  in  its 
course  up  the  forearm.  This  condition  is  often  found  in  Bright's 
disease,  in  gout,  affections  of  the  nervous  system,  and  in  degeuera- 
tion  of  vessels. 

In  arterial  degeneration  the  vessel  loses  its  elasticity,  its  lumen 
is  diminished, and  it  becomes  hard  and  rigid,  or  "pipe-stem  artery." 
This  is  a  very  significant  condition,  being  evidence  of  senile  decay 
of  the  arteries.  Many  persons  are  constitutionally  much  older 
than  their  years  will  warrant — they  are,  in  fact,  prematurely  old; 
while,  on  the  other  hand,  many  old  people  show  few  signs  of  old 

•ge- 
lt might  he  well  to  mention  cases  of  alleged  syphilis,  for  I  have 
seen  injustice  done  to  the  applicant  in  a  great  many  cases.  As  a 
rule,  applicants  know  nothiog  of  the  constitutiooal  symptoms  of 
syphilis,  and  if  they  have  had  a  chancre  and  have  fallen  into  the 
hands  of  a  charlatan,  he,  of  course,  has  syphilis,  and  goes  on  record 
as  such,  when,  in  fact,  in  many  instances,  he  has  had  a  chancroid  and 


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266       The  Atlanta  Medical  and  Surqical  Journal. 

not  the  infecting  chaoore.  In  these  cases  examioatioa  of  the  cer- 
vical glands  should  be  made,  and  &a  inquiry  into  the  constitutional 
symptoms — e.  g.:  eruption,  sore  throat  and  fever.  In  many  of 
these  cases  inquiry  will  reveal  that  applicant  had  none  of  the  symp- 
toms mentioned — and  the  physician  burned  the  chancre  and  it  gut 
well. 

Lastly  the  examination  of  the  urine  should  receive  our  attention. 
It  is  embarrassing  to  say  that,  as  a  rule,  examiners  do  not  seem  to 
realize  the  importance  of  making  a  careful  analysis  of  the  urine. 
Examiners  should  become  familiar  with  a  few  of  the  most  trust- 
worthy tests  and  be  capable  of  making  a  microscopical  examina- 
tion. In  many  instances  the  urine  is  the  index  that  points  to  le- 
sions that  are  just  beginning.  The  centrifuge  is  as  necessary  for 
daily  use  as  the  standard  solutions  for  chemical  test;  it  can  be  used 
for  quantitative  estimation,  and  in  sedimentation  for  microscopical 
examination.  My  experience  has  taught  ine  that  the  specific  grav- 
ity cannot  be  relied  upon,  and  I  have  known  of  many  who  rely 
upon  the  specific  gravity  and  make  no  further  analysis  of  the  urine, 
taking  it  for  granted  that  1,020  meant  normal  urine  when,  in  fact, 
albumin  and  sugar  may  be  present  with  a  specific  gravity  at  1,020. 
Normal  urine  may  range  in  specific  gravity  from  1,000  lo  1,030; 
the  food  eaten,  exercise  and  the  amount  of  water  imbibed — all  will 
change  the  specific  gravity  of  the  urine  without  altering  in  the 
least  the  healthy  coudition  of,  the  kidneys.  The  examiner  should, 
at  least,  become  &miliar  with  two  tests  for  albumin  and  two  for 
sugar.  The  tests  that  I  use,  and  the  ones  I  consider  the  simplest 
and  the  most  delicate  in  reaction,  are : 

For  albumin,  a  ten  per  cent,  solution  of  potassium  ferrocyanide, 
and  Heller's  nitric  acid  test. 

For  sugar  I  prefer  one  devised  by  Prolessor  Wesener  of  Chicago, 
consisting  of  cuprum  sulphate,  two  drachms;  stick  potash,  six 
drachms;  glycerine, one  ounce;  pure  water, enough  to  make  eight 
ounces.  Also  one  devised  by  Professor  Haines  of  Chicago,  prepared 
as  follows:  Cuprum  sulphate,  thirty  grains;  pure  water,  one-half 
ounce;  glycerine,  one- half  ounce;  liquor  potassa,  five  ounces;  either 
one  of  these  solutions  will  keep  and  is  very  delicate  in  reaction. 

In  examining  the  urine  one  should  know,  without  any  doubt. 


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Selections  and  Abstracts.  267 

that  the  urine  was  voided  by  the  applicant  a  few  houm  after  break- 
fast, and  (be  urine  should  be  allowed  to  cool  before  beiug  tested. 
A  careful  observation  should  be  made  of  its  appearance  aud  physi- 
cal character — if  the  color  be  very  light,  it  suggests  a  diminished 
specific  gravity  ;  if  the  color  be  of  greenish  tint,  it  suggests  the 
presence  of  sugar;  if  of  a  reddish  tint,  urates  of  blood  is  inferred. 
If  the  urine  is  cloudy,  add  a  few  drops  of  acetic  acid,  and  if  it  be- 
comes clear,  the  earthy  phosphates  were  the  cause  of  the  opacity. 
If  the  opacity  of  the  uriue  fails  to  yield  to  the  action  of  the  acid, 
warm  the  upper  layers  of  the  urine  by  holding  the  test-tube  over 
a  spirit  flame,  and  if  it  uow  clears  up,  the  opacity  was  due  to  urates. 
If,  however,  the  urine  still  remaina  cloudy,  it  ie  due  to  the  presence 
of  pus,  bacteria,  or  cellular  elements,  and  requires  a  microscopical 
examioation  for  diagnostic  purposes.  If  the  reaction  is  found  to 
be  sharply  acid,  as  indicated  by  turning  blue  litmus  red,  the  pos- 
sibility of  sugar  is  suggested.  If  the  red  litmus  turns  blue,  the 
urine  is  alkaline;  it  is  of  importance  to  know  the  cause  of  the  alka- 
linity to  determine  if  there  be  a  bladder  trouble  or  alkalinity  of 
the  blood.  These  conditions  may  be  solved  by  slowly  drying  the 
litmus  paper  and  if  the  blue  color  disappears,  and  if  it  returns  to 
its  original  color  red,  ammonia  is  present,  or  volatile  alkali,  and 
su^esta  chronic  inflammation  of  the  bladder  or  urinary  tract.  If, 
on  the  other  hand,  the  blue  color  remains  after  drying,  the  urine 
is  alkaline  from  fixed  alkali  and  may  not  mean  other  than  fasting 
or  the  absence  of  a  meat  diet.  This  condition  I  have  seen  so  many 
times  during  warm  weather  when  a  minimum  amount  of  meat  was 
used  ID  the  diet,  but  when  beef  was  orderad  the  urine  would  be- 
come naturally  acid. 

If  albumin  appears  in  large  quantity,  any  of  the  ordinary  tests 
for  albumin  will  make  it  apparent;  but  if  a  small  quantity  is  pres- 
ent, the  test  that  will  make  it  apparent  is  the  one  to  use.  For  this 
reason  I  prefer  a  ten  per  cent,  solution  of  potassium  ferrocyanide. 
¥\\\  a  test-tube  half  full  of  urine,  then  add  ten  or  fifteen  drops  of 
acetic  acid,  then  add  twenty  or  thirty  drops  of  the  ferrocyanide 
solution — if  albumin  is  present  amilky  color  will  appearand  spread 
through  all  the  urine;  by  shaking  the  teat-tube  a  few  times  the 
white  color  will  appear  more  quickly.     This  test  will  only  detect 


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268       The  Atlanta  Medical  and  Sdrsical  Jourxal. 

serum  albumio  and  is  DOt  a  source  of  error  as  are  other  tests  for 
albumin.  Heller's  uitrio  acid  test,  is  familiar  to  all;  suffice  it 
to  say  that  this  test  is  liable  to  be  a  source  of  error  as  it  will  give 
the  albuminous  reaction  with  other  substances  than  serum  albumin. 

In  testing  for  sugar  I  prefer  the  test  devised  by  Professor 
Wesener,  the  formula  of  vhich  is  given  above.  The  use  of  this 
test  is  simple:  in  a  test-tube  heat  over  a  spirit  flame  to  boiling 
point  equal  parts  of  urine  and  the  test  solution,  if  sugar  is  present 
the  urine  is  changed  to  a  brick-dust  color;  this  test  is  delicate  and 
will  keep  well. 

The  test  of  Professor  Haines  is  a  reliable  one  also.  Place  one 
drachm  of  the  test  solution  in  a  test-tube,  raise  to  the  boiling  point, 
then  add  four  or  five  drops  of  the  urine,  continue  the  boiling  and 
keep  adding,  drop  by  drop,  until  a  change  takes  place  to  a  brick- 
dust  color;  continue  the  adding  of  the  urine  until  ten  drops  are 
added,  then  cease.  Sometimes  the  reaction  will  take  place  when 
only  a  few  drops  are  added;  or  it  may-not  change  until  the  ten 
drops  are  added,  and  if  not  then,  sugar  is  not  present. 

In  all  cases,  where  albumin  is  found,  a  test  for  urea  should  fol- 
low. By  testing  for  urea  we  are  then  able  to  judge  the  real  condi- 
tion of  the  kidneys,  while  albumin  may  not  mean  anything  if  the 
urea  is  normal  in  amount.  In  testing  for  urea,  fillDoremus's  ure- 
ometer  with  a  fifty  per  cent,  strength  of  caustic  potash,  add  one  c.  c. 
of  bromide  and  mix,  incline  tube  so  that  solution  fills  it  perfectly, 
then  add  one  c.  o.  of  the  urine  to  the  eolution.  The  urea  will  be 
decomposed  to  nitrogen,  then  read  off*  per  cent,  from  above  down- 
ward. The  normal  amount  of  urea  passed  by  a  man  weighing  150 
pounds,  with  a  moderate  diet  and  exercise,  is  ten  to  twelve  grains 
per  ounce.  If  below  seven  grains  per  ounce  there  is  reason  to 
suspect  organic  disease  of  the  kidneys. — Dr.  L.  P.  Walbridoe, 
in  Medical  Examiner. 


Clean  Surqeey  in  Minor  and  Emergency  Cases. 

The  Virginia  Mediad  Semi-Montkly  contains  a  paper  by  Dr. 
Howard,  o(  Alexandria,  on  the  importance  of  clean  surgery  in 
minor  and  emergency  cases  of  the  general  practitioner. 


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Selections  and  Abstracts.  269 

I  do  not  inteod  to  eoter  into  a  discussion  or  consideratioD  of  the 
various  antiseptics  or  of  the  rationale  of  tbeir  action,  but,  accepting 
aothority,  aod  baving  urged  and  pleaded  for  tbeir  application,  to 
now  saggeBt  some  practical  bints,  hy  attention  to  which  clean  eur- 
gery  may  be  obtained  in  minor  work,  and  baving  become  a  habit 
in  this  class  of  cases,  will  be  assured  in  such  major  work  as  the 
general  practitioner  is  called  upon  to  perform. 

First,  then,  concerning  minor  work. 

Yoor  bands,  though  spotless,  soil  and  white,  and  but  just  washed 
and  dried  on  a  freshly  laundered  towel,  may  be  surgically  filthy. 
Adopt  some  one  of  the  various  accepted  methods  for  cleansing 
them,  as  bichloride,  permanganate  and  oxalic  acid,  etc.,  but  don't 
dry  them  afterwards  on  a  non-sterile  towel,  and  don't  cleanse  the 
nails  with  a  knife  which  may  not  be  clean  any  more  than  you  have 
scrubbed  them  with  a  brush  unclean  from  its  last  use . 

Remember  that  "rinsing"  in  bichloride  is  a  farce — laughable, 
but  that  it  is  criminal. 

Don't  grudge  the  time  necessary  to  prepare  to  do  "clean"  work, 
as  in  the  preparation  of  your  "tools,"  viz.:  instruments,  needles, 
sutures,  solutions,  applications,  and  dressings. 

All  instruments  should  be  sterilized  twice  after  each  operation 
and  before.  Boiling  in  soda  solution  [jjss-Oij]  is  as  good  a  method 
as  you  can  use.  Boil  for  five  minutes.  If  you  cannot  boil  an 
instrument,  passing  through  any  flame  will  sterilize  it;  fresh  soot 
is  not  unclean  surgically. 

Having  cleaned  your  instruments  and  hands,  do  not  soil  them  by 
contact  with  an  unclean  site  of  operation;  this  should  be  as  care- 
fully cleansed  as  your  bands,  by  scrubbing  and  the  use  of  some  ac- 
cepted antiseptic.  Remember,  bichloride  will  not  act  in  the  pres- 
ence of  grease,  and  that  alcohol  or  ether  will  remove  that  sub- 
stance. 

Hands,  instruments  and  sight  of  operation  being  now  clean,  viz., 
sterile,  do  not  soil  them  by  contact  with  immaculate  towels,  bed- 
clothing,  or  portions  of  your  own  or  patient's  body  not  prepared 
for  operation ;  let  not  that  which  is  clean  touch  anything  that  is 
unclean  ;  use  only  sterilized  water  for  irrigation  in  nonseptic  cases. 
Keiy  more  on  amountofthe  irrigation  fluid  used  in  septic  cases — that 


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270       Thb  Atlanta  Medical  and  Surgical  Journal. 

is,  on  its  tDeohanical  aotiseptio  action  rather  than  its  chemical  prop- 
erties, and  aid  its  thorough  application  hy  force  of  stream  and, 
where  feaaible,  by  "  rubbing  it  in."  Don't  irrigate  from  a  fountaio 
syringe  nozzle  which  has  not  been  boiled  since  last  used,  and  don't 
hang  nozzle  in  mouth  of  bag  when  not  in  use ;  if,  by  mistake,  you 
have  done  this  in  a  septic  case,  don't  use  bag  f^in  until  sterilized. 

Don't  use  a  pocket  case  which  you  cannot  sterilize ;  the  leather 
velvet-lined  case  is  an  "omnium  gatherum  microbium."  Don't 
use  an  instrument  having  a  wooden  handle  until  you  have  removed 
the  wood ;  the  best  handles  are  flat  with  square  edges. 

Don't  be  stingy  with  the  number  of  sutures,  nor  of  your  pa- 
tient's patience  in  placing  them ;  consider  that  you  are  to  be  judged 
by  cosmetic  effect. 

Don't  use  adhesive  strips,  or,  if  at  all,  not  so  as  to  touch  wound  ; 
they  are  always  of  doubtful  cleanliness.  Don't  use  iodoform  or 
other  dusting  powder  that  you  have  not  sterilized  by  "cooking," 
and  don't  consider  expense  in  its  use. 

Don't  be  stingy  with  your  gauze  and  absorbent;  of  the  former, 
plain  as  good  as  any,  but  don't  rely  on  the  reputation  of  the  house 
that  bottled  or  boxed  it — "cook"  it  yourself, 

Don't  think  that  absorbent  from  pound  package  is  made  clean 
for  swabs  by  dipping  in  bichloride.  Sterilize  them  beforchaud  by 
boiling  or  cooking. 

Don't  consider  any  wound  too  small  for  the  entrance  of  the 
death-bearing  agencies,  or  that  slight  pain  and  inflammation  do  not 
matter;  they  are  infallible  witnesses  of  carelessness  and  disregard 
of  duty. 

Don't  dress  your  wound  under  five  days,  unless  throbbing  pain, 
fever  or  redness  be  present,  or  unless  you  have  used  drainage,  which 
do  only  when  you  oannot  be  sure  of  your  wound  being  clean. 

Don't  be  ashamed  of  being  considered  by  any  as  finicky ;  quiet 
attention  to  detail  need  not  involve  fussiness.  Consciousness  of 
duty  performed  will  well  repay  for  the  sneer  that  you  are  making 
a  big  show ;  for  a  small,  neat  soar,  soon  to  disappear,  and  a  painless 
result,  will  in  time  convince  the  layman  that  it  is  not  so  much 
what  you  have  done  as  the  way  you  have  done  it. 

I  have  finished  with  Don'ts.     I  have  but  one  Do.     Do  be  clean. 


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Selections  and  Abbtbacts.  271 

AMpUcism,  clean  surgery,  to  be  effective,  must  be  perfect,  or  it  is 
oseleas.  It  is  only  to  be  attained  by  absolute  and  miDute  attention 
to  detail.  Ooe  streptococcus  pyogeoes  is  only  0  7  mm.  in  diameter,  is 
autogenous,  and  will,  if  applied  with  suitable  pabulum  and  condi- 
tions, beget  in  twenty-four  hours  a  family  which  would  fill  the 
Atlantic. 

So  much  for  clean  surgery  in  minor  work.  We  come  next  to 
such  cases  of  major  surgery  as  he  may  have  to  uodertake  uoder  cir- 
eumstaoces  and  surrouDdiugs  less  favorable  than  those  which  he 
could  commaud  for  his  minor  work. 

Such  attention  to  cleaulioess  as  we  have  suggested  under  minor 
work  may  best  be  attained  for  emergency  cases,  so  far  as  your  in- 
struments, applications,  dressings,  hands  and  site  of  operation  are 
concerned,  by  your  providing  yourself  with  an  emet^ocy  bag; 
and  it  will  well  repay  you  the  slight  outlay  required,  not  only  in  a 
pecuniary  sense,  but  in  others  which  I  have  in  the  early  part  of 
this  paper  touched  upon.  And  let  me  here  urge  most  earnestly 
that  it  IB  as  much  your  duty  to  possess  such  a  bag  and  to  have  it 
always  with  you  ready  for  use,  as  it  is  to  have  a  pair  of  obstetrical 
forceps ;  I  am  speaking  now  more  especially  to  the  country  doctor. 
There  are  many  emergency  satchels  now  on  the  market — some,  per- 
haps all,  beyond  the  means  of  some  of  our  ill-paid  number.  But 
surely  there  is  not  one  of  us  who  conid  not  afford  a  bag  say  six  by 
ten  inches,  in  which  were  two  scalpels,  one  dozen  hemostats,  one  or 
more  pairs  of  strong  scissors,  with  aseptic  lock,  three  sizes  of  Mur- 
phy's buttons  (in  case  of  strangulated  hernia  requiring  resection),  a 
carefully  selected  two  dozen  needles  in  a  wide-mouth  bottle  (two  of 
these  needles  of  a  size  suitable  for  Czerny's  sutures),  one  box  of 
sterilized  iodoform,  six  feet  of  rubber  tubing,  a  half  pound  of  ab- 
sorbent cotton,  one  bottle  of  drainage  tubes,  one  bottle  of  bichloride 
tablets,  three  two-ounce  packages  of  plain  gauze  (cooked),  four 
ounces  of  ether  or  chloroform,  twoouncesof  peroxide,  one  trephine 
and  elevator,  all  carefully  wrapped  in  a  sterilized  towel,  and  six 
small  sterilized  towels,  wrapped  in  oiled  paper  or  silk,  laid  on  top. 


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272       The  Atlanta  Medical  and  Surgical  Jodbhal. 
Modern  Gunshot  Wounds. 

In  these  times  of  war  there  ia  an  added  toterest  to  the  coDsider- 
alion  of  the  injuries  ioflicted  by  the  weapons  of  modern  warfare,  a 
subject  that  even  in  peace  forms  a  branch  of  the  department  of  sur- 
gery. At  this  time  of  writing  there  has  been  no  engagement  of 
land  forGei>,and  no  casualties  of  consequence  of  any  kind;,  but  since 
the  introdactioo  of  the  roost  recent  models  of  small  arras  there  have 
been  a  sufficient  number  of  engagements  in  various  parts  of  the 
world  to  make  it  posaible  to  predict  with  some  accuracy  the  kind 
of  wounds  with  which  the  army  surgeon  will  have  to  deal  while 
the  troops  are  engaged  in  driving  the  Spaniards  out  of  Cuba. 

So  rare  are  sword  cuts  and  bayonet  stabs  in  modern  battles  that 
wounds  from  these  sources  form  an  inconsiderable  part  of  the  cas- 
ualties of  the  battle-field.  Missiles  from  the  artillery  do  a  good  deal 
of  damage,  but  the  character  of  this  class  of  wounds  has  not 
changed.  Almost  ail  the  injuries  inflicted  in  battle  come  from  rifle 
balls,  and  in  this  firearm  there  have  been  great  changes  within  a 
few  years,  the  caliber  of  the  weapon  in  this  and  other  countries 
having  been  greatly  reduced,  while  the  range  has  been  enormously 
increased  by  giving  the  bullet  a  high  initial  velocity.  Another 
recent  feature  which  greatly  modifies  the  character  of  gunshot 
wounds  is  the  jacketing  of  the  leaden  bullet  with  a  harder  metal, 
such  as  nickel  or  German  silver,  preventing  deformity  of  the  mis- 
sile even  after  contact  with  hard  substances.  The  United  States 
has  adopted  as  the  regulation  arm  the  Krag-Jorgensou  rifle,  which 
has  a  caliber  of  30  one-hundredths  of  an  inch.  As  the  supply 
on  band  of  this  weapon  amounts  to  but  one  hundred  thousand,  only 
the  regulars  will  be  armed  with  this  ride,  the  volunteers  being  pro- 
vided with  the  Springfield  rifle  of  45  caliber.  The  Spanish  troops 
are  likewise  furnished  with  two  kinds  of  rifles,  the  Mauser  of  7 
m.  m.  caliber,  equal  to  about  28  one-hundredths  of  an  inch,  and  the 
Remington  array  rifle  of  43  caliber.  It  will  thus  be  seen  that  the 
armies  about  to  op[)ose  one  another  in  Cuba  will  be  on  a  practical 
equality  in  the  matter  of  firearms,  and  that  the  wounds  inflicted  on 
the  two  sides  will  be  much  the  same  in  character. 

At  very  short  ranges  the  small  caliber  ball   with  high  velocity 


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Selections  and  Abstracts.  27S 

produces  an  effect  described  as  "explosive,"  the  iiijury  to  the  tis- 
sues being  so  forest  and  so  widely  spread  that  when  these  wounds 
were  first  observed  in  battle  the  enemy  were  accused  of  using  ex- 
plosive bullets.  Explosive  effects  are  noted  particularly  io  the 
brain  and  liver,  these  organs  being  largely  destroyed  by  the  passage 
through  them  of  a  single  bullet.  In  the  soft  parts  of  limbs  the 
destruction  of  tissue  is  described  as  "frightful,"  while  the  long 
bones  are  fractured  and  comminuted  to  an  astooisbiDg  extent,  the 
splinters  and  fragments  of  bone  being  driven  to  great  distances. 

The  limit  of  range  at  which  explosive  effeols  are  observed  is 
variously  stated  by  different  observers.  In  experiments  made  upun 
cadavers  at  the  Frankford  arsenal  in  Philadelphia,  the  range  was 
given  as  250  yards  for  the  45  caliber  rifle  and  350  yards  for  the 
30  caliber. 

At  greater  distance,  up  to  2,000  yards,  covering  the  ranges  at 
which  the  majority  of  wounds  are  inflicted  on  the  battle-field,  the 
small  caliber  ball  of  high  velocity  produces  less  severe  wounds 
than  did  its  larger  and  slower  predecessors.  This  is  particulariy 
true  of  the  jacketed  bullet,  that  does  not  become  flattened  or  "  mush- 
roomed" on  striking  a  bard  substance.  The  email,  swift-moving 
bullet  perforates  the  skin  with  a  round,  narrow  orifice  with  clean 
edges.  In  fibrous  tissue  it  makes  a  narrow  slit;  in  muscle  a  fistu- 
lous track  a  little  larger  than  itself;  in  bone  a  hole  sometimes  as 
cleanly  cut  as  if  punched  out,  sometimes  with  splintered  edges, 
according  to  the  velocity.  An  important  difference  between  the 
old  and  the  new  wounds  is  where  an  artery  is  involved.  The  dan- 
ger of  hemorrhage  upon  the  battle-field  used  to  be  lightly  esteemed, 
but  the  bullet  with  high  velocity  cuts  arteries  as  sharply  as  does 
the  knife,  and  there  is  no  doubt  that  the  danger  from  primary  hem- 
orrhage will  be  greatly  increased. 

Beyond  the  limit  of  its  explosive  action,  the  bullet  from  the  new 
rifle  justifies  the  claim  made  for  it  that  as  compared  with  the 
old  rifle  ball  it  inflicts  wounds  less  severe  and  more  easily  recov- 
ered from.  Wounds  of  soft  tissues,  even  of  the  lungs  themselves, 
are  found  to  be  much  diminished  in  severity.  Indeed,  the  mildness 
of  the  injury  it  inflicts  is  urged  as  a  serious  objection  to  the  new 
rifle.    The  object  of  the  soldier  is  to  disable  the  enemy  as  quickly 


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274       The  Atlanta  Medical  and  Surgical  Journal. 

as  possible.  In  general,  the  shock  of  even  a  fleeh  wound  may  be 
depended  upon  to  preveot  a  man  from  taking  further  part  in  a 
battle,  but  the  swift-moving,  small-caliber  bullet,  with  a  hardened 
case  preventing  ita  deformity,  produces  so  little  shock  that  the  stop- 
ping power  of  the  new  rifle  is  comparatively  small,  and  there  is  a 
great  question  as  to  its  effectiveness  in  stopping  a  rush  of  fenalical 
and  barbarous  men  like  the  Dervishes  of  the  Soudan  or  the  Abye- 
sinians.  The  shook  to  horses  is  also  so  much  less  that  it  is  doubt- 
ful if  the  new  rifle  can  be  depended  upon  to  stop  a  cavalry  charge 
as  did  the  old  weapon.  Without  reference  to  the  part  hit,  the 
shock  depends  upon  the  loss  of  energy  of  the  ball  in  its  passage 
through  the  body.  As  it  is  evident  thata  bullet  that  passes  through 
the  body  undelormed  will  lose  much  less  enei^y  than. one  that  be- 
comes "mushroomed"  on  the  way,  experiments  have  been  made 
upon  the  use  of  bullets  with  sofl  tops  that  will  spread  out  when 
they  meet  with  an  obstacle,  and  be  so  slowed  as  to  increase  the 
amount  of  shock  produced. — Northttxstem  Lancet. 


CUHETTAQE    AND    PACKING   THE    UTERUS. 

J.  Duncan  Emmett  [Am.  Qyn.  and  Obstet.  Jour.,  May)  takes 
exception  to  the  general  teaching  that  endometritis  is  an  important 
or  even  a  common  factor  in  inflammatory  diseases  of  the  pelvis. 
In  the  popular  medical  mind  to-day  the  use  of  the  curette  implies 
a  belief  in  the  doctrine  of  endometritis  as  the  fona  et  origo — the 
foundation-stone,  in  fact — of  the  diseases  of  women.  This  is 
neither  just  nor  true,  in  the  opinion  of  the  author.  In  the  under- 
standing of  Dr.  Polk,  to  whom  is  given  the  chief  credit  for  the 
revival  of  curettage  and  drainage,  at  least  in  the  sense  of  popular- 
izing it,  and  in  that  of  the  vast  majority  of  its  present  supporters, 
the  chief  significance  of  this  operation  lies  in  the  claim  that  it  is 
curative  of  endometritis.  This  is  defined  as  an  inflammatory 
disease,  per  ae,  of  the  lining  membrane  of  (he  uterine  canal.  Its 
origin  is  by  extension  through  the  vagina,  extension  through  the 
tubes,  or  by  the  introduction  of  septic  matter  by  means  of  the 
lymphatics.  Its  clinical  symptoms  are  uterine  "leucorrhea"  and 
enlargement,   with   tenderness    in    and   around    the    uterus.      If 


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SBLBCTI0N8   AND   ABSTRACTS.  275 

eodometritis  io  its  acute  form  be  considered  as  a  priraarr  and  iude- 
pendent  disease,  as  its  advocates  claim  it  to  be,  we  should,  to  the 
estimation  of  the  author,  expect  some  evidences  of  distinct  inflam- 
mation io  the  endometrium  itself;  yet  we  never  find  this,  but  the 
whole  uterus  ae  well  as  the  peri-uterine  tissues  show  equal  evi- 
dences of  inflammation.  In  acute  eudometricis,  therefore,  it  is 
pure  assumption  to  claim  that  the  metritis  and  perimetritis  are  sec- 
ondary diseases  in  regard  to  it.  In  chronic  endometritis,  as  it  is 
called,  pathological  conditions  external  to  the  canal  are  still  mure 
easily  recognized  and  are  invariably  found,  so  the  same  argument 
holds  good  as  in  reference  to  the  acute  form.  But  although  the  author 
believes  endometritis  as  a  distinct  disease  is  rare,  the  endometrium 
has  the  power  of  very  rapid  aud  thorough  absorption.  Hence,  it 
is  through  and  by  means  of  this  membrane,  undoubtedly,  that 
septic  material  and  irritating  substauces  which  reach  the  canal  are 
frequently  carried  into  the  body  of  the  uterus  and  to  its  aduexa 
and  ligaments,  where  they  cause  an  ioflammation  of  more  or  less 
extent  and  distinctive  character.  The  endometrium,  from  its  ana- 
tomical connection  with  the  uterus,  must  likewise  become  involved, 
but  this  involvement  is  a  secondary  one  always  in  importance. 
The  author  queries:  What  is  more  probable  than  that  this  organ 
should  endeavor  to  rid  itself,  by  means  of  its  glands,  of  the  stasis 
in  its  venous  circulation  ?  And  this  is  his  belief,  in  that  he  considers 
uterine  "leucorrhea"  to  be  nothing  more,  io  the  majority  of  cases, 
than  a  symptom  of  some  form  of  inflammation  external  to  the 
endometrium,  and  usually  external  to  the  uterus  as  well,  and  as 
sigui&cant  alone  of  an  effort  oo  the  part  of  nature  to  find  relief 
from  a  blood-stasis.  This  view  of  the  subject  received  clinical 
confirmatioD  from  the  experience  of  most  physicians  who  have 
constantly  cored  completely  all  the  symptoms  ascribed  to  this  sup- 
posed disease  by  applications  of  astringent  drugs  to  the  vaginal 
vault  alone,  without  ever  suturing  the  uterine  canal.  The  author 
put«  forth  this  remarkable  statement:  "  That,  with  large  oppor- 
tuDJties  for  observation  both  in  my  own  practice  and  that  of 
others,  I  have  never  seen  a  case  cured  by  curettage,  unless  in  those 
diseases  already  excepted  in  the  beginning  of  this  article,  viz.: 
retained  placenta  or  secundinea,  acute  sepsis  from  operative  inter- 


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276       The  Atlanta  Mkdical  and  Suroical  Journal. 

fereoce  and  the  like,  or  in  acute  gooorrheal  infection.  The  symp- 
toms have  always  steadily  returned,  after  a  greater  or  less  interval, 
when  local  treatment  has  ceased  with  the  curetting."  Finally,  to 
support  his  positioD,  the  author  offers  the  dicta  upon  this  subjeet 
of  one  of  the  world's  greatest  pathologists,  appending  also  the 
notes  of  Professor  Welsh,  of  Johns  Hopkins  University,  on 
endometritis. 


Social  akd  Professional  Visits. 

The  young  man  entering  practice  is  oneo  in  a  predicament  &ai 
has  bard  work  to  make  fine  distinctions.  One  of  his  diflGoulties- 
is  in  knowing  how  and  when  to  make  friends  of  his  patients  and 
patients  of  his  friends.  An  older  physician  once  said  that  for 
every  friend  made  by  a  young  man  two  patients  were  lost. 

There  is  no  doubt  that  the  familiarity  which  springs  from  a 
close  acquaiutancesbip  between  physician  and  friend  soon  begets  a 
certain  amount  of  contempt,  and  in  too  many  cases  the  physician 
does  better  to  hold  himself  aloof  from  too  close  commuaioo  with 
ponsible  patients.  The  danger  of  making  friends  of  patients  is 
also  emphasized  when  the  visit  which  is  on  the  dangerous  border- 
land between  social  and  professional  is  viewed  from  different  sides 
by  patient  and  physician. 

A  physician  goes  to  see  a  eick  one,  be  it  man,  woman  or  child, 
and  he  is  asked  to  remain,  perhaps  to  spend  the  evening  or  to  take 
a  meal.  That  is  the  fatal  step.  As  soon  as  he  begins  to  drop  in 
in  a  familiar  way  to  ask  a  few  questions  and  make  a  few  sugges- 
tions, and  then  remain  for  a  social  talk,  just  so  soon  is  his  position 
as  family  physician  in  jeopardy.  Of  course,  there  are  exceptions 
to  this  statement,  when  the  physician  has  reached  the  age  of 
extreme  maturity,  and  then  comes  the  difBculty  of  turning  him 
off  when  the  family  likes  him  as  a  frieud,  but  feels  that  as  a  phy- 
sician a  better  man  might  be  found.  When  the  time  for  rendering 
bills  comes  around  then  the  position  of  both  parties  is  usually 
clearly  deGued. 

A  young  physician  in  New  York  State  has  just  brought  suit 
against  a  fair  patient  for  a  bill  for  services,  which  she  maiotaios 


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Sblections  and  Abstracts.  277 

she  does  not  owe,  as  so  many  of  the  visits  were  of  a  social  nature. 
By  briDging  suit  the  physician  made  clear  his  position  and  found 
an  enemy  in  his  fair  patient,  and  being  in  a  small  place,  he  prob- 
ably hurt  himself  more  than  the  amount  of  the  bill,  while  the 
patient  was  taught  the  lesson  that  good  services  may  be  rendered, 
even  though  harmless  talk  and  persiflage  be  mingled  with  the 
good  advice.  Still,  such  combinations  are  rather  dangerous,  and 
physicians  especially  are  much  more  appreciated  if  they  have  little 
to  say  and  refuse  to  converse  on  medical  topics  before  a  general 
audience  or  take  up  social  chit-chat  on  an  equality  with  the  patient 
ilnring  a  professional  visit. 

More  misunderstandings  arise  from  this  lack  of  business  methods 
than  from  many  other  causes.  As  long  as  there  is  illness  in  a 
house  social  visits  should  cease,  and  when  professional  advice  is 
asked  during  a  social  visit  it  should  either  be  given  cheerfully  and 
openly,  so  that  the  patient  understands  it  is  free,  or  else  it  should 
be  made  clear  that  it  is  a  professional  service. 

It  takes  more  than  mere  medical  knowledge  to  make  a  success- 
ful physician,  as  the  successful  man  with  tact  and  a  knowledge  of 
human  nature  so  well  knows. — Maryland  Med,  Journal. 


"Chkistian  Scjencb"  and  Science. 

It  seems  as  if  every  age  must  have  its  fad,  and  perhaps  we 
should  not  disquiet  ourselves  too  much  about  it.  Long  ago  the 
question  was  asked  why  the  heathen  raged  and  the  people  imagined 
a  vain  thing.  The  question,  especially  the  latter  part  of  it,  is 
equally  pertinent  to-day;  and  the  answer  we  venture  to  suggest  is, 
because  they  like  it. 

The  great  beauty  and  merit  of  Christian  science  in  the  eyes  of  its 
devotees  is  that  it  affirms  the  thing  that  is  not  and  denies  the  thing 
that  is.  It  has  to  make  grudging  concessions  to  the  law  of  gravi- 
tation and  a  few  ordinary  primary  conditions  of  existence.  In  a 
kind  of  way  it  admits  that  certain  injuries  to  the  bodily  frame  may 
impair  activity  and  even  destroy  life.  That  a  man  cannot  walk 
without  legs  or  do  much  useful  thinking  without  his  head  are 
propositions  which  it  has  not  yet  seen  its  way  to  combat;  but  it 


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278       The  Atlanta  Medical  and  Suroical  Journal. 

takea  its  revenge  on  the  syetem  of  visible  tilings  by  comprehensive 
dentals  ia  a  host  of  matters  only  a  little  less  indisputable.  It 
scornfully  refuses  to  recognize  pain  or  functional  irregularities  of 
any  kind.  Fevers,  indigestions,  iuflammations,  and  the  whole  tribe 
of  maladies  which  challenge  the  physician's  art  have  no  foundation 
in  reality,  and  only  need  to  be  suitably  ignored  in  order  to  be  put 
to  flight.  If  Job  of  old  could  only  have  planted  himself  at  the 
Christian  science  point  of  view,  he  could  have  got  rid  of  bis  boila 
in  short  order,  and  perhaps  saved  himself  from  the  interminable 
and  not  overcheetful  discourses  of  his  friends.  The  great  remedy, 
as  recommended  to-day  in  Christian  science  circles,  is  not  to  think 
about  these  things  at  all,  and  in  case  you  cannot  think  hard  enough, 
to  send  for  a  Christian  science  adept  to  help  you.  The  adept  will 
then,  with  cheerful  and  enthusiastic  mendacity,  inform  you  that 
you  haven't  any  pain,  ttiat  you  haven't  any  boils,  that  you  haven't 
any  rheumatism  or  sciatica,  or  whatever  it  may  be;  and  if  you 
should  point  ruefully  to  the  affected  part,  will  exclaim :  *'  Why,  that 
isn't  you;  that's  a  mere  mass  of  matter — and  you  are  a  soul,  a 
spirit.  You  ought  to  rule  your  matter  and  not  let  your  matter 
rule  you."  This  is  a  point  in  the  proceedings  at  which  the  faith  of 
the  sufferer  is  sometimes  severely  tried.  Cases  have  been  known 
in  which,  breaking  into  language  neither  wholly  Christian  nor 
rigorously  scientific,  the  patient  has  demanded  to  know  why,  if 
that  wasn't  him — even  grammar  may  be  sacrificed  in  these  emer- 
gencies— he  should  he  enduring  such  abominable  tortures  on  ac- 
count of  it;  and  up  to  date  the  satisfactory  answer  of  Christian 
science  to  that  particular  question  has  not  been  formulated. — Popular 
Science  Monthly. 

The  Akti-Vivisection  Ceaze. 
It  is  gratifying  to  note  an  occasiooal  protest  against  the  passage 
of  the  bill  to  prevent  vivisection  in  the  District  of  Columbia  in 
the  secular  papers.  A  few  months  ago  the  newspapers,  with  few 
exceptions,  appeared  to  £ivor  the  bill,  but  as  its  real  objects  become 
better  understood  the  sentiment  against  it  appears  to  be  growing. 
It  was  with  a  feeling  akin  to  surprise  that  we  read  the  following 
able  protest  against  the  bill  in  the  Times-^r  a  few  eveoiags  ago: 


DiclizedbyGoOgle 


Selections  and  Abstracts.  27ft 

"The  same  spirit  that  forced  Soerates  to  drink  the  deadly  hem- 
lock, that  compelled  Galileo  to  retract  his  aaeertioti  that  the  world 
moved,  that  made  Christopher  Columbus  a  butt  of  ridicule  for 
manj  years  before  he  discovered  America,  that  threw  every  possi- 
ble olwtacle  in  the  way  of  the  great  scientist  Harvey,  and  that 
made  it  crimioal  for  physiologists  hungering  for  knowledge  to  dis- 
sect a  corpse,  is  now  at  work  in  the  United  States  Congress  seeking 
to  prevent  any  form  of  vivisection.  The  spirit  is  prompted  by  ig- 
norance. It  comes  from  a  lot  of  misguided  &natio8  of  the  same 
kidney  as  those  who  insist  that  vaccination  against  smallpox  is  vain, 
that  all  bacteriologists  are  humbugs.  It  is  the  plan  of  these  fanat- 
ics to  pass  a  bill  through  the  United  States  Congress  forbidding 
vivisectioD  in  the  District  of  Columbia,and  use  thisasanentering- 
wedge  for  further  legislation  in  the  various  States  of  the  Union. 
As  yet  they  have  failed  to  prove  a  single  case  of  cruelty  in  the  con- 
duct o(  animal  experimentation  in  the  District,  Still  they  seek  to 
establish  a  system  of  espionage  upon  all  physicians  and  scienlista 
who  seek  to  enlarge  the  knowledge  of  the  world  upon  many  things 
pertaining  to  life  and  health  that  are  still  hidden  and  vital.  The 
commission  which  these  fanatics  urge  is  to  be  made  up  of  non- 
profeseional  persons,  who  are  to  be  given  the  power  to  judge  as  to 
motives  and  methods  of  scientists.  It  is  the  purpose  to  make  mas- 
ters out  of  tyros,  to  let  the  blind  lead  those  who  can  see. 

"The  same  spirit  of  fanaticism  forced  Lord  Lister,  who  has  prob- 
ably done  more  lo  alleviate  the  suEferings  of  the  wounded  than  auy 
other  thousand  scientists  of  the  present  century  by  his  discovery  of 
antiseptics,  to  leave  England  and  go  to  the  continent  of  Europe  to 
push  his  experiments.  As  a  result  of  the  Lister  discoveries,  blood- 
poisoning  in  cases  of  sui^ry  is  now  unnecessary.  During  the 
last  war  in  this  country  blood-poisoning  was  responsible  for  at  least 
seventy-five  per  cent,  of  the  deaths  of  those  who  were  subjected  to 
Bui^pery.  Experiments  in  vivisection  made  Lister's  triumph  possi- 
ble. One  of  these  anti-vivisectionists  recently  stated  that  his  de- 
sign was  to  stop  even  the  hypodermic  puncture  of  an  animal.  Car- 
rving  the  purpose  of  these  people  to  their  legitimate  conclusion, 
all  pbysiulogica)  work  would  be  stopped.  No  bacteriological 
experiments  could  be  made.     No  tests  as  to  relative  value  of  suture 


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280       Thb  Atlanta  Medical  and  Sdroical  Journal. 

materials,  do  new  abdominal  operatioas  could  be  devised  aod  tried 
beforehand,  DO  more  diphtheria  serum  eould  be  manufactured  in  this 
country,  nor  could  we  obtain  any  more  vaccine  virus  from  animals ; 
neither  could  we  consistently  import  any  of  the  animal  serums  or 
virus  for  use  here,  as  the  importation  of  these  articles  would  mani- 
festly create  a  necessity  for  the  use  of  the  animals  abroad  to  secure 
the  material. 

"There  is  no  scientific  man  in  this  country  of  any  prominence 
who  favors  the  bill.  The  purposes  of  vivisection  experiments,  car- 
ried on  as  they  are  in  the  majority  of  cases,  are  not  to  gratify  curi- 
osity, but  to  restore  the  health  and  prolong  the  life  of  human  be- 
ings. To  oppose  them,  as  the  pending  bill  proposes,  is  to  co-ope- 
rate with  disease  and  with  death." — Ohio  Med.  Jour. 


A  Decision  of  Impobtamce  to  Paybiciaks. 

A  case  of  interest  to  physicians  generally  was  decided  by  Judge 
Dunbar,  at  Boston,  last  week.  The  circumstances  of  the  case,  as 
reported  were  that  previous  to  May  1,  1896,  Dr.  Oscar  F.  George 
had  a  lucrative  practice  in  Lynn.  On  that  date  he  sold  it  to  Dr. 
Edward  B.  Herrick,  who  came  from  Amherst,  Mass.,  signing  an 
agreement  not  to  practice  in  the  city  as  long  as  Dr.  Herrick  re- 
mained there.  He  then  went  to  Newburyport  and  later  to  Ver- 
mont, and  about  March  1,  1897,  came  to  Swampscott,  where  be 
located  and  resumed  practice,  and,  as  he  admitted  upon  the  witness- 
stand,  again  began  practice  among  his  old  patients  in  Lynn.  Dr. 
Herrick  brought  a  bill  in  equity  in  the  superior  court  against  Dr. 
George,  to  have  bim  restrained  from  practicing  in  Lynn.  As  a 
result  Judge  Dunbar  enjoined  the  defendant  from  practicing  in 
Lynn  in  violation  of  his  promise.  The  decision  is  important  from 
the  fact  that  while  the  defendant  admitted  that  morally  he  was 
bound  to  keep  his  agreement,  legally  he  was  not  so  bound.  The 
judge,  however,  decided  that  he  was  both  legally  and  morally 
bound  to  keep  his  agreement,  and  enjoined  the  defendant  from 
further  trespassing  upon  the  ground  to  which  he  had  signed  away 
all  claim. — Boalon  Med.  and  Surg.  Jowna!. 


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Selections  and  Abstracts.  281 

Malaria  and  tbb  Cuban  Cahpaion. 

SuDimiDg  up  ao  iDterestiDg  editorial  ou  the  above  subject  in  the 
Monthly  Gydopedia  of  Practiced  Medicine,  Dr.  Charles  E.  Sajous 
oottcladee : 

The  followiDg  prophylactic  measures,  carried  out  simultaneously, 
become  necessary  in  malarial  districts  to  insure  adequate  protectioD: 

1 .  To  avoid  conlaminaiion  through  the  respired  air  and  inocula- 
tion by  insects. — Unacclimatized  meu,  white  or  black,  should  not 
be  employed  for  the  digging  of  trenches,  the  erection  of  defenses,  or 
any  other  kind  of  work  involving  upturning  of  the  soil.  Natives 
should  alone  be  utilized  for  this  work. 

High  ground  should  be  selected  for  camp^sites,  windward,  if 
possible,  of  any  swamp,  pool,  stream,  etc.,  that  may  be  in  the  neigh- 
borhood. 

The  men  should  sleep  as  high  above  ground  as  possible  (not  less 
than  two  feet,  and  if  practicable,  from  twelve  to  fifteen  feet)  and 
be  provided  with  mosquito  netting. 

While  crossing  malaria-laden  forests,  glens,  lowlands,  swamps, 
etc.,  the  men  should  be  ordered  to  avoid  talking. 

2.  To  avoid  contamination  by  water. — When  water  from  malarial 
regions  is  alone  available  for  drinking  purposes,  it  should  be  fil- 
tered or,  preferably,  sterilized  by  boiling. 

Bathing  should  not  be  permitted  when  water  from  a  malarial 
r^ion  can  alone  be  obtained,  but  washing  of  the  body  with  such 
water  is  permissible,  provided  carbolic-acid  soap  be  employed. 

3.  To  prevent  the  development  of  malarial  parasites  in  the  blood. — 
Four  grains  of  hydrochlorate  of  quinine  should  he  administered 
morning  and  evening  during  meals  as  prophylactic,  beginning  two 
days  before  the  malarious  region  is  reached. 

4.  To  conserve  the  general  powers  of  resistance  of  the  economy. — 
Regular  and  frequent  periods  of  rest  should  intersperse  long  marches. 
Drenching  and  wading  through  streams  should  be  avoided  when 
possible.     Varied  and  adequate  fuoil  should  be  furnished. 

The  head  should  be  so  protected  as  to  secure  a  maximum  amount 
of  coolness  under  all  degrees  of  temperature,  a  head-gear  such  as 
the  solar  tep^  being  furnished  for  this  purpose. 


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282       The  Atlanta  Medical  akd  Subqical  Journal. 

Bbsdlts  in  100  Abdominal  Opeeatiohs. 
Shoemaker  {Pkila.  Med.  Journal,  March  26)  gives  the  results  of 
an  investigation  in  a  consecative  group  of  celiotomy  cases  of  vari- 
ous sorts,  all  the  cases  being  women  with  gynecologic  disorders. 
Of  the  100  cases  6  died;  2  cases  of  hysterectomy  for  fibromata 
weighing  fifteen  and  one-half  and  seven  and  one-half  pounds  re- 
spectively; 1  case  of  extra-uterine  fetation,  septic  when  first  seen  ; 
1  following  removal  of  ovaries  in  intraligamentary  fibroid  tumor 
of  uterus,  adhesive  to  pelvis;  I  following  removal  in  severe  double 
gonorrheal  pyosalpiox  with  bowel  adhesions,  and  one,  unexpected, 
following  removal  of  one  diseased  ovary  and  tube  and  suspension 
of  retroverted  uterus.  Hysterectomy  was  done  19  times.  In  the 
series  3  were  malignant,  8  fibromas,  1  a  fibrocyst  in  an  extra-uterine 
case,  7  were  for  hopeless  infiammatory  disease  of  uterus,  tubes  and 
ovaries.  He  believes  that  "  the  uterus  is  better  removed  when  itself 
diseased,  if  large,  heavy  and  retroverted,  with  poor  support,  when 
it  has  been  for  years  the  channel  for  outpour  for  chronic  discharges, 
when  hemorrhage  has  been  excessive  from  glandular  degeneration 
of  the  endometrium.  This  is  especially  true  in  elderly  multipane. 
The  risks  of  removal  are  not  great."  He,  however,  is  opposed  to 
removal  of  normal  ovaries  for  nervous  conditions,  believing  in 
correction  of  the  disease  causing  the  persistent  irritation  or  hem- 
orrhage, as  a  means  of  relieving  the  nervous  condition.  Thirty- 
nine  cases  with  gross  anatomic  lesions  showed  marked  nervous  dis- 
turbance, and  77  per  cent,  are  cured  or  markedly  improved.  In 
numbers  of  cases  marked  hysteric  or  other  nervous  disturbance 
proved  to  be  only  a  liurface-play  of  symptoms,  while  serious  pelvic 
disease  had  been  one  of  a  chain  of  causes.  Hernia  in  operation 
wounds  occurred  six  times,  in  one  case  a  woman,  operated  on 
when  four  months  pregnant,  who  went  safely  through  delivery  at 
term,  the  hernia  occurring  nineteen  months  later.  Infiammatory 
disease  of  tubes  and  ovaries,  requiring  removal,  occurred  thirty- 
five  times,  extra-uterine  pregnancy  was  present  five  times,  cystic 
tumors  of  the  ovaries  seven  times;  in  one  case  there  was  a  large 
dermoid;  broad- ligament  cysts  were  present  three  times;  five  cases 
had  abdominal  tuberculosis.     Uterine  suspension   was  done  but 


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Bblbotiomb  and  Abstracts.  283 

once  as  ao  independent  operation  for  severe  symptoms  due  to 
retroversion  and  descent  of  the  uterus.  This  patient  was  cured 
permanently  and  has  remained  weil  more  tlian  two  years  after  ten 
years  of  suffering.  Of  the  ninety>four  cases  surviving  operation, 
49  (59  per  cent,  of  the  cases  heard  from)  are  cured  after  a  period 
of  from  six  months  to  two  years;  thirty-two  are  improved,  though 
fourteen  of  these  are  anatomically  cured;  four  of  the  five  tuber- 
culous cases  were  improved  and  one  cared.  The  roost  satis&ctory 
results  were  in  the  large  tumor  cases,  then  the  chroaio  pus  cases  in 
whioh  there  was  one  death  in  twenty-two  oases.  He  concludes: 
"As  to  benign  tumors,  there  are  none  involving  uterus,  tubes  and 
ovaries  that  cannot,  at  the  present  day  be  removed  with  a  com- 
paratively low  mortality,  depending  upon  the  stage  at  which  the 
case  is  seen  and  upon  the  skill  and  experieooe  of  the  operator  in 
abdominal  work,  on  his  sui^ical  judgment  and  on  the  organization 
of  assistants  and  plant,  with  the  aid  of  which  he  operates.  Very 
much  depends  upon  good  detail  work.  By  the  modern  steam 
steriliser  the  last  excuse  for  a  septic  death  has  been  removed. 
Even  the  stitchhole  abscess  should  be  rarest  of  exceptions  and 
call  (br  rigid  explanation." 

The  Scientific  American  Navy  Sdpplemeht. 

The  SdenHfie  Amaiean,  which  has  always  identified  itself  very 
elosely  with  the  interests  of  the  navy,  is  to  be  congratulated  on 
the  extremely  handsome  and  valuable  "Navy  Supplement"  which 
it  bas  lately  put  before  the  public.  We  think  that  if  the  average 
reader  had  been  asked  beforehand  what  kind  of  a  work  he  would 
prefer  upon  the  Navy,  he  would  have  asked  for  just  such  an  issue 
as  this. 

Both  the  illustrations  and  the  reading  matter  are  of  the  straight- 
forward explanatory  kind  which  is  necessary  to  put  a  technical 
subject  clearly  before  the  lay  mind.  It  was  a  happy  thought  to 
preface  the  work  with  a  chapter  npon  the  classification  of  warships 
and  insert  a  few  diagrams  by  way  of  explanation  of  the  subtle 
diferences  between  cruisers,  monitors  and  battleships;  for  after 
digesting  this  chapter  one  is  prepared  to  follow  intelligently  the 


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284       The  Atlanta  Medical  and  Surgical  Journal. 

detailed  descriptions  of  tbe  various  ships  wliioh  make  up  the  bulk 
of  tbe  issue.  One  of  tbe  best  things  about  this  number  is  that  it 
does  not  merely  give  an  external  illustration  of  each  ship,  but  it 
takes  the  reader  down  below  decks,  and  initiates  bim  into  the 
mjrsteries  of  tbe  magazines,  handling  rooms,  ammunition  hoists 
aud  motive  machiuery.  The  sectional  views  of  the  interior  of  the 
turrets  of  the  monitors  are  exceptionally  fine,  as  is  tbe  large  wood 
engraviDj;  of  the  engines  of  the  " Massacbusette."  Tbe  last  page 
of  the  number  contains  complete  tables  of  tbe  new  navy,  the  aux- 
iliary fleet  and  the  various  naval  guns.  A  handsome  colored  map 
of  Cuba  aud  tbe  West  ludies  is  iuruisbed  with  this  issue.  We 
extend  our  coogratnlations  to  our  contemporary  on  the  production 
of  a  work  which  is  well  conceived  and  admirably  carried  out. 
This  work  is  published  by  Munn  &  Co.,  of  361  Broadway,  New 
York,  for  25  cents. 


Fracture  of  the  Neck  of  the  Femob  is  Childhood. 

Whitman  (Annala  of  Surgery)  reports  ten  cases  of  fracture  of 
the  neck  of  tbe  femur  in  children  between  two  and  a  half  and 
eight  years  of  age,  and  presents  two  skiagraphs  showing  tbe  con- 
sequent deformity  of  the  bone  at  tbe  seat  of  tbe  injury.  In  the 
course  of  this  paper,  the  author  deals  with  certain  practical  diffi- 
culties in  connection  with  this  injury,  especially  its  immediate  diag- 
nosis, aud  its  differential  diagnosis  from  hip  disease  during  the  stage 
of  recovery.  It  is  held  that  the  traditional  age  limit  for  fracture  of 
the  oeck  of  the  femur  does  not  exist,  and  that  this  injury  not  only 
does  occur  in  childhood,  but  is  probably  not  an  uncommon  acci- 
dent  which  may  be  recognized,  or  may  at  a  later  period  be  mis- 
taken  and  treated  for  hip  disease.  In  opposition  to  the  ac- 
cepted teaching  that  the  symptoms  here  regarded  as  (hose  of  frac- 
ture are  due  to  separation  of  tbe  epiphysis  of  the  head  of  the 
femur,  tbe  author  holds  that  it  would  be  rather  extreme  violence 
followed  by  non-union  of  tbe  fragments  or  subsequent  disability 
that  would  favor  the  diagnosis  of  the  latter  form  of  injury.  Tbe 
less  the  violence  and  tbe  less  the  immediate  disability,  the  greater 
would  be  the  probability  pf  fracture  when  si^ns  of  fractare  sre 


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Selections  and  Abstracts.  286 

present,  becaoBe  a  bone  is  more  likely  to  break  id  its  weakest  thao 
in  itti  strongest  part,  and  because  rapid  unioQ  and  almost  Dormal 
fanclional  capacity  associated,  as  was  observed  id  all  the  author's 
cases,  with  upward  displacement  of  the  trocbauter,  prove  that  the 
solntiou  of  coutiouity  could  uot  have  involved  the  articulating  sur* 
&oe  of  the  femur. — Briiieh  Medical  Journal. 


Brain  Abscess  in  Infants. 
In  the  ArchivcB  of  Pediatrics  for  February  and  March,  Holt 
reports  Bve  cases  of  abscess  of  the  braiu  in  infants  and  a  summary 
of  twenty-seven  collected  cases  in  infants  and  very  young  children. 
He  concludes  that:  I.  The  affection  is  rare  under  iive  years  of 
age.  2.  Otitis  and  traumatism  are  the  principal  causes.  3.  It 
most  often  follows  neglected  cases,  though  rare  in  acute  otitis,  and 
is  usually  secondary  to  disease  of  the  petrous  bone.  4.  In  cases 
in  infancy  without  evident  cause,  the  ears  are  probably  the  source 
of  infection.  5.  Abscess  rarely  develops  ader  injury  to  the  bead 
without  fracture  of  the  skull,  and  cerebral  symptoms  arise  within 
two  weeks  after  the  injury  ia  nearly  all  traumatic  cases.  6.  Only 
general   symptoms  are  present  in  a  large  proportion  of  the  cases. 

7.  Unless  they  are  constant,  focal  symptoms  may  be  misleading, 
and  even  when  constant  may  depend  on  meningitis  or  other  asso- 
ciated  lesions.     The   motor  symptoms   alone   cao    be    relied  on. 

8.  Rapid  progress,  fever,  and  history  of  injury  generally  diag- 
nostic from  tumor,  while  lumbar  puncture  assists  in  slower  caws 
with  tittle  or  no  fever.  9.  Where  there  are  only  terminal  symp- 
toms, the  diagnosis  from  meningitis  is  impossible.  In  the  more 
protracted  cases  the  distinctive  points  are  the  slower  and  more 
irregular  oourse  and  generally  a  lower  temperature.  10.  Opera- 
tion should  not  be  urged  unless  definite  localizing  symptoms,  the 
principal  one  hemiplegia,  are  present. — Jour.  Am.  Med.  Assoen. 


Anemia. 

Jennie  M ,  Stamford;  aged  30;  first  seen  January  29, 1898. 

Anemia  and  general   malnutrition;  blood  profoundly   lowered   in 
quality,  and  all  the  usual  symptoms  of  a  well-defined  case,  such  as 


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286       The  Atlanta  Medical  and  Subsical  Journal. 

pale  gums,  waxy  complexion,  loss  of  flesh,  and  general  functiooal 
disturbance.     Patient  suffered  nightly  with  agouizing  neuralgia. 

Her  digestion  was  so  upset,  that  I  put  her  on  only  twenty  drops 
boviuioe  hourly,  in  iced  lime  water  to  correot  acidity.  This  was 
well  retained,  but  did  not  satisfy  hunger.  On  the  2 1st  gave  a  rectal 
injection  of  eight  ounces:  three  of  bovinine  and  five  of  milk.  This 
was  retained,  and  the  night  passed  without  the  neuralgia,  so  that 
she  awoke  greatly  reTreshed  and  improved.  A  drachm  of  bovinine 
in  milk  and  lime  water  was  now  given  every  two  hours,  and  was  re- 
tained, with  a  slight  gaseous  disturbance,  and  an  enema  of  two 
onnces  of  bovinine  and  four  of  milk  at  night,  which  was  retained, 
and  this  uight  also  passed  without  the  neural^a.  This  treatment 
was  continued  to  February  16th,  when  improvement  was  so  iar  ad* 
vanced  that  the  rectal  injection  was  discontinued,  and  a  tablespoon- 
ful  of  bovinine  in  old  port  wine,  alternated  with  milk,  was  com- 
fortably taken  per  mouth  every  three  hours,  until  the  10th;  when 
the  bovinine  was  again  increased  to  a  wineglassful  in  milk  every 
three  hours,  and  so  taken  until  the  19th.  At  this  time,  micro- 
scopical examination  of  the  blood  showed  very  little  shortage  of 
red  cells  and  hemaglobin,  and  externally  the  patient  presented 
every  appearance  of  restored  health.  On  the  20th,  the  cure  was 
pronounced  complete  and  case  discharged. 


Diabetic  Albuminuria  and  its  Treatment. 

Goudart  has  recently  devoted  much  attention  to  this  subject 
[British  Medical  Journal. ) 

First,  the  frequency  of  albumiuaria  in  diabetes  is  variable,  and 
may  occur  in  two  forms,  functional  and  that  due  tu  grave  nephritic 
disease.  In  the  first  form  it  may  be  extremely  slight,  or  else  con- 
stitute a  very  marked  feature  in  the  case.  When  slight,  proper 
dieting  and  small  docs  of  antipyrine  combined  with  a  little  bicar- 
bonate of  soda  in  the  form  of  a  powder  may  be  given  every  one 
and  a  half  hours  before  each  meal.  This  treatment  should  not  be 
continued  more  than  three  or  four  days,  beyond  which  time  the 
antipyrine  will  become  injurious.  It  is  well  to  prescribe  some 
quinine,  wine  and  Vichy  water  at  meals.  After  this  treatment  the 
sugar  decreases  considerably,  in  other  cases  it  remains  nnaffeoted. 


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SSLECTIONB   AND   AbBTRAOTS.  287 

Id  the  first  instance,  anti-diabetic  treatmeot  may  be  set  aside  and 
attention  devoted  to  the  albuminuria;  in  the  second  ioetaoce,  it  is 
advisable  to  order  small  doses  of  artteniate  of  soda  combined  with 
codeine  and  carbonate  of  lithia.  Most  usually  the  glucosuria  di- 
miDisbes  under  this  treatment,  and  the  albuminuria  is  then  treated 
in  the  same  manner  as  above.  This  line  of  treatment  is  usually 
followed  by  extremely  satisfactory  results.  After  a  fortnight  or  so 
it  is  recommended  to  give  phosphates  with  nuz  vomica,  or  later, 
hypophospbites  of  lime,  potash,  or  soda  with  quinine.  Should  the 
quantity  of  albumen  elimiuated  in  twenty-four  hours  reach  two  or 
three  grammes  the  case  is  practically  one  of  Brigbt's  disease,  and 
patient  is  put  on  milk  diet.  The  author  now  recommends  lactate 
of  etroDtium  in  small  doses. —  Charlotte  Medical  Journal, 


WOODBBIDOE   TeEATMENT  OF   TyPHOID. 

Rudolph  W.  Holmea  (PhUadelpkia  MedicalJoumal,  January  15, 
1898)  reports  twenty-six  cases  of  typhoid  fever  treated  by  the 
Woodbridge  method  under  Woodbridge's  direct  supervision,  and 
arrives  at  the  following  oouclusions:  (1)  Woodbridge  treatment 
does  not  abort.  (2)  The  mortality  is  not  influenced  by  the  treat- 
ment. (3)  Five  to  eight  per  ceut.  of  typhoids  in  an  epidemic  of 
mild  type  or  medium  severity  will  cure  themseWes  within  two 
weeks.  (4)  A  user  of  the  Woodbridge  treatment  who  invariably 
has    abortive    results   does   nut  correctly    diagnose  aU   his   cases. 

(5)  By  the  Woodbridge  treatment  complications  are  not  affected. 

(6)  Ad  immediate,  positive  diagnostic  aid  is  prerequisite  to  making 
statements  concerning  any  abortive  treatment  valuable.  (7)  Be- 
lievers in  the  abortive  treatment  of  typhoid  must  bear  in  mind  the 
existence  of  the  (Jxn-tive  form  of  lAebermeiater  and  the  iyphus  levU 
of  Griesinger  to  intelligently  differeotiate  typhoid  Irom  the  diseases 
with  which  it  may  be  confounded. —  University  Med.  Magazine. 


Care  op  the  Sick  and  Wounded. 

It  has  been  decided  that  the  naval  ambulance  ship  Solace  shall 

be  used  as  a  transport  for  the  sick  aud  wounded  of  both  army  and 

navy.    She  will  carry  men  physiciana  disqualified  for  active  service 


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288       The  Atlanta  Medical  and  Surgical  Joornal. 

from  the  fleet  or  from  Cuba  to  Key  West  and  Tampa.  A  hospital 
train  will  ruD  from  Tampa  to  northeru  poiuts  in  order  to  give  the 
sick  a  benefit  of  a  change  to  the  cooler  climate  of  the  middle  and 
northern  Atlantic  seaboard.  A  general  army  and  navy  hospital 
will  be  established  at  Key  West,  and  hospital  tents  will  be  sent 
there  to  accommodate  any  overflow  of  incapacitated  seamen  and 
soldiers.  The  selection  of  Key  West  for  this  general  hospital  is 
dne  chiefly  to  the  fact  that  the  island  is  more  healthful  than  places 
on  the  mainland.  In  the  event  of  a  fever  outbreak  among  the  men 
in  Cuba  or  on  the  warships,  the  treatment  of  the  stricken  there 
would  lessen  the  danger  of  a  spread  of  the  disease  to  the  coast 
proper.  Other  hospitals  are  to  be  established  in  the  department 
of  the  Gulf,  but  that  at  Key  West  will  be  the  headquarters  of  the 
medical  corps  of  both  military  services,  in  addition  to  the  marine 
hospital  service. — Med.  Jtecm-d. 


To  Determine  the  Sex  of  the  Child  in  Utero. 

The  following  metliod  is  about  as  reliable  as  any: 
Dr.  X.,  of  Paris,  has  discovered  an  in&llible  method  of  deter- 
mining the  sex  of  the  child  in  utero.  After  a  conecieutious  aus- 
cultation and  palpation  of  Madame  Z.,  he  annouuces  that  it  will 
be  a  boy,  and  at  the  same  time  notes  on  his  tablets :  "  Madame 
Z.— a  girl."  When  the  accouchement  takes  place,  if  the  new- 
comer is  a  buy,  well  and  good;  if  it  is  a  girl,  be  exhibits  his 
tablets  and  assures  the  mother  that  she  must  have  misunderstood 
htm.— Ex. 


Do  not  cauterize  infected  wounds  unless  it  is  to  obtain  a  moral 
effect  in  a  scared  patient.  It  was  shown  more  than  fifty  years  ago 
that  when  horses  were  inoculated  with  glanders,  and  sheep  with 
pox,  cauterization  with  red  hot  iron,  applied  ten  minutes  ailer  in- 
oculation, failed  to  check  the  disease.  An  infected  wound  should 
simply  be  well  laid  open  and  covered  with  a  wet  dressing.  The 
use  of  nitrate  of  silver  to  cauterize  wounds  is  a  barmfut  absurd- 
ity.— International  Journal  of  Surgery. 


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ATLANTA 

Medical  and  Surgical  Journal. 


h.  B.  GEANDY,  M.D.,  > 
DUNBAR  ROY,  M.D.,  j 


ORIGINAL  COMMUNICATIONS, 


MALIGNANT  DISEASE  OF  THE  UTERUS* 
Br  LOUIS  PRANK,  M,D., 

Lou  IB  VILLI,  Ky. 

The  frequency  of  maligoaDt  disease  of  the  uterus;  that  it  most 
often  occurs  during  the  time  of  life  when  symptoms  resulting  there- 
from are  apt  to  be  normally  present;  the  frequency  of  recurrences 
after  radical  operations;  that  many  of  these  patiente  are  not  seen  nntil 
too  late  for  operative  procedures,  with  other  equally  important  feat- 
ures, make  the  subject  one  which  the  gynecologist  has  given  most 
serious  consideration. 

Uterine  cancer  occurs  most  often  between  the  ages  of  thirty-five 
to  forty  and  from  fifty  to  sixty,  though  it  may  develop  at  any  age 
after  the  female  reaches  womanhood.  It  is  found  in  every  grade 
of  life,  and  in  nulliparee  as  well  as  multiparse;  in  the  latter,  how- 
ever, it  occurs  more  frequently  than  in  the  former,  being  compara- 
tively rare  in  the  nulliparous.  It  is  less  frequent  in  wealthier 
classes,  even  So  women  who  have  home  children,  because  they  are 

■AntbDr'*  abMrsot  of  a  paper  nad  before  tbe  Kentucky  State  Uedlcal  Society. 


^dbyGoogle 


290    .  The  Atlanta  Medical  and  Sdroical  Jodiuial. 

better  able  to  observe  precautioos  which  may  obviate  factors  some- 
times actiog  as  predisposiDg  causes. 

We  recognize  tliree  forms  of  cervical  cancer,  viz. :  (1)  The  cauli- 
flower or  papillomatous,  (2)  the  nodular  or  parenchymatous,  and 
(3)  the  ulcerative  or  excavating — the  Carcinoma  mucosa  colli  of 
some  authors.  Pozzi  also  describes  a  form  beginning  at  the  poste- 
rior junction  of  the  vagina  and  cervix,  which  he  terms  carcinoma 
liminare. 

Of  most  importance  is  early  recognition  of  the  disease;  therefore 
we  should  know  its  early  symptoms  and  clinical  course.  It  is  also 
well  to  bear  in  mind  structures  which  may  be  affected  secondarily* 
The  bladder  or  rectum  may  become  involved,  giving  rise  to  vesical 
and  rectal  symptoms;  we  may  also  have  nodules  formed  in  the 
peritoneum.  Cases  so  extensively  diseased  are  necessarily  inoper- 
ble,  therefore  necessarily  &tal.  Lymphatic  involvement  occurs 
oarlier  than  has  ordinarily  been  supposed,  and  because  of  this  fiict 
there  are  lew  permanent  cures  following  radical  operations  for  uter- 
ine cancer.  We  have  both  superficial  and  deep  pelvic  lymphatics, 
which  may  early  become  the  seat  of  carcinomatous  infiltration,  so 
that  recurrence  is  rapid  after  the  organ  has  been  removed.  Involve- 
ment of  the  lymphatics  may  be  so  slight  that  its  detection  is  impos- 
sible by  bimanual  examination,  just  as  in  cancer  of  the  breast  the 
axillary  glands  may  be  involved  without  exhibiting  an  appearance 
indicative  thereof. 

The  earlier  symptoms  of  cancer  are  most  important.  Among 
the  earlier  is  prolongation  of  the  menstrual  fiow,  or  the  occurrence 
of  metrorrhagia.  Menorrhagia  may  be  so  slight  that  cases  are  neg- 
lected during  the  period  when  most  could  he  done  for  them.  When 
we  remember  symptoms  att«oding  the  menopause,  and  the  time 
malignant  disease  usually  develops,  one  will  not  wonder  why  women 
believe  all  manifestations  occurring  at  that  period  to  be  normal; 
aud  even  the  physician  who  has  been  consulted  often  lightly  dis- 
misses the  case  with  the  statement  that  "this  is  due  to  the  change 
of  life/'  not  examining  the  patient  to  ascertain  whether  there  be  a 
local  cause  for  the  hemorrhage.  This  is  certainly  a  mistake,  and  I 
would  impress  upon  you  that  it  is  necessary  to  examine  every 


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Malignant  Disease  of  tbb  Uterus.  291' 

iranaQ  BuffcriDg  from  menorrhagia  or  metrorrhagia  during  the  cli- 
mact«rlc.     All  caees  are  oot  due  to  caDcer,  hut  many  are. 

A  suspicious  symptom  is  the  occurrence  of  leucorrbea,  which 
Htay  be  slightly  odorous,  between  the  menstrual  epochs,  am)  the 
latt«r  may  or  may  not  be  accompanied  by  pain.  Odorous  discharge 
is  a  valuable  sign,  though  it  may  not  occur  until  atler  recognitioo 
of  the  cause  thereof  will  be  of  no  value. 

la  so-called  parenchymatous  or  nodular  cancer  pain  may  be  the 
first  and  most  prominent  symptom,  which  is  also  true  of  cancer  of 
the  body  of  the  uterus.  Pains — pricking,  lancinating  and  cutting, 
radiating  througboat  the  pelvis,  down  the  hips  and  up  through  the 
abdomen — are  valuable  diagnostic  signs.  They  may  he  so  slight 
at  first  as  to  create  no  saspicion  or  alarm,  but  when  accompanied 
with  hemorrhage  or  odorous  discharge,  we  may  be  positive  that 
ulceration  and  necrosis  are  going  on.  There  may  be  little  or  no 
loss  of  flesh;  the  appetite  may  be  slightly  or  not  at  all  impaired; 
there  may  be  no  cachexia — nothing  upon  which  to  base  the  diag- 
nosis except  slight  hemorrhage,  with  the  revelations  made  by  the 
examining  finger  and  the  microscope.  With  loss  of  flesh,  and 
cachexia  or  cancerous  toxemia,  the  disease  has  reached  a  point 
where  radical  treatment  will  probably  be  of  no  value. 

Upon  digital  examinatioD  in  oases  where  the  vagina  and  a  por- 
tion of  the  cervix  are  involved,  it  is  usually  an  easy  matter  to  de- 
termine the  nature  of  the  trouble. 

The  most  difBcult  to  diagnose  are  early  cases  of  cancer  of  the 
cervix  and  those  where,  without  cervical  disease,  there  is  cancer  of 
tbe  body.  We  may  think  our  patient  has  only  an  endometritis,  or 
from  the  history  that  she  has  had  an  incomplete  abortion;  we 
curette  her,  the  hemorrhage  returns  afti^r  a  short  time,  and  then  are 
we  first  suspicious  of  the  true  nature  of  the  trouble. 

Menorrhagia  or  metrorrhagia,  no  matter  how  slight,  nor  when  in 
the  life  of  the  woman  they  occur,  even  in  tbe  absence  of  other 
symptoms  discoverable  by  vaginal  palpation  or  from  the  history, 
should  be  an  indication  for  microscopical  examination  of  scrapings 
from  tbe  uterus.  It  is  well,  In  cases  with  slight  nodulation  about 
the  cervix,  in  which  doubt  exists,  to  excise  a  portion  and  examine 
microscopically.     In  one  of  the  two  cases  in  which  I  have  opera- 


nd byGoOglc 


292       Thb  Atlanta  Medical  and  Surgical  Journal. 

ted  without  recurrence  the  diagnosis  was  made  by  the  microEcope. 
The  microscope,  however,  does  uot  always  give  entirely  satisfactory 
results.  In  the  variety  of  caucer  haviug  its  origin  in  glandular 
structure,  the  resemblance  to  the  mucosa,  and  especially  one  which 
has  been  the  seat  of  long-continued  inflammation,  is  so  striking  as 
to  render  a  positive  opinion  almost  impossible.  There  is  a  variety 
of  cancer  of  the  uterus  which  begins,  T  believe,  as  an  adenoma, 
and  which  might  be  better  termed  "  malignant  adenoma"  than  can- 
cer, where  even  the  microscopist  may  be  unable  to  say  positively 
whether  the  growth  is  malignant  or  uot.  In  such  cases  I  would 
trust  rather  to  the  opinion  of  the  clinician  than  the  microscopist. 
With  the  aid  of  the  microscope  it  may  be  difficult  to  differentiate 
between  carcinoma  of  the  body  of  the  uterus  and  a  fibroid  tumor. 
Still,  carefully  weighing  facts  elicited  by  close  questioning,  taking 
into  consideration  every  point  in  the  clinical  history,  with  the  prob- 
ability of  malignancy  from  the  microscopist's  report,  we  should  be 
able  to  arrive  at  a  positive  conclusion. 

Having  made  the  diagnosis,  what  is  to  be  done?  If  there  is  a 
chance  of  removing  the  diseased  structures,  total  extirpation  should 
be  undertaken.  Even  with  the  involvement  of  the  pelvic  lym- 
phatics, permanent  cures  may  result  by  removal  of  the  uterus  with 
the  lymphatics,  through  the  abdomen,  as  has  been  done  by  Clark 
of  the  Johns  Hopkins  Hospital.  His  work  has  shown  how  early 
there  may  be  involvement  of  the  lymphatics,  which,  as  previously 
stated,  is  often  the  cause  of  recurrence  when  all  disease  has  appar- 
ently been  removed.  Where  there  is  involvement  of  the  vagina, 
if  there  is  fixation  of  the  organ,  if  there  is  cachexia,  nothing  is  to 
be  gained  by  radical  operation,  and  I  believe  we  are  not  justified 
in  subjecting  the  patients  to  the  dangers  of  an  operation  of  this 
magnitude.  Curettage  will  lessen  the  hemorrhage,  and  curettage 
with  cautenzatioo  will  render  the  patients  more  comfortable,  cause 
a  cessation  of  the  discharge,  and  prolong  life  even  more  than  extir- 
pation of  the  organ.  My  experience  is  that  after  extirpation,  which 
I  have  done  in  several  instances,  recurrence  is  prompt,  and  the  dis- 
ease has,  if  anything,  run  a  more  rapid  course  than  had  I  resorted 
to  the  other  treatment. 

We  should  impress  upon  patients,  and  surgeons  should  impress 


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Early  Espbbie»ces  and  Eeminibcences.  293 

upoD  genera]  practitioDere,  that  every  woman  complainiDg  of  pelvic 
trouble,  any  irregularity  of  tbe  meauea,  any  copiousnees  of  the  dis- 
charge, either  at  the  menstrual  period  or  other  times,  should  he 
subjected  to  examination  by  a  competent  diagnostician.  Women, 
knowing  Tittle  about  their  generative  oi^ns,  hardly  appreciate  the 
importance  of  grave  and  uever  slight  symptoms,  and  this,  in  con- 
nection with  their  uatural  modesty,  often  prevents  discovery  of  le- 
sions which,  having  been  recognized  in  time,  would  have  enabled 
us  to  effect  cures. 

TO  SDMMABIZE. 

(1)  Cancer  may  occur  at  any  time  after  the  beginning  of  the 
menstrual  life  of  tbe  woman. 

(2)  The  early  symptoms  are  oftentimes  obscure. 

(3)  The  least  irregularity  during  tbe  climacteric  should  arouse 
oar  suspicions. 

(4)  Suspicious  cases  should  be  subjected  to  microscopic  examina- 
tions. 

(5)  Early  operation  is  the  only  hope  for  cure. 

(6)  Extirpation,  after  the  disease  is  very  evident,  after  appear- 
ance of  cachexia,  is  harmful  rather  than  beneficial.     In  these  cases 

'  our  efforts  should  be  directed  towards  making  the  patient  more 
comfortable. 

(7)  Finally,  it  is  our  duty  to  insist  upon  women  consniting  the 
physician  for  any  irregularities  in  the  menstrua]  flow. 


EARLY  EXPERIENCES  AND  REMINISCENCES  OF 
FORTY  YEARS  OF  PRACTICE. 

Bt  G.  G.  ROY,  M.D.,  Atlaht*.  G*., 
ProfcMor  Materia  Hedica  aod  Therapeuticg,  Southern  Medical  College. 

Abont  midnight  during  tbe  first  year  of  my  active  professional 
life  a  negro  messenger  rapped  at  my  office  door,  arousing  me  from 
profoDud  slumber  (not  from  exhausted  mental  and  physical  forces 
from  overwork,  but  more  likely  from  the  buoyancy  of  young  man- 
hood and  tbe  happiness  of  anticipated  fame  and  fortune,  not  un- 


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294       The  Atlanta  Medical  and  Surgical  Journal. 

usual  dreams  of  young  ptiysiciaDs  at  the  atari),  and  announced  that 
Aunt  Nancy  (the  negro  midwife)  had  sent  for  me  to  see  Lizzie 
(negro  woman),  and  said  I  must  "come  in  a  hurry,  because  Lizzie 
was  in  the  most  curious  fix  she  had  ever  seed  any  'oman  sence  she 
bin  ketchin'  babies." 

I  questioned  the  boy,  hoping  to  get  an  idea  of  the  woman's  con- 
dition, in  order  to  review  in  my  memory  all  the  books  I  had  read 
touching  such  a  case,  and  have  my  plans  well  laid  for  treatment  by 
the  time  I  reached  the  patient.  And  just  here  I  would  throw  out 
a  hint  to  my  young  brethren:  It  is  a  good  plan  to  get  all  the  in- 
formation about  your  patient's  symptoms  before  you  get  to  the 
house,  and  review  them  in  your  mind;  Jog  your  memory  and  bring 
back  everything  you  ever  read  or  heard  of  bearing  on  such  symp- 
toms; it  will  make  you  more  self-possessed  and  calmer  when 
you  enter  the  sick-chamber,  even  if  you  find  yourself  confronted 
with  a  serious  and  puzzling  case.  Nothing  hurts  a  young  doctor 
more  than  to  be  flurried  and  hesitating  about  what  to  do,  in  the 
minds  of  the  ignorant  attendants,  when  he  approaches  the  bedside 
of  a  patient. 

The  boy  said:  "De  Lord,  doctor!  I  don't  know  what's  de  mat- 
ter wid  Lizzie.  I  just  heard  Aunt  Nancy  a-telling  de  'omens 
standing  'round  dat  Lizzie  was  trying  to  have  a  baby,  and  de  baby 
and  de  whole  substunce  in  her  done  come  into  de  world,  and  de 
baby  and  de  whole  substunce  is  lyin'  on  de  bed  'twixt  Lizzie  knees." 

Isaid:  "What!  the  child  and  the  womb  all  out  on  the  bed  down 
between  her  knees?" 

"Dat's  just  what  Aunt  Nancy  tell  de  'omens." 

Now  you  better  believe  I  had  food  for  reflection  during  that 
hour  I  was  reaching  my  patient. 

I  had  never  seen,  or  read  of  such  a  thing  in  the  books.  The 
nearest  approach  to  it  that  my  mind  could  "conjure  up"  was  the 
cut  in  Professor  Chas.  D.  Meegs's  Obstetrics  of  a  case  of  prociden- 
tia uteri.  There  the  vagina  is  completely  inverted  and  the  womb 
is  exposed.  "But,"  thought  I,  "that  is  an  unimpregnated  womb. 
I  wonder  why  Dr.  Meegs  didn't  say  something  on  what  to  do  with 
a  womb  with  the  child  in  it?" 

I  rode  on,  hoping  and  praying  that  Aunt  Nancy  was  mistaken 


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Early  Experiences  and  Heminiscencbs.  295 

and  thiDgs  were  not  m  bad.  I  reached  ihe  house  and  entered  the 
room  of  my  patient  with  a  sinking  heart  but  a  bold  face. 

The  negroes  bad  put  out  the  "noration,"  and  about  all  the 
women  on  the  large  plantation  had  gathered  in  and  around  Lizzie's 
house. 

Aunt  Nancy  was  seated  by  the  bedside,  swaying  herself  back- 
ward and  forward  in  a  chair  (like  negroes  do  at  a  camp- meeting), 
with  a  tace  as  long  as  my  arm.  She  arctse  quickly,  took  me  out- 
side the  bouse  iuto  a  chimney-corner,  and  began  to  tell  me  her  ex- 
perience with  the  case,  winding  up  by  saying:  "I  neber  seed  such 
a  case,  ductor,  in  all  my  born  days.  Please  come  into  de  bouse  and 
try  to  do  sumting  for  dat  gal." 

I  went  in,  removed  the  covering,  and  saw  just  what  Aunt  Kancy 
and  the  boy  had  told  me  was  true.  There  lay  the  womb,  boldiug 
a  five  or  six  months'  letue.  I  rested  the  body  of  the  womb,  with 
the  fetus  in  it,  on  the  palm  of  my  right  band  and  arm,  supporting 
and  guiding  the  fundus  with  the  four  fingers.  I  cautiously  inserted 
my  band  in  the  pelvis,  pushing  the  womb  with  the  left  hand.  I 
replaced  it  in  Its  natural  position.  I  was  very  proud  of  this  achieve- 
ment, only  to  be  disappointed  in  a  few  minutes.  A  severe  pain 
came  on,  and  the  womb  and  baby  (in  it)  shot  out  bke  a  pebble  from 
a  sliog.  I  replaced  them  three  or  iour  times,  and  even  fried  to 
hold  them  in  situ  when  the  pain  came  on ;  but  It  was  no  use— out 
it  would  shoot  at  every  pain.  The  time  had  come  for  me  to  call 
for  Aunt  Nancy's  assistance.  I  made  her  grasp  the  fundus  and 
body  of  the  womb  with  both  hands — it  still  lay  out  on  the  bed.  I 
then  proceeded  to  dilate  the  os  until  I  could  get  a  firm  grasp  on 
the  head,  and,  using  my  fingers  as  forceps,  I  at  last  succeeded  in 
deltveriug  the  dead  fetus,  and  then  the  after-birlb.  All  this  was 
done  without  any  anesthetic,  but  whisky  as  a  stimulant.  Anes- 
thetics were  not  used  in  those  days  but  for  surgical  cases. 

After  the  removal  of  its  contents  I  replaced  the  womb,  and  for 
fear  an  after-pain  might  shoot  it  out  again  I  took  Lizzie's  finest 
petticoat,  tore  it  into  rags,  and  packed  the  vagina  as  tightly  as  it 
was  possible  to  get  it.  I  think  I  used  up  nearly  the  whole  of 
Lizzie's  petticoat,  for  which  I  don't  think  she  ever  forgave  me. 

In  spite  of  uterine  and  vaginal  douches  of  Darby's  Prophylactic 


^dbyGoOgle 


296       The  Atlanta  Medical  and  Surgical  Jouknal. 

and  hot  water,  severe  peritooitis  eupervened,  and  id  four  days  her 
abdomen  was  the  shape  of  a  potato-hill.  I  put  a  blister  all  over 
the  abdomen,  kept  her  bowels  open  with  calomel  and  salines,  kept 
up  the  antiseptic  douches,  and  procured  rest  and  sleep  with  opium. 

Lfizzie  made  a  good  recovery.  I  left  the  State  (Virginia)  soon 
afterwards,  entering  the  Confederate  army,  but  I  have  learned  that 
the  woman  has  had  several  children  since,  and  none  of  these 
troubles. 

A  moral  for  young  physicians:  Rely  upon  your  own  resources, 
think  for  yoursell,  and,  believing  juu  are  right,  go  ahead.  This 
adviceIgive,however,only  to  well-educated, thorough  physicians^ 
thorough  in  your  anatomy,  physiology,  and,  as  in  this  case,  obstet- 
rics. In  an  hour  I  could  have  gotten  mj  father  and  Dr.  Wm. 
Smith,  both  dislinguiahed  pbysieiaus  in  their  day,  but  I  felt  that  if 
they  came  to  my  assistance  they  could  not  do  anything  more  tbttn 
what  I  thought  was  the  proper  thing  to  do.  They  could  have  done 
just  what  I  did,  aud  they  would  have  gotten  all  the  credit;  whereas, 
when  I  told  them  what  I  did  do,  and  assured  them  the  woman  was 
not  dead,  they  said,  "  Well,  she  will  die ;  BOX,  if  she  gets  well  we 
shall  think,  with  more  experience  and  strict  attention  to  business, 
you  may  in  time  make  a  right  sharp  doctor." 


PERITONSILLAR  ABSCESS. 

Bt  DUNBAR  ROY,  A.B.,  M.D., 
Proreuor  Ophthilmologj  and  Otologj  in  Southern  Uedical  OoHege,  AtUoU,  Ga. 

The  reading  of  this  article  is  more  for  the  purpose  of  precip- 
itating a  discussion  than  an  efiort  to  add  any  new  ideas  upon  the 
subject.  A  great  deal  has  been  written  by  laryngologists  concern- 
ing the  etiology,  symptoms  and  treatment  of  acute  tonsillitis  and 
chronically  hypertrophied  tonsils,  but  very  little  can  he  found  con- 
cerning the  manifestations  of  peritonsillar  abscess;  and  even  the 
various  text-books  dismiss  this  practical  subject  with  but  few 
words,  if  at  all.  Fletcher  Ingalla  in  bis  excellent  work  denom- 
inates this  condition  as  phlegmonous  tonsillitis,  giving  as  synonyms 


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Peritonsillar  Abscess.  297 

"  suppurative  tonsillitis,"  "  abscess  of  the  tonaile,"  "  quinsy," 
"phlegmonous  sore  throat."  To  my  mind  these  aynonymons 
terms  are  inoorrect,  for  in  my  experience  the  abscess  is  nearly 
always  outside  of  the  tonsil.  Phlegmonous  sore  throat  is  inac- 
curate because  it  does  not  designate  what  portion  of  the  throat  is 
iovolved.  The  practical  point  of  opening  the  abscess  is  dismissed 
with  one  sentence.  Sajous  in  bis  text-book  makes  no  distinctioa 
in  the  forms  ot  tonsillitis  but  eonsiders  them  all  together  and  the 
condition  of  abscess  of  the  tonsil  but  a  final  result  of  acute  toa- 
sillitiB.  He  also  calls  it  an  abscess  of  the  tonsil  and  speaks  of 
opening  the  abscess  through  the  tonsil. 

Lennox  Browne,  while  recognizing  this  condition,  devotes  very 
little  space  to  its  consideration.  He  remarks  that  Cohen  uses  the 
term  " phlegmonous  pharyngitis"  as  synonymous  with  tonsillitis, 
bnt  remarks  "that  the  peritonsillar  tissue  is  affected  rather  than 
ibe  gland  itself  in  phlegmonous  inflammation." 

Max  Thorner  in  Burnett's  System  has  given  a  very  good 
description  of  this  affection  under  the  title  of  phlegmonous 
pharyngitis. 

Dr.  C.  E.  Beau  in  the  same  work  has  also  described  this  affec- 
tion under  the  title  of  acute  tonsillitis. 

Thus  we  see  various  writers  differ  as  to  the  pathology  and 
morbid  anatomy  of  this  affection. 

The  condition  which  I  wish  to  speak  of  to-day  I  have  desig- 
nated as  peritonsillar  abscess.  Phlegmonous  pharyngitis  is,  I 
think,  an  inelegant  term,  since  it  does  not  indicate  the  anatomical 
position  of  the  abscess  and  therefore  does  not  differentiate  it  from 
similar  conditions  in  other  portions  of  the  pharynx. 

The  tonsils  are  lymphoid  structures  situated  between  the  pala- 
tine arches,  the  anterior  and  the  posterior.  They  are  freely 
movable  in  their  bed  and  in  the  large  majority  of  cases  they 
preseot  fibrous  adhesions  to  both  the  anterior  and  posterior  pala- 
tine  pillars.  The  muscular  structures  therefore  inclose  the  tonsil 
on  all  sides  except  its  free  portion.  In  front  the  ramus  of  the 
lower  jaw  eocroaches  so  near  the  tonsil  that  there  is  very  little 
loose  cellular  space  left  which  could  be  filled  with  pus  and  exudate 
going  to  form  an  abscess.     Pus  always  seeks   that  region  where 


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298       The  Atlanta  Medical  and  Surgical  Journal. 

there  is  the  lese  resistance.  On  the  other  hand  the  anterior  pillar 
curves  around  the  top  oT  the  toDsil  and  seems  to  lap  itself  over 
the  posterior  pillar  and  is  lost  in  the  soft  palate  above.  This  is 
what  really  happens.  Posteriorly  to  ibe  toosil  there  is  quite  a 
loose  cellular  space  which  could  be  filled  with  pus  should  the 
emergency  come.  This  lapping  of  the  anterior  and  posterior 
pillar  above  seems  to  have  formed  a  triaugular  space  filled  with 
ooDoective  tissue  and  into  which  the  tonsil  commuuicates. 

For  these  anatomical  reasons  I  have  never  seen  a  peritonsillar 
abscess  the  result  of  infection  through  the  tonsillar  lacunse,  but 
what  had  its  seat  posterior  to  the  tonsil.  Abscesses  which  occur 
anteriorly  are,  io  my  experience,  the  result  of  suppurative  pro- 
cesses from  the  posterior  portion  of  the  alveolar  process  of  the 
lower  or  upper  jaw  on  the  same  side.  I  have  seen  abscesses  in 
front  of  the  tonsil  of  the  most  painful  character  which  were  the 
result  of  a  process  in  the  last  molar  tooth. 

The  question  now  arises  what  is  the  cause  of  these  peritonsillar 
abscesses?  Some  authors  hold  that  they  are  always  the  result  of 
a  previous  tonsillitis. 

In  the  light  of  our  present  knowledge  there  cau  be  uo  doubt  in 
my  mind  as  to  the  bacterial  origin  of  this  affection.  It  is  certainly 
true  that  in  the  large  majority  of  cases  a  severe  inflammation  of 
the  tonsil  precedes  the  formation  of  the  peritonsillar  abscess,  and 
yet  I  have  seen  cases  where  the  abscess  has  formed  and  the  tonsil 
remain  seemingly  scarcely  involved.  We  all  know  that  there 
exists  normally  io  the  mouth  and  throat  secretions  containing 
various  kinds  of  micro-oi^anisms,  therefore  when  a  tonsillitis 
-does  take  place  there  must  be  superadded  something  which  pre- 
viously did  not  exist  and  much  the  more  so  when  an  abscess  is 
formed.  For  it  is  the  daily  observation  to  see  a  case  of  severe 
tonsillitis  of  the  most  virulent  type  and  yet  no  abscess  is  seen  to 
follow.  Some  authors  say  that  it  is  due  at  (he  time  to  some  low- 
ered vitality  of  the  parts  of  the  whole  system  whereby  the  parts 
are  unable  to  throw  off  this  concentrated  poison.  Observation 
-certainly  seems  to  contradict  this  idea  unless  there  is  some  lowered 
vitality  of  the  parts  not  now  recognizable  to  the  medical  eye,  for 


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Pbritonsillab  Abscess.  299 

the  worst  cases  of  abscesses  which  I  have  ever  seen  have  occurred 
ID  pereoDs  showing  the  most  perfect  physical  health. 

The  tODBillar  crypts  and  ducts  are  certainly  the  carriers  of  the 
deadly  orgaoisms,  for  iu  the  large  majority  of  cases  these  crypts 
show  follicular  exudates  previous  to  or  at  the  time  the  abscess 
develops.  Whatever  may  be  the  condition  of  the  parts,  ooe  thing 
is  certain  and  that  is  this  affection  is  microbic  iu  origin  and  the 
warfare  between  the  leucocytes  and  the  pus-forming  organisms 
certainly  results  in  a  victory  for  the  latter. 

Must  we  not  in  the  end  be  obliged  to  admit  that  there  exists  a 
peculiar  idiosyncrasy  in  the  individual  which  we  are  unable  to 
explain  whereby  his  or  her  throat  is  liable  to  the  formation  of  pe- 
ritonsillar abscesses  ?  One  attack  seems  to  predispose  to  another, 
and  there  are  some  people  who  seem  especially  liable  to  just  such 
attacks.  I  have  one  patient  who  usually  has  one  severe  attack 
every  winter,  yet  when  the  attacks  are  over  the  tonsils  do  not  show 
any  pathological  changes. 

Is  it  Dot  perhaps  the  existence  of  this  triangular  space  of  which 
I  have  spoken  that  predisposes  to  the  formation  of  an  abscess  ?  I 
have  always  noticed  that  in  persons  who  suffer  from  these  abscesses 
the  anterior  pillar  seems  to  lap  more  than  ever  the  posterior,  and 
it  is  but  a  surmise  on  my  part  that  in  these  cases  there  is  a  larger 
posterior  cellular  space  for  the  filling  up  with  pus. 

Rice,  of  New  York,  in  the  Cincinnati  Lancet- Clinic,  in  a  very 
eihanstive  and  excellent  article  on  suppurative  tonsillitis,  has  this 
to  say  in  his  summary : 

"That  suppurative  tonsillitis  is  not  a  correct  name  because  the 
suppuration  occurs  in  the  connective  tissue  about  the  tonsils  and 
very  rarely  in  the  tonsils  themselves.  That  in  people  who  possess 
the  disposition  to  suppuration  about  the  tonsils,  we  find  the  tonsils 
either  adherent  to  or  covered  by  the  pharyngeal  pillars  and  that 
this  condition  plays  a  more  important  rAle  in  the  predisposition  to 
suppuration  about  the  tonsil  than  does  the  rbeumatio  or  other 


Such  a  space  affords  an  excellent  bed  for  the  propagation  of  pus 
germs.  Nor  have  I  ever  seen  any  special  character  of  tonsil 
which  seems  to  predispose  the  formation   of  an   abscess.     I  have 


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300       The  Atlanta  Medical  and  Surgical  Journal. 

seen  abscesses  form  where  tonsils  were  small  and  sclerosed  and 
again  where  thej  were  large  and  lymphoid  looking.  I  have  seen 
abscesses  form  when  the  tonsil  had  been  completely  removed. 

Most  writers  hold  that  peritonsillar  aod  tonsillar  abscesses  are 
more  common  in  children  than  in  adults,  and  yet  if  one's  expe- 
rience counts  for  anything,  mine  is  just  the  opposite.  With  the 
exception  of  two  cases  only  all  my  cases  have  been  in  adults. 

The  symptoms  of  this  condition  are  no  doubt  familiar  to  all. 
The  pain  is  severe  and  especially  intense  on  deglutition,  at  which 
moment  the  patient  distorts  his  fece,  makes  forced  movements  with 
his  whole  body  in  bis  effort  perhaps  to  swallow  even  a  drop  of 
saliva.  This  pain  is  pathognomonic,  and  even  in  the  very  earliest 
stages  is  often  indicative  of  the  coming  abscess.  The  pain  is  due 
to  the  ioBammatory  condition  of  the  muscles  of  deglutition,  and  it 
is  for  this  reason  I  think  that  so  many  authors  believe  that  a  rheu- 
matic diathesis  is  at  the  bottom  of  it  all.  This  view  my  observa- 
tion does  not  lead  me  to  accept. 

The  coated  tongue,  the  fetid  breath,  the  half  open  mouth,  the 
look  of  pain,  who  does  not  recognize  these  symptoms? 

Let  us  now  turn  to  the  practical  side  of  the  question,  that  is  of 
its  treatment.  Since,  as  I  have  said,  the  large  majority  of  cases  re- 
sult from  a  previous  inflammation  of  the  tonsil,  the  question  natu- 
rally arises,  can  the  abscess  be  aborted  ?  My  views  are  that,  if  the 
patient  is  not  one  of  those  predisposed  to  peritonsillar  abecese, 
and  the  inflammation  in  the  tonsil  has  started  upon  its  sur&ce, 
you  may  in  some  oases  abort  the  abscess,  but  in  the  lai^e  majority 
of  oases  you  are  powerless  to  stay  its  course.  The  treatment  of 
tonsillitis  and  also  peritonsillar  abscess  naturally  divides  itself  into 
the  medicinal  and  the  surgical.  Under  the  head  of  medicinal  let 
us  look  to  see  what  remedies  are  suggested  by  various  authors  as 
abortive  or  curative  in  their  action. 

Ingalls  says,  to  use  his  exact  words,  "  early  in  the  attack  the 
disease  (phlegmonous  tonsillitis)  may  be  aborted  as  in  acute  ton- 
sillitis in  about  one  case  out  of  four  by  the  application  to  the 
inflamed  gland  once  or  twice  a  day,  of  a  sixty-grain  solution 
of  nitrate  of  silver,  two  or  three  applications  usually  being  suffi- 
cient."    Of  this  prooedure  I  can  but  speak  in  the  very  highest 


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FSRITOHSILLAR   AbSCESS.  301 

terms  id  all  forms  of  acute  tODsillitis,  and  in  my  mind  it  should  be 
placed  above  all  other  remedies.  Dr.  Ingalls's  experience  with 
guaiac  is  just  as  mine  has  been,  and  that  is  very  unsatisfactory.  He 
believes  in  sodium  salicylate  and  bromide  of  potash.  He  reoom- 
mends  cold  applications  both  inside  and  outside,  but  also  remarks 
that  some  patients  are  made  uncomfortable  by  cold  applications 
and  then  hot  ones  should  be  applied.  He  believes  in  promoting 
resolution  if  the  abscess  cannot  be  aborted. 

Sajous  says  that  we  possess  a  remedy  which  is  a  specific  in  all 
forms  of  tonsillitis,  and  that  is  the  ammoniated  tincture  of  guaiac. 
He  prescribes  it  as  follows:  one  teaspoonful  in  half  glass  of  milk 
to  be  gargled  in  the  throat  and  then  swallowed.  He  also  recom- 
mends loKeuges  of  the  resin  of  guaiac.  He  recommends  a  gargle  of 
water,  hot  as  can  be  borne,  a  procedure  which  I  have  long  ago 
found  to  be  a  most  excellent  adjuvant  for  the  relief  of  pain.  As 
to  the  use  of  guaiac  I  can  but  say  that  in  my  hands  it  has  proved 
absolutely  useless. 

Lennox  Browne  considers  guaiac  to  be  almost  a  specific,  and  he 
says  further  that  this  action  of  guaiac  "strengthens  the  rheumatio 
analogy."  He  is  a  great  believer  in  large  doses  of  salicylic  acid. 
He  says  that  sprays  and  inhalations  are  useless  while  ice  internally 
s^ravates  the  pain.  Like  myself  be  believes  in  hot  gargles  of 
some  mild  antiseptic  solution.  He  considers  the  application  of  cold 
externally  by  means  of  the  Leiter  coil  one  of  the  most  valuable 
local  applications. 

BoBworth  thinks  "that  it  is  possible  to  abort  an  attack  within 
the  first  twenty-four  hours  by  giving  10  grains  of  quinine  and  1 
grain  opium,  administering  a  hot  foot-bath,  evacuating  the  bowels 
by  15  grains  of  calomel  to  be  followed  by  a  saline  purgative,  and 
giving  sodii  salicylas  and  applying  locally  to  the  throat  sodii  bi- 
carb," I  must  say  that  this  is  a  most  drastic  remedy,  and  if  the 
patient  survives  it,  nothing  short  of  a  cure  should  be   bis  reward. 

Max  Tbomer  recommends  the  administering  of  large  doses  of 
Balol  in  addition  to  local  applications.  I  am  in  full  accord  with 
this  writer  who  expresses  not  much  belief  in  cold  applications  but 
says  "  it  is  much  better  to  begin  early  with  hot  fomentations  around 


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802       The  Atlanta  Medical  and  Surgical  Journal. 

the  neck,  hot  gargles  aod  hut  mbalations,  ta  order  to  accelerate 
auppuratioD  and  to  shorten  in  this  way  the  duration  of  the  diseaee." 

Dr.  C.  B.  Bean,  ia  Buniett'8  Syetem,  says  that  be  places  more 
ooDfidence  in  salicylate  of  soda  thaa  any  other  remedy.  He  says 
that  usually  perraauent  relief  will  be  obtained  in  twelve  hours. 
He  administers  it  in  doses  of  15  grains  every  hour. 

Gougueheim  of  Paris,  baa  extolled  the  use  of  large  doses  of  ealol. 

Let  us  now  look  to  the  sui^ical  side  of  the  treatment  where  the 
abscess  is  either  suspected  to  have  formed  or  at  least  shows  all  evi- 
dences of  the  same.  I  will  first  take  the  liberty  of  again  quoting 
the  opinions  of  those  who  have  expressed  ihemselves,  and  in  con- 
clusion will  add  my  own  practical  ideas  to  this  practical  subject. 

Ingalls  says  "  pus  should  be  evacuated  as  soon  as  discovered." 
He  does  not  say  where  the  incision  should  be  made,  how  deep  it 
should  go,  nor  the  most  usual  place  for  the  bulging  to  occur.  These 
points  I  consider  of  very  practical  value. 

Sajons  says  that  the  abscess  should  be  evacuated  as  soon  as  it  is 
discovered  by  digital  pressure  and  the  incision  is  made  through  the 
tonsil. 

Lennox  Browne  lays  down  the  following  rules  which  I  quote: 

1.  Never  to  inflict  unnecessary  pain  by  useless  scarifications  on 
the  surface  of  the  tonsil  undergoing  inflammation. 

2.  Never  to  make  deep  incisions  unless  there  is  almost  certainty 
of  advanced  suppuration.  The  instrument  for  making  the  tnci- 
aions  should  be  a  curved-pointed  bistoury  with  not  more  than  one 
inch  of  cutting  edge,  and  the  cut  should  be  made  from  without  iq- 
wards,  so  as  to  avoid  the  not  impossible  risk  of  injuring  an  artery. 

Bean  says  the  abscess  should  be  opened  as  soon  as  pus  is  detected, 
and  that  it  should  be  done  with  a  bistoury  whose  cutting  edge  is 
an  inch  long.  He  says  also  that  the  point  for  opening  the  abscess 
is  usually  "  at  the  upper  and  anterior  surface  of  the  tonsil  near  the 
anterior  palatine  fold." 

My  observations  certainly  do  not  agree  with  this  latter  statement. 
'  Max  Thorner  also  says  that  the  abscess  should  be  opened  as  soon 
83  discovered,  and  gives  the  method  of  Stoerk  for  diagnosing  the 
condition.  The  physician  "  puts  the  fingers  of  one  hand  externally 
under  the  angle  of  the  lower  jaw,  pressing  the  skin  and  all  the 


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Peritonsillar  Abscess.  SOS 

tissues  inwardly,  while  the  iudex-finger  of  the  other  hand  moves 
slowly  over  the  iofiltrated  parts,  begiaaing  high  up  on  the  soft 
palate  aod  sliding  downwards  towards  the  tougue."  The  sense  of 
resistance  is  the  criterion  for  the  point  to  be  opened.  This  is  very 
good  for  a  Qerman  method  but  it  is  decidedly  too  rough  for  an 
American  patient,  as  it  frequently  happens  that  you  are  fortunate 
if  you  can  just  get  in  the  flat  blade  of  a  bistoury  between  the  half- 
open  mouth. 

Moure  of  Bordeaux  says  "  it  is  the  rule  to-day  not  to  wait  for 
the  appearance  of  pus  before  incising  the  inSamed  tissues."  He 
says  further  that  a  peritonsillar  abscess  should  he  opened  through 
the  anterior  pillar  by  a  longitudinal  incision. 

O.  Chiari  also  advises  early  incision,  even  when  no  pus  is  dis- 
covered and  says  the  abscess  should  be  opened  at  the  anterior  pil- 
lar. My  own  experience  certainly  does  not  agree  with  that  of  the 
last  two  writers. 

Gouguebeim  of  Paris,  deprecates  too  hearty  operative  measures 
in  phlegmonous  tonsillitis.  He  admits  surgical  intervention  on!y 
in  exceptional  cases,  and  that  is  when  the  appearance  of  whitish 
transparent  spots  reveals  the  purulent  focus. 

My  own  treatment  of  peritonsillar  abscess  is  governed  by  a  rule 
which  I  have  adopted  in  the  treatment  of  all  patients,  and  that  is 
the  adapting  of  atl  treatment  to  the  individual  case  and  not  the 
patient  to  the  treatment.  It  is  the  extreme  of  folly  for  physicians 
to  have  fixed  rules  in  the  management  of  all  cases.  It  might  be 
highly  proper  in  the  case  of  a  big  strong  lymphatic  working  man 
to  pick  up  your  bistoury  and  plunge  it  into  the  abscess,  press  its 
sides  and  evacuate  the  same  thoroughly,  and  he,  perhaps,  would 
hardly  flinch.  But  suppose  you  undertook  the  same  procedure  in 
ihe  case  of  a  highly  nervous  and  sensitive  woman  who  would  even 
faint  at  the  sight  of  a  knife.  Besides  it  is  equally  true  that  the 
formation  of  a  peritonBtllar  abscess  is  not  near  so  painful  in  some 
patients  as  iu  some  others,  aud  therefore  do  not  require  such  active 
surgical  measures.  As  the  majority  of  abscesses  follow  from  tonsil- 
litis, my  efforts  are  always  to  the  abortion  of  this  inflammation  and 
this  I  accomplish  if  at  all,  by  the  administration  of  a  good  dose  of 
calomel  followed   by  a  saline  purge.     The  tonsil  and  surrounding 


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304       The  Atlanta  Medical  and  Surgical  Journal. 

pillars  are  painted  thorouglily  with  a  60-grain  solution  of  nitrate 
of  silver,  and  this  is  repeated  once  daily.  I  start  early  with  hot 
.gargles  of  vinegar  and  hot  water,  as  hot  as  can  be  borne,  and  theD 
hot  fomentations  are  applied  externally.  Salol  and  phenacetia 
always  makes  the  patient  feel  more  comfortable,  and  for  this  reason 
alone  I  prescribe  it. 

Recently  we  have  all  seen  the  published  reports  of  the  wonder- 
ful effect  of  lactophenin  in  this  condition.  According  to  my  expe- 
rience it  is  no  more  good  than  so  much  sugar  of  milk.  If,  then, 
this  does  not  abort  the  abscess,  I  increase  the  use  of  the  hot  reme- 
dies and  wait  until  I  detect  fluctuation.  In  nervous  and  timid 
individuals  I  never  try  to  open  the  abscess  until  it  is  so  superficial 
that  the  slightest  puncture  will  rupture  its  walls.  Making  deep 
incisions  at  random,  without  findin),;  pus,  is  an  unnecessary  and 
barbarous  treatment. 

Nor  have  I  ever  opened  a  peritonsillar  abscess  at  any  point  ex- 
cept above  and  posterior  to  the  tonsil,  notwithstanding  such  emi- 
nent authority  as  quoted  above.  Nor,  furthermore,  do  I  make  deep 
incisions  with  a  knife,  hut  simply  make  a  small  puncture  about 
one-eighth  inch  deep,  and  then,  with  a  strong  probe  in  this  open- 
ing, I  push  it  back  into  the  triangular  space  described.  If  there 
is  pus  the  probe  will  readily  make  its  way,  and  the  presence  of  pus 
be  detected  at  the  opening.  If  present,  the  superficial  incision  is 
enlarged  and  the  abscess  emptied  by  pressure.  I  do  this  rather 
than  make  a  deep  incision,  because  I  have  seen  such  an  incision 
followed  by  severe  hemorrhage  and  no  pus  found ;  and  if  the  pa- 
tient is  at  all  nervous,  be  it  man  or  woman,  the  sight  of  spitting 
out  great  clots  of  blood  is  extremely  terrorizing.  While  writing 
thig  article  T  came  across  two  references  in  the  Laryngoscope  to 
articles  by  German  laryngologists,  whose  ideas  corresponded  with 
mine.  I  quote  the  exact  words  translated  from  Killian's  article : 
"Most  of  these  abscesses  are  located  in  the  depression  above  the 
tonsil  (fossa  supraion»illaris)  and  between  the  arches  of  the  pala,te. 
To  inspect  this  repon  the  patient's  tongue  is  extended  and  depressed, 
the  commissure  of  the  Up  is  contracted,  and  the  head  inclined  to- 
wards the  shoulder  of  the  diseased  side.  In  an  abscess  of  any 
coDsiderable  size  one  can  see  an  oval  bulging  of  the  affected  side. 


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1'eritoksillab  Abscess.  305 

This  area  is  cocainized,  and,  by  pressure  upwards  and  outwards 
witb  a  strong  probe,  the  abscess  cavity  can  be  reacUed.  The  opcn- 
iog  is  then  dilated  with  forceps  for  several  days  and  antiseptic  gar- 
gles ordered."  Grunwald,  in  the  Munchener  Med.  Woch.,  indorses 
this  method  and  insists  that  an  abscess  that  cannot  be  reached  in 
this  way  has  no  connection  with  the  tonsil.  In  support  oT  this 
view  he  reports  an  abscess  of  the  anterior  palatine  arch  and  velum, 
due  to  a  decayed  molar  tooth  and  its  alveolus.  This  last  view  cor- 
responds BO  entirely  with  my  own  that  I  feel  like  taking  it  as  my 
own  utterance.  If  any  amount  of  pus  has  formed,  noted  by  a 
swelling  above  and  to  the  inner  side  of  the  tonsil,  I  can  usually 
detect  the  point  for  opening  by  simply  sliding  a  blunted  probe  over 
the  surface  and  noting  the  point  of  greatest  paiu.  My  views  cor- 
respond with  those  of  Lennox  Browne,  and  that  is  never  to  do  un- 
necessary cutting. 

The  question  also  arises,  if  the  abscess  is  not  opened  will  it  open 
itself?  It  most  assuredly  would,  but  I  have  never  waited  for  such 
a  result  to  happen.  In  the  first  place,  it  might  open  while  the 
patient  was  asleep  and  cause  some  dangerous  symptoms.  Such 
cases  have  been  reported.  Dr.  Dunn,  of  Richmond,  Va.,  has  re- 
ported the  case  of  a  child  three  and  a  half  years  old  where  a  peri- 
tonsillar abscess  broke  spontaneously,  followed  by  such  severe  hem- 
orrhage that  the  common  carotid  had  to  be  ligated.  Norton  has 
reported  a  case  of  acute  suppurative  tonsillitis  in  a  girl  of  four 
years,  which  ended  &tally,  the  abscess  having  involved  the  carotid. 

Thos  we  see  that  peritonsillar  abscesses  are  by  no  means  an  insig- 
nificant affiiir.  Every  physician  no  doubt  manages  his  cases  difier- 
ently,  but  aAer  all  we  want  to  use  those  measures  which  will  bring 
the  best  results. 

Qrand  Opera  House. 


A  few  drops  of  strong  ammonia  water  added  to  the  water  in 
which  you  wash  will  greatly  facilitate  the  removal  of  grease  and 
blood.  About  half  a  teaspoonful  to  an  ordinary  basin  of  water 
will  be  the  right  proportion.  Of  course  you  must  use  soap  as 
well. — International  Journal  of  Surgery. 


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The  Atlanta  Medical  and  Suboical  Jodrnal. 


MENTAL    DISTURBANCES     IN   TURBINATE    HYPER- 
TROPHIES, OR  NASAL  STENOSIS. 

Bt  JOHN  P.  WOODWARD,  M.D., 

NOBPOLK.  V*. 

At  first  sight  the  title  of  this  paper  might  convey  to  you  the 
idea  of  a  more  profound  study  of  the  couditioDS  accompanying 
DHsal  stenosis  than  the  writer  is  prepared  to  discuss.  Seven  years 
ago,  wheu  I  first  began  to  study  this  subject,  it  was  comparatively 
Dew;  but  to-day  oae  is  astonished  at  the  literature  on  a  subject 
thought  to  be  new  wheu  he  takes  the  time  to  investigate.  There- 
fore I  will  not  attempt  to  give  a  citation  of  the  latest  authorities, 
nor  an  historical  sketch  of  its  growth  and  influence  upon  the  med- 
ical miud  in  the  last  few  years.  A  decade  of  facta  has  placed  it 
beyond  the  possibility  of  a  hypothesis,  and  fixed  it  permanently  iu 
the  chapter  of  scientific  realities. 

(Suye,  of  Amsterdam,  launched  forth  into  medical  nosology  the 
term  aprose:cia,  though  I  tbiuk  the  word  aphelia  (absence  of  mind, 
abstraction,  revery  and  inattention)  would  have  beeu  equally  as 
significant.  Nevertheless,  to  Guye  are  we  indebted  for  marking 
this  condition  as  a  distinct  niental  aberration. 

Although  I  have  never  seen  a  case  of  maniacal  fury  nor  ferocious 
insanity  result  from  this  state,  yet  I  believe  its  further  study  will 
open  up  avenues  of  investigation  that  may  solve  to  a  great  extent 
many  of  the  quixotic,  as  well  as  seemingly  malicious,  deeds  of  our 
fellow-man. 

For  I  know  of  no  single  ailment  that  will  so  soon  and  so  radi- 
cally change  a  patient's  spirits  and  disposition  from  peace  to  unrest, 
from  restlessness  to  irritability,  and  from  irritability  to  suicidal 
and  murderous  tendencies.  And,  too,  this  condition  leads  many 
patients  to  magnify  and  brood  over  other  troubles  that  might  other- 
wise he  forgot.  This  I  have  seen  iu  three  of  my  lady  patients. 
It  is  well  known  that  similar  sym|jtoms  in  the  same  person  at  dif- 
ferent times  mean  difierout  things,  as  there  is  an  alarming  varia- 
°Rea<)  by  title  before  the  Sautlieru  SeMloa  ottheOtologlcsl,  Rhluologlcal.  and  Lirrnsolos- 


,„i,z.d  by  Google 


Mbntal  Disthrbanoes  in  Nasal  SxBNOsia.  307 

bility  io  human  beings  as  to  their  ability  to  place  and  appreciate 
physical  abnormalities.  Thus  day  by  day  it  dawns  upoD  us  that 
there  are  endless  obaios  of  symptoms  maofesting  themselves,  under- 
currents as  it  were,  whose  meaniog  is  lost  in  the  agonies  of  real 
pain  or  f^motbered  in  the  charily  of  ignorance  and  idiopathies. 

The  nose  feels  keenly  the  ioflnenoee  of  the  advances  of  civiliza- 
tion— change  of  modes  of  living,  change  of  climate,  and  distur- 
bance of  the  equilibrium  of  oxygen  and  moisture  in  the  air  by 
sweeping  away  our  forests  and  shades  and  substituting  arid  fields 
and  hot  streets.  Nasal  disturbances  are  more  common  and  their 
infitience  upon  other  portions  of  the  system  more  manifest.  Man 
is  a  complex  being,  and  is  not  composed  of  any  isolated  special 
organs.  Every  part  is  in  relation  somehow  and  at  some  time  with 
every  other  part,  making  the  animate  being  an  anatomical  unit 
wherein  the  totality  is  but  the  centripetal  and  centrifugal  influence 
of  a  motorial  and  sensorial  automaton. 

Understand  the  two  nervoua  ^sterns,  and  you  have  the  key  to 
the  citadel ;  for,  outside  of  the  solar-plexus  and  the  uterine  reflexes, 
there  is  no  field  more  fertile  in  reflexes  than  the  nose  and  its  acces- 
sories. 

But  I  would  defeat  the  object  of  this  paper  were  I  dwell  too 
long  upon  reflex  neuroses;  I  shall  merely  refer  to  them  en  passant, 
as  I  am  thoroughly  convinced  that  most  of  the  mental  manifesta- 
tions in  nasal  hypertrophies  are  the  result  of  toxic  poisoning, 
either  auto-genetic  or  hetero-genetic. 

I  have  a  long  list  of  instructive  cases,  but  will  only  give  a  few 
to  help  substantiate  my  remarks : 

Case  1. — Mr.  P.  A.;  aged  27.  Consulted  me  iu  1891  about 
what  he  termed  a  "  peculiar  mental  feculty."  He  had  been  a 
drinking  man,  but  when  I  saw  him  he  was  very  moderate  in  his 
habit.  In  the  daytime  he  was  sluggish,  selfish,  melancholic,  morose, 
and  at  tiroes  very  irritable  and  easy  to  anger.  He  brooded  over 
imaginary  troubles,  and  I  have  heard  him  speak  of  the  relief  death' 
would  afford.  He  had  no  insane  hobby,  and  when  night  came  he 
would  bloom  out  into  one  of  the  most  complete  social  successes  lever 
saw — bright  and  brilliant.  I  found  a  decided  hypertrophy  of  both 
inferior  turbinates,  anterior  aud  posterior.     At  times  a  great  deal 


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308       The  Atlanta  Medical  and  Sdrgical  Journal. 

of  watery  discharge,  aad  never  a  clear  aod  open  Dose.  Tbis  he 
had  had  for  years,  aott  looked  upoo  it  as  natural,  and  bad  beeu 
using  a  little  cocain  in  his  uose  every  night,  hence  his  change  in 
disposition  at  that  time.  He  was  entirely  relieved  by  treating  and 
.reducing  the  turbinates.  There  were  no  reSexes  of  importance,  as 
he  seldom  had  as  much  as  a  headache. 

Ca8£  2. — Miss  8.  C.  saw  me  in  1892  about  her  nose.  She  was 
not  robust,  but  not  a  sickly  person  ;  aged  24,  of  healthy  parents; 
she  had  never  had  a  severe  spell  of  sickness;  looked  stupid  and 
inert,  and  her  friend  who  came  with  her  said  she  was  "queer."  I 
found  enlargement  of  both  inferior  and  middle  turbinates  on  the 
left  side,  with  pressure  of  the  inferior  against  a  cartilaginous  spur. 
The  spur  was  removed  and  the  swollen  turbinate  reduced,  with  the 
restoration  of  the  patient  to  a  bright  and  cheerful  young  lady.  She 
had  neuralgias,  migraine  and  ocular  distress — all  reflexes.  But  her 
toxic  symptoms  took  the  nature  of  melancholia  and  suicide,  and  at 
times  she  had  hystero-eataleptic  spells,  though  never  very  pro- 
found. 

Case  3. — Miss  M.  C;  aged  30;  stenographer;  family  history 
good.  For  weeks  she  has  been  feeling  dull  and  drowsy,  crabbed 
and  dissatisfied  with  everything,  so  much  so  that  her  friends  be- 
came alarmed  about  her.  Her  employer  said  that  her  spelling  and 
writing  were  so  bad  that  he  would  have  to  give  her  up.  She  found 
in  copying  her  dictation  that  words  and  sentences  were  incomplete. 
She  had  immense  enlai^ement  of  the  inferior  turbinates,  blocking 
up  tbe  nose  almost  completely  at  times ;  naso-pharyngitis  with  free 
mucous  discharge.  I  gave  no  nerve  sedatives,  simply  treated  the- 
nose  with  cautery  and  chromic  acid,  with  a  relief  of  all  her  dis- 
comfort in  about  six  weeks. 

Case  4. — Miss  B.  A. ;  aged  20 ;  stenographer ;  health  good. 
She  had  gotten  so  bad  that  her  physician  suggested  a  complete  rest 
from  all  work.  She  was  excitable  and  irritable,  and  said  that  her 
employer  was  cruel  to  her,  also  that  people  laughed  at  her  wherever 
she  went ;  constantly  expected  something  serious  to  happen  to  ber ; 
could  not  write  an  intelligible  letter;  bad  been  treated  for  migraine 
and  neuralgia  for  years.  She  had  had  adenoids  removed  many 
years  ago.     Turbinates  enlarged  and  boggy;  left  middle  turbiuate 


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Mental  Disturbances  in  Nasal  Stenosis.  309 

pressed  against  the  septum.  The  same  treatment  relieved  ber,  but 
it  took  six  weeks  or  more.     No  sedatives  were  u^ed. 

Mrs.  M,;  aged  35;  mother  of  three  cbildren,  with  good  general 
health.  Beautiful  and  intelligent,  but  at  her  first  visit  to  my  office 
she  was  a  wreck,  mentally  and  physically — hysterical,  suspicions,  had 
secret  warnings  of  impending  dangers,  such  as  loss  of  money  and 
divorce;  thought  her  husband  was  untrue,  and  longed  for  death; 
asked  me  to  give  her  a  slow  poison  eo  that  she  might  kill  herself. 
I  found  the  same  nasal  trouble  as  in  No.  4,  except  the  turbinates 
were  tense  and  redder.  I  treated  her  with  chromic  acid  by  point 
burning  for  two  weeks,  seeing  her  every  third  day,  and  then  once 
a  week  for  three  weeks,  at  which  time  she  was  as  well  as  ever. 

Case  6. — Mr.R.T.;  aged  39;  single;  health  good  except  slight 
dyspepsia  and  malaria.  He  used  to  drink  very  hard,  but  has  been 
a  total  abstainer  for  five  or  six  years.  In  1896  he  began  to  get 
nervous  and  fanciful ;  bad  exalted  imagination  with  peculiar  im- 
pressions as  to  bodily  harm  ;  the  simplest  physical  ailment  pre- 
sented a  fatal  disease;  afraid  to  go  about  by  himself,  afraid  to  use 
telephone,  imagined  that  it  would  kill  him ;  stopped  reading  news- 
papers because  he  had  all  the  troubles  that  he  read  about;  abso- 
lutely hopeless  about  himself,  and  no  will-power.  I  had  almost 
complete  control  over  him  by  su^estion.  His  left  nostril  was 
hIo<:ked  with  a  spur  on  the  cartilaginous  septum  ;  hypertrophy  ot 
iuferiur  and  middle  turbinates,  and  a  granular  pharyngitis  with 
free  secretions.  Removing  the  spur  and  reducing  the  turbinates 
have  almost  entirely  relieved  him. 

Case  7. — Mr8.S.T.  G.;  aged  30;  mother  of  four  children;  his- 
tory good;  attractive  aud  much  beloved  socially.  Comes  to  see 
me  twice  a  week  fur  treatment.  Right  inferior  and  left  middle 
turbinates  enlarged.  She  says,  "Really,  doctor,  I  cannot  think  at 
all,  and  my  mind  gets  confused  when  my  nose  stops  np,  and  I  lose 
my  temper  and  am  so  irritable." 

Case  8. — Miss  S.  C;  aged  24;  seamstress.  Came  to  see  me  in 
regard  to  headache,  dizziness,  flighty  spells,  great  depression,  loss 
of  memory,  horrible  dreams  and  general  inertia.  Middle  turbinate 
of  left  side  pressing  hard  against  the  septum ;  the  inferior  turbi- 
nate of  same  side  is  enlarged  in  its  posterior  aspect  against  a  de- 


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310        The  Atlanta  Medical  and  Suroical  Jocrkal. 

fleeted  eeptum.  Treating  the  nose  relieved  her  of  all  except  the 
headache  aod  the  dizzinese ;  these  were  cured  with  proper  glasses. 

Cases  9  and  10. — A.  R.  aod  C.  J.,  aged  7  and  o.  Both  vic- 
tims of  adenoids,  and  were  called  "  duoce  "  at  school ;  were  cross 
and  morose,  stupid,  and  wonld  not  play  like  other  children  ;  with 
mouths  open  most  of  the  time,  they  look  like  idiots.  One  operated 
upon  in  '96  and  the  other  in  '97;  now  they  both  look  healthy  and 
play  atid  study  like  other  boys. 

You  will  notice  that  all  of  these  eases  had  some  form  of  neu- 
rosis with  more  or  less  mental  manifestations — local  or  cephalic 
paresthesia  (Dana),  neuralgias,  migraine,  melancholia,  aprosexia, 
listlessness,  dread  of  some  awful  impending  calamity,  loss  of  will- 
power  and  fear  of  self,  irritable  and  loss  of  confidence  in  fellow- 
man,  emotional  hysteria  and  suicidal  tendeDciee ;  at  times  mentally 
bright  and  clear,  but  soon  becoming  morose,  irritable  and  careless, 
a  period  when  imaginary  dangers  might  easily  so  impress  the  mind 
with  imminent  calamity  that  the  welfare  of  others  might  be  jeop- 
ardized. 

I  might  cite  many  cases,  but  my  time  is  limited.  The  cases  re- 
ferred to  seem  to  suggest  a  predominance  of  mental  manifestations 
over  those  of  reflex  neurosis.  Thus  I  hope  to  stimulate  the  idea 
that  these  peculiar  mental  derangements  are  not  so  mncb  the  result 
of  reflex  neurosis  as  direct  circulatory  and  metabolistic  distur- 
bances taking  place  in  the  brain  from  the  absorption  of  hetero-  or 
auto-genetic  toxins.  Constant  or  periodical  exhibitions  of  func- 
tional mental  derangements  are  pretty  good  evidence  that  there  is 
some  latent  cell  or  fiber  irritation,  though  the  molecular  change 
may  be  slight. 

The  majority  of  my  cases  were  intumescent,  hypertrophic  or 
hyperplastic  enlargements  of  the  inferior  and  middle  turbinates, 
and  in  patients  otherwise  healthy. 

It  is  well  known  that  the  cavernous  sinuses  of  the  turbinates, 
undergoing  either  fibrous  or  mucoid  changes,  destroying  or  dis- 
tending the  sinuses,  do  not  stop  at  the  turbinates,  but  extend  to 
the  bone  cells,  affording  a  good  field  for  absorption  of  toxic  mate- 
rials, or  starting  a  neuro- vascular  disturbance  in  neighboring  ti^^ue. 
High   arterial   tension  in  the  brain  will  cause   insomnia,  and   (his 


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Mental  Dietdrbances  in  Nasal  Stenosis.  311 

bigb  teaeioD  is  geoerally  compensated  for  by  absorption  of  cerebro- 
epitial  fluid.  Cannot  this  pressure  be  kept  up  and  the  absorption 
prevented  hy  metabolistic  disturbances  ? 

Cumslon,  in  his  excellent  paper  od  auto-toxemia,  refers  to  Mere, 
Boec,  Reges,  Chevalier  aud  others,  who  suggest  that  many  mental 
diseases  are  due  to  auto-toxemia.  ThuS)  instead  of  so  many  idi- 
opathies,  we  must  admit  that  there  is  absorbed  into  the  biood  cer- 
tain products  of  internal  chemical  changes  whose  presence  produce 
clinical  signs  only  attributable  to  interference  or  excitation  of  cer- 
tain functional  organic  processes,  wherein  the  circulatory  acd  central 
nervous  system  take  a  most  active  part. 

There  may  be  differences  of  opiDion  as  to  the  nature  and  number 
of  bacteria  and  micro-organisms  in  the  nose,  but  there  is  a  very 
decided  belief  that  they  are  there,  and  especially  in  diseased  noses. 
Our  methods  of  nasal  surgery  go  to  prove  that  we  fear  to  neglect 
a  single  cbauce  to  render  the  nose  aseptic.  Admitting  the  pres- 
ence of  germs  in  the  nose  and  their  power  of  generating  toxins 
(ptotaaioes),  along  with  Flatau's  demonstration  of  the  commuoica- 
tioD  of  the  nasal  lymph  channels  with  the  subarachnoid  space,  thus 
agreeing  with  Schwalbe,  Key,  Schreiber  and  others,  seem  to  sug- 
gest that  the  osmotic  and  the  endosmotic  currents  are  potent  fac- 
tors ID  these  cases.  These  encephalopathies  seem  to  be  toxic  in 
nature.  In  diabetes,  kidney  diseases  and  typhoid  fever,  toxic  ab- 
sorptions produce  mental  disturbances. 

Baubold,  in  the  W.  Y.  Medical  /owrnai,  December,  1897,  writing 
of  self-intoxicatiou,  speaks  of  the  different  neurasthenias  that  arise 
therefrom,  and  has  this  to  say :  "  Most  frequent  of  all  are  perhaps 
the  manifestations  in  the  central  nervous  system,  occurring  ae  they 
do  in  many  degrees,  from  the  most  trivial  to  the  severest  and  most 
prolonged  symptoms — cephalalgia,  vertigo,  syncope,  instimnia,  anx- 
iety, stupor,  coma,  irritability,  delirium,  restricted  spasms  and  gen- 
eral convulsions,  epileptoid  seizures,  paralysis,  and,  not  infrequently, 
hypochondria,  melancholia,  and  mania."  Pick,  of  Prague,  believes 
in  mental  disorders  and  aberrations  occurring  as  complications  of 
nasal  diseases,  and  reports  cases.  Daly  reports  25  and  Foster  3 
cases  nenrastbenia  cured  by  nasal  treatment.  Many  cases  of  epi- 
lepsy have  been  reported,  and  some  cures. 


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312       The  Atlanta  Medical  and  Surgical  Journal. 

AdenoidB  are  the  only  deraugemeatB  of  tbe  nasopharynx  that 
are  apt  to  present  mental  ma ni  Testations,  and  their  damage  to  early 
childhood  cannot  be  estimated.  Arrowsmith  reports  700  cases  of 
adenoids,  many  of  whom  manifested  symptotus  of  headache,  asthma, 
choreiform  and  epileptiform  attacks,  convulsions,  aad  many  diseases 
of  speech.  White,  in  Burnett's  system  for  1893,  says:  "There  is 
no  question  about  the  improvement  effected  in  the  mental  condition 
of  many  childrea  by  removing  adenoids." 

T.  E.  Hopkins  says:  "  la  mild  cases  the  child  looks  stupid  and 
is  80.  This  stupidity  has,  according  to  A.  Jacobi  and  Solis-Cohen, 
an  anatomical  basis  in  the  relation  between  the  lymphatic  circula- 
tion through  the  brain  and  nasopharynx." 

Spicer,  of  Ixmdon,  writing  of  the  influence  of  nose  and  throat 
disorders  upon  children,  says :  "  First,  that  certain  nose  and  throat 
affections  in  children  are  among  the  special  causes  of  derangements 
of  sleep,  temper,  spirits,  energy,  intellectual  powers,  and  other 
functions  of  the  nervous  system.  Second,  that  long-standing  de- 
rangement of  these  functions  in  the  growing  child  implied  a  defect 
in  the  nutrition  of  tissue  which  would  leave  its  mark  on  the  ner- 
vous and  meutal  Acuities  of  the  grown  adult.  Third,  that  the 
nasopharyngeal  affections  capable  [of  causing  the  above  derange- 
ments were  chronic  catarrh,  with  erectile  and  hypertrophied  condi- 
tions of  the  mucous  membrane." 

Thus  it  seems  to  be  adenoids  aud  hypertrophic  rhinitis  that  cause 
these  mental  manifet^tations.  And  I  hope  to  elicit,  by  a  further 
discussion,  that  a  toxemia  rather  than  a  reflex  neurosis  acts  as  the 
excitant. 

35  Granby  St. 

Facial  Erysipelas. 

R    Ac.c»rbo)ici 

Tinct.  iodi 

SpW.  reclificit. M  J  i. 

Ol.  terebinth g  ii, 

GljoeHni 3  Mi. 

M.  Sig.:  The  lesions  to  be  painted  with  this  every  two  houre  sodcoTBrod  with 
(intiseptic  ^»aK.—Lo  Preast  Medicate. 

— Med.  Rev.  of  Revieas. 


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INDICATIONS  FOR  AND  ANTISEPTIC  TECHNIQUE  OF 
UTERINE  DRAINAGE  AFTER  LABOR  AND  ABOR- 
TION.* 

By  R.  R.  KIMB,  M.D., 

ATLiSTi,  Ga. 

When  we  coDsider  that  at  least  thirty  to  fifty  per  ceut.  of  diseases 
of  women  are  traceable,  directly  or  indirectly,  to  injuries  or  acci- 
dents during  or  after  labor  and  abortions,  that  fully  one-half  of 
that  number  are  due  to  infection  in  some  one  of  its  various  forms, 
we  need  no  apology  for  presenting  this  subject. 

While  some  would  consider  "puerperal  fever,"  so-called,  a 
threadbare  subject,  and  others  would  fain  relegate  it  to  oblivion  by 
saying  it  is  a  preventable  disease — that  the  physician  is  responsible 
for  all  such  cases — nevertheless  it  is  always  with  us,  and  many  a 
Woman  suffers  from  its  ravages. 

Volumes  have  been  written,  many  experiments  made,  mauy  lives 
lust,  and  the  question  is  far  from  being  solved  to-day. 

Semelweiss  and  Holmes  began  iuvestigations  and  promulgated 
view.^  which  have  been  reinforced  by  the  germ  theory  of  disease 
and  rendered  fertile  by  the  antiseptic  and  aseptic  era,  and  now  stand 
out  as  landmarks  in  the  prevention  and  relief  of  puerperal  infection. 

Life-saving  measures  have  thus  been  evolved  which  may  iilti- 
niately  lead  to  more  accurate  scientific  methods  in  the  prevention 
aod  relief  of  puerperal  infectioD  and  its  consequent  results.  Asaa 
evidence  of  the  unsettled  condition,  we  have  but  to  briefly  review 
the  methods  of  treatment  advised  and  practiced  for  the  preventiou 
and  relief  of  these  conditions. 

Some  use  ante-partum  douches,  some  use  post-partum  douches, 
olliers  condemn  both.  Some  use  antiseptic  methods  of  prevention, 
some  aseptic  methods,  others  none  whatever.  Some  advise  washing 
out  the  uterus  with  strong  antiseptics  in  puerperal  infection,  some 
use  weak  antiseptic  solutions,  otberscondemn  the  use  of  any.  Some 
advise  curetting  uterus  in  all  varieties  of  infection,  some  curette 
*K«ad  at  llie  meetlDE  ol  the  OmrzlB  Hedlcfti  AHOclaUoa,  April  30,  ie»3. 


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314       The  Atlanta  Medical  and  Sorgical  Jodbnal. 

only  in  putrid  infectioD  (sapremia),  othere  condemn  the  curette  in 
all  cases.  Some  advise  abdominal  section  in  severe  caaes,  some- 
perform  hysterectomy,  others  condemn  such  operative  measures  and 
resort  to  vaginal  drainage  by  incision  as  a  life-saving  measure. 
Some  advise  stimulants  in  large  quantities,  some  depend  upon 
strychnia,  quinine  and  nourishment,  while  others  kill  tbeir  patients 
with  the  coal-tar  ji^up  as  antipyretics.  Some  use  the  serum 
treatment,  some  the  nucleins,  othere  fail  to  get  good  results  from 
either.  Some  administer  opiates  in  full  doses,  some  advise  salines^ 
while  the  author  favors  elimination  and  drainage. 

Happy  is  the  man  that  can  judiciously  select  and  apply  to  each 
individual  case  such  treatment  as  will  not  only  save  life,  but  con- 
serve the  generative  organs  for  future  physiological  functions. 

In  the  treatment  of  puerperal  infection  we  must  consider  the- 
anatomical  relations  and  physiological  functions  of  the  female  gen- 
erative organs,  tbe  direct  communication  between  uterine  and 
pelvic  cavities  by  way  of  the  fallopian  tubes,  the  intimate  relations- 
of  the  pelvic  organs  by  the  lymphatic  and  vaaoiilar  channels,  ren- 
dering the  female  peculiarly  susceptible  to  the  invasion  of  infection. 

When  we  consider  the  great  changeR  wrought  in  tbe  generative 
organs  during  pregnancy,  and  the  nearer  to  full  term  the  greater 
the  size  of  the  uterus,  more  vascular  blood  supply,  greater  activity 
of  lymphatics,  with  consequent  retrograde  changes  necessary  to 
complete  involution  af^r  emptying  uterus,  we  have  indications 
which  should  direct  our  treatment  of  these  cases. 

An  infected  uterus  after  full-term  labor  is  large,  flabby,  relaxed^ 
will  cot  drain  itself  however  patulous  the  os,  does  not  contract  so- 
as  to  empty  cavity  and  shut  off  the  avenues  of  infection. 

The  placental  sight,  condition  of  endometrium,  and  retrograde- 
tissue  changes  necessary  to  involution,  require,  even  demand,  a. 
process  of  elimination  or  drainage  from  uterine  cavity,  even  in  nor- 
mal cases;   much  more  so  when  infection  occurs. 

When  we  have  putrid  infection,  septic  infection  or  pus  formatioi> 
in  other  parts  of  the  body,  the  rule  is  to  open  up,  disinfect,  wasb 
out  and  drain.  Why  should  the  uterus  be  an  exception  to  thi» 
rule? 

Nature  establishes  a  flow,currentof  elimination,  the  lochia  after 


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Utbrine  Dbainaoe.  SIS' 

labor;  obetrnct  that  chaoDel  of  elimiDation,  and  what  iatbe  result?' 
This  discbarge  unloads  the  endometrium,  relieves  the  lymphatics^ 
throws  off  toxine,  debris  and  germs  that  would  otherwise  be  re- 
taioed  or  absorbed  and  cause  trouble. 

I  do  not  believe  all  cases  of  puerperal  infectioa  are  due  to  con- 
tamination by  physician  or  nurse,  nor  that  the  physician  can  always 
prevent  such  infection. 

We  certainly  have  aufficienC  clinical  evidence  to  prove  that  where- 
a  uterus  faila  to  properly  drain  itself  (which  often  occurs),  remain- 
ing lai^  and  flabby,  a  blood-clot,  portions  of  placenta  or  a  cotyle- 
don is  retained,  infection  occurs  from  putrefaction  and  absorption 
of  uterine  contents.  Such  cases  are  usually  sapremia  or  putrid  in- 
fection, but  may  be  a  mixed  or  true  septic  infection,  due  to  pres- 
ence of  septic  or  pus-producing  germs  in  genital  tract  previous  to- 
confinement. 

It  is  it)  the  cases  of  sapremia  (putrid  infection)  where  some  phy- 
sicians get  good  results  from  the  use  of  curette,  antiseptic  douche 
and  gauze  tampou,  because  the  offending  material  is  removed,  ab- 
sorption checked  and  uterus  stimulated  to  contractioD. 

In  septic  infection  the  question  is  more  serious,  as  the  curette 
and  gauze  tampon  have  killed  more  patients  than  they  have  saved. 

It  is  time  the  authors  of  our  text-books  on  obstetrics  were  recog- 
nizing the  dangers  of  such  treatment  and  devising  better  methods, 
or  at  least  pointing  out  the  serious  dauger  of  curetting  a  puerperal 
eeptie  utema. 

When  an  active  puerperal  septic  condition  exists  long  enough  to 
produce  constitutional  and  local  symptomH  and  signs  sufRcieot  to- 
establish  a  diagnosis,  the  curette  cannot  reach  the  diseased  parts, 
fur  the  germs  have  extended  beyond  the  endometrium  into  the 
uterine  wall,  blood-vessels  and  lymphatics,  and  in  rapid  septic  cases 
has  extended  so  far  that  even  hysterectomy  is  not  justifiable  in  but 
few  ioatances. 

The  curette-  not  only  fails  to  remove  the  diseased  tissue  and 
germs  of  infection,  but  produces  serious  traumatism,  breaks  down 
nature's  barriers,  dislodges  thrombi,  increases  absorptive  surfaces, 
developing  hemorrhage  and  shock,  frequently  followed  by  chills- 
and  elevation  of  temperature. 


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316       The  Atlakta  Medical  and  Surqical  Journal. 

To  tbese  cooditioDs  add  tbe  use  of  ibe  gauze  tampon,  and  if  the 
patient  recovers  it  will  be  in  spite  of  the  treatment. 

I  care  not  if  small  portions  of  placenta  or  cotyledon  be  present, 
■efficient  drainage  will  eliminate  tbe  toxins  sufficiently  to  wait  for 
nature  to  separate  the  structures  far  more  efficiently  than  the  curette, 
when  they  can  easily  be  removed  by  forceps  without  traumatism  to 
parts  and  with  far.  greater  safety  to  patient. 

A  gauze  tampon  does  not  drain  and  should  never  be  used  id  a 
puerperal  septic  uterus  except  to  check  hemorrhage.  It  in  saturated 
with  blood  by  the  time  uterus  is  (lacked;  tbe  gauze  is  compressed 
in  uterine  cavity,  coustricted  in  cervical  canal,  shutting  off  capil- 
lary current,  while  the  debris,  corpuscular  elementsaud  germs  suon 
fill  its  meshes  and  obstruct  drainage,  else  it  would  not  check  hem- 
orrhage. In  a  few  hours  the  pulse  and  temperature  rise  as  an  index 
(jf  obstructed  drainage;  remove  the  tampon,  irrigate  uterus,  then 
the  pulse  and  temperature  fall  as  a  result  of  relieved  obstruction. 

Those  that  advocate  washing  out  uterus  say  irrigations  should  be 
repeated  every  few  hours.  Why?  Because  the  uterus  will  not 
drain  itself,  and  in  a  few  hours  the  toxic  elements  accumulate  in 
sufBcient  quantity  to  produce  constitutional  symptoms. 

Antiseptic  irrigation  of  alcohol,  formaldehyde,  mercuric  chIoride> 
carbolic  acid,  creolin,  iodine  in  weak  or  strong  solutii>n6,  do  not 
take  the  place  of  drainage. 

Strong  solutions  fail  on  the  same  basis  as  the  curette — they  can- 
not reach  all  the  diseased  tissues  or  germs;  they  affect  only  tbe 
endometrium,  usually  coagulating  a  film  upon  its  surface,  and  the 
septic  germs  play  havoc  beneath.  If  they  are  frequently  repeated 
they  interfere  with  nature's  repair  of  endometrium,  set  up  irrita- 
tion, favor  absorption  by  producing  raw  surfaces,  and  frequently 
-constitutional  effects  of  the  drug  used. 

If  weak  solutions  are  used,  then  tbey  must  be  often  repeated, 
thus  destroying  rest  of  patient;  require  constant  attendance  of  the 
physician,  and  if  not  properly  used,  tbe  disturbance  of  patient,  irri- 
gation of  endometrium,  pain  and  exposure  of  patient,  counterbal- 
ance the  good  effects  obtained. 


^dbyGoOgle 


Uterine  Drainage.  317 

The  iDdiscrimiDate,  reckless  use  of  stimulants  iu  these  cases  dues 
not  remove  nor  elimiuate  cause  of  the  disease,  and  should  be  rele- 
gated to  oblivioD  the  same  as  the  indiscrimiuate,  reckless  use  of 
opiates  and  the  coal-tar  group. 

The  serum  treatment  of  these  casee  is  on  trial,  with  a  hope  that 
some  good  may  result. 

So  far  as  the  present  treatment  of  these  cases  is  concerned,  I  con- 
sider uterine  and  alimentary  drainage  and  elimination  the  most 
potent  Actors  at  our  command.  Alimentary  elimination  secured 
by  salines,  but  not  carried  to  the  point  of  debilitating  and  weaken- 
ing the  patient,  and  not  too  often  repeated. 

Uterine  drainage  is  most  important,  and  is  secured  by  use  of 
drain  age*  tubes  and  strips  of  gauze  or  wicking. 

The  drainage-tubes  may  be  of  soft  rubber,  bard  rubber,  glass,  or 
alatninum.  So  &r  I  have  had  best  success  with  soft  rubber  tubes, 
the  next  best  being  hard  rubber,  both  made  as  seen  in  cuts — -black 
or  red. 


1.1,    Sorr  BOBBIB, 


Pro,  2.    Habo  Rdbbxb. 


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318       The  Atlanta  Medical  and  Suboical  Journal. 

Use  the  best  quality  ( black  or  red)  of  soft  rubber  tubing,  aa  large 
as  cervix  will  admit,  usually  one-balf  (})  iuch  in  diameter,  cut  so 
■as  to  be  long  enough  to  reach  fundus  and  protrude  1  to  1^  iucbes 
from  cervix  into  vaginal  canal;  cut  large  openings  in  iotra-uterine 
portion,  two  in  vagiual  portion,  one  anterior  and  one  posterior, 
near  end  of  tube.  Now  cut  off  a  piece  of  tubiog  same,  size  1  to  1} 
inches  long,  in  center  of  which  cut  two  openings  just  barely  large 
enough  to  admit  the  other  tube  and  fit  snugly  to  prevent  slipping. 

Place  the  short  tube  oa  the  other  tube  so  as  to  form  a  -j— 
Just  above  the  openings  in  vaginal  portion.  When  in  position 
the  cross-bar  should  rest  against  cervix,  and  the  ends  impinge  od 
lateral  vaginal  walls  sufficient  to  prevent  tube  slipping  -out  of 
uterus,  and  yet  not  make  suEBcient  pressure  on  vaginal  walls  as  to 
produce  irritation  or  ulceration.  The  length  of  cross-bar  should 
depend  upon  width  of  vagina. 

When  tube  is  in  position  the  openings  (large  and  plenty)  \u 
uteri  oe  portion  give  free  advent  of  all  discharges;  the  cervical  por- 
tion, being  without  openings,  conducts  discharge  to  the  vaginal  por- 
tion, where  it  fiuds  free  exit  through  the  two  lateral  and  end 
0|>enings  of  tube.  The  two'  lateral  openings  are  essential  to  suc- 
Kressful  drainage,  for  frequently  the  end  opening  becomes  obstructed 
by  burrowing  in  vaginal  folds. 

If  the  tube  is  curved  it  should  be  introduced  so  as  to  correspond 
with  the  curve  of  parturient  canal,  whether  uterus  be  anteverted, 
retroverted  or  in  normal  position. 

The  soft  rubber  tube  being  flexible  accommodates  itself  to  the 
]>arts  without  any  uudue  pressure,  hence  its  advantage  over  non- 
flexible  tubes. 

Those  not  accustomed  to  use  of  the  tube  will  find  the  hard  rub- 
ber tube  more  convenient  and  easier  handled. 

With  all  instruments  sterilized,  water  boiled,  solutions  for  irri- 
gation ready,  patient  is  placed  across  bed,  hips  near  edge  on  a  piece 
of  oil  cloth,  feet  and  legs  protected,  resting  on  chair  to  either  side, 
with  basin  between  to  catch  water.  Irrigate  vagina,  washing  out 
discharge,  then  introduce  a  Sims  or  bivalve  speculum,  Sims 
usually  preferable,  expose  cervix  and  steady  uterus  with  tenaculum, 


^dbyGoOgle 


Utebike  DRAmAOE.  319 

introduce  steel  dilators,  bold  cervical  canal  open  aotil  uterue  is 
thoroughly  irrigated. 

Grasp  iutra-uleriDe  end  of  tube  (sod  rubber)  with  slightly 
curved  uteri ne'dressiug  forceps,  anoint  end  only  with  carbolized 
vaseline,  cervix  steadied  with  tenaculum,  carry  tube  to  fundus  of 
uterus,  then  steady  the  tube  with  tenaculum,  forceps  or  finger, 
and  withdraw  the  uterine-dressingforceps,  leaving  tube  in  positiou. 

If  capillary  drainage  is  also  desired,  use  a  strip  of  gauze  the 
length  of  drainage-tube,  one  end  placed  in  grasp  of  forceps  and 
carried  to  fundus  with  dratuage-tube,  introduciog  both  at  same 
time,  leaving  the  other  end  protruding  through  cervix  iu  vagina. 

The  tube  should  be  removed  and  uterus  irrigated  once  or  twice 
iu  twenty-four  hours  in  severe  cases,  being  governed  by  pulse  and 
temperature.  If  they  rise  it  is  an  indicatiou  for  irrigation  or  that 
that  the  drainage  is  obstructed. 

After  first  irrigation  and  tube  worn  for  twelve  to  twenty-four 
hours  dilators  will  not  be  needed,  as  cervix  will  remaiu  open  and 
not  obstruct  the  return  current. 

Always  irrigate  vagina,  then  uterine  cavity  with  weak,  antiseptic 
solution  or  plain  hot  water  ( unless  it  be  at  first  or  second  irrigation, 
for  reasons  previously  stated )  before  placing  tube.  This  irriga- 
tion washes  out  any  debris  or  retained  toxic  material  in  uterine 
cavity  or  vaginal  canal,  preventing  its  absorption,  and  adds  to  the 
efficiency  of  drainage. 

The  drainage*tube  should  be  soaked  in  some  very  strong  anti- 
septic solution  while  irrigation  is  performed,  then  rinse  in  sterilized 
water  before  introducing. 

To  introduce  the  tUertne  di  ainage-tube  by  sense  of  touch  mtkont 
u«e  of  upeculum  is  as  gt-eat  a  breach  of  a«ep((c  vmrk  as  to  introduce 
uterine  sound  or  catheter  by  touch  without  cleansing  the  parts. 

Always  irrigate  vagina,  expose  cervix  with  speculum  and  irri- 
gate uterus  before  introducing  tube,  so  as  to  do  aseptic  work  with 
as  little  pain  and  discomfort  to  patient  as  possible. 

Locate  fundus  of  uterus  in  each  case,  using  bimanual  exam- 
ination and  catheter  of  irrigator,  bending  the  catheter  to  suit 
uterine  curve;  by  so  doing  the  irrigating  catheter  can  easily  be  car- 
ried to  fundus  and  the  draiuage-tiihe  guided   in  the  right  direction 


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320       The  Atlanta  Medical  and  Surgical  Journal. 

tu  facilitate  its  iatroductlon  with  little  pain  to  patient  and  leB» 
traumatism  to  part*. 

I  emphasize  these  miDor  parts  in  detail  and  the  prevention 
of  pain,  because  I  know  of  physicians  who  have  failed  to  get  good 
results  and  produced  so  much  pain  that  patients  have  rebelled  and 
refused  to  allow  them  to  carry  out  treatment,  which  was  due  to 
their  faulty  technique  and  methods,  and  not  to  the  principles  and 
results  of  uterine  drainage  properly  utilized. 

As  an  irrigator  always  use  a  metal  male  catheter  of  one  piece, 
about  No.  17  or  18  French  scale  with  moderate  curve,  to  suit  posi- 
tion of  uterus.  A  double  curve  will  frequently  facilitate  its  intro- 
duction. 

Avoid  soft  rubber  or  linen  catheters,  as  they  frequently  carry 
infection,  being  easily  roughened,  cracked,  at  times  broken,  and 
cannot  be  properly  disinfected.  The  metal  one  can  be  boiled^ 
heated  or  put  in  strong  antiseptic  solutions. 

Slip  the  metal  catheter  into  tubing  of  fountain  syringe,  or  con- 
nect it  by  a  short  piece  of  rubber  tubing  to  an  ordinary  household 
syringe,  which  completes  the  outfit,  all  being  rendered  aseptic- 
be  fore  use. 

All  instruments  used  with  septic  case  should  he  left  with  patient 
for  subsequent  use,  and  sterilized  when  taken  away. 

As  to  drainage  in  cases  of  incomplete  abortion,  there  are  difier- 
ent  conditions  to  deal  with.  We  limit  the  term  abortion  in  this 
paper  to  interruption  of  gestation  any  time  prior  to  the  complete 
formation  of  placenta.  The  uterus  is  small,  contracts  readily,, 
cavity  small,  eudometrium  bypertrophied,  placental  site  less  vascular,, 
the  decidua  serotina  mure  adherent,  smaller  bulk,  more  difficult  to 
separate  or  remove,  greater  demand  for  instrumental  interference,, 
cervix  less  obliterated,  os  smaller,  parts  less  vascular  with  lessened 
chances  of  infection,  with  a  lessened  metamorphosis  of  tissue 
requiring  absorption  by  lymphatics  to  complete  involution;  hence 
less  demand  for  elimination  and  drainage  than   at  full  term  labor. 

At  least  90  per  cent,  or  more  of  cases  of  infection  occurring  dur- 
ing or  after  abortion  are  putrid  infection;  hence  easier  controlled 
and  less  demand  for  drainage. 

To  relieve  such,  clear  and  wash  out  uterine  cavity  antisepticallyr 


^dbyGoOgle 


Utbrisb  Drainage.  321 

tben  tampon  with  gauze.  The  tampon  iQ  these  cases  is  used  to 
checlc  iiemorrhage  after  removal  of  materual  structures  by  use  of 
curette  or  forceps;  it  also  acts  as  a  surgical  dressing,  protectiug 
denuded  area  as  well  as  stimulatiog  uterine  contractions.  If  por- 
tion of  the  gauze  is  saturated  with  pure  camphorated  phenol  (gum- 
camphor  2  parts,  carbolic  acid,  pure  crystals,  1  part)  it  acts  as  an 
BDtiseptic,  prevents  further  infection  of  parts  and  further  elabora- 
tion of  the  putrid  toxin. 

If  an  active  septic  infection  occurs  tben  drainage  is  demanded, 
even  in  cases  of  abortion.  Such  cases  are  diagnosed  by  the  severe 
constitutional  and  local  symptoms  with  rapid  inflammatory  invasion 
of  the  pelvic  organs,  uterus,  tubes,  ovaries,  lymphatics,  blood-ves- 
sels and  pelvic  cellular  tissue,  part  or  all. 

The  dangers  and  contraindications  to  use  of  curette  and  tam- 
pon in  septic  cases  increases  in  proportion  to  the  advance  in  preg- 
oaacy  and  tbe  increase  in  size  and  vascularity  of  pelvic  organs.' 

While  we  advocate  an  antiseptic  gauze  uterine  tampon  after 
curetting  tbe  uterus  iu  cases  of  abortion,  it  is  to  act  as  a  surgical 
dressing,  prevent  further  infection,  check  hemorrhage,  stimulate 
uterine  contractions,  and  not  for  purpose  of  drainage. 

The  tampon  should  be  removed  in  twenty-four  to  forty-eight 
hours,  and  not  repeated. 

If,  ailer  gauze  is  removed,  there  is  elevation  of  pulse  and  tem- 
perature, with  constitutional  and  pelvic  disturbances,  then  drain- 
age and  elimination  are  indicated. 

The  diet  and  constitutional  treatment  of  these  cases  do  not 
come  within  the  scope  of  this  paper. 


Fever  Mixture  fob  a  Child. 
The  combination  given  here  will  act  most  efficaciously  in  reduc- 
ing the  temperature  of  a  child  in  those  cases  in  which  no  etiologic 
factor  is  discoverable : 

R     Tr.«coDiti KU.V. 

PotUBii  bromidL 3*8. 

Sot.  etberii  DitrotL 3  ij. 

Mitt.  poUuil  citratU.. 5  ij. 

M.    Sig. :  Teaspoonful  ever;  three  Iioun. 

— Canadian  Practitioner. 


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EDITORIAL. 


Tba  usee  of  Tie  JomiUL  to  SOS  ud  lon  FltMn  Building. 

AddraM  kll  eommunicfttloiu,  kod  make  all  remitUnoea  payable  to  Tsi  A'Tlutta  Uidku 
MD  BVBBioii.  JoDUAL,  AUanta,  Oa. 

Beprinta  of  arUol«a  will  t»  taralihed,  wbeo  dMlrad,  at  a  imall  ooet.  BeqaeMa  ror  U 
uns  (bmld  alwaT*  be  made  on  the  RKwuwrfpf. 


The  seoior  editor,  Dr.  Grandy,  has  beea  appoioted  by  the  Gov- 
ernor surgeon  of  the  Third  Georgia  Regiment  of  VoluDt«er8,  with 
the  rank  of  major.  The  duties  of  the  place  will  take  him  away 
from  Atlanta  for  an  indefinite  period,  during  which  the  editorial 
work  of  the  Journal  will  be  performed  by  his  friend  and  col- 
league, Dr.  Dunbar  Roy. 


THE  DENVER  MEETING. 

The  Denver  meeting  of  the  American  Medical  Association  was 
in  many  respects  oue  of  the  most  enjoyable  meetings  ever  held  by 
that  body.  The  profession  and  people  of  Denver  did  everything 
to  make  the  meeting  the  grand  success  which  it  proved  to  be. 
The  dinners,  receptions  and  entertainments  were  of  a  very  high 
order  and  unusually  enjoyable,  but  there  is  a  growing  feeling  that 
these  entertainments  should  be  curtailed,  as  they  take  a  great  deal 
of  time  that  might  be  employed  to  much  better  advantage  in  the 
work  of  the  Association.  The  suggestion  made  in  the  Journal  of 
the  American  Medical  Association  that  the  general  sessions  be  held 
at  night,  in  lieu  of  the  receptions,  strikes  us  as  a  good  one. 

The  American  Medical  Editors  Association  met  on  June  6th, 
and  00  the  evening  of  June  6tb  the  profession  of  Denver  gave  the 


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Editorial.  823 

AmericaQ  Medical  Editors  Associatioo  and  invited  guests  a  very 
handsome  dinner  at  tbe  Brown  Palace  Hotel,  which  was  most  de- 
lightAit  in  every  respect.  Dr.  I.  N.  Ijove,  of  St.  Louis,  acted  as 
toast-master  in  his  usual  graceful  and  winning  style,  and  the 
responses  to  the  toasts  were  very  enterlainiDg.  The  editors  seemed 
in  a  jolly  mood,  and  popular  patriotic  songs  and  airs  were  received 
by  them  with  great  enthusiasm. 

The  joint  section  dinner  of  (he  Surgical  and  Gynecological 
sections  at  the  Brown  Palace  Hotel  Tuesday  evening  was  the  most 
largely  attended  and  delightful  of  the  section  dinoers.  Dr.  W.  L. 
Rodman,  of  Louisville,  as  toast-master  did  himself  and  the  sections 
great  credit  by  the  very  graceful  manner  in  which  he  presided  over 
the  dinner. 

The  general  sessions  of  the  Association  were  very  interesting 
indeed.  The  address  on  general  medicine  by  Dr.  Mnsser,  of 
Philadelphia,  was  a  most  classical  and  entertaining  paper. 

The  address  on  surgery  by  Dr.  Murphy,  of  Chicago,  excited 
unusual  interest  on  account  of  its  novelty,  and  will  make  an  epoch 
in  the  treatment  of  pulmonary  tuberculosis  if  his  deductions  are 
correct.  He  takes  the  position  that  the  sui^icat  principle  of  rest 
should  be  applied  to  the  treatment  of  pulmonary  tuberculosis  just 
as  to  other  local  tuberculoses.  Dr.  Murphy  seems  to  have  demon- 
strated that  the  suddca  deaths  which  follow  opening  the  chest 
cavity  are  due  to  the  vibration  of  the  lung,  and  that  by  holding 
the  root  o(  the  luog  steady,  with  forceps,  this  issue  can  be  pre- 
vented. He  was  led  to  suggest  this  plan  of  treatment  by  the  fact 
that  as  80  per  cent. of  the  cases  of  pleurisy  are  tubercular,  and  as  a 
very  large  proportion  of  the  worst  cases  terminating  in  empyema 
are  cured  by  the  operation  of  removing  sections  of  the  ribs  allow- 
ing the  chest  wall  to  collapse,  consumption  ought  to  be  cured  by 
bringing  about  a  somewhat  similar  state  of  afihirs  artificially.  He 
was  led  to  the  use  of  nitrogen  gas  because  of  its  indefinite  and 


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324       Tee  Atlanta  Medical  and  Surgical  Journal. 

non- irritating  properties.  He  injects  the  pleural  cavity  with  this 
gas,  compressiog  the  lung  freely,  and  claims  very  great  relief  to 
cough  and  other  distressiug  syraptoraa.  The  nitrogen  gas  may  be 
removed  after  it  has  accomplished  its  mission  by  aspiratioa. 

A  sufficieut  number  of  cases  have  not  been  treated  for  a  suffi- 
cient length  of  time  to  prove  the  correctness  of  Dr.  Murphy's 
theory,  or  the  advisability  of  adopting  the  plan  of  treatment  sug- 
gested by  him.  So  many  cures  for  pulmonary  tuberculosis  have 
been  discovered  and  published  to  the  world,  which  have  proven 
failures,  that  I  am  somewhat  skeptical  as  to  the  value  and  practi- 
cability of  the  plan  of  treatment  suggested  by  Dr.  Murphy. 

The  side  trips  "around  the  loop,"  to  Colorado  Springs  and 
Pikes  Peakj  arranged  for  the  delegates  were  very  delightful  out- 
ings, and  a  large  number  availed  themselves  of  these  privileges. 

The  large  number  who  attended  the  Denver  meeting  shows 
what  great  interest  the  profession  at  large  feel  in  the  American 
Medical  Association  to  go  in  such  numbers  to  such  a  distance  to 
attend  the  meeting.  It  is  a  very  great  privilege  to  be  a  member 
of  the  American  Medical  Association,  and  while  the  Association  is 
growing  in  strength  and  numbers  every  year,  it  should  include  in 
its  membership  every  reputable  physician  in  the  United  States. 
By  becoming  a  permanent  member  one  avails  himself  of  all  the 
privileges  of  the  Association  and  gets  one  of  the  very  best  medical 
journals,  if  not  the  best,  published  in  the  United  States,  all  for 
$5.00  per  annum. 

There  is  one  thing  that  left  a  very  bad  impression  on  many  of 
the  members  and  delegates  who  attended  the  Denver  meeting,  and 
that  was  the  disposition  to  gunge  manifested  in  certain  quarters. 
This  was  especially  true  of  some  of  the  hotels,  and  there  was  very 
general  complaint  of  the  inadequacy  of  the  hot«I  facilities  and  of 
the  outrageous  charges  made  in  many  instances.  I  know  nothing 
personally  of  the  conducrt  of  any  of  the  hotel  authorities  except 


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Editorial.  325 

of  the  Albany.  I  have  never  received  as  poor  entertainment  any- 
where for  the  money  as  I  did  at  the  Albany.  The  table  service 
was  miserable,  the  food  very  had,  and  the  tendency  to  get  as  much 
for  as  little  as  possible  apparent  at  every  turn.  The  hotel  authori- 
ties absolutely  disregarded  positive  contracts  made  with  parlies 
prior  to  the  meeting.  One  gentleman  who  paid  his  bill  at  the 
same  time  that  Dr.  Murphy,  of  Atlanta,  paid  our  bill,  had  a  writ- 
ten contract  with  the  hotel  to  furnish  room  and  board  for  himself, 
wife  and  son,  to  which  the  clerk  refused  to  pay  any  attention  what- 
ever, and  charged  him  just  as  though  no  arrangement  bad  been 
made. 

This  kind  of  conduct  on  the  part  of  hotels  where  the  meetings  are 
held  K  simply  Outrageous,  and  it  is  siucerely  hoped  that  the  Com- 
mittee of  Arrangements  at  future  places  of  meeting  will  see  to  it 
that  such  impositions  are  not  again  practiced.  The  meetiugs 
should  not  he  held  anywhere  unless  there  is  a  guarantee  of  proper 
entertainment  of  the  Association  by  the  hotels  at  the  usual  rates. 

The  next  meeting  will  be  held  in  Columbns,  Ohio,  on  the  first 
Tuesday  in  June,  1899.  f.  w.  h. 


THE  ATLANTA  COLLEGE  OF  PHYSICIANS  AND 

SURGEONS. 

The  Atlanta  Medical  College  and  the  Southern  Medical  College, 
both  of  Ibis  city,  have  beeu  united.  Fur  many  years  both  of  these 
schools  have  been  in  a  very  flourishing  condition,  and  naturally 
both  have  been  rivals  for  popular  prestige.  The  Atlanta  College 
was  the  older,  and  in  fact  one  of  the  oldest  in  the  South,  while  on 
the  other  hand  the  Southern  was  very  much  younger,  yet  had 
already  attained  a  high  position  for  its  thorough  curriculum.     The 


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326       The  Atlanta  Medical  and  Surgical  Journal. 

members  of  the  faculties  in  the  two  achooU  were  all  good  frieode, 
and  realizing,  as  they  did,  that  it  would  be  far  better  for  both 
schoola,  and  also  for  the  profession  in  the  city  and  Stat«,  could  the 
two  schools  be  united  on  an  equitable  basis,  conferences  look- 
ing to  the  accomplishment  of  this  latt«r  object  were  instituted,  with 
the  result  as  stated  above.  The  action  of  the  two  medical  facul- 
ties was  concurred  in  by  the  two  boards  of  trustees,  so  that  the  two 
colleges  have  been  united  under  the  name  chosen,  "The  Atlanta 
College  of  Physicians  and  Surgeons."  The  new  faculty  as  consti- 
tuted will  be  as  follows: 

A.  W.  Calhoun,  M.D.,  Lt,.D.,  President  of  the  Faculty,  Pro- 
fessor of  Diseases  of  the  Eye,  Ear,  Nose  and  Throat. 

J.  S.  Todd,  M.D.,  Professor  of  Materia  Medica  and  Therapeutics. 

W.  S.  Kendrick,  M.D.,  Dean  of  the  Faculty,  Professor  Princi- 
ples and  Practice  of  Medicine . 

W.  F.  Westmoreland,  M.D.,  Professor  of  Surgery. 

Virgil  O,  Hardou,  M.D.,  Professor  of  Obstetrics  and  Gyne- 
cology. 

H.  P.  Coojrer,  M.D,,  Professor  of  Anatomy  and  Clinical  Surgery. 

L.  H.  Jones,  A.M.,  M.D.,  Professor  of  Chemistry. 

W.  S.  Elkin,  A.B.,  M.D.,  Professor  of  Clinical  aud  Operative 
Surgery. 

W.  P.  Nicolson,  M.D.,  Professor  of  Anatomy  and  Clinical  Sur- 
gery- 

J.  C.  Johnson,  M.D.,  Professor  of  Physiology. 

F.  \V.  McRae,  M.D,,  Professor  of  Gastro-intestinal  and  Rectal 
Snrgery. 

Dunbar  Roy,  A.B,,  M.D.,  Clinical  Professor  of  Diseases  of  the 
Eye  and  Ear, 

Jno.  G,  Earnest,  M.D.,  Clinical  Professor  of  Diseases  of  Women. 


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MEDICAL  ITEMS. 


Dk.  J.  L.  Pope,  of  Athens,  Ga.,  died  of  apoplexy  June  9th. 


Dr.  V.  H.  Taliafebro  has  moved  from  Atlanta  to  Eatootoa, 
Georgia. 

The  Medical  College  of  Alabama  opeDS  its  33d  session  October 
10.     See  their  advertisement  on  page  xxxii. 


Db.  J.  R.  Re£D,  of  Thomasville,  Ga.,  retired  from  practice  on 
account  of  old  i^  and  ill  health,  died  June  12tb. 


The  manufacturers  of  Mellin's  Food  have  changed  their  name 
from  The  Doliber-Goodale  Co.  to  the  Mellin'e  Food  Co.  This  ia 
pro|>er, 


Dr.  R.  C.  M.  Page,  so  well  known  to  many  of  our  readers  as 
Professor  of  General  Medicine  in  the  New  York  Polyclinic,  died 
June  19th. 


The  Dioa  Chemical  Co.  has  sent  out  a  nice  paper-weight  of 
glass.  Through  the  top  is  seen  the  names  of  Dios  preparations. 
In  the  bottom  is  a  mirror.     Quite  unique.     Mailed  free  on  request. 


An  Alabama  woman  has  named  her  twins  Fitzhugh  Lee  and 
Joseph  Wheeler,  hut  a  Pennsylvania  woman  went  her  one  better 
by  naming  ber  triplets  Sampson,  Schley  and  Dewey — and  Dewey 
18  a  girl,  too. — JEx. 


Wk  congratulate  our  frieud  and  townsman,  Dr.  McRae,  upon 
his  selection  for  the  address  on  sui^ry  at  the  next  meeting  of  the 


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328       The  Atlanta  Medical  and  Surgical  Journal. 

Americao  Medical  Association.  The  choice  was  a  good  one,  aod 
Dr.  McKae  will  demoustrate  at  the  next  meeting  that  the  honor 
waa  worthily  placed. 


The  Philadelphia  Medical  Journal  offers  $1,250  in  prizes  for  the 
best  monographs  upon  medicine,  su^ery,  obstetrics,  pathology  or 
the  sjiecialties,  the  competition  to  close  December  Slat.  Those 
wishing  further  information  should  address  the  Philadelphia  Pub- 
lishing Company,  1410  Chestnut  Street,  Philadelphia. 


Do  NOT  put  ofF  sending  bills  quarterly,  half-quarterly;  you  are 
giving  your  clients'  warm  gratitude  too  much  time  in  which  to 
cool.  You  yourself  receive  regularly  every  month  your  bills  from 
the  grocer,  the  tailor,  the  landlord,  and  are  expected  to  quickly 
liquidate. — Jour.  Am.  Med.  Asso. 


We  desire  to  thank  our  friend  Dr.  H.  F.  Harris,  now  Associate 
ProfesKor  of  Pathology  in  Jefferson  Medical  College,  for  interests 
ing  reprints  upon  "  Amebic  Dysentery,"  Dr.  Harris's  article  in  the 
American  Journal  of  Medical  Sciences  for  April  npon  this  subject 
is  a  most  valuable  and  complete  paper. 


The  sui^uns  who  have  thus  far  entered  the  volunteer  i 
from  Georgia  are :  Drs.  Garrard,  from  Macon ;  Jarrell,  from 
Savaunah ;  Little,  from  Macon  ;  Davie,  Drake,  Grandy,  Moucrief, 
Geer,  and  Corput,  from  Atlanta;  Harris,  from  Carrollton;  Pate, 
from  Uuadilla  ;  and  Gninn,  from  Conyera. 


In  case  of  fracture,  non-union  is  frequently  due  to  the  presence 
of  syphilis.  It  is  well,  as  a  matter  of  routine,  to  inquire  as  to  the 
existence  of  this  disease  in  any  case  of  bone  injury,  since  active 
anti-syphilitic  treatment  will  greatly  promote  union  and  repair  in 
any  case  in  which  the  disease  exists. — Intemai.  Jour,  of  Surgery. 


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Medical  Items.  829 

Epilepsy  seems  to  be  one  of  the  chief  infirmities  of  geaius. 
CfBsar  was  an  epileptic;  Talleyraod  is  the  authority  for  the  state- 
ment that  Napoleon  bad  an  epileptic  fit  at  Strasburg  just  before  the 
capitulation  of  the  Austrian  army;  and  Madden  informs  us  that 
Byron  bad  a  numberof  slight  attacks.  Shakespeare  makes  frequent 
allusions  to  it,  and  Dickens  gives  a  partial  description  of  it  in 
Walter  Wilding. — Medical  Age. 


The  tenth  volume  of  Transactions  of  the  Southern  Sui^ical  and 
Gynecological  Association  is  received.  As  usual,  the  Transactions 
contain  a  large  number  of  interesting  scientific  papers  upon  sur- 
gery and  gynecology  by  prominent  Southern  men.  The  next 
ueeting  of  the  association  will  be  held  in  Memphis,  tbe  second 
Tuesday  in  November,  1898.  The  president  is  Dr.  Richard 
Douglas  of  Nashville,  and  the  secretary  Dr.  VV.  E.  B.  Davis  of 
Birmingham. 


As  TO  articles  in  medical  journals,  every  editor  and  experienced 
■writer  knows  how  much  more  acceptable,  bow  much  more  likely 
to  be  read,  are  short,  concise,  rather  than  long  and  verbose  ones. 
Every  writer  for  journals  should  limit  his  article  to  an  aspect  as 
specific  and  single  as  possible,  and  not  try  to  cover  too  much  space 
or  too  many  phases  of  a  subject.  Write  more  often  if  you  please, 
but  drive  one  nail  at  a  time,  and  drive  that  home.  It  hardly  needs 
fiaying  that  one  should  not  attempt  writing  upon  a  subject  until  he 
is  thoroughly  certain  he  has  something  new  or  valuable  to  say. 
Writing  for  vanity's  sake  or  to  advertise  the  writer  is  the  bane  of 
medical  literature. — Philadelphia  Med.  Jour. 


The  American  Pediatric  Society  is  making  a  collective  investi- 
gation of  infantile  scurvy  as  occurring  in  North  America,  and  ear- 


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330       The  Atlanta  Medical  and  Sdrgical  Jodrnal. 

neatly  requests  the  cooperation  of  physicians,  tbrough  their  send- 
ing of  reports  of  case?,  whether  these  have  already  been  published 
or  Qot.  No  case  will  be  used  in  such  a  way  as  to  interfere  with  its 
Bubsequent  publication  by  the  observer.  Blanks  containing  ques- 
tions  to  be  filled  out  will  be  furnished  on  application  to  any  one  of 
the  committee.  A  final  printed  report  of  the  investigation  will  be 
sent  to  those  furnishing  cases.  Signed  J.  P.  Crozer  Griffith,  M.D., 
Chairman,  123  South  Eighteenth  St.,  Philadelphia;  William  D. 
Booker,  M.D.,  853  Park  Ave.,  Baltimore;  Charles  G.  Jennings, 
M.D.,  457  Jefferson  Ave.,  Detroit;  Augustus  Caille,  M.D.,  753 
Madison  Ave.,  New  York  City;  J.  Lovett  Morse,  M.D.,317  Marl- 
boro St.,  Boston,  Committee. 


Following  are  the  officers  of  the  American  Medical  Associa- 
tiou  elected  at  the  late  meeting  in  Denver  for  the  ensuing  year: 
President,  Joseph  M,  Matthews,  Louisville,  Ky.;  First  Vice-Presi- 
dent, W.  W.  Keen,  Philadelphia,  Pa.;  Second  Vice-President, 
J.  W.  Graham,  Denver,  Col.;  Third  Vice-President,  H.  A.  West, 
Galveston,  Texas;  Fourth  Vice-President,  J.  E.  Minney,  Topeka, 
Kansas;  Treasurer,  Henry  P.  Newman,  100  Washington  Street, 
Chicago,  111.;  Secretary,  William  B.  Atkinson,  Philadelphia,  Pa.; 
Assistant  Secretary,  E.  W.  Woodruff,  Columbus,  Ohio  ;  Librarian, 
George  W.  Webster,  Chicago,  111.;  Chairman  Committee  of  Ar- 
rangements, Starling  Loving,  Columbus,  Ohio;  Oration  on  Medi- 
cine, J-  C.  Wilson,  Philadelphia,  Pa.;  Oration  on  Surgery,  Floyd 
W.  Mcllae,  Atlanta,  Ga.;  Oration  on  State  Medicine,  Daniel 
R.  Brower,  Chicago,  111,  Place  of  Meeting,  Columbus,  Ohio, 
June  6-9,  1899. 


The  First  Nathan  Lewis  Hatfield  Peize  for  Oeigihai. 
Research  in  Medicine. — The  College  of  Physicians  of  Philadet- 


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Medical  Items.  881 

phia  aonouDces  through  its  committee  that  the  sum  of  five 
hundred  dollars  will  be  awarded  to  the  author  of  the  best 
essay  in  competition  for  the  above  prize.  Subject :  "  A  Patho- 
logical and  CliDical  Study  of  the  Thymus  Glaud  aud  its  Re- 
lations." Essays  must  be  submitted  on  or  before  January  Ist, 
1900.  Each  essay  must  be  typewritten,  designated  by  a  motto 
or  device,  and  accompanied  by  a  sealed  envelope  bearing  the  same 
motto  or  device  and  containing  the  name  and  address  of  the  author. 
No  envelope  will  be  opened  except  that  which  accompanies  the 
successful  essay.  The  committee  reserves  the  right  not  to  make  an 
award  if  no  essay  submitted  is  considered  worthy  of  the  prize.  The 
competition  shall  be  open  to  members  of  the  medical  profession 
and  men  of  science  in  the  United  States.  The  original  of  the  suc- 
cessful essay  shall  become  the  property  of  the  College  of  Physicians. 
The  trustees  shall  have  full  control  of  the  publication  of  the  memo- 
rial essay.  It  shall  be  published  in  the  transactions  of  the  college, 
and  also  when  expedient  as  a  separate  issue.  Address,  J.  C  Wil- 
son, M.D.,  219  South  Thirteenth  Street,  Philadelphia,  Pa. 


At  a  meeting  held  at  the  Academy  of  Medicine  in  New  York 
City  on  the  24th  of  May,  representatives  from  eight  States  were 
present  Eo  organize  a  "  National  Society  for  the  Study  of  Epi- 
lepsy and  the  Care  and  Treatment  of  Epileptics." 

Speeches  favoring  the  formation  of  such  a  society  were  made  by 
Dr.  Abram  Jacobi,  Dr.  Ira  Van  Gleson,  Dr.  C.  A.  Horter,  Dr. 
Frederick  Peterson,  Dr.  E.  C.  Fisher,  and  Dr.  William  P.  Spratling, 
of  New  York;  Dr.  H.  C.  Rutter,  of  Ohio;  Dr.  William  M.  Bul- 
lard,  of  Massachusetts,  and  Dr.  B.  D.  Evans,  of  New  Jersey ;  and 
the  following  ofBcers  were  elected  :  President,  Hon.  William  Pryor 
Letchworth,  LL.D.,  New  York  ;  First  Vice  President,  Dr.  Fred- 
erick Peterson,  New  York ;  Second  Vice-President,  Professor  Wil- 


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332       The  Atlanta  Medical  and  SuBorcAL  Journal. 

liaiD  Oaler,  M.D.,  Maryland  ;  Secretary,  Dr.  William  P.  Spratling, 
New  York ;  Treasurer,  Dr.  H.  C.  Rutter,  Ohio. 

The  society  organized  with  forty-four  members.  Application 
for  membership  shoiiM  be  addressed  to  the  Secretary  at  Craig 
Colouy,  Sooyea,  N.  Y. 


By  some  curious  chance  a  copy  of  (he  late  lamented  Magazine  of 
Medicine  (once  the  Moody)  found  its  way  into  the  editorial  rooms 
of  the  British  Medical  Journal.  Ordinarily  the  editor  of  the 
B.  M.  J.  is  a  very  serious  person,  but  that  some  things  may  move 
him  to  mirth  is  apparent  from  the  following  clipping  from  a  late 
issue: 

The  Magazine  of  Medieine,  A  '' medico- surgical  literary  journal,"  published  at 
Atlanta,  Ga,,  US  A.,  is  probably  the  only  medical  journal  in  tbe  world  which 
has  a  poet  among  tbe  regular  members  ot  \\f  edilorial  ^UfT.  Among  the 
*'  associate  editors  "  we  note  tbe  name  of  "  Wm.  Colby  Cooper,  M.D.,  poet" 
If  we  were  to  conlese  that  we  had  never  heard  the  name  of  this  medical  bard 
before,  we  ahould  doubtless  have  "Whom  not  to  know  argues  oneself  un- 
known "  quoted  against  ue ;  we  therefore  think  it  prudent,  like  Brer  Rabbit, 
to  "  lie  low  and  say  nuffen."  The  poet  can  speak  for  himself.  One  da;  when 
the  divine  afHatus  blew  hot  and  atrong  upon  him  a  strange  thing  happened — 
if  we  may  be  forgiven  a  phrase  which  overuse  baa  made  threadbare.  He  was 
eanied  away 

On,  on,  out  in  planet-ieled  space,  till  at  last 

A  crystalline  bound  burst  in  sight. 
With  star-circled  portal,  high-vaulted  and  vast. 

All  glowing  with  iridal  light. 
And  I  caught,  in  the  instant  the  gates  sprang  ajar, 

The  glimpse  of  a  ([littering  throng, 
And  there  fell  on  my  hearing  from  hosts,  near  and  far. 
The  refrain  of  a  triumphant  song. 

'Twill  haunt  me  forever,  through  pleasure  and  pain. 

That  song  from  Away  and  Above, 
With  its  Bweel  and  its  solemn  and  pacred  refrain : 

Tbe  Spirit  of  Beauty  Is  Love. 


^dbyGoOgle 


Medical  Items.  335 

We  do  not  deay  it.  But  aa  Mr.  Weller,  Beoior,  said  of  matrimoDj,  wss  it 
vanh  nhile  to  go  through  ao  much  to  learn  so  little  7 

We  may  inform  our  able  EuglUb  contemporary  that  although 
the  Magazine  of  Medicine  is  now  extinct,  "  William  Colby  Cooper^ 
P"el,  M.D.,"  still  lives,  in  full  possession  of  his  poetic  geaiim,  and 
llic  "divine  afflatus"  still  pursues  him. 


"  The  Doctor." 


Oh,  why  not  be  a  doctof,  and  (or  the  public  work  j 

Be  Ti;;ilHiit  and  fiiilbful,  vour  duty  never  ahirk? 

There's  lota  of  good  that  you  can  do  amoDg  tba  common  traih, 

Who  will  always  keep  you  buay  If  you  do  not  mention— cash. 

Don't  be  avaricioiu  and  wisb  that  you  vera  rich, 
But  labor  for  tbe  people,  who  are  wallowing  io  the  ditch; 
Sleep  with  one  eye  open,  on  dark  and  atorroy  nigbu. 
For  Jobnny  has  Ibe  croup,  and  Jenoie  haa  no  appetite. 

W  bat  if  you  do  go  hungry,  you're  but  a  public  dog ; 
You  ibould  wait  upon  al)  comert,  in  aunehine,  rain,  or  fog. 
Remember  your  profeaiion  is  a  very  sacred  thing; 
Your  duty  ia  to  cure  men,  not  aak  tbem  for  the  ''tin," 

In  caaea  of  contagion,  be  never  wanting  tbere. 

But  hurry  to  tbe  battle,  though  you  youraelf  despair; 

Don't  run  away  from  danger,  but  be  always  atriclly  "in  it," 

And  do  your  level  beat,  though  you  lose  your  lite  next  minute. 

Should  you  by  chance  live  many  yeara,  and  follow  my  advice. 
What  multitudea  of  people  will  tay  that  you  were  nice ; 
And  when  your  labor's  ended,  resting  in  that  narrow  lol, 
How  many  poor  will  bli-ss  vou,  and  sigh  for  gnod  old  Doc. 

— Medical  Age, 


idb,Googlc 


BOOK  REVIEWS. 


Yellow  Fever.  Clinical  Notea  by  Just  Tooatre,  M.D-  (Paris), 
Former  Physician-in-Chief  of  the  French  Society  Hospitfll,  New 
Orleans;  Member  of  Board  of  Experts,  Louisiana  State  Board  of 
Health.  Pp.  220.  Price  $2.50.  Published  hy  the  New  Orleam 
Medical  and  Surgical  Journal,  New  Orleaus,  Louisiana. 

This  is  the  sort  of  book  that  the  practitioner  needs.  It  is  the 
message  of  a  physician  to  physicians,  embracing  the  lessons  derived 
from  the  author's  contact  and  experience  with  yellow  fever  in  nine 
ejudemics,  during  a  residence  of  thirty-tbree  years  in  New  Orleans. 
The  following  expression  of  a  great  truth  is  too  much  lost  sight  of 
in  this  day  of  wild  chasing  for  germs :  "It  is  at  the  bedside  that  we 
learn  the  course  of  the  disease,  the  value  or  importance  of  a  symp> 
tom,  and  the  propriety  or  urgency  of  such  and  snch  medication. 
Hence  I  believe  that  while  it  is  necessary  to  keep  an  eye  on  the 
microbe,  the  enemy,  both  eyes  must  be  kept  wide  open  on  the 
patient,  the  victim.  *  *  *  Bacteriology  and  Practice  must 
march  hand  in  hand  and  assist  each  other;  for,  if  the  culture  tube 
aod  the  microscope  increase  our  knowledge  and  make  it  more  precise, 
it  is  Medicine  which  must  apply  the  new-born  truths  to  the  cure  of 
the  patient  and  the  clinician  must  remain  the  high  priest  of 
Medicine." 

Afler  some  general  observations  the  author  takes  up  symptomaiology, 
discnsees  each  symptom,  its  relative  frequency  and  importance. 
He  lays  great  stress  upon  the  value  of  Faget's  law  as  an  "  indispen- 
sable diaguostic  sign  "  during  the  first  or  second  day.  (This  law  is 
the  coincident  fall  of  puUe  wUh  rise  of  iemperaiure.)  An  original 
and  valuable  feature  of  the  book  is  a  reproduction  of  forty-six 
clinical  charts  with  clinical  histories  of  corresponding  patients. 
The   writer   makes  the  important  observation  that  all  the  great 


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Book  Reviews.  885 

•epidemics  in  New  Orleans  have  bef^un  id  May,  Jiioe,  or  July,  and 
all  epidemics  begiuaing  in  August  or  September  have  been  mild 
and  lacked  virulence. 

As  to  treatment  the  author  does  not  believe  in  much  medication. 
He  ut^;es:  (1)  absolute  rest  of  the  patient;  (2)  thorough  aeration 
of  the  room;  (3)  strict  personal  cleanliness;  (4)  cold  sponging  for 
the  fever,  and  other  indications  for  treatment  are  fully  discussed. 
The  author  believes  that  Sanarelli  has  discovered  the  germ  of  yellow 
fever  and  expects  much  from  the  promised  curative  serum. 

The  appearance  of  this  book  is  quite  timely.  Every  physician  in 
yellow  fever  districts  should  have  it  and  study  it.  It  must  remain 
for  many  years  au  authoritative  contribution  to  the  literature  of  this 
disease. 


Atlas  of  Legal  Medicine.  By  Dr.  E.  Von  Hofmann,  Professor 
of  Legal  Medicine  and  Director  of  the  Medico-Legal  Institute 
at  Vienna.  Edited  and  translated  by  Frederick  Peterson,  M.D., 
of  New  York,  and  A.  O.  J.  Kelly,  M.D.,  of  Philadelphia. 
W.  B.  Saunders,  Publisher,  925  Walnut  St.,  Philadelphia. 
[  Price  f  3.60  net.] 

"There  is  perhaps  no  field  of  science  in  which  the  value  of  illus- 
trations is  greater  than  in  forensic  medicine.  The  problems  which 
confront  the  coroner,  the  port-mortera  examiner,  and  the  courts  of 
lawmusthesolvedby  the  presentation  of  indisputable  facts.  *  * 
A  volume  such  as  this,  made  up  chiefiy  of  photographs  and  original 
drawings  of  various  lesions  and  pathological  conditions,  taken 
directly  from  actual  cases,  supplies  to  every  physician  and  student 
an  enormous  array  of  medico-legal  data,  such  as  would  take  one 
many  years  to  acquire  alone.  This  volume  is  a  veritable  treasure- 
house  of  information  gained  from  the  rich  material  of  one  of  tbe 
greatest  institutes  of  legal  medicine  in  the  world."  (Translators' 
Pre&ce.) 

The  volume  contains  56  plates  in  colors  and  193  half-tone  illus- 
Irations  in  black.     We  cannot  here  even  give  a  list  of  the  subjects 


^dbyGoOgle 


336       The  Atlanta  Medical  and  Surgical  Journal. 

and  coDditioDs  pictured.  Among  them  are:  Varieties  of  bymeo, 
vagioa  and  uterus  after  pregnancy  and  abortiou,  lungs  of  Dewly- 
born  infunts,  fractures  of  skull,  suicides  by  cutting  tbroat  aud  by 
strangulation,  varieties  of  wounds,  alterations  of  tissues  due  to 
irritant  puisous,  gunshot  wounds  of  skull  and  brain,  contusions  of 
the  brain,  estra-dural  hematoma,  etc.  The  work  will  be  exceedingly 
useful  to  the  physician  and  it  will  be  found  a  convenient  supple* 
ment  to  some  of  the  standard  text-books  on  medical  Jurisprudence. 
These  band-atlases  now  being  ittsued  by  Mr.  Saunders  will  be  of 
great  use  to  the  reader  in  helping  him  obtain  correct  pictures  of 
abnormal  conditions. 


Diseases  op  the  Skin,  Their  Constitutional  Nature  and 
Cure.  By  J.  Compton  Burnett,  M.D.,  Author  of  "Ringworm, 
Its  Constitutional  Nature  aud  Cure."  Third  Edition,  jrevised 
and  enlarged.     Philadelphia.     $1.00.     Bcericke  &  Tafel,  18dS. 

The  author  of  this  book  is  a  homeopath  with  peculiar  views. 
His  home  country,  England,  does  not  recognize  his  school. 

The  book  is  full  of  rubbish  and  is  unworthy  of  serious  considera- 
tion, save  in  so  far  as  is  necessary  to  give  warning  against  its  per- 
nicious teachings.  M.  B.  H. 


Lippincott's  Magazine  for  June,  1897. 

The  complete  novel  in  the  June  issue  of  Lippincott's,  "As  Any 
Gentleman  Might,"  is  a  rattling  tale  of  adventure  by  William 
T.  Nichols.  The  hero  is  an  Aniericau,  but  the  action  is  mainly  in 
England,  and  the  time  is  the  early  part  of  the  present  century. 

The  other  stories,  "ToHim  that  Hatb,"by  Annie  Nathan  Meyer, 
and  "From  the  Grand  Stand,"  by  Jean  Wright,  are  very  brief. 
The  former  shows  how  subscriptions  may  be  won  for  charitable 
work. 

"A  Feathery  Debut,"  by  Lalage  D.  Morgan,  is  a  charming  ac- 
count of  a  family  of  thrushes,  whose   domicile  was  in  the  writer's 


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Book  Reviews.  8S7 

garden.  Natural  history  is  further  represented  by  "A  Year  of 
Butterflies,"  by  Frank  H.  Sweet. 

Faooy  Bullock  Workman  describee  "SpaDiah  Plains  and  Sierras"; 
R.  G.  Robinson  writes  of  "  A  Yankee  Farmer  in  Florida";  and 
John  Murdoch  has  some  words  on  "Fireplaces  of  Snow." 

"College  Athletics"  are  vindicated  by  Albert  Tyler,  one  of  the 
American  victors  in  theOlympiau  games  at  Athens  in  18d6,  Francis 
M.  Butler  writes  of  "Teacup  Times,"  and  Edward  S.  Van  Zile  re- 
surrects "  New  York's  First  Poet,"  namely,  Jacob  Steindam,  whose 
works  appeared  in  1659  and  1661. 

The  poetry  of  the  number  is  by  Julien  Gordon,  Carrie  Blake 
Morgan  and  Grace  F.  Pennypacker. 


"The  Ship's  Doctor." 

Intense  interest  to-day  centers  about  our  gallaut  navy,  and  the 
recent  daring  exploits  of  our  sailor  heroes  add  new  luster  to  the 
brave  record  of  the  past.  Americans  are  proud  to  inscribe  new 
names  standing  for  heroic  deeds — the  names  of  Dewey,  Hobson  and 
Powell. 

Whatever  tells  of  warships  and  the  gallant  deeds  of  brave  sailors 
is  eagerly  perused  by  the  American  people.  Our  navy  is  the  pop- 
ular theme  for  story  and  picture.  The  brave  exploits  of  our  sail- 
ors are  the  absorbing  topics  in  newspaper,  review  and  magazine, 
and  everywhere  are  seen  the  pictures  of  great  battleships,  graceful 
cruisers,  of  sea  battles  and  sailor  heroes. 

But,  numerous  as  are  the  current  cbronictes  of  sea  warfare,  vivid 
as  are  many  of  the  portraitures  of  battle,  danger  and  death,  there 
has  been  one  void  in  the  record  of  heroic  deeds.  Deep  down  in 
the  bowels  of  the  ship  there  is  hidden  in  times  of  battle  a  phase  of 
sea  life  of  which  the  world  knows  nothing,  which  has  not  been  writ- 
ten of,  and  which  artists  have  rarely  seen  or  imagined.  Few,  in- 
deed, are  the  phases  of  human  life  which  have  not  been  dissected 
by  the  literary  anatomist,  or  fixed  in  vivid  horror  upon  the  can- 
vas of  the  artist ;  and  the  beautiful  brochure  eutitled  "The  Ship's 
Doctor,"  which  is  being  issued  to  physicians  by  The  Arlington 


^dbyGoOgle 


338       Tbb  Atlanta  Medical  and  Surgical  Journal. 

Chemical  Co.,  of  Yonkers,  N.  Y.,  is  of  uuique  interest.  Nor  is 
this  interest  due  solely  to  the  novelty  of  the  subject,  for,  iode- 
pendently  of  this,  the  booklet  is  notable  as  marking  the  hif^hest 
point  yet  reached  in  certain  features  of  artistic  bookmaking.  The 
deadly  battle  horrors  of  the  surgeon's  merciful  vocation  are  full  of 
dramatic  opportunities  for  the  artist;  but  only  an  artist  of  power 
can  make  such  gruesome  scenes  impressive  instead  of  merely  hor- 
rible. Mr.  W.  Granville  Smith  is  such  an  artist,  and  he  has  made 
for  "The  Ship's  Doctor"  a  series  of  battle  pictures  which  touch 
the  highest  mark  of  the  illustrator's  art.  A  great  naval  battle  is 
depicted  with  thrilling  realism,  and  the  grim  realities  of  war  are 
uncoverrd  by  portrayals  of  the  cockpit  during  an  action  and  of 
episodes  of  the  surgeon's  battle  duties.  Seldom  is  realism  and  local 
color,  the  very  feeling  of  a  scene,  better  rendered  than  in  tbesa 
strong  drawings,  and  the  force  of  the  artist's  work  is  preserved  by 
the  remarkable  character  of  the  mechanical  reproduction.  A  mar- 
velous advance  in  illustrative  art  has  followed,  and  the  powerful 
illustrations  of  "  The  Ship's  Doctor  "  are  among  the  most  perfect 
examples  of  a  beautiful  new  art. 

The  beauty  of  this  booklet,  its  professional  interest,  and  its  time- 
liness, are  certain  to  make  a  lively  call  for  it,  and  physicians  who 
have  not  received  a  copy  should  at  once  send  for  it,  as  the  edition 
is  limited  aud  will  be  issued  in  the  order  as  requests  are  received. 
The  more  important  pictures  are  admirable  subjects  for  framing, 
and  if  there  are  received  a  number  of  requests  sufficient  to  warrant 
the  great  expense,  a  series  of  plates  in  large  size,  with  liberal  mar- 
gins suitable  for  framing,  will  be  made  and  supplied  free  to  pbysi- 
.cians.  Physicians  who  would  like  to  have  them  for  framing  should 
make  their  requests  to  The  Arliugton  Chemical  Co.,  of  YonkerB, 
N.  Y.,  makers  of  Liquid  Peptoooids,  without  loss  of  time. 


A  True  Saying. —  Dr.  Sinclair,  of  Manchester,  is  responsible 
for  this  bon  mot :  "  Modern  medical  students  learn  sui^ry,  which 
but  few  practice;  uearly  all  practice  obstetrics,  which  kw  learn." — 
Ex. 


^dbyGoOgle 


SBLBCTIONS  AND  ABSTRACTS. 


Long,  the  Discovebbr  op  Anesthesia. 

The  JTanuary  Dumber  of  Janua,  a  Datch  journal  devoted  princi- 
pally to  medical  history,  oontaias  an  exceedingly  interesting  article 
upon  Dr.  Long's  discovery  of  anesthesia;  and  although  we  have 
given  much  of  oor  space  to  this-  matter  in  the  past,  we  know 
tbe  many  Menda  of  Dr.  Long  still  living  will  be  pleased  to  see 
bow  hia  connection  with  anesthesia  is  viewed  abroad.  In  faat,  no 
one,  even  in  America,  has  been  a  warmer  friend  or  abler  advocate 
of  Dr.  Long's  claims  than  the  author  of  this  paper,  Dr.  George 
Foy,  an  eminent  snrgeon  of  Dublin,  Ireland.  In  the  English 
medical  press  within  late  years  be  has  written  a  number  of  articles 
of  a  kind  with  the  following,  and  we  desire  in  this  place  to  tbank 
Dr.  Foy  for  his  kind  interest.     Dr.  Foy  says: 

Long,  the  IHscoverer  of  Ane^eeia,  is  the  subject  of  a  very  inter- 
esting sketch  in  the  August-September  Bulletin  of  the  Johns  JSop- 
Hns  HospUal,  of  Baltimore,  Maryland,  America.  It  is  contributed 
by  Dr.  Young,  one  of  the  resident  surgeons  of  the  hospital,  who 
had  the  good  fortune  to  meet  Dr.  Long's  daughter,  Mrs.  Fanny 
Long  Taylor. 

The  Longs  of  Geoi^ia  were  descended,  like  so  many  of  the  most 
successful  Americans,  from  a  north  of  Ireland  emigrant,  whilst  as 
yet  the  Atlantic  States  were  English  colonies.  Like  all  his  fellow. 
emigrants  from  tbe  north  of  Ireland,  he  brought  tbe  unspeakable 
gifts  of  industry,  sobriety  and  independence.  Of  such  emigrants 
came  the  McDowells,  the  Jacksons  and  the  McGuires — names 
which  have  become  familiar  as  household  words  south  of  the  Po- 
tomac. 

It  is  well  to  bear  in  mind  this  stock  from  which  Long  is  de- 
scended, for  it  tells  much  in  considering  the  mental  traits  and  ster- 
ling sense  of  honor  which  characterized  the  man. 

To  understand  the  caution  and  diEBdence  with  which  Long  sug- 


^dbyGoogle 


§40       The  Atlakta  Medical  and  Surgical  Journal. 

freated  the  abolition  of  p&iD  by  etherization  to  his  frieDd,  Mr.  James 
Venable,  the  reader  must  think  of  his  prototype,  the  cautious,  in- 
ilustrious,  contemplative  north  of  Ireland  peasant,  who  contends 
'with  a  poor  soil  and  a  cold,  hareh,  damp  climate;  who,  withal,  de- 
spairs not,  and  by  perseverance  and  untiring  industry  compels  the 
earth  to  yield  him  support.  This  being  understood,  we  can  all 
recognize  how  natural  it  was  for  Long  to  test  the  anesthetic  prop- 
erties of  ether  on  every  possible  occasion  before  making  known  in 
the  hamlet  circle  the  great  discovery  he  had  made.  Dr.  Young 
might,  however,  have  referred  to  this  psychological  factor  in  the  ob- 
ject of  his  biography.  And  it  would  have  been  well  to  point  out 
that  at  the  very  time  when  Long  was  pondering  on  the  properties 
of  ether  and  questioning  nature  for  an  answer,  the  fate  of  the 
unfortunate,  learned  and  accomplished  physician.  Dr.  Elliottson,  of 
the  University  College,  London,  had  become  common  and  known. 
It  was  a  dreadful  objective  lesson.  Elliottson,  like  Long,  sought 
an  anesthetic,  and  believed  he  found  one  until  he  was  rudely  awak- 
ened from  his  dreams  by  the  clear>headed  Thomas  Wakely,  who 
pulled  the  mask  from  a  pair  of  impostors. 

The  blow  was  too  great  for  the  poor  dupe,  and  Elliottson's  after- 
career  is  one  of  the  saddest  pages  in  English  medical  biography. 
Elliottson,  honestly  seeking  knowledge,  saw,  or  thought  he  saw, 
what  he  so  ardently  desired. 

Long's  mind  was  too  well-balanced  to  fall  into  such  an  error. 
Nevertheless  his  inherited  prudence  called  for  more  and  mora  evi- 
dence of  the  anesthetic  properties  of  ether  until  the  possibility  of 
error  was  eliminated;  then  be  came  forward,  and,  in  the  spirit  of 
a  Southern  gentleman,  and  imbued  with  the  feeling  of  the  Great 
Physician,  made  known  freely  and  fully,  without  any  thought  of 
self,  the  inestimable  blessing  of  anesthesia. 

All  this  careful  scrutiny  of  facts  and  testing  of  results  is  fixed 
upon  by  Long's  detractors  as  evidence  that  he  failed  to  see  the  dis- 
covery he  made  and  its  beneficial  effects  on  humanity,  until  Mor- 
ton and  the  staff  of  the  Massachusetts  Hospital  proclaimed  it  to 
the  world — proclaimed  that  Morton's  patent  medicine  "Lethon" 
was  on  sale.     And  all  were  invited  to  buy. 

The  New  England  Yankee  was  working  a  mine  of  wealth — all 


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Selections  and  Abstracts.  841 

euSering  humaDity  v&b  to  pay  tribute  to  bis  rapacity.  This  auda- 
cious attempt  called  forth  indignant  proteata,  and  amongst  the  most 
telling  of  these  was  that  of  Dr.  Arthur  Jacob,  of  Dublin,  in  bis 
journal,  the  Medical  Press. 

MurtoD  took  all  the  necessary  steps  to  secure  a  patent,  but  the 
court  refused  it — Long  having  produced  anesthesia  with  ether  four 
years  previously,  and  made  it  a  free  gift  to  the  world. 

How  Dr.  Long  came  to  use  ether,  and  the  story  of  its  earlier 
administrations,  and  the  documents  connected  with  them,  are  told 
by  Dr.  Young  with  great  fullness  from  the  papers  and  so  forth 
preserved  with  loving  care  by  Mrs.  Fanny  Long  Taylor,  and  there 
is  little  left  for  any  succeeding  biographer  to  add;  there  are,  how* 
ever,  some  slight  additions  which  may  interest  the  reader.  Dr. 
Long  was  a  personal  friend  of  Alexander  H.  Stephens,  and  as  such 
was  heartily  with  the  State's  rights  party,  and,  naturally,  his  friends 
in  Washington  were  too  much  preoccupied  in  demanding  Southern 
rights  to  6nd  sufficient  leisure  to  unravel  the  claims  of  Morton 
and  Jackson  to  the  discovery  of  anesthesia.  As  might  be  expected, 
Dr.  Long  declined  to  seek  any  &vor  from  the  enemies  of  his  State 
and  people. 

His  own  people,  however,  recognized  his  claims,  and  the  Geor- 
gia statues  in  the  capitol  are  to  Crawford  the  statesman,  and 
Lon^  the  discoverer  of  anesthesia.  War  came,  the  South  was 
invaded,  and  the  march  of  Sherman's  bummers  laid  waste  a  tract 
of  thirty  miles  in  width  throughout  Georgia  and  the  Carolioas; 
with  their  marching  song  of  hallelujah  they  robbed  and  destroyed 
the  homes  of  the  defenceless  women  and  children ;  nothing  was 
sacred  from  these  wretches;  they  were  incapable  of  mercy,  and 
knew  not  kindness.  They  made,  as  they  were  instructed  to  do,  a 
desolation . 

Dr.  Long  suffered  with  the  rest  of  the  people  in  Georgia.  But 
it  is  a  wonderful  testimony  to  his  skill  and  trustworthiness  that 
after  the  war  the  United  States  government,  when  they  made 
Athens,  Ga.,  a  military  station,  appointed  Long  sui^on  to  the 
military  hospital. 

Loved  by  his  people,  he  gradually  made  good  bis  losses,  and,  at 
the  end  of  a  useful  life,  died,  leaving  to  bis  family  |40,000 — a  sum 


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842       The  Atlanta  Medical  and  Sdrgical  Journal. 

which  Dr.  Young  may  think  small  \a  comparison  to  Northern 
fortuDCB,  but  one  which  cau  hardly  be  looked  upon  ae  poverty. 
Of  Long  the  world  outside  the  Southern  States  would  probably 
have  known  little  if  it  were  not  for  that  acoomplishfid  Yii^inian, 
Dr.  LandoD  B.  Edwards,  who  induced  Dr.  Marion  Sime  to  publish 
Long's  biography. 

The  attention  of  the  medical  profeedon  was  again  directed  to 
(be  subject  by  Dr.  Luther  B.  Qrandy,  Atlanta,  Ga.,  who  corrected 
Wilhite's  story  and  added  some  new  matter;  and  now  Dr.  Young 
gives,  with  a  fullness  never  before  attempted,  all  the  literature 
which  goes  to  support  the  claims  of  Dr.  Crawford  Long;  and  bis 
paper  cannot  fail  to  interest  all  in  the  great  discovery  of  anesthe- 
sia.—  Va.  Med.  Semi- Monthly. 

[One  error  in  the  above  should  perhaps  be  corrected.  There 
are  no  "  statues  in  the  capitol  to  Crawford  the  statesman,  and  Long 
the  discoverer  of  anesthesia."  Under  the  law  which  permits  each 
State  to  place  statues  of  two  of  her  distinguished  sons  in  the  Na- 
tional Gallery  of  Statues  in  the  capitol  at  Washington,  Georgia, 
twenty  years  ago,  at  the  suggestion  of  Alexander  Stephens,  decided 
thus  to  honor  James  E.  Oglethorpe  and  Crawford  W.  Long.  It 
was  found,  however,  that  there  was  no  provision  for  the  expendi- 
ture of  the  public  funds  for  such  a  purpose.  So  the  space  allowed 
to  Georgia  in  the  National  Capitol  is  still  vacant. — L.  B.  o.] 


Cheonic  Gastritis. 


A  report  of  a  very  severe  case  of  gastritis  was  freely  copied  in 
medical  journals  during  the  year  1896,  in  which  glycozone  was 
Buocessfully  used. 

At  that  time,  J.  W.,  aged  38,  a  blacksmith,  came  under  my 
care.  His  illness  began  in  1894  with  the  usual  symptoms  of  gas- 
tritis. In  January,  1896,  he  had  become  so  much  worse  that  be 
placed  himself  in  the  hands  of  one  of  our  best  physicians,  under 
whose  care  he  continued  until  November  of  the  same  year,  when 
I  was  consulted. 

Afler  hearing  his  history  and  the  treatment  given,  I  urged  him 


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Selections  and  Abstracts.  343 

to  return  to  bie  pb}-eiciaD,  insisting  tbat  nothing  more  could  be 
done.     My  protest  was  in  vain. 

EzaminatioD  revealed  an  emaciated,  thin  and  badly  nourished 
body;  bis  eye,  skin  and  color  fair,  though  pale  ;  his  temperature 
normal ;  the  bowels  inclined  to  constipation  with  occasional  diar- 
rhea, with  white,  pasty  oSensive  stools;  the  lunge,  heart  and 
kidueys  healthy ;  the  liver  a  trifle  small. 

There  was  no  painful  point  and  no  evidence  of  enlargement, 
tumor  or  ulcer.  He  was  so  thin  tbat  the  abdomen  could  be  most 
thoroughly  examined.  His  tongue  was  heavily  furred,  red  at 
the  tip,  indented  at  the  edges,  and  the  papills  red  and  prominent. 

He  complained  of  being  unable  to  lake  either  solid  or  liquid 
food  even  in  small  quantities  without  causing  heaviness,  weight, 
oppression,  pyrosis,  eructation  of  gases,  nausea  and  Boally  head- 
ache and  vomiting. 

SiD(%  1894  these  ^mptoms  bad  increased  in  severity,  the 
nausea  never  ceased  and  this  whole  array  of  complaints  would 
gradually  accumulate  in  force  and  energy,  overwhelming  bis 
system  with  an  attack  of  headache  and  intermittent  vomiting  that 
would  last  from  three  to  five  days. 

In  1895,  these  storms  growing  worse,  rendered  bis  life  almost 
unbearable.  I  had  been  attending  him  about  a  week,  when  one 
of  these  attacks  occurred.  He  had  been  vomiting  one  day  before 
I  saw  bim.  The  scene  was  truly  pitiable.  I  found  my  poor 
emaciated  patient  in  a  small  darkened  rc>om  scarcely  able  to  raise 
his  head,  gagging  and  straining  constantly,  bringing  up  finally  by 
the  greatest  of  efforts,  a  teaepoonful  of  white  glairy  mucus;  his 
bead  bound  tightly  or  wrapped  in  ice  cloths;  bis  eyes  congested; 
hie  cheeks  hollow ;  his  skin  sallow  and  pale;  bis  face  bespeaking 
the  intense  agony  he  suffered,  begging  and  pleading  to  those 
around  him  for  relief  from  the  horrible  nausea  and  retching. 

I  remained  with  him  an  hour  and  during  that  time  he  was  not 
free  for  five  minutes  from  efforts  at  vomiting.  His  sleepless, 
aching  brain  seemed  racked  to  distraction.  He  would  gag,  vomit, 
and  fall  back  exhausted. 

This  continued  three  days,  gradually  lessening.  Steep  came 
only  through  exhaustion.     Every  particle  of  food  (liquid  or  solid) 


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344       Thb  Atlanta  Mbdical  and  Surgical  Journal. 

was  promptly  vomited.  Diiriog  these  attacks,  the  temperature 
was  iDcreased  from  99  to  105. 

These  attacks  were  always  of  a  similar  character  and  from 
Kovember  1,  1895  to  July  3,  1896,  they  occurred  every  tea  days 
or  two  weeks. 

The  phyBiciau  who  had  treate^  him  had  used  drugs,  diets,  and 
lavage  faithfully  and  persistently,  so  that  at  the  outset  I  was  com- 
pletely handicapped. 

I  began  with  the  remedies  which  had  given  relief  in  similar 
cases,  and  in  turn  used  acids,  alkalies,  alteratives,  pepsin,  digest- 
ants,  purgatives,  tonics,  bitters,  sedatives,  diets,  etc.,  either  singly 
or  in  combination,  until  I  had  exhausted  all  the  resources  at  my 
command. 

Tbe  only  perceptible  relief  came  from  the  use  of  small  doses  of 
diluted  hydrochloric  acid  between  the  attacks  and  a  solution  of 
cocain  and  morphine  during  the  paroxysm. 

About  July  3,  1896,  I  read  the  article  referred  to  above,  and  in 
desperation  and  despair  of  ever  relieving  bim,  I  ordered  glycoeoue 
one-half,  then  one  drachm,  well  diluted,  twenty  minutes  before 
meal  time. 

In  a  few  days  he  said  be  felt  better;  within  a  week  he  repeated 
the  assertion.  To  tbe  utter  astonishment  of  myself  and  his  friends, 
one,  two,  four  and  even  six  weeks  passed,  without  a  recurrence  of 
bis  severe  symptoms. 

About  August  20th  he  was  so  much  improved,  that  to  bnrry 
matters,  I  concluded  to  try  lavage  again.  This  was  done  at  5 
p.  M.  and  at  10  that  night  be  was  In  the  throes  of  an  attack,  which 
lasted  two  days. 

He  then  resumed  his  glycozone  and  continued  to  improve  till 
October  15th,  when  on  account  of  inactivity  of  the  bowels  and 
costivenesB,  he  was  given  two  grains  of  calomel,  which  brought  on 
a  slight  headache  and  considerable  nausea. 

He  bad  already  been  taking  more  food,  but  from  this  time  ii 
was  increased  in  quantity  and  character,  eating  three  fairly  good 
meals  a  day  and  enjoying  them. 

After  beginning  the  use  of  glycozone,  the  acid  was  continued  a 
few  weeks,  after  meals,  then  left  off  entirely.     No  other  medicine 


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Sblbctions  and  Abstracts.  345- 

was  used,  except  occasionally  a  pill  of  aloio,  belladonna,  strychnia^ 
cascara,  when  bowels  were  sluggieli. 

To  him  glycozone  proved  the  greatest  boon,  and  to  me,  the 
relief  given  was  simply  wonderful. 

It  is  useless  to  add,  that  I  have  used  the  remedy  in  many  cases 
since,  and  have  met  with  excellent  and  even  astonishing  results. — 
Louis  A.  Kengla,  M.D.,  San  Francisco,  Gal.,  in  New  England 
ifedical  Uontkly,  Feb.,  1898. 


Diagnosis  of  Tumors  of  the  Breast. 

In  urder  to  properly  examine  a  neoplasm  of  the  breast,  the  pa- 
tient  should  be  palpated  lying  down,  and  both  mammary  glands- 
are  to  be  caretully  compared  by  iaspection. 

Now  if  one  of  the  breasts  is  the  seat  of  a  tumor,  we  have  to  first 
eliminate  the  premammary  tumors,  such  as  a  superficial  abscess, 
lipomata  and  various  types  of  erosions ;  and  secondly,  the  retro- 
mamniary  growth?,  such  as  eub-roammary  lipoma.  Thirdly,  the 
question  of  exostosis  of  the  ribs,  which  causes  the  breast  to  pro- 
ject, should  be  considered. 

We  should  then  determine  if  the  neoplasm  is  solid  or  liquid,. 
and  coDsqueDtly  its  tension  and  fluctuation  should  be  ascertained. 
If  fluctuation  be  present,  the  periphery  of  the  fluctuating  pocket 
should  be  explored  in  order  to  discover  if  by  chance  it  has  not 
developed  secondarily  in  a  solid  neoplasm,  in  which  case  an  ex- 
ploratory puncture  is  advisable. 

If  the  liquid  tumor  is  single,  we  would  first  consider  the  diagno- 
sis of  galactocele.  This  neoformation  commences  during  lactation 
or  at  the  time  of  weaning  the  child.  It  is  seated  in  the  external 
segment  of  the  gland,  its  development  is  slow  and  gradual,  it  is 
indolent,  rounded  in  shape  and  movable  under  the  skin  and  over 
the  underlying  tissues.  There  are  no  enlai^d  glands  in  the  azilla,. 
while  the  condslency  of  the  growth  varies. 

Next,  we  have  to  consider  chronic  tubercular  abscess,  the  diag- 
nosis of  which  is  not  always  easy,  especially  at  the  commencement 
of  the  aflectioD.  Afteratime  the  lymphatic  glands  in  the  axilla 
become  involved,  and  finally  fistulse  and  characteristic  ulcerationa 
will  appear. 


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346       The  Atlanta  Medical  and  Surgical  Journal. 

Thirdly,  we  have  the  so-called  simple  cysts  which  are  due  to  a 
chronic  mastitis  or  to  epithelial  neoplasms. 

When  we  are  dealing  with  multiple  liquid  tumors  we  are  in 
presence  of  Reclus's  cystic  disease,  which  is  a  syndrome  of  either  a 
•chronic  mastitis  or  an  epithelioma.  It  is  characterized  by  a  num- 
ber of  very  email  tumors,  which  give  to  the  feel  the  sensation  of 
«mall  lead  bullets.  This  disease  is  usually  bilateral,  and  deep  or 
cutaneous  adhesions  do  not  exist.  The  lymphatic  glands  arc  not 
involved. 

In  the  case  of  solid  neoplasms  we  have  carcinoma,  sarcoma  and 
adenoma,  although  pathologically  the  two  latter  growths  are  to  be 
included  in  the  same  class.  A  very  good  division  is  non-encapau- 
lated  twaors,  which  comprises  the  carcinomata  and  encapsulaUd 
■neoj^aams,  which  have  distinct  limits,  and  includes  the  sarcomata 
and  adeoomata. 

A  positive  diagnosis  of  the  non-encapsulated  class  can  be  made 
by  the  age  and  antecedents  of  the  patient  and  by  a  careful  palpa- 
tion of  the  tumors.  la  the  beginning  a  small,  hard  and  indolent 
lump,  usually  intimately  united  to  the  glandular  structure  with 
diffused  limits  and  which  can  remain  circumscribed  or  invade  the 
«Qtire  gland.  There  Boon  will  be  found  an  adhesion  between  the 
growth  and  the  skin,  and  in  order  to  find  this  condition  it  is  only 
necessary  to  pick  up  a  fold  of  the  skin  overlying  the  neoplasm  be- 
tween the  thumb  and  index-finger  when  a  puckering  of  the  skin  is 
to  be  seen  and  felt.     In  fact  the  aspect  is  that  of  orange  peeL 

To  ascertain  if  the  growth  is  adherent  to  the  aponeurosis  of  the 
pectoralis  major,  the  former  should  be  seized  with  the  hand  and  the 
tnusole  made  to  contract. 

Other  later  dgns  of  the  disease  are  retraction  of  the  nipple,  a 
discharge  of  serum  or  blood  from  the  nipple.  When  blood  comes 
from  the  nipple  the  neoplasm  is  in  all  probability  an  intra-canalic- 
ular  epithelioma.  As  development  of  the  growth  increases,  the 
axillary  glands  become  involved  and  sometimes  the  sub-clavicular 
or  the  axillary  glands  of  the  opposite  side  can  present  au  infiltra- 
tion. 

When  well  advanced  the  neoplasm  first  presents  a  small  ulcer- 
ating surface,  which  is  quite  superficial,  but  which  invades  in 


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Sblbctions  and  Abstracts.  347 

depth  little  by  little  aod  gives  rise  to  cooeiderable  hemorrhage. 
The  borders  of  the  ulceration  become  hard  but  not  undermined ; 
the  bottom  of  the  ulcer  is  uneven  and  secretes  a  fetid,  sanguineous 
dischai^.  Pain  is  also  complained  of  by  the  patieotand  is  caused 
by  the  compression  of  [the  nerve  trunks  in  the  axilla  or  by  direct 
neoplastic  infiUratioD  of  the  nerves,  and  to  end  the  clinical  pic- 
ture, cachexia  makes  its  appearance. 

As  to  the  differential  diagnosis,  we  h&v6  to  consider  the  two 
types  of  chronic  mastitis — viz.,  mastitis  with  multiple  nodules, 
which  are  more  likely  to  be  mistaken  for  an  adeno-Sbroid  than 
carcinoma,  and  a  mastitis  presenting  only  a  single  nodule.  Diag- 
nosis is  made  by  the  patient's  antecedents  (lactation),  the  oscilla- 
tions  in  the  size  of  the  growth,  the  earlier  and  greater  involve- 
ment of  the  axillary  glands,  the  pain  and  the  frequent  involvement 
of  both  breasts. 

Mammary  tuberculosis  is  an  infrequent  disease,  and  the  diag- 
nosis is  not  difficult  if  the  subject  presents  other  symptoms  of  the 
disease,  but  when  localized  in  the  breast  it  might  cause  great  diffi- 
culty in  the  diagnosis. 

Tertiary  syphilis  of  the  breast  is  infrequent  and  can  only  be 
diagnosticated  by  a  history  of  syphilis,  or  in  want  of  this  by  spe- 
cific treatment. 

The  shape  and  limits  of  the  mammary  tumor  are  to  be  consid- 
ered carefnlly.  We  have  circumscribed  tumors ;  the  ordinary  so- 
called  scirrhus;  a  form  of  soirrhus  sending  out  ramifications  in 
all  directions,  which  start  from  the  center  of  the  growth  and  are 
adherent  to  the  skin;  the  atrophying  soirrhus  has  a  slow  evolution 
and  causes  the  gland  to  shrivel  up,  while  the  lymphatic  glands  are 
involved  at  a  late  period,  and  ulceration  of  the  neoplasm  is  tardy 
and  superficial. 

Enoephaloid  differs  from  ordinary  scjrrhus  in  that  it  is  of  a 
leaser  consistence  and  cysts  may  develop  within  the  tumor,  but  its 
progress  is  far  more  rapid. 

Disseminated  pustular  scirrhus  is  characterized  by  the  presence 
of  multiple  cancerous  growths  in  the  skin  and  subcutaneous  cel- 
lular tissue  ;  its  prognosis  is  very  serious.  Scirrhus  en  cuirotee  is 
the  condition  met  with  when  the  entire  thorax  is  invaded  by  large 


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348       The  Atlanta  Medical  and  Surgical  Journal. 

patches  of  the  growth.  It  is  hard  and  violet  id  color,  producing- 
much  difficulty  in  respiration,  and  is  rapid  in  its  progress. 

Volkmann's  carcinoinatous  mastitis  occura  in  young  women 
during  lactation  and  from  the  beginning  invades  the  entire  gland^ 
in  many  instances  both ;  it  progresses  with  great  rapidity  and 
cachexia  appears  early,  while  death  results  io  a  few  months. 

The  histological  diagnosis  is  often  of  considerable  difficulty^ 
but  we  have  certain  clinical  characters  which  will  aid  us  in  dif- 
ferentiating a  canalicular  epithelioma  from  a  mastitis. 

The  encapsulated  neoplasms  are  to  be  recognized  by  their  mo- 
bility  over  the  gland,  by  the  absence  of  adhesions  with  the  skin, 
and  underlying  tissues  and  the  glands  in  the  axilla  are  not  in- 
volved. 

Adenoma  is  a  rather  small  tumor,  round,  smooth,  very  regular 
in  outline,  indolent;  its  consistency  is  elastic.  Generally,  several 
of  this  neoplasm  will  be  found  in  one  gland,  and  the  diagnosis  is- 
only  to  be  mistaken  for  multiple  nuclei  or  a  chroaic  mastitis.  The 
latter  affection  can  be  diagnosed  by  the  time  of  occurrence,  the 
pain  and  the  early  enlai^d  and  painful  glands  ia  the  axilla.  The- 
histological  diagnosis  of  the  type  of  adenoma  present  in  a  given 
case  can  only  be  made  after  removal  of  the  growth. 

A  sarcoma  is  a  smooth,  indolent  tumor  which  is  small  in  size  iU' 
the  beginning.  But  suddenly  it  takes  on  a  rapid  growth,  and 
when  developod  it  must  be  diagnosticated  from  carcinoma.  The 
diagnosis  is  based  upon  the  progress  and  manner  of  development, 
which  is  slow  at  the  commencement,  and  then  suddenly  rapid,  as- 
well  as  on  the  exterior  shape  of  the  growth,  which  is  lumpy  and 
projecting;  on  the  late  adbcsion  to  the  skin,  which  takes  place  en 
masse ;  by  the  presence  of  large  subcutaneous  veins,  in  oorct- 
nonta  we  sometimes  meet  vntk  a  varicose  condition  of  the  ?ym- 
jthatics,  but  the  veins  are  njot  dilated.  In  sarcoma,  the  skin  is  shiny 
and  distended  and  the  nipple  is  spread  out  and  not  retracted  as  it. 
is  in  most  cases  of  caiciooma.  The  characters  of  the  ulceration 
are  next  to  be  considered. 

Carcinoma  is  uniformly  bard  in  cunsistency,  while  sarcoma  is- 
semi-solid  or  semi-liquid,  and  enlarged  glands  in  axilla  are  not 


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Selections  akd  Abstracts.  349 

preseot  in  this  latter  neoplasm.  Sarcoma  has  a  tardy  influence  oa 
the  patient's  general  health  and  is  itaelf  usually  indolent. 

Becufrence  after  removal  is  common  to  both  carcinoma  and 
sarcoma,  but  diSere  in  that  the  neoplasm  returns  at  the  site  of  the 
former  growth  in  sarcoma,  while  in  carcinoma  the  affection  ap- 
pears in  the  lymphatics.  In  sarcoma  the  seconds  ry  foci  occur  in 
the  lungs  and  liver  more  especially,  the  disease  being  disseminated 
by  the  general  circulation. 

Sui^cal  interference  is  indicated  in  the  majority  of  mammary 
tumors  by  free  extirpation  of  the  growth  and  dissection  of  the 
masses  of  glands  in  the  axilla.  Adenoma  and  sarcoma  require 
only  a  free  extirpation.  Benign  tumors  of  the  breast  should  be 
removed,  as  they  may  undet^oa  malignant  degeneration  at  a  later 
period. — Annalg  of  Qynecoloffy  and  Pediatry. 


Aphthods  Stomatitis. 


A.  Levi  {Wiener  Medic.  Blatter,  1897,  xx,S9).  Stomatitis  aph- 
thous, according  to  most  authors,  is  an  acute  inflammation  of  the 
mucous  membrane  of  the  month,  characterized  by  a  fibrinous 
<lep08it  in  the  form  of  white  or  yellow  spots  of  the  size  ofaberap- 
seed  to  that  of  a  lentil.  Billard  and  others  consider  this  disease  an 
inflammation  of  the  mucoid  follicles  of  the  mouth.  Vogel  and 
Biedert  look  upon  aphtha  as  ulcerations,  and  divide  them  into 
aphthous  and  ulcerative  stomatitis.  Rilliet  and  Barthez  consider 
them  to  be  vesicles,  which  later  on  became  ulcers  (Stomatite  v^si- 
coulc^reuse  of  Billiet  and  Barthez).  Monti  describes  aphthous 
stomatitis  as  an  inflammation  of  the  mucous  membrane  of  the 
mouth,  which  causes  fibrinous  deposits  on  and  under  the  epithelium. 
In  the  author's  opinion  this  explanation,  as  we  shall  learn  from 
patbotogico-anatomical  investigations,  in  the  only  correct  one. 

Etiology  and  Pathogenetia. — Aphthous  stomatitis  is  a  disease  of 
fihildhood.  Id  the  adult  it  is  rarely  met  with,  and  then  usually  in 
women  during  the  meustrual  period,  in  child-bed  and  during  lacta- 
tion. From  the  statistics  of  1 11,143  cases  we  may  form  the  follow- 
ing conclusions : 


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350       The  Atlanta  Medical  and  Buroical  Journal. 

1.  That  aphthous  Btomatitis  is  present  id  children  in  0.972  per 
cent — i.  c,  about  1  per  cent, 

2.  That  the  disease  more  frequently  attacks  females  than  males- 
Levi  does  not  believe  that  this  circumstances,  which  has  already 
been  remarked  by  Monti  and  others,  should  be  given  any  piirticuUr 
importance. 

The  disease  is  found  in  children  of  every  constitution.  He  is 
not  able  to  agree,  from  his  experience  of  ninety  cases,  with  Billard, 
Rilliet  and  Barthez,  in  their  opiuion  that  weakly  and  lymphatic 
children  are  peculiarly  predisposed,  Monti  indeed  has  observed,  and 
Levi  confirmed  it,  that  this  disease  is  frequently  met  with  in  rachitic 
children.  He  does  not  believe,  however,  that  this  is  due  to  a  weak 
constitution,  but  is  due  to  disorders  of  digestion  to  which  these 
children  are  subject,  and,  as  Monti  suggests,  to  the  great  frequency 
of  carious  teeth.  As  regards  tbe  age,  aphthous  stomatitis  is  found 
even  in  infants  at  the  breast;  nevertheless  it  is  very  rarely  met  with 
before  the  period  of  dentition.  Monti  has  never  met  with  it  in 
tbe  new-born.  In  496  cases  which  Levi  has  gathered  he  found 
the  disease  once  in  a  child  fourteen  days  old,  and  once  in  a  child 
twenty-eight  days  old,  Bednar  found  one  case  in  100  new-born 
infants;  Bohn,  three  in  169  during  the  first  month  after  birth;  other 
cases  are  mentioned  by  Denis  and  Billard.  T^evi  agrees  with  Monti 
that  these  cases  were  probably  not  true  aphthous  stomatitis,  but  cases 
of  simple  isolated  aphtbte.  Its  rare  occurrence  before  the  period  of 
dentition  is  probably  due  to  the  uniform  nutrition  during  the  period 
of  infantile  life,  and  to  the  greater  care  observed  by  the  mothers  in 
regard  to  the  cleaDliness  of  the  inlant's  mouth. 

The  inflammation  of  the  mucous  membrane,  the  increase  in  the 
secretion  of  saliva,  the  raised  temperature  of  the  mouth — which 
frequently  accompany  detention — are  conditions  favorable  to  the 
development  of  micro-organisms  and  to  the  decomposition  of 
food. 

The  season  of  the  year  also  seems  to  play  an  important  r6le  in 
the  etiology  of  aphthous  stomatitis,  for  in  the  warmer  months  this 
disease  is  met  with  most  frequently.  Another  important  factor  is 
tbe  relation  of  this  disease  with  epizootic  aphthte.  Some  authors 
identify  both  diseases  and  assign  infection  through  the  milk  of  ani- 


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Selections  and  Abstracts.  S51 

mils  sufiering  from  aphtha  epjzootica  as  the  only  cause  of  the  dis- 
ease. 

Levi  was  fortunate  enough  to  be  able  to  demonstrate  that  this 
stomatitis  occurred  in  children  in  whom  an  infection  through  milk 
oonld  be  positively  excluded,  as  the  latter  was  always  carefully- 
sterilized  before  use. 

Aphthous  stomatitis  is  a  contagious  affection ;  drinking  glasses^ 
utensils,  soiled  clothing,  etc.,  may  become  carriers  of  infection. 

IHagnotia. — Bearing  in  mind  that  vesicles  only  are  found  and 
that  the  process  of  disease  consists  in  depositing  a  fibrinous  exudate 
in  the  shape  of  macules  on  different  parts  of  the  mucous  membrane, 
it  will  he  easy  to  make  a  diagnosis.  Mistaking  it  for  ulcerative 
stomatitis  may,  however,  occasionally  occur,  as  these  two  processes 
frequently  exist  together.  The  aphths,  however,  consist  of  an  in- 
flammation which  remains  localized  on  the  superficial  portion  of 
themucons  membrane  of  the  mouth  with  the  deposition  of  a  fibrinous 
exodate,  while  in  ulcerative  stomatitis,  necrosis  and  loss  of  sub- 
stance is  characteristic  of  the  disease,  because  we  have  to  deal  in 
the  latter  with  a  diffuse  parenchymatons  inflammation  followed  by 
an  ulcerative  necrosis.  Aphthous  stomatitis  is  exceedingly  painful; 
ulcerating  stomatitis  gives  the  patient  only  a  sensation  of  swelling 
and  pulsation.  From  sprue,  it  may  be  diatinguished  by  the  course 
of  the  disease  and  by  a  microscopical  examination.  In  Bechar's 
aphths,  the  seat  of  the  apbtbie  and  the  age  of  the  patient  will  lead 
us  to  avoid  mistakes. 

Prognosis  is  favorable  in  the  greater  number  of  cases.  It  may, 
however,  become  very,  very  grave  when  an  edema  of  the  glottis  is 
occasioned  by  the  formation  of  an  excessive  number  of  aphthEe  in 
the  posterior  portion  of  ihe  throat  and  in  the  confluent  epidemic 
form. 

Treatment, — Aphthous  stomatitis  being  an  infectious  disease,  iso- 
lation of  the  patient  is  of  the  greatest  importance  in  its  prophylactic 
treatment.  The  milk  should  always  be  boiled  or  sterilized.  The 
general  condition  of  the  child  should  be  carefully  looked  after. 
Local  or  general  disease  (for  example,  bronchitis,  gastroenteritis, 
eczema,  etc.)  should  at  once  be  combated,  for  the  greater  number 
of  cases  of  stomatitis  is  observed  in  these  cases.     The  hygiene  of 


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852       The  Atlanta  Mbdioal  and  Surgical  Jodenal. 

the  mouth  is  of  the  highest  importance,  as  without  doubt  various 
micro-organiBnis  will  be  formed  here  from  the  decomposition  of 
food  particles,  et«.  In  the  second  year  of  life,  and  during  the  pe- 
riod of  dentition  particularly,  the  hyj^iene  of  the  mouth  should  be 
observed  with  the  f^reatest  care,  as  the  children  at  this  time  are 
not  yet  able  to  masticate  thoroughly,  and  swallowing  of  all  food 
particles  are  not  perfectly  accomplished,  so  that  remnants  of  food 
frequently  remain  in  the  mouth.  In  (ever  patients  also  disintegra- 
■tion  of  the  food  occurs  more  rapidly.  In  these  cases  Vichy  water 
«r  the  following  has  a  very  good  eifect: 

a    Sodii  bicsrbon 30 

Sodii  borac ., 2.0 

AquK  deitill 100.0 

Uix. 

Antimycotic  remedies,  as  salicylic  acid,  benzoic  acid,  boric  acid, 
«tc.,  are  also  to  be  recommended.  Treatment  should  be  both  local 
and  general.  Locally  the  following  solutions  are  recommended, 
with  which  the  diseased  portion  may  be  painted  four  or  five  times 
a  day : 

B    Sodii  borax 4.0 

Tintt.  inyrrhK_ 8.1 

Sjr.  mororum.„ 60.0 


B     Borac_ 4.0 

Tinct.  benziM 2.0 

Aq.  dMtill 10.0 

Syr.  Bimpl 20.0 

or, 

B    Sodii  phosph 10.0 

Aq.  napbie., 26.0 

UelliRrouti 60,0 


B     C«Ic,  chlor 2.0 

HellU 20.0 


Potu.  cblor 8.0 

Aq.  dMtill „ 60.0 


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Bblections  and  Abstracts.  Jif).^ 

Baginsky  recommends  fiotaRsium  permanganate  (0.1  to  15.0), 
and  claimR  a  specific  action  for  it.     Hirtz  recommends 

K    Acid.  «alicvl.  2.0 

Alcohol....; 1O.0 

Gljcerin 20.0 

or, 

R     Sndii  BAlicyl 20.0 

Aq.  destill 100 

Most  coRes  will  yield  to  any  of  these  formnlse  or  heal  even  with- 
out treatment.  Again,  we  meet  with  those  which,  in  spile  of  early 
treatment,  present  a  grave  form  of  the  disease  as  early  as  the 
second  day. 

Levi,  from  the  observation  of  a  great  number  of  cases  of  stom- 
atitis, maintains  that  do  other  remedy  will  give  the  same  favorable 
results  that  chloric  potash  attains.  It  may  be  looked  upon  as  a 
specific.  Its  external  use  should  be  combined  with  Its  internal 
administration  to  obtain  the  very  host  results, 
Monti's  premier! ptiou  is  : 

R     PoUa.  ehlor, 4.0 

Aq.deetill. 200.0 

Tinct.  nijrrh*. .' 3.0 

M.    Sig. — FoT  wBshiDg  out  tho  mouth. 
and 

R     Potas,  cblor. 1.0 

Aq.  destill 90.0 

Sjr.  rubiida^i 10.0 

M.    Sig. — Keep  on  ice.     A  teaspoonrul  every  two  bmird. 

In  stubborn  and  severely  painful  cases  it  will  he  nece8.sary  to  use 
a  solution  of  salicylic  acid,  according  to  Hirtz,  or  of  corrosive 
sublimate. 

R     HydrarR.  bichlur.  corr 0.1 

Aq,  deatni 60.0 

M.     .Sig.— For  penciling  the  mouth. 

Should  this,  however,  fail,  or  should  the  aphthie  ytaas  into  an 
ulcerative  form,  a  superficial  cauterization  with  lapis  mitigatus  or 
Hulphalc  of  copper  must  be  resorted  to.  Where  pain  is  exceedingly 
great,  solutions  of  the  tincture  of  opium,  of  extract  of  opium  or  of 
cocain  may  bo  applied.  Only  cold  liquid  nourishment  should  he 
given,  and  this,  especially  in  cases  of  recurrent  aphthte,  which  are 
nearly  always  accompanied  by  a  state  of  irritation  of  the  gastro- 
intestinal mucous  membrane,  should  be  as  uulritious  as  possible. — 
Pediatries. 


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S54       The  Atlanta  Medical  and  Sdrqical  Journal. 
Family  History   in  Relation  to  Life  Insubance. 

The  age  at  death  of  parents  and  grandparents  is  important  as  in- 
dicating the  strength  or  weakness,  endnmuce  or  feebleness  of  consti- 
tution of  the  applicant,  and  his  probable  longevity.  It  is  an  ac- 
cepted maxim  that  long  life  runs  in  families,  and  that  an  inherited 
tendency  to  attain  old  age  is  the  primal  qualification  for  longevity. 
In  other  cases  the  opposite  tendency  is  shown,  and  often  every  in- 
dividual of  the  family  dies  before  reaching  middle  life.  It  is  no 
ezaggeralion  to  say  tliat  even  a  weak  and  pnny  child  of  a  long-lived 
race  is  more  apt  to  reach  three  score  and  ten  than  is  a  strong  and 
vigorous  child  of  a  short-lived  race. 

A  rough  and  ready  method  of  computing  an  applicant's  probable 
duration  of  life  consists  in  taking  the  sum  of  his  parents'  and  grand- 
parents' ages  at  death,  and  dividing  by  six.  The  quotient  indicates 
the  age  to  which  the  applicant  may  reasonably  expect  to  live;  the 
presumption  being  that  a  man  who  has  reached  maturity  in  good 
health  ought,  with  proper  care,  to  attain  the  average  age  of  his 
parents  and  grandparents.  This  method  serves  as  a  measure  of  his 
constitutional  vigor,  the  amount  of  capital  be  has  in  the  bank  of  life. 
For  example,  I  remember  once  examining  an  applicant,  the  sum  of 
whose  parents'  and  grandparents'  ages,  divided  by  six,  was  eighty- 
three  years;  while  the  man  himself  was  one  of  a  family  of  eleven 
children,  every  one  of  whom  was  then  living  and  in  good  health. 
Such  a  man  would  be  rated  as  a  desirable  risk  by  any  insurance 
company,  and  there  would  be  a  tendency  on  the  part  of  the  medical 
officers  to  overlook  any  minor  disabilities  or  unfavorable  circum- 
stances which  might  cause  the  rejection  of  an  applicant  of  less  favor- 
able  heredity. 

In  case  either  of  the  parents  or  grandparents  should  be  living 
and  in  good  health,  and  also  where  it  can  be  clearly  shown  that  the 
death  occurred  from  purely  accidental  causes,  not  in  any  way  in- 
dicating weakness  of  constitution,  it  may  be  safe  to  correct  the 
result,  adding  to  the  age  of  the  living  or  accidentally  dead,  the  ex- 
pectation of  life  for  the  given  age,  according  to  the  (able. 

The  age  of  brothers  and  sisters  is  also  imj)ortant,  and  further- 
more the  age  of  the  applicant's  children,  if  any — though  this  last 


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Selections  and  Abstracts.  355 

18  seldom  or  Dever  called  for  by  iasurance  blaoks — as  iudicating 
whether  the  vitality  of  the  earlier  geoeraliuiis  is  beiog  preserved, 
or  increased,  or  dioiiDiahed.  For  esainple,  if  the  average  age  of  the 
gniDdpareDtB  was  eighty,  aod  of  the  parents  sixty,  while  most  of  the 
applicaut's  brothers  and  sisters  died  youDg,  and  his  children  were 
feeble  or  died  in  infancy,  the  outJook  for  long  life  ou  his  part  would 
be  adjudged  far  less  favorable  than  would  be  the  case  if  op{)osite 
c3nditious  prevailed,  and  the  average  longevity  of  the  successive 
generations  was  increasing. 

The  cause  of  death  has  probably  had  more  importance  attached 
to  it  than  is  justly  its  due.  Especially  is  this  the  ease  when  the 
age  is  not  young.  In  any  case,  the  important  point  with  the  in- 
surance companies  is  not  what  particular  disease  the  insured  may  die 
of,  but  simply  that  they  may  live  out  their  expectation,  and  if 
possible,  go  on  beyond  that  to  a  green  old  age,  not  how  long  be 
may  be  sick  even,  but  how  long  he  will  live.  If  an  insured  {>ersfta 
reaches  seventy  years  of  age,  it  matters  little  whether  he  dies  of 
consumption,  or  pneumonia,  or  accident.  If,  however,  he  dies  be- 
fore forty,  his  death  is  presumably  due  to  a  lack  of  endurance,  vigor, 
and  vitality.  One  may  be  ill  and  suffer  many  years,  and  yet  have 
a  strong  constitution.  Indeed  it  is  the  strong  constitution  which 
enables  its  possessor  to  live  and  endure  suffering,  while  a  weaker 
person  would  die  at  the  6rst  severe  attack  of  disease. 

It  has  usually  been  assumed  that  there  is  an  especial  tendency 
on  the  part  of  the  child  to  die  from  the  same  disease  which  caused 
his  parent's  death,  in  coses  where  this  disease  was  of  the  class  kuowo 
as  hereditary.  Modern  researches  have  proved  conclusively,  how- 
ever, that  it  is  not  so  much  diseases  as  tendencies  that  are  inherited, 
and  that  the  tendency  is  not  always  to  a  particular  disease,  but  may 
oonsist  in  a  weakness  of  certain  organs  or  systems,  which  constitute 
an  increased  liability  to  certain  great  classes  of  disease.  Especially 
they  have  shown,  in  the  case  of  consumption,  that  the  child  of  con- 
sumptive parents  does  not  so  much  inherit  tuberculosis,  or  even  an 
especial  tendeucy  thereto,  as  he  does  a  weakened  constitution,  a 
lack  of  resisting  power,  which  makes  him  an  easy  prey  to  auy  form 
of  wasting  disease — the  s|)ecial  form  which  it  will  take  in  his  case, 
or  whether,  indeed,  he  may  eBca]>e  entirely,  to  be  determined  by  his 


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356       TuE  Atlanta  Medical  and  Surgical  Journal. 

particular  aurrouDtlinga  and  habits  of  life — iu  short,  by  bis  eaviroa- 
meDt.  Furtliernaore,  the  present  tendeDcy  is  to  look  upoo  many 
of  the  cases  of  coosumptiou  which  were  formerly  regarded  as 
hereditary,  as  the  result  of  contagion.  There  is  a  wide  field  for 
research  in  this  direction. 

Again,  the  liability  to  alcoholic  or  narcotic  inebriety  may  be  the 
result,  not  merely  of  the  like  inebriety  in  the  parent  or  graDd[Htrent, 
but  of  epilepsy,  hysteria,  ucurasthenia,  melancholia,  insanity  or  any 
form  of  nervous  instability.  There  is,  indeed,  a  system  of  reci> 
procity  between  the  principal  forms  of  hereditary  disease,  whereby 
each  may  result  from  the  other,  under  certain  conditions.  The 
great  essential  in  family  history  from  an  insurance  point  of  view, 
is  that  the  applicant  should  have  inherited  a  good  degree  of  con- 
stitutional vigor.  Euvironmeot  tells  the  rest. — Dr.  J.  M.  French, 
in  Medial  Examiner. 


Yellow  Feveh  and  the  War, 
The  report  published  last  week  that  yellow  fever  had  developed 
in  members  of  a  prize  crew  on  one  of  the  captured  Spanish  vessels 
held  at  Key  West  naturally  caui^s  !!ome  apprehension  at  this  par- 
ticular time.  "Yellow  Jack,"  always  a  most  unwelcome  guest, 
would  be  especially  so  now,  despite  the  excellent  tacilities  at  the 
command  of  the  Marine  Hospital  Service  for  preveutingor  stamp- 
ing out  an  epidemic.  The  great  importance,  however,  to  the  United 
States  of  the  yellow  fever  question  lies  in  the  fact  that  there  will 
probably  be  an  invasion  by  our  troops  of  territory  in  which  the 
fever  prevails  each  year  with  considerable  virulence.  It  will  be 
well  for  us,  therefore,  to  learn  our  lesson  from  past  rather  than  from 
present  and  future  experience.  We  must  not  foi^t  that  armies 
have  been  decimated  in  the  West  Indies  without  a  man  being  lost 
at  the  hands  of  a  human  enemy.  A  century  ago,  according  t« 
Johu  Hunter,  who  wasa  surgeon  iu  the  English  army  in  Jamaica, 
scarcely  a  man  was  left  iu  some  regiments  at  the  end  of  a  year, 
although  the  number  killed  in  battle  was  almost  nothing. 

All  authorities  agree  upon  this  point:  that  it  is  the  newcomer, 
and  especially  the  unacclimated  soldier,  who  suffers  to  the  greatest' 
extent.     The  ravages  of  former  times  among  European  troops  are 


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Selections  and  Abstracts.  357 

hardly  to  be  anticipated  in  an  Americau  army  of  invasion,  because 
we  now  know  that  hygienic  conditions  which  military  authorities 
can  control  have  much  to  do  with  keeping  down  the  dcath-rale. 
Our  soldiers  would,  for  example,  not  be  landed  in  an  impaired  state 
of  health  after  long  voyages  in  overcrowded  vessels.  The  food 
supply  would  be  much  superior  to  that  of  former  days,  and  quar- 
ters would  be  so  fur  as  possible  chosen  at  a  distance  from  swanip.t, 
while  the  water  supply  would  be  much  more  carefully  controlled. 
Overcrowding  aud  lack  of  sufiicient  air  space  have  been  imiiortuut 
causes  of  the  high  death-rate  in  barrack  and  hospital  informer 
West  Indian  campaigns — conditions  not  now  so  likely  to  exist, 
since  tbeir  danger  is  so  well  appreciated. 

Id  spite,  however,  of  all  that  is  known  of  the  dangers  of  yellow 
fever  and  of  the  means  of  prophylaxis,  many  deaths  might  occur 
among  our  men  from  a  lack  of  knowledge  of  proper  [lersonal  con- 
duct under  the  new  conditions  of  life.  It  would  be  well,  then,  that 
each  man  should  receive  instruction  as  to  his  mode  of  living.  '  In 
a  little  book,  just  published  in  London,  on  "  Yellow  Fever  in  the 
West  Indies,"  the  author,  Dr.  I/ett  Anderson,  states  that  after  an 
experience  of  more  than  thirty  years  he  can  say  that  undue  expo- 
sure to  the  sun  in  the  heat  of  the  day  is  the  most  potent  exciting 
cause,  aud  next  to  this  are  intemj>erance  and  debauchery. 

Earth  freshly  upturned,  as  in  the  diggingof  trenches,  is  a  source 
of  danger  which  it  might  at  times  be  imposiilble  to  guard  against. 
Past  experience,  however,  should  guide  in  sending  troops  into  a 
yellow  fever  region  to  engage  in  such  work,  since  it  has  been  found 
that  the  most  susceptible  subjects  come  from  the  more  northerly 
and  colder  regions,  while  colored-ski nued  races  arc  but  slightly 
endangered.  Then,  too,  those  who  have  acquired  immunity  by 
previous  exposure  should  be  first  utilized. 

We  cannot  here  enter  into  the  importance  of  an  early  diagnosis 
of  the  first  case  in  a  community,  or  of  the  difficulties  at  times  at- 
tending the  detection  of  the  affection  by  physieiuus  who  have  had 
no  practical  experience  with  the  fever.  The  author  above  referred 
to  dwells  especially  upon  the  dangers  of  faulty  diagnosis — in  in- 
stances in  which  the  disease  is  seen  for  the  first  time  by  the  phy- 
sician— in  the  stage  of  depression  or  decline  of  the  fever,  when  the 


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3&8       The  Atlanta  Medical  and  Surgical  Journal. 

symptoms  may  be  limited  almost  to  cutaneous  capillary  hyperemia 
and  conjunctival  injection,  und  when  the  patient  expresses  himself 
as  feeling  well  again.  The  treatment  be  recommends  embraces  an 
attempt  at  abortion  of  the  process  by  administering  twenty  grains 
of  calomel,  together  with  twenty  or  more  grains  of  quinine,  and 
repeating  the  dose  if  necessary  at  an  interval  ol'  three  or  four 
hours;  and  if  the  lever  remains  high,  even  a  third  duse  may  be 
given.  This  must  be  employed  early  in  the  first  stage,  and  is  par- 
ticularly suited  to  sthenic  cases  in  plethoric  soldiers,  especially  those 
who  have  recently  arrived  in  the  infected  region. 

Asa  routine  treatment  he  has  employed  for  many  years  : 

Aeidi  carbolici gr,  xviij. 

PutMsii  bicarbonatis „  3  iij. 

Aqum I   lij. 

Of  this  two  ounces  are  to  be  given  well  iced  every  two  or  three 
hours,  a  dessertspoonful  of  freshly  squeezed  lime  juiee  being  added 
to  the  effervescing  mixture  at  the  time  of  taking. 

Among  other  measures  recommended  are  wet  packs  to  the  body; 
"iced  drip"  to  the  head;  dry  cupping  to  prevent  or  relieve  sup- 
pression, together  with  drachm  doses  of  spirits  of  nitrous  ether 
every  hour;  and  bromide  of  ammonium  in  full  dose  given  in  iced 
milk  for  insomnia.  He  speaks  favorably,  too,  of  Sternbei^'s 
formula : 

Hydrargyri  bichloridi -  gr.  i 

Sifdii  bicurbvrialU (cr.  cl. 

AqiiiO 5     xl. 

S.    Tlireo  tab'espoonfuU  given  uvery  hour,  givan  ice-cod. 

It  is  gratifying  to  note  that  the  government  is  taking  must  active 
measures  to  sulve  this  great  war  problem,  and  that  an  officer  of  the 
Marine  Hospital  Service  has  been  detailed  to  accompany  the  army 
of  invasion,  whose  special  duty  it  shall  be  to  secure  for  our  sol- 
diers all  the  protection  possible  from  this  hidden  enemy.  Among 
the  measures  to  be  carried  out  are  the  establishment  of  a  base  of 
supplies  at  a  distance  from  any  yellow  fever  center,  and  prevention 
of  communication  between  the  army  and  infected  localities. 

The  latter  will  naturally  be  a  most  difBcult  thing  to  accomplish. 
The  only  absolute  safety  would  seem  to  lie  in  terminating  the  war 
in  Cuba  before  June,  when  the  annually  recurriug  epidemic  in  and 
about  Havana  makes  its  appearance,  or  in  sofar  accomplishing  this 


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Selections  and  Abstracts.  B59 

end  that  the  native  army,  assisted  by  immunes,  could  complete  the 
work  and  permit  susceptible  northern  troops  to  return  to  the  States. 

We  have  the  atmost  confidence  in  the  ability  of  our  Marine 
Hospital  Service  to  accomplish,  by  vigilance  and  scientific  sanita- 
tion, all  that  it  is  possible  to  do  in  the  matter  of  detecting  early 
evidences  of  danger  and  carrying  out  segregation.  A  disease,  how- 
ever, which  presents  such  an  appalling  mortality  in  severe  epidem- 
ics and  under  certain  condtions  should  likewise  be  regarded  as  an 
enemy  to  be  combated  until  conquered.  No  doubt  this  will  be 
one  of  the  results  of  the  present  warfare,  for  it  may  be  predicted 
that  with  Havana  under  United  States  control  the  unwholesome 
conditions  which  have  permitted  this  yearly  visitation  of  yellow 
fever  will  be  done  away  with  and  the  city  made  as  safe  from  June 
to  November  as  it  is  (rom  November  to  June. 

It  has  been  pointed  out  by  authorities,  and  former  experience  in 
our  own  country  has  shown  it  to  be  a  fact,  that  old  wharves 
with  their  rotting  timbers,  unpaved  streets,  collections  of  decaying 
vegetable  matter,  and  lack  of  proper  sewerage,  all  contribute  to 
epidemic  oulbreak.  Such  sanitary  defects  are  abundant  in  Cuba's 
capital,  and  it  will  become  our  duty  at  no  dislnnt  day  to  fortify  the 
city  by  modern  hygienic  improvements  tor  the  benefit  of  humanity 
at  large. — Gaillard'a  Med.  Journal. 


Proceedings  op  the  St.  Lodis  Medical  R(h;iety. 

M feting    of    Saturday    Evening,    February    5,    1898. — President 

Dr.  J.  C.  Mtdhall  in  the  Chair. 

Dr.  Keating  Bauduy  read  a  paper  entitled  "Observations  on  the 
Treatment  of  Some  Oases  "f  Neurasthenia,"  written  by  Jerome 
K.  Bouduy.  The  doctor  also  read  a  paper  giving  "Microscopical 
Report,"  by  Ur.  0.  Fisch,  Also  "Clinical  Report,"  by  himself. 
(See  Review  of  February  2G,  1898,  page  146.) 
discussion. 

Dr.  tkoffd. — I  would  like  to  ask  Dr.  Bauduy  whether  he  does 
not  tliink  the  dicllng  ol  jmiients  and  placing  them  in  hygienic 
surroundings  had  not  as  much  to  do  wiili  the  results  a.»  his  medi- 
cine. 

Dr.  Fairbrother.^I  would  like  to  ask  another  question:  I(  tliJs 
"Pcpto-Mangan  "  is  not  in  the  class  of  proprietary  medicines? 

Dr.  Keating  Bauduy. — I  will  endeavor  to  respond  to  the  ques- 
tions propounded.  Dr.  StofTel  wants  to  know  if  the  dietetic  and 
hygienic  measures  alone  being  adopted  would  not  have  efFecferi  a 
cure  in  the  cases  reported.     I  will  state  that  in  many  of  these  cases 


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■  ;^60       The  Atlanta  Medical  and  Surgical  JoiTRUAt. 

we  have  tried  other  preparations  of  iroo  and  with  rather  negative 
results;  and  in  all  these  cases  we  have  observed  hygienic  and  dietetic 
indications  without  obtaining  these  remarkable  improvements. 
Now  I  do  not  wish  to  be  understood  that  this  remedy  is  a  panacea; 
I  merely  give  you  the  data  and  clinical  facts,  and  the  results  of  the 
microscopic  investigation,  and  you  can  take  them  for  what  yon 
believe  them  to  be  worth, 

I  will  answer  Dr.  Fairbrother  by  saying  that  I  presume  that  this 
is  a  proprietary  remedy,  but  I  use  a  good  many  other  proprietary 
preparations.  I  nse  antipyrine,  and  I  supiwse  the  doctor  does;  I 
use  phenacetine,  snlfonal,  and  other  such  proprietary  remedies,  and 
I  will  tell  you  candidly,  gentlemen,  that  I  use  whatever  I  find 
benefits  my  patients.  Of  course  I  do  not  propose  to  use  nostrums 
or  remedies  of  which  we  know  nothing  about  their  composition. 
But  the  Gude  preparation  of  iron  does  not  belong  to  this  class;  a 
great  many  gentlemen  here  nee  it;  I  use  it  because  it  is  the  best 
remedy  that  I  have  obtained  for  the  treatment  of  these  cases. 

Dr.  Joknuton. — There  is  no  iron  in  it,  is  there,  doctor? 

Dr.  Kealinfj  Bauduy. — Yes,  sir,  there  is  iron  in  it;  in  the  form 
of  a  peptonate  of  iron. 

Dr.  Jerome  K.  Bauduy. — One  salient  feature  of  this  paper  which 
lias  not  been  brought  out  as  prominently  as  it  might  have  been,  on 
which  I  wish  to  lay  particular  emphasis,  is  that  whether  it  be  a 
proprietary  remedy  or  not,  matters  not  provided  it  cures  our 
patients.  It  is  our  business  to  cure  our  patients,  it  matters  not  by 
what  means.  But  the  point  is  this,  that  Jt  is  my  opinion,  based 
u|)on  observation  in  these  cases,  that  we  have  not  paid  sufficient 
Httention  to  the  ori/owtc  salts  of  iron;  in  other  words,  that  the 
other  preparations  of  iron  do  not  produce  the  results  that  these 
organic  preparations  achieve.  For  years  the  combination  of  iron 
and  manganese  I  have  used  in  daily  practice.  I  have  used  a  great 
many  of  these  prejtarations  and  the  great  point  has  been  to  obtain 
one  which  is  assimilable,  that  is  elegant,  and  that  will  not  produce 
anorexia  and  other  gastric  disturbances.  Now  with  the  organic 
salts  of  iron  we  have  had  startling  results,  and  I  intend  to  use 
them  as  long  as  they  benefit  my  patients,  I  do  not  wish  to  be 
undcrstooil  by  the  neurologists  and  others  present  aa  saying  that 
this  is  a  proper  remedy  for  all  cases  of  neurasthenia,  but  I  do  main- 
tain that  it  is  a  remedy  well  suited  to  those  neurasthenic  and 
anemic  cases  described,  especially  in  women  suffering  with  men- 
etrual  irregularities,  cs]>ecially  those  accompanied  by  hemorrhage. 
I  simjtly  want  the  gentlemen  to  judge  by  the  results.  "Facts 
speak  louder  than  words."  "Facta  non  verba." — Medical  Hericw, 
March  12,  18118, 


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ATLANTA 

Medical  and  Surgical  Journal. 


Vol.  XV. 

AUGUST, 

1898. 

Wo.  6. 

L.  B.  GRANDY 
DUNBAR  ROY, 

M.D 
M.D. 

} 

„™, 

H 

B. 

Bn 

HUTCHINS 

M.D., 

ORIGINAL  COMMUNICATIONS. 


SOME  RECENT  SURGICAL  WORK.* 

1.   NEPHRO-LITHOTOMY.       2.    HIP-JOINT    AMPUTATION    FOB    SAR- 
COMA.     3.   CRANIECTOMY.      4.   IMPACTED   CALCDLtJS. 

By  hunter  p.  COOPER,  M.D.,  Atlanta.  Qa., 

ProfMSor  Anatomy  and  Clinical  Surgery,  Atlanta  Collfge  of  Pbyeiciane  and 

Sui^eons. 

The  cases  which  I  wish  to  report  have  been  operated  on  either 
ia  my  hospital  service  or  in  the  Elkin-Cooper  Sanatorium,  and  are 
reported  because  they  are  deemed  of  sufficient  interest  to  bring  to 
the  attention  of  the  members  of  this  Association. 

The  first  case  is  one  of  nephro- lithotomy.  In  brief,  the  history 
of  the  case  is  as  follows: 

Dr.  M.,  aged  thirty-eight,  physician,  bad  suffered  with  attacks 
of  sharp  pain  in  the  right  side  throughout  bit)  life.  These  attacks 
varied  very  greatly  in  frequency  aad  severity.  The  pain  was  al- 
ways referred  to  the  right  side,  between  the  crest  of  the  ilium  and 
the  twelfth  rib.  During  such  attacks  the  urine  always  became 
•tm^  M.  (be  taM  auQuaJ  DweUnc  o(  Uie  OeorglK  Hedlol  A 


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362       The  Atlanta  Medical  and  Surgical  Journal. 

bloody.  In  the  last  ten  years  pains  have  been  amch  more  acut«^ 
altbougli  between  attacks  he  still  remained  free  from  pain.  Two 
years  ago  he  noticed  pus  in  the  urine.  This  soon  became  constaat, 
and  was  present  in  large  quantities.  Iq  November  last  he  went  to- 
New  York  and  was  operated  on  by  Dr.  Wyeth.  He  entered  the 
kidney  on  its  posterior  surface  and  let  out  a  large  quantity  of  pua 
accumulated  in  the  pelvis  of  the  organ.  Thorough  drainage  was 
established  and  the  patient  soon  returned  to  his  home  in  South 
Georgia.  His  pains,  however,  were  never  relieved  to  any  extent 
l}y  the  operation,  and  when  he  was  admitted  to  our  sanatorium  on 
January  19th  of  this  year  he  was  a  pitiable  object.  His  suffering 
was  almost  constant.  An  exploration  of  the  kidney  was  advised, 
with  the  idea  of  removing  the  organ,  if  possible ;  and  if  not  possi- 
ble, to  establi»:h  a  freer  drainage  of  the  abscess  cavity.  On  Janu- 
ary 2lst  he  was  anesthetized  and  a  crucial  incision  made  in  the 
lumbar  region,  Dr.  Elkin  being  present  and  rendering  me  valuable 
aid  and  counsel.  The  vertical  limb  of  the  incision  extended  from 
the  twelfth  rib  to  the  crest  of  the  ilium,  the,  horizontal  limb  from 
the  transverse  vertebral  processes  forward  about  nine  inches.  This 
extensive  incision  was  necessary  on  account  of  the  patient  being  a 
very  stout  man.  The  incision  was  deepened  uutil  I  came  in  con- 
tact with  the  kidney.  A  small  opening  was  found  on  its  posterior 
surface,  which  I  cut,  letting  out  a  considerable  amount  of  pus.  The 
finger  was  then  introduced  into  the  enlarged  pelvis  of  the  kidney, 
and  on  careful  examination  a  calculus  was  discovered  lodged  in  the 
substance  of  the  kidney  aud  presenting  in  the  cavity.  This  was 
shelled  out,  and  found  to  be  a  large  conical  calculus  nearly  an  inch 
in  its  longest  diameter,  and  having  somewhat  the  shape  of  an  In- 
dian arrow-head.  No  other  calculus  being  discovered,  and  tihe 
kidney  appearing  sound  enough  to  remain  behind,  it  was  decided 
to  leave  it.  The  future  history  of  the  case  was  very  satisfactory. 
The  highest  temperature  recorded  was  100|,  There  still  remains 
a  fistulous  opening  in  the  lumbar  region,  through  which  urine  and 
some  pus  are  |>assed. 

Case  2.  Amputation  at  the  Hip-joint  for  Osteosarcoma  of  the 
Femur. — Especial  interest  in  this  case  is  due  to  the  fact  of  a  sar- 
coma rapidly  following  a  traumatism. 


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Some  Recent  Surgical  "Work.  363 

Mr.  R.,  aged  thirty,  was  admitted  to  the  Elkin-Cooper  Sanato- 
riara  December  10,1897.  On  November  14tli  hie  left  leg  wan 
crushed  by  a  wheel  of  a  railroad  train,  neoessitatiDg  amputation 
above  the  knee.  The  operation  was  done  in  the  town  where  the 
accident  occurred.  Infection  followed  the  operation,  and  septice- 
mia resulted.  When  he  was  brought  to  the  sanatorium  his  temper- 
ature ranged  from  102  to  104,  pulse  from  120  to  136,  and  he  was 
very  weak  and  emaciated.  The  stump  was  unhealed,  the  end  of 
the  bone  protruding  an  inch  beyond  the  flaps.  The  abscess  ex- 
tended from  the  very  end  of  the  stump  to  within  three  inches  of 
Poupart's  ligament.  He  was  anesthetized  and  the  abscess  opened 
fully  by  an  eight-inch  incision  on  December  13th.  A  few  days 
later  the  end  of  the  bone  was  removed  and  the  granulations  cu- 
retted. His  general  condition  improved  rapidly  for  a  while,  but  it 
was  soon  noticed  that  large  kuob-like  masses  were  rapidly  forming 
around  the  end  of  the  bone.  These  grew  with  great  rapidity. 
One  of  these  was  cut  off  and  examined  microscopically  by  Dr. 
Bourns,  professor  of  pathology  in  the  Southern  Medical  College. 
He  reported  it  to  be  a  large-celled  sarcoma.  Amputation  at  the 
hip-joint  was  thereupon  advised,  and  consented  to.  It  was  done 
January  18th,  Wyeth's  bloodless  method  being  used.  Two  large 
drainage-tubes  were  inserted,  and  the  patient  recovered  without 
any  difficulty.  Tiie  highest  temperature  recorded  subsequent  to 
the  operation  was  100|,  the  temperature  ranging  most  of  the  time 
between  98|  ane  99J.  He  was  discharged  on  February  23d,  the 
wound  being  entirely  healed,  except  where  the  drainage-tubes  were 
brought  out.  I  have  seen  him  very  recently;  he  is  in  perfect 
health  and  has  gained  very  greatly  in  weight.  Throughout  the 
opemtioo  and  treatment  of  the  case  I  was  assisted  by  my  associate, 
Dr.  Elkin. 

Case  3.  Craniectomy  for  the  Relief  of  ImhedUty. — H.  W.,  white, 
seven  years  old,  was  admitted  to  my  service  in  the  Grady  Hospital 
on  the  7th  of  December,  with  the  following  family  and  personal 
history : 

Mother  has  three  living  children,  four  dead,  and  has  had  two 
miscarriages.  Two  of  the  living  children  are  well  and  healthy. 
The  four  died  from  the  following  causes:  First,  premature  labor, 


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364       The  Atlanta  Mbdical  and  Surgical  Journal. 

seveo  moDtbs ;  eecood,  malautritioo,  aged  five  montbe;  third,  mal- 
nutrition, aged  two  montbe;  fourtb,cauBe  unknown,  aged  six  montbe. 
Tbe^  were  all  bright  mentally,  but  never  grew  physically.  The 
mother  has  a  Eecond-couain  who  is  an  imbecile. 

Poet  History. — When  patient  was  born  mother  was  in  labor  forty- 
eight  hours.  Labor  was  severe.  Baby  weighed  twelve  pounds. 
The  child's  bead  showed  signs  of  bruises,  and  there  existed  for  sev- 
eral days  a  large  area  of  eztravasated  blood  over  the  occiput  and 
one  side  of  the  head.  After  nine  days  the  head  had  regained  its 
normal  shape,  and  was  said  to  be  a  very  finely-shaped  head.  On 
the  ninth  day  and  seven  succeeding  days  patient  had  convulsions, 
one  to  three  a  day ;  these  were  accompanied  by  high  fever.  During 
these  convulsions  the  frontal  suture  enlarged.  Following  this,  the 
Sagittal  and  lambdoid  also  opened,  and  at  the  fontanelles  the  mem- 
branes bulged  out.  The  spasms  were  clonic,  affectiug  all  the  mus- 
cles of  the  body,  but  seemed  to  be  worse  on  the  left  side.  Child 
very  stupid  for  next  three  weeks.  After  this,  child's  head  gradu- 
ally returned  to  normal  shape;  child  brightened  and  nursed;  be- 
came well  nourished;  walked  at  sixteen  months.  When  sittiag, 
head  had  a  tendency  to  fall  forward  on  chest.  When  the  head  was 
reduced  in  size  the  bones  of  the  right  side  overlapped  those  of  the 
left.  The  two  troubles  just  mentioned  were  all  that  bothered  the 
patient  at  eighteen  months.  At  this  time  s'he  bad  a  chill,  followed 
by  another  in  a  few  hours.  The  last  one  was  followed  by  a  con- 
gestion of  the  brain.  Patient  had  severe  spasms  and  loss  of  con- 
sciousness, lasting  twenty-four  hours.  Typhoid  fever  followed,  as 
diagnosed  by  family  physician,  lasting  seven  weeks.  Afterwards 
|>atient  did  not  walk  for  one  year,  and  did  not  talk  for  two.  She 
was  a  bright,  intelligent  child  at  eighteen  months,  when  last  trouble 
came  on.     Development  has  been  slow  since  then. 

Present  Hittory. — Patient  is  an  imbecile.  Sentences  consist  of 
only  two  or  three  words.  Makes  her  wants  known  without  much 
trouble.  Paresis  and  atrophy  on  left  side;  left  leg  drags  when 
walking.  Head  is  very  small  and  very  narrow  from  side  to  side, 
especially  in  frontal  and  parietal  regions.  Child  is  self-willed,  ir- 
ritable, nervous,  and  suffers  from  insomnia.  Subject  to  fits  of  ud- 
coDtrollable  rage  and  utterly  devoid  of  reason. 


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Some  Reobnt  Surqical  Work.  365 

On  AdmiaHon. — ToDgue  fairly  clean.  Appetite  fair.  Bowels 
regular.     Pulse  100-     Temperature  98. 

DiagnosU. — Imbecility.  lotra-craDial  space  too  small  to  permit 
brain  developmeut. 

Operation. — Crftoiectomy  advised.  Mother  coasented.  On  the 
dth  of  December  patient  was  prepared  ia  the  usual  maaner,  and  oa 
the  10th  I  made  the  operation,  making  an  incision  beginning  at 
bair  margin  in  Tront,  about  half  an  inch  to  right  of  sagittal  suture, 
and  carrying  it  back  to  the  lambdoid  suture.  Incision  slightly 
curved.  The  Rap  was  turned  back  ;  also  the  pericranium.  I  next 
trephined  the  skull,  and  with  the  cutting  forceps  removed  the  bone 
forward  for  two  and  one-half  inches  and  backward  for  about  two 
inches,  and  then  to  the  side  for  about  one  and  one-half  inches. 
The  space  between  the  two  edges  of  the  bone  is  about  au  inch  wide. 
Alt  hemorr.iage  was  stopped,  there  being  very  little.  Wound  was 
slightly  packed  with  iodoform  gauze  and  sutured.  Usual  dressing 
applied.  Dressed  first  on  the  third  day;  wound  in  good  condition. 
Stitches  removed  on  the  tenth  day;  union  perfect,  except  space  left 
for  drainage.  Patient  now  made  an  uninterrupted  recovery.  Bow- 
els kept  open  with  oil.  Action  caused  on  the  fourth  day  after  op- 
eration. Mother  noticed  some  change  for  the  better  in  the  child 
at  once.  Patient  was  discharged  on  the  28th  of  December.  Great 
improvement  in  tbe  mental  racultice  followed  the  operation.  She 
became  obedient,  had  no  more  fits  of  rage,  talked  much  better  and 
seemed  like  a  different  creature. 

By  my  advice  patient  returned  in  May  of  this  year  to  have  a 
similar  operation  performed  on  the  opposite  side  of  the  head.  It 
was  done  in  the  same  manner  as  before,  and  healing  took  place  by 
first  intention  throughout.  Patient's  mental  condition  has  been 
wonderfully  improved  by  the  two  operations,  and  I  have  no  doubt 
will  continue  to  improve  for  some  time  to  come. 

Case  4.  Slant  Impacted  in  Membranous  Urethra. — W.  R.  J.; 
child;  four  years  old.  Was  admitted  to  my  service  in  Grady 
Hospital  on  tbe  14th  of  December,  1897,  with  the  following  fam- 
ily and  personal  history. 

PaH  History. — Seven  months  ago  it  was  noticed  that  the  patient 
became  very  fretful  when   he  wanted   to   urinate,  and   seemed  to 


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366       Thb  Atlanta  Medical  ahd  Sckqical  Journal. 

suffer  very  much  duriog  the  act.  It  was  ooticed  that  the  urine 
came  very  slowly,  and  iu  &  very  small  stream.  He  gradually 
grew  worse,  urinated  more  frequently,  and  had  much  pain  each 
time.  Stream  grew  smaller,  and  for  the  last  four  luooths  the  uriu« 
has  just  beeu  dribbliug.     Passed  no  calculi  or  blood. 

Present  Condition. — Fatieut  has  suffered  from  retention  of  urine 
for  thirty-six  hours.  A  little  urine  was  passed  involuntarily  on 
the  train — very  little,  however.  The  bladder  reached  to  the  um- 
bilicus, aud  as  no  instrument  could  be  passed  into  the  bladder,  pa- 
tient waa  aspirated  and  a  large  quantity  drawn  off.  With  the  steel 
instrumect  a  calculus  could  be  lelt  in  the  membranous  urethra, 
very  near  the  prostate  gland. 

Diagnoaie. — Impacted  atone  iu  deep  urethra.  Operation  advised 
and  consented  to  by  lather. 

Optralion. — On  the  morniugof  December  14th,  just  after  pa- 
tient came  in,  he  was  prepared  for  operation,  anesthetized  and 
placed  on  the  table.  I  made  a  suprapubic  cystotomy,  and  then  a 
perineal  section,  the  stone,  which  was  the  size  of  a  small  bean, 
being  removed  by  the  latter  operation.  There  were  no  calculi  in 
the  bladder.  A  small  catheter  was  passed  into  the  bladder  through 
the  perineal  wound  and  fastened  for  drainage.  I  irrigated  the 
bladder  with  a  boric  solution,  then  caught  up  the  bladder  and 
fastened  it  on  either  side  with  a  suture  to  the  akin,  put  in  a  strip 
of  iodoform  gauze,  and  then  dressed  both  wounds  in  the  usual 
manner. 

Afler  Treatment. — The  bladder  was  irrigated  daily  with  boric  so- 
lution and  fresh  dressings  applied  each  time.  On  the  fifth  and 
sixth  days  after  the  operation  temperature  went  up,  but  came  down 
to  normal  immediately.  Bowels  moved  on  third  day.  Sutures 
and  drainage-tube  removed  on  the  seventh  day.  Wound  in  good 
condition.  Patient  made  a  good  recovery  and  was  discharged  on 
the  11th  day  of  January,  1898. 


AccoRDiKG  to  the  Medical  Summary  (  Western  Medical  Reviea, 
June  15th),  the  injection  of  a  glass  syringeful  of  lemon  juice  into 
the  nose,  after  it  has  been  cleaned  of  clots,  will  stop  bleeding  after 
everything  else  has  failed. 


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Cleft  Palate. 


THE   CONDITIONS    OF   IMPERFECT   DEVELOPMENT 

OF  THE  SEPTUM  BETWEEN  THE  MOUTH  AND 

NASO-PHARYNX,  USUALLY  TERMED 

CLEFT  PALATE.* 

By  U.  F.  CAKS0>',  M.D., 
Gkiffin,  Ga. 

la  order  to  place  their  treatment  on  a  more  scieutific  basis,  I  will 
first  consider  the  physiology  of  the  nose,  which  means  a  considera- 
tion of  the  mechanical  factors  that  determine  the  form  and  devel- 
opment of  the  nasal  cavities  of  the  upper  portion  of  the  pharynx, 
usually  described  together  as  the  "  naso-pharynx."  We  shall  then 
be  better  able  to  formulate  general  principles  on  which  our  meth- 
ods of  treatment  may  be  most  advantageously  based. 

The  principal  function  of  tbe  naso-pharynx  is  to  transmit  air 
into  tbe  lungs,  in  order  that  the  sensitive  surface  of  its  mucous 
covering  may  become  afleetcd  by  substances  contained  in  it.  In  short, 
this  part  of  the  body  is  constructed  essentially  for  the  purpose  of 
smell,  and  in  the  different  groups  of  animals  the  degree  of  its  de- 
velopment varies  with  the  importance  of  the  sense  of  smell  to  them. 
The  olfactory  nerve  is  distributed  to  the  upper  portion  of  the  nasal 
cavities,  and  the  current  of  air  is  distributed  esi>ecially  over  this 
area  by  the  act  of  sniffing.  During  natural  respiration  the  mouth 
is  kept  closed,  the  upper  lip  covering  the  upper  incisor  teeth  en- 
tirely. During  normal  respiration  the  air  passes  mainly  through 
the  lower  meatus,  while  there  is  practically  no  current  in  the  upper 
portion  of  the  cavity. 

It  is  therefore  very  obvious  that  any  obstruction  sufficient  to 
interfere  with  the  caliber  of  the  lower  nasal  cavities  will  eventually 
impair  their  capacity  for  performing  the  functions  for  which  they 
are  intended — namely,  the  transmission  of  air;  and  as  a  direct 
result  the  patieut  breathes  through  the  moutb.  When  this  is  done 
air  enters  so  freely  through  the  larger  and  more  direct  channel 
formed  by  the  mouth  that  it  ceases  to  pass  through  the  nose.  Th« 
Baad  M  (b«  lut  aoanal  msetlDK  of  tbe  OeorjilA  Medical  AnoclMloD. 


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368       Tbe  Atlanta  Medical  and  Sdrhical  Jourmal. 

most  importaat  fuoctioD  of  the  part  is  lost,  and  the  forces  which 
act  upoD  it  normally  to  develop  it  are  in  abeyance.  After  air  ha& 
eatirely  ceased  to  pase  through  the  nose  in  respiration,  it  doe^  so 
during  the  expiratory  proceee  of  vocalization  to  a  email  degree. 
The  so-called  nasal  intonation  does  not  develop  as  early  as  one 
would  imagine  in  association  with  so  much  loss  of  nasal  inspira- 
tion. 

It  is  at  once  visible  from  an  examination  of  a  vertical  section 
through  the  nasal  cavities  that  the  caliber  of  the  lower  part  of  the 
cavities,  or  of  their  respiratory  section,  is  enormously  encroached 
upon  by  any  ascent  of  the  hard  palate  above  its  normal  line,  and 
that  the  air-transmitting  capacity  of  the  naso-pharynx  varies  in- 
versely to  the  height  of  the  palate.  We  also  see  that  the  caliber 
of  the  entire  nasal  space  is  very  much  affected  by  the  slightest  va- 
riation in  the  interval  between  the  septum  and  the  structures  form- 
ing the  outer  "wall  of  the  epace.  We  all  know  how  exceedingly 
common  are  these  cases  of  imperfect  development  of  the  nasal 
cavity.  I  believe  that  if  we  exclude  those  diseases  of  the  nose, 
ear,  larynx,  and  even  luugs,  which  ate  either  directly  or  indirectly 
consequent  upon  some  imperfect  development  of  the  naso-pharynx, 
a  not  unimportant  portion  of  the  consideration  and  treatment  of 
disease  of  these  parts  would  have  to  be  taken  from  books  on  this 
subject.  It  is  essential,  therefore,  that  we  carefully  consider  the 
factors  which  are  responsible  for  such  imperfect  development,  in 
order  that  we  may  save  our  patients  from  numerous  complications 
which  may  not  at  first  sight  seem  directly  dependent  upon  it.  I 
believe  that  such  poorly  developed  conditions  result  mainly  from 
the  fact  that  for  some  reason  the  mechanical  factors  that  aid  in  the 
development  of  the  naso-pharynx  are  removed,  and  as  a  result  this 
space  does  not  develop  as  it  should.  We  should  not  forget  the 
&ct,  however,  that  some  children  inherit  a  degree  of  development 
which  is  less  than  the  normal.  Personally,  I  believe  that  the 
transmission  of  this  particular  condition  is  very  direct  and  rapid. 
The  absence  of  this  developmental  factor  is  caused  by  the  infection 
of  the  mucous  membrane  of  the  nose  so  commonly  called  a  cold  in 
the  head.  This  inflammation  produces  swelling  of  the  mucous 
membrane,  which  interferes  suflBclently  with  the  entry  of  air  and 


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Cleft  Palate.  86ft 

renders  it  necessary  to  breatbe  through  the  month.  This  at  once- 
deprives  the  naso-pharynx  of  that  fector  upon  which  it  is  solely 
dependent  for  its  developmeut  and  growth,  namely,  the  pressure  of 
air  upon  its  walls,  and  as  a  consequence  it  ceases  to  increase  in  size. 
The  interval  wbicb  separates  the  septum  and  the  outer  wall  of  the 
space  remains  uucbaoged,  and  the  septum  between  the  moutb  and 
nose  does  not  descend,  the  arch  of  the  palate  remaininiDg  abnor- 
mally high. 

The  infection  of  the  nasal  mucous  membrane  sets  up  an  inflam- 
mation of  the  lymphatic  mass  in  the  pharynx  often  called  the 
pharyngeal  tonsil,  and  later  tbe  lymphatics  of  the  neck,  which  re- 
ceive lympb  from  these  structures.  The  tonsils  often  become- 
affected,  as  well  as  the  larynx,  trachea  and  bronchi. 

The  enlai^ment  of  the  lymphatics  of  the  pharynx  often  inter- 
feres with  the  normal  functions  of  tbe  middle  ear,  with  which 
consequences  we  are  all  too  familiar. 

These  iuflai^ed  cervical  glands  afford  a  suitable  nidus  for  tuber- 
cular organisms,  which  produce  such  disastrous  results.  To  this 
condition  uf  nasal  obstruction  the  word  adenoids  has  been  applied. 
It  has  become  too  familiar  an  expression,  and  is  deservedly  regarded 
by  patients  with  considerable  dread.  I  may  be  too  young,  both  in 
years  and  experience,  to  criticise,  but  personally  I  believe  that  sur- 
geons have  too  often  regarded  tbe  secondary  infection  of  the  so- 
called  pharyngeal  tonsil  as  the  primary  cause  of  tbe  naso-pbarya- 
geal  obstruction,  and  have  endeavored  to  cure  the  condition  by  the 
unskilful  and  heroic  scraping  of  these  parts.  It  is  quite  apparent 
that  tbis  operation  is  not  alone  suGBcient  to  restore  to  the  nose  that 
mechanical  tactcr  upon  which  its  growth  and  development  depend. 
Such  a  procedure  may  occasionally  be  of  service,  but  the  operation 
alone  will  not  relieve  the  infected  mucous  membrane.  On  the 
same  principle,  we  had  as  well  attempt  to  cure  a  sore  on  the  penis 
by  removing  a  secondary  infected  bubo. 

Tbe  patients  who  are  minns  the  vigor  and  strength  and  energy 
to  get  rid  of  this  primary  infection  by  expelling  tbe  accumulated 
mucous,  and  receiving  air  through  into  the  nose,  are  much  alike  in 
many  respects.  Their  vital  powers  are  ni/;  there  is  a  total  absence 
of  enei^;  they  always  assume  attitudes  of  rest,  and  avoid  those 


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370       Tbe  Atlanta  Medical  and  Surgical  Journal. 

of  activity.  Tbe  quaatity  ofair  they  change  during  reiipiration  is 
very  small,  and  ie  produced  mainly  by  tbe  action  of  the  diaphragm, 
the  chost  remaining  in  the  position  of  rest. 

If  we  should  take  the  trouble  to  pass  a  tape  aronnd  tbe  chest 
duriug  respiration,  we  will  find  it  varies  little,  if  at  all.  As  a  re- 
sult we  get  the  fixed  resting  posture  of  the  body  often  described  as 
"dorsal  excurvation."  Finally,  asa  natural  result  we  get  complete 
fi.xation,  to  which  the  popular  and  unscientific  terms  lateral  curva- 
ture, scoliosis,  etc.,  have  been  applied. 

As  a  result  of  this  resting  attitude  of  the  chest  we  also  get  other 
deformities  called  fiat-foot  and  knock-knee.  These  patients  are 
supplied  with  such  small  quantities  of  oxygen,  and  are  loaded  with 
foul  pulmonary  products,  have  little  energy  to  expend  in  forcibly 
ventilating  the  naso-pbarjnx,  but  fall  back  on  the  more  easy 
method  of  procuring  it  through  the  mouth,  with  results  too  famil- 
iar to  all  of  us, 

I  have  often  wondered  why  it  is  that  medical  men  devote  so 
little  attention  to  the  manner  in  which  people  perfoim  that  most 
important  function  respiration,  since  it  is  by  far  the  most  important 
one  for  the  welfare  of  the  patient.  By  the  means  of  this  function 
alone  are  the  tissues  and  organs  supplied  with  oxygen ;  and  in  di- 
rect proportion  as  the  oxygen  supplied  is  good  or  bad,  so  are  tbe 
functions  of  these  tissues  and  organs  performed  in  a  satisfactory  or 
unsatisfactory  manner.  The  attention  of  most  medical  men  has 
been  fixed,  and  we  have  educated  our  patients  and  the  general 
public  to  fix  theirs,  upon  the  rapidity  with  which  the  products  of 
digestion  pass  along  the  intestinal  canal,  and  it  is  geuerally  assumed 
that  something  has  gone  wrong  if  tbe  bowels  fail  to  act  as  least 
once  a  day.  'Tis  strauge,  I  say,  that  no  attention  whatever  is  paid 
to  tbe  manner  and  character  of  the  respiration,  yet  it  is  of  infinitely 
more  importance  to  the  welfare  of  the  patient.  In  fact,  constipa- 
tion is  too  often  tbe  result  of  imperfect  oxygenation.  I  have  fre- 
quently seen  patients  who  perform  little  or  no  thoracic  respiration 
with  the  spine  fixed  in  the  position  of  extension  by  some  steel 
brace  or  other,  and  others  ordered  laborious  exercise  to  rapidly  ex- 
haust the  small  capital  without  adding  to  it  appreciably. 

I  believe  that  the  erroneous  treatment  results  from  a  deficient 


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Cleft  Palate.  371 

knowledge  of  the  mechauics  of  respiration  aod  of  the  important 
part  which  the  spinal  column  should  take  in  this  process.  Again 
I  may  be  too  young  to  criticize  our  able  physiologists,  but  I  believe 
they  have  misled  many  of  us  by  their  attempts  to  illustrate  the 
respiratory  process  by  meaus  of  a  mechanism  in  which  the  spinal 
column  is  represented  as  a  rigid  and  immovable  rod.  This  generally 
accepted  theory  is  absolutely  false,  since  the  variations  in  the  spine 
are  infinitely  more  visible  than  those  of  the  chest-walla,  I  would 
therefore  suggest  that  the  manner  ill  which  the  tissues  receive  their 
oxygen  receive  as  much  attentiou  as  the  rate  at  which  the  sewage 
products  of  the  body  pass  along  the  intestinal  canal. 

I  believe,  if  this  is  done  well,  that  adenoids,  resting  deformities 
and  many  other  diseases  resulting,  either  directly  or  indirectly, 
from  an  imperfect  supply  of  oxygen,  will  disapjKar. 

'Tis  not  my  intention  to  consider  tlie  subject  of  adenoids  further 
than  to  say  that  bloody  operative  procedures  are,  in  my  opinion,  in 
most  instances  wholly  unnecessary,  and  that  a  systematic  ventila- 
tion of  the  lungs  through  the  oaso-pharyux  furnishes  us  with  a 
means  not  only  of  applying  to  the  naso-pharyns  that  force  by  air 
being  driven  forcibly  through  it,  but,  by  oxygenating  the  blood 
more  fully,  removes  more  thoroughly  its  carbonic  acid  gas,  the 
tissues  of  the  body  are  better  nourished  and  perform  their  functions 
in  a  normal  manner.  In  ray  opinion  and  exjwrience,  this  is  best 
accomplished  by  placing  the  child  on  its  back  three  times  a  day  for 
at  least  twenty' minutes  atatime,and  make  it  breathe  in  and  out  as 
deeply  as  possible  through  the  nose,  the  mouth  being  kept  closed. 
This,  together  with  some  antiseptic  lotion  to  keep  the  infected 
membrane  clean,  is  in  my  judgment  the  most  rational  treatment  \a 
many  diseases  of  the  naso-pharynx. 

Returning  to  my  subject,  cleft  palate,  you  see  that  so  long  as  the 
nasal  cavities  are  in  communication  with  the  mouth  the  main  factor 
apon  which  they  depend  for  their  development  is  held  in  abeyance, 
and  therefore  they  cannot  develop.  As  a  consequence,  the  sides  of 
the  alveolar  arch  become  closer  together,  as  do  also  the  edges  of 
the  cleft,  and  the  roof  becomes  more  vertical.  Most  surgeons  claim 
that  in  delaying  the  operation  these  changes  occur  and  render  the 


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372      The  Atlanta  Medical  and  Suboical  Joubhal. 

operatiou  more  simple;  or,  to  put  it  plaialy,  the  least  developed 
the  nose,  the  easier  is  the  closure  of  the  fissure  id  the  floor. 

If  the  caliber  of  the  nose  bears  an  inverse  proportion  to  the- 
height  of  the  palate,  as  the  lower  portion  of  the  cavity  is  the  por- 
tion through  which  the  air  passes,  it  is  plain  that  this  space  is  en- 
croached upon  by  any  increase  in  the  height  of  the  palate.  Know- 
ing, therefore,  the  mechanics  of  the  naso-pharynx,  it  is  easy  to  see 
the  advantage  of  separating  these  two  cavities  as  early  in  life  as 
possible,  in  order  to  restore  to  the  nose  that  force  upon  which  its 
development  depends. 

Id  order  to  remind  you  of  the  practice  followed  by  most  surgeous 
of  to-day,  I  will  quote  from  three  of  our  standard  authors,  both  at 
home  and  abroad.  Mr.  Treves  says  that  in  the  in&nt  the  cleft  is 
wisely  deemed  inoperable,  and  that  the  time  of  election  is  from  four 
to  six  years  of  age.  The  author  does  not  appear  to  adduce  any 
argument  to  prove  that  it  is  unwise  to  operate  on  an  infant,  but  as 
he  is  authority  we  must  accept  it. 

Mr.  Erichsen  says:  "The  first  question  to  be  determined  is  the 
age  at  which  the  operation  should  be  performed,  as  the  success  of 
the  operation  depends  mainly  upon  the  patient  remaining  quiet 
during  the  operation,  upon  his  assisting  the  surgeon  by  keeping 
the  mouth  open,  and  that  it  is  not  expedient  to  interfere  until  the 
patieut  is  old  enough  to  understand  the  necessity  of  keeping  quiet." 

Mr.  Bryant  says  that  the  operation  may  be  undertaken  at  the  age 
of  five  in  a  healthy  child,  and  that  he  has  performed  it  himself 
successfully  as  early  as  four.  Are  we  to  accept  these  statements  as- 
true?  When,  in  the  past  winter,  in  Guy's  Hospital,  I  saw  thirty- 
eight  clefts  closed,  not  one  of  them  older  than  six  weeks,  and 
not  one  of  them  failed  to  recover.  Mo.  I  believe  that  the  treat- 
ment of  cleft  palate,  like  other  operations  in  surgery,  has  been  a 
creed  and  a  tradition,  and  that  if  we  treat  these  patients  as  we 
should  no  time  should  he  lost  in  restoring  to  the  nose  its  normal 
physiology. 

(1)  At  what  age  should  we  operate? 

(2)  What  is  the  best  method  to  do  it? 

(3)  How  may  complications  be  met  ? 

If  there  is  no  special  contraindication,  I  believe  the  best  time  to 


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Infant  FsBDiNa.  878 

operate  is  from  the  fourth  to  sixth  week.  Why  ?  First,  because 
the  child  stands  the  operation  well.  Second,  the  child  experiences 
■very  little  discomfort  afterwards,  and  is  soon  able  to  take  its  food. 
Third,  the  small  amount  of  hemorrhage  is  easily  controlled. 

The  details  of  the  operation  vary  in  different  cases,  but  in  the 
majority  of  cases  we  should  endeavor  to  raise  a  flap  of  mucous 
membrane,  together  with  the  periosteum  from  one  side,  and  attach 
it  securely  beneath  the  raised  margin  of  the  opposite  side,  a  modi- 
£oatioD  of  Mr.  Davies's  college  operation. 

Many  children  with  cleft  palates  have  harelip  also.  The  latter 
is  best  lefl  alone  till  the  cleft  in  the  palate  has  been  closed,  as  it 
sffords  more  room  to  reach  the  olefl. 


INFANT  FEEDING.* 

By  G.  p.  ROBINSON,  M.D., 
Atlanta,  Ga, 


To  prevent  disease  is  the  highest  province  of  every  practitioner. 
The  study  of  the  best  means  for  starting  young  life  is  the  highest 
"branoh  of  preventive  medicine. 

With  this  objective  point  in  view,  the  preventive  medicine  of 
young  life  consists  in  the  proper  and  intelligent  management  of 
the  nutriment  which  enables  it  to  grow  and  to  live.  Thus  the 
feeding  and  the  knowledge  of  the  proper  preparation  of  such  food 
becomes  of  paramount  importance. 

The  subject  of  infant  feeding  is  a  broad  one  and  should  be 
treated  broadly.  It  has  many  varied  aspects;  what  agrees  with 
«ne  child  is  almost  poison  to  another.  To-day,  through  the  study 
of  many  prominent  investigators,  our  knowledge  of  infant  feeding 
has  been  much  increased  and  brought  much  nearer  to  an  exact 
science.  Yet  we  still  have  much  to  learn.  It  is  my  hope  this 
evening  to  bring  before  you  a  description  of  the  principles  of  in- 
fant feeding  and  the  possibilities  of  substitute  feeding. 

I  fully  realize  the  difficulties  that  are  to  be  encountered  in  edu- 

•Koul  before  Uw  AUknta  Boolety  at  HedloUw. 


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374       The  Atlanta  Medical  and  Surgical  Jodbnal. 

eating  tbe  public  to  such  radical  changes.  The  old  method  of  chang- 
iug  the  food  to  this  or  that  because  the  preseot  food  does  not  agree 
with  the  child  must,  however,  disappear  if  the  profession  at  large 
will  only  iusist  that  such  changes  shall  be  made  only  on  a  scientific 
basis.  The  greatvanety  of  artificial  foods  on  the  market  and  used 
by  the  physicians  of  to-day  only  goes  to  show  that  artificial  feed- 
ing has  not  arrived  at  the  point  where  it  can  compete  with  breast 
feeding.  Many  infants  thrive  on  peculiar  mixtures,  and  again 
many  infants  will  not  thrive  on  the  food  that  nature  has  given 
them.  The  young  infant  is  essentially  a  carnivora  for  its  first 
twelve  months  of  life,  and  therefore  it  is  evident  that  an  animal 
food  freshly  derived  from  animal,  and  not  vegetable,  sources  is  the 
best  for  the  young  lives. 

The  Mammary  Glands. — You  will  pardon  me  if  I  revive  your 
memory  in  regard  to  the  mammary  gland.  I  quote  verbatim  from 
Foster's  Physiology:  "The  mammary  gland  is  a  compound  race- 
mose gland,  and  consists  of  a  number  of  lobes  composed  of  smaller 
divisions  of  lobules,  which  iu  tuni  are  still  subdivided  in  vesicles 
which  form  a  cluster  on  one  of  the  terminal  ducts.  They  are 
composed  of  a  basement  membrane  which  is  lined  with  glandular 
epithelium.  Each  lobule  has  a  common  duct,  which,  uniting  with 
others,  form  some  fifteen  or  twenty  large  ducta — the  lactiferous 
ducts."  So  much  for  the  partial  anatomy  of  the  gland.  The  milk 
is  the  result  of  the  activity  of  certain  protoplasmic  secretic  cells 
forming  the  epithelium  of  the  mammary  gland.  As  to  the  fat  of 
milk,  the  processes  taking  place  in  the  gland  are  very  instructive. 
The  fat  can  be  seen  to  be  gathered  iu  the  epithelium  cell  in  the 
same  way  as  a  fat  cell  of  the  adipose  tissue  and  to  be  disobarged 
into  the  channels  of  the  gland  either  by  breaking  away  from  the  cell 
or  by  a  contractile  extension  similar  to  that  which  takes  place 
when  an  ameba  ejects  its  digested  food.  All  the  evidence  we  pos- 
sess goes  to  prove  tbat  the  fat  is  found  iu  the  cell  through  a  me- 
tabolism of  the  protoplasm.  The  microscopic  history  is  supported 
by  other  facts,  thus  the  quantity  of  fat  present  in  milk  is  largely 
and  directly  increased  by  proteids,  but  not  increased  (on  the  con- 
trary, diminshed)  by  fatty  food.  This  is  intelligible  when  we  know 
that  proteid  food  increases  and  fatty  food  diminishes  the  metabo- 


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Infant  Feeding.  37& 

lism  of  the  body.  A  bitch  fed  oq  meat  for  a  given  time  gave  off 
more  fat  in  her  milk  than  she  could  possibly  have  takea  in  her 
food,  aad  that  while  she  was  gainiog  in  weight,  bO  that  she  could 
Qot  have  supplied  the  fat  at  the  expense  of  fat  previously  existing 
in  her  body.  She  obtained  it  apparently  from  the  proteids  of  her 
food.  We  have  also  iudicatious  that  the  casein  is,  like  fat,  formed 
in  the  cells  of  the  glaud^  and  not  simply  separated  from  the  blood. 
When  the  action  of  the  cell  is  imperfect,  as  at  the  begiouing  or 
end  of  lactation,  the  albumen  in  milk  is  iu  excess  of  the  casein,  but 
so  long  as  the  cell  possesses  its  proper  activity  the  formation  of 
casein  becomes  prominent.  Tbut  the  milk-sugar  is  formed  in  and 
by  the  protoplasm  of  the  cell  is  indicated  by  the  fact  that  it  is 
found  in  no  other  part  of  the  body,  and  that  its  presence  in  milk 
is  not  dependent  on  carbohydrate  food,  for  it  is  maintained  in 
tbaudance  in  the  milk  of  carnivora  when  they  are  fed  exclusively 
on  meat  as  free  as  possible  from  any  kiud  of  sugar  or  glycogen. 
We  thus  have  evidence  in  the  mammary  gland  of  the  formation  by 
the  direct  metabolic  activity  of  the  secreting  cell  of  the  representa- 
tives of  the  three  great  classes  of  food-stuffs:  proteids,  fat^,  and 
carbohydrates,  out  of  the  comprehensive  substance  protoplasm. 
That  both  the  secretion  and  ejection  of  milk  are  under  the  control 
of  the  nervous  system  is  shown  by  common  experience.  These 
physiological  facts  become  of  interest  and  of  the  utmost  impor- 
tance when  we  attempt  to  modify  or  change  the  product  of  the 
gland. 

A  word  now  of  the  mammary  gland  in  a  general  way.  The 
breasts,  when  in  an  absolutely  normal  condition,  are  a  most  beau- 
tiful living  machine,  producing,  measuring,  and  giving  out  a  fin- 
ished product  capable  of  sustaining  the  life  and  continuing  the 
growth  of  its  young  consumer;  Again,  the  structure  of  this  or- 
gan is  of  so  delicate  a  character  that  any  chauge  of  atmosphere, 
change  of  food,  emotions,  fatigue,  catamenia,  pregnancy,  sickness 
may  change  the  proportions  of  this  finished  product,  and  instead 
of  its  being  a  perfect  food  it  becomes  a  very  imperfect  food. 

It  is  not  necessary  for  me  to  speak  of  the  superiority  of  mater- 
nal feeding  nor  of  the  contraindications  to  maternal  feeding,  nor 


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376       The  Atlanta  Medical  and  Suroical  Journal. 

■of  the  care  of  the  mother  and  breasts,  but  I  would  like  to  say  juBt 
«  word  ID  regard  to  the  breast-pump. 

There  is  a  great  differeoce  of  opiniOQ  in  regard  to  the  use  of. 
the  breast-pump.  Personally,  I  am  strongly  opposed  to  its  use  in 
ordinary  cases  when  the  breasts  are  to  be  emptied,  but  for  its  occa- 
sional use  in  securing  samples  of  milk  for  analysis,  I  consider  the 
-end  decidedly  justifies  the  means. 

Having  considered  the  breast  as  a  gland  and  its  physiological 
functions,  let  us  briefly  look  at  its  finished  product,  human  milk 
and  its  clinical  aspect.  Unquestionably,  in  the  great  majority  of 
-cases,  breast  feeding  is  the  sine  qua  non.  Why?  Because  nature 
has  so  regulated  the  breasts  that  the  quality  and  quantity  ia  the 
best  milk  for  each  age  and  condition  of  each  individual  child.  It 
must  be  clearly  borne  in  mind  that  it  is  not  breast  milk  as  a  whole 
that  makes  it  the  beet,  but  the  varied  combination  of  the  different 
elements  of  that  milk.  From  the  analysis  of  Konig,  Foster, 
Meigs,  Harrington  and  others,  of  tbe  human  milk  of  many  women 
of  different  nationalities,  tbe  average  analysis  of  human  milk  is 
found  to  be  as  follows : 

BeaotioQ SI  ight]y  alkaline. 

SpeciBc  grafitir I02B-34.  dep«adiDg  on  tamp. 

Water 87-88. 

Total  Bolids 13-12. 

Pat 8-4  percent. 

Sugar. 0-7. 

Froteide „  1-2. 

Totalaeh 0.1-0.2. 

This  is  simple  and  the  constituents  are  few  and  easily  grasped, 
«nd  for  our  purpose  this  evening  there  is  no  necessity  for  going 
more  minutely  into  their  constituents. 

Our  knowledge  of  the  human  breast  has  shown  us  that  the 
quantity  for  each  succeeding  age  of  the  infant  is  regulated  by  the 
breast  itself,  so  that  if  we  find  an  infant  nursing  longer  than 
fifteen  or  twenty  minutes  before  the  child  is  satisfied,  it  should 
make  us  suspicious  that  the  milk  is  lacking  in  quantity;  or,  agaiu, 
dabby  breasts,  or  the  desire  of  the  infant  for  too  frequent  nursing, 
should  make  us  look  afler  tbe  quantity. 

Not  so  easy  always  is  the  determination  of  the  quality  of  such 


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Infant  FEBDraa.  877 

milk.  CliDioal  observation  teaches  that  two  thioga  mast  be  con- 
sidered in  the  management  of  in&nt  feeding. — viz.,  the  digestion  of 
the  in&Dt  and  its  nutrition.  A.  milk  may  be  easily  digested  bot 
not  Datritions,  or  again  it  may  be  nutritions  and  not  easily  digested, 
or  it  Boay  be  neither  nutritions  nor  easily  digested.  It  is  the  recog- 
nition and  regulation  of  these  conditions  in  the  mother  that  the 
physicioo  must  be  ready  to  meet.  Much  can  be  done  toward  this 
by  the  regnlation  of  the  diet  and  exercise,  accurately  and  intelli- 
gently aided  by  repeated  analyses  of  the  milk  at  each  step.  Just 
here  let  me  mention  one  of  my  cases  that  occurred  to  me  in  gen- 
eral practice  illustrative  of  what  changes  can  be  made  in  breast 

milk.     A  Mrs. ,  multipara,  whose  in&nt  was  five  months  old. 

The  child  had  thrived  for  the  first  two  months  of  its  life,  but  later 
b^an  vomiting  its  food  and  was  not  increasing  in  weight.  An 
analysis  was  made  of  the  mother's  milk  (the  exact  per  cent.  I  have 
not  got),  and  the  result  showed  a  very  low  per  cent,  of  tat  and  a 
very  high  per  cent,  of  proteids.  She  was  advised  to  eat  meat  and 
walk.  Seen  a  week  later,  there  was  little  or  no  improvement — 
there  was  plenty  of  milk,  but  no  improvement  in  the  child.  On 
iaqairy  I  found  bat  little  meat  had  been  eateu — one  small  piece 
per  diem — and  not  sufficient  exercise  had  been  taken.  She  was 
told  to  eat  meat  twice  and  walk  at  least  three  miles  each  day. 
From  that  on  there  was  steady  improvement,  the  child  stopped 
vomiting,  and  there  was  steady  increase  in  weight.  An  examina- 
tion of  the  milk  at  this  time  showed,  iat,  3.50;  sugar,  normal, 
and  proteids  reduced  to  2  per  cent.,  as  nearly  as  I  can  remember. 
Just  to  show  the  uunsual  percentages  that  a  breast-fed  child  will 
at  times  thrive  upon,  let  me  quote  a  case  of  Dr.  Rotch:  A  pri- 
mipara ;  in&nt  thriving,  but  as  a  matter  of  precaution  in  case  of  arti- 
ficial feeding  having  to  be  resorted  to,  an  analysis  was  made,  with 
the  following  result: 

Pat 6.16 

8ugM„ _ 6  88 

Proteidi, 4.14 

Aih 17 

Totol 16.16. 

W«tw 84.86 

100.00 


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378       The  Atlanta  Medical  and  Surgical  Journal, 

The  child  thrived  and  did  well  on  these  unusual  percentages. 

A  long  paper  might  be  written  on  the  oare,  regulation,  idioeyu- 
icrasies  and  changes  of  percentages  of  breast  feeding,  and  I  have 
given  it  conaiderable  space  that  we  may  more  intelligently  take  up 
the  subject  of  substitute  feeding. 

Before  taking  up  the  subject  of  substitute  feeding  let  me  say 
just  one  word  in  regard  to  mixed  feeding.  It  not  infrequently 
happens  that  the  mother's  milk,  while  agreeing  with  the  infant  in 
«very  way,  fails  in  quantity.  In  these  cases  an  exact  knowledge 
of  these  percentages  in  the  mother's  milk  enables  us  to  substitute 
its  exact  equivalent.  If,  again,  the  breast  milk,  while  agreeing  mth 
the  child,  does  not  nourish  sufficiently,  here  again  we  can  raise  the 
percentages  lackiug  in  the  mother's  milk  to  the  requisite  amount 
in  the  substitute  food. 

Indirect  Substitute  Feeding. — We  know  the  occasion  frequently 
arises  iu  civilized  communities  for  supplying  the  young  life  with 
food  other  than  breast  milk.  We  have  shown  that  children,  for 
the  first  twelve  months  of  life,  are  essentially  carnivora,  and 
that  we  are  in  no  position  to  improve  on  nature's  method  of 
feeding.  The  food  that  approaches  most  nearly  to  the  product  of 
the  human  mamma  is  that  produced  from  the  mammal  of  other 
animals.  Milk  is  the  food  that  reason  tells  us  is  the  proper  sub- 
stitute, and  a  milk  that  most  nearly  approaches  to  that  of  human 
milk.  Without  going  into  a  discussion  of  the  milks  of  different 
animals,  it  is  a  generally  accepted  fact  that  the  product  of  the 
mamma  of  the  cow  is  the  most  easily  obtained,  and  though  possi- 
bly not  so  closely  resembling  the  constituents  of  human  milk,  ret, 
as  all  milk  has  to  be  modified,  it  is  as  easy  to  modify  to  a  greater 
as  to  a  less  extent. 

Accepting,  then,  the  fact  that  cow's  milk  is  the  most  available 
for  substitute  feeding,  let  us  consider  for  a  moment  the  breeds  best 
adapted  for  our  purpose.  It  is  a  welUknown  fact  that  the  finer 
breeds  from  the  Channel  Islands  are  more  liable  to  contract  tuber- 
oulosis  in  our  harsher  climate  than  are  the  breeds  represented  by 
the  Durham,  Devon,  or  Holstein  cattle.  The  Jerseys  and  Gurn- 
seys,  too,  are  somewhat  richer  in  proteids,  already  too  high  in 
other  breeds.     It  is  also  a  tkct  that  Jerseys  cannot  raise  their  own 


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Infant  Feeding.  879 

youDg.  Tbe  old  theory  of  one  cow's  milk  is  also  fallacious,  inas- 
mucb  as  any  disturbaoce  of  the  equilibrium  of  the  mammary 
{[laads  through  fright,  bad  feeding,  or  disease  brings  about  a  cod- 
ditioD  of  tbe  milk  which  tbe  iufaat  gets  tbe  full  benefit  of.  The 
milk  from  a  herd  is  the  best. 
The  average  analysis  of  cow's  milk  shows: 

BeictioQ Slightly  «cid. 

Specific  grtvity 1029-83 

Wstor- 86-87 

ToUl«>lidB_ 11-18 

F»t„ 4  per  cent. 

Sugftr 4,60 

Proteid* 4.00 

Ash 70 

This  is  an  average  analysis  taken  from  a  large  number  of  com- 
mon cows  from  all  over  tbe  world,  though  it  has  been  shown  that 
by  certain  feeding  of  half  ripened  grasses  a  cow's  milk  may  be- 
come neutral  or  alkaline,  yet  tbe  ordinary-fed  cattle  produce  an 
acid  mixture. 

Before  speaking  of  the  modi6catioD  of  cow's  milk  which  must 
be  made  to  make  it  correspond  to  human  milk,  let  us  briefly  com- 
pare the  two.  Tbe  following  table  shows  tbe  percentages  in 
woman's  milk  and  cow's  milk : 

Womin's  Utlk. 

BflictioD   Slightly  alktline. 

Water 87-88 

ToUl  ftoHdj  _ 13-12 

Pat „ 4 


Reaction. — As  it  is  necessary  to  make  both  taste  and  reaction 
compare  to  mother's  milk,  and  as  the  acidity  of  cow's  milk  is 
largely  accountable  for  the  large  curds  so  frequently  seen,  it  be- 
comes essential  that  it  be  made  slightly  alkaline.  Harrington  has 
found  by  eiperiment  that  6.25  percent,  of  lime-water  will  produce 
an  alkalinity  corresponding  to  that  of  mother's  milk. 

Water. — There  is  one  per  cent.  less  water  in  cow's  milk  than  in 
human  milk.    Such  a  large  percentage  of  water  in  all  human  milk 


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S80      The  Atlanta  Medical  and  Sqbqical  Journal. 

showB  that  nature  intended  a  highly  diluted  food  to  be  the  beet 
fitted  for  the  young  life. 

Fai. — The  percentages  of  fat  of  both  the  average  bnman  and 
cow's  milk  18  the  same,  so  that  for  modificatioQ  we  r^ulate  only 
the  fat  as  a  whole. 

Sugar. — The  sugar  of  all  mammals  is  of  the  kind  known  as- 
milk-sugar  or  lactose.  The  percentages  in  the  two  kinds  of  milk,, 
yon  will  notice,  are  qnite  different,  that  of  human  milk  being  about. 
7  per  cent,  and  that  of  cow's  milk  about  4.60.  In  modification, 
this  can  be  easily  remedied  by  adding  the  milk-sugar. 

Proteida. — Tbeproteids  in  human  milk  have  quite  a  wide  range, 
yet,  considering  it  between  one  and  two,  it  can  be  stated  that  the 
relation  of  the  percent^^  between  cow's  milk  and  human  milk  is- 
as  4  to  1.6.  The  proteids  represent  the  nitrogenous  elements  of 
milk.  The  coagulabU  proteids  in  cow's  milk,  being  larger  than  ia> 
hnman  milk,  under  the  same  conditions,  a  larger  curd  will  be  pro- 
duced by  the  former  than  the  latter.  Harrington  has  worked  out 
an  extensive  table  showing  the  coagulability  of  milk  by  acetic- 
acid.  Woman's  milk  gives  no  curd  perceptibly  to  the  eye ;  cow's- 
milk,  row,  lai^  onrd.  Cow's  milk,  1  part;  water,  four  parts,  a 
fine  curd.  A  modified  mixture  of  &t,  4  parts;  sugar,  7 ;  proteids, 
1.6;  asli,  0.2;  reaction,  alkaline,  gave  a  wry  fine  curd,  and  water 
5  parts,  and  milk  1  part,  gave  no  curd  perceptible  to  the  eye. 
Cow's  milk,  direct  from  the  udder,  gave  just  as  large  a  curd  as  that 
24  hours  old.  Cow's  milk,  boiled,  steamed  or  raw,  also  gave  the- 
same  large  curd;  also,  with  lime-water  and  barley-water,  the  re- 
sults were  the  same  as  with  water.  All  this  shows  that  the  siw  of 
the  curd  depends  on  the  dilution  of  the  proteids  rather  than  on 
any  particular  property  of  the  substitute  with  which  it  is  diluted. 
This  is  well  to  remember  in  substitute  feeding — water  is  the  best 
diluent. 

Having  seen  how  human  milk  is  produced  and  how  its  percent- 
ages can  be  changed,  and  having  accepted  cow's  milk  as  the  best 
substitute,  and  having  seen  its  constituents  and  percentages,  I  think 
you  will  agree  with  me  that  the  mere  technique  of  such  modifica- 
tion must  be  simple.  I  also  think  that  you  will  agree  with  me  that 
the  importance  of  modifying  milk  with  the  most  exact  precision  is- 


^dbyGoogle 


Ikfaht  Fbbdino.  881 

•esMDtisl  if  we  wiah  a  perfect  substitute  food.  Uotil,  however,  we 
■can  get  a  laboratory  of  the  Walker-Gordon  typo  (which  I  hope 
will  not  be  long  in  coming  here),  the  absolute  perfection  in  the 
modifying  of  milk  cannot  be  reached.  In  the  "home  modifica- 
tion," however,  the  percentages  and  constituents  of  cow's  milk 
'  -can  be  so  changed  and  accurately  carried  out,  if  properly  attended 
to,  as  to  be  all  that  is  essential  in  the  copying  of  the  percentages 
of  breast  milk.  The  necessary  articles  for  the  modification  of  milt 
at  home  are  simple  and  can  be  easily  obtained  here  in  Atlanta. 

First,  a  simple  sterilizer,  containing  a  rack  with  oome  six  or  seven 
'  tubes;  into  the  lid  should  be  fitted  a  thermometer.  The  tubes  are 
«mple  bottles,  without  curves  so  that  tbey  may  be  easily  kept 
-clean,  and  can  be  used  as  nursing-bottles.  These  are  graduated 
«nd  placed  in  the  rack,  and  the  rack  in  the  sterilizer  where  the 
water  comes  to  the  top  of  the  milk.  Cotton  wool  for  stoppers  for 
these  bottles. 

A  oozy — simply  a  woolen  wrapper  to  retain  the  heat  in  the  ster- 
ilizer ader  the  lamp  or  stove  has  been  taken  from  beneath. 

A  glass  graduate  of  8  ounces  or  more,  divided  into  half-drachms. 

Milk-Bugar  and  lime-water. 

A  measure  containing  5  3|.  This  measure  does  away  with  the 
necessity  of  the  apothecary  doing  the  sugar  up  into  packages. 

A  sipbon  to  separate  the  cream  from  the  milk.  This  should  be 
-of  glaas  and  not  rubber.  To  operate  the  siphon,  fill  it  with  boiled 
water,  close  the  long  end  with  the  finger,  place  the  short  end  in 
the  milk,  and,  removing  the  finger,  allow  the  water  and  then  the 
milk  to  ruD  out.  Xever  use  the  lips  to  start  the  siphon.  The 
mother  should  be  told  to  follow  your  directions  implicitly  or  a 
uniformly  correct  result  will  not  be  obtained.  Cleanliness  iu  regard 
to  the  cattle,  and  the  obtaining  the  milk  from  a  herd  and  not  from 
one  cow,  as  the  percentages  in  the  milk  as  a  whole  are  less  likely 
to  vary,  should  be  explained.  The  cows  should  be  of  a  common 
breed,  as  we  have  seen.  The  milk  should  be  thoroughly  strained; 
After  straining  it  should  be  placed  in  a  quart  jar,  which  is  put  in 
ice-cold  water  and  allowed  to  stand,  covered  with  a  piece  of  freshly- 
boiled  cotton  cloth,  for  15  or  20  minutes  uotil  the  animal  heat  is 
«xhauBt«d.     The  jar  is  then  sealed  tightly  as  for  preserving  and 


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382       The  Atlanta  Medical  and  Surgical  Journal. 

allowed  to  stand  for  six  hoars  in  tlie  ice  water,  care  being  used 
that  the  temperature  of  the  water  does  not  fall  below  35  degrees, 
Fah.  At  the  end  of  six  hours  siphon  off  your  milk,  and  you  now 
have  your  various  materials  ready  for  any  combination  you  may 
wish  to  make.     These  are : 

The  milk  you  have  siphoned  off. 

The  cream,  containing  ten  per  cent,  of  fat,  remaining  in  the  jar. 

The  sugar. 

Some  fresh  lime-water. 

Some  clean  drinking-water  which  has  been  boiled  five  minutes. 

After  thft' various  materials  have  been  mixed  in  the  proportions- 
desired,  the  mixture  is  ready  for  the  sterilizer.  The  requisite 
amount  for  each  feeding  is  pUced  In  the  tubes  and  they  are  atopped 
with  cotton  wool,  care  being  used  to  have  it  tight  and  the  neck  of 
the  bottle  dry.  Then  place  the  bottles  in  the  rack  and  place  it  in 
the  sterilizer,  adjusting  the  water  to  the  level  of  the  milk  in  the 
tul>es.  Heat  is  then  applied  with  the  cover  off  until  the  water 
shows  171  degrees  Fah.  The  cover  is  then  replaced,  the  heat  re- 
moved and  the  cozy  wrapped  about  the  sterilizer.  The  thermome- 
ter should  then  mark  a  temperature  of  between  167  and  170  de- 
grees Fah.  for  thirty  minutes.  At  the  expiration  of  that  time  the 
tubes  are  to  be  removed  and  kept  in  a  cool  place  until  needed. 
On  using  the  tubes  they  should  be  warmed  to  blood-heat  and  a 
clean  nipple  attached. 

Arttjicnal  Food». — One  would  think  that  the  suggestion  for  the 
proper  rules  governing  substitute  feeding  should  emanate  from 
the  medical  profession  rather  than  from  the  non-medical  pro- 
prietors of  certain  preparations.  Yet,  in  looking  over  the  great 
field  of  artificial  feeding,  the  position  occupied  by  the  family  phy- 
sician, in  comparison  to  the  vendors  of  patent  foods  and  proprie- 
tary artificial  foods  administered  by  nurses,  is  a  most  humiliating 
one,  and  one  that  should  no  longer  exist.  In  view  of  the  large 
amount  of  work  done  by  our  own  profession,  and  especially  by 
Holt  and  Kotcb,  to  whom  I  am  largely  indebted  for  what  I  may 
know  of  infant  feeding,  we  should  certainly  bury  the  statements 
of  food  proprietors  who  are  constantly  trying  to  stem  the  tide  of 
progress. 


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Infant  Fbbdiko.  88S 

The  criticism  has  been  made  that  modification  is  too  expeneive, 
Rotch,  in  this  connection,  suggests  that  human  milk,  which  we 
are  trying  to  copy,  so  far  from  being  a  cheap  product,  is  a  very  ex- 
pensive one. 

The  artificial  foods  are  &r  from  being  reliable,  and  all  of  them^ 
even  when  containing,  as  claimed  in  their  circnlara,  certain  per- 
centages of  fat,  proteids,  etc.,  when  diluted  for  the  infant's  feed- 
ing, may  have  these  constituents  reduced  below  the  limits  of  nutri- 
tion. Let  as  continue  to  march  on  antjl  we  have  a  perfect  substi- 
tnte  and  proprietary  foods  fur  substitute  feeding  become  a  thing  of 
the  past. 


The  Radical  Tbeathent  of  Hydbocele. 

Block  (Bevue  de  Chirurgie,  Feb.  2, 1898)  describee  a  new  opera- 
tion for  the  radical  cure  of  hydrocele  of  the  tunica  vaginalis.  The 
old  method  of  injection  of  iodine,  be  points  out,  causes  a  very 
painful  inflammatory  reaction,  and,  in  common  with  the  more  re- 
cent treatment  by  incision  and  drainage,  necessitates  prolonged  rest 
in  bed,  and  does  not  insure  freedom  from  relapse.  The  author 
makes  a  free  incision  into  the  sac,  applies  a  three-per-cent.  solution 
of  carbolic  acid  to  the  surface  of  the  exposed  testicle  and  the 
whole  of  the  inner  surface  of  the  tunica  vaginalis,  and  stuffs  the 
cavity  with  strips  of  iodoform  ganze.  After  removal  of  the  gaase^ 
on  the  third  or  fourth  day,  the  wound  in  the  skin  is  closed  by  cat- 
gut sutures.  Of  eighteen  cases  treated  by  this  method,  the  patients 
having  been  seen  after  intervals  ^between  eight  .months  and  five 
years  from  the  date  of  operation,  in  one  only  was  a  relapse  noted. 
This  was  a  case  of  very  large  hydrocele  in  a  man  aged  sixty-four 
years. — Britieh  Medical  Journal,  March  IS,  1898. 


Piaster  of  Fans  sets  much  more  efBciently  with  sulphate  of 
potash  than  with  chloride  of  sodium.  The  potash  salt  may  he  used 
in  any  strength;  the  stronger  the  solution  the  quicker  the  setting. 
—Ex. 


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CORRESPONDENCE. 


Editor  Atlanta  Medical  and  Surgical  Journal: 

I  send  you  the  inclosed  clippiog,  taken  from  a  recent  issue  of 
that  excellent  medical  journal  Pediatrics.  Will  you  kindly  iaform 
me  whether  these  views  are  correct.  Very  truly,  M.D. 

We  should  be  glad  to  publish  replies  to  this  query  in  the  next 
issue  from  any  of  our  readers  whose  experience  justi6es  a  koowU 
«dge  on  the  subject. 

THE  COLOB  OP  THE  NEGRO  WHEN  BORN. 
There  has  been  a  discussiou  recently  in  France  as  to  the  color 
«f  newly-born  negro  children.  It  is  probable  that  scarcely  one 
out  of  a  million  white  laymen  would,  if  asked  this  question,  be 
able  to  answer  it  correctly.  The  lai^  majorily  of  the  medical 
profession,  too,  are  ignorant  on  the  puiut.  Not  that  it  is  a  matter 
of  great  moment,  but  in  these  days  when  one's  knowledge  is  ex* 
pected  to  be  absolutely  accurate,  it  is  satis&ctory  to  have  even  the 
most  minul«  details  made  clear.  On  the  authority  of  Dr.  Farabery, 
vhose  statement  will  doubtless  be  supported  by  many  medical 
practitioners  who  have  had  experience  in  negro  obstetrical  practice, 
'*'The  negro  baby  at  the  time  of  its  birth  is  exactly  the  same  color 
«A  its  white  brother,  and  it  shows  signs  of  color  only  after  an  in- 
terval usually  of  several  days,  but  often  extending  to  many  weeks." 
Some  little  time  ago,  says  an  English  journal,  there  was  an  cxhi- 
bitioD  in  the  Champ  de  Mars  of  a  Soudanese  village,  the  colony  of 
which  numbered  several  hundred  persons  aH  black  as  ever  were 
born.  An  eminent  French  physician  saw  there  an  opportunity  to 
settle  this  vexed  question,  and  he  thus  expressed  bis  deductions: 
"The  negro  baby  comes  into  the  world  a  tender  piok  color;  the 
second  day  it  is  lilac;  ten  days  afterward  it  is  the  color  of  tanned 
leather,  and  at  fifteen  days  it  is  chocolate.  iThe  coloring  matter  in 
the  case  of  the  negro  lies  between  the  layers  of  the  epidermis. 
This  pigment  is  semi-Buid,  or  in  the  form  of  fiue  granulations;  in 
the  Indian  it  is  red,  and  in  the  Mongolian  yellow.  It  is  influenced 
Qot  only  by  sun  and  by  climate,  but  by  certain  maladies,  and  the 
oegro  changes  in  tint  just  as  the  white  person  does. 


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EDITORIAL. 


TbB  offlca  of  Ths  JoiTkKAi.  U  30e  Md  SM  Fittan  Building. 

Addran  tU  oonumuilotlon*,  kod  make  &U  nunltUnoa  paykbLe  to  Tbe  Ati^Hta  Medioai. 
■D  Smoioii.  Jt>CB>AL,  AUauta,  Qft. 

BaprlDla  of  artlDlM  will  be  lunilahed,  wheo  dealred,  »t  »  (mall  coat.  Kaqaaau  rnr  tbe 
in*  iboold  alwayi  be  made  im  Uit  monuMrfpl. 


THE  NEW  CURE  FOR  CONSUMPTION. 

The  daily  papers  have  been  giving  great  Bpace  recCDtly  to  a  pa- 
per read  by  Dr.  Jno.  B.  Murphy,  of  Chicago,  before  the  last  meet- 
ing of  the  American  Medical  Association.  A  paper  coming  from 
such  a  source  aud  read  bv  such  a  distinguished  man  and  upon  such 
an  all-important  subject  was  well  calculated  to  attract  atteutiuD. 
Dr.  Murphy  stands  in  the  foremost  ranks  of  American  surgeons,  a 
man  of  original  ideas  and  a  pioneer  worker  in  all  he  undertakes. 
Under  these  circumstances  bis  views  on  any  subject  will  have  great 
weight  with  the  profession.  We  only  trust  that  time  and  expe- 
rience may  verify  the  truthfulness  of  his  theory — for  such  must  it 
be  until  otherwise  demonstrated.  His  theory  certainly  looks  logi- 
cal, if  comparison  is  ever  justifiable  as  a  working  basis.  From 
what  we  can  gather  in  the  garbled  medical  extracts,  the  original 
paper  having  as  yet  uot  been  published,  Dr.  Murphy's  theory  is 
this:  In  order  for  an  abscess  to  heal,  or  even  any  inflamed  tissue, 
the  parts  must  be  put  thoroughly  at  rest,  and  this  we  always  try  to 
do.  Now,  the  question  is,  if  the  lung  in  the  tuberculous  was  put 
absolutely  at  rest,  then  this  rest  would  give  the  tissue  time  to  re- 
pair. Dr.  Murphy  proposes  to  accomplish  this  by  filling  the 
pleural  cavity  with  uitrogeu,  and  thus  so  compress  the  lung  as  to 


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386       The  Atlanta  Medical  and  Sdbgical  Journal. 

reoder  its  activity  impossible.  This  gas  can  be  easily  removed 
wbeoever  the  condition  of  the  patient  demands  it,  and  thua  intervals 
of  rest  can  be  given  to  the  diseased  lung.  We  have  not  beard  as 
yet  whether  other  internal  medication  is  given.  We  wait  with  a 
good  deal  of  interest  for  the  time  when  this  treatment  has  been  tried 
au£Bcient1y  long  and  thoroughly  so  as  to  give  some  trustworthy 
data  upon  which  to  base  an  opinion.  Kew  remedies  for  the 
cure  of  consumption  are  frequently  brought  forth;  hence  it  is  that 
the  medical  profession  always  looks  to  find  out  who  the  originator 
is.  Dr.  Mnrphy  is  too  well  known  for  his  theory  not  to  be  given 
a  full  practical  trial.  The  old  adage,  that  "  there  is  nothing  new 
under  the  sun  "  certainly  seems  to  be  true.  Just  at  this  writing 
we  find  that  Dr.  W.  H.  Meyer,  of  Fort  Wayne,  comes  forward 
with  the  statement  that  the  "Murphy  method,"  or  "Chicago 
method,"  fur  treating  phthisis  is  not  new,  and  substantiates  bis 
statements  by  ample  quotations  from  a  recent  work  of  Dr.  Paget. 
He  says:  "In  Rome,  1894,  Professor  C.  Farlanini  read  notes  of 
cases  treated  by  forming  an  artificial  pneumothorax.  The  whole 
method  is  set  forth  in  vol.  3,  Proceedings  of  the  International 
Medical  Congress  for  1894.  Farlanini  stated  the  pleura  bears  air 
well,  but  that  nitrogen  is  preferable,  as  it  is  absorbed  more  slowly. 
The  therapeutic  results  were  local,  being  overpowered  by  the  gen- 
eral  conditiou  and  that  of  the  other  afFected  lung.  His  paper  went 
to  show  that  the  method  only  is  practical  where  the  lesion  is  lim- 
ited and  moDolateral.  The  discussion  was  by  Professors  Teneo, 
of  Pisa;  Slone,  of  Bondeno;  Sutherland,  of  North  London  Con- 
sumption Hospital.  The  latter  thought  the  rest  secured  of  great 
value.  The  same  views  were  held  by  Hilton  Flagg  in  1891.  In 
1881  Dr.  Herard,  Hotel  Dieu,  Paris,  stated  that  an  accidental  hydro- 
pneumothorax  arrested  phthisis  and  became  an  unboped-for  means 
of  safety  to  the  patient." 


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PHYSICIANS'  ACCOUNTS. 

It  is  said,  and  certainly  with  a  good  deal  of  truth,  that  physi- 
cians generally  make  a  living,  but  that  few  of  them  ever  lay  np 
much  of  this  world's  goods.  The  cause  of  this  is  twofold :  first, 
because  the  physician  is  notoriously  a  poor  business  man ;  and,  sec- 
ondly, because  the  profession  is  so  overcrowded  that  no  single  phy- 
sician is  apt  to  have  a  monopoly  of  professional  work.  Many  a 
poor  physician  would  be  well  off  if  he  could  only  collect  the  honest 
bills  that  were  due  him.  But,  for  some  unknown  reason,  posterity 
has  decreed  that  the  physician's  bill  shall  be  the  last  to  be  paid. 
This  we  think  is  largely  the  result  of  the  methods  usually  em- 
ployed by  physicians.  "The  laborer  is  worthy  of  his  hire,"  and 
the  physician  should  send  bis  hill  just  as  soon  as  his  work  is  com- 
pleted or  the  case  dismissed.  "Time  softens  many  a  wounded 
Jeeting"  is  true,  but  it  also  softens  the  spirit  of  payment  after  the 
patient  has  recovered.  Dr.  H.  C.  Wood's  remarks  are  certainly 
apropos : 

In  the  American  Medico-Swgical  Bulletin  for  June  25,  1898, 
Dr.  H.  C.  Wood  thus  discourses  concerning  "Physicians'  Ac- 
counts": 

"  If  it  be  desired  by  any  doctor  to  have  his  accounts  kept  in  such 
a  way  that  they  shall  bring  a  smile  of  approval  to  the  stern  judi- 
cial countenance,  he  should  keep  a  day>book,  in  which  should  be 
entered  the  particulars  of  the  visit,  when  it  was  made,  how  long 
it  continued,  what  was  done  and  medicines  were  given,  the  exact 
value  according  to  the  system  of  charging  adopted  of  such  medi- 
cine, the  charging  together  in  a  single  sum  for  'professional  ser- 
vices and  medicines'  being  a  'lumping'  of  charges  su£Gciently 
irritating  to  the  judicial  mind  to  produce  apoplexy  in  a  testy  judge, 
and  sure  to  be  thrown  out.     Probably  few  successful,  and  there- 


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388       The  Atlanta  Medical  and  Surqical  Jouknal. 

fore  busy  aod  overworked  physicians,  would  be  willing  to  become 
«  slave  of  tbe  day-book,  and  to  try  in  the  wee  hours  of  the  morn- 
iug  to  satisfy  the  judicial  interrogators.  Certainly  the  writer  of 
the  present  article  would  rather  be  thought  a  fraud  by  the  orphans' 
-court  judges  and  lose  various  hills  than  spend  such  a  life  of  toil  at 
tbe  galley-oar  of  accounts. 

"The  case  of  the  surgeon  is  still  more  dlEBcult.  The  details  of 
his  work  are  so  great  and  elaborate  that  the  amount  of  bookkeep- 
ing required,  according  to  the  advice  which  we  have  heard  given 
by  lawyers  of  repute,  would  be  overwhelming.  It  is  asserted  that 
the  surgical  book  of  original  entry,  to  be  satisfactory,  should  state 
how  many  visits  were  paid  before  and  afler  the  operation,  and 
should  also  show  exactly  what  was  done  and  the  time  consumed  in 
such  visits,  also  the  details  of  the  operations,  how  long  it  took  for 
etherization  and  other  preparation,  what  amount  of  ether  and  other 
materials  were  used  and  the  value  of  such  ether  and  other  mate- 
rials, what  was  done  at  each  stage  of  the  operation  in  detail,  and 
a  history  of  the  final  after-treatment;  also  the  number  of  assist- 
ants employed,  and  exactly  what  each  assistant  did.  In  fact,  if  it 
took  an  liour  for  the  operation,  it  would  probably  take  an  hour 
and  a  half  for  its  entrance  in  tbe  book  of  entry. 

"Under  all  the  circumstances,  it  appears  rather  strange  that  tbe 
physicians  are  paid  as  well -as  they  are,  not  that  they  lose  so  many 
accounts.  The  proper  measure  for  decreasing  the  percentage  of 
losses  seems  to  us  to  lie  not  so  much  in  proper  bookkeeping  as  in 
the  approximation  to  a  cosh  basis.     .     .     , 

"  All  this  issufBcient  to  make  an  old-fashioned  physician  shudder. 
We  shall  never  forget  the  hours  of  unrest  and  anger  produced  in 
one  of  tbe  old-time  doctors  by  a  patient  having  personally  asked 
him  for  a  bill  instead  of  writing  a  note.  'Just,'  as  the  old  gen- 
tleman said,  'as  if  I  were  a  carpenter  or  a  mason.'  Trade  methods 
in  their  best  aspects  are,  however,  afler  all  only  proper  methods  of 


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Editorial.  88^ 

dealing  between  man  and  mao;  and  if  the  profession  as  a  profes- 
sion desires  to  collect  its  just  pecuniary  dues,  such  trade  methods- 
must  be  to  a  greater  or  less  extent  adopted.  Long  credits  ought. 
to  be  abolished.  Kecently  an  account  was  rendered  in  our  or~ 
phaos'  court  for  services  rendered  during  a  period  of  five  years,  andi 
was  very  properly  thrown  out  except  for  the  last  year.  The  possi- 
bility of  fraud  in  such  an  account  is,  of  course,  very  obvious:  the- 
natoral  supposition  is,  that  the  physician  did  not  send  his  bill  be- 
oanse  he  was  afraid  he  would  not  get  it  from  the  patient  while- 
alive.  In  our  opinion,  the  law  should  not  allow  a  demand  for 
payment  of  aay  professional  service  to  be  made  more  than  a  year 
aAer  they  are  given.  The  right  procedure  for  a  doctor  is  to  ren- 
der his  account  at  least  every  six  months,  and  better  every  three- 
months.  A  few  of  our  leading  and  progressive  surgeons  in  Phil- 
adelphia are  now  having  their  bills  sent  in  monthly,  with,  as  they 
assert,  a  very  good  effect  upon  their  incomes. '^ 


CONSOLIDATION  OF  MEDICAL  COLLEGES. 

This  seems  a  year  of  consolidation,  certainly  as  far  as  medical' 
schools  are  concerned.  In  the  last  issue  of  The  Joubnal  we- 
spoke  of  the  union  of  the  Atlanta  and  Southern  Medical  Colleges, 
of  this  city,  forming  what  is  now  known  as  the  Atlanta  College  ot 
Physicians  and  Surgeons.  News  comes  to  us  of  still  further  unions 
in  this  direction. 

The  Niagara  University  Medical  College  and  the  Bu£blo  Uni- 
versity Medical  School  have  consolidated  under  the  Medical  De- 
partment ot-^the  University  of  Baltimore. 

The  Cornell  University,  of  Ithaca,  N.  Y,,  has  also  embraced, 
unto  itself  a  medical  department  by  reorganizing  and  taking  most 
of  the  men  Irom  the  old  New  York  Medical  College. 

The  University  of  the  Qty  of  New  York  has  appropriated  the- 


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390       The  Atlanta  Medical  and  Suroical  Joornal. 

old  Bellevue  Hospital  Medical  College,  and  benceforth  it  will  be  a 
department  of  that  ioatitution. 

We  canDot  but  ea^  that  we  are  glad  to  see  these  changes.  Id 
two  instances  two  medical  institutions  have  been  made  one,  thus 
reducing  the  number  of  medical  colleges  in  the  Uuited  States.  The 
number  of  medical  colleges  in  the  United  States  is  alarming,  and 
it  will  soon  be  so,  with  the  present  rate  of  increase,  that  each  State 
can  claim  the  existence  of  four  or  five  medical  colleges  within  its  bor- 
ders. Already  some  States,  and  even  citie3,are  farinexcessof  this. 
With  this  state  of  affairs  confronting  us,  we  can  but  bold  a  pessimis- 
tic view  of  the  future  medical  profession  in  this  country.  Medical 
colleges  are  beginning  to  be  nothing  more  than  money-making 
machines,  either  by  money  received  from  students  who  ought  to  be 
in  a  second-grade  country  school,  or  by  being  able  to  prefix  to  their 
names  the  word  professor  they  are  better  «iabled  to  deceive  the 
public  as  to  their  ability.  This  is  no  overdrawn  picture.  Then, 
again,  the  polyclinic  schools  are  doing  harm,  as  Dr.  Scheppegell, 
of  New  Orleans,  has  shown  in  a  recent  paper,  by  giving  students 
certificates,  after  an  attendance  of  six  weeks,  allowing  them  to 
branch  out  as  "full-fledged  specialists,"  thus  bringing  the  world 
of  specialism  into  still  more  disrepute.  The  field  of  medicine  cer- 
tainly does  not  oBer  an  inviting  Geld  for  young  men  of  brains. 
"But  the  end  is  not  yet." 


Odr  colaborer  and  editor.  Dr.  Luther  B.  Grandy,  has  entered 
the  volunteer  service  of  the  United  States  Army.  He  has  been  ap- 
pointed chief  surgeon,  with  the  rank  of  major,  in  the  Third  Kegi' 
ment  of  Georgia  Volunteers,  which  is  now  in  camp  at  GriEBn,  Ga. 
While  we  miss  bis  active  labors  on  The  Journal,  yet  we  expect  to 
hear  from  him  frequently,  giving  to  the  readers  of  The  Journal 
some  medical  items  with  warlike  tinge.  Our  best  wishes  go  with 
him  in  his  new  duties. 


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News  AND  NOTES. 


Dbs.  W.  S.  Elkin,  C.  E.  Murphy  and  F.  W.  McRae  attended 
the  last  aDuual  meeting  of  the  American  Medical  Aseociatioa,  in 
Itenver,  Col.  They  report  a  most  delightful  trip  and  a  most  pros- 
perous meeting. 


Db.  G.  p.  Robinson,  late  of  Boston,  Mass.,  has  settled  in  At- 
lanta, Dr.  Kobinson  will  limit  himself  to  the  practice  of  diseases 
of  children.  We  present  in  this  issue  an  article  from  bis  pen. on 
"Infant  Feeding." 


Dr.  F.  W.  McRae,  of  this  city,  was  recently  elected  to  deliver 
the  annual  address  on  surgery  at  the  next  meeting  of  the  American 
Medical  Association,  in  Columbus,  Ohio.  This  is  a  complimeut 
worthily  bestowed.  Medical  journals  will  please  note  that  the 
name  is  McRae  and  not  McCrea. 


Db.  Frank  S.  Bourns,  of  this  city,  has  been  appointed  chief 
surgeon  on  General  Merritt's  staff,  and  perhaps  has  already  arrived 
at  the  Philippine  Islands.  Dr.  Bourns  at  one  time  lived  for  four 
years  upon  the  Islands,  and  this  previous  knowledge  will  be  of 
great  value  to  General  Merritt  as  well  as  to  the  doctor  himself  in 
the  discbai^  of  bis  new  duties.  Dr.  Bourns  expects  to  return  to 
Atlanta  and  be  connected  with  the  new  College  of  Physicians  and 
Surgeons. 


Dr.  Luther  B.  Grandy,  Atlanta,  Ga.,  has  been  appointed  sur- 
geon, with  the  rank  of  major,  of  the  Third  Regimeat  Georgia 
Volanteers.      Governor   Atkinson    has   before  this  distinguished 


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392       The  Atlanta  Medical  and  Borqical  Jodekal. 

faimself  by  the  excellence  of  bis  medical  appoiDtmenta.  Scareely 
could  a  more  popular  Soutbera  surgical  commisetou  bave  been  issued 
than  the  one  to  Dr.  Grandy.  He  leaves  a  lAvge  and  influential 
practice  in  Atlanta  to  respond  to  the  call  of  his  coantry. —  Va.  Med, 
Semi-MontMy. 


Fort  McPhebson,  one  of  the  army  posts  erected  in  recent  years^ 
is  one  of  the  best  in  the  South.  It  is  situated  justoutaide  of  At- 
lanta's limit  and  readily  accesuble  by  street-car  lines.  Since  the 
beginning  of  the  Spanish-Amerioan  war  there  has  been  opened  a 
large  general  hospital,  to  which  the  wounded  may  be  sent.  It  will 
perhaps  be  the  central  point  for  the  Bouth,  in  that  Atlanta  is  so 
accessible.  The  hospital  can  accommodate  four  hundred  patients, 
and  perhaps  more  if  it  was  found  necessary.  The  main  buildings 
are  four  in  number  and  two  stories  in  height.  Each  building  is 
about  lOO  feet  in  length,  haa  porches  in  the  front  and  back,  and  has- 
four  main  wards  on  the  upper  floor,  with  a  number  of  smaller 
wards,  wash-rooms,  kitchens,  etc.,  on  the  lower  floor.  The  wards  are- 
well  lighted  and  well  ventilated.  There  is,  in  addition,  the  regular 
post  hospital  reserved  for  officers.  Each  ward  is  nsed  for  the  recep> 
ttOQ  of  one  class  of  cases.  At  present  there  are  occupied  two  sur- 
gical wards,  one  fever  ward,  one  ward  for  general  medical  cases  and< 
convalescents,  and  one  for  venereal  cases.  The  nurHing  is  in  the 
hands  of  a  trained  hospital  corps,  and  this  will  soon  be  supplanted 
by  a  force  of  trained  female  nurses. 


Db.  S.  C.  Ayebs,  of  Cincinnati,  has  been  elected  professor  of 
ophthalmology  in  the  Medical  College  of  Ohio,  the  medical  de- 
partment of  the  University  of  Cincinnati. 


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News  akd  Notes.  89S 

These  drug  houses  aottfy  us  that  they  will  stand  the  revenue- 
tax  on  their  preparations:  Peacock  Chemical  Co.  and  Sultan  Drug 
Co^,  St.  Louis. 


Jeffebson  Medical  College,  of  Philadelphia,  is  preparing  to  erect 
a  new  college  building  on  the  old  site.  It  will  be  eight  stories 
high,  and  when  completed  will  be  most  perfect  in  every  detail. 


Commodore  Geobge  Dewey,  the  hero  of  Manila,  is  the  son 
of  Dr.  Jnlius  Y.  Dewey,  first  president  and  medical  director  of  the 
National  Life  Insurance  Co.  of  Vermont.  His  brothers  still  live 
there. 


PaOFEssoB  Adam  Politzer,  the  well-known  otologist  of  Vi- 
enna, will  soon  occupy  his  own  chair  and  that  of  Professor  Gruher 
in  the  University  of  Vienna,  since  the  latter  has  resigned  this 
chair,  which  be  has  held  so  long  and  so  faithfully. 


We  note  that  some  of  the  most  distinguished  American  sui^eons 
have  given  up  a  lucrative  practice  in  order  to  offer  their  services 
to  their  country.  Some  of  those  who  have  enlisted  are  Drs.  Nico- 
las Senn,  George  Ityerson  Fowler,  Wm.  H.  Daly,  Donald  McLean, 
and  a  host  of  other  well-known  surgeons. 


Memphis  has  just  completed  its  new  City  Hospital,  at  a  cost  of 
f70,000.  It  is  first-class  in  every  respect,  being  supplied  with 
enameled  bedsteads,  electric  elevators,  indoor  telephones,  a  hand- 
some and  thoroughly  sterilizabie  operating-room,  etc.  There  will 
he  a  training-school  for  nurses  attached  to  the  hospital. 


The  American  Association  of  Genito- Urinary  Surgeons  met  at 
Vest  Point  June  7th  and  8th.     Dr.  James  Bell,  of  Montreal,  was 


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894       The  Atlanta  Medical  and  Surqical  Journal. 

made  president,  Dr.  Samuel  Alexander,  of  New  York,  vice-preei~ 
deot,  aad  Dr.  William  K.  Otis,  of  New  York,  secretary  and  treas- 
urer.   Tbe  uext  meeting  will  be  at  Niagara  Falls,  May,  1899. 


The  Memphis  Hospital  Medical  College  has  decided  for  the 
future  to  postpone  the  regular  commencement  of  the  work  of  the- 
curriculum  until  November  1st,  for  the  reason  that  this  date  better 
suits  the  convenience  of  the  students,  whose  tuition-fees  are  only 
forthcoming  after  tiie  harvesting  of  the  cotton  crop.  This  arrange- 
ment will  prove  beneficial  to  both  sides. 


In  view  of  persistent  charges  of  mismanagement  preferred  by  Dr. 
Chas.  B.  Kelsey,  who  was  formerly  a  member  of  the  faculty  of  the 
New  York  Post-Gradnate  School,  the  State  Board  of  Charities  has 
finally  decided  to  investigate  the  matter,  and  the  same  is  now  going 
on  behind  closed  doors.  The  chief  charge  seems  to  be  that  money 
donated  for  the  endowment  of  special  beds  or  other  purposes  had 
been  used  for  paying  current  expenses,  a  total  of  985,000  having 
been  thus  diverted. 


Mb.  David  H.  King,  Jr.,  of  New  York,  has  offered  to  the  gov- 
ernment the  use  of  his  residence  and  estate  on  Jekyl  -  Island,  off 
Brunswick,  Ga.,  without  cost  or  restriction,  as  a  military  hospital 
until  tbe  close  of  the  war.  Jekyl  Island  is  owned  by  a  club,  and 
is  rarely  visited  by  any  but  its  members.  Half  a  million  dollars 
have  been  expended  upon  it,  and  it  has  been  transformed  from 
dreary  sand  and  rioting  foliage  into  a  beautiful  pleasure  ground. 
Tbe  residence  is  a  new  and  handsome  cue  and  would  form  an  ideal 
convalescent  hospital  for  wounded  soldiers  and  sailors. — Med.  JVews. 


The  Marine  Hospit&l  Service,  July  9,  gave  out  the  following 
copy  of  a  report  from  the  surgeon  in  chaise  at  McHenry,  Miss.^ 


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News  and  Notes.  895 

aoDouDcing  the  discharge  of  the  last  case  of  yellow  fever  at  that 
point.  It  was  dated  July  8,  and  reads:  "Last  of  yellow  fever  dis- 
charged; tent  and  bedding  in  steam  disinfector;  under  treatcaent, 
none;  suspicious,  none;  will  continue  doing  sanitary  work."  This 
leaves  the  entire  country  without  a  case  ef  yellow  fever.  While 
the  cases  at  McHenry  have  been  under  treatment  sui^ons  of  the 
Marine  Hospital  Service  have  been  inspecting  and  watching  care- 
fully many  other  points  where  it  was  thought  possible  the  fever 
might  appear,  but  no  cases  have  developed.  The  success  which  has 
followed  the  oonGning  and  stamping  out  of  the  disease  at  McHenry 
is  attributed  to  the  early  knowledge  of  the  first  case  and  the  rigor- 
ous and  painstaking  action  taken  immediately  by  the  Service  and 
State  authorities.  The  State  authorities  have  cooperated  in  the 
work  of  watching  for  and  controlling  the  disease.  The  Service 
has  kept  under  surveillance  not  only  the  sick  and  suspicious, 
but  has  followed  refugees  to  many  points  and  kept  watch  over 
them  as  a  safeguard  against  any  possibility  of  the  disease  ap- 
pearing in  any  quarter  and  remaining  temporarily  undiscovered. 
The  statement  given  by  the  Marine  Hospital  Service  makes  the  total 
number  of  cases  at  McHenry  2S;  at  Euculla,  1;  total,  24;  deaths, 
none.  

The  First  Nathan  Lewis  Hatfield  Prize  porObiginal 
Research  is  Medicise. — The  College  uf  Physicians  of  PhiladeU 
phia  announces  through  its  committee  that  the  sum  of  five  hundred 
dollars  will  be  awarded  to  the  author  of  the  best  essay  in  compe- 
tition for  the  above  prize.  Subject:  "A  Pathological  and  Clinical 
Study  of  the  Thymus  Gland  and  its  Relations." 

Essays  must  be  submitted  on  or  before  January  1st,  1900.  Each 
essay  must  be  typewritten,  designated  by  a  motto  or  device,  and 
accompanied  by  a  sealed  envelop  bearing  the  same  motto  or  device 
and  containing  the  name  and  address  of  the  author.  No  envelope 
will  be  opened  except  that  which  accompanies  the  successful  essay. 


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896       The  Atlanta  Medical  and  Sdkgical  Jocbnal. 

The  committee  will  return  the  unsuccessful  essays  if  reclaimed 
by  their  respective  writers  or  their  agents  within  one  year.  The 
committee  reserve  the  right  Dot  to  make  ao  award  if  no  essay  sub- 
mitted is  considered  worthy  of  the  prize. 

The  treatment  of  the  subject  must,  io  accordance  with  the  ooo- 
dittons  of  the  Trust,  embody  ori^ual  observations  or  researches  or 
original  deductions.  The  competitioa  shall  be  open  to  members 
of  the  medical  profession  and  men  of  science  in  the  United  States. 

The  original  of  the  successful  essay  shall  become  the  property 
of  the  College  of  PhysioiaoB.  The  trustees  shall  have  full  control 
of  the  publication  of  the  memorial  essay.  It  shall  be  published 
in  the  Transactions  of  the  College,  and  also,  when  expedient,  as  a 
separate  issue.  Address  J.  C.  Wilson,  Chairman  Collie  Physi- 
cians, 219  South  Thirteenth  St.,  Philadelphia,  Pa. 


Mrs.  Faddb,  Faith*curist:  "  How  is  your  grand&ther  this  morn- 
ing, Bridget?" 

Bridget;  "He  still  thinks  he  has  the  rheumatism  mighty  bad, 

«  You  mean  he  thinks  he  has  the  rheumatism.  There  is  no  such 
thiug  as  rheamatism." 

A  few  days  later: 

"And  does  your  graadfather  still  persist  in  bis  delusion  that  be 
has  rheumatism  ?  " 

"No,  mum;  the  poor  man  thinks  now  thot  he  is  dead.  We  buried 
um  yisterday." — IndtanapolU  Journal, 


Caatidy  (reading) — It  siz  here  that  boicoicle  scorching  makes  a 
mon  gray-haired,  round-shouldered,  narrow-chisted,  bow-legged, 
sailer-faced  and  bump-backed. 

Regan  (who  is  deaf) — Bebivins !  that's  only  too  true,  Casaidy  ; 
and  still  min  will  kape  on  gittio'  married. — Puck. 


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BOOK  REVIEWS,    PAMPHLETS,   BXCHANOBS. 


The  lAvmg  Age  is  sdll  a  welcome  visitor  on  our  exchange  table. 
It  always  contaioa  much  that  is  worth  reading,  and  each  number  is 
complete  in  itself.      , 


IS.  Sbabf  &  DoHHE  have  just  issued  a  nice  looking  and 
complete  price-list.  No  doubt  they  will  be  glad  to  mail  a  copy  to 
any  physiciao  who  requeete  it. 


The  following  pamphlets  and  repriuta  have  been  received  : 

New  Forceps  for  iDtestinal  Anastomosis.  By  Ernest  Laplace, 
M.D.,  LL.D. 

Auto-IntoxicatioQ  in  its  Relations  to  the  Diseases  of  the  Ner- 
vous System.     By  Daniel  R.  Brower,  M.A.,  M.D.,  Chicago. 

Some  Observations  on  the  Treatment  of  Tabes  Dorsalis.  By 
Daniel  R.  Brower,  M.A.,  M.D.,  Chicago. 

Michigan  Monthly  Bulletin  of  Vital  Statistics. 


EXCHANQBS. 


The  Memphi$  Lancet  is  a  new  monthly  journal  which  is  wel- 
comed among  our  exchanges.  To  judge  whatever  of  its  career  by 
its  initial  number,  success  certainly  seems  assured.  The  Lancet  cer- 
tainly has  an  able  corps  of  editors,  and  none  the  least  among  them 
is  our  good  friend  Dr.  E.  C.  Ellett.  We  wish  the  new  journal 
success. 


"Medical  Libraries"  is  a  new  publication  which  has  just  made 
its  initial  appearance.  Its  chief  aim  as  stated  is,  "  to  encourage 
Uie  founding  of  medical  libraries  and  medical  departments  in  pub- 
lic libraries  wherever  the  medical  profession  is  &irly  organized." 
This  is  certainly  a  worthy  project,  and  should  be  enconn^^  ia 


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398       The  Atlanta  Medical  ahd  Surgical  Journal. 

every  way  possible.  We  are  glad  to  welcome  this  publication  Id 
our  list  of  exchanges.  It  is  edited  by  Dr.  C.  D.  Spivak,  in  Den- 
ver, Col, 


BOOK  REVIEWS. 


The  Treatment  of  Choleraic  Diarrhea.     Published  by  the 
Lambert  Pharmaeal  Co.,  St.  Louis. 

This  is  a  small,  neatly  bound  in  cloth  book,  giving  reports  of 
cases  and  their  treatment  with  drugs  put  out  by  the  publishers. 
Though  more  expensive  than  the  average,  the  book  will  be  sent 
gratis  to  physicians  who  request  it. 


Report  op  the  Comhissioneb  of  Education  for  the  Year 

1896-7.    Vol.  L 

We  have  just  received  the  first  volume  of  this  work  from  Wash- 
ington. Judging  by  this  volume,  the  work  taken  altogether  will 
be  very  valuable.  It  contains  matter  concerning  education,  both 
here  and  abroad,  which  will  make  it  an  invaluable  reference  book. 


A  CoMPEND  OF  Diseases  of  the  Skin.  By  Jay  F.  Bchamberg, 
A.B.,M.D.  Associate  in  Skin  Diseases,  Philadelphia  Polyclinic; 
Dermtttologist  to  the  Union  Mission  Hospital,  etc.  99  illustra- 
tions. Philadelphia,  P.  Blakiston's  Son  &  Co.  1898.  Price, 
80c.  net. 

This  is  a  very  small  and  concise  book.  Suitable  for  quick  refer- 
ence or  review  study.  The  best  authorities  and  their  illustrations 
have  been  liberally  used  in  the  preparation  of  the  book.  It  will 
suit  for  the  purpose  intended.  M.  B.  h. 


Atlas  and  Abstract  op  the  Diseases  of  the  Laeynx.  By 
Dr.  L.  GrQnwald,  of  Munich.  Authorized  Translation  from  the 
German.  Published  by  W.  B,  Saunders,  Philadelphia.  Price, 
J2.50. 

This  volume  is  one  of  the  series  of  Atlases  which  are  now  being 
published  by  this  well-known  house.  Like  all  of  the  others,  it  is 
excellent.     The  main  feature  of  the  Atlas  is,  of  course,  the  colored 


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Book  Reviews.  399 

"platee  representiDg  the  various  diaeases  of  tbe  larynx.  We  niiiRt 
say  that  these  are  beautifully  executed,  aod  will  give  one  a  moat 
-excellent  idea  of  tbe  disease  which  tbe  plate  represents.  Accom- 
panying each  plate  is  the  history  of  the  case  which  it  represents, 
which  therefore  is  doubly  interesting.  The  laryngologist  will  find 
this  volume  a  most  excellent  addition  to  his  library.  The  pub- 
lishers are  certainly  to  be  congratulated. 


OONSEBVATIVE  GYNECOLOGY  AKD  ELECTK0-THBEAPEtJTIC8.  A 
Practical  Treatise  on  the  Diseases  of  Women  and  their  Treat- 
ment by  Electricity.  Third  edition.  Revised,  rewritten  and 
greatly  enlarged.  By  G.  Betton  Massey,  M.D.,  Physician  to 
the  Gynecic  Department  of  Howard  Hospital,  Philadelphia; 
Late  Electro-Therapeutist  to  the  Infirmary  for  Nervous  Diseases, 
Philadelphia ;  Fellow  and  ex-Presideut  of  the  American  Electro- 
Therapeutic  Association,  of  the  Soci^t6  Fran^aise  d'Eiectrothera- 
pieof  the  American  Medical  Association,  etc.  Illustrated  with 
twelve  full-page  original  chromo-lithographio  plates  in  twelve 
-colors,  numerous  fulUpage  original  half-tone  plates  of  photographs 
taken  from  nature,  and  many  other  engravings  in  the  text.  Royal 
octavo.  400  pagee.  Extra  cloth,  beveled  edges,  $3.50  net. 
The  F.  A.  Davis  Co.,  Publishers,  1914-16  Cherry  St.,  Philadel- 
phia; 117  W.  Forty-second  St.,  New  York  City;  9  Lakeside 
Building,  218-220  S.  Clark  St.,  Chicago,  III. 

The  third  edition  of  this  work  by  Dr.  Massey  has  just  been 
Issued  from  the  publishers'  press .  It  shows  many  changes  of  value 
And  almost  makes  a  new  book.  The  colored  plates  showing  the 
-different  diseases  of  the  cervix  uteri  are  most  beautifully  executed. 
Tbe  work,  ofcourse,  treats  principally  of  the  electric  treatment  of  the 
various  diseases  found  in  the  range  of  the  gynecologist.  No  one 
can  now  doubt  the  eEBcacy  of  this  mode  of  treatment  in  a  large 
number  of  cases  which  consult  the  gynecologist.  Dr.  Massey  is  a 
{uoneer  worker,  and  this  volume  of  his  is  exceedingly  clear  and  ex- 
plicit. Being  familiar  with  electric  appliances.  Dr.  M.  has  made 
tbe  subject  so  clear  as  to  be  understood  by  everj'  physician.  We 
predict  a  rapid  demand  for  this  new  edition.  It  is  certainly  a  val- 
oable  work. 


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400       Thb  Atlanta  Medical  and  Sukgical  Journal. 

A  System  of  Pbactical  Medicine.  By  American  Authors. 
Edited  by  Alfred  Lee  Loomis,  M.D.,'Late  Professor  of  Pathol- 
ogy  and  Practical  Medicine  in  the  New  York  University,  and 
■  William  Gilman  Thompson,  M.D.,  Professor  of  Medicine  in  the 
Cornell  University  Medical  College,  New  York.  In  four  impe- 
rial octavo  volumes.  Volume  IV. — Diseases  of  the  Nervous 
System  and  Mind;  Vasomotor  and  Trophic  Disorders;  Diseases 
of  the  Muscles;  Osteo-Malacia;  Rachitis;  Kheumatism;  Arthri- 
tis; Gout;  LithEemia;Obe8ity;Scurvy;  Addison's  Disease.  1099 
pages,  95  engravings,  and  8  full-page  plates  in  colors  and  mono- 
chrome. For  sale  by  subscription.  Per  volume,  cloth,  $5.00; 
leather,  $6.00;  half-morocco,  f  7.00.  Lea  Brothers  &  Co.,  Pub- 
lishers, Philadelphia  and  New  York.     1898. 

This,  the  fourth  and  last  volume  of  this  most  excellent  work,  is 
before  us.  The  authors  have  certainly  done  their  work  well,  and 
no  less  can  be  said  of  the  publishers.  It  is  a  monumental  work 
and  will  long  live  as  such  to  the  name  of  both  its  editors.  The 
authors  for  the  various  subjects  treated  in  this  volume  have  been 
well  selected,  just  as  they  have  been  for  all  the  previons  volumes, 
and  there  is  no  lack  of  thoroughness  in  every  detail.  As  a  refer- 
ence book  to  the  System  of  Medicine  it  has  no  superior.  It  is 
obliged  to  meet  with  success. 


Hay  Fever  and  Its  Successful  Treatment.  By  W.  C.  Hol- 
Iopeter,'A.M.,  M.D.,  of  Philadelphia.  Published  by  P.  Blakis- 
ton's  Son  &  Co.,  Philadelphia.     Price,  $1.00  net. 

This  little  brochure  is  just  before  ua.  The  author  has  this  to 
say  in  his  pre&ce:  ''Having  had  remarkable  and  uniform  success 
with  a  simple  treatment  of  bay-fever  for  the  last  ten  years,  during 
which  time  I  have  given  complete  relief  to  crver  two  hundred  pa- 
tients in  my  private  practice,  and  having  made  a  thorough  clinical 
study  of  this  affection,  as  well  as  an  exhaustive  review  of  the  lit- 
erature relative  to  it,  I  feel  justified  in  presenting  the  results  of  my 
labors  in  this  short  treatise." 

This  statement  we  consider  remarkable,  for  if  the  treatment  has 
been  "uniformly  successful,"  then  Dr.  Hollopeter  has  given  to  tbe^ 
world  one  of  the  most  remarkable  cures  in  recent  years,  and  a  boon. 


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Book  Reviews.  401 

to  hundreds  of  sufferers  who  have  looked  io  vaia  for  this  "balm  of 
Gilead." 

The  author  has  given  us  a  most  excelleot  review  of  the  history 
of  hay-fever,  and  also  of  the  literature  bearing  upon  the  subject. 

The  history  of  hay-fever  embraces  twelve  pages;  its  exciting 
causes  seventeen  pages;  its  predisposing  oauses  twenty-five  pages; 
and  then  follows  the  time  of  occurrence,  duration,  symptoms,  com- 
plications and  sequelte,  pathology,  diagnosis,  prognosis  and  treat- 
ment. 

The  author  says  he  has  been  uniformly  successful.  To  sum  up 
in  bi^  own  words,  his  treatment  consists  entirely  in  this :  "  By  a 
daily  sterilization  of  the  nares  and  post-nasal  spaces,  the  victims  of 
bay-fever  may  remain  in  the  city  attending  to  their  usual  duties 
surrounded  by  dust,  or  iu  the  country  amid  blooming  flowers." 

The  method  of  sterilizing  these  parts  is  given  and  the  remedies 
used.  It  seems  strange  that  so  simple  a  treatment  was  never  dis- 
covered before.  Experience  alone  will  justify  the  author's  con- 
clusions. 


SuBoiCAL  Hints. 


Never  allow  rubber  plaster  to  come  in  contact  with  a  surface 
uncovered  by  normal  skin.  Since  it  cannot  be  sterilized  by  heat, 
it  must  be  considered  as  dirty. 

Before  operating,  always  find  out  whether  the  patient  has  any 
malarial  history.  The  discovery  of  this  &ct  will  save  you  many  a 
bad  scare  when  temperature  rises  suddenly  after  operation. 

As  long  as  any  urine  issues  from  the  urethra  it  cannot  be  said 
that  there  is  au  impassable  stricture.  Patience  and  gentleness  will 
do  wonders.  The  most  skilful  surgeons  see  very  few  strictures  that 
prove  impassable. 

An  aseptic  dressing  placed  over  a  wound  that  is  expected  to  unite 
by  first  intention  should  be  left  undisturbed  until  it  is  time  to  re- 
move the  stitches,  or  until  there  is  reason  to  believe  that  the  case 
is  not  running  the  expected  aseptic  course. — International  Journal 
of  Surgery. 


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SBLECTiONS  AND  ABSTRACTS* 


Should  all  Milk  Used  fob  Infant  Feeding  be  Heated  foe 
THE  Purpose  of  Killing  Qekmb  ?     If  so,  at  "What  Tem- 

PBRATUBE  AND  How  LONQ  CONTINUED?* 

AlthoDgh  ID  this  paper  I  will  preseDt  do  new  facts,  I  hope  to 
be  able  to  make  niy  remarkB  intereatiDg  by  presenting  to  you  a 
summary  of  the  answers  I  have  received  to  the  questions  I  eeut 
to  the  members  of  the  Society  relating  to  the  heating  of  milk  for 
the  deetruclioD  of  germs.  I  wish  also  to  express  my  thanks  to 
the  members  of  the  Society  for  their  very  courteous  co-operation, 
which  has  made  it  possible  to  present  this  summary  of  the  opin- 
ions of  many  of  the  most  prominent  pediatrists  of  the  country. 
The  questions  I  sent  out  were  rather  hurriedly  drawn  up  and  were 
not  perhaps  as  definite  in  their  meaning  as  they  should  have  been ; 
but  iu  general  the  answers  received  gave  evidence  that  they  were 
understood  as  was  intended. 

I  have  received  37  answers,  of  which  34  were  categorical  and 
3  in  the  form  of  letters.  One  of  these  letters  gave  details  of  a 
process  used  by  the  writer  in  which  the  milk  was  twice  boiled, 
while  two  letters  gave  no  details,  and  were  thus  not  suitable  for 
this  purpose. 

In  answer  to  the  first  question,  "Do  you  consider  that  milk  ig 
rendered  more  digestible  by  sterilization  or  pasteurization?"  the 
answers  were ;  Yes,  3 ;  a  qualified  yes,  1 ;  no,  19  ;  a  qualified  no, 
4;  while  three  thought  it  less  digestible  when  sterilized,  and  four 
more  digestible  when  pasteurized.  The  great  majority,  then,  con- 
sider that  heating  does  not  render  the  milk  more  digestible. 

In  answer  to  the  second  question,  "  Is  sterilization  or  pasteuriza- 
tion to  be  advised  for  this  purpose?"  the  answers  are  as  follows: 
Yes,  1;  qualified  yes,  1 ;  no,  21;  qualified  no,  1;  pasteurization,  5. 

The  third  question,  "  Would  you  recommend  that  milk  should 

t,  twlore  the  Anurlcui  FedlMrlc  So- 


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Selections  and  Abstracts.  403 

always  be  heated  for  this  purpose?"  was  answered  as  follows: 
Yes,  3 ;  qualified  yes,  4 ;  do,  25 ;  qualified  no,  1.  It  is  thus  evi- 
■dent  that  a  very  lai^e  proportion  of  these  gentlemen  believe  that 
milk  may  be  fed  raw  under  certain  conditions. 

The  fourth  question,  "If  not  always,  when,  if  ever,  is  it  imper- 
ative?" The  answers  may  in  general  be  grouped  as  follows: 
Always,  1 ;  when  not  kept  cold  or  in  summer,  17;  in  gastric  or 
-enteric  disorders,  4 ;  when  dairy  hygiene  is  questionable,  12;  during 
epidemic  of  scarlet  fever,  measles,  cholera,  or  typhoid  fever,  1 ; 
when  milk  is  old,  3;  in  cities,  7. 

The  fifth  question,  "Bo  you  prefer  pasteurization  or  steriliza- 
tion?" brought  the  following  answers:  Pasteurization,  23 ;  pas- 
teurization under  certain  circumstances,  6;  sterilization,!.  la- 
-cludiDg  the  latter  mentioned  before,  we  would  have  2  preferring 
«terilization ;  one  prefers  pasteurization  in  private  practice  and 
sterilization  in  hospital  work. 

As  to  the  temperature  for  pasteurization:  1  uses  140"  for  15 
minutes;  1,  150*^  for  30  minutes;  2,  155°  for  30  minutes;  1, 
165°-158°  for  15  minutes;  3,  155°-163°  for  15-30  minutes;  I, 
160°  for  20  minutes;  1, 160°-167°  for  20-30  minutes;  1,160°-170° 
for  36  minutes;  1,  160°-177°  for  20-30  minutes;  1,  160°-170  for 
35  minutes;  1,  165°  for  35  minutes;  18,  167°  for  intervals  rang- 
ing from  6  to  35  minutes,  the  majority  being  from  20  to  30  minutes; 
1,  according  to  Walker-Gordon  method. 

The  question  concerning  the  duration  of  sterilization  was  an- 
swered by  only  13  members,  the  time  varying  from  15  minutes  to 
1}  hours. 

The  last  question,  "Are  there  any  practical  disadvantages  in 
beating  milk  for  sterilization?"  brought  forth  a  variety  of  answers, 
■as  follows:  Yes,  2;  no,  2;  less  digestible,  7;  sterilized  milk  less 
-digestible,  3 ;  less  nourishing,  6;  possibly  a  contributing  factor 
in  scurvy,  8 ;  objectionable  taste,  4  ;  objectionable  odor,  1 ;  change 
ID  color  of  milk,  1;  destroys  emulsion,  1;  cream  not  evenly  mixed, 
1 ;  constipating,  2;  household  sterilization  unsatisfactory,  1. 

These  replies  seem  to  show  a  remakable  unanimity  of  opinion 
-of  the  members  of  the  Society  throughout  the  country,  the  predom- 
inating opinion  being  that  raw  milk  would  be  the  best  food  were 


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404       The  Atlanta  Medical  and  Soroical  Journal. 

it  possible  to  obtain  it  clean,  wbile  a  coDsiderable  number  are  evi- 
dently willing  to  take  their  chaDcee  witb  raw  milk  during  certaio 
seasons  of  the  year  and  under  certain  conditions  of  dairy  bygiene. 

It  was  therefore  surprising  to  me  tbat  more  of  the  members 
had  not  made  use  of  pastenrizatioo  at  a  temperature  lower  than 
167°  F.  There  seems  ample  evidence  tbat  155°  F.  for  30  minutes 
(a  temperature  exposure  which  does  not  change  the  taste  of  tbe 
milk)  is  sufficient,  but  only  six  of  the  replies  advocate  ibis  tem- 
perature. One  answer,  which  coincides  very  uearly  with  my  views, 
comes  from  Dr.  Victor  C.  Vaughn,  of  the  University  of  Michigan,, 
whose  authority  in  such  matters  is  widely  recognized.  This  I  will 
take  the  liberty  to  present  in  full : 

"  Deab  Sir — I  will  answer  your  questions  as  follows  : 

"I  do  not  think  that  milk  is  rendered  more  digestible  by  steril- 
ization or  pasteurization. 

"  2.  Sterilization  or  pasteurization  is  not  advised  for  the  purpose- 
of  rendering  milk  more  digestible. 

"  3.  If  milk  could  be  obtained  from  healthy  animal  under  com- 
plete aseptic  precautions,  I  do  not  think  it  would  be  necessary  or 
desirable  to  have  it  heated  before  feeding  it  to  children. 

"4.  Practically,  sterilization  or  pasteurization  is  imperative,  be- 
cause milk  is  not  obtained  at  all  times  from  healthy  cows,  and 
very  rarely,  if  ever,  under  aseptic  precautions. 

"  5.  I  prefer  pasteurization  to  sterilization.  Pasteurization, 
should  be  carried  out  at  a  temperature  of  155°  to  158°  F.  When 
milk  is  heated  to  160°  F.,  it  is  so  changed  that  a  marked  difference- 
in  taste  is  produced. 

"  6.  I  think  that  a  temperature  o(  155°  to  158°  F.,  maintained 
for  fifteen  minutes,  is  sufficiently  active  to  kill  toxicogenic  germs- 
that  may  be  present,  provided  that  the  milk,  after  having  been 
heated,  be  kept  at  a  very  low  temperature.  The  keeping  of  milk 
at  a  low  temperature  after  heating  and  before  it  is  fed  to  tbe  child 
is,  I  think,  absolutely  necessary,  because  we  know  that  even  boil- 
ing does  not  destroy  the  spores  of  certain  harmful  germs  in  milk; 
but  these  spores  do  not  develop  at  a  low  temperature,  and  there  is 
reason  for  believing  that  these  germs  do  not  develop  in  the  body. 


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Selections  and  Absteacts.  405 

"7.  If  milk  is  sterilized,  I  think  fifteen  minutes  long  enough 
time. 

"  8.  Theie  are  practical  disadvantages  in  heating  milk  for  eter- 
ilizatioD,  Some  of  these  practical  disadvantages  are  inbereqt  and 
others  are  accidental  and  avoidable." 

It  does  not  seem  to  me  that  our  dairy  bygine,  even  under  the 
beat  circumstances,  has  reached  a  point  -where  it  can  produce  a  raw 
milk  which  ia  absolutely  safe  food.  Cow's  milk  must  be  obtained 
by  pressure  on  the  teats  of  a  cow,  and  these  teats  hang  beneath  an 
udder  which  is  covered  with  hair,  and  from  the  belly  of  the  cow 
which  is  also  cevered  with  the  same  hair-covered  hide.  Moreover, 
,  thi^  portion  of  the  cow  is  particularly  liable  to  be  soiled  with  dirt, 
as  it  comes  in  contact  with  the  ground  when  the  cow  lies  down. 
Its  hairy  covering,  moreover,  holds  the  dirt,  which  is  gradually 
shaken  out  by  friction.  If  the  cow  has  loose  fecal  movements, 
these  run  down  the  inner  surface  of  the  thighs  and  the  posterior 
portion  of  the  udder.  The  contamination  dries  on  the  udder  in 
the  air,  and  during  milking  ia  apt  to  fall  as  dust  into  the  pail. 
Moreover,  the  milk  ducts  of  the  cow  may  contain  many  bacteria, 
although  usually  contamination  from  this  source  is  not  great.  In 
some  cases,  howevec,  it  is  considerable,  and  then  it  is  not  always 
eliminated  by  throwing  away  the  milk  from  the  first  few  squeezes 
of  the  teat.  I  have  found  it  present  in  the  milk  forced  out  by 
even  the  fortieth  squeeze.  Milk  may  thus  become  contaminated  in 
the  milk  ducts,  and  at  any  rate  has  to  be  obtained  from  a  bad  im- 
mediate environment.  Many  efiforts  are  being  made  to  minimize 
these  dangera,  but  with  the  best  methods  now  used  they  still  exist 
to  a  considerable  extent. 

But  this  is  not  all.  The  milkman's  hands  are  almost  never 
clean,  and  of  necessity  hardly  can  be.  The  milkman  must  labor 
hard  with  his  hands  all  day,  causing  a  thick,  rough  callus,  which 
is  difficult  to  clean,  if  an  effort  to  clean  them  is  made.  His  hands 
are  employed  in  handling  manure,  and  iu  attending  to  many  du- 
ties involving  contamination.  Occasionally  they  are  used  during 
the  day  in  waiting  on  some  one  sick  with  a  contagious  disease,  and 
when  such  is  the  case  the  consumers  of  the  milk  are  apt  to  suffer. 


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406       The  Atlanta  Medical  and  Surgical  Journal. 

If  wet  milkiag  is  used,  the  milkmaa's  hanclB  are  practicalljr  waghe<} 
over  the  milk-pail. 

We  have  here  again  in  the  mikrnan  a  danger  to  the  milk  which 
cannot  yet  be  eliminated,  and  even  with  great  eai'e  on  the  part  of 
the  dairy  superintendent,  it  will  be  difficult  to  entirely  do  away 
with  these  dangers. 

Epidemics  due  to  milk  have  originated  from  a  mild  unrecog- 
nized case  of  typhoid  in  a  milkman,  also  from  a  beginning  diph- 
theria in  a  milkman.  Such  sources  of  danger  may  exist  in  very 
carefully  conducted  dairies,  although  the  liability  to  them  is  much 
diminished. 

It  haB  seemed  to  me  worth  while  to  go  over  these  dangers  to- 
milk  and  to  consider  the  difficulty  in  eliminating  them  in  connec- 
tion with  the  matter  of  heating  milk,  to  shpw  how  difficult  this 
problem  of  obtaining  clean  milk  really  is. 

The  original  contamination  of  milk  up  to  the  time  of  hottliug^ 
in  well-conducted  dairies  where  great  efforts  are  made  to  obtain 
clean  milk,  rarely  amountslto  less  than  five  thousand  bacteria  in 
each  c.  c.  By  the  time  such  milk  reaches  the  consumer  the  con- 
taroination  is  still  greater,  and  if,  as  is  usnal,  the  milk  is  used  during- 
the  twenty-four  hours  following  delivery,  itis  apt  to  he  very  con- 
siderable before  a  fresh  supply  arrives,  and  is  probably,  as  a  rule, 
something  between  fifty  thousand  and  five  millions  s  c.  c,  or  is,, 
roughly,  between  three  thousand  and  three  hundred  thousand  a 
drop.  These  bacteria  are  for  the  most  part  air  bacteria,  but  they 
may  be  putrefactive  bacteria,  or  toxin-producing  bacteria,  or  path- 
ogenic bacteria,  and  thus  may  produce  in  the  iniant  that  is  fed  on 
the  milk  a  gastro-euteritis  or  acute  poisoning,  or  the  infections  dis- 
ease of  which  the  special  organism  present  is  the  canse.  Many  in- 
stances representing  each  of  these  classes  of  illness  due  to  milk 
have  been  reported. 

Does  it  seem  right,  in  view  of  what  we  know  of  the  bacteriology 
of  mother's  milk,  to  give  such  contaminated  milk  raw  to  infants? 

It  has  seemed  to  me  that  although  fresh  uncooked  milk  is  the 
ideal  and  rational  form  for  infant  feeding,  the  practical  impossi- 
bility of  obtaining  cow's  milk  clean  has  rendered  some  form  of 
sterilization  necessary.     It  does  not  seem  fair  to  put  into  an  in- 


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Selections  and  Abstracts.  40T 

&Dt'8  ntomacb  a  food  contaiaing  thousands  of  bacteria  in  each 
drop,  these  bacteria  heiog  of  unknown  quality  and  very  possibly  of 
dangerous  and  pathogenic  nature. 

For  the  present,  then,  some  sort  of  sterilization,  it  seems  to  me,, 
must  be  used.  High  temperature  sterilization  causes  certain  chem- 
ical changes  in  milk.  The  change  in  the  taste  of  milk  occurs  at 
70"  C.  (158°  F.),  and  the  changes  found  by  chemists  begin  with. 
a  temperature  of  about  8U°  C.  (176°  F.)  Clinically,  it  has  been 
observed  that  children  fed  on  milk  heated  to  a  boiling  temperature 
do  not  thrive  as  those  fed  on  raw  milk,  and  also  that  this  bottled 
food  seems  to  be  a  predisposing  cause  of  scurvy.  On  this  account, 
iben,  it  would  seem  that  the  lowest  temperature  which  is  efficient 
should  be  used  for  sterilizing^  Moreover,  a  lower  temperature 
continued  for  a  long  time  is  as  sufficient  in  its  bactericidal  action 
as  a  much  higher  temperature  for  a  very  shorC  period.  We  should, 
then,  use  a  temperature  for  heating  which  is  the  lowest  whicbt- 
when  oontiuued  for  a  considerable  time,  will  destroy  with  certainty 
all  those  pathogenic  bacteria  most  feared  in  milk,  as  well  as  the 
bulk  of  the  bacteria  present. 

As  I  stated  before  this  Society  two  years  ago,  I  believe  that  on 
the  consideration  just  mentioned,  68°  C.  (155°  F.)  for  thirty  min- 
utes, followed  by  a  rapid  cooling,  is  the  best  temperature  exposure- 
Such  a  temperature  will  destroy  the  germs  of  diphtheria,  typhoid 
fever,  and  tuberculosis,  and  so  many  of  the  other  germs  present 
that  a  plate  planted  from  milk  so  treated  and  kept  at  a  laboratory 
temperature  will  usually  show  no  growth  in  twenty-four  hours.. 
At  the  same  time  this  milk  has  not  been  heated  sufficiently  to  give 
it  a  "cooked-milk"  taste  or  to  change  its  taste  at  all,  and  the  tem- 
perature to  which  it  has  been  exposed  is  more  than  ten  degrees  centi- 
grade below  that  at  which  the  chemical  changes  in  milk  due  to  beating 
are  said  to  take  place.  It  is,  however,  evident  that  pasteurization 
at  this  temperature  has  been  as  yet  but  little  used.  I  would  urge 
on  those  gentlemen  who  have  used  a  temperature  of  about  167°  F., 
and  who  are  inclined  to  favor  raw  milk,  to  try  first  pasteurization 
at  this  lower  temperature.  In  using  this  temperature  care  must 
be  exercised  that,  approximately,  this  temperature  is  sustained  for 
half  an  hour,  and  equally  that  the  milk  is  immediately  and  rap- 


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408       The  Atlanta  Medical  and  ScaaicAL  Jodmtal. 

idly  cooled  and  kept  cool.     Raw  milk,  I  believe,  cannot  yet  be 
considered  a  Bafe  food. — Pediatrica. 


Pbofebsob  Schenck's  Eeseabches  on  the  Fbedetebhinatiok 
OF  Sex. 

The  pamphlet  opens  with  the  atatemeot  that  it  is  impossible  to 
command  natural  processes,  but  possible  by  scientific  means  to  ex- 
ercise a  more  or  less  effectual  influence  upon  them,  in  order  to  extract 
from  them  the  beat  possible  results.  His  essay  falls  into  three  parts — 
a  summary  of  the  writings  of  his  predecessors,  an  account  of  bis  own 
researches  and  deductions,  and  finally  a  description  of  the  method 
of  treatment  be  has  devised,  with  illustrative  oases. 

In  the  development  of  an  embryo  the  generative  oi^ns  are  at 
first  indifferent — hermaphrodite;  in  the  further  process  of  growth 
one  set  develops  while  the  other  atrophies.  This  tendency  must 
be  predetermined  from  (he  time  of  fertilization,  for  each  cell  formed 
from  the  ovum  must  have  sexual  characters,  since  these  are  not 
confined  to  the  generative  organs,  but  appertain  to  the  whole  body. 
The  readiness  with  which  an  ovum  can  be  fertilized  depends  upon 
its  position  in  the  ovary,  the  thickness  of  its  envelope,  etc.,  and 
these  may  also  have  a  bearing  on  the  question  of  the  sex.  Id  other 
words,  the  predetermination  may  precede  fertilization,  and  of  this 
confirmation  is  found  in  the  development  of  bees  and  in  the  pro- 
duction of  male  and  female  flowers  by  plants  under  different  nutri- 
tive conditions.  In  this  connection  Professor  Schenck  enunciates 
and  discusses  at  considerable  length  the  views  of  previous  writers. 
He  points  out  that  the  male  sex  preponderate  to  a  definite  though 
slight  degree  in  the  total  number  of  births,  and  that  the  sex  of  the 
child  is  more  likely  to  be  that  of  the  older  parent.  He  pays  par- 
ticular attention  to  the  theory  of  crossed  sexual  heredity,  by  which 
each  sex  tends  to  propagate  the  other.  Thus,  if  the  sexual  power 
of  the  male  be  greater,  a  female  offspring  is  more  likely  to  result, 
and  mce  versa.  This  theory  is  threshed  out  most  thoroughly  and 
with  abundance  of  quotations  and  examples.  In  the  end  Professor 
Schenck  practically  accepts  it,  and  makes  use  of  it  in  bis  further 
work. 


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Selections  and  Abstracts.  409 

With  regard  to  the  ioflueDce  of  environnieDt  upon  sex,  he  quotes 
Kobin's  statemeot  that  iu  'w^rna  climates  females  predomioate,  in 
-cold  and  uncomfortable,  male.  Born  also  showed  that  ninety-five 
per  cent,  of  artificially  fertilized  frogs'  e^a  hatched  out  as  females, 
this  being  an  effect  of  nutritive  conditions  acting  after  fertilization. 
"Thury's  researches  are  fully  analyzed,  and  are  stated  to  have  origi- 
nally called  Professor  Schenck's  attention  to  the  subject.  Thury 
found  that  cattle  fertilized  at  the  beginning  of  "heat"  threw  more 
females ;  at  the  end,  more  males.  This  he  explained  by  the  degree 
-oi  ripeness  of  the  ovnm,  but  Schenck  accounts  for  it  on  the  crossed- 
iuheritaoce  theory,  the  sexual  power  of  the  female  being  at  its 
greatest  at  the  end  of  the  period  of  rut.  This  part  of  the  work  is 
summed  up  in  the  statement  that  the  sex  of  offspring  largely  de- 
pends upon  the  state  of  nutrition  of  the  parents,  particularly  that 
of  the  mother  during  pregnancy.  During  this  period  the  differ- 
ence between  intake  and  excretion  represents  the  food  of  the  em- 
bryo, and  hence  requires  special  attention.  The  temperature  is 
slightly  raised  owing  to  the  oxidation  processes,  which  entail  aoon- 
fiiderable  consumption  of  red-blood  corpuscles,  and  consequent 
dimiotition  of  hemoglubin. 

The  second  section  begins  with  the  enumeration  of  the  tact  ob- 
served in  domestic  animals  and  iu  insects,  that  the  better  the  mother 
in  nourished  the  more  females  she  produces,  the  number  of  males 
remaining  practically  constant.  This  influence  upon  the  fetus  in 
utero  has  received  but  little  attention  from  the  practical  point  of 
view,  and  Scbenck  consequently  set  out  upon  a  series  of  observa- 
tions based  upon  the  theory  of  crossed  sexual  inherilauce.  He  first 
investigated  the  excreta,  and  particularly  the  carbohydrates  of  the 
urine.  The  presence  of  a  certain  amount  of  sugar,  which  is  com- 
monly recognizable  by  the  phenyl  hydrazine  test  in  perfectly  nor- 
mal individuals,  indicates  incompleteness  of  the  oxidation  pro- 
cesses, whereby  a  certain  quantity  of  heat  is  lost  to  the  body.  This 
physiological  output  of  carbohydrates  is  in  the  male  sex  most 
marked  during  the  period  of  growth — that  is,  between  the  ages  of 
fourteen  and  nineteen.  In  women  there  is  no  corresponding  io- 
-crease,  but  small  quantities  may  appear  in  the  urine  before  and 
^affer  menstruation,  while  Iwanoff  and  others  have  shown  that  gly- 


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410       The  Atlanta  Medical  asd  Surgical  Journal. 


B  common  in  pregoaut  and  parturient  womeo.  Xow  the 
amount  of  sugar  normally  excreted  is  equal  in  men  and  women, 
but  more  sigaificant  in  the  latter,  owing  to  the  lesser  activity  of 
their  metabolic  processes.  For  the  perfect  ripening  of  the  ovum 
it  is  necessary  that  osidation  shall  be  perfect — that  is,  that  no  sugar 
shall  be  left  unburot.  Where  there  is  a  remainder  of  unburnt 
sugar  the  ovum  stands  a  chance  of  being  less  ripe  and  less  well 
nourished.  Ilence  the  properties  of  its  protoplasm  are  less  well 
developed,  and  by  the  theory  of  crossed  inberitaace  it  is  mure- 
likely  to  produce  a  female  child.  On  the  other  hand,  when  the 
urine  is  free  from  sugar  the  ovum  can  altaiu  perfect  development 
and  give  rise  to  male  offspring.  It  is  upou  this  cardinal  principle 
that  Schenck's  theory  is  based.  He  holds  that  a  prolonged  course 
of  appropriate  nourishment,  both  before  and  after  fertilization,  will 
tend  to  the  conception  of  male  children  only. 

The  next  question  is  of  the  means  to  be  adopted  to  insure  this 
end.  If  a  male  child  is  desired,  and  the  maternal  urine  contains- 
no  sugar,  but  abundance  of  reducing  substance  (particularly  the 
levoratatory  glycuronicacid),  he  allows  impregnation  forthwith.  If^ 
on  the  other  hand,  sugar  is  present,  it  must  be  removed,  and  the 
reducing  substances  increased,  before  fecundation  can  take  place. 
It  is  found  that  the  urine  of  a  woman  pregnant  with  a  boy  contain» 
more  reducing  substances  than  that  of  one  with  a  girl.  We  need 
not  enter  into  details  of  the  diet  recommended,  beyond  saying  that 
it  contaius  a  large  amount  of  proteid,  which  seems  to  be  required 
by  a  male  embryo. 

Finally,  Scbenck  gives  what  may  be  called  his  clinical  results. 
He  quotes  numerous  cases  to  show  that  the  bearing  of  female  chil- 
dren is  associated  with  glycosuria.  In  such  instances  he  recom- 
mends a  diet  comprisiug  plenty  of  proteid  and  fat,  and  as  little 
carbohydrate  as  can  be  tolerated;  thiis  must  be  taken  for  two  or 
three  months  before  and  three  months  after  irapregoatioo.  He 
gives  an  example  in  which  six  boys  were  born  in  succession  under 
this  treatment,  and  a  girl  immediately  it  was  relaxed;  and  others 
in  which  boys  were  born  after  repeated  births  of  girls  before  the 
treatment.  lu  all,  out  of  seven  recorded  cases  six  were  successful. 
He  concludes  that  the  nutrition  of  the  mother  plays  a  most  impor- 


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Selections  and  Absteacts.  411 

tant  part  id  the  determination  of  uex,  aod  tbat  io  couotries  where 
mucli  flesh  is  consumed  there  is  a  marked  preponderance  of  male 
children.  This  can  be  imitated  artificially,  but  it  is  far  more  im- 
portant to  insure  the  completeness  of  oxidation  processes  in  tbe 
body.  As  long  as  the  combustion  of  the  food  is  perfect  and  the 
arine  is  totally  free  from  sugar,  the  exact  amount  of  meat  consumed 
18  of  secondary  importance.  The  birth  of  male  children  can  thus,  in 
certain  cases,  be  predetermined,  but  the  voluntary  production  of 
girls  is  a  problem  yet  unsolved. — BritUh  Medical  JourncU. — Med- 
ical Review. 


Inhalation  op  Vineoab  to  Control  Nausea  and  Vomiting 
AFTZR  Anesthesia. 
Many  and  varied  are  the  methods  proposed  and  used  to  overcome 
the  nausea  following  the  administration  of  an  anesthetic,  but  one 
of  the  simplest,  and  in  my  own  experience  one  of  the  most  satis- 
&ctory,  methods  of  controlling  this  condition  has  been  the  admin- 
istratiou  of  strong  vinegar  by  inhalation.  The  use  of  vinegar  in 
this  manner  for  vomiting  was  first  proposed  in  1829,and  was  prac- 
ticed from  time  to  time  by  various  surgeons,  but  it  remained  for 
Mackenrodt  to  apply  it  extensively,  be  probably  having  adopted  it 
from  the  recommendations  of  earlier  surgeons,  who  lived  in  both 
tbe  pre-  and  post-anesthetic  days.  Its  beneficent  action  is  explained 
by  Lewiu  as  due  tti  the  neutralization  of  the  free  chlurin,  one  of 
the  products  of  chloroform,  by  the  acetic  acid.  The  chlorin  acts 
as  a  marked  irritant  to  the  pharyngeal  mucous  membrane  and  in- 
duces vomiting,  but  it  is  neutralized  by  the  acid,  which  sOothes  the 
irritated  [rarts  as  well.  Ether,  however,  is  much  more  directly 
irritating  to  the  respiratory  passages  during  inhalation,  but  tbe  vin- 
egar gives  as  satisfactory  results  after  it  as  aAer  chloroform  nar- 
cosis. The  simplest  explanation  of  its  good  effects  is  that  its  pun- 
gency stimulates — it  beiog  too  dilute  to  exert  any  irritative  action — 
tbe  respiratory  mucous  membrane  and  promotes  the  normal  secrn- 
tions,  and,  by  its  soothing  action  upon  the  peripheral  nerves  of  tbe 
parte,  lessens  the  irritability  of  the  pneumogastric  or  its  centers, 
and  (be  reflex  condition  of  vomiting  is  controlled.  Furthermore, 
ibat  vinegar  is  a  restorative  and  soothing  stimulant  to  the  respira- 


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412       The  Atlanta  Medical  and  Surgical  Journal. 


toiy  tract  and  to  the  oervouB  system,  is  well  attested  by  its  wide- 
spread use  among  the  ladies  in  their  vinaigrettes  in  place  of  "  smell- 
ing salts."  In  certain  countries  the  pungent  qualities  of  the  aro- 
matic vinegar  are  used  aloioat  to  the  exclusion  of  the  ammonia  or 
lavender  salts,  and  all  because  of  the  more  refreshing  effects  fol- 
lowing its  use. 

Whatever  the  correct  explanation  may  be,  certain  it  is  that,  in 
cases  which  have  been  properly  prepared  for  operation,  and  whose 
stomach  has  not  been  tilled  with  blood  during  the  operation,  it  al- 
most, if  not  completely,  prevents  vomiting.  The  method  of  ad- 
ministration is  by  saturating  a  towel  or  cloth  with  fresh,  strong 
vin*?gar  (preferably  that  made  from  cider),  and  holding  it  a  few 
inches  above  the  patient's  face,  or  banging  it  from  the  bedstead  so 
that  it  will  be  near  his  head.  It  should  be  used  directly  after  the 
anesthetic  has  been  discontinued,  and  kept  up  continuously  for 
hours. 

In  one  case,  to  which  ether  had  been  given,  nausea  began  soon, 
but  ceased  in  about  one  and  one-half  minutes  after  using  the  vine- 
gar. This  waR  then  removed  and  the  nausea  returned,  but  again 
disappeared  after  the  vinegar  was  given.  The  action  was  so  marked 
that  the  process  was  repeated  five  or  six  times,  so  as  to  verify  the 
conclusions,  and  each  time  the  result  was  the  same  as  first  noted, 
the  patient  quickly  becuming  quiet  as  though  going  under  com- 
plete anethesia. 

Another  case  was  given  chloroform  for  the  removal  of  pharyn- 
geal growths,  and  swallowed  considerable  blood.  Vomiting  of  the 
clotted  blood  occurred,  but  ceased  immediately  after  and  did  not 
return. 

These  have  been  duplicated  by  about  twenty-Sve  or  so  others  in 
whom  the  action  was  almost  uniformly  beneficial.  The  relief  from 
thirst  to  the  patient  is  most  marked,  and  the  refreshing  effect  is 
both  grateful  and  welcome  to  the  sufferer.  Its  simplicity  and  effi- 
ciency commend  its  use  to  all  having  aught  to  do  with  such  cases. 
It  is  also  free  from  any  toxic  eftects,  and  can  occasion  no  harmful 
conditions. 


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Selections  and  Abstracts.  413 

The  C0MPBE8S10N  Treatment  of  Pulmonary  Tuberculosis. 

The  receDt  address  of  Dr.  Murpby,  of  Chicago,  before  the  sec- 
tion in  surgery  of  the  American  Medical  Association  was  a  most 
notable  cootribution  to  the  subject  of  pulmonary  surgery.  The 
address  was  read  only  in  abstract,  and  it  is  to  but  one  feature  of  it 
that  we  are  now  going  to  call  attention,  namely,  the  part  relating 
to  the  treatment  of  tuberculous  disease  of  the  luDg  by  compres- 
sion of  the  organ.  As  we  understand  the  matter,  Dr.  Murphy 
proceeds  upon  the  assumption  that  a  tuberculous  lesion  of  the  lung, 
like  one  of  a  joint,  for  example,  may  ordinarily  be  healed  quite 
readily  by  securing  immobility,  functional  rest,  of  the  affected 
part.  In  pursuance  of  this  idea  he  immobilizes  the  lung  by  com- 
pressing it,  crowding  it  back  upon  its  hilum,  establishing  a  sort  of 
artificial  atelectasis.  This  he  accomplishes  by  injecting  a  quantity 
of  nitrogen  into  the  pleural  sac.  Nitrogen,  he  finds,  neither  ex- 
erts any  untoward  effect  upon  the  pleura  nor  is  absorbed  to  any 
appreciable  extent;  it  simply  keeps  the  pleura  distended  and  the 
pulmonary  tissue  compressed.  It  is  said  that  during  the  contiuu- 
ance  of  the  compression  the  patient  feels  remarkably  free  from  the 
symptoms  that  had  previously  preyed  upon  him. 

The  gas  is  allowed  to  remain  in  the  pleura  for  a  period  of  sev- 
eral  weeks,  and  then  it  is  withdrawn.  In  a  goodly  number  of 
instances  the  symptoms  do  not  return,  and  the  inference  is  drawn 
that  the  disease  has  been  overcome.  The  lung  again  becomes  aer- 
ated and  expands  almost  if  not  quite  to  its  normal  size,  if,  on  the 
removal  of  the  nitrogen,  the  morbid  symptoms  return,  more  of  the 
gas  is  thrown  into  the  pleura  and  kept  imprisoned  there  for  an- 
other term  of  weeks.  It  is  said  that  this  second  injection  is  by  no 
means  always  found  necessary,  and  that  when  it  is  called  for  it 
almost  invariably  suffices  for  the  cure  of  the  disease  in  that  lung. 
Then  the  other  lung  is  treated  in  the  same  way. 

We  have  here  given  only  a  general  outline  of  Dr.  Murphy's 
plan  of  treatment.  For  the  details,  upon  which  much  undoubtedly 
depends,  the  profession  will  have  to  wait  until  the  address  is  pub- 
lished. One  may  picture  to  himself  a  number  of  difficulties  in 
the  way  of  success  with  this  method  of  treatment,  but  not  one  of 


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414        The  Atlanta  Medical  and  Surgical  Journal. 

them  seems  to  be  insurmountable.  The  first  that  occurs  to  us  is 
the  task  of  passing  the  eye  of  a  hypodermic  needle  through  the 
parietal  pleura  without  at  the  same  time  passing  it  through  the 
visceral  layer,  provided  there  is  no  pleural  efiusion.  It  is  pointed 
out,  however,  that  the  outer  layer  of  the  pleura  is  held  firmly  at- 
tached to  the  wall  of  the  chest,  while  the  pulmonary  layer  is  free 
to  yield  before  the  pressure  of  a  blunt-pointed  needle,  and  so  escape 
puncture.  Still,  we  may  suppose  that  adhesions  in  the  immediate 
neighborhood  of  the  puncture  might  seriously  impair  this  evasive 
yielding  of  the  pulmonary  pleura.  Nevertheless,  whatever  diffi- 
•cuUies  might  be  encountered  in  the  attempt  to  make  the  eye  of  the 
needle  pass  the  parietal  pleura  and  stop  short  of  the  visceral  in  the 
ordinary  way  of  inserting  the  instrument,  they  might  all  be  over- 
come readily,  we  presume,  by  cutting  down  methodically  and  pick- 
ing up  the  outer  layer  of  the  serous  membrane  with  a  forceps. 

Auother  difficulty  that  has  been  suggested  lies  in  the  frequent 
presence  of  extensive  pleuritic  adhesions,  so  extensive  as  practi- 
cally to  abolish  the  potential  cavity  of  the  pleura.  But  this  state 
of  things,  we  understand.  Dr.  Murphy  meets  by  breaking  up  the 
adhesions — a  procedure  which  is  no  doubt  thoroughly  practicable 
in  a  great  many  instances.  We  have  heard  this  further  objection 
mentioned,  that  the  preponderance  of  tuberculous  lesions  in  the 
apex  would  render  the  majority  of  cases  refractory.  This,  we 
presume,  rests  on  the  assumption  that  the  compression  exerted  by 
the  nitrogen  would  be  subject  to  the  limitations  of  that  exercised 
by  plural  effusion — an  assumption  that  seems  to  us  not  wholly 
warranted.  At  all  events,  when  so  careful  a  man  as  Dr.  Murphy 
has  been  experimenting  with  the  treatment  for  three  years,  as  we 
understand  be  has,  aud  when  he  reports  a  number  of  cases  of  cure, 
all  such  theoretical  objections  as  those  we  have  mentioned  must  be 
held  in  abeyance  until  the  distinguished  author's  full  data  have 
been  laid  before  us  and  until  the  plan  Las  had  ample  trial  in  bis 
bands  and  those  of  others.  The  present  time  seems  to  be  an  era 
of  glorious  possibilities  in  the  treatment  of  tuberculous  disease, 
and  more  than  one  of  them,  we  think,  will  be  realized.  The 
chances  are,  it  seems  to  us,  that  Dr.  Murphy's  ingenious  plan  will 
turn  out  to  be  one  of  those  from  which  decided  advantage  may  be 
derived. — N.  Y.  Medical  Journal. 


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Sblections  and  Abstracts.  415 

Surgeon  Nicholas  Senn. 

"Lieutenant-Colonel  Nicholas  Senn,  U.  S.  Volunteers,  ohief 
«urgeon  Sixth  Army  Corps,  under  command  of  Major-General 
WiUoD,  Camp  Thoman,  Chickamauga,"  severs  bis  connectioD  witli 
the  National  Guard  of  Illinois  and  announces  the  same  to  the  med- 
ical profession  at  the  close  of  a  six-page  letter  published  in  the 
Asaociaiion  Journal  of  June  11th. 

It  is  a  remarkable  incident  of  our  volunteer  service,  the  most 
•eminent  of  American  surgeons — ao  author  and  teacher  of  repute,  a 
man  of  wealth  acquired  in  bis  profession,  the  donator  of  vast  med- 
ical libraries  to  the  public  library  of  his  adopted  city— enlisting  in 
the  volunteer  service  of  his  country.  And  yet  it  seems  easy,  nat- 
4iral  and  appropriate. 

Senn  has  sucked  the  Chicago  orange  dry ;  he  has  reached  the  top 
round  of  the  ladder  of  sur^pcal  fame.  He  is  without  opposition ; 
bis  social  and  medical  status  is  assured ;  he  has  legioue  of  students, 
readers  and  admirers;  he  was  president  of  the  American  Associa- 
tion at  its  greatest  celebration,  and  in  bis  address  stood  for  the  old 
code  without  changes,  and  did  all  that  his  commanding  personality 
could  accomplish  to  insure  the  perpetual  autonomy  of  the  county 
«nd  state  organizations  which  have  their  annual  expression  in  the 
American  Medical  Association,  the  mightiest  and  most  influential 
of  medical  gatherings  among  English-speaking  people.  What  is 
it  to  Senn,  Western  autochthon  of  the  surgical  world,  that  be  gives 
Another  winter  of  clinics  and  lectures  in  the  arenas  of  Rush  or  Cook 
-County  Hospital,  or  compiles  his  annual  treatise,  or  takes  another 
winter  month  off  to  go  hunting  again  in  Texas? 

But  war,  always  alluring  to  men  of  genius,  discovering  to  the 
nations  such  as  Grant  and  Lincoln,  has  attractions  and  possibilities 
-even  for  those  who  have  accomplished  great  achievements  in  civic 
life.  The  greater  the  man  the  greater  the  opportunity.  The  best 
Are  none  too  good  for  the  uses  of  patriotism.  Senn  is  fond  of 
travel  and  of  history;  witness  his  observations  of  Pompeiian  sur- 
gical instruments,  of  the  Grieco-Turkisb  war.  Here,  indeed,  is  a 
great  opportunity — to  carry  aseptic  surgery  into  camp  and  field;  to 
«mploy  the  modern  prophylaxis  against  infectious  disease;  to  direct 


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416       The  Atlanta  Medical  and  Surgical  Journal. 

the  largest  possible  surgical  and  medical  cHaics  since  the  civil  war; 
to  measure  the  medical  and  surgical  skill  of  our  army  medical  corps- 
agaiusi  the  magoificeut  accomplieb  meats  of  the  Germans  in  the 
Fran  CO- Prussian  war,  and  also  to  see  what  may  be  done  to  protect 
great  bodies  of  troops  from  temperate  zones  against  the  plagues  of 
tropical  cities,  coasts  and  climates. 

Finally,  there  is  the  joy  and  glory  of  being  part  of  the  actual 
thing,  of  chronicling  the  results  and  employing  them  in  after  work,, 
like  .^neas  in  the  Trojan  war,  to  be  able  to  say,  "All  of  which 
I  saw  and  part  of  which  I  was."  There  is  no  more  romantic  figure 
among  our  surgeons  of  the  civil  war  than  that  of  McFadden  Gas- 
ton, who  treated  the  first  Uoioo  soldier  injured  when  Anderson 
sainted  the  American  flag  as  it  was  taken  down  for  four  years  at 
Fort  Sumter,  who  was  loyal  to  his  Southland  through  the  civil 
war,  and  whose  last  military  service — such  are  the  accidents  of 
civil  war — was  caring  for  United  States  soldiers  and  sailors  on 
shipboard  between  New  Orleans  and  New  York  after  the  surren- 
der at  Appomattox.  Wliat  a  riohness  of  story  and  honorable  rem- 
iniscence! 

But  to  go  with  certainly  conquering  troops,  with  the  approval  of 
the  nation,  and,  in  the  observation  of  the  medical  and  civic  worlds 
as  the  acknowledged  surgeon  of  the  decade,  rich  in  every  knowl- 
edge and  expedient,  and  with  the  medical  and  surgical  resources  of 
the  greatest  nation  in  history  at  one's  beck  and  call — wliy  not? 

Who  would  stay  at  home  when  every  opportunity  is  offered,, 
when  there  is  no  personal  sacrifice,  and  when  there  is  infinite  ne- 
cessity and  possibility  of  alleviating  pain  and  saving  life,  and  at 
the  same  time  of  laying  up  material  and  experience  for  the  future?* 
No  surgeon  is  too  great  or  too  useful  for  his  country's  good. 

Surgeon  Sean's  letter  to  the  Association  Jbunt«/ comprises,  first,. 
a  dissertation  on  war  and  an  enthusiastic  eulogium  on  the  justice 
and  conduct  of  the  Spanish-American  war;  second,  a  description 
of  Camp  Tanner,  at  Springfield,  and  a  glowing  tribute  to  Governor 
Tanner  and  his  wife — the  Governor  "a  worthy  successor  to  Yates 
and  Oglesby";  then,  third,  a  description  of  the  examinations  o( 
the  seven  volunteer  regiments,  and  a  list  of  the  examination  ques- 
tions in  the  medical  department.     Ten  thousand  men  were  exam- 


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Selections  and  Abstracts.  417 

iDed  at  the  rate  of  niae  huDdred  daily.  The  common  causes  for 
rejection  were  hernia,  varix,  poor  physique,  heart  disease,  lack  of 
chest  space,  loss  of  teeth,  aud  flat-foot.  Varicocele  was  present  in 
twenty-five  per  cent,  of  the  cases,  but  only  two  were  rejected  on 
this  account.  Flat-foot  was  very  common,  but  few  were  rejected, 
as,  like  the  varicocele  patients,  they  were  not  impaired  by  the  de- 
formity. The  rejections  for  all  causes  were  less  than  ten  per  cent., 
and  more  were  rejected  from  the  country  troops  than  from  the  city. 
Frequently  the  rejected  "were  pale,  speechless  and  staggering  on 
learning  that  they  were  deprived  the  great  boon  of  defending  the 
honor  of  their  country." 

The  medical  stafi*were  put  through  a  school  of  instruction  from 
8  to  10  daily,  with  operations  on  the  cadaver.  A  score  of  lectures 
were  given  on  proper  topics — sterilization,  sunstroke,  blood-stop- 
ping, dysentery,  anesthetics,  shock,  prevention  of  camp-diarrhea, 
etc.  The  vaccination  rules  are  admirable,  and  prevented  septic 
complications.  Three  cases  of  cerebro-spinal  meningitis,  with 
death,  are  reported  on  at  length  ;  it  was  sporadic  and  controllable. 

The  pneumonia  present  was  malignant;  two  out  of  thirty-two 
cases  died.  Measles  and  mumps  were  controlled  by  prompt  isola- 
tion. Assistant  Surgeon  Cole,  of  the  Sisth  Infantry,  died  at  Fort 
Wayne,  Ind.,  of  pneumonia,  while  en  route  to  Washington. 

The  entire  report  is  of  the  highest  interest;  it  is  sane,  fervid, 
scientific  and  enthusiastic.  Senn  will  have  an  enormous  induence 
in  the  volunteer  service  upon  the  medical  staff.  His  presence  will 
inspire  confidence  and  give  tone  to  the  medical  and  surgical  work. 
Plain  of  speech,  modest  in  manner,  genial  and  approacbable,  known 
throughout  the  medical  world,  and  without  personal  motive,  actu- 
ated only  by  scientific,  humaniiarian  and  patriotic  motives,  he  will 
be  a  commanding  figure  in  the  medical  and  slirgical  history  of  the 
present  war. — Indiana  Medical  Journal. 


Normal  Salt-Solution — The  Vaeious  Methods  and  Ixdi- 
catioss  fob  its  employment, 

Dr.  p.  Findley  concludes  an  article  on  the  above   subject  with 
the  following  summary  (^Med.  Stand.): 


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418       The  Atlanta  Medical  and  Surgical  Journal. 

1.  Whea  noriDal  salt-solution  is  indicated,  enteroclysis  is  the 
method  of  choice,  providing  there  is  time  to  await  its  effect. 

2.  The  body -temperature,  vascular  tension,  renal,  cutaneous,  and 
intestinal  secretions  are  influenced  in  direct  ratio  to  the  temper- 
ature of  the  injected  fluid. 

3.  Injected  solutions  of  high  temperature,  however,  may  lower 
the  body-heat  by  promoting  the  excretions. 

4.  A  solution  of  60"  to  70°  F.,  given  within  the  colon,  will  first 
stimulate  and  later  depress  the  blood-tension  and  the  secretions  of 
the  skin  and  kidneys.  It  is  therefore  to  be  used  with  caution,  par- 
ticularly in  renal  insufficiency. 

5.  In  the  subcutaneous  method  we  have  all  that  is  required, 
when  immediate  effect  is  desired,  except  when  abdominal  section 
may  indicate  intraperitoneal  injection;  where  the  withdrawal  of  a 
quantity  of  blood  has  made  it  possible  to  give  intravenous  injec- 
tion with  the  least  possible  loss  of  time,  and  where  the  serous 
cavities  have  been  relieved  of  a  quantity  of  fluid  which  may  be 
replaced  by  a  normal  salt-solution. 

6.  As  a  rule,  no  time  is  gained  by  the  employment  of  the  intra- 
venous method,  which  should  only  be  used  when  preceded  by  ven- 
esection for  the  withdrawal  of  a  quantity  of  blood. 

7.  Id  intravenous  injections  it  is  possible  to  cause  death  from 
too  great  dilution  of  the  blood — an  accident  quite  impossible  in 
hypoderraoclysis  or  enteroclysis. 

8.  Normal  salt-solution  is  indispensable  in  the  treatment  of 
alarming  hemorrhage,  and  is  of  great  value  Id  the  treatment  of  the 
various  toxemias,  and  in  renal  insufficiency. 

9.  After  the  removal  of  a  large  quantity  of  fluid  from  the  pleura 
«avity,  the  salt-solution  may  be  injected  into  the  cavity  as  a  substi- 
tute for  the  effusion,  and  will  thereby  lessen  shock  and  relieve  sep- 
tic infections. 

10.  In  cholera  and  cholera  infantum,  normal  salt-solution  is  in- 
valuable as  a  substitute  for  the  lost  serum. 

1 1.  Venesection  with  the  withdrawal  of  a  quantity  of  toxic  blood 
is  indicated  in  toxemias,  where  the  patient  is  plethoric,  and  should 
be  followed  by  intraveuous  injections  of  an  equal  or  greater 
amount  of  normal  salt-solution. 


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Selections  and  Abstracts.  419 

12.  In  hemorrhage  Dormal  salt-solut'iOD  maintains  the  circula- 
tion by  adding  to  the  volume  of  the  circulating  fluid,  which  would 
otherwise  stagnate  in  the  veins,  because  there  is  not  sufficient  vol- 
ume for  the  heart  to  propel. 

13.  In  toxemias  normal  ealt-solution  dilutes  the  toxins  of  the 
blood  and  fevors  their  elimination  by  stimulating  the  excretory 
organs. — Charlotte  Med.  Jour. 


The  Management  op  Patients  before  and  after 
Laparotomy. 

Wiggin  {Medical  Record)  concluded  his  paper  on  this  subject  aa 
follows,  calling  attention  to  the  points  which  he  considers  impor- 
tant: 

1.  The  importance,  whenever  practicable,  of  prolonged  prepar- 
atory treatment  of  patients  about  to  undergo  an  abdominal  opera- 
tion. 

2.  The  importance  of  the  admini»tratioa  of  cathartics  in  the 
early  part  of  this  period,  followed  by  large  enemas  for  the  purpose 
of  cleansing  the  intestinal  tract. 

3.  The  importance  of  keeping  a  record  of  the  bodily  tempera- 
ture, respirations  and  pulse-rate  for  several  days  in  advance  of  the 
operation,  and  of  making  a  final  examination  of  the  urine. 

4.  The  necessity  in  the  female  of  arranging  to  have  the  opera- 
tion performed  a  few  days  after  the  menstrual  period,  and  the 
cleansing  of  the  vagina,  even  when  it  is  intended  that  the  opera- 
tion shall  be  by  the  abdominal  route  only. 

5.  The  administration  of  a  small  quantity  of  peptonized  food 
(one  ounce)  containing  stimulants  two  hours  before  giving  the  an- 
esthetic, for  the  purpose  of  lessening  the  tendency  to  nausea  and 
vomiting  after  the  recovery  of  consciousness. 

6.  The  aecessity  of  the  anesthetic  being  given  by  an  experienced 
physician  and  in  the  smallest  possible  quantity. 

7.  The  necessity  of  protecting  the  patient's  body  properly  with 
clothing  and  blankets  during  the  operation. 

i.  The  advantage  of  stimulating  the  pulse  before  the  heart  has 


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420       The  Atlanta  Medical  and  Surgical  Journal. 

become  much  exhausted,  and  of  using  intraveDOua  saliue  injections 
before  the  radial  pulse  has  become  extinct. 

9.  The  leaving  in  the  abdomioal  cavity,  after  a  free  irrigation, 
of  a  quantity  of  hot  salioe  solution,  for  the  purpose  of  stimulating 
the  patient,  preventing  (?)  the  forniatioD  of  intestinal  adhesions, 
and  lessening  the  danger  of  septic  infection  of  the  peritoneum. 

10.  The  necessity  of  making  the  patient  comfortable  hy  change 
of  position  during  the  first  two  days  of  convalescence,  and  by  the 
use  of  the  rectal  tube. 

11.  The  necessity  for  early  administration  of  food  in  reasonable 
quantities  and  at  proper  intervals. 

12.  The  aecessity  of  withholding  stimulating  euemata  after  op- 
eration in  which  extensive  and  lirm  pelvic  adhesions  have  been 
broken  up. 

13.  The  necessity  for  deliberation  as  to  the  wisdom  of  reopening 
the  peritoneal  cavity  in  a  given  case  of  supposed  concealed  bem- 
orrhage. 

14.  The  importance  of  washing  out  the  stomach  as  soon  as  the 
diagnosis  of  intestinal  paresis  is  made,  and  of  the  persistent  use  of 
saline  cathartics  till  the  bowels  move. 

15.  The  importance  of  not  administering  cathartics  to  those  con- 
valescing from  abdominal  operations  and  who  are  pursuing  a  nor- 
mal course  too  early  or  in  too  large  doses. — Gkarlotte  Med,  Jour, 


Injections  of  Aixx»hol  in  Cabcinoua. 

A  detailed  description  and  careful  estimate  of  the  results  thus 
far  obtained  from  the  treatment  of  cancer  by  injections  of  alcohol, 
is  given  by  Sajous,  in  the  Monthly  CycloptEdia  of  Practical  Medi- 
cine for  January.  Beginning  with  the  eighteen  cases  of  mammary 
carcinoma  treated  by  Hasse  twenty  years  ago  —  with  fifteen  com- 
plete cures  and  no  recurrence — the  survey  closes  with  Kuhs  re- 
cently reported  cure  of  primary  cancer  of  the  nasal  pharynx.  The 
author  decides  that  this  last  case,  added  to  the  others,  "  establishes 
alcohol  on  a  basis  seldom  equaled  by  any  agent  proposed.  It  is 
safe  to  state  that  if  tuberculin  had  bad  to  its  credit  but  half  of 
the  bona  fide  points  already  noted  in  &vor  of  alcohol  in  the  treat- 


,„i,z.d  by  Google 


Selections  and  Abstracts.  421 

ment  of  cancer,  it  could  have  withstood  the  test  of  time."  The 
remedy  acts  by  forming  a  consecutive-tissue  capsule  around  each 
growth,  causing  obliteration  of  the  blood-vessels  and  contraction 
of  the  neoplastic  tissues.  According  to  Hasse,  the  eifect  on  the 
general  health  is  even  more  surprising.  The  pain  and  uneasiness 
pass  away,  and  sleep,  appetite,  assimilation  and  strength  return  in 
a  most  remarkable  manner.  By  employing  alcohol  in  different 
varieties  of  tumor,  rapid  reduction  in  the  size  and  grow^tb  has  been 
produced,  but  it  was  found  that  if  too  much  be  injected  at  one 
time,  sloughing  of  the  growth  and  general  intoxication  of  the  sub- 
ject  will  follow.  To  secure  a  successful  result,  the  treatment  must 
be  carefully  conducted. 

Id  the  cases  reported  as  cured  by  him,  Hasse  injected  a  mixture 
of  thirty  parts  of  absolute  alcohol  to  seventy  parts  of  water  twice 
a  week  around  the  tumor,  as  well  as  into  any  infiltrated  glands. 
The  quantity  injected  varied  according  to  the  size  of  the  neoplasm, 
and  sometimes  reached  twenty  Pravaz  ayringefuls.  The  only  in- 
convenience observed  was  pain  (for  which  local  or  even  general 
anesthesia  might  be  resorted  to)  and,  occasionally,  slight  intoxica»- 
tion.  In  order  to  avoid  making  the  injection  into  a  blood-vessel, 
Hasse  inserted  the  syringe-needle  deep  into  the  tissues,  then  uufaa- 
tened  it,  leaving  the  canula  in  place.  He  then  wailed  a  moment; 
if  the  blood  did  not  issue  from  the  canula  he  readapted  the  syringe 
and  made  the  injection;  but,  if  blood  did  flow  out,  he  removed 
the  needle  and  made  another  puncture  elsewhere.  Under  the  in- 
fluence  of  these  injections  the  tumor  diminished  in  size  and  soon 
became  less  painful.  The  treatment  should  be  continued  for  some 
time  atler  apparent  cure,  at  intervals  more  and  more  prolonged. 

In  conclusion,  an  earnest  plea  is  advanced  that  alcohol  be  given 
the  faithful  trial  in  this  affection  which  it  seems  to  merit. — Medi~ 
eal  Times. 


The  Non-surgical  Treatment  of  Pyelitis. 
Br.  Kobin  writes  that  though  pyelitis  is  usually  and  rightly  con- 
sidered a   surgical  affection,   there  are    nevertheless   many    cases 
where  medicinal  measures  may  be  employed  with  great  benefit 
{BuU.  g&n.  de   T/Urap.,  April   30,  1897).     The  treat&ient  may  be 


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422       The  Atlanta  Medical  and  Surgical  Journal. 

divided  iDto  hygienic  aad  medicinal.  The  hygienic  treatment 
consists  of  an  absohite  milk  diet,  of  light  broths,  of  mild  alkaline 
waters,  and  of  stimulating  the  functions  of  the  skin.  For  this 
purpose  the  author  recommends  vigorous  rubbing  of  the  skin  with 
the  following  liniment : 

Tr.  of  cinclions )     wlOOdr. 

Spirit  of  camphor } 

Tincture  of  nui  vomica 25  dr. 

Menthol 1  dr. 

As  a  direct  counterirrilant  over  the  region  of  the  kidney  hoi 
irons  are  recommended,  but  cantharidal  plaster  is  prescribed,  as 
the  possible  absorption  of  the  cantharidin  may  cause  or  aggravate 
any  existing  kidney  trouble.  Internally  benzoic  acid  or  sodium 
benzoate  is  administered  in  small  dose  (Id  to  20  grn.  in  twenty- 
four  hours),  or  balsam  of  tolu,  copaiba  or  eucalyptol.  As  astrin- 
gents are  administered  krameria,  tannic  or  gallic  acid,  and  opium. 
As  an  internal  renal  antiseptic  salol  is  recommended. 

For  hematuria  the  following  combination  is  recommended  : 

Ergotin 4  dr. 

Oil  of  turpentine 4  dr. 

Gallic  acid 2  dr. 

Simple  diiir 100  dr. 

DoM :    One  or  two  tsiBpoonfuls  everj  8  houra. 

If  the  urine  contains  too  much  pus,  large  doses  of  quinine  are 
to  he  taken.  If  the  pain  is  too  severe  an  opium  suppository  is  tu 
be  used  per  rectum,  and  a  liniment  consisting  of  camphorated  oil, 
chloroform,  opium,  hyoscyamus  and  belladonna  is  to  be  rubbed 
over  the  region  of  the  kidney. — American  Medieo-Snrgieal  Bulletin. 


Serum  Therapeutics  and  Prophylaxis  op  Yellow  Fever. 
Sanarelli  reports  very  encouraging  results  with  his  serum  in  an 
epidemic  at  S.  Carlos  do  Pinlial.  Twenty-two  patients  were  treated 
with  it,  with  six  deaths;  a  mortality  of  27  per  cent.,  instead  of  the 
average  45,  and  this  merely  the  first  tests  of  the  serum,  determin- 
ing doses,  concentrations,  etc.,  step  by  step,  and  administering  it  to 
several  patients  evidently  beyond  all  help  before  being  seen.  In 
one  case  abrupt  convalescence  followed  a  single  injection  the  second 


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Selections  and  Abstracts.  423 

day.  He  eoosiderstbe  eerum  bactericidal  rather  tban  antitoxic  in 
its  effects,  aod  obtained  most  strikiog  results  witb  intravenous  in- 
jections of  large  doses.  In  three  of  the  fatal  cases  the  bacillus  ic- 
teroides  was  isolated  from  the  blood  during  the  agonid  period,  by 
using  the  serum  reaction  method.  He  fiuds  the  horse  best  adapted 
to  the  production  of  the  serum.  He  is  especially  encouraged  by 
the  results  at  the  prison  where  yellow  fever  attacked  a  prisoner  and 
two  guards,  all  early  fatal  cases,  but  prompt  prophylactic  injectious 
arrested  the  disease  at  once,  and  no  further  case  occurred.  He 
adds;  "The  instantaneous  suppression  of  this  focus  of  infection 
was  obtained  in  spite  of  the  most  unfavorable  conditions  and  the 
tack  of  active  aerum,  the  borse-serum  being  all  exhausted  and 
nothing  left  but  the  much  weaker  beef-sernm.  The  persons  who 
received  the  injectious  were  also  either  mostly  unacclimated  stran- 
gciB  or  in  wretched  physiologic  conditions  owing  to  the  depressing 
and  extremely  unhygienic  surroundings,  and  thus  exceptionally 
predisposed  to  the  disease."  His  report  is  published  iu  full  in 
0  Brazil  MMico  of  April  1  and  8.  He  vouches  strongly  for  the 
absolute  barmlessness  of  the  prophylactic  injections,  from  experi- 
ence on  himself  as  well  as  on  others.  His  facilities  were  limited, 
as  he  only  had  a  few  auimais  at  bis  disposal. — Jotir.  Am.  Med.  A»8o. 


The  Physician  as  a  Business  Man. 
A  medical  journal  of  the  present  day  is  hardly  complete  without 
some  reference  to  the  physician  as  a  business  man,  and  when  there 
is  so  much  smoke  there'must  be  fire.  The  commencemeut  day  or- 
ator, who  used  to  proclaim  the  physician's  calling  above  the  mere 
strife  for  "  filthy  lucre,"  now  calls  attention  to  the  fact  that  the  phy- 
Eician  has  been  woefully  negligent  to  himself  and  family  by  not 
combining  business  principles  with  his  noble  calling.  A  good  deal 
of  Ibis  poor  management  can  be  laid  to  the  men  old  in  practice — 
those  who  sent  in  their  bills  once  a  year  or  semi-annually.  This 
plaa  may  be  well  enough  in  rich  farmiug  communities,  but  in  the 
larger  towns  and  cities,  if  carried  out,  the  doctor's  cupboard  will 
soon  be  like  "Old  Mother  Hubbard's,"  The  people  in  the  larger 
cities,  to  quite  an  extent,  "fold  their  tents  like  the  Arabs  and  assj- 


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424       The  Atlanta  Medical  and  Surgical  Journal. 

lently  steal  away,"  cheating  the  landlord  as  well  as  the  doctor.  There 
is  DO  reason  why  the  physician  should  uot  send  his  bills  monthly, 
and  if  no  response  is  made  during  the  following  month  go  and  find 
out  where  the  trouble  is.  Short  accounts  make  long  friends,  and 
the  man  who  owes  the  doctor  a  bill  is  ever  ready  to  damn  the  poor 
doctor  with  faint  praise.  The  writer  has  collected  at  least  eighty- 
five  per  cent,  by  following  up  accounts  close,  and  people  do  not 
take  offense  so  much  as  one  might  imagine.  It  is  a  good  plan  to 
carry  in  the  pocket  a  small  book  containing  a  list  of  debtors,  with 
amount  due,aDd  when  some  anxious  (?)  debtor  meets  you  on  the  street 
there  will  be  no  need  of  telling  him  to  come  to  the  office  so  yon 
can  look  it  up.  Never  haggle  over  your  bill,  but  state  the  amount 
and  stick  to  it. — Charlotte  Med.  Jour. 


Narcxdtic  Notes. 

The  Journal  of  Inebriety  (April)  has  the  following: 

Investigations  in  France  go  to  show  that  the  mortality  among 
children  of  women  working  in  tobacco  is  considerably  more  than 
double  that  of  children  of  other  working  women. 

Of  1,000  cases  of  the  morphine  habit— 650  meu  and  350  women 
— the  medical  profession  supplied  iorty  per  cent. 

Morphinoiuania  occurs  most  commonly  between  twenty-five  and 
forty. 

The  cocaine  slave  is  far  more  depraved  than  the  alcoholic.  He 
has  no  moral  sense.  He  will  lie  for  the  mere  pleasure  of  lying 
and  will  steal  without  purpose. 

Patients  should  never  know  they  are  taking  cocain.  It  should 
not  be  prescribed  for  asthma,  hay-fever,  etc.,  conditions  in  which 
it  is  at  best  merely  palliative. 

"Knock-out  drops"  are  found  to  be  uniformly  highly  concen- 
trated solutions  of  chloral. 

Bromides  used  for  their  sedative  eff'ecta  should  be  accompanied 
by  hot  baths  and  saliues. 

Chloral  should  not  be  combined  with  bromides  for  sedative  ef- 
fects upon  inebriates. 

Stop  bromides  with  fall  of  temperature  and  feeble  heart. — Med- 
ical Age. 


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Selections  and  Abstkacts.  425 

The  Hypodermic  Ikjection  of  Quinine. 
Professor  V.  Stoffella,  of  Vienoa  {Oazetle  kebdomadaire  de  mide- 
cine  d  de  ekirurgie,  i/lay  22i),  points  out  that  the  insolubility  of 
quinine  has  for  a  loDg  time  prevented  its  use  hypodcrmicaDy. 
Some  time  ago  an  Italian  physician  discovered  that  quinine  hydro- 
chloride dissolved  easily  in  association  with  antipyrine.  This  fact, 
which  was  confirmed  by  Gessard,  was  applied  by  Laveran,  who 
prescribed  the  following  formula  for  hypodermic  injection: 

R  Qulnins  hydrochloride 46  grains. 

Antipjrine 80  grains. 

DiiUI led  water „ IJ  drachmB. 

Professor  Santerson,  of  Stockholm,  showed  that  in  reality  a  new 
combination  was  thus  formed — viz.,  quinopyrine — whose  toxicity 
was  less  than  that  of  quiuiue.  The  author  has,  however,  found  the 
association  of  quinine  with  antipyrine  useless  and  has  employed 
hydrochloride  of  quinine  alone  for  some  years  after  the  following 
plan :  He  puts  thirty  grains  of  hydrochloride  of  quinine,  of  whose 
alkaline  reaction,  and  this  he  deems  very  important,  he  has  pre- 
viously satisfied  himself,  in  a  test-tube  containing  a  hundred  and 
fifty  minims  of  distilled  water.  The  test-tube  is  heated  gently,  and 
at  a  temperature  of  about  105°  F.  the  solution  is  complete  and  is 
maintained  for  some  time.  On  cooling,  the  quinine  is  precipi- 
tated in  the  form  of  a  whitish  mass,  which  redissolves  with  heat, 
or  on  plunging  the  test-tube  into  hot  water.  The  injection  is  quite 
painlessa  and  besides,  as  the  drug  remains  soluble  at  the  blood 
temperature,  there  is  not,  as  is  the  case  with  injections  of  quino- 
pyrine, the  induration  at  the  point  of  injection.  A  Provaz  syringe 
contains  under  these  conditions  about  three  grains  of  hydrochloride 
of  quinine,  which  may  be  given  three  times  a  day. — N.  Y.Med. 
Jour. 

Care  of  Patients  after  the   Opebation    for 

Appendicitis. 

J.  M.  Barton,  M.D.,  Philadelphia  Polyclinic,  separates  the  cases 

into  four  groups-   (1)  where  the  abscess  is  o|>eoed  without  entering 

the  peritoneal  cavity ;  (2)  where  au  operation  is  performed  between 

attacks  and  uo  pus   is  present;     (3)    where    general    [>eritoneaI 


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426       'fflE  Atlanta  Medical  and  Sdraical  JoubnaL. 

cavity  is  opened  and  the  abscess  emptied  ;  ( 4 )  where  the  geoeral 
septic  peritODitis  exists  at  the  time  of  operation.  Id  all  operations 
for  appendicitis  there  is  but  little  danger  from  shock,  and  none 
from  hemorrhage,  afler  the  operation  is  llnished.  If  there  is  any 
shock  it  will  readily  yield  to  heat  and  strychnia.  Death  is  caused 
by  general  septic  peritonitis.  There  is  some  diflerence  in  treat- 
ment of  each  class,  but  speaking  generally  (not  saying  anything 
of  the  last  group)  the  treatment  consists  of  perfect  rest  in  bed,  no 
food  at  all  for  twenty-four  hours,  and  but  a  limited  amount  of 
water.  By  the  third  day  he  can  have  ordinary  diet  in  moderate 
amounts,  such  as  soft-boiled  eggs,  stewed  chicken  or  mutton,  milk 
and  dried  toast,  etc.  The  soiled  dressings  should  be  -removed 
once  or  twice  daily,  but  syringing  out  of  the  cavity  is  not  advisa- 
ble. The  stitches  may  be  removed  from  the  seventh  to  the  ninth 
day;  at  this  time  the  drainage-tube  (if  one  has  been  used)  may 
be  shortened  and  taken  out  the  fifteenth  day.  There  is  no  hurry 
about  the  bowels  being  opened,  and  under  no  circumstances  is  it 
advisable  to  purge  for  several  days.  To  prevent  hernia  the  wound 
should  be  strongly  supported  from  the  first  by  a  rubber  plaster 
fitted  with  tapes,  and  continued  for  months. — Medical  and  Surgu- 
eal  Bulletin. 

AuYLOLYTic  Ferments. 

In  an  article  on  this  important  subject  Wyatt  Wingrave* 
M.R.C,S.,  Eog.  (Assistant  Surgeon  to  the  Central  London  Throat 
and  Ear  Hospital),  in  the  London  Lancel,  May  7,  1898,  weare  in- 
formed of  a  personal  necessity  that  arose  in  the  writer's  experience 
for  a  reliable  starch  digestant.  A  crucial  comparative  examination 
was  therefore  made  of  many  malt  extracts  aud  of  Taka- Diastase, 
the  tests  being  condncted  both  chemically  and  clinically. 

He  summarizes  briefly:  1.  That  Taka-Diastase  is  the  most 
powerful  of  the  starch  or  diaetatic  ferments  and  the  most  reliable, 
since  it  is  more  rapid  in  its  action — i.  e.,  "  tt  will  convert  a  larger 
amount  (of  starch)  in  a  given  time  thnii  will  any  other  amylolytic 
ferment."  2.  That  Taka-Diastase  seems  to  be  less  retarded  in  its 
digestive  action  by  the  presence  of  the  oi^auic  acids  (butyric,  lac- 
tic, acetic),  and  also  by  tea,  coffee  and  alcohol,  than  are  saliva  and 


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Sblbctions  ahd  Abstracts.  427 

the  malt  extracts.  This  is  an  important  point  in  p^rroeis.  3.  That 
all  mineral  acids,  hydrochloric,  etc.,  quickly  stop  and  permanently 
destroy  all  diastatic  action  if  allowed  sufficient  time  and  if  present 
in  sufficient  quantities.  4.  That  Taka-Diastaae  and  malt  diastase 
have,  like  ptyalin,  no  action  upon  cellulose  (uncooked  starch).  AH 
starch  food  should  therefore  be  cooked,  to  permit  of  the  starch  fer- 
ment assisting  nature  in  this  function.    . 


Malaria. 


In  a  clinical  lecture  published  in  the  Tri-8tate  Medical  Journal 
and  Practitioner,  Dr.  Francis  Dclafield,  of  New  York,  says:  "An 
arrangement  which  works  here  in  New  York  ia  a  combination  with 
the  quinine  of  acetanilid  and  arseuious  acid: 

B    QuiniDce  Bulphalis gr.  iij. 

Aicidi  aroenioei gr.  j^. 

Acetanilid gr.    ij. 

H.  et  ft.  in  capeulum  No.  j. 

8ig-:  Take  four  in  the  twenty-lour  hours. 
"Now,  why  this  combiuation  is  better  than  quinine  alone,  or 
when  arsenic  is  added,  or  why  adding  two  grains  of  acetanilid 
makes  it  more  efficacious  than  one-thirtieth  of  a  grain  of  arsenions 
acid  and  three  grains  of  quinine,  is  a  question  I  cannot  answer. 
I  have  found  that  it  is  au  by  personal  experience;  I  found  that  the 
adding  of  the  acetanilid  gave  me  such  results  that  I  could  not  get 
along  without  it.  I  do  not  give  large  dosea  of  quinine  alone.  I 
have  been  treating  malarial  fever  in  New  York  for  twenty  years; 
and  I  find  that  just  such  a  combination  of  drugs  answers  very  wdl 
in  my  hands;  it  is  even  better  than  Warbui^'s  tincture." 


Peevention  op  Glaucoma. 
The  etiology  of  glaucoma  is  still  disputed,  but  Schoen,  the  new 
professor  of  ophthalmology  at  Leipsic,  asserts  (Wien.  Klin. 
Rundach.,  Nos.  26  to  31,  1897;  {Am.  Jottr.  of  Surg,  and  Gyv.) 
that  no  one  is  obliged  to  lose  his  sight  from  this  cause.  It  can 
always  be  prevented  if  the  eyes  are  seen  in  time  by  an  expert  and 
his  warnings  heeded,  as  the   invariable  cause  is  excessive  strain  in 


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428       The  Atlanta  Medical  and  Soroical  Journal. 

the  effort  of  accommodation,  which,  of  course,  iDcreasea  with  age. 
The  particulars  of  tbe  last  one  hundred  and  forty  cases  he  has 
treated  are:  Forty-eight  per  cent,  hypermetropic;  not  one  bad 
possessed  a  distance  lens.  Astigmatism  was  present  in  33  per 
cent.;  in  none  had  tbe  astigmatism  been  corrected.  In  20  per  cent, 
there  were  no  glasses,  or  tbey  bod  been  utterly  inadequate.  Nearly 
twice  as  many  cases  of  glaucoma  occur  among  women  as  in  men, 
tbe  former  shrinking  from  wearing  glasses  until  too  late.  While 
the  excessive  straiu  above  mentioned  produces  anatomic  changes 
which  lead  directly  to  glaucoma  in  time,  yet  any  constitutional 
morbid  tendency,  any  weakening  or  depressing  cause,  violent 
coughing,  night  watching,  etc.,  may  bastea  its  appearance. — Mtdi- 
cal  Times. 


Tkichlohacbtic  Acid. 
Dr.  St«in,  of  Moscow,  highly  recommends  trichloracetic  acid  in 
the  treatment  of  nose  and  throat  trouble.  He  says :  "  Weak  solu- 
tions of  trichloracetic  acid  used  in  the  nose  in  simple  atrophic 
rhinitis  for  a  considerable  time  sometimes  produce  such  a  decided 
hypertrophy  of  the  turbinated  membranes  that  it  may  become  nec- 
essary to  cauterize  them  in  order  to  secure  free  breathing.  No 
other  medicine  of  which  the  writer  is  cognizant  produces  such  a 
remarkable  effect,  and  thus  this  agent  is  particularly  applicable  in 
the  treatment  of  ozena."  In  true  ozena  Dr.  Stein  applies  stronger 
solutions  than  he  did  at  first.  He  now  uses  a  solution  of  one-half 
to  ten  per  cent,  in  the  treatment  of  ozena,  and  says  that  the  odor  is 
not  so  quickly  nor  so  thoroughly  abolished  by  any  other  medicinal 
agent  as  by  the  acid.  In  solutions  of  l-to-500  to  l-to-2000  it  will 
keep  all  suppurative  processes  in  abeyance  for  a  week.  In  dilute 
solution  it  is  one  of  the  best  antiseptic  remedies  that  Dr.  Stein  has 
ever  employed,  and  it  causes  greater  stimulation  of  atrophic  mem- 
brane than  any  other  application  with  which  he  is  acquainted. — 
The  Pharmacologisl. 

Croupous  ToNsiLLms. 
In  the  cases  of  adults  (he  writer  has  in  many  instances  aborted 
follicular  tonsillitis  by  the  following  method:     Each  affected  crypt 


^dbyGoogle 


Selections  and  Abstracts.  429 

was  in  turn  washed  out  with  peroxide  o(  hydrogen,  by  means  of  a 
Blake's  middle-ear  caaula  screwed  on  to  a  hypodermic  syringe. 
The  curved  tip  of  the  cauula  employed  is  about  one-half  inch  in 
length  and  capable  of  reaching  to  the  bottom  of  the  follicle.  Only 
a  drop  or  two  of  the  peroxide  is  injected  at  one  time,  but  the  pro- 
cess is  repeated  until  all  of  the  exudate  has  disappeared.  A  fine 
Allen's  probe  with  a  few  fibers  of  cotton  wrapped  about  its 
end  is  then  bent  at  an  appropriate  angle  aud  aller  being  dipped 
into  a  solution  of  nitrate  of  silver,  one  drachm  to  the  ounce,  is 
carried  to  the  bottom  of  a  follicle  and  the  process  repeated  until 
each  of  the  affected  crypts  have  received  the  silver  solution.  The 
surface  of  the  tonsil  is  then  painted  with  the  same  solution.  The 
treatment  is  followed  immediately  by  a  sense  of  relief  and  comfort 
and  the  difiiculty  in  swallowing  is  in  great  measure  alleviated. 
The  process  may  be  repeated  two  or  three  times  a  day  and  in  suc- 
cessful cases  brings  about  a  cure  at  tbe  end  of  the  second  or  third 
day. — Dr.  Gleaaon,  AtlarUio  Med.   Weekly. 


Record  of    Medico-Suroical  PRAcncE    with    Auxiliary 

Blood-Supply — "Hematherapy" — (or  otherwise) 

AT  Sound  View  Hospital,  T.  J.  Biggs,  M.D., 

Stamford,  Connkcticut. 

Caialogue  Case  No.  40.  Tubercular  N^krith.  Operation. — 
T H -,  Springdale,  C(inn.;  male;  Engliub;  ago  12;  admit- 
ted April  15,  1898.  Three  weeks  before  )>atieut  bad  been  seized 
with  a  violent  chill,  followed  by  fever;  and  although  the  fever  bad 
been  reduced  under  treatment,  the  temperature  could  not  be  gotten 
under  100.5.  He  had  lost  flesh  rapidly;  suffered  great  pain  in  tbe 
right  kidney;  passed  large  quantities  of  light  urine,  in  which  some 
blood  was  occasionally  present.  Microscopic  examination  of  urine 
disclosed  numerous  tube  cants  and  tubercle  bacilli.  Chemically,  it 
showed  a  half  of  one  per  cent,  albumen.  I  suggested  operation, 
deeming  it  the  only  wise  plan  in  view  of  the  condition  being  so 
painful  and  progressing  so  rapidly.  This  was  refused.  I  then  put 
tbe  patient  on  a  teaspoonful  of  bovinine  in  mitk  every  two  hours, 
and  half  a  drop,  of  kreasote  and  a  teaspoonful  of  sanmetto  every 


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430       The  Atlanta  Medical  and  Suboical  Journal. 

three  faourg.  UDder  this  treatment  he  showed  some  improvement 
up  to  22d;  after  which  the  paio  and  general  symptoms  of  the  pre- 
vious condition  returned.  I  again  strongly  advised  operation, 
which  was  again  refused.  On  the  28th,  told  the  parents  that  if 
they  would  not  coubent  to  do  as  I  said,  absolutely  in  every  detail, 
I  would  no  longer  assume  responsibility  in  the  case.  On  the  29tb 
they  consented  to  permit  me  to  do  as  I  saw  fit.  Consequently, 
after  a  day  of  preparatory  treatment,  was  ojierated  on,  May  1st. 
An  esploratory  incision  was  made  posteriorly,  and  the  kidney  was 
brought  to  the  surface  of  the  wound.  It  was  found  tremendously 
congested,  and  presenting  the  appearance  of  a  wcll-defiued  case  of 
renal  tuberculosis.  So  thoroughly  ^as  the  kidney  involved,  that 
on  account  of  the  child's  weakened  condition  I  deemed  it  unwise 
to  allow  it  to  remain,  and  therefore  removed  it.  I  found  that  the 
surrounding  tissues  gave  no  sign  of  tubercular  deposit,  but  seemed 
to  be  in  a  thoroughly  healthy  condition.  After  cleansing  the  cav- 
ity with  peroxide-ou-bovinine  and  Thiersch  irrigation,  a  glass 
drainage-tube  was  inserted,  and  the  edges  of  the  external  wound 
were  brought  together  around  it.  Bovinine  was  applied  four  times 
a  day  to  the  stump  of  the  kidney,  through  the  glass  tube,  until  the 
I2tli;  when,  being  found  in  a  healthy  condition,  the  drainage-lube 
was  removed,  and  the  external  edges  of  the  wound  were  brought 
in  apposition  with  one  silver-wire  suture  and  six  silk  sutures.  On 
the  24th  this  wound  was  entirely  healed,  and  oh  May  27,  1898,  the 
patient  was  dischargetl  cured. 

Remark:  The  rapidity  with  which  the  condition  in  this  case  was 
healed  is  nndoubledly  due  to  supplied  blood,  and  a  parallel  to  it  I 
do  not  know. 

Qilaloffue  Caite  No.  89.  Chronic  StilpinffUis.  Condemned  Ovary 
Saved. — Mrs.  McC ,  Stamford,  Conn.;  American;  age  32;  ad- 
mitted April  II,  1898:  Salpingitis  of  left  ovary.  Had  been  un- 
der the  care  of  a  leading  physician,  who  advised  her  to  have  the 
ovary  removed.  This  was  absolutely  refused,  and  I  was  called  in 
consultation.  I  did  not  agree  with  my  colleague  that  the  removal 
was  absolutely  necessary.  This  pleased  the  patient  so  much  that 
she  decided  to  enter  the  hospital  for  treatment.  Digital  examina- 
tion revealed  a  soggy  mass  posteriorly  on  the  lefl  side,  the  womb 


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Selections  and  Abstracts.  43l 

considerably  retroverted,  and  aevere  endometritis.  My  theory  was 
that  abitorption  had  taken  place  through  the  tube,  and  that  if  the 
endometritis  were  thoruughly  cured  the  ovarian  condition  would 
subside,  there  being  no  positive  evidence  as  yet  of  any  pus.  I 
therefore  decided  to  put  the  patient  on  the  following  course  of 
trftattneut:  A  teaspoonful  of  bnviniae  in  old  port  wine  every  two 
hours,  with  a  hot  vaginal  douche  of  plain  sterilized  water.  This 
treatment  was  continued  to  the  27th,  when  the  pain,  which  had 
l>eeD  previously  very  severe,  was  entirely  relieved.  On  the  28th, 
after  etherizing  the  patient,  I  thoroughly  curetted  the  womb,  aud 
after  depuration  with  the  bo vinine- peroxide  reaction,  packed  it 
with  bi-sterilized  gauze  saturated  with  iodoform-bo vinine.  This 
was  removed  in  forty-eight  hours,  the  womb  was  again  bovinine- 
peroxidised,  and  repacked  with  gauze  saturated  with  bovinine 
pure.  These  depurations  and  packings  were  repeated  until  May 
5th,  when  they  were  discontinued,  and  bovinine  tampons  were  ap- 
plied twice  a  day.  The  bovinine  by  mouth  was  increased  to  a  wine- 
glassful  in  grape-juice  every  four  hours.  Patieut  now  felt,  as  she 
expressed  it,  well  and  happy,  aside  from  the  weakness  resulting 
from  former  sulferings.  The  bovinine  tampons  continued  to  be 
applied  until  the  20th,  when  the  womb  was  found  in  a  normal  con- 
dition, there  was  no  tenderness  over  the  ovary,  and  the  patient's 
general  condition  was  better  than  it  had  been  for  years.  A  Thiersch 
douche  was  now  employed  at  bedtime,  up  to  the  28th.  May  29, 
1898,  she  was  dischat^ed  cured,  and  delighted  that  her  ovary  had 
been  saved. 

Dispensary  Casat  ( T.  J.  B.).     Caruncle  of  Urethra —  Ulceration 

cxxv. — Marie  B- ,  New  Canaan,  Conn.;  American;  age  45;  first 

Been  May  3,  1898;  Caruncle  of  urethra.  History:  Six  months 
previously  she  had  found  it  necessary  to  consult  a  physician,  hav- 
ing suffered  much  distress  during  urination,  followed  by  excruci- 
ating pain  after  the  bladder  wa^^  emptied.  The  physician  told  her 
that  she  had  cancer  of  the  meatus  and  first  part  of  urethra,  and 
advised  immediate  operation  for  removal  of  the  same.  Accord- 
ingly, a  few  days  later,  under  etherization,  a  growth  was  partially 
removed.  The  patient  reacted  well  from  the  immediate  effects  of 
the  operation,  hut  now  experienced  greater  pain  than  ever,  which 


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432       The  Atlanta  Medical  and  SuBarcAL  Journal. 

was  continuous.  She  consulted  another  physician,  who  put  her 
through  a  course  of  treatment,  but  in  spite  of  thi?  she  steadily 
grew  worse. 

On  May  3,  1898,  she  came  under  my  care*  Esamination  re- 
vealed a  large-sized  canincio,  involving  the  entire  circumference 
of  the  meatus  and  from  a  half  to  thrce-fouitbs  of  the  auterior  por- 
tion of  the  urethra.  Iditerally,  on  the  right  side,  was  a  very  hard 
and  painful  cicatrix,  resuttiog  from  the  former  operation.  I  ad- 
vised operation,  and  the  palieut  consented.  But  her  condition 
being  one  of  pronounced  neurasthenia  and  general  debility,  I 
deemed  it  wise  to  put  her  on  a  few  days  of  preparatory  treatment 
before  operating.  After  regulating  the  secretions  I  ordered  given 
her  a  teaspoonfnl  of  boviniue  in  milk  and  grape-juice  alternately, 
every  two  hours.  May  6th,  the  patient's  condition  being  favora- 
ble, she  was  chloroformed  aud  the  growth  and  scar  were  both  care- 
fully dissected  out.  The  urethra  was  uuw  packed  gently  with  a 
strip  of  bi-sterjlized  gauze  packed  with  boviuine  pure.  Incident- 
ally it  may  be  meutioued  that  the  urethra  was  thoroughly  dilated, 
so  that  incontinence  of  urine  might  result  for  a  few  days,  to  pre- 
vent contraction  of  the  urethra  down  on  the  denuded  surface  of  the 
wutiud.  At  the  end  of  twelve  hours  the  packing  was  removed, 
and  urethra  and  bladder  were  washed  out.  A  glass  tube,  prepared 
with  msny  perforations  all  over  its  circumference,  was  now  in- 
serted, and  held  iu  place  by  an  improvised  harness;  the  object  be- 
ing to  not  only  thoroughly  draiu  the  bladder,  thereby  giving  the 
muscles  rest  and  keeping  the  deuuded  surfaces  apart,  but  also  at 
the  same  time  provide  for  feeding  the  denuded  sur&ces  by  drop- 
ping iu  and  difitisiug  boviuine,  which  was  done  hourly  the  finit 
day,  and  every  twu  hours  the  second  day.  This  tube  was  allowed 
to  remain  in  until  the  10th,  when  it  was  removed,  and  the  urethra 
was  found  to  be  in  a  healthy  grauulating  condition.  Buviuiue  pure 
was  now  injected  with  a  glass  syringe  every  two  hours,  and  urine 
drawn  three  times  a  day,  until  the  16th,  when  the  surfeces  were 
almost  entirely  bealed,  the  normal  power  of  the  urethra  was  re- 
stored, and  urine  was  voided  without  any  pain;  the  only  part  not 
healed  being  the  site  of  the  old  scar  made  by  the  former  operation. 
May  2l8t,  this  also  being  healed,  the  patient  was  discharged  abso- 
lutely cured. 


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ATLANTA 

Medical  and  Surgical  Journal. 


SEPTEMBER,  1898. 


DUNBAR  RUY,  A.B.,  M.D.,  M.  B.  HUTCUINS,  M.D., 

EDITOR.  BUSINrae   HANAOER. 


ORIGINAL  COMMUNICATIONS, 


"RECURRENT"  GONORRHEA.* 

By  feed.  C.  valentine,  M.D., 
ProteBsor  of  Geni to-Urinary  Diseases,  New  York  School  oE  Clinical  Medicine ; 
Gen i to-Urinary  Surjieon,  West  Side  German  Disipensary;  Genito- 
urinary Coosultant,  United  Hebrew  Charities,  etc.,  etc. 

RfiSCMfi. 

1.  Cessation  of  the  symptoms  of  clap  does  act  prove  that  the 
■case  ifi  cured. 

2.  No  female  cured  of  the  evidences  of  clap  should  be  (dismissed 
without  proving  that  the  appareutly  uormal  urethra,  Bartholini's 
glands,  the  cervix  and  the  sub-mucous  tissues  (especially  those  of 
the  cul-de-sac)  are  free  from  gonococci. 

3.  No  male  should  be  dismissed  from  treatment  until  it  is  defi- 
nitely ascertained  that  his  urethra,  seminal  vesicleo  and  prostate 
are  free  from  the  disease. 

4.  The  methods  of  securing  positive  evidence  of  the  cure  of 
gonorrhea  are  within  the  general  practitioner's  reach. 

5.  The  treatment  of  recurrent  gonorrhea  is  not  difficult,  nor  does 
it  require  special  skill. 

'Wrilteu  at  Uie  request  of  Tbe  A-tlinti  Uidicil  ash  Bdroical  Jodrkil. 


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484       Tbb  Atlanta  Medical  and  Surgical  Journal. 

At  the  onset  it  is  well  to  acknowledge  that  the  title  of  this  pa- 
per is  a  misuomer,  expressing,  as  it  does,  merely  one  manifestation 
of  residual  gonorrhea.  ■ 

The  general  practitioner  is  as  well  acquaioted  with  the  condition 
as  18  the  specialist.  In  ai&ay  a  case  apparently  cnred  of  guDorrhea 
a  discbat^e  suddenly  presents  weeks,  occasionally  monttii,  after  (he- 
last  evidence  of  disease  was  ohserved.  This  happens  sometimes- 
after  coitus,  sometimes  without;  after  a  glass  of  beer,  after  tran- 
sient erotic  excitement,  or  without  any  apparent  provocative  cause. 
Unless  one  knows  the  patient,  well,  such  a  case  may  tax  the  pracii- 
tiooer's  &ith,  if  he  would  not  deem  the  recurrence  a  new  infec- 
tion. 

On^ntimes,  indeed,  microscopic  examination  shows  such  a  sud- 
denly appearing  discharge  to  be  loaded  with  gonooocci,  grouped  id 
the  manner  as  they  are  most  frequently  in  a  recent  iofectiou. 
These  microbes  are  sometimes  also  disseminated  throughout  th& 
dii^charge,  or  they  appear  scattered  only. 

The  principal  causes  of  such  a  "  recurrent "  gonorrhea  are : 

1.  Marital  reinfection. 

2.  Infarctiou  of  crypts,  glands,  or  follicles  of  the  anterior  ure- 
thra. 

3.  Chronic  residual  posterior  gonorrheal  urethritis. 

4.  Gonorrheal  prostatitis. 

5.  Seminal  vesiculitis. 

Any  two  or  all  these  causes  may  be  united,  in  one  case. 

Whatever  the  cause,  irrigations  may  soon  bring  about  their  ap- 
parent cure.  And  the  disappearance  of  all  symptoms  of  disease- 
may  be  so  rapid  as  to  cause  the  patient  and  the  physician  to  de- 
ceive themselves  into  believing  that  a  woaderfiil  cure  has  been  ef- 
fected. The  young  practitioner  especially  should  be  warned  against 
taking  even  a  successioo  of  such  cases  into  statistic  consideration^ 
unless  in  each  case  he  has  assured  himself  that  the  patient  is  free 
from  the  causes  of  recurrence.     To  briefly  discuss  them  : 

1.  Marital  reinfection.  The  evidences  of  gonorrhea  in  a  woman 
may  be  so  slight  as  to  be  imperceptible.  In  another  j>aper*  I  endeav- 
ored to  outline  the   methods  by  which  the  ability  of  a  woman  to 

•Vaiciiiiiie:    Kealdunl  OonorrhSA  In  Woman.  Jnurnalo/  ayntenlogi/  and  Surperji,  Sept..  1S%. 


idb,Googlc 


"Recurrent"  G-onorrhea.  435 

iofect  caa  be  determined,  eveD  if  ehe  have  no  discharge  at  all,  and 
where  none  can  be  obtaiDed  by  expressing  the  urethra,  Bartholini's 
glands,  or  scraping  the  cervis.  The  bopeleBsaeia  of  obtainiog  a  cure 
in  a  man  who  is  continually  exposed  to  marital  reinfection  is  too 
evident  for  discussion. 

2.  Infarction  of  crypts,  glands,  and  follicles  of  the  anterior  ure- 
thra. Experience  daily  shows  patients  so  far  returned  to  apparent 
health  that  the  urine  is  perfectly  free  even  from  granules.  Months, 
years,  may  go  by,  without  any  results  from  provocative  cause. 
Then  suddenly  the  urioe,  from  constitutional  causes,  becoming 
irritaut  to  the  urethra,  reawakens  its  susceptibility  to  the  gonooocci 
that  remained  quiescent  within  its  crypts,  glands,  and  follicles,  and 
an  apparently  new  gonorrhea  springs  up.  One  of  many  casex  in 
point  may  serve  to  illustrate  this.  A  gentleman,  aged  thirty-four, 
acquired  gonorrhea  in  his  eighteenth  year.  When  he  was  twenty- 
eight  he  married,  having  had  no  manifestation  of  the  disease  for 
ten  years.  Shortly  after  his  marriage,*  as  so  often  happens,  he 
had  what  appeared  to  be  a  very  severe  fresh  attack  of  gonorrhea. 
His  wife  was  similarly  affected.  Cunsciuus  that  for  six  mouths 
before  he  had  not  exposed  himself  to  infection,  and  his  wife  but  re- 
cently having  been  a  virgin,  he  attributed  their  illness  to  that  mys- 
terious, albeit  often  quoled  cause,  a  "  strain,"  for  which  he  sought 
no  treatment  until  violent  orcho-epididymitia  bound  him  to  his  bed. 
It  had  progressed  to  suppuration,  which  caused  the  destruction  of 
one  testicle  and  epididymis. 

After  this  he  had  no  further  evidence  of  disease  until  five  years 
laler.  His  wife  then  had  returned  home  after  an  absence  of  sev- 
eral weeks.  Their  first  oitus  was,  withiu  four  days,  followed  by 
acute  gonorrhea  in  both.  Xever  having  been  guilty  of  infidelity, 
he  suspected  her,  with  the  usual  result  of  a  family  disruption.  This 
laste<1  until  it  was  shown  him  that  either  or  both  could  harbor  gon- 
ococci  for  years  without  any  appreciable  manifestatiDn  thereof.  In 
both,  the  disease  yielded  rapidly  to  irrigations.  The  wife,  on  sub- 
sequent examination,  was  found  to  be  free  from  the  disease.  The 
husband,  however,  three  weeks  after  responding  negatively  to  all 

•Valeniloe:  "  Wben  May  Qonon-neal  Patlenta  Uarry?  "   dmerhun  Ucrllco  Surglail  BaUtlln, 


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436       The  Atlanta  Mbdical  and  Surgical  Journal. 

tests,*  when  examined  uretbroscopically,  showed  some  enlarged, 
gapiDg  glands.  Their  contents  being  expressed  with  Kollmaa's 
spatula,  showed  gonococci,  which,  with  an  adequately  exciting 
cause,  would  have  sufficed  to  produce  an  apparently  fresh  clap. 
After  electrolysis  t  of  these  glands  the  patient  resumed  relations 
with  bis  wife  and  his  usual  mode  of  high  living.  Examination  of 
the  entire  genito-urinary  apparatus  six  months  later  showed  no 
abnormal  condition,  except,  of  course,  the  destroyed  testicle  and 
epididymis. 

3.  Chronic  residual  posterior  gonorrhea.  As  described  in  an- 
other paper,]:  this  cause  of  auto-reinfection  is  perhaps  the  most  ob* 
scure,  the  most  difficult  to  diagnose,  but  not  very  difficult  to  treat. 
Its  precise  differentiation  requires,  however,  something  beyond  or- 
dinary  experience  in  urethroscopy,  and  therefore  is  more  proper 
for  discussion  in  a  paper  written  for  specialists  in  genito-urinary 
diseases. 

Roughly,  though,  it  may  be  said  that  when  the  first  morning 
urine  is  free  from  even  granules,  expression  of  the  posterior  urethra 
may  detach  sufficient  flakes  to  be  carried  in  the  first  urine.  This, 
centrifuged  and  examined  microscopically,  may  reveal  gonococci, 
of  which  no  suspicion  oould  be  otherwise  obtaiued. 

The  technique  of  expression  of  the  posterior  urethra  is  simple 
enough  for  even  a  tyro  to  perform.  It  in  nowise  difTers  from  mas- 
sage of  the  prostate  and  stripping  the  seminal  vesicles  (to  be  out- 
lined further  on),  except  that  to  obtaiu  certainty  regarding  the  loca- 
tion of  the  affection,  pressure  upon  the  prostate  and  vesicles  must 
be  avoided. 

4.  Oonorrheal  proxlatitie.  In  a  brilliant  paper  on  the  subject, 
\Vo3sidlo,§  of  Berlin,  urges  that  no  case  of  gonorrhea  should  be 
dismissed  without  assurance  being  obtained  that  the  prostate  is  free 
from  disease.     Perhaps  the  majority  of  cases  of  what  I,  for  want 

'VoleoUae:  "Tbe  Prooh  of  Cure  of  ODnorrhea."    Clinical  Bceonfcr,  April.  ISW. 

tValenlloe:  "Chrontc  QonarrheB:  lu  ScientiQc  Treatment,"  CUnfcol  Jtnordn-,  Juiuarr,  ItOS. 

IValenCine:  "  A  Contribution  to  tbe  Study  of  the  Symptoms  of  Chroaic  aaDorrhea."  &«ad 
before  tlie  American  Uodicdl  AssociattOD.  Denver,  June,  ISSit.  Will  eooa  be  published  in  Uw 
Journal  of  (Ac  Jnterlcin  Midkil  Jnodddnn. 

^Wonldlo:  "Chronic  Proatatitls."  Headbcrore  the  American  Hedical  AXDClatlon.D^Tcr. 
June,  IJM,  BOOH  to  be  publlsbed  In  the  Joarnil  qf  the  Amttiean  Uedieat  Anoclaliim. 


idb,Google 


"Recuerbnt"  Gonorrhea.  437 

of  a  better  term,  have  called  "  recurrent"  gonorrhea,  are  dne  to 
prostatic  invaeion. 

It  is  interesting  and  important  to  note  the  length  oT  time  the 
prostate  can  bold  goDOcooci  without  any  manifestatinn  whatever. 
At  the  risk  of  unduly  lengthening  this  paper  I  will  cite  an  illus- 
trative case : 

A  gentleman  had  an  attack  of  gonorrhea  in  his  eighteenth  year. 
At  twenty-six  be  married.  His  wife  bore  him  two  healthy  chil- 
dren. Whea  he  was  forty-three,  bis  wife  not  having  become 
pregnant  for  ten  years,  he  was  taken  with  salpingitis  at  about  the 
same  time  that  he  became  affected  with  evidence  of  prostatic  en- 
tailment, such  as  diminution  of  the  force  of  the  stream,  frequent 
nocturnal  urination  and  inability  to  entirely  empty  his  bladder. 
Mere  examination  of  the  enlarged  gland  brought  forth  a  very  small 
quantity  of  a  grayish  muco-pus,  which  was  found  replete  with  gon- 
ococci.  So  here  is  a  case  in  which,  for  twenty-five  years,  the  pros- 
tate held  gonococci  without  any  manifestation  whatever,  not  even 
preventing  the  procreation  of  two  healthy  children. 

The  diagnosis  of  prostatitis  will  be  outlined,  together  with  that 
of  seminal  vesiculitis. 

5.  Seminal  veeiculitia,  if  gonorrheal,  as  it  is  in  the  majority  of 
cases,  may  be  the  cause  of  recurrent  clap.  Its  other  symptoms, 
even  more  ao  than  those  of  prostatitis,  supply  that  vast  array  of 
manifestations  so  often  diagnosed  as  neurasthenia. 

If,  in  a  case  of  recurrent  gonorrhea,  marital  reinfection  can  be 
excluded  by  examination  of  the  woman ; 

b,  infarction  of  the  crypts,  glands,  and  follicles  by  urethroscopy; 

c,  chronic  residual  posterior  gonorrheal  urethritis  by  expression 
of  the  posterior  urethra  and  posterior  urethroscopy; 

d,  gonorrheal  prostatitis  by  massage  of  the  prostate, 
then  we  most  look  for  gouorrheal  vesiculitis. 

The  local  manifestations  of  the  three  last  mentioned  conditions 
are  grossly  the  same,  differing  only  in  detail. 

For  such  an  examination  I  deem  it  best  to  place  the  patient  on  a 
eo&,  lying  on  his  back.  The  apex  of  the  index-finger  and  the  bed 
of  the  nail  being  tightly  packed  with  soap  and  then  thickly  anointed 
with  vaseline,  the  finger  is  gently  inserted  into  the  rectum.    The 


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438       Tbb  Atlanta  Medical  and  Sdrgical  Journal. 

other  hand  rests  above  the  pubis  to  steady  and  press  down  the 
pelvic  viscera- 

The  pulp  of  the  finger  is  turned  toward  the  front  of  the  patient, 
and  lightly  outlines  the  prostate,  but  exercises  not  even  the  slightest 
pressure  upon  any  part  of  it.  If  the  operator  desires  to  elicit  evi- 
dence of 

Chronic  residual  posterior  gonorrhea,  he  lets  the  finger  glide  from 
the  prostate  and  exercises  pressure,  with  increasing  force  in  a 
stroking  motion  forward  from  the  lowermost  margin  of  the  pros- 
tate, endeavoring  with  each  stroke  to  force  tbe  posterior  urethra 
against  the  posterior  aspect  of  the  pubis. 

The  patient  is  then  ordered  to  urinate,  and  if  this  is  the  region 
affected,  the  urine  will  contain  flakes,  perhaps  even  filameote  or 
shreds,  which  tbe  urinary  stream  was  unable  to  detach.  Micro- 
scopy of  these  products  of  massage  will  reveal  tbe  character,  prob- 
ably gonorrheal,  of  the  posterior  urethritis.  If  this  results  nega- 
tively, examination  for 

Prostatitis  may  be  made  in  the  same  manner,  several  days  later- 
The  size,  shape,  and  hardness  or  softness  of  each  lobe,  as  well  as  of 
tbe  isthmus,  sboald  be  ascertained;  lobulation  or  smoothness  should 
be  elicited,  depressible  points  located,  and  tbe  prostatic  juice,  if 
any  exudes  from  the  meatus,  microscopically  examined.  If  none 
escapes,  the  first  urine  the  patient  passes  after  this  massage  of  the 
prostate  should  be  centrifuged  for  examination.  If  the  prostate 
contains  gonococci,  they  will  be  found  either  in  the  discharge  that 
escapes  from  tbe  meatus  or  flows  into  the  posterior  urethra  or 
bladder  and  is  carried  off  by  the  urine.  If,  however,  the  prostate 
is  found  to  be  normal,  then  the  patient  should  be  examined  two  or 
three  days  later  for 

Seminal  veaieulitis.  This  is  done  in  the  same  manner,  except 
that  the  finger  is  parsed  up  tbe  rectum  further,  beyond  the  prostate 
aud  to  its  sides.  In  health  the  seminal  vesicles  can  be  barely,  if 
at  all,  felt.  When  enlarged  by  disease,  they  assume  the  shape  of 
more  or  less  tensely  filled  little  sausages.  In  engaging  the  finger 
as  high  up  as  possible  on  these  bodies,  by  curving  the  finger  down- 
ward and  towards  the  center  with  increasing  force,  tbe  seminal 


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"Reccrbent"   Gonorehba.  439 

veeicles  may  be  stripped  of  tbeir  ooateots.  These  are  treated  in 
the  msBoer  as  described  uoder  the  examination  for  prostatitis. 

The  first  of  either  of  these  examiDations  is  usually  attended 
-with  some  pain,  but  the  relief  the  patient  experiences  is  usually  so 
great  that  he  will  ask  for  its  repetition. 

As  in  all  other  geoito-urinary  work,  gentleness  in  these  manipa- 
'  lations  cannot  be  too  strictly  followed.  Nothing  is  gained  by  vio- 
lence, even  harm  can  be  done.  Physicians  unable  to  devote  the 
most  exquisite  gentleness  and  sympathy  to  these  cases  would  do  well 
to  relegate  thera  to  others. 

The  treatment  of  recurrent  gonorrhea  should  be  directed  to  its 
-cause,  or,  perhaps  better,  its  location. 

Where  marital  reinfection  is  the  cause,  attempts  to  oure  the  hus- 
band mast  prove  futile  while  the  wife  remains  ill,  as  in  the  major- 
ity of  instances  prohibitions  regarding  coitus  are  of  no  avail. 

Where  the  crypts,  glands  orfoUielea  of  the  anterior  urethra  harbor 
£onococci,  if  systematic  dilatations  and  irrigations  do  not  entirely 
sufBce,  electrolysis  will  complets  the  cure,* 

When  posterior  urethritis,  prostatitis,  or  seminal  vesiculitis  causes 
the  exacerbations  of  auto-reinfection,  Kollman's  posterior  dilator, 
massage  of  the  prostate,  and  stri[>})ing  of  the  vesicles  will  be  re- 
quired. Irrigations,  as  elsewhere  described,  wilt  be  found  valuable 
adjuvants  to  the  treatment.  While  it  is  not  at  all  likely  that  even 
the  most  copious  irrigations  will  wash  away  enough  of  the  maieries 
morbida  to  materially  affect  the  disease,  they  procure  an  artificial 
«dema  wbicb  renders  the  muoons  membrane  an  un&vorable  culture- 
medium  for  the  gonococci. 

In  all  cases  the  general  condition,  as  well  as  the  nervous  system, . 
suffers  deterioration.  This  must  be  met  by  constitutional  treat- 
ment, tonics,  baths,  attention  to  digestion,  indeed  every  means  at 
our  command  to  fortify  the  patient's  resistance  against  further  in- 
roads of  the  disease. 

2^9  West  4Sd  Street,  New  York. 


■Vklentlne:  "UbroDic  Ooaoirbea:  lu  SeimtJQc  Tnatment,"    CUnleul  Steorder,  jKauur, 


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440       The  Atlanta  Medical  akd  Surqioal  Jodbnal. 


THE  SERUM  DIAGNOSIS  OF  TYPHOID  FEVER. 

By  MICHAEL  HOKE,  M.D., 
Atlanta,  Oa. 

Since  1886  there  have  been  many  efforts  to  utilize  the  presence- 
of  the  typhoid  bacillue  for  the  diagnosis  of  typhoid  fever,  but  untiL 
the  application  of  the  test  by  Widal,  June,  1896  (the  nature  of  it 
aod  technique  having  been  described  by  others),  nothing  practical 
for  the  practitioners  had  been  developed,  because  the  tedionsness 
of  and  uncertain  results  from  all  previous  methods  had  prevented 
t^eir  adoption. 

The  steps  in  the  development  of  this  test  were  as  follows: 

Id  1889  Charrinand  Roger  noticed  the  clumping  of  the  bacillus 
pyocyanicus  when  grown  in  the  serum  of  an  animal  immune  against 
this  organism. 

In  1894,  Pfeiffer  introduced  cholera  spirilla  into  the  peritoneal 
cavity  of  a  guinea-pig  immune  against  the  disease.  Esamiuation 
of  the  peritoneal  fluid  showed  that  the  organisms  therein  soon  lost 
t^eir  motility,  agglomerated  and  soon  broke  up  into  fine  granules. 
Id  1896  Pfeiffer  and  £olb  demonstrated  the  phenomenon  for  ty- 
phoid infection  also. 

In  1896  Durham,  and  afterwards  Durham  and  Gruber,  published 
papers  explaining  the  nature  of  the  .action  of  immune  sera  on  bac- 
teria outaide  of  the  animal  body.  The  microscopic  and  macroscopic 
tests  were  described.  It  was  shown  that  by  the  test  it  was  possible 
.to  differentiate  between  bacterial  species,  and  to  determine  whether 
one  bad  bad  an  attack  of  typhoid  fever  or  cholera  previously. 
Widal  was  the  first  to  apply  this  developed  test  to  the  diagnosis 
of  the  disease  in  the  early  stage  of  infection. 

He  withdrew  blood  from  a  superficial  vein  at  the  elbow  of  the 
patient  with  a  syringe,  under  aseptic  precautions.  The  serum, 
after  the  blood  bad  coagulated,  was  decanted  and  added  to  a  bouillon 
culture  of  the  typhoid  bacillus  in  the  proportion  of  one  part  serum 
to  fifteen  parts  bouillon.  The  culture  so  treated  was  placed  in  a- 
thermostat  at  37°  C.     The  serum  was  also  added  in  the  same  pro- 


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The  Sebum  Diagnosis  of  Typhoid  Fever.  441 

portiuD  to  a  bouillon  culture  of  the  oolou  bacillua.  This  culture 
was  placed  in  the  thermostat  with  the  other  one.  In  four  or  five 
hours  the  tube  coDtaiuing  the  colon  bacillus  became  cloudy,  while 
the  one  containing  the  typhoid  bacillus  was  clear.  At  the  end  of 
twenty-four  hours  the  tube  containing  the  colon  bacillua  became 
cloudy  throughout,  while  the  typhoid  bacillus  culture  was  still  clear^ 
the  bacteria  having  been  precipitated  to  the  bottom  as  whitish  flakes. 

A  drop  of  the  culture  of  the  colon  bacillus  examined  under  the 
microscope  showed  isolated  bacteria,  activity  motile.  A  drop  of 
the  culture  of  the  typhoid  bacillus,  examined  microscopical ly^ 
showed  scattered  clumps  of  bacteria  which  had  lost  their  motility 
and  were  agglutinated. 

These  two  phenomena,  the  formation  of  flakes  visible  to  the  eye 
in  the  culture  and  precipitated  to  the  bottom,  and  the  agglutina- 
tion, agglomeration  and  immobilization  as  seen  by  the  examinatioD 
of  a  drop  of  the  culture  with  the  leas,  constitute  the  characteris' 
tics  of  the  macroscopic  and  microscopic  tests,  respectively.  Some- 
times there  is  complete  clumping  and  partial  toss  of  motion  or 
complete  immobility  and  partial  clumping. 

The  value  of  this  test  for  diagnostic  purposes  depends  upon  the 
specificity  of  the  change  in  the  blood  brought  about  by  infection 
with  the  typhoid  organism  or  intoxication  with  its  products. 

The  normal  blood  possesses  in  a  certain  degree  the  power  of 
agglutinating  the  typhoid  bacillus,  but  the  result  of  infection  is  to 
increase  this  power  far  beyond  that  which  has  been  observed  for 
the  normal  blood. 

What  the  substance  is  in  the  blood  which  possesses  the  agglu- 
tinative power  is  not  known.     Blood-serum  deprived  of  globulin- 
looses  the  power,  while  the  globulin  retains  it.     When  the  fibrin 
and  globulin  are  separated,  each  possesses  the  property,  while  the  ' 
plasma  left  does  not. 

The  a^lutinative  property  in  typhoid  fever  has  been  found  in 
blister-serum,  pleural,  pericardial,  peritoneal,  inflammatory  and 
edematous  fluids;  in  the  milk,  aqueous  humor,  urine  and  stools. 
The  blood  acquires  the  agglutinative  property  usually  by  the  end 
of  the  first  week  after  the  entrance  of  the  organism  or  its  products. 
This  power  increases  irregularly  during  the  infection,  gradually 


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442       Tbb  Atlanta  Medical  and  Surqical  Journal. 

disappearing  weeks  or  moaths  or  years  after  recovery.  In  some 
instances  it  occurs  as  early  as  the  fourth  day,  in  others  not  until 
the  end  of  the  third  week  or  later,  rarely  not  at  all. 

The  agglutinative  property  is  not  destroyed  by  drying  the  blood 
for  months.  It  resists  the  action  of  sunlight.  Prolonged  heating 
at  60*  C.  "weakens  it,  and  heating  at  75'  for  ten  minutes  destroys  it 

The  blood  may  be  obtained  by  pricking  the  tip  of  the  finger  or 
the  lobe  of  the  patient's  ear.  Several  large  drops  are  then  col- 
lected on  a  clear  slide,  which  is  tilted  so  as  to  partially  separate 
the  clot  and  serum.  The  blood  is  allowed  to  dry.  The  test  may 
be  made  at  once  or  at  leisure.  Another  way  is  to  withdraw  the 
blood  frtlm  a  veio  of  the  arm  with  a  syringe  under  aseptic  precau- 
tions. The  blood  is  forced  out  into  a  tube;  the  serum  separates 
from  the  clot.  This  method  gives  an  abundance  of  serum.  Still 
another  method  is  to  collect  the  blood  from  the  pricked  finger  in  a 
small  capillary  tube.  The  serum  separates  and  may  be  dropped  in 
quantity  desired. 

The  use  of  the  dried  specimen  has  given  excellent  results,  and 
possesses  the  advantage  of  ease  of  collection,  freedom  from  con- 
tamination, and  readiness  of  transportation.  For  precision,  it  pos- 
sesses the  disadvantage  of  inaccuracy  in  the  quantitative  dilutions, 
but  for  all  practical  purposes  it  suffices. 

If  the  dried  specimen  is  used,  it  is  brought  into  solution  by 
mixing  it  with  about  five  times  the  quantity  of  water;  then  a  drop 
of  this  mixture  is  placed  on  a  cover-glass,  and  to  it  is  added  a  drop 
of  bouiltoD  culture  of  the  typhoid  bacillus  eighteen  hours  old,  or 
a  drop  of  a  suspension  in  bouillon  of  au  agar  culture  of  the  same 
age.  This  cover-glass  is  inverted  over  a  boUow  slide  and  exam- 
ined with  a  one-half  oil  ot  immersion  lens. 

If  one  uses  the  capillary  tube  or  syringe  in  obtaining  the  speci- 
men, absolute  accuracy  in  the  quantitative  dilutions  becomes  possi- 
ble. If  a  large  quantity  of  serum  has  been  obtained,  it  is  sucked 
up  with  a  graduated  pipette  to  the  jraint  marked  1,  and  then  blown 
out  into  a  watch-glass.  From  a  bouillon  culture  of  a  typhoid 
bacillus  is  sucked  up  as  many  times  the  quantity  of  culture  or 
serum  as  is  desired,  the   number  depending   upon  the  dilution 


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The  Sebum  Diagnosis  of  Typhoid  Fever. 

nished.     This  is  mixed  with  the  serum  in  the  watch-gli 
drop  or  two  of  the  mixture  is  used  to  make  the  examinal 

If  the  capillary  tube  is  used,  a  drop  of  the  serum 
added  to  just  as  many  drops  of  the  culture  as  will  give  tl 
dilution.     The  capillary  tube  used  iu  dropping  the  cultur 
of  tbe  same  diameter  as  the  one  used  in  collectiag  and 
the  serum.     A  cover-glass  is  prepared  as  above  and  exam 

If  the  reaction  develops  slowly,  one  soon  notices  that 
the  bacilli  are  not  as  actively  motile  as  they  should  be.  i 
are  gathered  here  aud  there  in  groups  of  twos,  threes,  fi 
the  bacilli  stick  to  one  another,  tugging  to  get  loose.  ' 
Ijzing  of  motility  and  clumping  is  progressive.  Fina 
was  at  first  a  field  of  isolated,  actively- motile  bacteria  bee 
ID  which  oi^nisms  are  gathered  here  and  there  in  clui 
clear  spaces  between,  and  partially  or  completely  devoi 
tility.  If  the  reaction  has  been  complete  and  immediati 
as  the  slide  is  examined  the  organisms  are  seen  to  be 
and  stuck  together  in  clumps.  The  various  degrees  bel 
immediate  and  delayed  reaction  are  observed  accordin 
quantity  of  the  agglutinative  substances  in  the  blood  an' 
gree  of  dilution. 

The  normal  blood-serum  possesses  the  a^lutinative  pov 
luted  in  proportion  of  not  more  than  one  part  serum  to 
culture.  On  account  of  this  fact  it  is  necessary  to  make  th< 
sufficiently  great  to  preclude  the  possibility  of  an  error 
source.  Various  standards  of  dilution  have  been  sugges 
one  to  twenty-five  to  seven  to  fifty.  In  only  a  few  eases  o 
fever  has  the  reaction  been  observed  in  dilutions  less  th 
fifty.  Very  few  cases  would  be  missed.  A  negative  r 
preliminary  test  with  equal  parts  serum  and  culture  ex( 
phoid  fever.  If  the  examination  be  positive  and  immed 
dilutions  one  to  fifteen  or  one  to  twenty,  the  diagnosis  ol 
fever  can  be  made ;  but,  to  be  absolutely  certain,  other  tes 
be  made  with  higher  dilutions  if  the  quantity  of  serum 
If  only  one  test  is  made,  it  should  be  with  a  dilution  ( 
fifty  with  a  time  limit  of  one  to  two  hours. 

In  a  total  of  422  cases  of  typhoid  or  suspected   typhi 


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444       The  Atlanta  Medical  and  Surgical  Journal. 

collected  by  the  New  York  health  departmeat,  rejmrted  by  fifteen 
observers,  404  were  poflitively  diaguosticated  to  be  typhoid  fever 
or  not — 312  positively,  92  negatively;  or,  in  about  95  per  cent, 
the  diagnosis  was  confirmed  by  the  test  on  the  first  examination. 

The  ease  with  which  typhoid  fever  may  deviate  from  the  classi- 
cal type  and  the  existence  of  a  great  number  of  symptoms,  desig- 
nated by  the  term  "typhoid,"  which  may  be  present  in  profound 
infections  other  than  typhoid  bacillus,  are  but  evidences  of  the 
confusion  which  may  sometimes  be  in  the  mind  of  even  the  most 
skilled  practitioner  over  the  entity  of  a  doubtful  febrile  attack. 
The  similarity  between  certain  cases  of  meningeal,  peritoneal,  and 
acute  miliary  tuberculosis,  ulcerative  endocarditis,  estivo-antum- 
nal  type  of  malaria,  septic  infections,  etc.,  are  well  known.  The 
value  of  this  test  in  clearing  up  the  doubt  in  these  cases  has  been 
tuoroughly  demonstrated  io  the  municipal  laboratories  and  the 
hospitals  of  the  large  cities  ia  this  country  and  abroad  for  the  last 
two  years.  Particularly  should  it  be  of  value  in  the  South  ftT 
elucidfltiog  the  nature  of  many  doubtful  short  fevers. 

This  incomplete  review  and  description  of  the  technique  of  .this 
test  may  be  pardoned  if  it  point  out  the  tardiness  of  its  adoption. 

m?  Peachtree  St. 


SOME  ABDOMINAL  CASES.* 

Br  GEORGE  BEN  JOHNSTON;  M.D.,  Richmond,  V*., 

Profeesor  of  Gynecologf  and  Abdomiaxl  Sargery,  Medical  College  of  Vir- 
ginia; Fellow  of  the  A.mericaii  Surgical  Hssociation;  Member  of 
the  Soatbem  Surgical  and  Gynecological  Asaociatioa,  etc. 

It  is  a  source  of  regret  to  me  that  I  have  not  for  the  past  ten 
or  fifteen  years  kept  the  pathological  specimens  that  have  come 
from  the  various  operations  I  have  performed,  because  great  bene- 
fit may  be  derived  later  on  from  a  correct  study  of  these  speci- 
mens. With  this  in  view,  for  the  last  few  months  I  have  kept  all 
specimens  worth  preserving,  concerning  a  few  of  which  I  speak  to 

•KMd  before  the  Riabmood  Acwlemy  of  Medlalne  Mid  Sursery,  Jane  It,  1818. 


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Some  Abdominal  Cases.  445 

you  to-night,  giving  a  brief  history  of  the  oases  from  which  they 
were  obtained. 

Casr  1. — The  first  specimen  I  wish  to  show  was  taken  from 
Mrs.  R.  D.  B.,  aged  twenty-four  years,  referred  to  me  by  Dr.  J,  P. 
Haller,  Pocahontas,  Va.  Admitted  to  the  Old  Dominion  Hospi- 
tal January  17,  1898.  Previous  history  imeveotful  save  an  attack 
of  typhoid  (ever  six  years  ago.  Married  six  years;  one  child  five 
years  of  age;  no  miscarriages.  For  two  years  has  suffered  with 
leucorrhea  and  very  painful  menstruation.  Periods  have  not  ap- 
peared for  five  months. 

An  examination  of  this  case,  made  on  the  18tb  day  of  January, 
revealed  a  large,  globular  tumor  in  the  lower  part  of  the  abdo- 
men, some  enlargement  and  swelling  of  the  breasts,  discoloration 
of  the  nipples  and  fiuid  in  the  breasts.  On  minuter  examination 
fetal  movements  could  be  Feebly  discerned.  A  digital  examina- 
tion by  the  vagina  revealed  a  large  and  eroded  cervix,  and  inspec- 
tion discovered  a  large  ulcer  upou  the  cervix  which  turned  out  to 
be  a  carcinoma. 

This  condition  confronted  us:  Here  is  a  woman  only  twenty- 
four  years  of  age  presenting  a  carcinoma  of  the  cervix,  complica- 
ted by  pregnancy  advanced  to  the  fifth  month.  Complete  hyster- 
■ectomy  was  the  only  course  for  her  relief.  I  thought  it  a  pity  to 
sacrifice  the  child,  and  therefore  determined  to  keep  her  under  ob- 
servation to  discover  whether  or  not  the  disease  was  making  rapid 
strides.  It  was  ascertained  that  the  spread  was  slow.  I  therefore 
determined  it  would  be  justifiable,  so  lar  as  the  woman  was  con- 
cerued,  to  defer  any  o{>erative  interference  until  the  child  was  at 
least  viable.  I  recommended  a  return  to  the  hospital  after  the 
termination  of  the  seventh  mouth  of  pregnancy. 

She  was  readmitted  to  the  hospital  on  the  13tb  day  of  March, 
and  was  operated  upon  the  22d.  The  operation  was  the  Porro,  and 
the  anesthetic  used  was  chloroform.  All  of  the  ordinary  prepara- 
tious  of  the  patient  were  made.  The  first  step  in  the  operation 
was  the  complete  destruction  of  the  cancerous  tissue  of  the  cervix 
by  meaus  of  the  galvano-cautery.  A  long,  free  incision  was  made 
in  the  abdominal  wall,  and  quickly  carried*  down  to  the  uterus, 
which  was  exposed  and  delivered  through  the  wound.     Two  loops 


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446       The  Atlanta  Medical  and  Surgical  Jodrnal. 

of  a  large  elastic  ligature  were  thrown  around  the  cervix  but  not 
tightened.  An  assistant  grasped  the  cervix  firmly  with  the  hand 
to  control  bleeding.  The  uterus  itselt  was  then  iucised  by  a  free 
and  rapid  incision,  and  immediately  the  child  was  delivered,  cord 
clamped,  and  the  child  turned  over  to  the  accoucheur.  The  liga- 
tare  around  the  cervix  was  at  once  tightened  and  clamped,  and 
when  this  was  completed  a  large  pad  uf  gauze  was  put  into  the 
uterus,  and  two  stiehes  of  pedicle  sitk  were  made  to  close  the 
uterine  incision.  No  attempt  was  made  to  dislodge  the  placenta, 
end  a  gauze  sponge  was  placed  in  for  the  purpose  of  absorbing 
any  oozing  that  might  occur,  thus  diminishing  the  risk  of  contam- 
inating the  peritoneal  cavity.  In  the  meantime  the  intestines  had 
be^n  protected  by  large  sheets  of  gauze.  From  this  point  on,  the 
operation  was  one  of  simple  hyBterectoroy.  The  ovarian  vessels 
were  ligated,  divided  between  the  ligatures  and  then  the  uterine 
arteries  were  secured,  the  vagina  opened  from  above,  the  cervix 
dissected  out,  as  was  also  the  upper  portion  of  the  vagina.  As 
soon  as  this  was  accomplished,  the  proper  toilet  of  the  peritoneum 
was  made  and  the  wound  closed  by  througb-and-through  silk- 
worm-gut sutures.  I  have  long  .abandoned  the  practice  of  closing 
the  abdominal  wound  with  tiers  of  sutures,  using  only  througb- 
and-through  suturen  of  silkworro-gut.    Vaginal  drainage  wa^  used. 

This  woman  made  a  very  happy  recovery.  The  child,  which 
was  rather  poorly  nourished,  perished  at  the  end  of  two  and  a  half 
hours.  The  second  day  there  appeared  in  the  breasts  a  considera- 
ble flow  of  milk,  which  was  suppressed  by  the  application  of  the 
so-called  Murphy-jacket.  The  s^iecimen  from  this  case  shows  the 
uterus  with  placenta  firmly  attached,  the  umbilical  cord  and  por- 
tions of  the  letal  nierabraues.  I  was  much  struck  iu  this  instance, 
as  I  have  been  iu  others,  to  see  the  extent  to  which  very  mtiscular 
s|)ecimens  shrink  after  removal. 

Cabe  2. — Tlie  next  specimen,  a  rare  one  as  preseoting  a  very 
curious  combination  of  pathologic  conditions,  is  from  the  case  of 
Mrs.  A.  V.  W.,  referred  to  me  by  Dr.  H.  C.  Beckett,  Clover,  Va. 
This  patient,  a  white  female,  aged  fif^y  years,  gave  the  Tollowiug 
history :  Married  at  twenty-seveu,  but   never  had  any  children. 


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Some  Abdominal  Cases.  447 

Menstruated  at  fieveoteeo,  after  which  courses  were  regular,  but 
atteuded  with  tnucb  pun  since  marriage.  Has  considerable  leu- 
corrbea  and  bloody  discharge.  About  eighteen  years  ago  consulted 
a  physician  in  this  city,  who  told  her  she  had  a  small  fibroid  which 
would  disappear  at  change  of  life.  Not  troubled  again  until  June 
of  last  year,  since  which  time  she  has  had  six  attacks,  each  of  in- 
creasing severity,  of  intense  pain  in  abdomen,  accompanied  by 
some  bloody  discharge,  and  confining  her  to  bed  several  days  during 
each  attack.  Admitted  to  tbe  Old  Dominion  Hospital,  May  3, 
1898. 

An  examination  of  this  patient  revealed  the  uterus  perhaps  five 
times  as  large  as  normal,  nodular,  and  somewhat  depressed,  the 
cervix  being  within  easy  reach  of  the  examining  fiuger,  which  also 
revealed  an  ulcer  upon  the  cervix,  and  tbe  further  fact  that  carci- 
noma of  the  cervix  was  complicated  by  fibroids  of  the  uterus. 

A  complete  hysterectomy  was  undertaken,  and  was  free  from 
incident.  Upon  removal  of  the  uterus  it  was  discovered  that  uot 
only  were  there  fibroids  in  the  structure  of  this  organ,  but  also  a 
subserous  fibroid,  situated  on  the  posterior  surface  of  the  uterus 
and  about  the  size  of  a  small  walnut,  which  had  undergone  calca- 
reous degeneration.  You  can  hear  the  sound  as  it  is  struck  by  the 
nail.  It  was  covered  only  by  peritoneum  with  an  absence  of  all 
other  tissue.  In  the  body  of  the  uterus  other  masses  went  plaiuly 
seen.  This  patient  also  made  a  perfectly  satisfactory  recovery  and 
has  returned  home. 

Case  3. — One  of  the  roost  interesting  specimens  I  have  to  show 
you  is  that  taken  from  a  negro  woman,  Maria  Prosser,  referred  to 
me  by  Dr.  C.  M.  Miller,  of  this  city.  This  patient,  aged  forty- 
eight  years,  was  married  at  nineteen,  and  has  had  fifteen  childreu, 
triplets  once.  Menopause  six  or  seven  years  ago.  No  previous 
illness.  Complains  ot  severe  pain  and  enlarged  abdomeu,  whi»^h 
symptoms  were  first  noticed  about  four  years  ago.  Pain  intermit- 
tent. Four  montlis  ago  had  very  severe  attack  of  pain  and  rapid 
increase  of  swelling.  Had  general  edema  and  some  cougestioa 
of  kidneys,  due  to  pressure.  Occasional  discharge  from  vagina, 
but  no  hemorrhage. 

When  I  first  saw  her,  in  consultation  with   Dr.  Miller,  she  was 


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448       The  Atlakta  Medical  and  Sokgical  Journal. 

much  debilitated,  greatly  reduced^  thoroughly  anemic,  abdomen 
enorniously  swolleo,  not  only  from  the  tumor  but  also  from  a  col- 
lection of  ascitic  fluid,  and  edema  of  the  lower  extremities.  Ex- 
amination showed  a  large,  irregular  tumor  occupying  (he  lower 
portion  of  the  abdomen,  extending  above  the  umbilicus,  higher  on 
the  right  than  oo  the  left  side.  The  abdominal  walls  were  .very 
thin.  Prominently  ehown  above  the  symphisis  was  a  protuber- 
ance half  the  size  of  a  coooauut,  movable  from  side  to  side  and 
plainly  attached  to  the  tumor.  The  neck  of  the  uterus  was  out  of 
reach  of  the  examining  linger.  The  mass  resembled  a  full  bladder 
■displaced  by  a  pelvic  tumor,  but  was  pronounced  to  be  the  uterus 
with  tumor  attached.  The  diagnosis  made  was  intraligamentous 
■cyst  of  right  side  with  uterus  lilted  out  of  the  pelvis.  Deeming 
it  unwise  to  operate  in  her  present  condition,  she  was  put  under  a 
preparatory  course  and  then  operated  upon  st  the  Old  Dominion 
Hospital    on  May  21st. 

After  the  incision  was  made  and  the  tumor  exposed,  the  accuracy 
of  the  diaguosls  was  verified.  Ordinarily  this  would  have  been  an 
extremely  difficult  case  and,  in  all  likelihood,  radical  operative  in- 
terference would  have  proved  fatal.  Goodell  says,  "These  are  the 
patients  that  die  on  the  table." 

We  are  indebted  to  Dr.  Rufus  B.  Hall,*  of  Cincinnati,  for  a  re* 
«ent  method  of  dealing  with  intraligamentous  cysts  which  renders 
the  operation  almost  as  safe  aa  an  ovariotomy.  The  old  method 
was  to  split  the  peritoneum,  then  proceed  to  enucleate  the  cyst- 
As  the  blood  supply  is  very  large,  this  meant  very  profound  and 
sometimes  fatal  hemorrhage.  The  operator  was  embarrassed  by 
the  great  flow  of  blood,  had  to  work  with  the  utmost  rapidity,  his 
manipulations  had  to  be  carried  on  by  the  sense  of  touch  and  not 
by  sight.  Having  heard  Dr.  Hall  describe  his  method  at  the  re- 
■cent  meeting  of  the  Southern  Surgical  and  Gynecological  Associa- 
tion, where  he  exhibited  a  specimen  very  similar  to  the  one  before 
us,  I  coucluded  to  try  his  method  in  this  case,  and  found  it  to 
work  admirably. 

I  proceeded  to  do  a  supra-vaginal  hysterectomy,  and  was  able  to 
control  the   blood-supply   to  the   tumor.     I  Hgated  the  ovarian 

•Tntiw.  Suuib.  aurg.  and  Qyn. 


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Some  Abdominal  Cases.  449 

-arUry  on  the  bealtby  side  witb  a  double  ligature,  then  severed  tbe 
tissues  betweeD  tbe  ligatures,  went  down  to  the  uterine  artery  on 
tbe  same  side  and  ligated  it,  after  securing  which  I  returned  to  the 
affected  side  and  Itgated  the  ovarian  artery.  This  left  no  vessel  of 
magnitude  eave  the  uterine  artery  on  the  afFected  side.  I  then 
severed  tbe  cervix  from  tbe  good  to  the  affected  side  until  I  reached 
tbe  ut«riDe  artery,  passed  a  ligature  arouud  this  and  proceeded  to 
liil  tbe  tumor  out.     Practioally  no  blood  was  lost. 

After  removal  the  tumor  was  discovered  to  have  three  very  large 
.  cavities  filled  with   fluid  and  accumulated  blood.     One  of  these 
cavities  contained  a  clot  very  firmly  organized;  in  the  others  tbe 
fluid  was  thin  and  left  clean  walls. 

This  woman  did  extremely  well  for  the  first  three  days;  then, 
in  the  temporary  absence  of  tbe  nurse,  got  up  and  sat  in  a  chair. 
Untoward  symptoms  developed  and  ber  life  was  despaired  of,  but 
tbe  symptoms  subsided  and  an  excellent  recovery  followed,  the  pa- 
tient leaving  the  hospital  at  the  end  of  six  weeks.  This  case  is  of 
particular  interest  as  occurring  in  a  negro  woman.  Tumors  of  this 
type  in  tbe  negro  race  are  even  rarer  than  ovarian  tumors,  which 
latter  are  almost  never  seen.  Tbia  specimen  may,  therefore,  be 
regarded  as  a  surgical  curiosity. 

Tbe  next  specimen  is  that  taken  from  a  woman  recently  ad- 
mitted lo  tbe  Old  Dominion  Hospital,  referred  to  me  by  Dr.  R.  W. 
Fry,  of  Roauoke.  Mrs.  M.  C.  W.,  aged  tbirty-five  years;  mar- 
ried. Previous  history:  Menstruated  at  fifteen  ;  regular  ever  since. 
Married  at  eighteen;  three  children  and  five  miscarriages;  last 
three  due  to  lacerated  cervix.  Typhoid  fever  at  tbe  age  of  twenty- 
five.  Says  sbe  bas  suffered  with  congestion  of  the  womb  for  ten 
years,  and  has  been  treated  for  ulceratiou  of  the  womb.  Pain  is 
most  severe  between  periods;  is  located  in  lower  part  of  the  ab- 
domen, extending  down  tbe  thighs,  especially  the  right  one.  Dr. 
Fry  examined  the  patient,  and,  Bnding  a  mass  in  tbe  pelvis  to  right 
of  uterus,  diagnosed  some  form  of  ovarian  tumor,  and  referred  tbe 
case  to  me.  Admitted  to  tbe  Old  Dominion  Hospital  June  8, 
1898.  On  tbe  right  side  I  found  a  mass  the  size  of  a  large  orange ; 
on  the  opposite  side  there  was  an  enlarged  &llopian  tube,  the  nature 
-of  which  I  was  unable  to  make  out,  though  oonviaced  that  it  was  a 


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450       The  Atlanta  Medical  and  Surgical  Joubmal. 

hydrosalpinx  or  pyosalpinx.     The  ovary  on  the  left  side  was  ea~ 
larged  and  very  firm. 

Operated  upon  on  Juoe  11th.  Upon  opening  the  abdomen  it 
was  found  that  the  entire  pelvis  was  domed  over  by  a  mass  of 
matted  adhesions,  the  like  of  which  I  have  rarely  seen.  It  seemed 
impOBsible  to  enter  this  roof  in  order  to  get  down  into  the  crev- 
ices where  lines  of  cleavage  could  be  estahlished.  After  a  time  we 
were  successful  in  our  attempt,  and  began  to  excavate  the  uterus 
and  its  appendages.  When  this  was  accomplished,  the  left  tube  was 
found  ill  a  state  of  hydrosalpinx  as  large  as  the  thumb  of  a  good- 
sized  hand.  The  ovary  on  the  same  side  contained  hematoma. 
The  mass  on  the  right  side  was  digcovered  to  be  an  ovarian  ab- 
scess. Supra-vuginal  hysterectomy  was  decided  upon  and  accom- 
plished in  the  usual  way,  after  which  a  glass  drain  was  inserted. 
The  patient  made  an  excellent  recovery.  This  is  a  very  interesting 
specimen  as  showing  a  multitude  of  pathologic  conditions. 

Case  6. — Here  is  another  specimen,  which,  I  regret  to  say,  has- 
been  practically  destroyed  by  the  evaporation  of  the  alcohol  from 
the  preserving  fluid.  It  comes  from  a  woman  referred  to  me  by 
Dr.  J.  Boiling  Jones,  of  Petersburg.  Miss  A.  L.  F.,  white,  aged 
thirty-eight  years,  was  in  good  health  up  to  sixteen  years  ago.  At 
that  time  noticed  a  protrusion  of  the  cervix.  Thie  has  given  her 
much  discomfort.  Marked  nervousness;  indigestion  and  nausea. 
Admitted  to  the  Old  Dominion  Hospital  December  7,  1897. 

It  was  perfectly  easy  to  diagnose  hypertrophied  cervix,  descended 
uterus,  fibroids  (which  were  everywhere  to  be  felt  over  the  fundna 
of  the  uterus),  and  also  a  tumor  the  size  of  a  cocoauut  to  the  right 
of  the  uterus;  but  as  to  what  the  tumor  was  I  felt  uncertain.  I 
gave  the  diagnosis  of  probable  dermoid  cyst,  and  the  operatioD 
proved  its  correctness. 

The  uterus  was  found  to  contain  a  number  of  fibroid,  varying 
in  size  from  a  hickory-nut  to  a  small  lemon.  Apparently  all  of 
them  were  subserous.  It  was  therefore  not  necessary  to  re- 
move the  uterus,  but  was  to  do  myomectomies.  Therefore, 
these  four  fibroids  were  enucleated  and  the  button-holes  through 
which  they  were  removed  from  under  the  peritoueum  were  stitched 
up  by  Zjembert  sutures.     The  mass  to  the  right  of  the  uterus  wa» 


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Cod-Liver  Oil  in  Eye  and  LABTsaEAL  Troubles.    451 

eDucleated,  raised  out  of  the  pelvis  and  removed  by  the  ordinary 
method  of  ligating  its  pedicle.  A  ventro-fixation  was  next  per- 
formed. The  cervix  was  fouod  hypertrophied  and  withia  the 
vagina.  As  a  matter  of  safety,  the  uodiaeased  ovary  was  removed, 
hopiogto  produce  aaatropliy of  the  uterus,  diminishingthe  elongated 
cervix  and  Feuderiug  the  fixation  more  safe.  These  objects  were 
accomplished  by  the  operation. 

On  examining  the  tumor  it  was  found  to  be  a  dermoid  cyst,  filled 
with  the  characteristic  cheesy  masses  and  oily  fluid,  and  contained 
a  great  deal  of  long,  coarse,  brown  hair,  growing  very  abundantly 
from  the  cyst  wall.  Teeth,  bone,  serous  and  mucous  membranes 
are  occasionally  found  iu  these  tumors,  and  by  one  or  two  observ- 
ers it  has  been  reported  that  tissue  resembling  brain  substance  has 
been  found  in  them.     This  patient  made  a  first-rate  recovery. 

407  Eaet  Grace  St. 


SCOTT'S  EMUI^ION  OF  COD-LIVER  OIL  IN  EYE 
AND  LARYNGEAL  TROUBLES. 

Bv  A.  BETHUNE  PATTERSON,  M.D., 
Atlanta.  Ga. 

Many  eye  and  throat  troubles  that  we  are  called  upon  to  treat, 
and  which  appear  to  be  local  maladies,  really  have  their  origio  in 
some  materies  morbi  circulating  in  the  blood.  Their  successful 
management  depends  largely  upon  our  recognition  of  the  peculiar 
constitutional  conditions;  then,  again,  there  are  local  troubles, 
chronic  in  charter,  that  do  not  appear  to  be  due  to  any  special  con- 
stitutional dyscrasia,  though  make  little  progress  to  recovery  when 
only  local  remedies  are  applied,  but  quickly  yield  to  a  course  of 
tonics,  alteratives,  and  remedies  which  directly  improve  the  nutri- 
tive fluids. 

There  are  a  host  of  therapeutic  agents  which  are  classified  as 
tonics  and  alteratives,  and  whose  therapeutic  action  are  uuexplaiu- 
able,  bnt  exert  a  salutary  influence  ou  the  nutrition,  either  directly 
or  indirectly.    Of  the  former  there  are  but  few.     Cod-liver  oil  I  re- 


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452       The  Atlanta  Medical  and  Surgical  Journal. 

gard  as  preeminently  the  most  fitting.  It  is  not  ooly  a  food  agent, 
but  possesses  medicinal  properties  as  well.  Its  antiseptic  properties 
either  exert  a  retardiog  iDfluence  upoo  germ  life,  or  antidotal  or 
Dutritizing  effect  u\K>n  the  toxins.  J^ard  and  other  oils  have  long 
enjoyed  the  reputation  of  possessing  antidotal  properties  in  cases 
of  poisoning.  It  is  a  well-know  fact  that  a  Tat  hog  sufiers  no  in- 
convenience from  the  bite  of  a  rattlesnake,  while  a  lean  ooe  quickly 
succumbs.  Melted  lard  is  a  domestic  remedy  in  all  cases  of  pois- 
oning in  domestic  animals.  The  popularity  that  castor-oil  enjoys 
is  surely  not  entirely  due  to  its  cathartic  or  laxative  effect.  That 
it  has  a  controlling  influence  on  the  ferments  in  the  alimentary 
canal  there  can  be  no  doubt. 

The  medical  properties  of  cod-liver  oil  do  not  appear  to  be  ap- 
preciated generally.  It  increases  the  appetite,  and  with  it  the 
digestion  improves,  the  bowels  become  regular,  there  is  a  marked 
increase  in  the  red  corpuscles  of  the  blood,  the  cheeks  of  the  pale 
and  anemic  become  rosy,  the  ears,  lose  their  waxy  appearance  and 
become  plethoric.  The  oil  has  a  wonderful  tonic  effect  upon  cells 
which  are  rapidly  exfoliating  and  therefore  never  reach  a  state  of 
maturity  or  full  growth. 

It  is  an  erroneous  idea  to  suppose  that  cod-liver  oil  is  a  remedy 
for  consumption  only.  It  is  a  remedy  peculiarly  fitted  to  meeting 
the  indications  in  nearly  all  chronic  ailments.  Toe  unpalatahle- 
ness  has  been  its  greatest  drawback,  though  this  has  been  largely 
overcome  in  the  preparation  known  as  Scott's  Emulsion,  contain- 
ing the  hypophosphitea,  which  are  valuable  adjuncts  to  the  altera- 
tive and  antiseptic  properties.  I  have  always  prepared  the  oil  in 
an  emulsion. 

Shoemaker  says:  "There  can  be  no  question  that  the  digestibil- 
ity of  the  oil  is  increased  by  mechanical  and  chemical  conditions, 
as  when  in  the  form  of  a  good  emulsion,  .  .  .  and  by  tbe 
addition  of  paucreatin,  and  also  by  the  association  with  certain 
restorative  agents  like  the  hypophosphites." 

The  following  cases  trom  my  note-hook  illustrate  the  prompt 
action  of  cod-liver  oil  in  combination  with  the  hypophosphites: 

C.  M,,  aged  9,  comes  on  account  of  corneal  ulcers.  With  the 
exception  of  repeated  attacks  of  these  ulcere  during  the  last  three 


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Cod-Liver  Oil  in  Eye  and  Laryngeal  Troubles.     453 

^ears  the  general  health  has  been  coDsidered  good.  The  history 
shows  that  the  ulcers  were  obstinate  and  did  not  yield  to  the  iron 
tonics  and  local  treatment  in  a  satisfactory  manner.  This  attack 
is  of  four  week's  duration;  the  general  health  has  suffered,  spirits 
depressed,  appetite  and  digestion  poor,  bowels  constipated.  Or- 
dered, 

El    Hydrargchl.mit gr.  i, 

SlUltODiDe  gt.  SB. 

Sugar  milk,  q.  e.  to  make  ooe  powder. 
To  be  given  at  bedtime,  and  repeat  if  necessary  next  morning. 
Also, 

R    Pore  cod-liver  oil,  sterilized , g  i- 

Atropine- gr  i. 

M.  S.  Drop  in  eyes  every  tliree  or  four  hours,  and  to  be  bathed  frequently 
with  antiseptic  lotion  of  boracic  acid.  Scott's  Emulsion  of  cod-liver  oil  in  tea- 
spoonfal  doae«  three  or  four  times  a  day. 

The  improvemeat  was  observed  by  parents  as  being  more  rapid 
than  in  former  attacks  when  iron  formed  the  basis  of  constitutional 
treatment. 

G.  R.,  aged  6,  comes  with  phlyctenular  ophthalmia,  with  his- 
tory of  subsequent  attacks;  tongue  furred,  disordered  digestion, 
abdomen  distended  and  tympanitic,  ears  waxy,  indicating  poor 
blood.  Ordered  hydrarg.  ehl.  mit.  and  santoniue,  balf-grain  doses 
night  and  oiorulng  until  bowels  are  freely  moved. 

B    Atropin gr.  i< 

Fluid  est.  hydrastin m  x. 

Glycerine m  xx. 

Aqua 51. 

)I.  S.  Drop  in  eyes  three  or  four  times  a  day.  Teaspoonful  doses  of  Scott's 
Emulsion  of  cod-liver  oil  three  times  a  d'ay. 

At  the  end  of  three  weeks  patient  discharged  with  Instructions 
to  continue  the  cod-liver  oil  three  weeks  longer. 

J.  W.,  aged  30.  Chronic  naso-pharyngeal  catarrh  and  chronic 
laryngitis.  Comes  on  account  of  the  latter  trouble,  which  is  of 
two  years'  standing;  voice  is  husky,  and  complains  of  pain  and 
fullness  in  larynx;  cough,  with  some  expectoration,  which  is  free 
of  tubercle  bacilli;  a  constant  feeling  of  languor  and  debility. 
After  three  mouths'  treatment,  consisting  of  daily  local  applications 
to  larynx  and  uaso-plLirynx,  with  Scott's  Emulsion  of  Cod-liver 
Oil  three  times  a  day,  and  laxatives,  with  the  improvement  of 
health  and  laryngitis,  hi^  visits  were  discontinued  to  my  ofBce. 

S07  Engligk-Amerioan  Building. 


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NEW  YORK  LETTBR. 


New  York,  August,  1898. 
To  the,  Editor  of  the  Atlanta  Medical  atid  Surgical  Journal  : 

Reports  of  proceedtDgs  of  some  of  our  medical  societies  so  fre- 
quently briog  up  fur  consideration  the  feasibility  of  adopting  op- 
eratjve  procedure,  wben  the  question  whether  uncoutro verted  facta 
as  alleged  should  really  be  accepted  as  indicative  of  such  interfer- 
ence. Such  statements  frequently  go  unchallenged  without  even  a 
dissenting  voice.  On  the  face  of  these  publications  it  appears  evi- 
dent that  they  savor  of  unguarded  pretensioDS  of  empiricifim,  bor- 
dering on  pure  unalloyed  charlatanry.  Quite  frequently  reports  of 
some  of  our  prominent  scientific  societies  contain  descriptions  of 
operation,  not  in  any  sense  minor,  which  appear  brazenly  contrain- 
dicated,  but  are  simply  extolled  by  an  unscrupulous  and  deceiving 
tongue  simply  to  create  an  impression  upon  the  audience.  Proba- 
bly in  no  domain  of  medicine  during  the  last  decade  has  more 
rapid  strides  been  made  thau  iu  surgery,  especially  is  it  so  with 
gynecology;  and  verily  it  may  be  said  that  in  no  branch  has  a 
greater  tendency  manifested  itself  to  resort  to  ambiguous  opera- 
tious,  and  in  no  branch  has  this  been  more  abused  than  in  gyne- 
cology. Indiscriminately  our  gynecologists  seek  to  outdo  each 
other  and  record  novel  procedures  and  a  large  number  of  opera- 
tions, without  in  any  way  innately  consulting  the  future  welfare  of 
the  patient.  This  may  appear  ludicrous,  but  it  is  true.  Were  it 
not  for  the  fact  that  this  condition  of  affairs  constantly  tends  to 
increase  and  assume  an  alarming  aspect,  I  should  never  have  tried 
to  influence  or  curtail  the  operative  furor  of  a  few  of  my  friends. 
Only  during  the  past  week  two  similar  cases  have  come  under  my 
observation  showing  the  mutilating  effects  of  the  scalpel  guided  by 
a  morbid  brain.  One  of  these  cases  is  so  pathetic  that  I  cannot 
refrain  from  referring  to  it,  but  cursorily.  During  my  summer 
vacation  I  left  a  lovely  young  woman  who  was  wearing  a  pessary, 


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New  York  Letter.  455 

loserted  for  a  plain,  uncoiti plicated  case  of  retroversion,  in  charge 
■of  one  of  my  confreres  to  look  after.  Of  the  latter  condition 
I  was  fairly  certain  that  I  was  correct.  This  patient,  how- 
ever, was  informed  by  a  friend  that  a  certain  gynecologist  could 
cure  her  quickly,  and  she  induced  her  to  consult  blm.  He  reit- 
erated  that  a  pessary  was  of  no  avail,  and  induced  her  to  subroit  to 
an  operation,  to  which  she  consented,  and  following  which  he  guar- 
anteed complete  relief  to  all  symptoms  and  a  permanent  cure. 
What  the  operation  was  I  do  not  know,  but  the  result  was  that 
this  brilliant  operation  made  the  patient  worse,  terminating  finally 
in  another  operatiou,  with  a  guarantee  affixed  that  she  would  fuUy 
recover  after  total  extirpation  of  the  uterus.  I  am  well  informetl  of 
the  facts  of  the  case,  and  never  should  I  have  been  induced  to  raise 
my  pen  in  protest  were  it  not  that  my  passion  was  infuriated  at 
the  reckless  disregard,  aye  haughtiness,  with  which  this  practi- 
tioner viewed  his  destructive  mutilating  work.  At  the  expense  of 
these  poor  creatures,  sacrificing  as  much  tissue  as  possible,  repeated 
successes  make  these  brazen-faced  men  bolder  and  bolder,  and  the 
furor  to  equip  or  excel  each  other  is  so  great  that  poor  suffering 
humanity  is  their  goal.  Yes,  by  success  they  mean  quite  a  differ- 
ent thing  from  ultimate  relief  of  suffering.  Success  is  gauged 
only  by  their  avaricious  self-aggrandizement.  I  am  quite  sure  I 
voice  the  sentiments  of  a  large  number  of  our  profession  when  I 
say  that  almost  at  the  eve  of  this  century  competition  and  the 
stru^le  for  a  livelihood  have  become  more  acute,  and  the  energetic 
young  man  Is  taught  by  the  energetic  older  members  those  unscru- 
pulous attainments  and  practices  in  order  to  aggrandize  oneself  and 
perform  uncalled-for  operations  at  the  expense  and  sacrifice  of 
some  poor,  inert,  harmless  organ.  Thus  its  victims  strut  about 
in  daily  intercourse  with  the  brilliant  physician  who  points  with 
pride  to  his  wobegone  fame.  The  wonderful  successes  attained  at 
a  great  cost  are  constantly  ventilated ;  the  great  number  of  brilliant 
oj>erationB  give  vent  to  expressions  of  the  acquisition  of  a  grand 
and  noble  man  to  the  community,  and  a  shining  light  has  his 
beavers  secretly  and  quietly  working  for  his  salvation,  the  quin- 
tessence of  which  is  merely  to  him  of  a  pecuniary  character. 
Proud  and  inflated,  he  considers  himself  as  a  distinct  entity  from 


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456       The  Atlanta  Medical  and  Surgical  Jodrsal. 

al]  of  the  rest,  and  is  ready  to  explode  at  any  minHte;  but  id  his^ 
own  consciousness  be  well  kaows  that  his  fondness  for  ostentation- 
ia  forgotten  at  the  expense  of  some  poor  creature,  and  deceptive 
pretensions  merely  seek  to  induce  a  general  plethora  of  his  pocket- 
book  rather  than  a  scrupulous  pathetic  obligation  to  his  patient. 
The  relation  be  should  bear  to  his  patients  seeks  a  remunerative  out- 
let rather  than  to  succor  and  alleviate.  The  results  appear  unmis- 
takably evanescent,  rather  than  of  permanent  benefit,  but  with 
this  he  has  not  time  to  he  annoyed.  This  glaring  evil  is  especially 
linked  to  our  larger  cities,  which  are  apt  to  breed  embryo  instruc- 
tors and  professors  with  utter  disregard  of  a  clear  conscience. 
Such  heinous  and  ghastly  procedures  as  I  have  depicted — and  I 
really  speak  reservedly,  not  condemnatory — are  of  almost  daily 
occurrence,  and  afford  a  subject  for  just  criticism.  How  different  is 
the  aspect  of  the  question  when  propounded  to  them  if  they  were 
put  face  to  face  and  requested  to  perform  such  operations  upon  the 
members  of  their  own  household.  Record  of  a  large  number  of 
such  operations  appear  brilliant;  paper  is  fortunately  submissive, 
and,  usually,  so  is  the  profession;  what  consternation  would  it 
create  if  it  could  only  speak  the  result!  Frequently  it  dawns 
upon  me  that  the  true,  veritable  physician  is  gradually  passing 
away;  as  the  century  draws  to  a  close  the  weak  must  make  room 
for  the  most  corrupt,  the  most  unscrupulous,  and  the  most  degen- 
erate. Regardless  of  the  future  welfare  of  their  patients,  if  these 
physicians  were  confronted  with  the  result  of  their  over-zealous 
activity  years  thereafter,  what  an  array  of  failures  this  would  de- 
pict I  and  how  their  consciences,  if  any,  would  compel  them  to 
crawl  and  cower  like  a  dog  under  the  lash  of  a  whip!  The  pangs 
of  their  guilt  would  be  manifestly  visible  upon  their  faces.  Mr. 
Editor,  you  probably  will  have  considered  me  rather  severe  in  my 
criticisms  of  this  class,  but  it  is  only  an  iota  of  what  they  justly 
deserve.  They  should  be  actuated  by  uobler  motives  of  charity, 
and  embody  those  true  attributes  requisite  to  the  vocation  they 
have  selected.  This  result  is  partly  brought  about  by  egotism, 
'  the  greed  for  self-aggrandizement  and  the  strife  to  excel  others,, 
and  ibey  consider  themselves  of  a  higher  ideal,  and  believe  witb 
Dr.  Stockton,  who  says  "the  majority  are  always  wrong."     Yoa 


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New  York  Letter. 

will  agree  witb  me  the  case  I  have  but  referred  to  is  a  pt 
Similar  ones  occurring  daily  io  a  large  metropolis  like  i 
aphobia  for  operatioua  walks  extant  and  can  be  eaail 
One  can  always  find  one  of  those  charming,  progresaiv 
of  our  profeaeioD  who  is  satisfied  to  operate  in  order  aim 
a  person's  fears,  as  they  aay,  when  abaolutely  no  indicat 
operative  interference  exista.  -  A  cure  is  certainly  pn 
what  are  we  to  consider  a  cure?  If  an  innocent  and  hart 
is  slightly  bent  out  of  its  natural  place  without  produci 
any  symptoms  at  all,  radicalism  suggests  to  them  the  on 
unaex  the  woman,  not  in  order  to  help  her,  but  to  extol 
derful  boldness  and  achievements  at  a  medical  meeting 
late  reports  among  the  patients'  numerous  friends;  to  o 
ttge,  and  to  gloat  over  their  success — all  strictly  witbi 
code  of  ethics.  But  not  for  a  moment  would  this  man 
vulge  to  bis  patieut  that  she  would  practically  becon: 
make  her  unfit  for  maternity,  and  deprive  her  of  t 
charm  God  had  given  her.  Unable  to  beget  children, 
life  is  practically  at  an  end.  With  a  promise  to  relieve 
toms,  they  now  really  appear  and  increase  in  number,  aE 
of  phenomena  call  for  explanation.  Providing  our  fri 
be  acruptiloua,  hia  conscience  will  rebel,  and  he  must  e: 
ergy  by  attacking  other  organs.  This  operation  was 
why  should  not  the  others  also  be  so.  The  (uture  of  i 
was  destroyed,  now  you  might  just  try  and  go  a  step  f 
wantonly  remove  the  vagina,  and  attack  other  organ 
either  hit  or  raias.  Witb  impunity  you  can  fortify  your 
actuated,  of  courae,  only  by  motives  of  charity.and  relie 
humanity  by  performing  another  operation  on  the  sam< 
ture.  Go  right  ahead  and  be  bold.  No  guilt  but  dif 
pride  attaches  to  you.  With  impunity  you  have  attacked, 
and  removed  the  burdens  of  suffering  humanity.  Yoi 
to-date  practitioner,  and  if  you  do  not  soon  amend  you 
the  last  straw  and  sink  to  the  bottom,  with  scalpel  ii 
bodying  destruction  and  warfare  against  all  organs  thi 
removal."  Max  Nordau  has  deplorably  overlooked  yo 
whose  charitable   instincts  are  worthily  humane   in  or 


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458       The  Atlanta  Medical  and  Sdrgical  Journal, 

and  that  is  the  other.  (?)  But,  you  may  argue,  this  scieDce  is  only 
iu  its  infancy  and  requirea  eDcourageraent.  True,  it  has  brighter 
hopes,  or,  rather,  brighter  hopes  may  be  expected  in  the  future. 
Poor,  charitable  man!  how  sympathetic  you  appear  in  the  guise  of 
a  learned  and  true  physician  in  order  to  relieve  your  fellow  men 
of  their  burdens  (of  money),  but  I  tell  you  the  hereafter  will  not 
be  able  to  cope  with  those  just  burdens  you  will  duly  be  required 
to  carry.  You  pretend  to  be  ignorant  of  the  reason  why,  but  the 
■fruits  of  your  worldly  and  badly-begotten  labors  are  not  so  joy- 
fully enjoyed  as  you  appear  to  manifest.  You  have  olten  tasted 
the  scorpion's  sting,  but  have  been  immune  to  its  venomous  effects, 
as  your  callousness  has  been  pretty  well  cultivated.  How  sweet, 
after  all,  it  is  to  bear  another's  burden!  and  what  a  consolation 
you  appear  to  derive  from  it  all! 

The  world  JB  all  a  fleeting  Bhow. 

For  man's  illusion  given  ; 

Tlie  smiles  of  joy,  tlie  tears  of  woe. 

Deceitful  shine,  ileceitful  flow, 

There's  nothing  true  bul  Heaven  '.—Moore. 

Pardon  my  insistency,  Mr.  Editor,  but  am  I  right? 

I  am  your  obedient  servant, 

ChAS.  J.  PROBEN,  M.D. 
970  Lexington  Ave.,  Keic  York  City. 


Treatment  of  Whooping-cough. 

Marfan  {Lyon  midical,  June  5th)  recommends  the  followiog: 

K     Antipyrin „  15  gruni. 

Syrup  of  belladonna ^     6  drachma. 

Syrup  of  Tolu 8  ouncM. 

The  initial  daily  amount  recommended  to  be  taken  is — from 
birth  to  one  year,  from  one  to  two  teaspooufuls ;  from  two  to  three 
years,  four  teaspoonTuts;  from  five  to  ten  years,  six  teaspoonfuls- 
The  dose  should  be  augmented  daily  by  half  a  teaspoonful  until 
either  a  diminution  of  the  paroxysms  occurs  or  until  intolerance  is 
reached,  as  evidenced  by  dilatation  of  the  pupil,  drynestt  of  the 
throat,  etc. — N.  V.  Med.  Joitr. 


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CORRESPONDENCE, 


Atlanta,  Ga.,  August  5,  1898. 
Editor  Atlanta  Medical  and  Surgical  Journal.- 

I  beg  to  state  throtigh  your  jonroal  that  in  the  announcement  of 
the  Atlanta  College  of  Physicians  and  Surgeons  for  the  session  of 
1898—9  the  publishing  of  my  name  as  "Professor  of  Pliysiology," 
in  the  Dental  Department  of  that  college,  is  not  only  totally  nn- 
warranted,  but  has  been  done  iu  the  face  of  the  fact  that  I  have 
positively  declined  said  position.  I  have  had  no  connection,  im- 
mediate, or  remote,  with  the  Atlanta  College  of  Physicians  and 
Surgeons,  Very  respectfully, 

John  C,  Olmsted,  M.D. 


Jakin,  Ga.,  July  20,  1898. 
Editor  Atlanta  Medical  and  SurgicalJournal : 

I  report  this  case  because  I  have  never  seen  one  like  it,  nor 
have  I  ever  read  of  one.  On  July  15  Mrs.  B.  gave  birth  to  twins 
without  any  accident,  the  second  child  being  born  about  thirty 
minutes  after  the  first.  Twelve  hours  later  this  child  began  to 
have  fever,  and  twenty-four  hours  after  birth,  when  I  saw  him,  lie 
had  a  tenifjerature  of  104.5.  I  could  find  no  cause  for  the  fever 
whatever.  I  saw  the  child  again  forty-eight  hours  after  birth,  and 
at  tbat  time  he  had  but  little  fever,  renpiratioD  very  shallow  and 
frequent,  pulse  could  not  be  counted,  tips  of  lingers  and  toes  were 
blue,  and  also  a  bluish  discoloration  around  mouth  and  eyes.  The 
face  was  drawn  and  indicative  of  much  suffering.  Was  said  to 
have  had  several  convulsions.  I  told  the  parents  tbat  I  did  not 
think  the  child  could  possibly  live  through  the  night.  However, 
when  I  returned  the  next  day  he  was  much  better,  and  has  contin- 
ued to  improve,  and  is  now  well.  The  nurse  told  that  the  child 
continued  to  grow  worse  during  the   night,  and  at  one  time  she 


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460       The  Atlanta  Medical  and  Surgical  JoniujAL. 

thought  it  dead.     Scarcely  aoy  medicine  was  given  at  all.     What 
could 'have  caused  the  fever  so  soon  after  birth  ? 

Yours  truly,  H.  G.  MlNTEB. 


BiBMiNOHAM,  Ala.,  August  9,  1898. 
Editor  Atlanta  Medical  and  Surgical  Joui-nal: 

I  notice  in  your  valuable  journal  of  August  issue,  page  384, 
uuder  head  of  Correspondenoe,  that  inquiry  is  made  with  reference 
to  an  editorial  which  appeared  in  January  number  of  Pediatrics. 
I  inclose  a  reply  which  was  published  in  the  Alabama  Medicoi  and 
Surgical  Age,  in  the  June  issue,  and  I  believe  it  is  the  only  reply 
or  comment  on  this  editorial  which  has  been  published,  at  least  it 
is  the  only  one  which  has  come  uuder  my  observation, 

I  send  it  to  you  in  accordance  with  your  request,  that  you  would 
like  to  publish  comments  on  the  subject. 

I  am,  yours  very  truly,  John  C.  LeGeand,  M.D. 

The  following,  by  Dr.  T.  L.  Robertson,  of  Birmingham,  Ala.: 

"After  you  assume  the  most  universal  ignorance  of  the  laity  on 
the  subject,  and  lately  the  medical  profession,  you  proceed  to 
treat  the  subject  as  a  matter  of  no  great  moment,  except  as  it  re- 
lates to  the  importance  of  accuracy  of  knowledge  in  these  days, 
and  in  that  interest  alone  I  ask  to  intrude  these  statement  A 
knowledge  of  just  where  Dr.  Farabery  got  the  information  upon 
which  to  base  the  statement  that  'The  Negro  baby  at  the  time  of 
its  birth  is  exactly  the  same  color  as  its  white  brother'  would 
prove  a  revelalioa  to  be  much  appreciated  by  many  members  of 
the  medical  profession  who  have  spent  a  life  of  active  service 
among  the  Negro  race  in  the  Southern  States,  without  even  a  suspi- 
cion that  they  would  be  confronted  with  a  white  baby  at  birth  by 
Negro  parents.  That  colony  of  Soudanese  Negroes,  which  afforded 
that  eminent  French  physician  an  opportunity  to  settle  the  vexed 
question,  must  have  been  a  peculiar  lot,  or  the  doctor  was  laboring 
under  some  mental  or  optical  delusions  to  arrive  at  his  deductions, 
since  our  ample  experience  with  the  new-born  Negro  baby  justi- 
fies no  such  deductions.  I  have  been  actively  in  the  practice  of 
medicine,  including  obstetrics,  in  Alabama,  without  intermission. 


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Correspondence.  461 

eince  the  spring  of  1858.  Many  others  here  have  bad  ao  equally 
long  and  ample  experience,  to  assume  the  attitude  of  authority  on 
the  subject  uoder  discussioa,  and  our  deductions  would  be  that  ba- 
bies born  of  negro  pareots  are  black — some  of  them  very  black, 
others  not  quite  so  black  as  they  get  to  be  later  on.  Those  born 
of  mulattoes,  or  mixed  bloods,  vary  according  to  the  predominance 
of  the  white  or  black  race;  but  however  light  the  general  surface 
may  be,  if  uegro  blood  exists,  the  scrotum  in  the  male  is  usually 
black ;  tbe  female  genitals  do  not  show  such  dintinguishing  features 
so  clearly.  The  offspring  from  a  light  mulatto  or  white  mother 
by  black  father  will  usually  be  very  dark,  and  vice  veraa.  I  must 
coofess  it  was  a  matter  of  great  astonishment  to  me  to  find  so 
many  statements  so  far  at  variance  with  tbe  facta  in  so  short  an 
article,  when  facilities  for  correct  knowledge  on  the  subject  are  at 
your  door.  You  cao  learn  very  near  home  that  it  takes  neither 
sunlight  nor  climate  to  make  the  negro  baby  black.  He  comes 
into  the  world  black,  and  remains  so,  unless  by  disease  tbe  pig- 
ment is  destroyed,  which  sometimes  happens." 


Louisville,  July  10,  1898. 
Editor  Atlanta  Medical  and  Surgical  Journal; 

It  win  be  appreciated  if  you  will  iusert  the  following  notice  in 
an  early  issue.  Very  truly  yours, 

Hbkby  E.  Tcley,  Secretary. 

The  twenty-fourth  annual  meeting  of  tbe  Mississippi  Valley 
Medical  Association  will  beheldat  Nashville,  Tenn., October  11—14, 
<inder  the  presidency  of  Dr.  John  Young  Brown,  of  St.  Louis,  Mo. 

This  Association  is  second  in  size  only  to  the  American  Medical 
Association,  and  has  done  most  excellent  scientific  work  in  the 
past.  The  annual  addresses  will  be  made  by  Dr.  James  T.  Whitta- 
ker,  of  Cincinnati,  on  Medicine,  and  by  Dr.  Geo.  Ben  Johnston,  of 
Richmond,  Va.,  on  Surgery.  Tbe  mere  mention  of  tbe  names  of 
these  gentlemen  establishes  the  fact  that  the  Association  will  hear 
two  scholarly  and  scientific  addresses. 

Kashville  is  a  most  excellent  convention  city,and  is  well  equipped 
with  hotels;  and,  with  the  record  of  the  meeting  in  Louisville  in 


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462-      The  Atlanta  Medical  and  Sukgical  Journal. 

1897  as  aD  example,  the  local  profeseioQ,  under  the  leadership  of 
Dr.  Duncan  Eve  as  Chairman  of  the  Committee  of  Arrangements, 
has  prepared  to  have  a  better  meeting. 

Already  titles  of  papers  are  being  received.  These  should  be 
sent  to  the  Secretary,  Dr.  Henry  E.  Tuley,  No.  Ill  West  Ken- 
tucky street,  Louisville,  Ky.,  as  early  as  possibly  to  insure  a  good 
place  on  the  program.  Reduced  rates  on  railroads  will  be  granted 
on  the  certificate  plan. 


We  have  received  the  following  letter  from  the  permauent  Sec- 
retary of  American  Medical  Association,  with  the  request  that  we 
publish  the  same.  For  fear  that  some  of  our  readers  may  not  re- 
member the  "standard  of  requirement"  of  the  American  Medical 
College  Association,  we  publish  this  as  taken  from  the  Constitu- 
tion of  this  Association,  to  which  this  communication  refers: 

Philadelphia,  June  30,  1898. 

Dear  Sir — At  the  recent  meeting  of  this  Association  the  fol- 
lowing was  unanimously  adopted : 

Whereas,  The  American  Medical  Association  did,  at  Detroit  in 
1892,  unanimously  resolve  to  demand  of  all  the  medical  colleges 
of  the  United  States  the  adoption  and  observance  of  a  standard  of 
requirements  of  all  candidates  for  the  degree  of  doctor  of  medicine 
which  should  in  no  manner  fall  below  the  minimum  standard  of 
the  Associatiou  of  American  Medical  Colleges;  and 

Whereas,  This  demand  was  sent  officially  by  the  Permanent 
Secretary  to  the  deans  of  every  medical  college  in  the  United  States 
and  to  every  medical  journal  in  the  United  States,  now  therefore 
the  American  Medical  Association  gives  notice  that  hereafter  no 
professor  or  other  teacher  in,  nor  any  graduate  of  any  medical 
college  in  the  United  States,  which  shall  after  January  1,  1899, 
confer  the  degree  of  doctor  of  medicine  or  receive  such  degree  on 
any  conditions  below  the  published  standard  of  the  Association  of 
American  Medical  Colleges,  be  allowed  to  register  as  either  dele- 
gate or  permanent  member  of  this  Association. 

Resolved,  That  the  Permanent  Secretary  shall,  within  thirty  days 
after  this  meeting,  send  a  certified  copy  of  these  resolutions  to  the 


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Correspondence.  468 

deaa  of  each  medical  college   ia   tbe  United  States  aud   to  each 
medical  journal  ia  the  United  States. 
Reepectfully  youra, 

Wm.  B.  Atkinson,  Permanent  Secretary. 

AMERICAN   MEDICAL   ASSOCIATION   OF   COLLEGES. 

ARTICLB   III.  OF  THB   COSSTITUTION, 

Section  1.  Members  of  this  Associatiou  shall  require  of  all  ma- 
triculants an  English  composition  of  not  leas  than  1^00  words  in 
the  handwriting  of  the  applicant,  and  an  examination  by  a  commit- 
tee of  the  Faculty  or  other  lawfully  constituted  board  of  examiners, 
in  higher  arithmetic,  algebra,  elementary  physics  and  Latin  prose. 

Sec.  2.  Graduates  or  matriculates  of  reputable  colleges  or  high 
schools  of  the  first  grade,  or  normal  schools  established  by  State 
authority,  ot  those  who  may  have  successfully  passed  tbe  entrance 
examination  provided  by  the  statutes  of  the  State  of  New  York, 
shall  be  exempt  from  the  requirements  of  section  1, 

Sec.  3.  Students  conditioned  in  one  or  more  of  the  braucbes 
enumerated  as  requirements  for  matriculation,  shall  have  time  until 
the  beginning  of  the  second  year  to  make  up  such  deficiencies, 
provided,  however,  that  students  who  fail  in  any  of  the  branches 
required  in  this  second  examination  shall  not  be  admitted  to  a  sec- 
ond course. 

Sec.  4.  Colleges  granting  final  examination  on  elementary  sub- 
jects  to  junior  students,  shall  not  issue  certificates  of  such  final  ex- 
amination, nor  shall  any  member  of  this  Association  confer  the 
degree  of  Doctor  in  Medicine  upon  any  person  who  has  not  been 
first  examined  upon  all  tbe  branches  of  tbe  curriculnm  by  the 
faculty  of  tbe  college  granting  the  degree. 

Sec.  5.  Candidates  for  the  degree  of  Doctor  of  Medicine  shall 
have  attended  three  courses  of  graded  instruction  of  not  less  than 
three  separate  years. 

Sec.  6.  Students  who  have  matriculated  in  any  regular  college 
prior  to  July  1,  1892,  shall  be  exempted  from  these  requirements. 

At  tbe  meeting  held  in  Detroit  the  American  Medical  Associa- 
tion adopted  the  following : 

Resolved,  That  ibis  Association  most  heartily  indorses  the  efforts 


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464       The  Atlanta  Medical  and  Surgical  Journal. 

■of  the  AssociatioD  of  American  Medical  Colleges  to  advance  the 
-cause  of  medical  education,  aud  demands  of  the  medical  colleges 
of  the  United  States  the  adoption  and  obeervani^  of  a  standard  of 
requirements  which  shall  not  in  any  respect  fall  below  the  mini- 
mum standard  requirements  adopted  hysucb  college  association. 


Yellow  Fever  "  Immunes. 

Dr.  J.  C.  LeHardy,  Health  Officer  at  Savannah,  Ga.,  who  has 
practiced  through  seven  epidemics  of  yellow  fever,  is  of  the  opinion 
-that  there  is  no  such  person  as  a  "yellow  fever  immune";  that  any 
person,  although  be  has  bad  yellow  fever,  is  still  liable  to  contract 
the  disease  if  exposed  to  it.  Said  Dr.  LeHardy  on  the  subject : 
"The  general  belief  is  that  you  cannot  have  yellow  fever  twice. 
This  is  an  error,  due  to  the  want  of  actual  knowledge  of  the  dis- 
ease.' Some  persons  never  have  it,  but  I  have  treated  others  four 
times  during  one  epidemic  (three  times  with  black  vomit).  I  have 
treated  others  three  times,  and  many  twice.  Again,  I  have  treated, 
in  1854,  persons  who  had  the  disease  in  1820  and  1S30.  In  1848 
I  attended  numbers  who  suffered  again  in  1854.  In  1876,  the 
last  time  we  had  the  fever  in  Savannah,  I  had  patients  who  had 
been  victims  of  three  previous  epidemics. — Med.  Fortnightly. 


Stonewall  Jackson's  Medical  Director  aoain  in  Service. 

Dr.  Hunter  McGuire,  the  famous  surgeon  of  Richmond,  Va-, 
who  was  during  the  civil  war  medical  director  of  Stonewall  Jack- 
eon's  corps,  has  accepted  a  position  on  the  staffs  of  Major-General 
Fitzbugh  Lee  and  will  accompany  that  general  to  the  front,  or 
wherever  else  the  latter  may  be  ordered,  as  soon  as  he  recovers 
from  a  temporary  illness  with  which  he  is  now  suffering.  Dr.  Mc- 
Guire is  at  present  sojourning  with  his  family  at  his  White  Sulphur 
Springs  cottage,  the  same  which  was  at  one  time  occupied  by  Mrs. 
U.  S.  Grant. — North  Amancan  Med.  Revieir, 


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J 


EDITORIAL. 


The  BlulnMi  offlce  ot  Tas  Joushil  1b  EC6,  aOS  Fltlen  Bnlldlns. 

The  XdltorlAl  office  !■  Boom  Mil,  MB  GnDd  Opera  Bonw. 

Addceas  sll  Bnstnesa  commiuitoftElODS  to  Dr.  U.  B.  Hutchlna,  Mgr. 

U»ke  remlttkuees  paTsble  to  Thi  Atunta  UkmciL  imd  SuboicaL  Jonan 

On  matlen  pertaining  (o  the  Sdlktrlal  sad  OrlglDftl  commnnlo&tlODS  »ddr 
Boj,  Gnad  Opera  Hoiue,  AtlaaUi. 

SeprlDtS  of  orlglnkl  &rttclva  will  be  tarnished  iit  ooat  price.  KeqnesM 
•hoald  klw>78  be  nuule  on  the  manuicrtpt. 

We  will  present,  post  p«ld.  on  reqneat,  to  each  oontrlbotor  of  an  original  i 
<90)  marked  copies  of  Thi  JoDBHal  containing  Bach  article. 


MEDICAL  COLLEGES  AND  THE  AMERU 
MEDICAL  ASSOCIATION. 

Elsewhere  in  this  issue,  under  the  head  of  Correspor 
he  seen  a  commuDicatioa  from  the  Fermaaent  Secre 
.A.  M.  A.  ID  regard  to  a  resolution  passed  at  the  last  i 
Denver,  concerning  the  relationship  of  medical  colleges 
berehip  in  this  Association.  Thinking  that  there  we 
number  like  ourselves  who  are  not  perfectly  familiar  wif 
quirements"  referred  to  in  the  letter,  we  wrote  to  the 
and  asked  him  to  send  us  these  requirements  as  furmuh 
American  Medical  College  Association.  This  be  did,  ai 
subjoined  this  to  the  letter  first  received.  From  the 
this  article  taken  from  the  Constitution,  we  do  not  < 
meaning  in  the  same  way  as  does  our  friend  the  e<] 
Texat  Courier-Reeord  of  Medicine.  In  the  July  num 
journal  there  appears  an  editorial  under  the  heading,  "' 
ican  Medical  Association  and  the  Medical  Colleges,"  in 
writer  deplores  the  fact  that  this  resolution  was  passed  »i 


^dbyGoOgle 


466       The  Atlanta  Medical  and  Surgical  Journal. 

meeting  in  Beaver  so  as  to  put  it  in  force  after  January  1st,  1899^ 
believing  that,  iu  justice  to  a  great  many  Southern  medical  collegee^ 
such  action  should  be  delayed  until  1900,  thus  giving  all  medical 
colleges  an  opportunity  of  being  on  the  same  standard.  In  the- 
course  of  bis  remarks  the  writer  has  this  to  say: 

"Moreover,  these  same  schools  have  numbers  of  students  [those- 
Dot  members  of  the  American  College  Association]  who  have  en- 
tered them  and  taken  one  or  two  courses  of  lectures  with  the  dis- 
tinct understanding,  or  under  contract,  if  you  please,  that  they 
should  be  allowed  to  come  up  for  graduation  afler  attendance  upon 
three  courses  of  lectures.  .  .  .  We  approve  most  heartily  the- 
principle  involved  in  this  action  of  the  Association,  hot  regret 
very  much  that  it  bad  not  delayed  the  time  for  the  law  to  go  into- 
effect  at  least  until  the  beginning  of  the  year  1900.  This  would 
have  given  all  schools  that  propose  to  adopt  the  four-years  course 
time  in  which  to  accommodate  themselves  to  the  new  order  of 
things,  and  notify  their  prospective  patronage  and  clientele  of  the 
change  of  requirements  for  graduation." 

We  fully  agree  with  the  writer  of  this  article  if  his  premises  are 
right.  We  ourselves  may  be  wrong,  but  it  was  for  the  purpose  of 
a  clearer  understanding  of  this  adopted  resolution  that  we  wrote 
to  the  Secretary  for  the  requirements  as  formulated  by  the  College 
Association-  From  this  we  understand  that  the  graded  require- 
ment for  a  medical  college  is  for  three  years,  and  not  four  years, 
as  the  writer  of  the  above  editorial  seems  to  think.  This  is  cer- 
tainly our  interpretation  of  article  3  of  Constitution  as  sent  to 
us  by  Dr.  Atkinson.  If  we  are  wrong  we  wish  to  be  righted, 
as  it  is  a  too  important  subject  not  to  be  brought  prominently  for- 
ward before  the  colleges  which  do  not  belong  to  the  American 
College  Association,  The  time  is  rapidly  approaching,  and,  indeed^ 
is  already  upon  us,  when  all  medical  colleges  must  adopt  a  four- 
years  graded  course.     It  has   been   too  easy  to  obtain  a  medical 


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Editorial.  46T 

diploma,  aod  a  halt  must  be  called  upon  turniog  out  ill-prepared 
doctors  of  medicioe.  However,  as  ve  understand  it  now,  a  posi- 
tion in  a  college-which  has  a  three-years  graded  course  will  not 
debar  you  from  membership' in  the  American  Medical  Association. 

While  writing  the  above  we  have  received  a  circular  illustrated 
advertisement  of  the  University  Medical  College  of  Richmond,. 
Va.,  from  which  we  quote  the  followiug: 

"  The  resolution  passed  at  Denver,  Colorado,  at  the  last  meeting 
of  the  American  Medical  Association,  refusing,  afler  January  Ist, 
1899,  the  privileges  of  membership  in  that  Association  to  grad- 
uates of  three-year  colleges,  has  been  found  to  be  unconstitutional^ 
and  will  not  be  enforced." 


THE  PATENT  ON  ANTITOXIN. 

Some  changes  should  be  made  in  our  present  patent  laws,  judg- 
ing by  the  granting  of  a  patent  right  to  Professor  Behring,  of 
Germany,  for  the  sole  and  exclusive  sale  of  Antitoxin  in  the 
United  States.  It  is  a  shame  upon  the  American  medical  profes- 
sion to  have  inflicted  upon  them  the  eoactmeut  of  such  patent 
laws.  We  do  not  believe  that  any  United  States  court  of  justiee 
will  allow  this  law  to  stand  should  an  appeal  to  them  be  made. 
Are  we  to  allow  a  foreign  commercial  house  to  dictate  to  us  the 
use  of  their  products  alone?  As  potent  an  antitoxic  serum  a^^  can 
be  found  is  made  right  here  in  the  United  States.  Messrs,  Parke, 
Davis  &  Co.  inform  us  that  they  will  protect,  without  one  cent  of  cost 
to  the  purchaser,  those  who  may  continue  to  purchase  the  serum 
made  by  that  firm,  A  recent  editorial  iu  the  Medical  Age  dis- 
cusses this  subject  with  a  great  deal  of  clearness: 

"The  principle  which  lies  at  the  foundation  of  the  invention 
of  diphtheria  antitoxin  and  that  which  underlies  all  serum  thera- 
peutics is,  that  the  blood  of  immune  animals  can  be  used  iu  the 


^dbyGoogle 


468       The  Atlanta  Medical  and  Surgical  Journal. 

treatment  of  others.  Behring  did  not  discover  this  principle,  and 
io  its  application  he  was  undoubtedly  anticipated  by  the  Japanese 
workers.  If  to  any  single  man  must  be  ascribed  the  distinction 
of  being  the  inventor  and  discoverer  of  the  beneficent  principle  of 
immunization,  the  honor  belongs  to  the  immortal  Faatenr. 

"The  manufacture  of  antitoxin  has  been  carried  out  for  many 
years  in  England,  France,  Switzerland,  Italy,  Russia,  and  Japan, 
and  in  these  countries  no  one  has  had  the  temerity  to  attempt  to 
control  exclusively  its  msnafacture.  In  this  country  it  is  made  by 
five  boards  of  health  and  by  several  manufacturing  firms.  In  this 
country  alone  has  au  attempt  been  made  to  monopolize  its  produc- 
tion, it  being  admitted  that  elsewhere  the  claims  of  any  patentee 
are  inadmissible. 

"If  Professor  Behring  admits  any  merit  in  the  work  of  his  pred- 
ecessors and  contemporaries,  his  claim  to  be  the  exclusive  inven- 
tor of  diphtheria  antitoxin  is  in  contravention  of  all  the  ethics  of 
a  scientist's  career.  His  claim  is  an  offense  against  common  mo- 
rality. Had  Simpson  patented  chloroform  anesthesia,  or  hadjLister 
patented  antiseptic  sui^ry,  the  world  would  have  had  two  selfish 
empirics,  and  lost  two  medical  heroes.  If  Behring,  by  the  right- 
eous judgment  of  mankind,  can  be  adjudged  sole  and  undisputed 
inventor  of  antitoxin,  he  has  a  place  in  the  Temple  of  Fame  for 
achieving  the  most  beneficent  discovery  of  modern  times.  It  re- 
mains to  be  seen  whether  the  temptation  to  be  rich  will  overcome 
his  ambition  to  be  great,  and  whether  for  a  tinsel  crown  he  will 
barter  a  diadem  of  everlasting  renown." 


THE  AMERICAN  MEDICAL  PRESS. 

Theaverage  busy  practitioner — and  even  he  who  is  not  so  blessed 
— rarely  gives  a  thought  to  the  Medical  Press  of  this  country,  to 
what  it  is,  to  what  it  costs  in  eS'ort   and  money,  to  the  immense 


^dbyGoOgle 


Editobial.  46ft 

power  for  good  which  lies  latent  in  it,  and  for  progress  or  deterio- 
ration of  which  he  alone  ia  directly  responsible.  If  he  thinks  of 
it  at  all,  he  soon  dismisses  it  as  a  necessity — agreeable  or  otherwise, 
afi  he  happens  to  be  fond  of  his  profession  or  is  merely  a  money- 
grabber — for  which  he  pays  or  expects  to  pay  in  the  very  distant 
future.  A  short  dissertation  on  this  subject,  therefore,  will  be  a 
very  profitable  employment  of  time  to  most  of  our  esteemed  read- 
ers, and  will  be  the  medium  of  information  upon  a  topic  than 
which  none  can  be  of  greater  interest,  because  this  touches  most 
closely  the  physician  himself  in  his  reputation  aod  in  his  capacity 
and  the  opportunity  for  earning  his  daily  bread.  For  the  medical 
press  is  what  its  subscribers  make  it.  It  is  a  lever  of  mighty 
power — "a  lever  to  move  the  world" — and  its  significance  to  the 
profession,  is  whether  the  handle  of  this  lever  is  controlled  by  the 
profession  or  whether  the  profession  rest  upon  the  short  end  and 
the  long  end  is  held  in  the  hands  of  those  who  know  its  value  and 
have  BO  long  exploited  it.  The  value  of  the  press  to  us — and  who 
will  deny  its  potential  might? — lies  in  its  control,  its  universal  and 
absolute  control,  by  ourselves,  by  medical  men  who  are  bound  by 
professional  obligations,  by  that  common  interest  which  binds  us 
all,  that  remnant  of  medical  ethical  feeling  which,  notwithstanding 
the  stupendous  and  blind  selfishness  of  the  individual  practitioner, 
is  still  powerful  enough  to  define  our  conduct,  each  to  all  and  all 
to  each,  within  certain  fixed  limits.  Encourage  with  your  sup- 
port such  a  press,  make  it  an  accomplished  fact  by  subscribing  and 
promptly  paying  your  8uf>8ertption8,  and  you  need  not  doubt  that 
the  editors  and  medical  proprietors  will  unite  and  act  together  for 
the  common  good.  Medical  editors  know  very  well  that  a  power- 
ful press  must  be  a  united  press,  aud  must  equally  represent  a  pow- 
erful and  united  body  of  men — i,  e.,  the  profession;  for  if  we  edi- 
tors had  universal  influence  and  our  written  words  the  convincing 
force  of  a  Cicero  and  a  Demosthenes,  of  what  avail  if  the  profes- 


,y  Google 


470       The  Atlanta  Medical  and  Surgical  Joornal. 

«ioQ  wbicb  we  represented  aod  for  which  we  spoke  remained  dis- 
rupted, weak  and  incapable  of  self-gOTerament  and  the  use  of 
power?  The  profession  and  its  press  are  indissolubly  united  for 
good  or  evil.  Beform  your  press,  and  it  will  in  turn  reform  and 
unite  you.  Support  and  eocourage  medical  proprietorship  in  your 
journalism — not  by  platooic  good  wishes,  but  by  your  exclusive 
patronage  and  by  your  money,  and  you  will  find  the  lever  of  a 
mighty  press  for  use  at  your  hand.  Eocourage,  by  your  selfish 
indifference  to  everything  which  may  benefit  others  as  well  as  your 
individual  sell*,  journalistic  proprietorship  by  lay  publishing  houses, 
and  your  medical  press  will  continue,  as  it  has  hitherto  done,  to 
use  you. 

When  this  journal  first  entered  the  Geld,  something  more  than 
six  years  ago,  it  was  almost  the  only  first-class  journal  owned  and 
«dit«d  by  a  professional  man  in  this  country ;  to-day  there  are 
probably  a  dozen  or  more  in  this  category.  We  doubt  not  that  at 
least  a  majority  of  these  medical  proprietors  and  editors  are  actu- 
ated by  singleness  of  purpose  to  work  for  the  good  of  the  profes- 
sion, to  create  a  great  press,  and  that  they  are  sustainecl  by  the 
hope  that  the  profession  will  one  day  recognize  practically  the  hon- 
esty of  their  purpose  and  its  self-sacrifice.  Do  you  fancy  that  all 
these  journals  are  supported  by  the  profession  ?  Does  that  fatuous 
thought,  perchance,  cross  the  mind  of  the  subscriber  who  throws 
bis  bill  aside  to  be  paid  in  a  year  or  two?  Does  that  contributor 
also  believe  this  who  sends  hts  article  to  be  published  by  some  lay 
medical  journal  rather  than  by  one  owned  by  a  medical  man,  not 
because  the  former  is  better  or  has  a  larger  circulation  (thank  God, 
that  excuse  will  not  hold  to-day),  but  because  he  thinks  he  can 
get  a  longer  subscription  credit  and  better  terms  for  new  medical 
books? 

Kemember  this:  If  you  wish  this  movement  toward  bringing 
the  medical  press  under  medical  control  to  succeed,  you  muel  not 


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Editorial.  471 

■expect  credit;  you  mastpay  your  subscriptions  in  advance.  You 
must  make  up  your  miod  to  that  sacrifice  for  the  sake  of  the  great 
good  to  be  obtaioed.  Medical  proprietors  have  not  large  capital 
behind  them  ;  you  mast  supply  the  capital  to  work  with.  After 
all,  you  are  only  expected  to  pay  for  what  you  receive,  and  we  say, 
without  a  moment's  hesitation,  io  the  case  of  every  journal  for 
which  you  may  have  subscribed,  you  get  your  money's  worth  and 
more.  If,  on  the  other  baud,  you  have  no  sympathy  with  the 
struggles  of  these  medical  men  to  give  you  a  medical  press  which 
you  yourselves  shall  own  and  whose  policy  shall  always  be  dictated 
by  your  interests;  if  you  prefer  your  press  to  remain  always  merely 
.a  grab-bag  from  which  you  will  have  the  privilege,  as  you  wish, 
to  draw  out  a  more  or  less  interesting  onginal  article  or  society 
proceeding,  you  can  accomplish  this  end  without  exertion.  It  is 
only  necessary  to  neglect  to  pay  your  subscription.  You  will 
force,  in  this  gentle  and  easy  manner,  every  medical  proprietor  out 
of  the  journalistic  field,  and  you  will  hand  over  the  medical  press 
absolutely  to  the  great  lay  publishing  houses  who  do  not  expect 
you  to  support  their  journals,  which  are  not  published  in  your  in- 
terests but  as  advertising  mediums  for  their  other  publications. 

It  is  this  uneven  fight  which  we  editors  are  figbling,  and  the 
-question  at  stake  is  whether  the  profession  to  which  we  belong  and 
in  whose  interest  we  work  mean  to  aid  us  or  to  turn  aside.  After 
all,  it  is  for  you,  the  profession,  not  for  us;  for  we  venture  to  say 
there  is  not  one  medical  proprietor  in  this  country  who  could  not 
earn  more  at  his  profession  with  half  the  labor  expended  in  jour- 
nalism than  he  could  ever  expect  from  the  most  generous  support 
hia  subscribers  could  give  him.  The  decision  and  the  responsibility 
iie  with  you.  It  is  easy  (for  the  individual  sacrifice  is  not  great) 
to  create  a  great  American  medical  press  under  medical  control. 
It  is  easier  still  to  place  it  back  again  where  for  so  many  years  it 
Temained — on  a  plane  of  mediocrity  and  in  the  hands  of  lay  pub- 
lishing houses. — American  Gynecological  and  Surffical  Journal. 


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472       The  Atlanta  Medical  and  Surgical  Journal. 

OVER-PRODUCTION  OF  PHYSICIANS.' 

The  foUowiDg  notice,  taken  from  a  clipping  in  the  Ameriiian- 
Journal  of  Surgery  and  Gynecology,  is  certainly  well  worth  the 
reading.  It  shows  that  the  same  condition  of  affairs  in  the  United 
States  has  its  counterpart  in  other  conntries.  IrVhat  will  be  the- 
aequei  time  alone  can  tell. 

"Our  Canadian  brethren  seem  to  be  as  much  troubled  with  tfae- 
over-produotion  of  doctors  as  are  we  of  the  States,  judging  from 
what  the  Canadian  Journal  of  Medicine  and  Surgery  remarks:  "That 
in  some  walks  of  life  the  struggle  for  an  existence  should  be  so 
strennous  is,  we  think,  a  pretty  sure  indication  that  these  vocations 
are  not  only  overcrowded,  but  overcrowded  to  the  danger  point. 
Wherever  human  energy  is  concentrated  there  will  necessarily  be 
competition,  and  to  the  spirit  of  competition  or  peaceful  rivalry  is- 
perhaps  due  every  step  of  human  progress.  But  of  late  years  an- 
other meaning  has  been  given  to  the  word  competition  which  dif- 
fers very  widely  from  the  original  signification.  It  is  natural  and 
paiseworthy  that  a  worker  in  any  capacity  should  be  ambitious  lo- 
do  better  work  than  his  fellows.  It  is  right  that  a  man  should  be- 
fond  of  his  work  and  proud  of  it  when  he  attains  to  excellence  in 
it;  and  when  members  of  the  same  craft  or  the  same  profession 
vie  with  one  another  in  the  performance  of  the  most  perfect  work- 
manship, as  much  for  love  of  their  art  as  for  the  material  guerdon 
which  may  ensue,  they  may  be  said  to  be  in  legitimate  competitionr 
with  one  another;  and  without  such  competition  life  wonid  be  in- 
describably flat.  But  wheu  the  amount  of  work  to  be  done  is 
limited  and  those  equipped  to  perform  it  are  greatly  in  excess  of 
the  number  needed  for  its  accomplishment,  it  must  necessarily  fol- 
low that  only  a  few  will  have  anything  to  do  at  all  and  that  the- 
large  majority  will  be  unemployed.  To  this  condition  of  things  the 
term  competition  has  been,  we  think,  falsely  applied  of  late  years. 


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Editorial.  47S 

Tbe  labor  to  be  accomplisbed  is  viewed  Id  the  light  of  spoils,  and 
the  horde  of  workmen  surround  the  coveted  prey  in  turbulent 
warfare  with  one  another.  Thrice  happy  is  he  who  in  this  war  to 
the  knife  is  able  to  snatch  from  the  midst  of  the  conflict  some  por- 
tion of  the  plunder  and  hear  it  away.  However,  it  has  been  said 
that  all  is  fair  in  love  or  war.  In  this  war  of  competition  a  great 
many  methods  seem  to  be  regarded  as  fair  which,  without  the  light 
of  our  venerable  proverb,  would  hardly  be  so  regarded.  Pecu- 
liarly to  tbe  present  conditions  iu  the  medical  profession  do  these 
remarks  apply,  for  of  all  branches  of  handicrafl  tbe  physician's  seems 
to  be  tbe  most  overcrowded.  The  great  desideratum  of  the  pres- 
ent day  seems  to  be  a  'respectable'  calling.  We  suppose  this  is 
one  of  the  unfortunate  indications  of  the  prevailing  vulgarity  of 
the  time.  One  of  the  first  results  of  university  extension  and  uni- 
versal education  of  all  classes  will  be  that  everybody  will  wish  to 
live  by  his  wits,  or,  as  it  is  sometimes  more  pompously  expressed, 
be  a  'brain-worker,'  forgetful  of  the  fact  that  we  all  cannot  be 
parasites!  The  world  will  support  only  a  limited  uupber  of  para- 
sites, whether  they  be  physicians,  barristers,  clergymen  or  artiste; 
as  a  tree  in  the  South  will  support  only  a  given  weight  of  the 
Spanish  moss.  When  the  moss  thrives  beyond  the  tree's  power  of 
support,  it  kills  the  tree,  and  with  the  fell  of  the  tree  comes  the 
extermination  of  the  vegetable  parasite.  All  cannot  be  doctors 
and  ministers  and  musicians,  but  a  great  part  of  the  population, 
unfortunately,  has  set  up  as  one  or  the  other.  This  unnatural  con- 
dition will  lest  until  it  brings  its  own  heavy  punishment,  and  then 
will  come  the  slow  and  painful  readjustment.  At  present,  however, 
the  parasitical  class  seem  in  a  fair  way  to  destroy  the  supporting 
class,  and  the  quarreling  among  the  parasites  affords  an  amusing 
tragi-coraedy  for  the  cynical  observer." 


^dbyGoogle 


474       The  Atlanta  Medical  and  Surgical  Jodrnal. 

THE  OLMSTED  BILL. 

In  our  News  and  Notes  of  this  issue  will  be  fouud  a  clipping 
from  the  Medico-Surgical  Bvlletin,  in  which  its  editor  congratulates 
Dr.  Olueted,  of  this  city,  on  having  beeu  paid  his  fee  of  $500.00 
by  the  Board  of  Health  for  services  rendered  the  city  in  treating 
a  case  of  yellow  fever.  Our  readers,  no  doubt,  will  remember  the 
circumstances,  and  the  fact  that  the  Board  of  Health  refused  to 
pay  the  bill  of  $500.00  rendered  by  Dr.  Olmsted  on  the  ground 
that  the  fee  was  too  large.  Nearly  every  medical  journal  in  the 
country  passed  comments  on  this  action  of  the  Board  of  Healthy 
and  without  exception  they  criticised  its  action.  Soon  after  this 
action  of  the  board  its  personnel  was  changed  under  the  varying 
fortunes  of  resignations  and  politics,  so  that  the  matter  of  the 
"  Olmsted  Bill  "  was  again  brought  up,  and  this  time  unanimously 
passed,  recommending  to  the  city  its  payment.  We  thought  this 
would  end  the  matter,  but  now  comes  the  startling  fact  that  the  city 
refuses  to  pay  Dr.  Olmsted,  on  the  grounds  that  they  cannot  take 
the  money  out  of  the  appropriation  to  the  Sanitary  Department,  and 
that  there  is  no  available  money  from  which  such  a  payment  could 
be  made.  It  looks  like  a  plain  case  of  the  city  trying  "to  do" 
Dr.  Olmsted,  just  as  physicians  are  "done"  frequently  by  individ- 
ual members  of  the  community.  It  matters  not  from  what  source 
the  city  gets  the  money,  the  &ct  remains  simply  this:  that  the  city 
is  obligated  for  this  bill,  and  Br.  Olmsted  ought  to  be  paid  imme- 
diately. If  ever  there  was  a  legitimate  payment  from  the  city's 
funds,  then  this  is  the  case;  for  if  this  should  be  the  only  black 
mark  registered  against  the  city  for  misappropriated  funds,  then 
our  city  fathers  would  wear  white  wings  from  henceforth  and  for- 
ever. We  want  to  see  Dr.  Olmsted  get  what  he  deserves,  and 
he  deserves  every  cent  of  the  five  hundred  dollars. 


,„i,z.d  by  Google 


NOTICE  TO  SUBSCRIBERS. 

On  BDother  page,  under  the  head  of  Correepondej 
found  a  query  from  one  of  our  subscribers.  Now,  this 
beginning  of  whet  we  should  like  to  make  the  most 
part  of  our  journal.  We  solicit  from  you  such  <juer 
ewers  as  may  be  of  interest  to  you,  and  the  same  will 
prove  interesting  to  others.  Many  a  physician  has  son 
method  of  treatment  which  has  proven  invaluable  to  1 
treatment  of  certain  diseases.  Why  not  give  these  to 
feasional  brethren?  Give  a  short,  succinct  report  of  s 
€sting  case,  and  the  manner  in  which  it  was  treated, 
long  ago  held  that  the  attendance  upon  society  meetings 
uable  to  the  physician  simply  for  the  reason  that  it  alio 
«nt  expression  of  ideas  upon  the  same  subject,  and  thi 
beneficial.  Why  not  accomplish  the  same  thing  in  a  mt 
nal  through  correspondence?  Your  case  is  perhaps 
«ome  other  brother  practitioner,  and  if  you  need  aid 
glad  to  give  it.  Let  us  hear  from  you,  and  let  us  make 
respondence  Department"  highly  entertaining. 


MEDICAL  EXAMINING  BOARD  IN  GEOB 

Geoigia  now  has  three  Boards  of  Medical  Examin 
senting  the  three  different  schools  of  medicine,  viz. 
Homeopathic,  and  Eclectic. 

At  the  last  meeting  of  the  Regular  Board  of  Examic 
eenting  the  regular  school,  a  resolution  was  passed  mi 
Atlanta  Medical  and  Surgical  Journal  the  officii 
the  Board,  and  in  which  the  regular  proceedings  will  he 
The  Secretary,  Dr.  E.  R.  Anthony,  of  Griffin,  Ga.,  will 


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476       The  Atlanta  Medical  and  Surgical  Journal. 

ture  furoish  data  coDceroiDg  th«  meetings  of  tbe  Board,  wbicb 
will  thus  hv  a  guide  to  medical  men  all  over  the  State.  At  the  last 
meeting,  held  in  Atlanta  oa  July  6,  a  large  number  of  physicians 
came  before  Ibe  Board,  seeking  the  necessary  qualifications  for 
practicing  in  the  State.  V^e  are  sorry  not  to  be  able  to  publish 
a  list  of  those  who  were  given  certificates.  The  following  is  tbe 
examination  that  was  given  : 
MATERIA  MEDICA  AND  THBRAPEUTICS— By  Dr.  W.  A.  O'Dasizi- 

1.  How  is  quinine  an  antiperiodic,  and  how  is  it  chiefly  elimi- 
nated? 

2.  What  are  tbe  official  preparations  of  bydrastis,  the  dose  of 
each,  and  its  therapeutics  ? 

3.  What  crystal  lizable  principle  is  contained  in  pipsissewa? 

4.  Give  antidotes  for  poisoning  by  phosphorus? 

5.  Name  the  most  useful  emetics,  and  the   dose  and   mode  of 
administration  of  each. 

6.  Give  the  physiological  action  and  therapeutics  of  digitalis. 

7.  Name  the  drugs  which  tend  to  be  cumulative  in  tbe  system 
during  long  periods  of  administration. 

CHEMISTRY.— Da.  E.  R.  Anthony. 

1.  Give  Avogadro's  law, 

2.  Name  sftverat  electro-positive  elements  and  several  electro- 
negative elements. 

3.  Combine  H  and  a  negative  element  or   radical  and  what  is 
produced? 

4.  What  is  hydroxyl?     Give  me  its  formula. 

5.  What  kind  of  albumin  is  found  in  tbe  urine  in  albuminuria?' 
Give  a  good  test  for  same. 

PHYSIOLOGY.— Db.  E.  R.  Antho.ny. 
1.   What  is  the  origin  of  tbe  colorless  blood  corpuscles?     From 
what  are  the  colored  corpuscles  derived  ? 


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Editorial, 

2.  What  is  the  size  and  weij^ht  of  the  beart 
pacity  of  its  chambers?  What  is  the  compai 
the  walls  of  the  right  and  letl  ventricles? 

3.  What  is  the  object  of  respiration?  When 
of  oxygen  and  carbon  diozid  take  place? 

4.  Briefly  describe  the  digeBtion  of  albumin. 

5.  Select  a  cranial  nerve  and  give  me  its  fun 

ANATOMY.— Dr.  F.  M.  Eidlb\ 

1.  Kame  movable  joints  and  give  kinds  of  n 
in  same. 

2.  Name  muscles  composing  quadriceps  exi 
give  origin  and  insertion  of  each. 

3.  Describe  relation  of  external  carotid  and 

4.  Name  nerves  composing  brachial  plexus  at 
fi.  Describe  solar  plexus.     Give  origin,  coui 

of  pnemogastric  nerve. 

SURGERY.— Dr.  F.  M.  Ridley. 

1.  Define  inflammation,  and  describe  chang 
rounding  tissues  and  blood-vessels  during  same 

2.  Describe  eapremia,  septicemia,  pyemia, 
symptoms. 

3.  Name  varieties  of  fractures.  Differential 
fracture  and  dislocation.  Name  cardinal  prin 
of  fracture.     Give  treatment  of  a  recent  compc 

4.  Give  patbology,  diagnosis  and  treatmei 
diagnosis,  of  chancre  and  chancroid. 

6.  What  is  hernia?  Give  diderential  diagaos 
hernia  and  hydrocele.  Name  coverings  from 
an  oblique  inguinal  hernia.  Describe  an  open 
«ure. 


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478       The  Atlanta  Medical  and  Surgical  Journal. 

GYNECOIX)GY.— De.  -J.  B.  S.  Holmw. 

1.  Describe  the  gross  aaatomy  of  the  uterus. 

2.  Describe  the  blood  supply  of  the  uterus. 

3.  Describe  the  round  ligaments. 

4.  What  is  pudeudal  beruia?  aud  what  is  the  treatment? 

5.  Describe  briefly  the  operation  of  vaginal  hysterectomy. 

OBSTETRICa-DR.  J.  B.  8.  Holmbs. 

1.  What  are  the  causes  of  nausea  aud  vomiting  of  pregnancy*' 
What  is  the  tteatment? 

2.  How  should  the  band  of  an  obstetrician  be  prepared  before 
examining  a  woman? 

3.  When  may  an  anesthetic  be  used   in  normal  labor?     What 
anesthetic  is  to  be  preferred? 

4.  What  should  a  physician  carry  with  him  in  attendiog  an  ob- 
stetric case? 

5.  Alter  a  delivery  when  should  a  physician  leave  aod   when 
should  be  return? 

PRACnCK-Da.  A.  A.  SMITH. 

1.  Give  symptoms  and  appropriate  treatment  for  chorea? 

2.  What  abnormal  constituents  would  you  expect  to  find  in  the 
examination  of  the  urine  in  diabetes? 

3.  Give  the  most  prominent  diagnostic  symptoms  in  yellow  fever. 

4.  What  is  pericarditis?   Give  symptoms  and  treatment  for  same. 

5.  Give  definition  of  hematuria. 

6.  Give  symptoms  nod  treatment  of  acute  peritonitis. 

7.  Give  symptoms  and  treatment  of  cholera  infantum. 

8.  Give  appropriate  treatment  for  typhoid  fever. 


In  our  last  issue  an  error  occurred  which  should  have  been  cor- 
rected. In  our  editorial  on  "Consolidation  of  Medical  Colleges' 
it  should  have  read,  "the  N^iagara  University  Medical  College  aud 
the  Buflalo  Uni%'erslty  Medical  School  have  consolidated  under  the 
name  of  the  Medical  Department  of  the  University  of  BufiFalo." 


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NBWS  AND  NOTES. 


Dk.  Van  Qoidtsnoven  has  been  elected  Treasurer  of  the  At- 
lanta Society  of  Medicine  in  the  place  of  Dr.  L.  B.  Grandy. 


We  have  received  a  most  beautiful,  a8  well  aa  useful,  half-year 
calendar  from  the  Ijactopeptine  Company.     Such  "ads."  always 

pay-  

We  extend  our  sympathies  to  Dr.  J.|B.  Baird,  of  this  city,|in  the 
lose  of  bis  most  estimable  wife.  She  was  a  woman  ^eatly  beloved 
by  a  large  circle  of  friends. 


Dr.  Henry  Bak,  a  former  resident  of  Atlanta  but  who  for  the 
last  few  years  has  lived  in  Chicago,  has  returned  to  the  former 
city,  and  has  again  entered  actively  into  the  practice  of  bis  pro- 
fession. 


An  error  occurred  in  a  former  issue  of  The  Journal  in  stating 
that  Dr.  V.  H.  Taliaferro  bad  moved  to  Eatonton,  Ga.  The  doc- 
tor is  located  in  elegant  new  quarters,  706,  708  EDglish-Ameriean 
Building. 

A  MOST  enthusiastic  reunion  of  the  alumni  of  the  old  Southern 
Medical  College  was  held  in  Atlanta  during  the  Confederate  Vet- 
erans' Reunion.  Good  papers,  followed  by  excellent  discussions^ 
were  read  by  some  of  the  members. 


We  call  attention  to  the  article  on  Dr.  Nicolas  Senn,  under  the 
head  of  "Selections  and  Abstracts,"  in  the  last  issue  of  The 
Journal.  In  it  reference  is  fittingly  made  to  our  fellow  towns- 
man and  eminent  surgeon.  Dr.  J.  McF,  Gaston. 


^dbyGoOgle 


480       The  Atlanta  Mbdical  and  Surgical  Journal. 

On  AugUBt  7,  the  Army  Hospital  at  Ft.  McPherson  reported 
five  buodred  cases  of  typhoid  fever.  Patients  have  beeo  so  crowded 
and  sanitary  arrangements  thus  so  hindered  that  a  new  camp, 
known  as  "  Camp  Hobson,"  has  been  established  at  Litbia  Springs, 
-Ga,,  80  as  to  relieve  the  congested  state  at  Ft.  McPherson. 


The  new  Atlanta  College  of  PhysiciaDS  and  Surgeons  has  be- 
come thoroughly  organized  and  ready  for  the  opening  of  the  session 
in  October.  The  new  organization  will  occupy  the  buildings  for- 
merly known  as  the  Atlanta  Medical  College,  with,  however,  con- 
siderable additions  which  are  now  beiog  added  in  the  way  of  com- 
plete renovations.     A  large  attendance  is  expected. 


We  would  most  earnestly  request  that  physicians  all  over  the 
State  send  us  items  of  news  from  their  city  or  district.  Deaths  of 
physicians  or  marriages  are  often  not  known  to  the  editor,  and 
the  same  would  be  of  interest  to  the  profession  all  over  the  State. 
Notices  of  medical  meetings  will  be  cheerfully  published,  and  thus 
we  can  find  out  what  is  going  on  in  a  medical  way  all  over  the 
State.     Help  us  to  make  The  Jouhnal  "  newsy." 


Db.  Leokabd  Wood,  whom  many  here  in  Atlanta  remember 
-when  he  was  stationed  at  Fort  McPherson  as  Assistant  Surgeon, 
has  been  made  military  Governor  of  Santiago  de  Cuba.  Dr. 
Wood,  or  General  as  is  now  his  title,  since  distinguishing  himself 
before  Santiago  at  the  head  of  the  Rough  Riders,  was  a  great  lover 
of  athletic  sports,  and  played  for  several  seasons  on  the  Techno- 
logical football  team.  He  was  a  fine  specimen  of  physical  man- 
hood, and  had  many  friends  here  in  Atlanta. 


We  have  just  received  the  new  catalogue  of  the  University  and 
Belleyne  Hospital  Medical  College.  The  Faculty  consists  of  forty- 
iseven  Professors,  Adjunct  and  Clinical  Professors,  besides  Assist- 


ed byGoOgle 


Nbws  and  Notes.  481 

ants  and  iDStructors.  We  have  not  yet  received  tbe  catalogue  of 
the  new  Cornell  University  Medical  School,  but  suppose  that  its 
Faculty  will  not  be  outdone  in  numbers.  We  suppose  that  such 
a  Faculty  must  be  organized  on  a  purely  philanthropic  basis,  and 
that  is,  to  give  all  uf  its  friends  a  showing  in  the  new  institution. 
Compensation  cannot,  of  course,  be  thought  of. 


Col.  Ray's  Regiment  of  Immunes  has  been  found  out  to  be 
a  misnomer.  This  regiment  was  formed  with  the  idea  that  tbe 
members  who  composed  it  would  be  immune  to  yellow  fever,  and 
therefore  would  be  in  a  condition  to  stand  the  terrible  fevers  which 
were  disabling  many  even  of  the  Spanish  soldiers  in  and  around 
Santiago.  As  a  matter  of  fact,  very  few  of  the  members  of  the 
regiment  were  tbe  "  so-called  immunes,"  but  the  whole  body  was 
made  up  of  young  men  who  perhaps  had  never  had  simple  mala- 
rial fever.  This  was  certainly  true  of  the  Atlanta  delegation,  and 
we  understand  it  was  almost  true  throughout  the  regiment. 


The  Olmsted  yellow-fever  bill  that  we  commented  upon  not 
long  since  in  the  BuUetin  has  at  last  been  paid  by  the  Atlanta 
Board  of  Health.  It  should  never  have  been  fought,  as,  under 
the  circumstances,  the  amount  was  very  reasouable.  We  congrat- 
ulate Dr.  Olmsted  on  receiving  his  check  for  ?500  alter  so  long 
a  wait;  and  a  vote  of  thanks  is  due  the  judge  who  stood  by  him 
when  members  of  the  medical  profession  were  calling  for  a  reduc- 
tion. The  reason  doctor's  fees  average  so  much  smaller  than  those 
of  lawyers  is  that  petty  jealousy  and  spite  seem  to  control  the  for- 
mer more  than  the  latter.  A  united  profession  would  bring  bet- 
ter pay  and  more  respect  to  medical  men  than  can  ever  be  theirs 
while  thus  divided. — Medico-Surgical  BuUetin. 


The  United  States   Hospital  at   Fort   McPherson   has   been 
crowded  with  soldiers  from  Santiago.     There  have  been  but  few 


^dbyGoOgle 


482       The  Atlanta  Medical  asd  Surgical  Journal. 

surgical  cases,  most  of  them  beiDg  eases  of  fever.  The  "Ladies' 
Kelief  Association  of  Atlanta"  has  done  much  good  by  minister- 
iog  to  the  wants  of  the  wounded  and  sick.  Some  of  the  ladiee 
have  gone  out  every  day  to  the  Hospital,  oud  in  fact  have  almost 
acted  as  nurses.  They  are  women  who  for  the  most  part  have 
never  done,  such  work  before,  hut  who  have  become  so  enthused 
that  they  nearly  overdo  the  matter  in  their  attention  to  the  sick 
soldiers.  A  very  amusing  incident  occurred  a  few  days  ago.  One 
of  the  very  intense  enthusiasts  went  out,  and  on  beholding  the 
pallid  face  and  weary  look  of  one  of  the  poor  unfortunates,  her 
sympathy  immediately  went  out.  "  Can't  I  bring  you  some 
water?"  she  said ;  but  the  soldier  shook  bis  head.  "  Let  me  do 
something  for  yon,  let  me  bring  you  some  milk  or  jelly  ";  aud 
again  the  soldier  shook  his  head.  Finally,  with  one  last  effort, 
♦'Let  me  wash  and  bathe  your  face,"  With  a  weary  look  of  pain 
the  soldier  murmured,  "I  will  try;  you  are  the  seventeenth  lady 
who  has  washed  my  face  to-day."  Enthusiastic  womeu  sometimes 
do  too  much. 


PfiYSiciAK  wanting  location  address  Lock  Box  38,  Adel,  Ga. 


Db,  Jno.  D,  Martin,  of  Savannah,  Ga.,  one  of  the  oldest  phy- 
sicians in  the  State,  died  on  August  3. 


Dr.  R.  T.  Hilluak,  of  Senoia,  Ga.,  one  of  the  most  prominent 
physicians  of  the  State,  died  of  typhoid  fe%'er  on  August  6. 


Dr.  E.  R.  Anthony,  of  Griffin,  Ga.,  is  spending  a  month  or 
two  in  New  York  in  attendance  upon  the  numerous  hospital  clinics. 


Pbrsokal. — Dr.  W.  J.  Green,  of  Clayton,  Rabun  county,  Ga., 
will  be  in  the  State  Senate  November  and  December  of  this  year. 
He  wants  a  man  of  some  experience  to  take  his  practice  during 


^dbyGoOgle 


News  and  Notes.  483 

that  time.     The  field  is  good  and  pays  well.     Write  to  Dr.  Green 
for  particulars. 


The  New  Orleans  Polyclinic  will  this  fall  have  a  "fall  session" 
—an  inaovation  in  this  school  to  which  the  attention  of  our  read- 
rs  is  directed. 


The  International  Association  of  Railroad  Surgeons  recently 
held  its  annual  meeting  in  Toronto,  Canada,  under  the  Presidency 
of  Dr.  Geo.  Ross,  of  Richmood,  Va.  The  next  meeting  will  be 
held  in  Richmond,  Ya. 


In  the  death  of  Dr.  Wm.  Pepper,  of  Philadelphia,  the  profes- 
sion at  tai^e  has  lost  one  of  its  most  able  exponents.  Dr.  Pepper 
was  a  man  of  world-wide  reputation  and  the  very  backbone  of  the 
University  of  Peunsylvania. 


The  daily  papers  report  that  cattle  and  horses  which  are  pastured 
on  Kings  River,  California,  are  sufFering  from  Texas  or  splenetic 
fever.  Within  a  few  days  200  head  of  cattle  succumbed  to  the 
disease,  which  is  spreading  rapidly. 


Cmabqes  against  a  New  York  Medical  School  Set  aside. 
.^The  chaises  against  the  New  York  Post-Graduate  Medical 
School  and  Hospital,  relative  to  a  misapplication  of  funds,  have 
been  iuvestigated  by  the  State  Board  of  Charities  and  set  aside  as 
unfounded. 


Fob  Urticaria. — Ord  has  found  strophanthus,  in  five-drop 
doses,  almost  a  specific  in  the  chronic  forms  of  urticaria.  It  is 
particularly  indicated  in  the  aoemia  of  young  womeu,  especially  if 
there  is  accompanying  cardiac  weakness  with  palpitation. — Jfed. 
Times. 


^dbyGoOgle 


484       The  Atlanta  Medical  and  Surgical  Journal. 

Two  BILLS  have  been  iotroduced  m  Congress,  oue  providing  for 
the  appoiDtment  of  Army  Dentists,  to  have  equal  rank  with  sur- 
geons; the  other  providing  for  the  eDlistmeut  of  one  hundred  female 
nurses  to  serve  od  board  the  ambulance  aliip9  and  in  the  military 
hospitals  during  the  coutinuauce  of  the  war. 


Gift  of  a  Hospital  to  the  Red  Cross, — Mr.  James  Arm- 
gtrong,  of  New  York,  has  ofiered  the  Red  Cross  Society  the  use  of 
his  country  house  at  Centre  Hill,  Fla.,  as  a  hospital.  The  house 
has  twenty  large  rooms,  and  is  built  ou  one  of  the  highest  points 
of  land  in  the  State,  about  seventy  miles  from  Tampa. 


Db.  William  Osler,  Professor  of  Medicine  at  Johns  Hopkias, 
18,  according  to  the  N.  Y.  Medical  Record,  "one  of  the  fifteen 
scientists  selected  this  year  by  the  Committee  of  the  Royal  Society 
to  be  recommended  for  membership  in  the  Royal  Society  of  Eug- 
land."     A  very  distinguished  honor  very  worthily  bestowed. 


The  Tri-State  Medical  Journal,  of  St.  Louis,  reports  the  suddeii 
death  of  a  boy  fifteen  years  old,  which  followed  in  thirty  minutes 
an  immuuiziug  dose  of  antitoxin.  The  preparation  was  said  to 
have  t>een  of  the  strength  of  1,500  units.  Between  three  and 
four  cc.  were  used.     The  name  of  the  manufacturer  was  not  given. 


It  is  asserted  by  medical  authority  that  there  are  more  blind  peo- 
ple in  Spain,  in  proportion  to  population,  than  in  any  other  coun- 
try in  Euro[ie.  At  the  beginning  of  the  war  it  appeared  that  the 
whole  nation  was  blind,  but  there  is  strong  reason  for  the  opinion 
that  surgical  operations  by  the  United  States  will  open  their  eyes. 
— Medical  Age. 

DiclzedbyGoOgle 


News  and  Notes.  485 

Announcement. — The  partnership  hitherto  existing  between 
Presley  Blakiston  and  Kennith  M.  Blakiston,  ucder  the  firm  name 
of  P.  Blakiston,  Sou  &  Co.,  expired  June  30,  1898,  on  aocountof 
the  death  of  the  senior  member.  The  business  of  publishing,  im- 
porting and  dealing  in  medical  and  scientific  books,  as  established 
in  1843,  will  be  continued  by  Kenneth  M.  Blakiston,  trading  as 
P.  Blakiaton's  Son  &  Co. 


Sir  John  Lubbock  has  gone  to  the  ant  again,  and  if  be  keepe 
up  his  visits  and  others  imitate  him,  that  interesting  insect  will 
become  useless  for  Sunday'school  purposes.  Sir  John  succeeded 
in  getting  fifty  ants  helplessly  drunk  and  then  placed  them  outside 
an  ant  bill.  The  sober  ants  came  out,  picked  .up  their  friends,  and 
put  them  to  bed  to  sleep  olf  the  effects  of  Sir  John's  liquor:  the 
strangers,  however,  they  sternly  rolled  over  into  the  ditch, — Soien- 
iific  American. 


Yellow  Fever  Promptly  Suppressed, — The  Marine  Hos- 
pital Service  announced,  July  {I,  1898,  that,  as  far  as  is  known, 
there  is  not  a  single  case  of  yellow  fever  in  the  United  States. 
The  total  number  of  cases  iu  the  recent  invasion  at  McHenry, 
Miss.,  was  24.  The  last  patient  was  discharged  July  8.  There 
are  no  other  cases  uuder  treatment  and  no  suspicious  ones  under 
observation.  Since  this  announcement  was  made  we  hear  that 
cases  of  yellow  fever  have  occurred  among  the  troops  in  camp  at 
Tampa. 


A  Special  Commitfee  Appoikted  to  Commemorate  Joseph 
-O'DwYER. — At  the  meeting  of  the  Section  on  Diseases  of  Children, 
of  the  American  Medical  Association,  held  at  Denver,  Col.,  June 
7-10,  1898,  it  was  moved  and  carried  unanimously  that  a  Memo- 
rial  Committee  be  appointed  to   commemorate    the  late  Joseph 


^dbyGoOgle 


486       The  Atlanta  Medical  asd  Surgical  Journal. 

O'Dwyer,  with  suitable  powers,  etc.,  to  collect  sjich  moneys  aod  to- 
act  with  other  bodies  for  the  same  purpose.  The  committee  is- 
composed  of  the  following:  Dr.  Louis  Fischer,  New  York,  Chair- 
man; Dr.  J.  P.  Crozier  Griffith,  Philadelphia;  aod  Dr.  F.  E. 
Waxham,  Denver,  Col. 


The  Canadian  Journal  of  Medicine  and  Surgery  has  issued  a 
special  edition  in  its  August  number.  It  gives  a  very  interesting 
and  complete  account  of  the  meeting  of  the  International  Associa- 
tion  of  Railroad  Surgeons,  which  was  held  in  Toronto  on  July  6. 
Our  Canadian  reporter  certainly  wields  a  &cile  aod  entertaining 
pen,  juijging  by  the  striking  manner  in  which  some  of  the  occur- 
rences are  put.  la  speaking  of  that  charming  Southern  gentle- 
man, Dr.  Geo.  Ross,  of  Ricbmoad,  Va.,  the  President  of  the  As- 
sociation, our  Canadian  reporter  thus  describes  him  :  "A  soldierly- 
looking,  elderly  man,  with  a  white  mustache  and  chin  beard." 


Mobile  and  New  Orleans  have  been,  metaphorically,  making 
feces  at  each  other  for  some  time  over  what  is  called  "Louisiana's 
Inexcusable  Quarantine."  It  is  charged  that  Iiouisiana  is  quaran- 
tining places  known  not  to  be  infected,  and  so  violating  every 
principle  of  true  quarantine,  and  that,  too,  merely  to  satisfy  the 
unreasonable  fears  of  an  ignorant  public.  The  Mobile  Register  of 
July  8  says  that  "the  light  is  breaking  through  the  fog  of  the  'in- 
fernal quarantine  '  that  afflicts  this  part  of  the  world."  Alabama 
seems  to  be  converted  to  a  national  quarantine,  and  the  papers  are 
endeavoring  to  show  that  such  a  quarantine  would  not  be  opposed 
to  States'  rights.  Will  our  States  aod  cities  adopt  the  Louisiana 
plan  and  keep  out  the  brave  boys  from  Santiago  when  they  seek 
to  return  home  because  they  have  been  exposed  to  yellow  fever? — 
Medico-Surgical  Bulletin. 


^dbyGoogle 


News  and  Notes.  487 

The  European  press  has  reported  an  operation  that  is  probably 
destined  to  bsve  much  more  than  ordinary  sigailicaace.  The 
deufjrhter  of  the  Sultan  of  Turkey  was  operated  on  successfully  for 
what  would  seem  to  have  been  hypertrophic  steuosis  of  the  pylo- 
rus. The  operation  was  performed  by  Djemil  Pasha,  whom  visi- 
tors to  the  surgical  section  of  the  recent  International  Medical  Con- 
gress at  Moscow  will  remember  as  an  unassuming  young  man  who, 
though  the  representative  of  the  Turkish  government,  was  only  in 
evidence  when  he  had  something  to  say,  which  he  did  briefly  and 
pointedly.  After  the  operation  he  received  the  Osmanic  order. 
Seven  surgeons  were  present  at  the  operation,  and  the  dissemina- 
tion of  the  knowledge  of  the  operation  among  the  Turks  is  likely 
to  have  a  most  salutary  effect  with  regard  to  the  medical  and  sur- 
gical treatment  of  Turkish  women  by  men. — Medical  Age. 


A  Notice. — It  ia  contrary  to  the  custom  of  the  Journal  to  take 
its  business  into  its  reading  pages,  but  the  recent  insolent  effort  of 
an  agency  of  this  city  in  the  interests  of  a  much-advertised  pro- 
prietary preparation  to  demonstrate  the  venality  of  the  American 
medical  press  cannot  be  permitted  to  go  unnoticed.  This  journal's 
position  requires  no  definition — the  advertisement  was  unquali- 
fiedly rejected.  It  was  accepted,  however,  by  a  number  of  papers 
whose  names  have  been  widely  circulated  by  this  agency  in  viola- 
tion of  every  tenet  of  decency  in  business  dealings.  The  murder 
being  out,  and  the  impossibility  of  adequate  explanation  recognized, 
the  names  of  the  journals  accepting  the  advertisement  will  be  re- 
moved from  our  exchange-list.  There  is  no  other  method  by 
which  disapproval  can  be  so  effectually  demonstrated.  We  are 
pleased  to  note  that  the  Joiintul  of  the  American  Medical  Aaaocia- 
tion  has  forced  a  retractiuu  from  the  organ  of  this  agency  of  the 
statement  that  it  had  accepted  the  proposition. — Journal  of  Cuta- 
neous and  Genito- Urinary  Diseases,  July,  1898. 


,„i,z.d  by  Google 


BOOK  REVIEWS,    PAMPHLETS,   EXCHANGES. 


BOOK  REVIEWS. 

ICodtrlbuMona  lollcltsd  tor  fbti 


We  are  id  receipt  of  a  complimentary  copy  of  a  small  brochure 
entitled  "A  CouDtry  Doctor,"  by  Dr.  Thomas  Hall  Shastid,  of 
Battle  Creek,  Mich.  This  ts  a  plain  but  beautiful  tribute  to  the 
life  of  a  "country  doctor"  who  has  been  the  author's  best  friend, 
that  is  his  father.  The  illustratious  are  very  true  to  life  and  eo- 
hance  very  much  the  appearance  of  the  book.  The  Doctor  is  to 
be  congratulated  upon  the  charming  mauuer  in  which  he  presents 
the  life  of  "A  Country  Doctor." 


A  Manual  of  Modern  Surgeev,  General  akd  Operative. 
By  John  Chalmers  DaCosta,  M.D.,  Clinical  Professor  of  Sur- 
gery, Jefiferson  Medical  College,  Philadelphia.  Published  by 
\V.  B.  Saunders,  Philadelphia. 

When  we  coutemplate  the  great  number  of  escellent  works, 
both  large  and  small,  on  the  subject  of  Surgery,  and  see  that  in 
four  years  the  author  of  the  above  work  has  had  to  issue  a  second 
edition,  then  that  of  itself  speaks  for  the  excellency  of  the  book. 
Dr.  DaCosta  is  comparatively  a  young  man,  and  yet  by  bis  ability 
and  energy  has  gained  a  foremost  position  as  a  surgeon.  In  this 
second  edition  a  good  many  new  subjects  ha%'e  been  treated,  which 
will  still  further  enhance  the  value  of  the  work.  We  believe  that 
its  continued  success  is  assured.     It  is  certainly  a  safe  guide. 


Atlas  and  Epitome  of  Operative  Surgery.  By  Dr.  Otto 
Zuckerkoudl,  of  Vienna.  With  twenty-four  colored  plates  and 
217  illustrations  in  the  text.  Published  by  \V.  B.  Saunders, 
Philadelphia.     Price,  §3.00  net. 

This  is  another  one  of  the  popular  atlases  being  published  by 
the  well-known  house  of  W.  B.  Saunders.  They  are  tran^dations 
from   the  original  German  edition.     In  this  case  the  Americau 


^dbyGoOgle 


Book  Reviews.  489 

Editor  U  Dr.  Chalmers  DaCoata,  a  man  emineotly  fitted  for  Bucb 
work.  Thie  character  of  a  book  ia  quite  ao  iDDOvatioo,  but  we 
must  Bay  that  it  commends  itself  to  us.  This  especial  Atlas  on 
Operative  Surgery  is  not  quite  so  well  gotten  up  in  colored  plates  ' 
as  some  of  the  others,  but  the  otber  illuatratious  are  very  good  ia- 
deed.  Such  a  work  as  this  is  extremely  helpful  to  the  student  and 
even  to  the  busy  surj^eon.  To  see  an  operation  well  illustrated, 
especially  if  in  colors,  is  better  understood  by  the  reader  than  two 
pages  of  text.  Indeed,  such  is  often  uuderslood  where  reading  the 
text  produces  coufusiou.  As  a  quick  reference  book  they  are  ex- 
tremely valuable. 

The  subject  of  amput&tions  is  especially  well  treated,  as  is  also 
the  ligation  of  vessels.  In  fact,  every  portion  of  operative  surgery 
is  well  represented.     We  predict  a  Inrge  sale  for  these  works. 


Lectcbes  ox  Tomors.  By  John  B.  Hamilton,  M.D.,  LL.D., 
Professor  of  Surgery,  Rush  Medical  College  and  Chicago  Poli- 
clinic; Consulting  Surgeon  to  St.  Joseph's  Hospital,  etc.,  etc., 
etc.  Third  Edition.  Twenty-one  Illustrations.  Philadelphia. 
P.  Blakiston's  Son  &  Co.  1012  Walnut  street.  1898.  Price, 
$1.25  net. 

This  is  a  collection  of  the  lectures  of  Dr.  Hamilton  to  the  stu- 
dents of  the  Medical  Department  of  Georgetown  University, 
which  lectures,  keeping  pace  with  surgical  knowledge,  were  re- 
I>eated  to  the  students  of  Rush  Medical  College.  The  book  is  in 
lecture  form  as  heretofore,  and  its  purpose  is  to  aid  students  in 
their  preparations  for  recitation,  though  of  course  this  does  uot  im- 
pair its  value  as  a  reference  for  practitioners. 

The  introduction  is  a  brief  description  of  some  methods  of  pre- 
pariug  sections  for  microscopic  examination — a  very  useful  part 
of  the  book.  The  appendix  gives  the  Rush  Medical  College 
methods. 

"General  considerations"  deal  with  the  features  which  must  be 
borne  in  mind  in  diagnosis.  The  classification  is  that  of  the  Royal 
College  of  Physiciafls,  1896,  though  it  is  not  claimed  to  be  perfect. 
The  different  tumors  are  next  treated  in  detail.  His  description  of 
"Condyloma"  is  rather  obscure.  He  is  rather  too  willing  to  ac- 
cept the  (alleged)  parasite  of  epithelioma.  The  brevity  and  prac- 
ticality of  the  little  work  should  recommend  it  to  the  busy  practi- 


,„i,z.d'by  Google 


490       The  Atlanta  Medical  and  Surgical  Jodenal. 

The  Office  Trbatmest  of  Hemorrhoids,  Fistula,  etc., 
WITHOUT  Operation.  Together  with  Remarks  on  the  Rela- 
tion of  Biseayee  of  the  Rectum  to  Other  Diseases  in  Both  Sexes, 
Especially  in  Women,  aod  the  Abuse  of  the  Operation  of  Co- 
lostomy.    By  Charles  B.  Kelsey,  A.M.,  M.D.,  New  York. 

The  subjects  treated  comprise  three  lectures  delivered  by  the 
aiiihor  to  his  class,  and  have  reached  us  from  the  publisher,  E.  R. 
PeltoD,  So.  19  East  Sixteenth  street,  New  York. 

The  author  gives  a  practical  and  common-sense  view  of  the 
subject' matter  of  his  little  book,  which  makes  it  a  valuable  acqui- 
sition to  the  library,  not  only  of  the  surgeon,  hut  of  every  intelli- 
gent practicing  physician.  He  shows  that*"the  usual  and  generally 
adopted  surgical  operation  for  the  radical  cure  of  piles  is  not  al- 
ways necessary,  but  it  can  be  done  by  competent  and  skillful  phy- 
sicians without  resort  to  the  knlTe  or  cautery. 

In  the  second  lecture  he  points  out  the  complications  likely  to 
exist  in  cases  of  piles  in  women,  such  as  enlargement  of  the  womb 
and  prolapse  of  the  ovary,  and  the  futility  of  expecting  a  radical 
cure  of  piles  without  first  relieving  the  uterine  and  ovarian  troubles. 

In  the  third  lecture  he  condones  colostomy  (or  making  an  arti- 
ficial anus)  as  being  the  best  means  fur  the  radical  cure  of  stricture 
of  the  rectum  from  ulceration,  thickening  and  contraction  of  tfae 
tissues,  preferring  removal  of  the  diseased  parts  and  making  an 
artificial  anus  at  the  natural  outlet.  He  emphasizes  the  danger  of 
the  operation  in  unskillful  hands,  but  says  that  with  the  skill  born 
of  long  practice  it  may  be  done  as  safely  as  colostomy. 

We  would  advise  all  interested  in  the  subjects  treated  to  read 
this  little  hook.  o.  g.  r. 


Atlas  of  Syphilis  and  the  Venereal  Diseases,  Including  a 
Brief  Treatise  on  the  Pathology  and  Treatment.  By  Prof.  Dr. 
Franz  Mracek,  of  Vienna.  Authorized  Translation  from  the 
German.  Edited  by  L.  Bolton  Bangs,  M.D.,  Consulting  Sur- 
geon to  St.  Luke's  Hospital  and  the  City  Hospital,  New  York, 
etc.,  etc.  With  71  colored  plates.  Philadelphia.  W.  B.  Saun- 
ders.    Price  ?3.50,  net.     1898. 

The  first  three-fourths  of  this  book  is  composed  of  illustrations 
of  the  various  lesions  of  the  genitals,  skin,  mouth,  throat  and 
other  parts,  reproduced  mostly  in  colors.     The  picture  occupies  the 


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Book  Reviews.  491 

right-hand  page,  while  on  the  left,  opposite,  ia  given  the  history 
of  the  case,  with  satisfactory  brevity  and  clearness.  Many  unusual 
lesions  are  found  pictured  and  described,  even  those  of  great  rarity. 
The  colors  are  rather  too  vivid,  but  the  illustrations  as  a  whole  are 
as  nearly  perfect  as  could  be. 

The  remainder  of  the  book  is  occupied  with  a  condensed  but 
very  full  description  of  syphilis  and  the  venereal  diseases.  The 
author  retains  the  old  division  of  syphilis  into  primary,  secondary, 
and  tertiary.  Treatment,  both  internal  and  ejtternal,  is  very 
thoroughly  gone  into.  Simple  ulcers,  gonorrhea  and  its  compli- 
cations, and  condyloma  acuminata  are  next  described,  with  treat- 
meut.  M.  B.  H. 


PAMPHLETS  AND  EXCHANQBS. 


Reprints  received : 

Cataract  Operations:  Mule's  Operation;  Capsulotomy;  Operation 
for  Pterygium.     By  L.  Webster  Fox,  A.M.,  M.D.,  Philadelphia. 

A  Homily  on  Doctor's  Fees;  The  Hlppocratic  Oath;  Early 
Signs  of  Conception.    By  W.  Symington  Brown,  Stoneham,  Mass. 

The  Tuberculin  Test  in  Cervical  Adenitis.  By  Edward  O. 
Otis,  M.D.,  Boston,  Mass. 

The  Newer  Preparations  of  Bismuth.  By  W.  R.  Wilcox,  M.D., 
of  New  York. 

The  Essential  of  the  Art  of  Medicine.  By  J.  H.  Musser,  M.D., 
Philadelphia. 

The  Diagnostic  Importance  of  Fever  in  Late  Syphilis.  By 
J.  H.  Musser,  M.D.,  Philadelphia. 

Renal  Calculus.     By  J.  H.  Musser,  M.D.,  Philadelphia. 

The  Myocardium.  By  J.  H.  Musser,  M.D.,  and  J.  D.  Steele, 
M.D.,  Philadelphia. 

Diseases  of  the  Lachrymal  Passage — Their  Causes  and  Man- 
agement.    By  Leartus  Connor,  A.M.,  M.D.,  Detroit. 

The  Prevention  of  Diseases  now  Preying  upon  the  Medical 
Profession.     By  Leartus  Connor,  A.M.,  M.D.,  Detroit. 


CoUier's  Weel^ff  ia  certainly  giving  to  the  public  the  beat  pictorial 
representation  of  the  war  that  can  be  found  in  any  weekly  or 
monthly  magazine.     Besides  this,  its  war  comments  are  exceed- 


ed byGoOgle 


492       The  Atlanta  Medical  akd  Surgical  Journal. 

ingly  entertaiDiDg.     It  is  certainly  the  weekly  megaziae  for  the 
home. 


One  of  the  mogt  iateresting  of  our  exchangeB  is  the  monthly 
journal  Items  of  Interest,  published  by  the  Consolidated  Dental 
MaDufactiiring  Compaoy,  of  New  York-  It  is  bright,  newsy,  and 
thoroughly  up  to  date.  We  note  in  the  July  number  an  excellent 
photographic  deacriptioo  of  one  of  Atlanta':]  best  dentists — 
Dr.  T.  P.  Hinman. 

MAGAZINE  NOTES. 


Dr.  Moritz  Buscu,  who  has  beeo  sometimes  described  as  Bis- 
marck's Boswell,  and  who  enjoyed  terms  of  special  intimacy  with 
the  great  Chancellor,  is  the  author  of  an  important  paper  on 
Bismarck  and  William  I.,  which  will  be  published  entire  in  Tht 
Living  Age  of  September  3.  It  was  written  with  a  view  to  publi- 
cation after  Bismarck's  death,  and  it  contains  so  much  that  was 
communicated  to  the  author  by  Bismarck  himself  that  it  is  almost 
autobiographic. 

The  relations  of  England  and  America  continue  to  be  much 
discussed  in  the  English  reviews.  Two  noticeable  articles,  looking 
at  the  question  from  slightly  differeut  points  of  view,  are  reprinted 
in  The  Living  Age  from  The  Nineteenth  Century.  One  is  by 
Frederick  Greenwood  and  the  other  by  Sir  George  Sydenham 
Clarke. 


Perhaps  the  last  bit  of  magazine  writing  from  the  pen  of  Mrs. 
Oliphant  is  the  article  on  Siena,  contained  in  The  Living  Age  for 
August  13.     It  is  a  charming  piece  of  description. 


The  Living  Age  bas  lately  printed,  in  its  issue  for  August  6,  an 
article  on  Social  Conditions  in  America,  translated  from  the  lead- 
ing Italian  review,  Ntiova  Antologia.  The  writer,  G.  M-  Fla- 
mingo, shows  a  wider  knowledge  and  a  better  discrimination  than 
most  foreigners  treating  this  subject,  aud  his  views  are  cordial  and 
sympathetic. 


^dbyGoOgle 


SELECTIONS  AND  ABSTRACTS. 


Tbeatment  op  Locomotor  Ataxia  by  Systematic 
Exercise.* 

The  greatest  advance  which  has  been  made  in  the  treatment  of 
or^nic  nervoue  dieeafie  is  that  gaioed  by  the  exercise  treatment  of 
locomotor  ataxia.  It  is  true  that  th'ia  is  nut  the  treatment  of  tt  dis- 
ease, but  of  a  symptom.  But  it  is  the  treatment  of  that  symptom — 
ataxia — which  is  the  most  promiuent  and  moiit  disabling,  and  its 
improvement  or  cure  oii  euables  the  hedriddeo,  or  those  in  en- 
forced idleness,  to  again  move  among  their  fellows.  The  treat- 
meut  to  some  extent  also  relieves  other  symptoms. 

So  many  therapeutic  measures  of  but  little  or  uo  avail  have  been 
tried  or  vaunted  in  the  treatment  of  locomotor  ataxia  that  it  is  a 
great  satislaction  to  find  a  mode  uf  treatment  o)  such  signal  value. 

This  treatment  consists  esseutially  in  this,  that  movemenls, 
which  have  become  ataxic  as  the  result  of  disease,  are  practiced 
systematically  with  great  care  until  they  are  again  done  in  a  nor- 
mal, or  nearly  normal,  .manuer.  This  is  re-education  in  co-ordi- 
nated movements.  Originally,  all  co-ordinated  movements  are 
acquired  by  long  practice.  The  infant  learning  to  walk,  the  child 
to  write,  the  piano-player  to  play,  are  illustrations  of  this  fact. 
The  act,  at  first  difficult,  as  it  is  practiced  over  and  over  again,  be- 
comes more  and  more  easy  until  it  becomes  automatic,  or  quasi* 
automatic. 

In  locomotor  ataxia,  as  the  result  of  loss  of  seosoryf  guidance, 
this  acquired  co-ordination  of  movement  becomes  impaired  or  lost, 
and  il  now  needs  greater  efibrt  to  reacquire  it  than  in  the  begin- 
oing.  To  attain. this  we  must,  firstly,  call  upon  what  sensory  con- 
trol still  remains,  and  by  our  strenuous  efiorts  we  probably  stir 
into  action  sensory  fibers  which  have,  hitherto,  lain  dormant. 
Secondly,  we  call  in  the  assistance  of  vision.  Its  power  to  substi- 
tute, in  part,  lost  sensory  guidance  we  have  always  seen,  in  that  the 
ataxic  walks  better  by  day  than  by  night,  and  stands  more  firmly 
and  uses  his  hands  more  skillfully  with  the  eyes  opened  than 
closed.     Thirdly,  the  patient  must  pay  the  most  careful  attention 

'By  Pt^lllR  Zeaner,  A.M.,  M.D.,  CinclnDBti,  Lecturer  on  Nervous  D1»«M«  In  the  Medical 
College  or  Ohio.    Re»d  by  litis  before  the  "  " 

tThe  I  hear;  or  teoKiry  origin  or  atSiili 
accepteil,  !■  consiantly  k^'iIoe  In  ■Irfngti 


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494       The  Atlanta  Medical  asd  Surgical  Journal. 

that  the  desired  movement  is  made  with  the  greatest  possible  pre- 
cision. By  menus  of  these  three,  the  remaioiug,  aud  )>erhaps  to 
be  increased,  sensory  control,  vision,  and  painstaking  effort,  and  at 
the  same  time  systematic  practice  of  the  given  exercises,  eo-ordi- 
ualion  can  be  reacquired,  and  ataxia  proximately  or  altogether 
cured. 

The  value  of  this  treatment  in  locomotor  ataxia  rests  upon  two 
facts:  Firstly,  as  any  given  ataxic  movement  cau  be  remedied  by 
re-education  in  co-ordination  of  given  muscles,  so  all  the  ataxia 
manifested  may  be  removed  if  the  proper  exercises  are  given ;  and, 
secondly,  that  locomotor  ataxia  is  usually  slow  in  it«  progress,  often, 
apparently,  stationary. 

We  owe  this  treatment  to  Frenkel,  of  Heiden,  Switzerland.  A 
patient  of  his  at  the  firpt  examiuatioa  showed  a  good  deal  of  ataxia 
of  the  haode  iu  trying  to  bring  the  index-fiugers  together,  while  at 
the  second  esaminatioo  he  succeeded  in  making  this  test  perfectly. 
The  patient  slated,  in  explanation  of  the  great  improvement,  that 
he  had  been  coustantly  practicing  the  exercise  since  bis  first  visit. 
It  was  after  this  obeervation  that  the  thought  of  systematic  treat- 
ment of  this  kind  occurred  to  Frenkel,  and  he  soon  demonstrated 
by  actual  experience  the  value  of  such  treatment.  Frenkel's  first 
publication  was  in  1883.  Since  then  he  has  had  abundant  oppor- 
tunity for  the  application  and  amplification  of  liis  method.  The 
fame  of  his  treatment,  and  his  brilliant  results,  caused  ataxics  to 
flock  to  his  institution  in  no  small  numbers,  so  that  his  experience 
and  opportunities  for  observation  have  been  very  large.  He 
learned,  thereby,  that  the  treatment  was  applicable  not  only  to  tight 
cases,  as  be  had  at  first  supposed,  but  to  very  bad  cases  also,  and 
that  the  improvement  and  cure  were  of  indefinite  duration.  But 
he  learned  also  that  the  treatment  was  not  an  easy,  but  a  very 
difficult  one,  requiring  for  its  success  the  most  careful  study  of  its 
mode  of  applicatiou  to  the  individual  case.  So  great  has  been  his 
success  that  he  believes  that  failures,  unless  ther^  be  contraindica* 
tione  to  the  treatment,  are  always  due  to  faulty  methods. 

Because  this  treatment  is  not  nearly  so  well  known  as  its  deserts 
merit,  and,  at  the  same  time,  should  belong  to  the  general  prac- 
titioner, and  because  my  personal  experieuce  has  tjiught  me  how 
easily  failures  may  result  without  full  knowledge  of  the  rules  gov- 
eruing  the  application  of  ibis  method,  I  have  deemed  the  subject 
well  worthy  to  be  brought  before  the  American  Medical  Asso- 
ciation. 

To  get  a  clearer  idea  of  what  can  be  done,  let  us  first  consider 
the  limitations  of  treatment. 


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Selections  and  Abstracts.  495 

As  coDtraindicatioDs  of  treatnient  may  be  mentioned: 

(a)  Fragility  of  the  bones. 

(b)  Joint  disease. 

(c)  Bliudnees.     Virion  is  essential  to  the  treatment. 

(<^  Mental  disease.  Nothiog  can  be  done  without  the  intelli- 
gent co-operation  of  the  patient. 

(«)  A  meningeal  type  of  disease,  or  that  with  strong  cord  or  root 
irritation  symptoms.     Here  exercise  is  likely  to  increase  the  pain. 

(/)  Acute,  or  rapidly  progressive  disease.  Rest,  not  exercise,  is 
here  indicated. 

(g)  Spasticity  or  muscular  atrophy,  especially  if  of  high  degree. 

(A)  Serious  organic  disease,  especially  heart  disease.  If  the  con- 
ditions still  permit  the  treatment,  it  should  be  instituted  with  great 
care- 
Other  conditions  require  preparation  for  the  treatment.  In  case 
of  anemia,  or  bad  nutrition,  or  other  impairment  of  health,  the 
general  health  should  be  restored  before  beginning  the  exercise 
treatment.  Frenkel  has  called  special  attention  to  a  condition  of 
the  muscles  in  locomotor  ataxia,  which  he  terms  hypotoous,  a  loss 
of  muscular  tone,  making  the  joints  less  firm,  and  excessive  move- 
ment [wssible.  Fur  instance,  a  normal  individual  lying  on  his 
back  can  usually  lilt  his  leg  but  to  a  right  angle,  while  with  the 
hypotonus  spoken  of  he  can  bring  the  leg  much  nearer  the  trunk. 
This  hypotonus,  causing  relaxed  muscles  and  tendons  and  weak- 
ened joints,  must  be  relieved  by  electricity,  massage,  bandages  and 
the  like,  before  much  benefit  can  be  ex{>ected  from  the  exercise 
treatment. 

The  favorable  oases  for  this  treatment  are  those  in  good  general 
health,  intelligent  and  hopeful,  where  the  disease  is  advancing  very 
slowly,  or  is,  practically,  at  a  standstill.  The  lighter  forms  are 
the  more  easily  and  quickly  improved,  hut  had  cases,  though  the 
treatment  is  necessarily  of  longer  duration,  often  give  brilliant 
results. 

Let  us  for  a  moment  consider  the  different  forms  or  degrees  of 
ataxia  which  may  be  presented. 

The  lightest  and  usually  first  to  appear,  is  static  ataxia.  The 
patient  sways  when  standing  with  closed  eyes,  is  unsteady  if  he 
stands  on  one  foot,  cannot  stand  on  tip  toes,  etc.  A  step  further 
and  locomotion  becomes  difficult;  the  gait  is  taxic,  first  manifested 
in  running,  dancing,  sudden  turning  and  the  like.  A  Still  higher 
degree  oT  ataxia  is  that  of  the  separate  limbs.  Even  in  a  position 
of  rest  the  ataxia  of  the  leg  may  be  shown  in  the  unsteady  way 
the  patient  touches  the  knee  of  one  leg  with  the  heel  of  the  other 
fitot,  or  like  movements;  and  the  same  may  be  seen  in  the  niove- 


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496       The  Atlanta  Medical  and  Surgical  Journal. 

meots  of  the  hands,  if  tbe  upper  extremities  be  affected.  Still 
higher  degrees  of  ataxia  are  those  where  the  patient  can  hardly 
lilt  himself  Irom  the  chair,  needs  support  uo  one  or  both  sides  iu 
walking  or  where  any  movement  becomes  difScuit  or  almost  im- 
possible. The  bedridden,  so-called  paralytic,  cases  are  often  ooly 
cases  of  extreme  loss  of  coordinating  power,  proven  by  their  im- 
provement under  this  method  of  treatment. 

For  these  various  degrees  and  location  of  ataxia  differences  iu 
the  method  of  treatment  are  called  for,  as  to  tbe  choice  of  exer- 
cises, frequency  and  duration  of  treatment,  etc. 

I  give  herewith  a  series  of  exercises  described  by  Hirsehberg,* 
who  supervised  their  execution  under  Frenkel's  instruction  at  the 
iSalpetriere. 

EXERCISES    FOR    THE    TRUSK    AND    LOWER    EXTRBUITIBS. 

Exercises  in  Sed. — The  patient  is  laid  on  a  bed  or  sofa,  the  legs 
bare,  the  head  raised  so  he  can  see  his  legs;  then  he  performs  the 
following  exercises: 

1.  Flexion,  extensiou,  abduction  and  adduction  of  one  foot,  then 
the  other,  then  both  together. 

2.  Movement  of  rotation  at  ankle. 

3.  Flexion  of  knee. 

4.  Flex  leg  on  abdomen  with  knee  beut. 

0.  Abduction  and  adduction  of  thigh,  knee  bent,  sole  of  foot  to 
rest  on  bed,  pelvis  immobile ;  to  be  done  in  four  stages — abduction, 
return  to  median  line;  adduction,  return  to  mediau  line. 

6.  Raise  the  leg  as  a  whole,  without  making  zigzag  movements; 
then  practice  abduction  and  adduction  and  rotation  with  the  leg  at 
tbe  hip-joiut. 

7.  The  legs  are  straightened  out  and  brought  together;  the  pa- 
tient is  then  to  raise  himself  in  bed  without  tbe  use  of  bands  and 
without  moviog  his  legs. 

Standing  Exercises, — For  these  exercises  one  should  have  a  large, 
well-lit  room  with  little  furniture,  with  a  floor  which  has  not  been 
waxed  or  covered  with  a  carpet.  The  patient  ought  to  be  lightly 
clothed.  Women  should  wear  bloomers.  At  the  beginning  of 
treatment  it  is  very  important  that  patients  should  be  able  to  see 
their  legs. 

Exercises  in  Static  EqjtHibrium. — The  patient  is  standing,  the  doe- 
tor  at  his  side.  If  the  patient  cannot  walk  he  is  to  be  supported 
by  the  aid  of  Frenkel's  belt.  If  he  can  hold  himself  erect  by  the 
aid  of  a  cane  this  is  permitted  him  in  the  outset. 

1.  Stand  immobile,  the  feet  slightly  separated,  bands  resting  at 
the  side.     Stand  in  this  position  one  or  two  minutes. 


'Archlrtidt Ktvnilogit,  K 


idb,Google 


Selections  and  Abstracts.  497 

2.  Same  exercise,  feet  closo  together. 

3.  With  the  feet  a  tittle  apart,  <3o  exercises  with  the  arms ;  raise 
them,  lower  them,  exteod  them,  etc. 

4.  Same  exercises  with  the  feet  close  together. 

5.  Benil  body  in  different  directions,  moving  head  also. 

6.  Same  exercises  with  feet  together. 

7.  3end  forward  and  straight«n  up  slowly. 

5.  Same  with  feet  together. 

9.  Bend  body  forward  and  touch  toes  with  tipa  of  fingers. 

10.  Same  with  feet  together. 

11.  Stand  OQ  toes. 

12.  Same  with  feet  together. 

13.  Stand  with  knees  hent. 

14.  Same  with  feet  together. 

15.  While  standing  with  knees  bent  exercise  arms. 

16.  Stand  on  one  leg. 

17.  While  standing  on  one  leg  bend  the  knee. 

EXERCISES  OF   LOCOMOTION. 

1.  While  erect  extend  foot  slowly  length  of  one  step;  bring 
back  foot  into  place  with  one  movement;  repeat  this,  putting  foot 
backwards.  Do  this  sideways.  For  this  exercise  it  is  well  to 
mark  on  the  floor  with  a  piece  of  chalk  just  where  the  foot  nhall 
be  placed.     Perform  these  exercises  with  both  feet. 

2.  Put  one  foot  in  front  of  the  other  in  the  same  Hue,  and  stand 
qiiietly. 

'■i.  Walk  forward  twenty  steps,  putting  the  feet  down  gently, 
and  touching  the  floor  with  the  entire  foot.  The  patient  should 
count  his  steps  aloud. 

4.  Walk  along  a  straight  line — a  broad  stripe  painted  on  the 
floor. 

6.  Walk  backwards. 

6.  Walk  sideways. 

7.  Walk  with  long  stretches. 

8.  Walk  with  knees  bent. 

9.  Walk  on  the  toes. 

10.  Walk,  at  command,  with  sudden  stop  or  change  of  direction, 

11.  Walk  with  obstacles:  pieces  of  wood  are  placed  on  the  floor 
at  equal  distances  from  one  another,  and  the  patient  should  walk 
between  them  without  displacing  them. 

12.  Get  up  from  chair  without  use  of  bands. 

13.  Sit  down  slowly  and  carefully. 

14.  Exercise  one's-self  in  going  up  and  down  stairs  without 
holding  on  to  the  banister. 


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498       The  Atlanta  Medical  and  Sdroical  JocRSAt. 

For  ataxia  of  the  upper  extremities  very  many  simple  or  com- 
plex movements  may  be  resorted  to — simple  movements  of  fingers, 
hands  and  arms,  the  ordinary  test  movements  by  which  we  com- 
monly test  for  ataxia,  etc.  As  skilled  movements  of  the  bands 
mean  much  greater  nicety  of  action  than  that  required  of  the  legs 
and  trunk,  Frenkel  has  devised  a  number  of  apparatus  for  such 
exercises.  For  instance,  balls  of  different  sizes  are  suspended 
by  strings ;  the  balls  are  set  in  motion,  and  the  patient  is  requested 
to  grasp  a  given  one  between  finger  and  thumb.  Again,  a  board 
containing  a  number  of  botes  in'  which  are  fitted  violin  keys  or 
stops  is  placed  before  the  patient.  He  is  ordered  to  remove  and 
replace  certain  specified  number  stops.  He  holds  the  band  behind 
the  bead  and  slowly  or  rapidly  executes  the  desired  movement.* 

Dana  {The  Poat-GradtuUe)  gives  the  following  exercise  for  the 
hands  and  arms: 

1.  Sit  in  front  of  a  table,  place  the  hand  upon  it,  then  elevate 
each  fiQger  as  far  as  possible.  Then,  raising  the  band  slightly, 
extend  and  then  fiex  each  finger  and  thumb  as  far  as  possible.  Do 
this  first  with  the  right  band  and  then  with  the  left.     Repeat  once. 

2.  With  the  hand  extended  on  the  table,  abduct  the  thumb,  and 
then  each  finger  separately,  as  far  as  possible.     Repeat  three  times. 

3.  Touch  with  the  end  of  the  thumb  each  finger-tip  separately 
and  exactly.  Then  touch  the  middle  of  each  phalanx  of  each  of 
the  four  fiugere  with  the  tip  of  the  thumb.     Repeat  three  times. 

4.  Place  the  hand  in  the  position  of  piano-playing,  and  elevat* 
the  thumb  and  fingcrB  in  succesBion,brIugiDg  them  down  again,  as 
in  striking  the  notes  of  the  piano.  Do  this  twenty  times  with  the 
right  hand,  and  same  with  the  left. 

6,  Sit  at  table  with  a  large  sheet  of  paper  and  pencil,  make  four 
dots  in  the  four  corners  of  the  paper  and  one  in  the  center.  Draw 
lines  from  corner  dots  to  center  dot  with  right  hand;  same  with  left. 

6.  Draw  another  set  of  lines,  parallel  to  the  first,  with  the  right 
band ;  same  with  left. 

7.  Throw  ten  pennies  upon  the  paper,  pick  them  up  and  place 
them  in  a  single  pile  with  the  right  hand ;  then  with  the  left. 
Repeat  twice. 

8.  Spread  the  pennies  about  on  the  table,  touch  each  one  ex- 
^actly  with  the  forefinger  of  right  hand;  then  with  the  forefinger 

of  left. 

9.  Place  ordinary  solitaire  board  on  the  table,  with  the  marbles 
in  the  grooves  around  the  holes.  Put  the  marbles  in  their  places 
with  right  hand;  same  with  lefl  hand.  Patient  may  with  advan- 
tage practice  the  game  for  the  purpose  of  steadying  his  band. 


°BetUnan ,  J<ntrnal  American  Medical . 


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Selections  and  Abstracts.  499 

10.  Take  ordinary  fox-aod-geese  board,  with  holes  and  pegs, 
and,  begioning  at  one  corDer,  place  the  pegs  in  the  holes,  one  after 
the  other,  using  iirst  the  right  hand,  then  the  left. 

The  physician  should  select  from  this  long  array  of  exercises 
those  most  appropriate  for  bis  case,  or  he  may  find  others  still  more 
suitable.  The  idea  is  an  exercise  at  first  performed  in  an  ataxic 
manner  is  done  over  and  over  again  until  it  is  executed  in  a  nor- 
mal, or  nearly  normal,  manner.  Usually  the  exercises  are  done  for 
a  half  hour  or  an  hour  once  or  twice  a  day,  with  rest  pauses  be- 
tween the  different  acts.  In  this,  too,  one  must  individualize. 
Bad  bedridden  cases  should  at  first  not  attempt  much,  perhaps 
exercise  a  very  little  every  hour. 

Freakel  has  his  patients  exercise  in  the  morning  in  bed.  These 
bed  exercises  he  terms  the  ab  oo(  the  coordinating  act  of  the 
lower  extremities,  and  he  permits  cases  with  light  degrees  of  ataxia 
to  omit  them  altogether.  Then  in  the  course  of  the  day  bis  pa- 
tient practices  in  sitting,  standing,  walking,  promenading,  climb- 
ing  steps,  etc.,  according  to  the  character  of  the  case. 

Frenkel  emphasizes  very  strongly  the  danger  from  over-fatigue 
in  these  cases.  It  must  be  remembered,  if  these  exercises  are 
properly  done,  the  patient  making  most  strenuous  efforts  to  do 
them  with  exact  precision,  they  tax  him  both  mentally  and  physi- 
cally. At  the  same  time  the  sense  of  fatigue  is  usually  more  or 
less  blunted  in  ataxics,  so  that  the  first  intimation  of  fetigue  or 
over-fatigue  may  be  the  increased  ataxia  which  the  undue  exertion 
baa  caused. 

For  this  reason  one  must  constantly  guard  his  patient  from  over- 
fatigue. The  exercises  should  not  be  too  prolonged  nor  such  as  are 
too  taxing  for  him.  Frenkel  is  accustomed  to  have  the  physician 
at  the  side  of  the  patient  when  he  is  exercising  in  standing  and 
walking,  so  as  to  save  him  the  added  eftort  or  strain  that  would 
accrue  if  he  were  constantly  fearing  or  trying  to  prevent  himself 
from  falling.  Then  the  patient  should  not  waste  bis  time  and 
strength  on  unnecessary  exercises,  those  that  be  already  does  easily 
and  well,  repeated  simple  muscular  contractions  not  related  to  his 
ataxia,  etc.  It  must  not  be  forgotten  that  the  exercises  are  not  for 
the  purpose  of  increasing  muscle  strength,  but  to  remove  ataxia. 

Frenkel  denounces  severely  the  use  of  ordinary  gymnastics  in 
these  cases.  He  even  warns  those  in  the  pre-ataxia  stage  of  tabes 
against  over-iatigue ;  and  advises  no  excessive  walking,  no  bicy- 
cliDg,  no  horseback  riding,  etc.  In  such  cases  Frenkel  is  also  ac- 
customed to  have  massage — muscle- kneading,  not  skin-nihbing — 
applied  to  all  his  patients  for  the  purpose  of  improving  the  muscle 
tone,  and,  possibly  lessening  the  effects  of  &tigue. 


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500       The  Atlanta  Medical  and  StJKaiCAi.  Journal. 

The  necessary  duratioa  of  treatment  varies  according  to  the  se- 
verity of  the  case,  from  a  month  or  more  for  the  light  cases  to  ax 
months  or  a  year  for  the  bad  ones.  But  the  exercises  must  be  con- 
tinued permanently  to  maintain  the  improvement.  Frentel  has 
cases  under  observation  in  which  the  improvement  or  apparent 
cure  has  already  been  of  several  years'  duration.  In  case  of  ex- 
acerbation of  the  disease  the  improvement  in  the  ataxia  gained  by 
the  treatment  is  temporarily  lost,  but  it  is  easily  regained  by  the 
same  treatment  afler  the  relapse  is  over. 

The  improvement  depends  much  on  the  temperament  and  intel- 
ligenoe  of  the  patient.  The  nervous,  restless,  those  with  little 
power  of  attention  and  weak  will  power,  often  make  little  progress. 
Occasionally  improvemeut  is  very  slow  without  any  known  cause, 
though,  as  already  mentioned,  Frenkel  thinks  that  failure,  when 
there  is  no  contraindication,  is  always  due  to  faulty  methods.  He 
says  the  latter  especially  lead  to  disappoiotment  in  those  quite  com- 
mon cases  where  a  degree  of  improvement  is  easily  and  quickly 
attained,  while  further  progress  is  always  slow,  and  only  to  be  obr 
tained  when  the  method  of  treatment  is  thoroughly  understood. 

This  treatment,  as  already  stated,  is  that  of  a  symptom,  and  has 
no  effect  whatever  upon  the  structural  disease.  But  while  it  is  in- 
tended only  for  the  relief  of  ataxia,  other  symptoms  have  some- 
times been  benefited,  notably  the  lancinating  paius  and  crises  of 
tabes.  The  spinal  myosis  and  Westphal  symptom — lost  knee 
jerks — are  unaffected  by  the  treatment. 

Frenkel  speaks  of  the  ofttimes  necessity  of  institutional  treat- 
ment, in  order  to  obtain  benefit  from  the  treatment,  or  at  least  tbe 
largest  possible  benefit.  There  is  no  doubt  that  one  who  has  bad 
Frenkel's  large  experience  in  this  treatment  is  best  prepared  to 
apply  it  to  the  individual  case,  nor  that  a  patient  in  Frenkel's  in- 
stitution who  sees  the  brilliant  results  there  obtained  would  be  so 
buoyed  up  with  hope  and  the  expectation  of  a  cure  as  to  put  new 
life  into  him  and  a  vigor  into  bis  efforts  not  otherwise  attainable. 
But  not  every  case  of  locomotor  ataxia  can  go  to  Heiden  or  Paris, 
and  there  is  no  reason  why  the  general  practitioner,  if  he  studies 
the  method  of  treatment,  and  studies  his  patient,  should  not  gain 
very  much  from  the  treatment  in  suitable  cases.  But  unless  he 
carefully  supervises  the  treatment  he  can  expect  nothing  but 
failure. 

I  shall  attempt  to  formulate  what  has  been  said  in  this  paper  in 
the  following  rules: 

1.  All  cases  should  be  benefited  by  the  exercise  treatment,  maoy 
to  the  degree  of  apparent  recovery,  unless  there  be  special  contra- 
indication to  the  treatment.     Failures  under  these  circumstances 


^dbyGoogle 


Selections  and  Abstracts.  501 

usually  meaD  faulty  methods,  or  that  the  treatraeot  has  not  been 
persevered  iu  sufEcieatly  loug. 

2.  Contraiadications  are :  Loss  of  vision,  mental  impairment, 
bone  and  joint  disease,  spasticity  and  muscular  atrophy,  the  pres- 
ence of  strong  irritation  symptoms,  rapid  progress  of  the  disease, 
a  state  of  great  exbaustibility,  and  serious  organic  disease. 

3.  In  cases  of  anemia,  poor  nutrition  and  lax  joints,  these  general 
and  local  conditions  should  be  remedied  liefore  the  treatment  is  in- 
stituted. 

4.  The  conditions  most  favorable  for  the  treatment  are,  a  sta- 
tionary, or  almost  stationary,  state  of  the  disease  ;  good  general 
health,  intelligence,  hojiefulness,  and  perseverance. 

6.  Light  cases  are  more  amenable  to  a  (practical)  cure,  but  bad, 
even  bedridden,  cases  often  give  brilliant  results. 

6.  The  necessary  duration  of  treatment  varies  from  a  month  or 
more  for  the  lightest,  to  six  months  or  a  year  for  bad  cases;  but 
the  exercises  must  be  kept  up  in  order  to  insure  the  continuance  uf 
the  improvement. 

7.  Success  of  treatment  dejiends  upon  thorough  knowledge  of 
the  method.     This  is  especially  true  of  bad  cases. 

8.  Exercise  should  be  chosen  most  suitable  to  remedy  the  ex- 
isting ataxia,  and  every  effort  should  be  made  to  do  them  with 
greatest  precision. 

9.  The  sense  of  fatigue  is  often  blunted  in  ataxics,  while  over- 
fatigue injures  tbem.  The  patient  should  therefore  be  guarded 
against  too  taxing  or  too  prolonged  exercises  or  other  unnecessary 
efiorta. 

10.  To  obtain  most  benefit  from  the  treatment  the  constant  su- 
pervision of  the  physician,  at  least  in  its  early  periods,  is  abso- 
lutely necessary. — dncinnali  Lancet-Clinic. 


The  Bearing  of  Pathological  Processes  on  the  Therapy 
OF  Morbid  Conditions  along  the  Genito- 
urinary Tract  in  tub  Male. 

Thomas  H.  Manley,  M.0.,  Professor  of  Surgery  in  the  New 
York  Clinical  School  of  Medicine,  contributes  a  paper  with  this 
title  to  The  Canadian  Medical  Journal,  June,  189S,  in  which  he 
says: 

"In  no  larger  classes  of  malitdies common  to  the  human  subject 


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502       The  Atlanta  Medical  and  Surgical  Journal. 

has  the  rate  of  progress  been  greater  in  the  diagoosis  and  treat- 
ment of  tbeiu  during  the  past  twenty-five  years  than  those  involv- 
ing the  genito-urinary  organs. 

"The  tendency  to  mutilation  and  severe  mechanical  interference 
has,  DO  doubt,  very  often  been  too  great.  In  the  management  of 
calculus  of  the  renal  pelvis,  the  ureter,  the  bladder,  or  urethra,  the 
employment  of  the  crusher  or  blade  is  yet  imperative,  but  in  tuber- 
culosis,  prostatic  diseaBe  or  cystic  inflammation,  the  tendency  now 
is  in  the  direction  of  reaction  and  less  severe  surgical  measures. 
This  is  the  attitude  of  the  ^French  school,  as  expressed  by  Guyon. 

"  Tuberculosis  of  the  urinary  tract,  or  the  kidney,  was  a  condi- 
tion but  imperfectly  understood  until  of  late  years.  But  now  we 
know  that,  exclusive  of  blennorrhagic  infection,  there  is  probably 
no  pyogenic  microbe  so  prolific  as  a  factor  in  renal  suppuration  as 
the  bacillus  of  tuberculosis.  When  a  knowledge  of  this  fact 
came  into  our  possession,  it  was  assumed  that  in  its  treatment 
the  same  principles  must  apply  as  with  the  management  of  a  tuber- 
cular lesion  elsewhere,  viz.,  by  an  early  ablation  of  the  focus  in- 
volved, even  nephrectomy,  when  the  entire  kidney  was  involved. 
But  events  have  transpired  which  have  turned  us  around,  so  to 
speak.  The  mortality  has  been  very  large  after  operations,  and, 
further,  we  bad  no  assurance  that  the  other  kidney  was  not  in- 
volved. One  might  say,  however,  that  any  oue  was  a  bungler  aod 
behind  the  times  who  did  not  determine  beyond  peradventure  by 
ureteral  catheterization  whether  one  or  both  kidneys  were  involved, 
by  pyogenic  processes. 

"It  may  be  well  to  remember,  in  this  connection,  in  spite  of 
Alberan's,  Kelly's,  or  Neisser's  cystoscopic  devices,  ureteral  cathe- 
terization in  the  male  is  impracticable  in  any  other  than  exception- 
able cases.  This  was  so  declared  at  a  late  meeting  of  Genito- 
urinary Section  of  the  Academy  of  Medicine  in  New  York.  We 
have,  further,  learned  the  salutary  lesson  that  certain  types  of  renal 
tuberculosis  are  frequently  amenable  and  curable  by  simple  and 
safe  expedients. 

"My  own  experience  has  been  that  when  renal  tuberculosis  de- 
velops, consecutive  to  pulmonary  invasion,  the  progress  of  the  dis- 
ease toward  death  is  rapid.  On  the  contrary,  when  the  disease  is 
unilateral  or  ascending,  appropriate  treatment  is  rewarded  by  grat- 
ifying results. 

"In  the  beginning  it  may  be  well  to  bear  in  mind  that  when 
tubercular  destruction  seizes  on  any  epithelial  structure  its  behavior 
is  quite  the  same  after  the  stages  of  vascular  stasis  and  inflammation, 
suppuration  and  ulceration  set  in.  Now,  iu  the  lung,  while  the 
vomica  is  forming  and  the  residual  putrid  elements  of  inflammation 


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Selections  and  AbstbacTS.  503 

and  decotupositioD  are  accuiDulatiog^  th«  coostitational  disturbaDcee 
and  local  distress  are  very  great;  but  let  them  burst  icto  a  bronchus 
or  out  through  the  chest  walls,  immediate  relief  follows.  The  oavity 
again  filling  without  a  free  escape  of  its  contents,  we  have  reinfec- 
tion and  great  misery;  not  from  local  affection  so  much  as  from 
misery  incurred  through  ao  ascending  infection  of  the  bronchi, 
the  tracheal  and  laryngeal  mucous  membrane.  In  luug  affections 
an  insurmountable  difficulty  comes  through  the  carrying  away  in- 
fected products,  as  we  cannot  drain  up-hill,  gravity  being  against  us. 
In  renal  tuberculosis,  on  the  contrary,  the  advantage  of  gravity  is 
with  ua;  and  more,  once  the  abscess  opens  into  a  urioiferous  tubule, 
an  incessant  stream  of  fluid  is  carrying  downward  and  out  of  the 
body  it*  contents. 

"The  attitude  of  the  body,  then,  is  &  most  helpful  aid  in  renal 
drainage.  Trouble  comes  here,  nevertheless,  as  with  the '  pulmo- 
nary organs,  from  stasis  and  stenosis. 

"  When  the  purulent  discharge  from  the  kidneys  consists  of  a 
mixed  infection  with  a  predominance  of  the  streptococcus,  the  mu- 
cous membrane  ot  the  prostate,  the  ureter  or  the  bladder  becomes 
involved;  (or  some  unknown  reason  the  urethral  mucous  mem- 
brane escapes.  The  mucous  membrane  becomes  infiltrated  and 
thickened,  ulcerated  or  destroyed  in  severe  cases.  When  the  cys- 
tic mucous  membrane  is  iuvolved,  inflammatory  hyperplasia  ex- 
tends into  and  through  the  muscular  walls,  with  the  result  that  the 
bladder  discharges  the  urine  incompletely.  A  residual  quantity 
remains,  decomposition  and  ammoniacal  reaction  begins,  the  puru- 
lent drip  from  the  ureter  now  undergoing  a  mucoid  ropy  transfor- 
mation, a  condition  always  resulting  from  the  action  of  alkali  on 
pus. 

"  When  this  stage  is  reached  the  miseries  and  woes  of  the  af- 
flicted are  great.  The  racking,  harassing  cough  of  tubercular 
bronchitis  is  trying  enough,  but  the  torturing  tenesmus  and  stran- 
gury of  cystic  tuberculosis  is  a  most  agonizing  state. 

"Happily,  in  the  great  majority  of  cases,  local  and  constitutional 
treatment  will  yield  surprising  results,  and,  in  most  cases,  dispense 
with  the  need  of  radical  surgery. 

Proslalie  Lesiona. — The  prostate  is  an  organ  of  whose  existence 
we  are  quite  unconscious  until  it  makes  its  way  into  the  bladder, 
gives  off  an  outgrowth  from  its  isthmus,  and  blocks  up  the  urethra. 

"  About  midage  it  is  prone  to  begin  hypertrophic  changes,  alter 
its  position  and  undei^  neoplastic  mutations.  These  pathological 
changes  in  themselves  are  entirely  innocuous,  and  only  become  a 
source  of  trouble  wheu  they  invade  the  bladder ;  and  this  they  often 
do  to  such  an  degree  as  to  make  advanced  age  miserable. 


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504       The  Atlanta  Medical  and  Surgical  Journal. 

"Besides,  they  are  not  infrequeDtly  the  cause  of  death,  through 
retrograde  changes,  ext^ndiag  up  the  ureters  into  the  kidoeys. 

"Our  hopes  of  successfully  dealing  with  the  prostate  by  radical 
measures  have  been  most  disappointing.  Prostatectomy,  perineal 
or  suprapubic,  is  full  of  peril,  but  few  surviving  the  operation. 
Castration  is  a  procedure  of  questionable  propriety,  if  catheter-life 
is  possible.  Fortunately,  as  with  reuai  tuberculosis,  very  much 
can  be  accomplished  in  these  cases  by  simple  measures. 

"Let  us  not  overlook  the  fact  that  in  a  large  number  the  en- 
lai^meut  is  not  neoplastic  at  all,  but  simply  a  vascular  turges- 
cence,  with  probably  an  admixture  of  inflammatory  deposits;  or, 
in  other  words,  that  the  condition  is  transient,  and  not  that  it  is  a 
catwe  of  vesical  implication,  but  that  it  is  a  sequence  of  morbid 
conditions  within  the  blat^der  itself.  The  urinary  stasis  or  pro- 
static enlargement,  under  many  circumstances,  is  dependent  upoD 
a  more  complex  pathology  than  is  generally  supposed,  and  we  have 
reason  to  believe  that  the  initial  factors  are  veswcU. 

"At  the  stage  of  life  when  this  begins,  inertia  of  both  smooth 
and  stripped  muscles  commences. 

"  The  general  atheroma  of  interstitial  vascular  changes  which 
impair  the  uutrition  of  the  alimentary  canal  also  begin  to  tell  on 
the  walls  ef  the  bladder.  The  organ  fails  to  completely  contract  or 
expel  its  contents,  and  hence  residual  urine  remains.  Pavy  found 
that  transient  glycosuria  is  not  uncommon  in  those  past  middle 
life.  Here  we  have  a  change  in  the  composition  of  the  urine,  with 
the  necessary  ferment  to  stir  into  activity  changes  of  decomposi- 
tion and  bacterial  action. 

"Cystitis  begins,  and  the  infection  is  promptly  propagated  into 
the  collar  of  glandular  tissue  which  is  essentially  an  integral  part 
of  the  bladder. 

"  From  the  foregoing  it  is  therefore  apparent  that  if  we  would 
relieve  the  prostate  we  must  begin  with  the  urethra  and  the  blad- 
der; for  in  all  these  cases  there  is  invariably  a  coincident  deep  ure- 
thritis. 

"First,  washing,  irrigating. 

"The  passage  oj>ened,  we  irrigate,  first  with  an  abundance  of 
medicated  solution;  the  carboUzed  being  the  most  valuable. 

"  The  morphological  elements  of  the  urine  from  day  to  day  will 
tell  us  how  the  ease  is  progressing.  And  when  the  urine  has 
cleared  up  and  inflammation  has  ceased,  a  cure  is  eEFected  which  is 
often  permanent.  In  some  cases,  however,  the  arti6cial  drain 
must  be  employed,  and  catheterization  contiuued  indefinitely." — 
Medical  Review  of  Reviana, 


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ATLANTA 

Medical  and  Surgical  Journal. 


OCTOBER,  1898. 


DUNBAR  ROY,  A.B.,  M.D., 


ORIGINAL  COMMUNICATIONS. 


TUBERCULOSIS  OF  BONES  AND  JOINTS.* 

By  FLOYD  W.  McRAE,  M.D.,  Atlanta,  Ga. 
ProfesBor  of  Gastro-Inteetinal,  Rectal  and  Clinical  Surgery  Atlanta  College  of 
Ph/eiciane  and  Surgeon e  ;  Elected  to  deliver  Address  on  Surfcery  before 
AmeTican  Medical  Aasociation,  1899;  Ei-Secretary  Section  on  Surgery 
and  Anatomy  of  American  Medical  A«eociation;   Es-V ice- President 
Southern   Surgical   and  Uynecological  Association  and  Tri-State 
Medical  Association  of  Georgia.  Alabnma  nnd  Tennessee;  Ex- 
Secretary  and  President  Atlanta  Society  of  Medicine. 

I  shall  only  briefly  review  some  of  the  most  important  foots 
beariog  upon  this  very  ioleresting  elasa  of  diseases. 

For  centuries  these  chronio  inflaDimatory  conditions  of  bones 
4ind  joints  have  been  recognized  as  local  manifestations  of  aconsti- 
4utionsl  condition.  There  are  a  few  very  able  surgeons  who  are  of 
the  opinion  that  injuries  to  the  bones  and  joints  are  a  predisposing 
«ause.  I  shall  not  attempt  (o  discuss  the  difference  between  slru- 
■mous  and  tubercular  bone  diseases,  because,  in  my  opinion,  they 
*re  the  ^me.  I  shall  briefly  submit  for  your  consideratiou  some 
■of  the  reasons  which  convince  me  of  the  tuberculous  character  of 

■K(adlieloraAUaitUSo«I«lTatH«dlcln«.   (SnblectHlecUdtijFTeifdent.) 


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506       The  Atlanta  Medical  asd  Scrgical  Joprmal. 

these  aSectioDs.  la  doing  so  I  shall  follow  Seuo's  work  on  "Tu- 
berculosis of  BoDes  and  Joints." 

There  are  quite  a  number  of  cases  on  record  which  show  clearly 
that  these  conditions  have  been  the  result  of  direct  infection,  and 
the  following  case  reported  by  Verneuil,  of  a  "student  who  injured 
the  fold  of  the  nail  of  his  right  finger  at  a  post-mortem,  with  the- 
result  of  causing  a  local  tuberculosis  of  the  skin.  This  was  treated 
in  various  v/a.ys  without  permanent  improvement,  and  after  treat- 
ment of  three  years  there  was  still  a  tubercular  ulcer  on  the  finger 
and  abscess  on  the  back  of  the  hand.  This  abscess  was  opened 
and  the  ring  finger  was  amputated,  but  chronic  abscesses  continued 
to  form,  and  the  patient  died  six  years  after  the  injury  of  spinal 
meniDgitis,  due  to  suppuration  in  conuection  with  tubercular  dis- 
ease of  tbe  vertebra."     (Senn.) 

The  numerous  cases  of  inoeuiation  reported  by  various  observers^ 
— Tbe  inoculations  are  almost  uniformly  productive  of  either 
general  or  local  tuberculosis,  according  to  the  amount  of  the  ma- 
terial used  and  the  point  of  inoculation.  It  seeuis  to  make  very  little 
difference  whether  tubercle  bacilli  are  injected  directly,  granulation 
tissue  implanted,  or  other  tuberculous  material  used,  there  is  un- 
doubtedly a  direct  relationship  existing  between  tbe  amount  of  in- 
fection and  the  severity  of  tbe  disease.  Animals  receiving  a  large 
number  of  bacilli  directly  iu  tbe  circulation  soon  die  of  general 
miliary  tuberculosis,  while  a  small  amount  of  tubercular  matter 
embedded  in  tbe  tissues  produces,  primarily,  local  manifestations, 
with  subsequent  general  infection.  It  is  further  shown  by  these 
experiments  that  it  is  necessary  to  inject  a  definite  amount  of  tu- 
berculous matter  in  order  to  produce  any  reaction  at  all. 

Sone  and  joint  tuberculosis  have  been  produced  in  the  lower  animaU 
by  direct  inoculation. — "Stuttgart,  in  1880,  studied  tbe  localiEa- 
tion  uf  the  tubercular  virus  experimentally  in  tbe  same  manner  as 
others  have  studied  the  localization  of  pus  microbes.  He  inocu- 
lated animals  with  the  products  of  tubercular  inflammation;  sub- 
sequently produced  contusions  and  sprains  of  joints,  and  observed 
that  localization  usually  occurred  at  the  seat  of  the  injury.  If  the 
tuberculous  virus  was  introduced  by  inhalation,  the  same  typical 
leuious  occurred  in  the  injured  joint  as  when   injection  was  made 


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TUBERCDLOSIS    OF    BoNES    AND    JoiKTS.  507 

more  directly.  In  all  cases  the  products  of  the  local  lesion  cor- 
respond with  the  character  of  the  material  iotroduced  through 
some  remote  poiat."     (Senn.) 

The  frequent  association  of  bone  and  Joint  Ivhefculosisvntk  tuber- 
cvioitis  of  other  organs. — "Billroth  and  Meozel  found,  on  search- 
ing the  post-mortem  records  at  Vienna  for  a  period  of  fifty  years 
(1817  to  1867),  that  there  had  been  20,106  cases  of  caries  of  bones 
and  Joints,  and  of  these  more  than  half  were  complicated  with  tu- 
berculosis of  the  internal  organs.  Neumeister  has  collected  438 
cases  from  the  Wurzburg  Clinic  and  other  sources,  with  60,  or  15 
per  cent.,  of  deaths  from  acute  tuberculosis.  Willemer  had  ascer- 
tained from  some  statistics  which  be  collected  and  studied,  that,  in 
case  of  chronic  affection  of  the  knee-joint,  one  per  cent,  of  the 
patients  die  of  tuberculosis  during  the  first  year  of  the  disease, 
seven  per  cent,  during  the  second,  six  per  cent,  during  the  third, 
making  a  mortality  of  fourteen  per  cent,  from  acute  Luberculosis 
within  three  years. 

"Konig  states  that  in  only  21  per  cent,  of  all  cases  of  joint  tu- 
berculosis is  the  disease  confined  to  the  joints."     (Sena.) 

The  microaaofical  structure  of  the  diseased  tissue  and  the  caseation 
of  the  injtammaiory  products. — The  most  careful  observers  report 
series  after  series  of  cases  where  they  have  not  failed  in  a  single 
instance  to  find  tubercle  bacilli,  though  the  search  is  frequently 
tedious  and  long  before  they  are  discovered.  Bacilli  are  found 
in  the  pus,  in  the  caseous  material,  in  the  granulation  tissue,  etc. 

Another  proof  which  Senn  presents  is  the  reaction  to  tuberculin. 
There  area  few  interestinj;  pathological  facts  to  which  I  wish  to 
call  your  attention.  One  of  the  most  interesting  and  important 
to  a  thorough  understanding  of  the  subject  is  the'scant  blood  sup- 
ply of  the  tuberculous  nodule.  Whether  the  beginning  of  the 
process  is  in  the  blood  or  in  the  connective  tissue,  there  is,  sooner 
or  later,  a  complete  destruction  of  the  blood-vessels  in  the  affected 
area.  When  the  point  of  infection  is  within  a  blood-vessel  there  is 
immediate  anemia,  the  result  of  a  tubercular  thrombus  in  the  vec- 
set.  Where  the  infection  occurs  outside  of  the  vessel,  granulation 
tissne  forms,  and  there  is  a  gradual  growth  of  the  tubercular  nodule, 
separating  the  vessels  and  finally  so  compressing  them  as  to  corn- 


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608       The  Atlanta  Medical  and  Sdroical  Journal. 

■pletely  shut  off  the  circulation  through  them.  This  accounts  for 
'the  production  of  the  "wedge-shaped  sequestra"  so  frequently  ob- 
iserved  in  the  extremities  of  long  bones.  The  tubercular  nodules 
enlarge  by  the  development  of  granulation  tissue.  The  tubercle 
bacillus  attacks  more  frequeulty  connective  tissue  thau  any  other 
structure,  though  its  ravages  are  not  confined  by  any  means  to  con- 
nective tissue. 

One  of  the  most  interesting  manifestations  of  the  tubercular  pro- 
cess is  caseation,a  condition  which  is  not  well  understood  by  patholo- 
gists, but  which  ^eems  to  follow  coagulative  necrosis  resulting  from 
tubercular  inflammation.  Very  frequently  small  masses  of  caseous 
material  are  found  which  have  existed  for  years  without  producing 
either  local  or  general  symptoms,  and  not  infrequently  bone  and 
joint  lesions  seem  to  have  had  tbeir  origin  in  these  caseous  masses. 
Tubercle  bacilli  may  remain  for  years  embedded  in  this  caseous 
material  without  producing  symptoms.  When,  however,  as  a  re- 
sult of  injury  or  diminished  resistance  of  the  surrounding  tissue 
from  any  cause,  there  is  liquefaction  of  this  material,  the  bacilli 
are  taken  up  by  the  absorbents  and  transported  to  more  or  less 
distant  points. 

The  tubercular  abscess,  or  cold  abscess,  as  it  is  called,  contains 
a  kind  of  emulsion  composed  of  liquefied  tubercular  material,  and  is 
never  actively  inflammatory,  unless  infected  with  either  streptococci 
or  staphylococci.  A  comprehensive  review  of  the  various  mani- 
festations of  tubercular  ostitis,  properly  osteomyelitis,  would  be 
interesting  had  we  sufficient  time  at  our  disposal.  Though  these 
conditions  are  the  result  of  a  general  dyscrasia,  traumatism  is  often 
the  exciting  cause.  The  trauma  simply  diminishes  local  resistance, 
and  there  develops  a  local  tuberculosis,  though  the  point  of  en- 
trance of  the  bacilli  may  have  been  either  the  lungs  or  the  ali- 
mentary canal.  The  bacilli  circulated  harmlessly  through  the 
system  until  a  point  of  diminished  resistance  was  reached. 

The  diagnosis  of  tubercular  bone  disease  is  difficult  in  obscure 
cases.  Fain  is  always  present  in  tuberculous  joints,  though  usually 
not  acute.  The' pain  is  not  infrequently  reflected  to  a  more  or  leas 
distant  point.  For  instance,  pain  in  the  knee  in  diseases  of  the 
hip-joint,  or   persistent   pain    in   the   chest  or  abdomen  in  dis- 


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Tdbsrculosib  op  the  Bones  and  Joints.  609 

eases  of  the  vertebra-  There  is  always  a  point  of  ertreme  tender- 
ness corresponding  to  the  carious  point  in  the  bone.  Swelling  is 
more  or  less  marked,  though  sometimes  only  slight.  There  is 
never  redness  or  discoloration  of  the  skin,  unless  there  is  mixed 
infection  with  abscess  formation,  or  the  skin  is  involved  in  (he 
tuberculous  process.     Muscular  atrophy  is  marked. 

The  prognosis  in  these  cases  of  bone  and  joint  disease  is,  in  the 
majority  of  instances,  favorable,  provided  patients  are  seen  early 
and  can  be  controlled  and  given  proper  treatment.  The  treatment 
is  both  local  and  general.  Every  effort  should  be  made  to  bring 
about  a  general  improvement  in  the  health:  tonics,  cod-liver  oil, 
nutritious  diet,  sunshine,  exercise  in  the  open  air,  and  every  agency 
which  tends  to  the  upbuilding  of  the  general  health,  are  of  value  in 
the  treatment  of  these  affections.  I  shall,  however,  in  this  paper  de- 
vote my  remarks  to  local  treatment,  as  the  subject  of  general  treat- 
ment has  recently  been  gone  over  very  thoroughly  by  one  of  my 
colleagues  before  this  society.  The  local  measures  which  may  be 
employed  are  numerous,  and  possess  more  or  less  value  according 
to  existing  conditions.  Of  first  importance  in  all  cases  is  the  great 
principle  of  rest.  This  may  be  brought  about  by  the  numerous 
mechanical  devices  which  are  employed,  or  by  putting  patient  to 
bed  and  enjoining  strict  recumbency.  Where  rest  to  the  inflamed 
booQ  or  joint  can  be  procured,  and  the  patient  be  allowed  at  the 
same  time  free  exercise  in  tbe  open  air,  the  best  results  are  to  be 
expected.  When  it  is  necessary  to  put  the  patient  to  bed,  it  is  a 
delicate  question  to  decide  just  bow  long  he  or  she  shall  be  kept 
there,  and  there  is  quite  a  divergence  of  opinion  on  this  subject. 
Where  there  is  extensive  destruction  of  tissue  in  the  joint,  with  or 
without  active  inflammatory  conditions,  more  radical  measures  are 
indicated:  resection,  removal  of  sequestra,  and  amputation  even, 
are  occasionally  called  for. 

Cases  seen  early  should  be  immediately  fitted  with  proper  appa- 
ratus to  secure  rest  to  the  inflamed  joint,  and  such  general  treat- 
ment instituted  as  Indicated.  Counter-irritation,  and  especially 
tbe  actual  cautery,  gives  good  results  in  properly  selected  cases. 
This  treament  should  be  persevered  in  for  months  or  years,  as  de- 
manded.     Special   modifications  may  be   necessary  from   time  to 


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510       TuE  Atlanta  Medical  and  Suhqical  Journal. 

time,  but  the  general  plan  above  indicated  should  be  persisted  in 
until  a  cure  is  eSectedj  or  complieatiooa  arise  which  demand  more 
radical  measures.  When  there  is  marked  accumulation  of  fluid  io 
a  joint,  or  a  lai^e  cold  abscess  has  formed,  the  fluid  should  be 
drawD  off,  the  cavity  washed  out  carefully  with  boric  acid  or  other 
mild  antiseptic  solution,  and  a  ten  per  cent,  emulsion  of  iodoform 
and  glycerin  or  olive-oil  injected  and  allowed  to  remain.  This 
operation  should  be  done  under  the  strictest  antiseptic  precautions. 

Infection  with  streptococci  or  staphylococci  converts  a  cold 
abscess  into  a  pus  cavity,  and  adds  to  a  tubercular  joint  the  dan- 
gers of  an  acute  suppurative  inflammation.  After  infection  with 
either  streptococci  or  staphylococci,  with  subsequent  suppuratiooi 
free  incision,  careful  cleansing  and  free  drainage  must  be  resorted 
to  or  serious  results  soon  follow.  In  advanced  cases  resections  of 
joints  are  frequently  called  for  and  amputations  are  sometimes  nec- 
essary iu  order  to  save  the  life  of  the  patient.  Where  there  is 
carious  bone  outside  of  joints,  it  should  be  removed  whether  the 
amount  be  large  or  small.  Extensive  destruction  can  often  be 
prevented  by  prompt  incision  through  all  the  soft  parts,  including 
the  periosteum.  All  sequestra  should  be  removed,  but  healthy 
bone  and  periosteum  should  be  preserved. 

I  have  several  times  removed  the  whole  shaft  of  the  tibia,  leav- 
ing new  bone  and  periosteum,  with  most  excellent  results. 

All  tubercular  cavities  should  be  most  carefully  cleansed  by  cu- 
retting, wiping  and  washing,  so  as  to  insure  the  thorough  removal 
of  all  tuberculous  material.  As  the  tubercle  bacilli  are  found  in 
the  granulation  tissue,  it  also  should  be  removed. 

The  final  success  of  the  operation  will  depend  upon  the  thorough- 
ness with  which  these  measures  have  been  carried  out  and  the  gen- 
eral condition  of  the  patient. 

63i  WhUekaUSt. 


Corsets  Prohibited. — The  Russian  Minister  of  Public  In- 
struction has  issued  a  decree,  prohibiting  the  use  of  corsets  by 
women. — Ex. 


^dbyGoOgle 


Articulations  of  the  Shoulder. 


A  FEW  BRIEF  OBSERVATIONS  ON  THE  PATHOLOGY 

OF    THE    TRIPLE   ARTICULATIONS  OF   THE 

SHOULDER. 

By  THOMAS  H.  MANLEY,  M.D., 
Niw  York. 

The  morbid  chaugeg  succeediug  the  application  of  violence,  or 
coincident  with  dieeased  conditions  of  the  shoulder,  bave  always 
been  a  subject  of  great  interest,  especially  since  Obareot,  Duchenne 
and  others  have  demonstrated  that  when  the  heads  of  the  bones 
or  the  articulations  are  involved  the  etiological  iactors  in  operation 
may  be  of  central  origin.  But  it  will  be  my  purpose  in  the  jtreseot 
instance  to  very  briefly  review  a  lew  only  of  the  more  salient  fea- 
tures noted  in  connection  with  the  ordinary  lesions  centered  in  the 
alar  appendages  or  tbe  shoulder,  after  injuries. 

Stricture. — Tbe  shoulder  is  made  up  of  the  bones  for  a  frame- 
vork,  the  clavicle,  scapula  and  humerus.  Tfie  coUar-bone  is  a  hor- 
izontal, lateral  girder,  which  serves  tbe  purpose  only  of  imparting 
squareness  and  contour  to  tbe  shoulder.  It  is  necessary  neither  for 
agility  nor  strength;  in  fact,  it  is  an  impediment  to  both,  as  tbe 
fleetest,  most  powerful,  or  climbing  quadrupeds  are  without  it. 
ITie  seapiiia,  or  shoulder-blade,  is  an  osseous  plate  with  a  series  of 
surfaces,  borders  and  spurs  of  bone.  It  serves  as  a  base  of  support 
and  fulcrum  to  tbe  humerus.  The  humerus  has  two  heads,  an  intra- 
capsular and  fx/ra- capsular,  with  two  necks,  an  anatomical  and 
sut^ical. 

The  shoulder  has  three  articulations,  all  anatomically  atypical. 
First,  tbe  costo-scapular,  capable  of  permitting  a  wide  range  of  mo- 
tion; second,  the  scapulo-clavicular,  a  double-joint  of  very  limited 
motion;  third,  the  bumero-scapular,  quite  identical  with  the  costo- 
scapular  articulation,  in  being  devoid  of  ligameuts  and  solely  sup- 
ported by  muscles,  although  this  has  a  large,  strong  capsule.  It  ia 
therefore  absurd  and  misleading  to  speak  of  "the  shoulder-joint," 
ibr  there  is  no  such  structure,  but  rather  " shoalAer-joints." 

Nerves. — The  powerful  nerve-cords  coming  down  to  supply  the 


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612       The  Atlanta  Mbdical  amd  SuaoiCAL  Journal. 

upper  extremity  have  a  large  proportion  of  fibrous  tissue  in  their 
composition,  and  hence  tend  to  serve  as  ligaments  in  holding  the 
shoulder  up  anteriorly.  They  pass  down  under  the  clavicle  and  in 
the  axillary-space  lie  in  loose  myxomatous  tissues,  at  such  a  distance 
from  its  articulation  as  to  in  no  manner  impede  joint  action.  Next 
to  the  muscles  the  nerves  here,  are  most  exposed  to  injury  in  the 
application  of  violence. 

Vascular  Supply. — The  arterial  supply  of  the  shoulder  is  quite 
entirely  from  the  subclavian  and  axillary.  The  lai^  blood-vessels 
in  the  axillary-space  are  noticed  tu  pursue  a  somewhat  winding 
course  and  are  in  close  contact  with  the  larger  nervc'cords.  These 
vessels  iii  the  axillary-space  are  freely  movable  and  take  such  a 
course  as  to  escape  over-tension,  compression  or  laceration  in  many 
of  the  severe  forms  of  shoulder  traumatisms.  The  lower  two- 
thirds  of  the  axillary  vein,  in  its  inner  and  inferior  aspects,  is  in 
close  contact  with  the  lymph-ganglia.  Quite  the  entire  arterial 
supply  to  the  forearm  passes  down  through  the  axillary-space,  but 
the  venous  return  pours  upward  through  two  different  channels — the 
median  oepbalic  passing  up  over  the  deltoid  to  discharge  its  con- 
tents into  the  first  part  of  the  axillary  in  the  center  of  the  costo- 
coracoid  membrane,  the  basilic  coursing  up  the  arm  tu  join  the 
brachial  vena-comes  and  form  the  axillary  vein. 

The  Muscular  Structures. — The  muscles  playing  in  the  shoulder 
are  principally  of  two  kinds :  one,  large  and  powerful,  employed  in 
support  and  leverage,  as  the  trapezius,  the  deltoid  and  pectoralis 
major;  the  other  of  minor  development,  which  rather  serves  the 
purpose  of  ligaments,  as  the  subclavius,  the  lesser  pectorals,  and 
the  internal  rotators.  The  trapezius  and  deltoid,  -whiob  serve  jiow- 
erfully  retentive  as  well  as  contractile  purposes,  have  a  lai^  ad- 
mixture of  aponeurotic  struclure.  Besides  the  preceding  structures, 
bnrsee  or  larger  accessory  synovial  pouches  and  lymphatic  or- 
gans deserve  special  consideration,  the  former  in  consequence  of 
their  tendency  to  inflammatory  changes  afler  trauma,  and  the  latter 
because  of  their  invasion  in  specific  diseases. 

The  preceding  very  brief  aud  incomplete  sketch  of  the  anatom- 
ical structures  is  necessary  before  it  is  possible  to  deal  with  morbid 


^dbyGoOgle 


Articulations  of  the  Bbodldeb.  &1S 

changes.  Did  space  permit,  mucli  might  be  said  on  the  complex 
fuDctioDs  or  physiology  of  the  parts. 

With  a  structure  so  exposed  as  the  shoulder,  of  its  remarkable 
etreogth,  its  complex  mechanism  and  great  activity,  we  may  ex- 
pect to  fiad  it  the  frequent  seat  of  many  pathological  changes  after 
the  application  of  violence. 

ItemiUs  of  Violence  to  the  Shoulder. — First,  sprainB.  Sprains  of 
the  shoulder  are  as  diverse  in  their  varieties  here  as  are  the  difler- 
ent  types  of  fracture.  They  differ  not  only  in  degree,  but  in  the 
structures  involved,  and  hence  in  some  their  full  force  falls  on  the 
articulations,  in  others  on  the  periarthritio  structures;  at  one  time 
the  muscles  and  another  the  nerves,  the  bursa  or  bones,  much  de~ 
pending  on  the  quality  and  volume  of  force — on  whether  there  ha» 
been  a  contusion,  torsion  or  deep  laceration.  In  severe  forms  the 
bones  are  fissured,  the  smaller  blood-vessels  opened,  nerves  torn, 
the  muscles  lacerated  or  torn  from  their  attachments. 

The  pathological  changes  succeeding  are  inflammatory  or  non- 
in/Iammatory.  The  latter  are  always  of  more  serious  import,  as 
they  point  to  extensive  nerve  lesion. 

The  acute  changes  attendant  on  inflammatory  action  involve 
chiefly  the  connective  tissues  and  are  most  accentuated  when  the 
bursse  have  suffered  violence.  The  parts  over  the  joints  are  ecchy- 
mosed,  tumefied  and  sensitive.  Muscular  rigidity  is  marked  and 
joint  action  is  limited. 

In  severe  cases  there  has  been  an  effusion  of  blood  into  the 
muscle-spaces  and  the  osseous  parts  have  shared  in  the  damage- 
Of  late,  since  the  Roentgen  rays  have  been  employed  to  clarify 
diagnosis,  otlentimes  what  bad  been  regarded  as  simple  sprains 
have  been  found  associated  with  non-displaced  fracture.  (Bilhaut, 
Jourde,  Dr.  Ortkopccditjue,  javice  1897.) 

In  certain  cases  the  extent  of  tumefaction  immediately  following 
is  so  great  as  to  render  definite  examination  impossible  without  an 
anesthetic.  In  hysterical,  neuralgic  or  rheumatic  subjects  the  degree 
of  pain  borne  is  great  and  its  course  is  very  protracted. 

Non-inflammatory  types  of  sprain  are  generally  those  of  a  seri- 
ous character  at  the  outset.  Id  these  we  have  a  history  rather  of 
a  twist   or  violent  over-tension  of  the  parts  than  a  bruise  from 


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^14       The  Atlanta  Medical  and  Surgical  Journal. 

a  blow  or  fall.  All  the  soft  parts  have  been  evideotly  over- 
stretcbed;   there  has  been  a  conditioD  of  arthritic  ectasia. 

After  this  type  of  sprain  the  most  prooouoced  and  palpable 
signs  of  pathological  changes  are,  first,  muscular  atrophy,  a  marked, 
visible  wasting,  or  an  interstitial  soflening  sensible  to  the  touch. 
With  the  body  in  the  upright  attitude,  the  levator  muscles  yield 
and  there  is  a  marked  drooping  of  the  whole  shoulder,  which, 
however,  is  more  or  less  fitted. 

Muscular  rigidity  is  at  once  noted  when  an  attempt  is  made  to 
begin  full  joint  action.  This  condition  is  somewhat  overcome  by 
pulmonary  anesthesia;  in  some,  however,  only  slightly.  It  may 
remain  over  a  long  period.  Until  it  disappears,  restoration  of  func- 
tioD  is  impossible. 

The  most  prolific  cause  of  this  condition  is  dependent  on  mus- 
cular changes,  either  interstitial  or  peripheral,  degeneration  or  ab- 
sorption of  the  muscular  fibers,  with  a  contracted,  shortened  state 
of  the  entire  muscle. 

One  of  the  must  frequent  causes  of  muscular  rigidity  is  inter- 
muscular adhesions;  the  inflammatory  deposits,  having  undergone 
condensation,  glue  the  muscle  sheaths  together,  so  that  their  free- 
gliding  action  on  each  other  is  impeded.  These  adhesions  seri- 
ously embarrass  the  free  movement  of  the  circulatory  current,  and 
thus  iudirectly  impair  the  nutrition  of  the  aSected  limb.  It  may 
be  well  to  note,  in  passing,  that  a  similar  state  of  the  limb  may 
ensue  after  various  erratic  types  of  muscular  rheumatism,  espe- 
cially in  children,  and  be  mistaken  for  genuine  joint  disease. 

Psychical  symptoms  are  quite  invariably  present  in  those  cases 
which  pursue  a  chronic  course.  The  afflicted  are  despondent  and 
are  prone  to  believe  that  their  cases  are  incurable,  that  they  will 
become  dependents,  and  that  the  impaired  limb  may  remain  feeble; 
hence  the  impression  on  the  system  is  marked,  their  digestion  &ils, 
and  anemia  is  pronounced. 

Dishcaliona,  C&mpUte  and  Incomplete. — A  dislocation  is  s  sprain 
plus  a  displacement  of  bone. 

At  the  shoulder  we  have  lioo  typical  dislocations,  one  of  the 
humerus  and  the  other  of  the  clavicle. 


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Articulations  of  the  Shoulder. 

The  humeral  luxatious  are  quite  entirely  depeudeot  o 
damage,  the  clavicular  on  a  rendiog  of  the  ligaments. 

Id  humero-scapula  dislocations  it  is  of  fundamental 
to  remember  that  they  are  complete  aud  incomplete,  the  h 
*odds  the  most  common  and  most  manageahle.  In  thi 
muscle  is  seriously  compromised.  The  deltoid  is  overs 
paralyzed,  the  capsule  is  stretched  but  not  torn,  some 
articular  aurface  of  the  Inner  humeral  head  is  yet  in  c< 
the  glenoid  surface.  The  massive  deltoid  alone  holds  tl 
well  up  under  the  acromion  vault.  This  any  one  < 
demonstrate  on  the  cadaver.  Let  this  muscle  be  com 
vided  by  a  transverse  incision,  with  its  base  deflected  up 
at  once  the  humeral  head  leaves  the  glenoid  cavity,  pa 
over  the  root  of  the  tricepital  head  iuto  the  axilla,  or  f 
under  the  coronoid  spur. ' 

By  this  simple  procedure,  too,  the  tax  disteusile  prof 
capsule  is  readily  demonstrated.  The  tenacious,  loug  h 
biceps  offers  some  resistance  to  forwanl  advance,  but  it 
ing  structure,  which  rather  steadies  the  humeral  head  th 
positive  tension  over  it. 

In  complete  luxations  the  extent  of  damage  to  the 
tures  is  ofteu,  no  doubt,  very  considerable;  the  deep  i 
torn  from  their  attachments,  important  nerve  trunks  an 
and  the  capsule  suffers  at  times  great  damage.  Cases  ar 
in  which  the  capsule  has  been  completely  torn  from  the' 
neck,  widely  opened  or  rent  in  two. 

But,  that  it  is  always  opened  or  torn  ofi  in  complete  < 
is  certainly  not  the  case.  This  was  demonstrated  last  si 
case  brought  to  me  by  Dr.  W.  G.  Gaudineer,  of  this 
patient  was  a  child  of  six  years.  He  had  a  complete 
the  humerus  for  three  months.  The  bead  made  exten 
sions  forward  under  the  clavicle  and  down  into  the  a 
.pletely  out  of  the  cavity;  yet  on  dissection  the  capsule 
entirely  intact. 

In  these  dislocations,  besides  the  great  damage  to  I 
and  nerve  branches,  the  three  great  nerve-cords  may  su 
■or  irreparable  injury.     The  brachial  plexus  may  be  viidi 


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516       The  Atlanta  Medical  and  Surgical  Jourhal. 

stretched,  contused  or  ruptured.  But,  as  Derve-tisBue  posseaees  a 
luoat  remarkable  resistance  to  trauma  aud  its  recuperative  property 
is  marvelous,  ve  are  not  able  to  precisely  demonstrate  at  the  time 
of  injury,  or  later,  just  how  far  this  participation  of  nerve  injury 
proceeds. 

Striped  muscular  tissue  is  not  prone  to  inflammation,  but  when 
it  develops  in  consequence  of  physical  violence  it  pursues  a  chronic- 
course.  Therefore,  as  the  muscles  almost  alone  bear  the  brunt  of 
all  types  of  humero-scapula  luxations,  we  may  expect  to  find  any 
degree  and  variety  of  pathologic  changes  in  their  substance.  For 
weeks  and  months,  sometimes  indefinitely,  after  injury  they  remaia 
weak,  painful  and  wasted,  and  hence  the  joint  never  quite  fully 
recovers  it£  function.  With  the  deltoid  ruptured,  permanent,  com- 
plete reduction  of  the  humeral  bead  is  impossible.  The  counter- 
acting muscles,  preserving  their  integrity,  keep  up  a  pull  with 
nothing  to  resist  them.  In  vain  violent  and  repeated  efTorts  at  re- 
duction are  made;  but  instantly  on  releasing  force  the  glenoid  hol- 
low is  found  empty.  Sometimes,  under  these  circumstances,  it  is. 
said  that  the  humeral  head  has  "  button-holed  "  through  the  cap- 
sule, but  I  have  been  unable  to  gather  from  the  recorded  cases  of 
arthrotomy  for  dislocation  of  the  humerus  any  such  an  anatomical 
conditiou.  It  has  been  my  privilege  to  witness  five  arthrotomies 
by  various  surgeons  in  America  aud  Europe  for  irreducible  humero- 
scapula  dislocations,  but  in  none  was  there  any  button-holing  of 
the  capsule. 

The  pathological  conditions  consecutive  to  humero-scapula  dis- 
locations are  manifold  and  depend  upon  two  factors,  the  results  of 
the  trauma  and  constitutional  states.  From  trauma  may  result  ar- 
thritis, periarthritic  inflammation,  ostitis  and  periostitis,  muscular 
atrophy,  paralysis  and  vascular  changes. 

Gmsfilulional  Ivfluence  as  a  Complicating  Factor. — In  all  severe- 
joint  injuries,  whether  attended  with  luxations,  fractures  or  not, 
the  constitutional  state  plays  an  important  rdle;  constitutional  or 
acquired  tendencies  and  the  various  cachexias  may  leave  tbeir  im- 
press here. 

lu  some  instances  it  is  most  extraordinary  to  note  the  wide- 
spread coDBtitutional  disturbances  which  may  succeed   these  trau- 


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Articulations  of  thb  Shoulder.  517 

matisms;  the  profouDd  impression  on  the  seDsonum  and  on  the 
whole  spinal  system  of  nerves,  the  extreme  degree  of 
tioo  provoked,  the  marked  rigidity,  ancfaylosis  or  esten 
phic  wasting  of  the  limb. 

That  vague,  protean,  obscure  state  of  the  system  knov 
teria  here,  exercises  a  most  potent  influence.  Rheumati 
next.  In  every  instance  presenting  intense  reaction,  rui 
a  chronic  state,  it  is  well  not  to  overlook  the  possibility 
dent  gonorrhea,  the  tubercular  diathesis  or  specific  taint. 

The  Disorganization  of  Structure. — Bearing  in  mind 
are  clinically  two  types  of  humero-scapula  dislocations, 
plele  and  the  incomplete — and  this  is  essentially  peculiar  1 
tioua  at  this  articulation — we  may  expect  a  very  wide  dil 
the  degree  and  character  of  physical  disorganization  sust 

In  incomplete  dislncations  here  the  primary,  domina 
logical  feature  present  is  an  over-tension  of  the  deltoi 
with  probahle  rupture  of  many  fasciculi  rn  its  vertical  or 
segment.  The  capsule  is  yet  completely  intact,  and  thi 
bead  has  not  moved  entirely  out  of  its  socket.  The  great  m 
have  been  overstretched,  but  none  of  their  important  pot 
been  t^ra  off.  The  bursee  have  all  suffered  compressior 
periartbritic  structures  have  sustained  contusion. 

The  consecutive  changes  in  this  subluxation  are  first 
im-y  and  secondly  atrophic. 

The  inflamed,  overstrained  deltoid  has  become  relax 
lows  the  head  of  the  humerus  to  roll  forward  or  downwi 
the  hollow  of  the  glenoid  cavity.  This  tendency  to  disph 
augmented  by  a  free  effusion  of  sero-sanguinous  fluid  iato 
vial  sac. 

With  a  proper  appreciation  of  these  conditioDS,  it  is  i 
parent  why  our  efforts  at  complete  restoration  are  futile  i 
fnl,  when  the  state  of  the  surface  points  to  a  lai^  synovi 
-of  either  a  sanguioous  or  serous  substance.  Superadded 
a  multiple  neuritis  and  trophic  changes  involving,  in  \ 
^rees,  the  muscular  components  of  this  joint. 

In  complete  humero-scapula  luxations,  superadded  to 


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518       The  Atlanta  Medical  and  Sdrgical  Journal. 

of  Biirain  aud  to  the  violeot  over-teDsioD  of  subluxation,  are  th& 
extensive  laceratioD  of  parts  vital  to  the  integrity  of  the  joint. 

It  is  true,  as  was  detnonst rated  in  a  case  of  my  own  last  sum- 
mer, that  we  may  have  esteusive  excursions  oi  the  head  of  the 
humerus,  far  away  from  the  glenoid  cavity,  without  (he  capsule 
giving  way;  but,  from  the  few  cases  on  record  permitting  of  dissec- 
tion early  aiter  the  accident,  it  is  clearly  demonstrated  that  in  most 
instances  of  complete  dislocation  the  capsule  is  opened  and  the 
head  passes  through  it,  or  the  capsule  is  torn  off,  partly  or  com- 
pletely, either  at  the  anatomical  neck  or  at  the  border  of  the  glen- 
oid fossa.  In  this  event,  when  the  humeral  head  is  driven  far 
forward  across  the  coracoid  arch,  the  long  head  of  the  biceps  is  torn 
off,  some  part  of  the  tendon  of  the  subscapularis  has  sundered,  and 
it  is  impossible  that  the  musculo-spiral  and  circumflex  nerves  can 
escape  serious  damage.  I  can  find  no  case  on  record  where  the 
blood  trunks  have  been  seriously  compromised  hy  a  dislocation 
here,  though  the  number  is  large  of  the  recorded  cases  in  which 
they  have  suffered  various  degrees  of  disoi^nization  and  destruc- 
tion in  violent  efforts  at  reduction. 

DislooalionB  at  tJie  scapulo-clamcutar  joint  involve  no  important 
structures  except  the  ligaments,  and  hence  the  pathological  state- 
resulting  is  devoid  of  those  features  dominant  in  other  dislocations. 
Although  the  acromion  end  of  the  clavicle  is  restricted  in  its  up- 
ward range  of  action,  it  may  be  said  that  its  fixed  position  depends 
quite  exclusively  on  ligaments.  When  the  acromion  head  of  the 
clavicle  is  completely  displaced  its  duplex  capsule  is  quite  com- 
pletely disorganized,  and  therefore  the  rotary  movement  of  the 
shoulder  on  the  central  plane  of  the  body  is  greatly  diminished,  it 
not  entirely  lost. 

This  type  of  dislocation  derives  its  greatest  interest  from  the 
great  tendency  to  overlook  it,  especially  in  fat  subjects,  on  asuper^ 
ficial  examination;  and  besides,  because  when  of  an  aggravated 
character  it  cannot  be  so  treated  as  to  effect  complete  and  perma- 
nent reduction. 

Dislocation  or  displacement  of  the  shoulder  en  masse  is -never 
!<eeii,  though  partial  displacements  are  not  infrequent.  They  are 
of  three  kinds:  First,  and  mostcoiunion,  those  seen  after  any  severe 


^dbyGoogle 


Articdlations  of  the  Shoulder. 

injury  of  the  shoulder,  when  it  droops  downward  and  sii 
ward  and  inward;  second,  when  the  lower  angle  of  the 
projects  outward  from  a  displacement  of  the  latissimus-dor 
cles;  third,  after  operations,  those  for  mammary  cancers,  wb 
tail  the  excision  of  the  pectoral  muscles  and  costo-coracoic 
when  the  e<]uipoi6e  of  the  shoulder  is  lost  and  it  is  drawc 
ward  by  the  aerratus-magnus,  rhomboid  and  levator  of  the 
muscles. 

When,  from  any  cause,  the  nerve-supply  of  the  parts 
volved  by  disease,  in  rheumatic  or  other  process  of  inflam 
seizing  on  and  inducing  trophic  changes  in  the  muscles,  i 
deviations  in  the  position  of  the  shoulder  are  noticed. 

SUMMARY. 

Sprains,  twists,  contusions  and  dislocations  at  the  should 
atitute  the  most  important  class  of  traumatisms  that  we  arc 
upon  to  treat  in  the  upper  extremity. 

In  aggravated  form  the  whole  system  suffers  violent  distu 
strength  and  functions  are  impaired,  and  permanent  ' 
changes  may  succeed. 

In  consequence  of  the  mechanical  construction  of  the  si 
and  its  triple-jointed  arrangement,  limitation  in  range  of  at 
any  one  articulatiou  is,  in  varying  degrees,  compensated  1 
hence  but  moderate  deformity  or  physioal  impediment  permi 
results. 

The  shoulder  being  a  structure  in  close  relation  to  the  e« 
circulation,  with  an  abundant  vascular  supply,  in  the  abi; 
pathological  conditions  of  a  constitutional  origin,  is  genera 
ceptible  to  prompt  reparative  proceasea. 

Being  an  appendage  of  the  body  in  an  exposed,  indep 
suspended  position,  it  is  susceptible  to  a  rigorous  esaminati 
the  application  of  direct  and  energetic  treatmeut. 

The  principal  pathological  conditions  calling  for  remed 
after  the  injuries  enumerated  depend  on,  first,  and  the  pre] 
ance  of  cases,  damage  to  the  muscles,  contusion,  over-ten: 
laceration;  second,  neural,  or  injury  to  the  nerves,  the  moti 
Bory,  or  trophic;  third,  the  arthritic  structures;  fourth,  the 


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520       The  Atlanta  Medical  amd  Surgical  Journal. 

structures,  tbe  periosteum  uii<ler  the  attacbmeut  of  the  muscles  or 
teudnns,  or  the  vsQcular  cancellus  structures  which  constitute  the 
■articular  eur&ces;  fifth,  iojury  of  the  burste,  with  or  without  a 
propagation  of  inflammatory  changes  into  the  articulations;  sixth, 
a  traumatic  arthritis — a  uecessary  part  of  every  dislocation — the 
coincident  association  of  pycbical  manifestations  is  important  to 
note  under  many  circumstances;  seventh,  in  order  that  treatment 
may  be  eflective  and  a  safe  forecast  of  results  may  be  made,  it  is 
imperative  that  the  existence  or  tendency  to  various  constitutional 
-diseases  be  sought  for. 
1]5  Wait  49th  St. 


THE  TREATMENT  OF  IMPACTED  BILIARY 
CONCRETIONS. 

By  E.  B.    JACKSON.  M.D.. 
HouOTON.  Tex. 

This  is  quite  a  painful  and  serious  condition.  It  is  not  possible 
4;o  predict  tbe  number  of  days  that  an  attack  will  last.  The  attack 
will  often  come  on  suddenly,  though  this  is  by  no  means  always 
tbe  case.  If  a  stone  of  small  size — say  equal  to  a  grape  seed — 
leaves  tbe  gall-bladder  in  a  quiescent  stale,  so  to  speak,  engaging 
tbe  commune  ductslowly,it  may  be  two  weeks  in  paseing,and  with- 
out producing  great  pain,  since  there  may  be  ample  space  for  tbe  pass- 
age of  bile  through  the  duct  by  the  angles  of  the  calculus.  And  the 
stone  may  never  be  entirely  impeded  at  any  point  in  tbe  duct, 
therefore  the  patn  may  be  only  slight.  But  if  a  large,  round  stone 
suddenly  engages  the  duct  aud  becomes  at  once  completely  im- 
peded, we  have  pain  the  intensity  of  which  I  cannot  with  words 
describe.  It  is  periodical — comes  on  every  few  minutes  in  tbe 
form  of  violent  colic,  but  the  cycles  are  often  quite  irregular.  Tbe 
patient  may  or  may  not  have  jaundice— much  uftener  not.  There 
is,  however,  nearly  always  a  certain  grade  of  cachexia,  due  to 
■chronic  inactivity  of  tbe  liver,  and  malarial  toxemia.  Tbe  &ce  is 
■usually  muddy,  tbe  complexion  spotted  with  patches  of  brown  pig- 


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Tbbatmbnt  of  Impacted  Biliabt  Concretions.        521 

meat.  It  is  easy  to  see  that  such  a  stagnaDt  conditiou  of  the  sys- 
tem would  readily  aid  the  formation  of  gall-stooes,  namely,  by 
&voriog  the  exudation  of  mucus  in  the  duct,  by  producinf;  a  ca- 
tarrhal condition  of  the  bile  bladder  itself,  and  by  promoting  the 
secretion  from  the  liver  of  bile  of  such  consistency  as  that  its  de- 
generation, when  pent  up  in  the  gall-sac,  most  easily  occurs,  par- 
ticularly insomuch  as  it  must  lie  in  cootact  with  an  unhealthy 
surface,  and  be  shut  ofF  from  the  abdomen  by  bloclcing  of  the  duct 
with  mucus  aud  abnormal  cell  proliferations  due  to  catarrhal  in- 
flammation. If  the  gall-bladder  be  much  enlai^ed  it  may  be  felt 
as  an  oblong  tumor  uuder  the  tip  of  the  tenth  rib.  This  being 
felt,  it  is  easy  to  account  for  the  tympanitis  that  is  also  seen  in  con- 
nection with  a  case.  You  must  of  course  give  morphine,  for  noth- 
ing else  ever  coming  under  our  observation  was  sufficient  to  quell 
the  insufferable  pain;  give  it  by  all  means  hypodermically  in  one- 
fourth  grain  doses  four  times  a  day,  and  oftener  if  the  case  re- 
quires it.  You  must  put  ou  what  we  are  in  the  habit  of  callicg  a 
turpentine  stupe  poultice.  It  is  made  of  linseed  meal  wet  with 
«qual  parts  of  ether  and  turpentine.  You  are  to  apply  this  over 
the  gall-bladder.  If  you  wish  to  shorten  the  passage  of  the  stone 
by  internal  remedies,  you  must  administer  chionia  for  removing 
the  dibris  from  the  duct  and  gall-bladder,  and  for  normalizing  the 
flow  and  consistency  of  bile.  We  believe  also,  from  our  experi- 
ence with  three  recent  cases,  that  it  exerts  a  favorable  influence  in 
relaxing  the  grasp  of  the  duct  upon  the  stone,  for  the  exit  of  each 
one  of  them  seemed  more  readily  accomplished  than  in  many  cases 
formerly  treated  when  chionia  was  not  administered,  but  the  other 
measures  herein  recounted  were  applied.  If  you  desire  happy  re- 
sults from  internal  treatment,  by  all  means  prescribe  one  teaspoon- 
ful  of  chionia  four  times  a  day  in  hot  water.  There  is  but  little 
doubt  that  this  remedy,  if  used  in  advance  of  serious  impaction, 
would,  by  its  power  in  aiding  the  liver  and  bowels  to  resume  their 
normal  functions,  prevent  paroxysms  of  hepatic  colic  by  prevent- 
ing the  formation  of  concretions  in  the  gall-sac. 

A  word  in  reference  to  obolecystotomy,  if  the  case  becomes  obsti- 
nate. If  many  ngly  symptoms  develop — such  as  approaching  jaun- 
dice, extreme  tenderness  and  tympanitis,  extreme  enlargement  of 


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622       The  Atlanta  Medical  and  Sdkgical  Joubnal. 

the  gall-bladder,  and  general  teDdency  to  prostration  becomes  im- 
minent— it  ia  best  to  operate  and  relieve  the  condition  in  this  man- 
ner, namely:  make  a  eemi-ciroular  incision  large  enough  to  get  the 
hand  in  over  the  tip  of  the  tenth  rib,  turning  the  fiap  upward,  fix- 
ing it  temporarily  to  the  skin  of  the  chest.  Open  the  peritoneum 
and  immediately  pack  it  with  Bat  sponges  under  the  lower  mat^in 
of  the  wound;  now  put  a  stout  ligature  through  the  most  depen- 
dent margin  of  the  liver,  that  it  may  thus  be  bridled  upward  by 
an  assistant  and  maintained  so  throughout  the  operation;  now 
make  a  longitudinal  incision  in  the  gall-aac,  letting  out  all  stones, 
mucus  and  disorganized  bile;  now  remove  the  sponges — take  care 
that  all  oozing  is  checked;  then  stitch  the  skin,  the  peritoneum 
and  the  margin  of  the  incision  in  the  gall-bladder  all  together,  just 
as  you  would  stitch  a  buttonhole  were  you  a  tailor ;  now  insert  a 
long  rubber  tube,  long  enough  to  reach  from  the  wound  to  the  pa- 
tient's side-pocket,  so  that  the  drain  from  the  gall-eao  may  be  con- 
veyed by  the  tube  into  a  bottle  that  the  patient  can  easily  wear  in 
his  pocket  all  through  the  process  of  closure  of  the  resultant  fis- 
tula— sometimes  requiring  months.  After  this  tube  is  inserted  the 
wound  can  be  closed  around  it  and  carefully  packed  with  iodoform 
gauze  and  covered  with  oil-silk.  The  operation  is  simple  and  as 
easily  and  quickly  performed  as  colotomy;  and  we  have  heretofore 
reported  one  successful  case,  and  the  patient  is  still  living,  this 
being  the  sixth  year  of  comparative  health  which  she  has  enjoyed. 


A  EEPOKT  OF  SOME  SURGICAL  CASES.* 

By  T.  R.  GARLINGTON,  M.D., 
Vice-President  of  the  Association  of  Sorgeons  of  tlie  Soutbem  Railway  Com- 
pany, Uember  of  Americao  Mt^dical  AasociHtion,  Oeorfria  Medical 
Association,  Chief  Sut^eon  C.,  R.  &  S.  Ry.  Co-,  Local  Snr- 
geon  Sonthem  R/.  Co.t  Burgeon  Citjr  Eiectric  Ry.  Co. 

The  cases  which  I  wish  to  report  are  deemed  of  sufficient  inter- 
est to  bring  to  the  attention  of  the  members  of  this  Association. 

Tbe  first  case  is  one  of  empyema  in  an  infant,  aged  seventeen 
months. 


n  OeoiEla  Medical 


^dbyGoogle 


Soufi  SuRoicAL  Cases.  528 

The  hUtoiy  of  tbia  case,  as  related  by  its  mother,  is  to  some 
extent  iateresting. 

About  Ist  of  February  child  caught  cold,  which  was  subse- 
quently followed  in  three  or  four  days  by  symptome  of  earache, 
developing  suddenly  at  night,  and  attended  apparently  by  high 
temperature.  After  a  while  the  child  was  soothed  to  sleep,  and  the 
next  morning  she  still  had  fever.  The  family  physician  was  called 
and  made  a  diagnosis  of  pneumonia,  for  which  she  was  treated  for 
three  or  four  weeks ;  and  as  her  condition  continued  to  grow  worse 
a  consultation  was  asked  for,  which  was  had.  A  diagnosis  of  uu- 
resolved  pneumonia  was  agreed  npon. 

Vigorous  treatment  was  instituted  to  induce  resolution  ;  however, 
all  measures  of  course  failed.  The  child's  condition  grew  so  des- 
perate that  her  physicians  despaired  of  her  recovery,  and  so  in- 
formed the  parents. 

I  was  then  called,  and  made  my  first  visit  on  April  28th;  the 
child  bad  been  ill  about  twelve  weeks. 

The  symptoms  were  extreme  pallor  with  profound  emaciation ; 
respiration  very  greatly  embarrassed;  a  continuous  backing  cough; 
pulse  weak  and  greatly  accelerated ;  chest  bulging  or  barrel-shaped 
on  right  side,  with  marked  dullness  on  percussion;  auscultation 
negative;  lefl  side  retracted  and  slightly  resonant;  weak  vesicu- 
lar breathing. 

I  made  a  diagnosis  of  empyema,  which  was  confirmed  by  aspira- 
tion. I  advised  an  immediate  operation,  which  was  consented  to; 
but  as  the  child's  condition  was  so  extremely  critical  I  could  not 
make  a  favorable  prognosis. 

I  made  an  incision  in  the  sixth  interspace,  and  drained  the  cavity 
with  rubber  drainage-tubes. 

I  am  quite  sure  tnlly  half  a  gallon  of  pus  was  discharged 'from 
time  to  time. 

Irrigation  was  not  resorted  to,  as  I  consider  it  to  some  extent 
dangerous. 

I  removed  the  tubes  in  about  two  weeks,  and  my  litlle  patient 
made  a  complete  recovery. 


,„i,z.d  by  Google 


-524       The  Atlanta  Mbdical  and  Surqical  Jottbnal. 

eecapitulation. 
'^ere  are  two  points  worthy  of  ootice  id  this  case:  First,  the 
age  of  the  patient  at  which  this  condition  developed,  and,  second, 
the  fact  that  an  error  was  made  in  the  diagnosis. 

That  pleurisy  with  effusion  and  empyema  is  quite  a  common  com- 
plication with  pneumonia  in  in&ocy  and  childhood  there  can  be  no 
<]oubt.  And  that  errors  in  diagnosis  are  commonly  made  is  evi- 
^lenced  by  the  above  case,  together  with  two  others  which  I  have 
4}uite  recently  operated  on,  in  which  errors  were  made  in  both 
-cases.  In  one,  a  diagnosis  of  spinal  curvature  was  made  and  a 
plaster  jacket  was  about  to  be  applied.  This  common  error  can 
be  avoided  if  the  physician  will  take  the  pains  to  make  a  careful 
physical  examination  of  the  patient's  chest;  and  should  any  doubt 
exist,  aspiration  with  a  hypodermic  needle  should  be  made,  which 
would  confirm  a  diagoosin  of  pleurisy  with  effusion  or  an  em- 
pyema. 

Case  No.  2. — This  patient,  Jesse  H.  White,  aged  about  twenty- 
two,  was  an  employee  of  the  Southern  Railway  Company  and  a 
member  of  the  bridge  gang. 

While  repairing  a  trestle  be  lost  his  footing  and  was  precipitated 
to  the  ground,  a  distance  of  about  twenty-five  or  thirty  feet.  He 
ieU  across  a  mudsill  at  the  bottom  of  an  excavation,  produciof;a 
compound  comminuted  fracture  of  the  femur  at  the  junction  of  the 
upper  and  middle  third,  with  great  laceration  and  contusion  of  sub- 
cutaneous tissue. 

A  physician  living  in  the  country  near-by  was  called,  and  be 
applied  a  temporary  dressing.  Four  days  later  I  was  called  to  the 
patient,  and  upon  my  arrival  I  found  him  with  acute  septicemia 
complicating  his  injury,  with  a  temperature  of  10.5. 

I'removed  the  bandages  and  splints,  and  a  great  deal  of  foul  pus 
was  discharged. 

Fcchymosis  was  very  pronounced  and  extended  from  the  knee 
to  a  point  just  above  the  iliac  crest  on  the  abdomen. 

I  recognized  at  once  that  I  had  a  very  grave  condition  to  deal 
with  to  save  my  patient's  life,  to  say  nothing  of  his  leg. 

I  enlarged  the  wound  and  made  a  counter  incision  about  tax 
.inches   long  down    to  the  bone  on  the  back   of  the  thigh,  and 


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Some  Surgical  Cases.  525 

after  thorough  irrigation  with  1-2000  hichloride  solution  I  drained 
with  large  gauze  ropes,  and  then  placed  my  patient  on  quinine  and 
whisky.  In  about  a  week  his  temperature  came  to  normal,  and  a 
week  later  I  performed  a  resection. 

When  I  made  my  incision  I  found  the  bone  denuded  of  its  peri- 
osteum and  apparently  dead  for  several  inches  on  both  the  lower 
and  upper  fragments.  I  resected  about  twoand  a  half  inches  from 
the  loweraod  about  two  inches  from  the  upper  fragment;  in  neither 
instance  did  I  get  beyond  the  denuded  surface.  After  resecting 
about  one  inch  from  upper  fragment  I  found  the  medullary  canal 
suppurating  and  discharging  very  foul  pus.  I  wentan  inch  higher, 
endeaviiring  to  get  beyond  the  point  of  suppuration,  which,  how- 
ever, I  failed  to  do. 

Ae  my  patieut  was  taking  ether  badly  I  concluded  to  stop  at  this 
and  take  chances  on  the  result. 

I  drilled  and  wired  the  bones  end  to  end  with  a  large  silver 
wire,  leaving  the  ends  long  and  bringing  them  out  through  the 
incision.  I  closed  the  wound  both  above  and  below  and  drained 
through  and  through  with  large  rubber  drainage-tubes.  I  used  for 
dressing  the  wound  four  cardboard  splints  molded  to  fit  the  thigh, 
and  then  applied  sandbags. 

After  three  or  four  days  I  substituted  a  plaster-cast,  with  fenes- 
tra. The  wound  was  irrigated  with  bichloride  solution  1-2000 
and  dressed  every  second  or  third  day  for  two  weeks,  at  which  time 
the  wires  were  removed;  altewards  dressed  as  the  occasion  de- 
manded. 

I  allowed  the  plaster-cast  to  remain  on  about  four  weeks,  and 
after  its  removal  I  applied  sandbags  and  kept  my  patient  in  bed 
four  to  six  weeks  longer. 

I  obtained  a  most  excellent  result,  and  my  patient  is  to-day  well 
and  hearty,  and  is  employed  as  fireman  at  the  Massachusetts  Cot- 
ton Mills  in  Georgia,  where  be  informs  me  that  be  lifts  several 
tons  of  coal  every  day,  and  has  as  good  a  leg  as  anybody. 

SDMHABY. 

This  case  serves  to  illustrate  well  the  reparative  properties  of 
bone,  and  I  herewith  make  a  plea  for  conservatism  in  all  railway 
as  well  as  other  injuries  to  bone,  and  especially  among  the  labor- 
ing classes. 


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S26       Ths  Atlanta  Mbdical  and  Sitboical  JotnmAL. 


THE  DANGER  OF    CHLOROFORM    ANESTHESIA    BY 
GASLIGHT. 

By  EUGENE  H.  CORSON,  M.D., 
Savahh*b,  Ga. 

The  danger  of  chloroform  aoeatbesia  by  gaslight  has  beeD  again 
brought  to  the  notice  of  the  profeseioD  hy  a  death  in  the  Catholic 
hospital  at  Heme,  id  Westphalia.  A  case  of  gunebot  wound  in 
the  abdomen  was  operated  upon  at  night  under  gaslight,  and  the 
decomposition  of  the  chloroform  vapor  sufFocated  two  surgeons  and 
several  nurses,  one  of  the  latter  dying  from  the  effects  ot  it.  How 
the  poor  patient  fared  is  not  known;  but  think  of  the  danger  to 
the  patient  under  such  circumstances! 

Last  year,  in  our  own  city,  a  case  of  appendicitis  operated  upon 
by  gaslight  showed  the  danger  of  the  use  of  chloroform  in  the 
presence  of  a  flame  which  could  oxidize  and  decompose  thecbloro- 
form  vapor.  The  suffocating  fumes  of  the  products  formed  almost 
drove  the  occupants  out  of  the  room. 

I  can  find  nowhere  any  statement  of  the  exact  reaction  which 
takes  place,  but  I  have  worked  out  the  following  formulte,  which 
I  believe  represeot  the  correct  reactions.  I  have  submitted  them 
to  a  good  chemist  and  he  has  pronounced  them  correct.  Accord- 
ing to  the  completeness  of  the  combustion  or  oxidation,  two  reac* 
tions  are  possible.  If  the  oxidation  is  complete  we  have  the  fol- 
lowing reaction: 

4  CHCl,+5  0,=2  H,0+4  CO,+  6  CI,. 

Here  the  really  poisonous  product  formed  is  the  free  chlorine,  a 
most  dangerous  gas  when  existing  to  any  extent  in  the  atmosphere. 

When  the  oxidation  is  not  so  complete,  we  have  a  quite  differ- 
ent.  reaction,  with  the  formation  of  formaldehyde  in  addition  to 
the  chlorine.     The  reaction  may  be  thus  represented : 

4  0H01,+3  0,=2  CH,0+  2  C0,+6  CI„  or,  four  molecules  of 
chloroform  with  three  molecules  of  oxygen  produce  two  molecules 
of  formaldehyde,  two  molecules  of  carbon  dioxide,  and  six  mole- 
cules of  chlorine  gas.  It  is  at  once  apparent  bow  deadly  such  s 
decomposition  must  be  in  an  ordinary  room  with  ordinary  ventila- 


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Danqsr  07  Chloroform  bt  Gasliqht.  527 

tion,  and  a  number  of  cases  on  record  bear  witness  to  it.     It  is 
evident  that  iUuniioatiDg  gas  in  itself  is  not  the  trouble,  but  it  is 
tbe  flame,  which,  burning  in  an  atmosphere  charged  with  chloro- 
form vapor,  causes  its  combustion  and  decomposition.     A 
flame  would  do  the  same — as  an  alcohol  flame  or  a  flame  fro 
sene  lamp,  for  example. 

It  may  be  interesting  to  note  the  reactions  from  comt 
some  allied  compounds.  Methyl  alcohol,  for  example,  i 
active  combustion  which  takes  place  in  the  ordinary  spiri 
represented  as  follows: 

2  CH,HO+3  0,=2  C0,+4  H^O.  In  other  words, 
composed  into  carbon  dioxide  aud  water. 

Note  again,  where  the  oxidation  of  the  methyl  alcohol 
complete  we  have  another  reaction,  as  follows: 

CH,HO+0,=HC  H0,+H,O,  or,  one  molecule  of  met 
hoi  and  one  molecule  of  oxygen  produce  one  molecule  < 
Acid  and  one  molecule  of  water. 

Reduce  still  further  the  amount  of  oxygen,  as  seen  ^ 
methyl  alcohol  is  burnt  in  a  lamp  constructed  for  the  pur 
we  have  the  production  of  formaldehyde,  so  largely  emp 
day  as  a  disinfectant  and  germicide : 

2  CH,H0+0,=2  CH,0+2  H,0,  CH^O  representing 
maldehyde. 

The  inflammability  of  sulphuric  ether  is  more  general 
nized,  but  the  ether  must  be  brought  directly  in  contact 
flame  to  explode.  I  once  witnessed  a  very  serious  accidei 
kind,  where  a  surgeon  and  nurse  were  very  severely  bu 
number  of  instruments  destroyed.  The  products  of  such 
tion,  however,  are  not  so  bad;  witness  the  reaction  tbuscl 
stated: 

C.Hj,0+6  0,=6  H,0+4  CO,. 

Ether  vapor  in  the  atmosphere  coming  in  contact  wit 
would  therefore  not  be  serious  under  the  conditions  wl 
ordinarily,  and  ether  anesthesia  could  be  used  by  gaslight 

Electric  lighting  is  so  generally  superseding  gas  that  th' 
opportnnity  for  ignorance  to  cause  trouble,  and  such  an  a( 
recently  occurred  will  be  very  rare. 


^dbyGoOgle 


SOCIETY  REPORTS. 


RICHMOND  ACADEMY  OF  MEDICINE  AND  SURGERY. 

HEUrriNG    HELD    JITLY    12,    1898. 

Dr.  M.  D.  Hoge,  Jr.,  Tresident,  in  the  chair.  Dr.  Mark  W. 
Peyeer,  Secretary  and  Reporter, 

Dr.  George  Ben  Johnston  reported  some  abdominal  cases  (§ee 
page  444). 

Dr.  Jacob  Michaux  esbibited  casts  of  the  palms  of  the  hands 
and  soles  uf  the  feet  of  a  young  man  aged  nioeteen  years.  The 
patient  had  a  fever,  102°,  the  nature  of  which  was  indefinite.  The 
patient  was  of  spare  build.  There  was  no  eruption  nor  tongue 
symptoms.  He  was  not  seen  until  three  days  after  the  inception 
of  the  fever,  A  dose  of  three  grains  of  quinine  was  given,  and 
three  hours  after  there  was  almost  a  convulsion,  though  conscious- 
ness was  retained.  In  four  or  five  hours  a  rash  appeared.  Dr- 
Michaux  said  he  would  have  been  uncertaio  as  to  the  influence  of 
the  quiniue  and  its  dose  producing  the  exfoliation  were  it  uot  for 
the  information  derived  from  the  mother,  au  intelligent  woman, 
that  it  bad  occurred  before,  hut  she  had  neglected  to  mention  it. 
He  had  heard  of  but  one  other  case.  The  casts  in  this  came  off  in 
a  week,  and  the  whole  epidermis  of  the  body  was  shed  in  particles. 
His  explanation  of  the  phenomenon  was  idiosyncrasy,  and  a  rather 
remarkable  case  was  that  of  Dr.  Bolton,  who,  whenever  he  un- 
corked a  bottle  of  morphine,  although  holding  it  out  at  arm's 
length,  would  haveau  eruption  to  appear  all  over  the  body.  The 
first  time  the  effect  was  produced  was  when  weighing  out  a  half- 
grain,  a  sunburnt  appearance  was  noticed  around  the  eyes.  The 
canse  was  not  suspecled  for  some  time. 

Dr.  J.  N.  Upshur  said  the  history  of  Dr.  Michaux'a  case  was 
more  like  scarlet  fever  than  anything  else.  He  did  not  think  the 
mother's  information  amounted  to  anything,  for  that  kind  derived 
from  relatives  of  patients  was  unreliable.     There  was  nothing  in 


^dbyGoOgle 


Society  Reports.  629- 

tbe  physiological  actioD  of  quinine  to  explain  the  condition.  The 
period  of  incubation  was  that  of  scarlet  fever,  and  the  explanation 
thus  was  more  natural  than  hy  qiiioine. 

Dr.  Michaux  asked  leave  to  stale  that  he  had  again  givet 
dose  of  quinine  with  a  like  result.  Tbe  inrormation  obtain* 
the  mother  was  given  her  by  an  intelligent  physician  who 
tended  tbe  patient  in  time  past. 

Dr.  Johnston  said  he  believed  Dr.  Michaux's  explanation 
case  the  correct  one,  namely,  idiosyncrasy.  He  had  nev 
such  a  profound  effect  from  quinine,  but  had  seen  a  severe 
titis.  The  following  coR6rmed  his  belief:  In  the  case  of 
lady,  a  five-grain  dose  of  iodide  of  potassinm  produced  al 
symptoras.  Two  and  a  half  grains  produced  the  same,  ai 
wise  did  continued  reductions,  even  until  one-tenth  of  a  gr 
reached,  when  there  were  the  same  symptoms,  with  the  st 
gree  of  violence.  Dr.  J.  B.  McCaw  will  faint  when  be 
camphor.  Dr.  Bryant  brought  a  case  to  him  for  operation, 
was  about  to  pack  with  iodoform  gauze  when  the  doctor  as 
time  to  leave  the  room,  saying  if  he  rematoed  until  the  i 
was  opened  be  would  have  nettlerash  before  he  could  re 
bottom  of  the  stairs.  Dr.  Morris,  of  this  city,  cannot  pass 
seven  feet  of  growing  poison-oak  witbont  having  its  charai 
effect.  All  these  being  so,  why  could  not  quinine  prodi 
effect  as  shown  by  Dr.  Michaux  ?  He  was  prepared  to  bt 
true. 

Dr.  W.  8.  Beazley  exhibited  three  teeth  extracted  fn 
mouth  of  an  infant,  the  first  when  it  was  thirteen  days  < 
second  on  the  fifteenth  day,  and  the  third  on  its  nineteen 
He  saw  the  in&nt  on  the  third  day  after  birth,  and  fou 
left  cheek  and  eye  and  the  nose  inflamed,  the  last  two  t 
charging.  In  examining  the  jaw  later  he  saw  an  openin) 
gum  from  which  pus  was  exuding,  and  also  a  loose  tooth,  w 
pulled.  Two  days  later  a  molar  was  seen,  which  was  pull 
again  in  four  days  a  second  molar,  which  met  the  same  fat 
the  teeth  came  from  tbe  left  upper  jaw.  He  was  told  there 
evidence  of  teeth  at  birth. 


^dbyGoogle 


CORRESPONDENCE. 


THE  CHICAGO  ACADEMY  OF  MEDICINE. 

Chicago,  September  4,  1898. 

Mb.  Editor: — The  recently  issued  catalogue  of  the  Chicago 
"College  of  "Osteopathy"  coutaias  the  asaertioD  that  the  "orificial- 
ist  surgeon,"  E.  H.  Pratt,  one  of  its  faculty,  is  a  member  of  the 
Chicago  Academy  of  Medicine.  He  has  never  been  a  member,  nor 
is  he  eligible.  He  is  probably  a  member  of  the  Chicago  Academy 
of  Homeopathic  Physicians  and  Surgeons,  an  organization  with  to- 
tally different  objects  and  purposes. 

Kindly  publish  ibis  in  justice  to  the  Chicago  Academy  of  Med- 
icine. Jas.  G.  Kiebnan,  Secreiary. 


Mineral  Spsikos,  Abk.,  August  20,  1'898. 
EdiloT  Atlanta  Medical  and  Surgical  Journal: 

SiH ; — In  reply  as  to  the  color  of  new-born  negroes,  I  would 
state,  in  the  experience  of  twenty  years  I  have  never  seen  one  that 
«ouId  not  readily  be  distinguished  from  a  white  infant.  Generally 
they  are  very  light  at  birth,  but  not  of  the  pink  color  of  the 
whites,  and  they  always  have  a  dark  area  around  the  anus.  The 
lightest  are,  of  course,  of  mixed  blood,  but  I  have  seen  real  black 
ones  St  birth.  Yours  truly,  T.  J.  Dbapeb,  M.D. 


GiFFOBD,  S.  C,  September  20,  1898. 
EdUor  Atlanta  Medical  and  Surgical  Journal: 

I  report  this  case,  as  I  have  never  read  nor  heard  of  such  in 
medical  literature:  On  September  11,  Lizzie  McT.,  colored,  gave 
ibirth  to  triplets;  the  first,  a  girl,  was  born  about  11  o'clock  a.m., 
the  other  two,  one  a  boy  the  other  a  girl,  not  until  eleven  boars 
Afterwards;  the  two  last  children  were  bom  within  fifteen  minutes 


,„i,z.d  by  Google 


Correspondence.  531 

-of  eaoh  other,  and  io  about  thirty  minutes  the  placenta  was  deliv- 
ered; the  three  placentas  were  attached  to  each  other.  I  wascalled 
in  to  see  the  case  ten  hours  after  the  first  child  was  born,  there  only 
beinj;  a  midwife  with  the  patient  wbeo  I  was  called.  Tb< 
of  the  case  was,  that  the  patient  had  a  fall  from  a  feoce  ab 
feet  high,  and  complaioed  of  pain  the  entire  time  after 
for  about  three  weeks  until  her  labor  took  place.  The  sec 
-children  were  delivered  by  forceps.  The  first  child  lived  1 
thirteen  hours,  the  other  two  died  in  about  thirty  minuti 
"woman  gave  the  history  of  being  pregnant  about  seven 
previous  to  her  iall.  There  was  no  more  hemorrhage  thi 
The  patient  has  never  complained  of  any  pain  since  her  le 
«he  is  walking  about  apparently  as  well  as  ever.  The  i 
uterus  had  to  be  dilated  with  a  Goodell's  dilator  before  th 
two  children  were  born,  as  the  internal  os  was  firmly  coi 
and  they  were  delivered  in  the  course  of  fifteen  or  twenty 
after  the  os  was  dilated. 

1.  What  could  have  caused  the  internal  os  to  contract 
first  child  was  born  and  prevent  the  delivery  of  the  other 

2.  What  caused  the  labor  to  be  delayed  so  long  after  th 
Very  truly  yours,  J.  S.  Greekleap, 


MACON  ITEMS. 


Work  on  the  annex  of  the  Macon  Hospital  is  going  rap 
-ward.  Sandstone  and  pressed  brick  will  be  the  materials 
its  construction.  The  building  will  have  two  wards,  havi 
pacity  of  twenty  beds  each,  a  modern  operating-room, 
fooms,  rooms  for  ward  patients,  kitchen,  and  a  morgue. 

The  building  is  the  gift  of  Mr.  T.  B.  Gresham  and  hi 
Mrs.  Mochin,  of  Baltimore,  Md.,  and  is  a  memorial 
father,  who  was  once  an  honored  citizen  of  Macun.  It 
known,  therefore,  as  the  "J.  J.  Gresham  Memorial  Bi 
The  wards  are  intended  for  white  patients  only.  The  mai 
the  hospital  are  anxioos  to  build  at  once  a  similar  buildinj 
colored  patients. 


^dbyGoOgle 


632       Thb  Atlamta  Medical  ahd  Sdrhical  Jodbhal. 

Dr.  H.  McHattOD,  who  bae  been  for  the  past  six  weeks  in  the- 
mountaias  of  Carolina  and  North  Georgia,  baa  returned,  and  is 
full  of  fiah  stories. 

At  the  meeting  of  tbe  Macon  Medical  Society  Tueaday  evening, 
February  6,  Dr.  Olin  J.  Weaver  read  a  moat  interesting  article 
on  "  Drainage,"  which  was  discussed  by  Drs.  Jackson,  K.  P.  Moore, 
and  Williams. 

Dr.  K.  P.  Moore  reported  a  eaae  of  coccyalgia  upon  which  be 
bad  operated.  The  most  interesting  feature  of  the  case,  and  tbe 
one  to  which  be  called  especial  attention,  waa  tbe  presence  of  angar 
iu  tbe  urine,  which  was  relieved  by  tbe  operation.  Tbe  doctor 
supposed  the  presence  of  augar  was  a  coincidence  until  be  looked 
up  the  subject,  and  found  that  sugar  in  the  urine  was  not  an  unu- 
sual complication  of  spinal  bnne  lesions.  The  case  was  discussed 
by  Drs.  Jackson,  Weaver,  Shorter  and  Williams. 

Dr.  Moore  also  exhibited  a  very  large  ovarian  cyst,  the  contents 
and  sack  weighing  over  forty  pounds.  Tbe  results  in  both  tbe  op- 
erations reported  were  perfectly  satisfactory. 

Dr.  Williams  exhibited  a  man  who  waa  atabbed  July  30,  in  tbe 
left  chest,  just  below  tbe  clavicle,  tbe  wound  beginning  half  an  inch 
from  tbe  sternum  and  extending  four  inches  outwards  and  down- 
wards. Tbe  second  rib  was  cut  in  two  just  beyond  the  sternal  at- 
tachment; the  lung  tissue  was  punctured,  and  there  had  been  an 
extensive  hematothorax  and  pneumatothorax.  The  bleeding  was 
from  the  second  intercostal  artery,  aud  was  controlled  by  a  plug  of 
gauze  thrust  between  the  ribs  iu  tbe  shape  of  a  pouch,  then  filled 
with  absorbent  cotton  and  pulled  up  tightly.  It  was  impossi- 
ble, owing  to  tbe  exsanguinated  condition  of  tbe  patient,  to  hunt 
for  and  ligate  the  bleeding  vessel.  The  patient  made  a  slow  re- 
covery; still  bad  a  fistulous  tract  communicating  with  the  pleural 
cavity.  The  drainage  liad  been  good,  the  collapsed  lung  bad  re- 
expanded,  and  the  man  was  doing  well.  If  in  the  course  of  a  few 
monthe  tbe  fistula  does  not  close,  and  there  remains  any  pyopneu- 
mothorax, a  resection  of  the  ribs  will  have  to  be  performed. 

The  case  waa  discussed  and  examined  by  Drs.  Shorter,  Jackson, 
Moore,  Weaver,  Peete,  and  Gewinner. 


^dbyGoOgle 


COBHBSFONDBNCB.  588 

DR.  D.  DOMINGO  MADAN* 

TransUted  from  CrOmea  MSdico-Qairurgica  de  la  Hahana 

By  B.  J.  WORD, 
Atlanta,  Ga. 

Here  is  a  oame  born  to  the  life  of  science  together  with  the 
CTdnica  Midico-Quirurgica  de  la  Hahana,  in  wbich  he  wa$  a  col- 
laborator when  yet  a  very  young  maD.  The  inscrutable  designs  of 
natore  have  not  permitted  him  to  outlive  this  actual  uufortunate 
epoch  ;  be  has  fallen  in  the  middle  of  bis  course;  and  this  publica- 
tion, always  so  dear  to  him,  in  which  he  leaves  so  many  treasures 
of  learning,  and  which  at  a  more  or  less  distant  time  be  would 
have  been  called  to  manage,  being  one  of  the  youngest  of  its  first 
editors,  devotes  to  him  a  fear  and  tries  to-day,  although  not  accord- 
ing to  the  full  measure  of  its  wishes,  to  present  him  to  his  country- 
men, and  also  to  posterity,  with  the  triple  encomium  of  altruist, 
patriot,  and  an  exemplary  physician.  His  calling  for  medicine  and 
his  generous  and  noble  sentiments  manifested  themselves  at  an  early 
period,  when  be  was  performing  the  functions  of  an  assistant  in  the 
clinical  wards  for  eye  diseases  of  Dr.  J.  Santos  Fernandez.  Mauy 
are  those  upon  whom  be  operated  who  remember  yet  the  gentleness 
of  that  young  man — young  in  years  but  mature  in  wisdom — when 
advising  and  persuading  them;  but  when  he  established  himself  in 
his  native  town,  Matanzas,  the  kindness  of  his  heart  was  not  yet 
developed,  although  it  increased  day  after  day  and  reached  a  height 
where  his  generosity  and  love  towards  his  neighbor  gave  him  the 
character  of  an  apostle.  In  that  provincial  capital  be  loved  so 
much,  and  which  has  claimed  his  remains,  there  is  hardly  a  benefi- 
cent institution  where  his  hand  has  not  intervened,  especially  the 
Orphans',  the  Old  People's  Homes,  and  the  Dispensary  for  Chil- 
dren, the  first  of  its  kind  founded  in  Cuba,  which  have  been  his 
exclusive  work.  For  three  decades  to  the  present  day  the  beauti- 
ful city  of  Matanzas, justly  called  the  "Athens  of  Cuba,"  has  been 
the  victim  for  many  reasons  of  a  decadence  great  and  profound, 
■It  1*  ft  s^**^  pls^io'*  ^  bo  ftblo  U>  {iraent  the  lifo  o(  to  noble  »  Cuban  pbrslobui. 


idb,Googlc 


534      The  Atlanta  Medical  and  Sobqical  Jouksal. 

which  ID  these  later  days  baa  become  a  real  disaster,  and  there  is 
no  ueed  to  try  to  describe  the  effect  which  such  had  produced  npon 
the  seneitive  soul  of  our  friend.  Iq  vain  he  strove  to  coanteract 
the  effects  of  hunger  and  misery  in  the  unhappy  children,  and  with 
a  solicitude  never  equaled  before  he  attended  them  in  the  dispen- 
sary established  by  himself  before  the  oomiog  of  this  terrible  situ- 
ation. How  he  was  iofusing  into  his  colleagues  that  same  spirit  of 
kindness  which  was  fioodiog  from  him  so  profusely,  so  that  the- 
grand  work  of  charity  should  indeed  show  result  and  be  a  living 
image  of  that  of  the  Savior  when  be  exclaimed,  Let  children  come 
unto  me — Sinite  parrmlos  venire  ad  me  ! 

For  the  aid  of  that  dispensary,  whose  sustenance  was  chiefly  the 
origin  of  the  disease  from  which  he  died,  Dr.  Madan  made  a  trip 
to  £urope  in  order  to  study  in  a  perfect  manner  this  class  of  estab- 
lishments for  destitute  children;  but  this  was  not  the  only  time  he 
crossed  the  seas  for  humanity's  sake,  as  be  went  twice  to  Paris, 
appointed  by  the  Bacteriological  Tjaboratory  of  Havana,  with  the 
object  of  removing  difficulties  relative  to  the  installation  in  Cuba 
of  the  prophylactic  method  for  the  treatment  of  hydrophobia  con- 
ceived by  Pasteur,  And  all  this  was  willingly  and  cheerfully  done, 
just  as  if  there  was  no  sacrifice  at  all  to  give  up  his  interests  and 
family,  without  any  personal  benefit  whatever  and  only  for  the 
public  welfare.  If  we  would  relate  all  the  numerous  episodes  at- 
tached to  these  general  points  of  his  devotedness  to  good  works,  we 
would  need  many  pages,  but  the  reader  will  not  miss  those  details 
although  we  do  not  write  them,  as  they  are  a  necessary  consequence 
of  an  abnegation  revealed  in  the  most  salient  lines  of  bis  eminently 
altruistic  character. 

As  a  public  man  be  never  shirked  any  responsibility.  He  occu- 
pied in  the  municipality  and  other  corporations  the  posts  assigned 
to  him  by  the  vote  of  his  fellow  men.  He  always  remained  affili- 
ated to  the  autonomist  party  and  by  the  side  of  those  who  pro- 
claimed the  liberal  ideas  as  a  sure  means  of  avoiding  the  explosion 
of  impatiences  born  from  the  doubt  of  obtaining  redress  of  invet- 
erate wrongs  from  the  supreme  powers.  He  constantly  advocated 
that  concord  so  much  in  conformity  with  his  temperament,  and  if 
he  had  political  adversaries  he  never  had  very  bitter  ones,  because 


^dbyGoOgle 


OORRKSPONDENCB.  58&> 

hb  tolennoe  on  one  mde  aod  bis  coDciliatory  manners  on  the  otber- 
permitted  him  to  get  from  both  sometbing  good  for  bis  country — 
tbe  only  object  of  bis  solicitude  and  cares. 

When  the  clear  sky  of  tbe  island  was  darkened  by  the  smoke  of 
battles,  wbea  the  report  of  cannons  went  Ibrough  tbe  air  and  re- 
sottnded  in  his  wonnded  soul,  bis  complexion  lost  its  former  fresh- 
ness, smiles. fled  from  bis  lips,  and  bis  languid  look  revealed  a  con- 
stant mourning.  All  those  who  descended  to  tbe  grave  in  that 
horrible  struggle  took  with  them  in  tbe  folds  of  tbeir  mortuary- 
clothes  a  breath  of  bis  life,  and  this  repeated  affliction,  together 
with  tbe  one  producing  hunger  and  misery  as  an  inevitable  conse- 
quence of  war,  undermined  his  constitution,  impaired  by  a  fatigue 
provoked  through  hie  desire  to  heal  them,  and  thus  favored  the 
triumph  of  tbe  disease  which  carried  him  to  tbe  grave  in  spite  of 
ecieuce  and  of  tbe  efiorts  of  his  colleagues  and  friends,  who  fougbt 
it  eagerly  in  tbe  hope  of  ibe  return  to  health  of  a  man  so  dearly 
respected. 

He  served  hts  country  as  a  member  of  tbe  Boards  of  Public  In- 
struction and  Health,  in  which  he  worked  assiduously;  contributed 
to  tbe  maintenance  of  this  publication,  not  only  with  tbe  fruit  of 
his  deep  intelligence,  bat  also  with  a  ready  and  seasonable  advice. 
Be  understood  that  the  "country"  begins  iu  tbe  family,  and  be 
was  a  model  of  sons  in  tbe  home  where  now  lie  overwhelmed  with 
grief  bis  virtuous  parents,  yesterday  so  happy,  and  so  unfortunate 
in  the  present  boor. 

As  soon  as  the  people  of  Mataozas  were  made  aware  of  tbe  sad 
news  of  bis  death  in  Havana,  at  4  o'clock  p.m.  on  the  24tb  of  July, 
they  expressed  tbeir  vehement  desire  to  become  tbe  possessors  of 
his  remains.  On  tbe  following  day  tbe  whole  city  was  waiting  for 
them,  and  in  tbe  midst  of  tears  of  gratitude  they  were  carried  to 
the  necropolis,  where  they  are  resting  by  the  side  of  those  three 
illustrious  physicians,  Presas,  Jjlarao  and  Jtmioez,  for  whom  Madan 
'  professed  so  much  respect  and  contributed  in  a  great  measure  to  the 
homage  paid  them,  and  which  in  a  higher  degree  he  receives  him- 
self from  his  native  city  as  a  just  premium  for  bis  acknowledged 
patriotism. 

His  pablic  spirit  and  tbe  attention  given  to  the  calls  of  society. 


^dbyGoOgle 


'536       The  Atlanta  Medical  asd  Sukqical  Jouhhal. 

of  which  he  was  a  promioeDt  member  in  spite  of  bis  natural  mod- 
■esty,  never  prevented  him  from  tbe  practice  of  medicine  and  from 
bie  studies;  and  although  there  is  a  tendency  to  believe  that  only 
-one  can  be  obtained  at  a  time,  but  never  both  together,  Madan  was 
writing  what  he  was  observing  daily,  and  in  this  manner  was  ere- 
■atingourown  medicine.  In  this  lies  the  priocipal  merit  of  hia 
numerous  memoirs,  some  published  in  the  columns  of  this  pnblica- 
tion,  others  read  before  the  society  for  clinical  studies,  aod  not  a 
few  published  by  the  Royal  Academy  of  ISciences,  of  which  he  was 
only  a  correspondent,  on  account  of  not  being  a  resident  of  Havana. 
His  first  works  were  on  ophthalmology,  having  collected  all  those 
of  his  master  and  publishing  them  in  two  volumes  under  the  head- 
ing of  "Cliniea  de  enfermedades  de  los  ojos."  Later,  be  invaded 
courageously  the  field  of  pathology,  and  with  great  predilection  for 
pediatrics.  Close  to  a  patient's  bedside  and  in  the  presence  of  a 
rebellious  disease,  he  rose  giantlike  and  displayed  with  a  skill 
above  imilation  the  resources  of  a  therapeutics  which  bis  fervent 
enthusiasm  was  expanding  and  studying  in  its  effects.  His  great 
erudition  was  only  revealed  when  in  private  and  in  a  friendly  con- 
versation his  advice  was  sought  for.  He  was  noted  for  two  quali- 
ties seldom  found  together — a  memory  to  utilize  opportunely  the 
ideas  of  others,  and  a  privileged  intelligence  to  discourse  with 
effect  and  produce  something  new  and  original,  by  which  he  was 
placed  at  tbe  head  of  our  most  conspicuous  physicians. 


A  MlXTUHE  FOR  THE   FeTID   DiARRHEA  OF  THE  INITIAL  StAOS 

OF  Scarlatina. 
Filatov  (Remte  menauelU  dee  maladiea  de  Venfance,  July)  recom- 
mends the  follpwiug; 

DUiilled  water 6  ouocea. 

Syrup 4o0  gwiiw. 

A  teaspoonful  or  tablespoon ful,  according  to  the  child's  age,  from 
hour  to  hour.  This  draught  is  markedly  anodyne  and  is  well  taken 
by  little  children. 


^dbyGoOgle 


EDITORIAL  NOTES  AND  COMMENTS. 


The  BiuineBB  oKee  of  The  JolrBNA^  In  BUS,  SW  FIttFn  BulldlUK. 

The  Bditortnl  offiec  U  Room  401,  W3  Grand  Oppra  House. 

Addrewall  Baslnpss  commnhlcatlons  lo  Dr.  M.  B.  ButcliEna.  M 

ilakt  rpmlttsnws  payable  Co  The  Atlanta  Medical  and  Suboicai,  . 

On  matl^ra  pertaining  to  the  Edllorlal  and  OHglhal  com manic^at Ions  addrvas  Dr.  Dunbar 
Rny.  (irand  0}<en  Hiiusi',  Atlanta. 

Reprlnu  ot  original  articles  wilt  be  turnlghed  at  coal  price.  Requests  for  the  same 
should  alwajs  be  made  on  llie  manairrlpL 

We  will  present,  poat-pald,  on  rrquest.  toeacli  contributor  of  an  original  articln.  twentr 
(SD)  marked  copira  of  The  JoUBNALnintalnlngxuuh  article. 


OSTEOPATHY. 

THE  osteopaths  are  still  increasiog  io  numbers  and  daily  coii- 
verts  are  being  added,  if  we  may  judge  from  some  of  the  jour- 
nals which  are  being  published  in  the  interest  of  osteopathy. 
However,  this  is  not  surprising,  for  there  are  thousands  of  people 
anxiously  waiting  for  something  new  to  "turn  up"  in  order 
that  they  may  rush  io  and  give  it  a  trial.  We  believe  it  was  Bar- 
num  who  said  that  "the  American  people  love  to  be  humbugged." 
Massage  ia  not  new,  and  yet  the  osteopaths  put  it  iu  a  disguised 
light  by  calling  it  another  name.  The  Swedes  are  the  best  osteo- 
paths in  the  world.  It  ia  really  amusing  to  read  what  an  over- 
enthusiastic  convert  sometimes  writes  about  osteopathy.  Here  ia  a 
sample  from  one  who  has  been  greatly  benefited.  The  patient,  8 
lady,  thus  defines  osteopathy:  Technically,  "Osteopathy  is  that 
science  which  consists  of  such  exact,  exhaustive  and  verifiable 
knowledge  of  the  structure  and  functions  of  the  human  mechanism, 
anatomical,  physiological  and  psychological,  including  the  chemistry 
and  physics  of  its  known  elements,  as  has  made  discoverable  cer^ 


^dbyGoOgle 


538       The  Atlanta  Medical  and  Sorgical  Jocesal. 

tain  organic  laws  and  remedial  resources  within  the  body  itself  by 
which  nature,  under  Bcientific  treatment  peculiar  to  oeteopotfaic 
practice,  apart  from  all  ordinary  methods  of  extraneous  artificial 
or  medicinal  stimulation,  and  in  harmonious  accord  with  its  own 
mechanical  principles,  molecular  activities  and  metabolic  processes 
may  recover  from  displacements,  disorganizations,  dcrangemeats 
and  consequent  disease,  and  regain  its  normal  equilibrium  of  form 
and  function  in  health  and  strength." 

There  you  have  a  concise  definition  of  osteopathy,  and  as  clear 
as  mud.  The  writer  adds  (in  jest,  of  course) :  "  This  is  a  long  sen- 
tence, but  comprehensive."  Still  further,  the  writer,  who  has  evi- 
dently given  great  study  to  the  subject  and  has  it  under  entire  con- 
trol, gives  the  method  of  treatment  as  follow^: 

"The  patient  places  himself  in  the  hands  of  an  expert  anato- 
mist, otherwise  be  can't  be  worthy  of  his  name.  The  sufferer  is 
divested  of  the  outer  olotbiug  covering  the  trunk  (?)  of  the  body. 
Then  the  operator  with  the  tips  of  the  fingers,  that  are  trained  to 
the  utmost  sensitiveness,  examines  the  spinal  column  from  the  me- 
dulla oblongata  to  or  below  the  lumbar  region.  To  the  layman  it 
is  astonishiug  to  have  the  expert  tell  him  or  her  the  exact  condi- 
tion of  every  internal  organ.  The  diplomate  (the  name  given  to 
the  practitioner  of  osteopathy)  has  detected  any  pressure  upon  the 
nerves  issuing  from  the  vertebra,  spinal  curvatures  or  contractions 
of  any  kind;  in  fact,  he  has  ascertained  just  the  condition  of  the 
entire  system.  Internal  difficulties  can  be  diagnosed  without  the 
use  of  the  X-ray,  and  the  diseased  parts  relieved  through  treat- 
ment of  the  nerve  centers  governing  the  base  (?)  motor  and  sympa- 
thetic nerve  centers  of  the  system." 

How  beautiful  and  fairylike,  yet  how  childlike  and  simple ! 

We  trust  these  references  may  give  to  our  readers  a  perfect  un- 
derstanding of  the  science  of  osteopathy. 


^dbyGoOgle 


MEDICAL  JOURNAL  ADVERTISEMENTS- 

THE  Tri-Slaie  Mediccd  Journal  and  Practitioner,  in  an  editoriaf 
io  its  August  number,  bas  tbis  to  say; 

*'  We  are  grieved  to  notice  that  in  the  past  six  montbs  the 
advertisement  of  Ayer's  Cherry  Pectoral  has  appeared  in  several 
journals  which  are  supposed  to  he  conducted  for  the  regular  medi- 
cal profession.  Amoog  those  which  have  lapsed  from  the  path  of 
rectitude  we  notice  the  following:  Sfedioal  Mirror,  QaiUard'a  Med- 
ical Journal,  Iowa  Medical  Journal,  Charlotte  Medical  Journal,  Cin  • 
annaii  LancetrClinic,  Kansas  City  Medical  Index." 

What  the  future  of  medical  journalism  will  be  is  a  question 
which  only  time  can  tell.  At  the  present  outlook  the  tendency  of 
a  larfre  majority  of  the  journals  is  to  he  run  in  the  interest  of  tbe  ad- 
vertisers,  and  even  these  latter  are  not  selected.  So-called  journals 
are  even  published  which  contain  nothing  but  abstracts  and  a  re- 
hash of  other  medical  journals,  their  only  purpose  being  either  to 
get  new  books  from  publishers,  to  see  their  names  iu  print,  or  to 
make  a  dollar  or  two  by  being  the  medium  for  the  advertisement 
of  some  secret  nostrums.  Medical  journals  have  ceased  to  be  pub- 
lished for  the  profession,  but  tbey  are  "cut-throat"  advertising 
mediums  for  whatever  they  can  get.  The  policy  of  the  Atlanta 
Medical  and  Sdbqical  Journal  has  always  been  the  same — 
i.  e.,  itB  pages  are  for  the  ethical  professional  men,  and  its  rates  for 
legitimate  advertisements  are  the  same  to  all.  We  make  do  re- 
ductions. Only  in  the  last  month  have  we  refused  two  advertise- 
ments because  the  advertisers  wanted  to  dictate  their  own  terms, 
and  yet  you  can  hardly  pick  up  a  medical  journal  wherein  you  will 
not  find  these  very  advertisements,  and  it  is  proof  positive  that  the 
pages  of  those  journals  are  open  to  the  advertisers  on  the  basis  of 
"  What  will  you  pve  us?"     There  is  no  ethics  in  medical  journal- 


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-540       The  Atlanta  Medical  and  Sdrqical  Journal. 

ism.  There  are  a  few  journals  which  we  are  always  ready  to  rec- 
ognize as  standing  solely  for  the  good  of  the  profession,  but  the 
igreat  bulk  of  the  jouroals  which  are  published  never  for  a  moment 
have  the  medical  proFeeaion  at  heart.  Journals  which  make  their 
living  from  the  support  fnrnished  them  through  their  adverUsing 
pages  don't  need  the  support  of  the  profession,  but  simply  send 
complimentary  copies  all  over  the  country  and  then  represent  to 
the  advertising  agents  that  they  have  the  largest  circulation  of  auy 
journal  published.  Nowhere  in  the  world  doea  this  state  of  affairs 
eiist  except  in  the  United  States.  Whenever  you  pick  Dp  a  for- 
eign  medical  journal  you  can  rely  upon  it  that  its  pages  contain 
8ome  good  reading-matter.  Yet  we  see  no  remedy,  the  only  solu- 
tion  being  that  as  su^^ested  by  the  editorial  published  in  our  last 
issue  from  the  American  Obstetrical  and  Gynecological  Journal. 

THE  ANESTHETIST  A  SPECIALTY. 

THE  above  is  the  title  to  an  article  by  Dr.  E.  T.  Duke  in  Septem- 
ber issue  of  the  Mai-yland  Medical  JowncU.  The  article  is  ex- 
cellent througboat  and  corresponds  exactly  to  oar  own  views 
on  this  subject.  The  practice  of  assigning  the  giving  of  the  anes- 
thetic to  a  young  medical  student,  or  graduate  who  has  had  no 
practical  experience,  is  to  our  mind  absolutely  suicidal,  and  if  any- 
thing unfortunate  should  be  the  result  in  giving  the  anesthetic 
there  would  be  just  grounds  for  malpractice.  To  our  mind,  in  any 
operation  the  position  of  the  anesthetist  is  the  most  important  of 
all.  Ask  any  physician  who  is  going  to  be  operated  npon,  and  yoa 
will  Sod  that  be  wants  to  choose  his  own  anesthetist;  and  yet  phy- 
sicians don't  look  at  it  in  the  same  light  when  they  are  not  the 
patient.     Dr.  Duke  says : 

"Some  years  spent  in  the  study  and  administration  of  anesthet- 
ics, both  in  hospital  and  private  practice,  convinces  me  of  the  bet 


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Editorial.  541 

that  the  persoo  performio^  this  importaDt  duty  should  be  specially 
qualified  for  it  by  study  and  experieoce.  The  ability  of  many  good 
surgeons  counts  for  little  when  the  anesthetic  is  in  the  bands  of  an 
inexperienced  person.  This  fact  is  well  known,  but  so  far  nothing 
has  been  propOHed  to  remedy  the  difficulty, 

"A  skilled  anesthetist  in  every  city  and  town,  and  at  convenient 
points  in  the  country  districts,  would  answer  the  need.  A  theoret- 
ical knowledge  of  anesthetics  and  their  administration  is  not  suffi- 
cient. Just  as  a  surgeon  becomes  skilled  by  constant  performance 
of  sui^ical  operations  and  attentiou  to  the  little  details  of  his  work, 
so  the  anesthetist  by  daily  experience  becomes  perfect  in  his  spe- 
cialty, and  is  able  to  perceive  intuitively  the  danger  signals  of  an- 
esthetic narcosis  and  employ  means  to  avert  serious  results.  It  is 
this  skill  acquired  by  constant  practice,  coupled  with  study  and  a 
desire  to  excel,  that  constitutes  the  ideal  anesthetist. 

"  The  surgeon  knowing  the  anesthetic  is  in  skilled  hands  is  re- 
lieved of  any  responsibility  on  that  score  and  ie  thereby  enabled  to 
accomplish  better  results.  Particularly  ia  this  true  in  private  prac- 
tice, where  hospital  facililies  are  not  available  and  the  surgeon  is 
otherwise  hampered  in  his  work.  In  this  class  of  work  the  anes- 
thetist stands  uext  to  the  surgeon  in  point  of  responsibility,  and  it 
is  especially  important  that  he  should  be  qualified.  As  long  as  the 
anesthetist  is  made  to  feel  his  inferiority  so  long  will  he  remain  an 
inferior  person.  The  recognition  of  his  importance  to  patient  and 
surgeon  will  stimulate  good  men  to  remain  in  or  adopt  this  impor- 
tant branch  of  surgical  work  as  a  specialty." 


WG  note  that  a  considerable  number  of  the  medical  journals 
devote  a  lai^  amount  of  space  to  the  publication  of  queries 
and  the  answers  thereto.     They  seem  to  pose  as  authorities 
on  all  subjects,  and  to  a  most  incoherent  question  they  can  give  a 


^dbyGoogle 


642       The  Atlanta  Medical  and  Suroical  Journal. 

moBt  certain  and  positive  answer.  In  fact,  if  you  will  only  give 
ihem  tlie  color  of  the  patient's  eyes  they  will  write  out  a  most  ex- 
tended description  of  the  case  and  give  the  most  accurate  treatment 
in  every  detail.  From  the  iucrease  in  the  number  of  pages  which 
these  juurnels  exhibit  from  time  to  time,  it  loots  as  if  "all  the  fools 
are  not  yet  dead,"  but  are  blissfully  accepting  everything  that  these 
journals  tell  them.  It  is  really  amusing  sometimes  to  pick  up  one 
of  these  journals  and  notice  some  of  the  questions  asked  and  the 
answers  given.     For  instance,  we  find  the  following: 

"Query  174,  I  have  a  case  of  chronic  catarrh  involving  the 
posterior  nares  and  pharynx;  a  female,  aged  twenty-two;  family 
history  good ;  menstruates  regularly;  health  good  in  every  other 
way;  good  appetite;  a  hearty,  robust  lady.  Answer:  This  case  is 
one  of  atrophic  rhinitis  (7).  You  have  removed  all  obstruc- 
tions from  the  nares,  and  now  what  remains  is  stimulation,  in  or- 
der to  render  the  atrophied  mucous  membrane  as  active  as  possible. 
Mitchell's  soluble  gelatin  pencils  sometimes  do  remarkably  well  in 
such  cases." 

This  shows  exceedingly  close  relationship  between  the  symptoms 
given  and  the  diagnosis  made. 


THE  Times  and  Register,  of  Philadelphia,  in  an  editorial  on  the 
advantages  oflered  by  the  New  York  School  of  Clinical  Med- 
icine to  those  desiring  postgraduate  instrnctiou,  has  this  un- 
fortunate sentence:  "The  school  knows  no  creed,  code,  or  color, 
only  requiring  that  the  matriculant  be  a  graduate  in  medicine,  and 
is  earnest  in  bis  desire  to  acquire  knowledge."  We  object  to  such 
language  used  in  reference  to  a  school  which  has  such  excellent 
men  in  its  faculty.  In  our  last  issue  The  Journal  contained  an 
article  by  Br.  Valentine,  and  in  this  issue  we  present  to  our  read- 
ers a  most  excellent  paper  by  Dr.  Tbos  H.  Manley,  both  of  whom 
are  connected  with  the  Mew  York  School  of  Clinical   Medicine. 


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Editorial.  548 

The  editorial,  in  its  enthasiasm  for  the  school,  has  overstepped  the 
bounds.  To  say  that  a  school  is  governed  by  "  no  creed  "  is  taota- 
mount  to  saying  that  it  has  no  medical  ethics,  and  wheo  it  saye  it 
is  governed  by  "no  color,"  then  all  Southern  patronage  must  be 
eschewed.  It  is  unfortunate  that  the  editorial  has  made  such  a 
bold  statement,  as  we  are  sure  it  does  not  represent  the  character 
of  the  school  iu  question.  It  may  be  all  right  in  Boston  where 
the  editor  lives  for  schools  to  have  no  restrictiou  as  to  the  color  of 
their  students,  but  such  schools  could  never  be  patronized  from  the 
South. 


THBBE  is  is  not,  perhaps,  much  in  the  name  Smith  to  attract 
attention  as  a  usual  rule,  but  the  name  A,  Lapthorn  Smith, 
M.D.,  M.R.C.S.,  has  certainly  filled  the  pages  of  the  medical 
journals  for  the  last  month.  Professor  Smith  is  one  of  the  most 
brilliant  Canadian  gynecologists,  and  whenever  he  writes  you  may 
depend  upon  it  as  heiog  eminently  instructive.  Most  medical  jour- 
nals usually  have  an  announcement  to  the  effect  that  "  no  article 
will  be  allowed  to  appear  in  the  Original  Department  which  is 
published  in  any  other  medical  journal."  This  rule  has  certainly 
ceased  to  stand  in  the  case  of  Br.  Smith,  for  during  last  month  we 
were  scarcely  able  to  pick  up  a  single  medical  journal  without  our 
eyes  seeiug  the  following  under  "  Original  Articles  ":  "  Pregnancy 
Following  Ventrofixation,  with  Improvements  in  Technique." 
This  title  has  become  almost  as  familiar  as  our  morning  paper. 

Pott's    disease  of  the  spiue,  or,  in  common  parlance,  what  is 
known  as  "humpback,"  has  in  the  last  few   years  received  a 
marked  impetus  in  the  way  of  treatment.     Forcible  reduction 
under  an  anesthetic,  as  first  advocated  and  practiced  by  Chipault 
and  Calftt,  of  Paris,  has  come  to  he  an  operation  of  recognized 
value.     It  is  of  course  especially  applicable  in  young  children, 


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544       The  Atlanta  Medical  and  Sijrgical  Jourmal. 

where  the  vertebral  structures  are  more  pliant  tliao  at  a  later  age. 
The  cases  of  course  have  their  limitatiou.  Dr.  Peckham,  in  an 
article  io  the  September  issue  of  the  Archives  of  Pediatriet,  has 
this  to  say  in  discussing  the  subject:  "As  to  the  cases  suitable  for 
this  operation,  it  can  easily  be  demonstrated,  without  ether,  by 
means  of  exteosioa  and  direct  pressure,  gently  applied,  whether  or 
not  there  is  any  yielding.  If  there  is,  it  may  be  inferred  that  the 
deformity  is  susceptible  to  treatment.  Where  there  is  firm  anchy- 
losis I  should  consider  forcible  correction  contraindicated."  This 
seems  to  he  the  indications  and  contraindications  'o  a  outshell.  It 
is  certaiuly  pleasant  to  know  that  there  is  a  ch&oce  of  overcoming 
the  large  number  of  "humpbacks"  in  children. 


THE  Medical  Fortnightly  for  September  has  printed  on  its  front 
cover-piece  Georgia  Edition.  We  have  not  as  yet  found  out 
what  these  two  words  signify.  Our  first  impression,  upon 
seeing  the  words,  was,  that  the  contents  were  filled  with  articles 
written  by  Geoi^ia  physicians;  or  that  it  was  a  climatology  edition, 
and  gave  the  special  geographic  and  topographic  features  of  the 
Empire  State  of  the  South,  showing  its  advantages  as  a  winter 
climate;  or  perhaps  that  it  gave  biographical  sketches  of  some  of 
the  noted  physicians  of  Georgia.  We  have  looked  carefully 
through  its  pages,  but  nowhere  can  we  find  a  reference  to  this  State. 
It  may  perhaps  have  been  a  typographical  error  on  the  part  of 
the  printer  that  the  word  Georgia  was  printed,  hence  we  acknowl- 
edge our  ignorance  in  seeing  any  connection  between  the  two. 
However,  Georgians  are  always  glad  to  read  a  good  medical  jour- 
nal like  the  Medical  Fortnightly. 


THE  Kentucky  School  of  Medicine  seems  about  to  he  swamped 
by  internal  changes.     There  exists,  or  at  least  did  exist,  two 
rival  factions  in  the  medical  faculty,  and  now  comes  the  news 
of  a  decided  rupture.     At  a  recent  meeting  of  the  Board  of  Regents, 


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Editorial.  545 

a  majority  of  the  Board  declared  vacaatthe  chairs  of  Dra.  Kelly  and 
Woody,  and  elected  Wartheo,  Dean,  and  Dr.  Orendorf,  Secretary, 
although  it  was  claimed  that  Dr.  Woody  had  previously  been 
elected  Dean,  aod  Dr.  Marvia  Secretary.  An  iojunction  has  been 
issued  against  Dr.  Warthen  to  restrain  him  from  usiug  the  office 
of  Deau,  and  the  decision  of  the  court  is  yet  to  be  heard  from. 
In  the  meaotime  Dr.  Jos.  M.  Matthews  has  resigned  from  the  Ken- 
tucky School  of  Medicine  and  has  been  elected  to  the  Faculty 
of  the  Hospital  College  of  Medicine. 


DK.  CoLEV,  of  New  York,  thus  speaks  of  the  operation  for  her- 
nia iu  children:  "I  believe  it  to  he  a  good  rule  never  to  ad- 
vise operation  in  children  until  a  truss  baa  been  satisfactorily 
tried  for  a  reasonable  time — e.g.,  one  or  two  years — without  benefit. 
There  are,  however,  important  exceptions  to  this  rule:  (l)  In  fem- 
oral hernia  operation  may  be  at  once  advised,  for  the  reason  that 
the  chances  of  cure  by  means  of  a  truss  are  too  slight  to  be  con- 
sidered. (2)  Irreducible  or  adherent  omentum  (rare  in  children) 
and  reducible  hydrocele  may  furnish  sufficient  reason  for  early  op- 
erative interference.  (3)  There  are,  furthermore,  a  number  of  cases, 
especially  in  dispensary  practice,  in  which  the  rupture  cannot  be 
satisfactorily  retained  on  account  of  insufficient  care  on  the  part  of 
the  parents,  and  such  cases  may  with  profit  be  subjected  to  immediate 
operation." 


WE  have  received   the  following  notice  through  The  Medical 
and  Surgical  BuUetin,  of  Nashville: 

"At  the  September  meeting  of  the  Medical  Department 
of  the  University  of  Nashville,  the  faculty  unanimously  decided 
that  all  students  matriculating  after  the  present  session  of  1898-99 
shall  be  required  to  attend  four  full  courses  of  lectures  before  being 
permitted  to  apply  for  graduation." 


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-546       The  Atlanta  Medical  and  Sqroical  Jocknal. 

A  TTEMTION  ie  called  to  tbe  meeting  of  the  Southero  Surgical  and 
Xl.  Gyaecological  Aasociation,  which  takee  place  in  Memphis, 
TeoD.,  on  the  8th,  9th  and  10th.  This  is  one  of  the  best 
associatioDs  in  the  United  States,  and  iis  work  is  always  of  the 
highest  order.  Its  Secretary,  Dr.  W.  K  B.  Davis,  informs  us  that 
this  promises  to  be  one  of  the  most  successful  sessions  in  the  his> 
tory  of  the  associatioo.  Members  of  the  medical  profession  are 
earnestly  and  cordially  invited  to  attend. 


THE  State  Board  of  Medical  Examiners  of  this  State  will  meet 
in  the  Senate  Chamber  of  tbe  State  Capitol  at  9  a.m.,  Octo- 
ber 11,  1898.     Those  desiring  admission  to  the  practice  of 
medicine  in  (his  State  can  then  have  an  opportunity  of  standing  the 
required  examination.     This  journal  will  print  the  questions  for 
that  examination  in  the  November  issue. 


Yellow  Feveb  in  Cuba. — The  reports,  without  exception, 
seem  to  show  that  what  yellow  fever  there  may  be  in  and  about 
Santiago  is  well  in  hand,  and,  on  the  whole,  is  diminishing.  If 
firesent  conditions  are  continued,  it  Is  tafe  to  say  that  this  much 
talked  of  menace  to  our  troops  has  been  greatly  exaggerated.  Gieo- 
«ral  Sbafler  reports  six  deaths  from  yellow  fever  iu  the  hospital  at 
Sibouey,  but  none  from  the  front.  About  1,500  are  sick  with 
fever,  but  of  these  only  about  150  have  yellow  fever.  The  sugges- 
tion which  has  been  made  of  at  once  improving  the  drainage  of 
Santiago  should  undoubtedly  be  carried  out,  whatever  the  general 
health  of  the  inhabitants  may  be.  Precautions  of  tbe  most  rigid 
sort  are  being  taken  to  prevent  tbe  introduction  of  yellow  fever 
into  our  southern  ports.  The  suspicion  of  its  appearance  at  Fort 
Monroe  has  not  yet  been  confirmed,  but  a  quarantine  will  be  at 
Once  established  should  the  fever  actually  break  out.  It  is  said 
that  quarantine  officials  have  refused  to  permit  wounded  soldiers  to 
land  at  Old  Point  Comfort  for  fear  of  yellow  fever. 


^dbyGoOgle 


NEWS  AND  NOTES. 


Db.  E.  W.  Boyd  has  returned  from  a  year's  study  of  general 
nedicioe  and  surgery  in  London,  and  is  now  located  at  128  South 
Pryor  street. 


The  Atlanta  Medical  College  aud  the  Southern  Medical  College 
of  Atlanta,  Ga.,  have  heen  consolidated  under  the  name  of  The 
Atlanta  College  of  Physicians  and  Surgeons.  Dr.  W.  8.  Kendrick 
is  Dean  of  the  school.  We  wish  it  abundant  success,  and  there  is 
much  territory  to  vhich  it  is  justly  entitled.  There  is  no  reason 
why  Atlanta  should  not  be  a  great  medical  center,  and  many  good 
reasons  why  it  should  be  selected  for  the  training  of  physicians 
intending  to  practice  in  our  Southern  country. — Soulhem  Clinic. 


The  Journal  of  the  Americnn  Medical  Associafion  reports  that 
Dr.  Benjamin  F.  Wright,  of  Youngs,  Ga.,  died  on  August  10th. 


Dr.  Richard  J.  Nunn,  of  Savannah,  has  been  elected  Treas- 
urer again  of  the  American  Electro-Therapeutic  Association.  This 
is  an  office  which  has  been  filled  by  Dr.  Kunn  for  several  years. 


The  monument  to  Charcot,  the  celebrated  Parisian  neurologist, 
will  be  formally  unveiled  in  the  Salipdtrifire  in  Paris  on  October 
23d. 


Pbofessob  Wh.  H.  Welch  has  resigned  as  Dean  of  the  Johns 
Hopkins  University,  and  Professor  Osier  will  fill  this  position  in 
the  future, 


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648       The  Atlanta  Medical  and  Surgical  Jocrhal. 

Dr.  L.  W.  Glazebbook,  of  WasbiDgton,  D.  C,  has  reported  the 
death  of  a  child  four  and  a  half  years  old  due  to  the  use  of  hromu- 
form  ID  whooping-cough. 


A  MONUMENT  will  he  uDveiled  iu  October  at  Copenhagen  in 
honor  of  Wilhelm  Meyer,  the  one  man  who  brought  before  the 
profession  the  pathological  importauce  of  the  presence  of  adenoid 
vegetations  in  the  nasopharynx. 


Dr.  Duncan,  of  the  Twenty-second  Kansas  Volunteers,  who 
ghoullshly  desecrated  the  grave  of  a  Confederate  soldier  near  Camp 
Alger,  has  been  courtmartialed  and  sentenced  to  five  years'  im- 
prisooment.     We  think  the  penalty  was  too  light. 


Teacher:  "I  hear  your  mother  has  scarlet  fever.  Yoa  must 
not  come  to  school  till  she  is  well,  as  you  might  get  the  disease  and 
give  it  to  the  other  children." 

Tommy:  "Oh,  you  needn't  worry,  teacher.  She  is  my  step- 
mother and  has  never  yet  given  me  anything." — Fliegende  BlaeUer. 

A  NEW  medical  school  has  opened  in  Kansas  City,  Mo.,  known 
as  the  Columbian  Medical  School.  The  itfeijica/ Tntfex  says:  "We 
believe  that  with  the  addition  of  this  school  Kansas  City  outranks 
St.  Louis  and  every  other  city  in  the  world  in  the  number  of  med- 
ical colleges,  regular  and  irregular,  in  proportion  to  its  popula- 
tion." 


Governor  Foster,  of  Louisiana,  has  appointed  the  following 
physicians  to  constitute  the  State  Board  of  Health :  Dr.  Emnnd 
Souchon,  New  Orleans,  President ;  Drs.  Hampden  S.  Lewis  and 
Chas.  A.  Gaudet,  New  Orleans;  J.  C.  Egan,  Shreveport;  T.  T. 
Tarleton,  Grand  Coteau ;  R.  L.  Randolph,  Alexandria,  and  W.  Gv 
Owen,  Whitecastle. 


,„i,z.d  by  Google 


Nbw8  and  Notes.  549 

Women  Honobed. — An  Italian  woraao,  SigDorina  Esther  Bo- 
Domi,  bas  obtained  at  tbe  University  of  Genoa  the  first  doctorate 
in  medicine  granted  to  a  female  student,  in  modern  times  at  least, 
in  Italy.  Another  woman,  named  Dr.  Katharioa  van  Tusscben- 
broek,  has  been  appointed  to  the  professorship  of  gynecology  in  the 
University  of  Utrecht. 


Db.  R.  C.  M.  Page,  who  died  a  few  months  ago  in  New  York, 
and  who  was  so  well  known  at  the  New  York  Polyclinic  as  a 
teacher,  left  a  very  excellent  medical  library.  This  has  been  pre- 
sented to  tbe  University  of  Virginia  by  Mrs.  Page.  Dr.  Page  was 
«ducated  at  this  latter  institution,  and  the  name  belongs  to  one  of 
tbe  oldest  families  in  tbe  Old  Dominion. 


"I  AH  glad  to  find  you  better,"  said  John  Hunter,  the  famous 
su^eon,  to  Foote,  the  equally  famous  actor,  one  morning.  "You 
followed  my  prescription,  of  course?"  "Indeed  I  did  not,  doc- 
tor," replied  Sam,  "for  if  I  had  done  so  I  would  have  broken  my 
neck."  "Broken  your  neck!"  exclaimed  Hunter,  in  surprise. 
"Yes,"  said  Foote,  "for  I  threw  your  prescription  out  of  a  three* 
story  window," 

Thbee  deaths  and  thirty-two  serious  cases  of  illness  werfe  re- 
cently caused  by  tbe  eating  of  ice-cream  at  a  summer  boarding- 
house  at  Greenfield,  in  Ulster  canuty,  New  York.  An  investiga- 
tion is  in  progress,  but  it  has  not  yet  been  determined  whether  tbe 
trouble  was  caused  by  ptomaines  or  by  poisonous  matter  in  the 
lemon  extract  with  which  the  ice-cream  was  flavored.  It  is  stated 
that  the  extract  was  purchased  from  a  strolling  peddler. 


Dfi.  Pbatt  and  the  Chicago  Academy  of  Medicine. — Dr. 
James  G.  Kiernan,  the  Secretary  of  the  Chicago  Academy  of  Med- 
icine, announces  over  his  signature  that  tbe  recently  issued  cata- 


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550       The  Atlanta  Medical  and  Surqical  Journal. 

logue  of  the  Chicago  College  of  "  Oeteopathy  "  coataimt  tbe  asser- 
tion that  the  "  orificialist  siirgeoD,"  E.  H.  Pratt,  ooe  of  its  faculty, 
is  a  member  of  the  Chicago  Academy  of  Mediciae.  Dr.  Kiernan 
says  that  he  has  never  been  a  member,  nor  is  be  eligible. — Med. 
News. 

Americans  Killed  in  Battle. — The  official  records  of  the 
War  Department,  as  &r  as  completed  September  6th,  show  that 
during  the  war  with  Spain  there  were  33  officers  and  231  enlisted 
men  of  the  army  killed  in  battle,  a  total  of  264.  This  number 
includes  all  the  lives  lost  in  battle  in  the  Philippines  as  well  as 
those  in  Cuba  and  Porto  Rico.  The  percentage  of  officers  killed 
is  strikingly  lai^e,  and  is  said  to  be  unprecedented  in  the  battles 
of  the  world, — Med.  News. 


The  Denver  Meeting  of  the  American  Medical  Asso- 
ciation.— The  generous  hospitality  accorded  tbe  members  of  the 
Association  and  invited  guests  at  the  meeting  in  Denver  will  be 
long  remembered  by  those  who  accepted  it.  It  is  gratifyiog  to 
know  that  after  all  bills,  including  the  subscription  of  f  2,000  to 
the  Rush  Mouotaio  fund,  had  been  paid  by  the  local  committee  of 
arrangements,  something  over  f  4,000  remained  in  the  hands  of  the 
committee  and  was  returned  pro  rata  to  the  subscribers  to  the  en- 
tertainment.— ifed.  Neips. 


Mortality  from  Heat. — The  extreme  heat  of  the  last  two 
days  of  August  and  first  four  days  of  September  caused  a  consider- 
able increase  in  the  mortality  of  the  city.  On  September  2d  there 
were  21  deaths  from  the  direct  effects  of  the  heat  reported,  and  on 
September  3d  no  less  than  64,  by  far  the  largest  record  of  any  one 
day  during  the  present  season  ;  45  of  the  deaths  occurred  in  Man- 
hattan Borough,  17  in  Brooklyn,  and  2  in  Queens.     On  Sunday, 


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News  and  Notes.  551 

the  4th,  there  were  almost  ae  many  fatalities — 60 — and  the  death- 
list  would  no  doubt  have  been  still  greater  if  it  had  been  a  work~ 
ing  day.  One  of  the  victinas  of  sunstroke  was  a  member  of  the 
Seventy-first  Regiment,  New  York  Volunteers,  now  on  furlough, 
who  had  safely  passed  through  the  tropical  campaign  of  Santiago. 
It  must  be  understood  that  these  reports  represent  only  a  part  of' 
the  actual  mortality  from  the  beat,  as  tbey  do  not  include  any  casea 
regularly  attended  by  physicians,  but  only  those  coming  under  the- 
notice  of  the  police,  when  the  patients  actually  died  on  the  street 
or  shortly  after  their  removal  to  hospitals. — Med.  Neiea,  N.  V. 


The  Lanceio(  Julyl6  prints  an  amusing  example  of  the  conver- 
sation that  passed  between  the  French  statistical  department,  anx- 
ious to  obtain  definite  information  on  certain  matters  from  the- 
Turkisb  provinces.  The  Pasha  of  Damascus  returned  his  list  with- 
the  following  answers: 

"  Question :  What  is  the  death-rate  per  thousand  in  your  princi- 
pal city?  Answer:  In  Damascus  it  is  the  will  of  Allah  that  all 
must  die;  some  die  old,  some  young. 

"Question:  What  is  the  annual  number  of  births?  Answer r 
We  don't  know ;  only  God  alone  can  say. 

"Question  :  Are  the  supplies  of  drinking-water  sufficient  and  of 
good  quality  ?  Answer :  From  the  remotest  period  no  one  in  Da- 
mascns  has  ever  died  of  thirst. 

"  Question  :  General  remarks  on  the  hygienic  condition  of  youp- 
city.  Answer:  Since  Allah  sent  us  Mohammed  his  prophet  to  purg& 
the  world  with  fire  and  sword  there  has  been  a  vast  improvement.. 
But  there  still  remains  much  to  do.  Eeverywhere  is  opportunity 
to  help  and  (o  reform.  And  now,  my  lamb  of  the  West,  cea8& 
your  questioning,  which  can  do  no  good  either  to  you  or  to  any  one- 
else.  Man  should  not  bother  himself  about  matters  which  concern 
only  God.     Salem  Aleikura  I " 

Tht  Laned  adds :  "  It  is  clear  that  the  doctrine  held  by  the 
Cbristian  that  God  helps  those  who  help  themselves  finds  no  favor 
in  the  municipal  government  of  Damascus." 


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552       Tee  Atlanta  Mbdical  and  Suiiqical  Joubnal. 

Death  in  Crape. — "Many  a  woman  has  been  laid  io  her 
coffin  by  the  weariog  of  crape/'  writes  a  phyBiciaa.  "It  is  a  sin 
to  do  or  wear  anytbiDg  that  hurts  the  health,  and  therefore  I  think 
it  positively  sinful  for  women  to  wear  mourning.  Even  plain 
black  is  not  wholesome.  It  is  aBtooishiog  that  this  custom  has  not 
been  abolished,  for  women  have  grown  very  sensible  in  the  matter 
of  dress.  It  would  have  been  aboliBhed  long  ago  were  it  not  for 
the  fact  that  woman  cares  more  for  what  other  people  say  than  she 
does  for  herself.  For  example,  if  a  woman's  husband  dies  she 
would  not  dare  to  go  without  along  crape  veil  and  a  crape-trimmed 
gown,  or  the  world  would  say  she  was  glad  to  get  rid  of  him; 
after  wearing  it  a  while  she  is  not  brave  enough  to  leave  it  off,  for 
she  knows  the  same  relentless  world  will  say  that  she  is  looking 
for  number  two.  Women  claim  that  mourning  is  a  protection.  If 
oue  is  really  grief-stricken  one's  own  feelings  are  sufficient  protec- 
tion against  society,  and  for  my  part  I  believe  that  crape  and  other 
mourning  habiliments  are  often  directly  responsible  for  bad  com- 
plexion, bad  eyes,  bad  digestion,  and  bad  temper." — Dietetic  and 
Hygienic  Gazette. 

The  Unsung  Heroes. — Dewey  and  Bagley  and  Hobson  and 
Schley  and  Blue  and  Neville  and  Shaw,  the  heroes  of  Guatanamo, 
Capron  and  Shafter,  and  all  the  long  list  of  men  who  have  dis- 
tinguished themselves  in  this  war,  officers  and  men,  ar^  deserving 
of  all  the  generous  praise  that  has  been  bestowed  upon  them  for 
the  brave  deeds  they  have  done  and  for  their  unfaltering  devotion 
to  duty.  Their  example  is  of  inestimable  value  for  its  influence 
upon  their  fellow-citizens,  both  in  civil  and  military  life.  They  are 
a  source  of  inspiration  which  tends  to  a  higher  order  of  patriotism 
in  all  the  walks  of  life  and  all  the  duties  of  the  citizen.  The  patri- 
otic uplift  is  discoverable  to  the  most  distant  part  of  the  country, 
and  in  the  remotest  hamlet.  It  manifests  itself  in  greater  love  for 
the  flag,  greater  i)ride  in  citizenship,  greater  fidelity  to  civic  duties. 
War  is  a  great  character-maker.  The  heroes  of  the  field  aud  of  the 
wave  are  its  exemplars,  and  under  the  spell  of  hero-worship  men 
grow  better.  All  honor  to  the  Deweys  and  Hobsons  and  the  rest 
of  them.     Yet  there  is  one  class  of  heroes  whose  praises  are  seldom 


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Nbws  and  Noths.  553 

aang  aod  whose  patriotio  sacrifices  receive  but  slight  reoognitioo  in 
the  dispatches  from  the  front.  But  they  are  there,  ezpoeed  in 
greater  or  leas  degree  to  the  fortunes  of  war,  doing  their  duty  witli- 
out  hope  of  acknowledgment,  and  .performing  their  daily  and 
nightly  taeks  tvith  a  devotion  that  knows  no  flagging,  and  without 
the  spar  and  the  inepiraUon  of  the  cavalry  charge,  or  the  shriek 
and  crash  of  the  flying  shells  on  board  the  man-of-war.  The  sur- 
geon's duties  on  the  field  and  in  the  hospital  tent  preclude  the  in- 
centive of  excitement,  and  are  attended  by  none  of  the  dramatic 
action  of  war.  No  matter  what  the  condtttons,  whether  for  the 
time  in  comparative  safety  or  \rhen  his  scene  of  operations  becomes 
the  center  of  the  hottest  fire,  as  sometimes  happens,  he  stands  to 
bis  poet,  offering  his  own  that  he  may  save  the  life  of  another. 
While  remembering  the  heroes  of  the  saber  and  the  gun,  do  not 
foiget  the  heroes  of  the  scalpel  and  the  probe.  They  are  never 
court-martialed  for  cowardice.  And  no  wonder.  Bravery  in  the 
face  of  danger  is  no  new  thing  for  them.  The  volunteer  surgeon 
has  not  learned  courage  and  ceased  to  be  afraid  because  of  any 
"baptism  of  fire."  He  has  faced  danger  before.  The  faithful  and 
skillful  doctor  is  always  in  the  thickest  of  the  fight  in  the  battle  of 
life.  He  has  learned  all  there  is  to  be  learned  of  bravery  and  self- 
sacrifice  in  the  midst  of  the  deadly  epidemic,  and  in  the  panic  of 
pestilence  and  plague  he  acquired  the  courage  which  makes  a  hero 
of  him  now.  God  bless  the  doctors!  They  are  the  salt  of  the 
earth.  No  class  of  men  see  so  much  of  the  suCTeriDg  and  misery 
of  life ;  none  do  so  much  to  relieve  distress  without  hope  of  reward 
in  this  world.  And  the  doctors  at  the  front — Congress  passes  no 
resolution  of  thanks  to  them,  and  presidents  and  public  do  not  ap- 
plaud their  fidelity  to  duty.  Why,  then,  are  they  there?  What 
glory  awaits  their  efforts?  Their  only  reward  is  the  satisfaction  of 
duty  done;  the  approval  of  their  own  consciences  that  their  skill 
and  experience  and  their  limit  of  endurance  have  been  spent  with- 
out hesitation  in  the  service  of  their  country  and  in  behalf  of 
their  fellow  men.  Bemember  the  men,  give  praise  and  honor  to 
sacrifice  and  courage  and  steadfastness  in  the  ftce  of  the  enemy, 
and   remember    the    unsung    heroes  too. — MiriTieapolia   Journal, 


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554       The  Atlanta  Medical  and  Surgical  Joorkal. 

The  folloiring  ie  the  official  program  of  the  meeting  of  the  Tri- 
State  Medical  Society  of  Alabama,  Georgia,  and  Tenneseee,  which 
will  be  held  id  Birmingham,  Ala.,  on  October  25,  26,  27,  1898: 

President's  Address — J.  A.  Gorans,  Alexander  City,  Ala. 

Early  Diagnosis  of  Cancer  of  the  Uterus — Thos.  S,  Cullen,  Bal- 
timore, Md. 

Acute  Anterior  Poliomyelitis — E.  D.  Bonduraot,  Mobile,  Ala. 

A  Case  of  Complete  Obstruction  of  the  Common  Bile  Duct  by 
a  Floaticg  Gall-stone.  Operation.  Immediate  Recovery  and 
Restoration  to  Perfect  Health.  A  Short  Study  of  Gall-stones  io 
the  Common  Ducts — W.  H.  Hudson,  LaFayette,  Ala. 

A  Simple  Operation  for  Hemorrhoids  without  Injections,  Liga- 
ture, Clamp,  Cautery,  or  Cruehing — R.  R.  Eime,  Atlanta,  Ga. 

Total  Amputation  of  the  Penis  so  that  the  Patient  Can  Urinate 
Normally — H.  M.  Hunter,  Union  Springs,  Ala. 

Functional  Impotence — W.  H.  Mangum,  Geoi^iaDa,  Ala. 

Extirpation  of  the  Pancreas — H.  Berlin,  Chattanooga. 

Two  Cases  of  Surgery — S.  W.  Purifoy,  Lowndeaboro,  Ala. 

Fracture  of  the  Spine.  Presentation  of  Two  Cases — B.  G.  Cope- 
laud,  Birmingham. 

The  Treatment  of  Intestinal  Obstruction  and  Constipation  by 
Electric  Injections — R.  P.  Johnson,  Oak  Park,  HI. 

A  Case  of  Dislocation  of  the  Humerus  with  Fracture  of  the  Sur- 
gical Neck — Geo.  S.  Brown,  Birmingham. 

Conservative  Gynecology  per  Rational  Medication — R.  H.  Hayes, 
Union  Springs,  Ala. 

Some  Interesting  Cases  of  Laparotomy — C,  Hamilton,  Rome,  Ga. 

Ectopic  Gestation — W.  E,  B,  Davis,  Birmingham. 

A  Few  Remarks  on  the  Treatment  of  Puerperal  Fever,  with 
Illustrative  Cases — J.  C.  Johnson,  Glen  Allen,  Ala. 

Puerjieral  Septicemia — Robt.  B.  Stapletou,  Dothan,  Ala. 

Supravaginal,  viz..  Vaginal  Hysterectomy — Clement  Ritter, 
Selma,  Ala. 

Recent  Advances  in  the  Treatmout  of  Gonorrhea — F.  Goodwin 
Dnbose,  Florence,  Ala. 


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News  and  Notes.  555 

Modern  Treatmeot  of  Corneal  Opacities,  with  Report  of  Cases 
— M.  li.  Heffelfinger,  Huiitaville,  Ala. 

Surgical  Treatment  of  Trachoma — S.  Eirkpatrick,  Selma,  Ala. 

Keratitis — A.  A.  Greene,  Aoniston,  Ala. 

Purulent  Ophthalmia:  A  New  Method  of  Treatment — Frank 
"Trester  Smith,  Chattanooga. 

Syphilis  of  the  Nose — S.  L.  Ledbetter,  Birmingham. 

Fevers  of  Alabama — Charles  McAlpine  Watson,  Florence,  Ala. 

Color  Blindness — H.  S.  Persons,  Montgomery,  Ala. 

Some  of  the  Emergencies  of  the  Lying-in  State — David  A.  Mor- 
ton, Boaz,  Ala. 

Some  Fevers  of  St.  Clair  County,  Ala. — Eugene  P.  Cason,  itag- 
laud,  Ala. 

Continued  Malarial  Fever  of  Southeast  Alabama — Wm.  K. 
Belcher,  Daleville,  Ala. 

Some  Malarial  Manifestations — J.  N,  Pearson,  Florence,  Ala. 

Typhoid  Fever — E.  Eugene  Mitchell,  Oneonta,  Ala, 

Typhoid  Fever — E.  A.  Mathews,  Clanton,  Ala. 

Typhoid  Fever — J.  D.  Gibson,  Birmingham. 

Typhoid  Fever— S.  W.  Welch,  Alpine,  Ala. 

Typhoid  Fever,  Report  of  Cases — C.  L.  Guice,  Harris,  Ala. 

Some  Siiggestious  in  the  Treatraeot  of  Typhoid  Fever — J.  C, 
EeGraad,  Birmingham. 

Diphtheria— H.  L.  Appleton,  Cedar  Bluff,  Ala. 

Scarlet  Fever  and  Its  Sequelse — John  Thomas  Chapman, 
Selma,  Ala. 

Smallpox — Frank  Prince,  Bessemer,  Ala. 

Lobar  Pneumonia,  with  Treatment — J.  U.  Eay,  Jr.,  Blocton,  Ala 

Chorea — S.  W.  Fain,  Chattanooga. 

Organic  Disease  of  Mitral  Valve — J,  T.  Seay,  Fern  Bank,  Ala. 

A  Case  of  Addison's  Disease  Treated  with  Adrenal  Extract — H.  A. 
Moody,  Bailey  Springs,  Ala. 

Disobedience  to  the  Mandates  of  Xature  is  Treachery  of  a  Sui- 
-cidal  Tendency — P.  (J.  Trent,  Sr.,  Roanoke,  Ala. 

Suggestions  in  the  Healing  Art — E.  T.  Camp,  Gadsden,  Ala. 

Animal  Heat — W.  S.  Edwards,  Gadsden,  Ala. 


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556       The  Atlanta  Medical  asd  SuftoicAL  Journal. 

Eye  Affectiooe  in  General  Diseases — J.  L.  Minor,  Mempbia,  Tepn. 

Membranous  Colitis — Louis  Wm,  Johnston,  Tuskegee,  Ala. 

The  TreatmeDt  of  Tj-phoid  Fever — Julius  Jones,  Rockfork,  AJa. 

Curettage  of  the  Uterus — John  G.  Clay,  Thotnp80D'sStatioD,TeDii. 

Puerperal  Eclampsia — Thos.  P.  Moore,  Linwood,  Ala. 

Laparotomy  for  Gunshot  Wound  of  the  Abdomen;  Report  of 
Case,  with  Unique  Features — R.  E.  Fort,  Nashville,  Tenn. 

Peritonitis;  Report  of  a  Case — D.  8.  Middleton,  Rising  Fawn,  Ga. 

The  Treatment  of  Burns  on  Modern  Surgioal  Principles— C.  B. 
Jackaon,  Horse  Creek,  Ala. 

A  Few  Remarks  on  Bone  Surgery — M.  Goltman,  Memphis,  Tenn.. 

Neurasthenia  and  Its  Treatment — Cbas.  F.  J.  Smith,  Atlanta,  Ga, 

Abortion — Emmett  K.  Moon,  Bridgeport,  Ala. 

Communal  Hygiene — Ernest  B.  Sangree,  Nashville,  Tenn. 

The  Management  of  the  Puerperal  State — C.  C.  Jones,  Fast 
'  Lake,  Ala. 

Perfection  of  the  Aseptic  Technique — W.  F,  Westmoreland^ 
Atlanta,  Ga. 

Hypodermic   Medication — E.  P.  Nicholson,  Valley  Head,  Ala. 

Syphilis  of  the  Nervous  System,  with  Report  of  Cases— W.  J. 
Love,  LaFayette,  Ala. 

Diphtheria — W.  D,  Travis,  Covington,  Ga. 

Smallpox  in  Alabama — G.  B.  Wimberly,  Reform,  Ala. 

A  Rational  Treatment  for  Typhoid  Fever — Gaius  R.  Johnson, 
Marion  Ala. 

Typhoid  Fever — G.  Manning  Ellis,  Chattanooga. 

Abnormal  Cardiac  Phenomena :  Their  Differentiation  and  Signifi- 
cance— R.  M.  Cunningham,  Pratt  City,  Ala, 

The  Treatment  of  Affections  of  the  Singing  Voice — Richmond 
McKinney,  Memphis,  Tenn. 

Malaria— W.  H.  Bell,  Oxford,  Ala. 

Fever  Indigenous  to  the  Cumberland  Plateau— N.  L.  French,, 
Wartburg,  Tenn. 


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BOOK  REVIEWS,    PAMPHLETS,   EXCfiANQES. 


BOOK  REVIEWS. 


A  System  of  Medicine.  By  maoy. writers-  Edited  by  Thomas 
Clifford  Allbutt,  M.A.,  M.D.,  LL.D.,  F.E.aP.,  P.R.S.,  F.L.S., 
F.S.A.,  R«gius  Professor  of  Physic  iu  the  University  of  Cam- 
bridge,  Fellow  of  Gonville  and  Caius  College.  Published  by 
the  MacMillan  Company,  Fiflh  avenue,  New  York.  pp.  lOSS- 
Price  ?5.00. 

The  sixth  volume  of  this  most  excellent  system  disoaesee  dis- 
•eases  of  the  respiratory  organs,  of  the  pleura,  and  of  the  circula- 
tory system.  Dr.  Wm.  Ewart  ably  treats  of  the  various  forms  of 
bronchitis  and  bronchiectasis.  The  section  on  pneumonia  by  Dr. 
Pye-Smitb  is  interesting  reading,  especially  perhaps  the  historical 
sketch  and  the  pages  devoted  to  treatment.  The  author  is  one  of 
those  who  have  been  disappointed  in  the  use  of  digitalis.  To  Dr. 
Percy  Kidd  has  been  given  the  very  important  subject  of  phthisis. 
He  emphasizes  the  importance  of  energetic  endeavors  towards  pre- 
vention of  infection ;  gives  full  directions  for  the  treatment  of  each 
symptom ;  and,  the  subject  of  special  climates  having  already  been 
considered  in  another  volume,  refers  to  the  now  generally  recog- 
nized fact  that  fresh  air  is  the  desideratum,  rather  than  any  special 
climatic  feature.  The  other  respiratory  diseases  are  discussed  by 
Drs.  Arlidge,  RoUeston,  Kiogston  Fowler  aud  Goodhart.  The 
section  on  the  pleura,  by  Drs.  Gee,  Herringham  and  Finlay,  is 
especially  to  be  commended  for  study,  owing  to  the  undoubted  fkct 
that  these  are  not  infrequently  overlooked  or  incorrectly  diagnosed. 
The  Diseases  of  the  Circulatory  System  are  not  complete  in  this 
-volume,  but  the  section  includes  the  various  blood  diseases,  by 
Drs.  Michael  Foster,  Moockton  Copemau,  Sherington,  Allbutt, 
Sydfaey  Coupland,  West,  Wiekham  Legg,  Thomson,  S.  MacKenzie, 
Johnson-Smith,  Cbeadle,  Muir  and  Dickinson,  whose  names  are 


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558       The  Atlanta  Medical  and  Surgical  Jocrnal. 

sufficieot  guaraotee  for  the  excellence  of  their  work.  Of  heart 
diseaEeB  we  have  Congenital  Malformations  by  Dr.  L.  Uumphryr 
Diseases-  of  the  Pericardium  by  Dr.  F.  T.  Roberts,  Funotional 
Dieorders,  Mechanical  Strain,  and  Aortic  Valvular  Diseases  by 
the  Editor;  Injuries  by  the  Electric  Current  by  Dr.  T.  Oliver,. 
Endocarditis  by  Dr.  Dreschfield,  Diseases  of  the  Myocardium  by 
Dr.  Douglas  Powell,  and  Diseases  of  the  Mitral  Valve  by  Dr.. 
Sansom.  This  volume  is  in  keeping  with  the  others  to  which  we 
have  already  drawn  attention  as  an  exceedingly  valuable  series  for 
all  who  desire  to  profit  by  the  experience  and  judgment  of  many 
of  the  best  men  of  the  day.  A.  w.  s. 


Manual  of  Skin  Diseases.  With  Special  Reference  to  Diag^ 
nosis  and  Treatment,  For  the  use  of  Students  and  General 
Practitioners.  By  W.  A.  Hardaway,  M.D.,  Professor  of 
Diseases  of  the  Skin  in  the  Missouri  Medical  College,  St.  Louis. 
Second  edition,  entirely  rewritten  and  much  enlarged.  In  one 
handsome  12mo  volume  of  560  pages,  with  40  engravings  and 
2  colored  plates.  Cloth,  f2.25  net.  Lea  Brothers  &  Co.^ 
Publishers,  Philadelphia  and  New  York. 

This  is  a  smaller  work  than  the  majority  of  books  on  the  sub- 
ject, as  is  to  be  expected  of  a  "  manual."  Kecessarily  the  test  is- 
condensed,  only  the  essentials  being  given.  The  author  goes  right 
into  his  subject  with  the  first  line,  his  "introductory  observa- 
tions" dealing  with  general  principles — as  symptoms,  diagnosis,^ 
etc.  In  the  description  of  primary  and  secondary  lesions  he  in- 
dicates the  diseases  which  bear  one  or  more  of  these  lesions  as  a 
constant  feature,  or,  in  other  words,  shows  that  certain  lesions  are 
characteristic  of  certain  diseases.  Under  "Treatment"  he  speaks  of 
the  " fanaiical"  taking  of  Turkish  and  like  batba  as  likely  to  set 
np  mischief.  He  puts  oatmeal  in  the  list  of  articles  of  diet 
to  be  avoided. 

The  author  considers  Dermatology  a  branch  of  surgery  rather 
than  of  medicine,  and  taken  as  a  whole  it  does  not  require  a  strain 
of  the  mind  to  believe  him  correct.  Classification  is  that  now 
usually  followed.  What  is  said  upon  the  subject  of  the  various- 
erythemata  clears  the  atmosphere  of  confusion  very  satisikctorily. 


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Book  Reviews.  659 

He  teels  himself  justified  in  continuing  the  title  "Eczema  Sebor- 
rhoicum."    The  doctor  thinks  that  any  good  to  be    got   from 
arsenic  (Fowler'n  solution)  is  to  be  had  from  five-drop  doses  lone 
continued,  not  from  pushing  the  drug.     The  work  is  th 
practical   throughout  and  up-to-date.     We  are  a  little 
that  the  originator  of  the   use   of  electrolysis  should  ai 
miUiamperemeter  is  not  necessary  in  the  work.  u 


An  American  Text-book  op  the  Diseases  op  Childi 
American  Teachers.  Edited  by  Louis  Starr,  M.D.,  of 
phia.  Published  by  W.  B.  Saunders,  Philadelphia 
cloth,  17.00.     Sold  only  by  subscription. 

This  work  is  before  us  and  all  that  we  can  say  must  b< 
mendation.  It  is  a  work  compiled  by  the  most  eminent  j 
teachers,  and  each  department  has  been  given  to  men  of  ex 
ability  in  some  particular  line  of  research  in  |the  domaii 
eases  of  children. 

The  work  is  divided  into  parts  as  follows : 

Part  I.  Injuries  Incident  to  Birth  and  Diseases  of 
Born. 

Part  II.     Diathetic  Diseases. 

Part  III.     The  Infectious  Diseases. 

Part  IV.     General  Diseases  not  Infectious. 

Part  V.     Diseases  of  the  Blood. 

Part  VI.     Diseases  of  the  Digestive  Organs. 

Part  VII.     Diseases  of  the  Nervous  System. 

Part  VIII.     Diseases  of  the  Respiratory  System. 

Part  IX.     Diseases  of  the  Heart. 

Part  X.     Diseases  of  the  Genito-Urinary  System. 

Part  XI.     Orthopsadics. 

Part  XII.     Diseases  of  the  Skin. 

Part  XIII.     Diseases  of  the  Ear. 

Part  XIV.     Diseases  of  the  Eye. 

This  is  indeed  a  monumental  work  produced  by  men  v 
clinical  experience,  and  therefore  a  work  of  inestimable  ve 
physicians.  It  is  complete  in  every,  detail  and  made  so  tb 
serviceable  for  ready  reference  by  the  numerous  photogj 


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560       The  Atlanta  Medmal  and  Soroical  Jogrhal. 

colored  plates.  That  portion  whicb  treats  of  Diseases  of  the  Ner- 
vous System  is  especially  of  valae,  as  it  is  written  by  neurologists 
of  exceptional  ability.  We  have  no  hesitancy  in  declaring  that 
it  18  the  best  and  most  comprehensive  work  yet  published  in  the 
English  language. 


A  Text-book  upon  the  Pathogenic  Bactebia  for  Students 
OP  Medicine  and  Physiciaks.  By  Joseph  McFarland,  M.D., 
Professor  of  Pathology  in  x\ie  Medioo-Chimrgical  College, 
Philadelphia;  Pathologist  to  the  Medico-Cbirurgical  Hospital 
and  to  the  Rush  Hospital  for  Consumption  and  Allied  Diseases, 
Philadelphia;  Fellow  of  the  College  of  Physiciana -of  Phila- 
delphia. With  134  illustrations.  Second  edition,  revised  and 
enlarged.  Price  $2.50.  W.  B.  Saunders,  925  Walnut  Street, 
Philadelphia. 

The  second  edition  of  this  book,  which  is  just  from  the  press,  is 
worthy  of  a  place  in  every  physician's  and  student's  library.  If 
is  written  in  accordance  with  the  latest  views  of  the  most  emiuent 
bacteriologists,  and  is  noteworthy  for  its  clear,  concise  and  pointed 
style.  It  is  not  necessary  to  be  a  bacteriologist  to  appreciate  the 
book.  As  the  title  of  the  book  implies,  this  work  d^ls  only  with 
the  pathogenic  bacteria.  The  author  gives  a  general  history  of 
-  bacteriology,  the  morphology  and  biology  of  bacteria,  and  then 
follows  a  practical  description  of  laboratory  technique  for  those 
who  may  desire  to  make  the  investigations  for  themselves.  The 
author  then  takes  up  each  pathogenic  bacterium  seiMirately  and 
deals  with  it  thoroughly  m  Its  relation  to  that  particular  disease 
which  it  produces.  The  value  of  the  work  lies  in  its  simplicity, 
and  does  not  burden  the  reader  with  unnecessary  detul.  It  is 
especially  suited  to  the  busy  practitioner  who  has  not  time  for  the 
minute  details  of  bacteriology,  but  who  desires  to  keep  thoroughly 
up  to  date  in  regard  to  the  pathogenic  bacteria.  The  work  is  up 
to  date  in  every  way,  and  the  chapter  upon  immunity  apd  suscepti- 
bility is  good  indeed. 

The  work  is  printed  upon  calendar  paper,  bound  in  cloth,  and 
nicely  illustrated.  The  illustrations  from  the  microphotographs  are 
much  better  than  the  average. 


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■  Book  RBrviEws.     ■  §61 

An   American   Text-book  op  Gynecology,  Medical  and 

■  SbBGICAL,  for  PaACTinOKBBS  AND  STUDENTS*  By  Henry  T. 
Byford,  M.D.,  J.  M.  Baldy,  M.D..  Edwin  B.  Cragin,  M.D.) 
J.  H.  Etheridge,  M.D.,  William  Goddell,  M.D„  Howard  A, 
Kelly,  M.D.,  Florian  Krug,  M.D.,  E.  E.  Montgomery,  M.D., 
William  R.  Pryor,  M.D.,  George  M.  Tuttle,  M.D.  Publiahed 
by  "W.  B.  Saunders,  Pliikdelphia.  Price,  #6  cloth,  J7  sheep. 
Sold  only  by  rabsoription. 

This  work,  like  all  the  others  of  the  American  Tex-book  series 
published  by  the  well-known  house  of  W.  B.  Saunders,  is  a  model 
«f  its  kind.  It  differs  a  little-  from  some  of  the  others,  in  that  the 
names  of  the  authors  are  placed  together  at  the  beginning  of  the 
work,  and  one  is  unable  to  tell  who  is  the  special  author  of  the 
various  sections  of  the  book.  This  is  a  revised  edition  of  the  same 
work,  and  shows  a  great  many  improvements,  especially  the  chap- 
ter oa  diaeaaea  of  thebladder,  ureters,  etc.  The  work  is  profusely 
illustrated  with  cuts,  and  there  are  thirty>dght  colored  and  half- 
tone plates.  Apt  illustrations  go  a  long  way  in  adding  to  its  v^lue 
for  the  student,  and  even  the  practitioner.  A  good  illustration  is 
better,  than  ten  pages  of  description,  but  when  you  have  both,  then 
-excellence  can  be  aesnred.  The  fir^  obapteri  on  the  "  Examination 
of  the  Female  Pelvic  Organs,"  is  exceedingly  clear  and  profusely 
illustrated,  which  is  just  the  thing  for  the  medical  student.  Gyne- 
-cology  is  now  such  an  important  study  in  the  medical  college  cur- 
riculum that  a  good  text-book  is  indispensable  to  the  student. 
Dr.  Baldy  has  gotten  together  as  collaborators  men  well  fitted  for 
writing  such  a  book.     It  is  sure  to  have  a  good  sale. 


A   HiSTOHY  OP    Yellow   Fever,  Oriqih   akd  Causb,   and 
Dengue^ 

The  above  ie  the  title  of  an  interesting  brochure  from  the  pen  of 
W.  L.  Coleman,  M.D.,  of  Houston,  Texas.  The  author  adopts 
the  theory  of  I>r.  Andouard,  made  to  the  French  Academy  of 
Sciences,  but  which  was  entirely  ignored  by  that  learned  body,  who 
permitted  his  valuable  work  to  become  musty  in  the  archives  of 
their  learned  society,  because  they  were  unwilling  to  accept  or  in- 
vestigate his  theory  of  the  origin  and  cause  of  yellow  fever. 


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562       The  Atlanta  Medical  and  Surgical  Jodbnal. 

This  theory  of  its  origin  aad  cause  is  that  the  disease  originated 
ill  the  holds  of  the  vessels  and  ships  engaged  in  the  Africao  slave 
trade,  and  that  the  disease  was  generated  in  the  filth  which  accumu- 
lated in  the  holds  of  these  vessels,  and  ia  this  way  disseminated  at 
all  points  where  these  vessels  reached  and  dischai^d  their  cargoes. 

The  author  gives  an  intereetring  history  of  yellow  fever,  its  ori- 
gin and  cause,  from  its  first  introduction  by  ships  engaged  in  this 
unholy  traffic  to  the  present  time,  and  intimates  that  this  terrible 
plague  was  a  retribution  of  God  upon  the  people  engaged  in  this 
wicked  business  for  their  sin. 

The  doctor  has  evidently  been  a  close  student  of  this  fever,  and 
entertains  opinions  of  his  own  which  he  is  not  afraid  to  put  into 
print.     Read  his  booklet.     It  will  interest  and  instruct  you. 


■  Elements  op  Histology.  By  E.  Klein,  M.D.,  F.R.S.,  Lecturer 
on  G-eneral  Anatomy  and  Physiology  in  the  Medical  School  of 
St.  Bartholomew's  Hospital,  London,  and  J.  S.  f>ikins,  MA., 
M.B.,  Joint  Lecturer  on  and  Demonstrator  of  Physiology  in  the 
Medical  School  of  St.  Bartholomew's  Hospital,  London.  In  one 
12mo  volume  of  506  pages,  with  296  illustrations.  Cloth, 
$2.00  net.    Lea  Brothers  &  Co.,  Philadelphia  and  Kew  York. 

This  little  book  in  red  binding  has  long  been  recognized  as  one 
of  the  best  elementary  works  on  Histology  that  has  ever  beeo  pub- 
lished. In  our  student  days  we  remember  studying  out  of  the 
"  little  red  hook."  Additions  have  been  made  in  this  last  edition 
which  renders  it  more  desirable  than  ever  for  the  student.  Some 
photographic  cuts  of  specimens  are  especially  good.  The  clear  and 
explicit  manner  in  which  the  author  describes  histologically  every 
portion  of  the  human  anatomy  gives  great  value  to  the  hook. 
From  it  the  student  can  learn,  and  understand  what  he  learns.  We 
believe  that  it  will  always  holds  its  place  as  a  standard  work. 


Diseases  op  the  Stomach.     By  Wm.  W.  VanValsah,  A.M., 
M.D.,  and  J.  Douglass  Nisbet,  A.M.,  M.D.     Illustrated.    Phila- 
delphia.    W.  B.  Saunders.     1898. 
The  authors  of  this  work  have  given,  in  a  very  concise  and  lucid 

style,  the  results  of  their  own  experience,  together  with  that  of 


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Book  Rbviewb.  563 

other  leading  authorities.     In  this  well-written  book  oa  diseases 
of  the  etomach,  the  chapter  od  diet  is  very  elaborate  and  complete, 
aod  the  geueral  practitiooer  will  find  a  great  deal  of  vi  ~ 
formation  in  this  chapter.     The  authors  have  given  mor 
to  gastric  ulcer  than  the  importance  of  the  disease  won 
demand  from  the  standpoint  of  the  general  practitioner, 
tion  on  the  vicious  circles  of  the  stomach,  or  other  org 
eases  of  the  stomach,  showing  how  diseases  of  the  ston 
other  organs — liver,  kidneys,  nervous  system,  and  cir 
the  blood,  etc. — is  strikingly  original  and  excellently  wril 
ing  considerable  study  and  accurate  clinical  observation 
itself  well  worth  the  price  of  the  book.     As  a  whole  we  < 
recommend  this  work.  i 


Diseases  of  Woueh  :  A  Manual  of  Gynecology. 
especially  for  the  use  of  Students  and  General  Practiti 
Francis  H.  Davenport,  M.D.,  Assistant  Professor 
cology  in  the  Medical  Department  of  Harvard  1 
Boston.  New  (3d)  revised  and  enlarged  edition.  In 
some  12mo  volume  of'  387  pages,  with  155  ill 
Cloth,  $1.75  net.  Lea  Brothers  &  Co.,  Philadelphia 
York. 

This  little  manual  of  j^ynecology  has  again  been  issue< 
well-known  publishing  house  of  Lea  Brothers  &  Co. 
third  edition  and  bears  many  marks  of  excellency.  In  1 
to  this  edition  the  author  says :  In  this  edition  I  have 
enlarge  somewhat  the  scope  of  this  book.  It  has  seem 
include  sui^ical  as  well  as  non-surgical  methods  of  treal 
the  same  time  I  have  not  departed  from  my  aim  in  w 
book  originally,  to  make  it  a  journal  for  students  ai 
tioners."  It  is  certainly  a  most  excellent  little  book  and 
intended  for  its  author.  The  cuts  and  illustrations, 
those  representing  the  principles  of  diagnosis,  are  e: 
good-  

Glaucoma:  Its  Symptoms,  Vaeieties,  Pathology  a: 
MENT.     By   Alex.   W.    Stirling,  M.D.,   CM.  (Edin. 
(Lond.),  AtlantA,  Ga. 
The  editor  is  in  receipt  of  a  complimentary  copy  from 


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564       The  Atlanta  Medical  and  Surgical  Journal. 

of  the  above  brochure.  In  his  preface  the  aathor  has  this  to  say  : 
"The  contents  of  this  volume  were  pot  together  in  great  part  Id 
connection  with  my  lectures  to  the  students  of  the  Fostgradiiat« 
Medical  School  and  Hospital,  l^ew  York."  They  had  appeared 
serially  in  the  Annals  of  Ophthahhotogy.  '  The  subject  is  minutely 
and  historically  handled,  and  is  a  clear  exposition  of  the  theories 
and  treatment  of  glaucoma  to  date.  It  embodies  in  concrete  form 
the  views  of  all  the  various  authors  upon  this  subject/ both  at  home 
and  abroad,  and  it  certainly  makes  a  most  valuable  addition  to  the 
library  of  every  ophthalmologist.  The  work  of  the  publi^er  is  well 
executed  and  the  binding  is  exceediugly  attractive  in  appearance. 


MAOAZINBS  AND  BXCHANQBS. 


The.  Psychioier  is  a  sew  publication  which  haa  just  issued  its  first 
number.  It  is  published  ^od  edited  at  the  Hospital  Illinois  by  Wm. 
O.  Stearns,  M.D.,  Superintendent  of  the  Illinois  Eaat«rn  Hospital 
for  Insane,  and  other  members  of  the  medical  stiff.  The  first  issue 
is  welj  gotten  up  and  presepts  some  most  escelleut  reading-matter. 
We  welcome  it  among  our  exchanges.  It  will  be  issued  four  times 
a  year. 

Wb  note  among  our  exchanges  the  appearance  of  the  Or6niea 
Midieo-^irurgiea  de  la  Hahtma,  which  we  had  uot  seen  for  nasy 
months.  The  cessation  of  hostilities  and  the  resuniii^  c^  busineeB 
in  Havana  has  permitted  again  the  publication  of  this  journal.  Its 
editor,  Dr.  J.  Santos  Fernandez,  is  a  maa  of  great  ability,  and  wc 
welcome  again  to  our  list  the  {Miblieation  of  our  coDrrdre,'WbMii 
while  it  was  not  dead,  was  yet  sleeping.  The  issue  is  entirely  taken 
up  with  the  life  of  Dr.  D.  Bomtngo  Madan,  of  Cuba,  a  man  evidently 
much  beloved  and  of  marked  ability.  We  print  elsewhere  this 
lite  of  the  man,  tran^ted  from  the  Spanish  by  Mr.  B.  J.  Word, 
of  this  city. 

Mr.  W.  B.  Sadndbss,  the  medioal  publisher,  is  .'giving  to  the 
medical  profession  some  excellent  publications  witli  which  to  stock 
his  library.  The  hand-atlases  are  gems  in  every  respect.  Mr. 
Saunders  is  making  preparations  for  the  production  of  these  atlasn 


^dbyGoogle 


Book  .  Reviews.  565 

on  a  larger  scale,  Bince  the  aales  have  been  up  to  this  time  so  phe- 
nomenal. 

The  folloiring  art  tome,  of  tbe  publioQtiona  "whioli-haTe  alreadjr 
been  issued  from  this  house,  or  are  in  preparation  for  an  early 
issue : 

1.  Da  Costa's  Modern  Surgery. 

2.  McFarland's  Pathogenic  Bacteria. 

3.  An  American  Text-book  of  Diseases  of  Children. 

4.  An  American  Test-book  of  Gynecology. 
6.  Vierordt's  Medical  Diagnosis. 

6.  Griffith's  Care  of  the  Baby. 

7.  Butler's  Materia  Medica  and  Therapeutics. 

8.  Stengel's  Text-book  of  Pathology. 

9.  Hirst's  Text-book  of  Obstetrics. 

10.  Americftu  Text-book  of  Diseases  of  Eye,  Ear,  Nose  an(3 
Throat. 


REPRINTS  RECEIVED, 


The  Conservative  Treatment  of  Fibroid  Tumors  by  Myomectomy  ; 
The  Conservative  Treatment  of  Pelvic  Suppuration  of  Puerperal 
Origin.     By  Charles  P.  Noble,  M.D.,  of  Philadelphia. 

Report  of  the  Keosington  Hospital  for  Women,  136  Diamond 
Street,  Philadelphia. 

Advance  in  the  Domain  of  Preventive  Medicine.  By  J.  M.  B. 
Carter,  M.D.,  Waukegan,  III. 

Principal  Poisonous  Plants  of  the  United  States.  By  V.  K. 
Chestnut.  Produced  from  the  United  States  Department  of  Agri- 
culture, Division  of  Botany. 

Post- Operative  Insanity.  By  R.  Harvey  Reed,  Rock  Springs, 
Wyoming. 

Michigan  Monthly  Bulletin  of  Vital  Statistics,  August. 
.    From  Dr.  E.  C.  EUett,  Memphis,  Tenn.: 

1:  Acute  Inflammation  of  the  Middle  Ear. 

2.  A  Case  of  Tenonitis. 

3.  The  Determining  Cause  of  the  Site  of  Ulcers  on  the  Nasal 
Septum. 

4.  Hemorrhagic  Glaucoma.  Report  of  a  Case  with  Micropbo- 
tograpbs. 


^dbyGoogle 


SELECTIONS  AND  ABSTRACTS. 


What  a  Trained  Xurse  Needs  besides  a  Techkical 
Training.* 

No  one  cao  be  considered  a  trained  nurse  to-day  udUbs  sbe  has 
had  the  benefit  of  lectures  and  lessons,  of  observation  and  expe- 
rience, under  the  direction  of  competent  teachers.  lu  other  words, 
she  must  receive  a  technical  training  for  the  work  of  her  chosen 
calling. 

Is  there  nothing  else  needed? 

Is  that  technical  training  enough  for  her  highest  efficiency? 

Let  me  suggest  some  ot  the  other  qualifications  which  every  good 
nurse  should  have. 
First,  the  nurse  should  have  a  kindly  spirit. 

The  very  vocation  of  the  nurse  implies  the  possession  of  a  kindly 
spirit. 

It  is  a  kindly  calling.  It  must  have  the  response  of  a  kindly 
soul.  She  cannot  nurse  sick  people  as  a  woman  may  keep  a  set  of 
books  in  an  office,  or  may  sell  goods  behind  the  counter  of  a  store. 
The  vocation  of  the  nurse  implies  the  possession  of  a  heart  that 
responds  to  the  cry  for  help.  When  a  nurse  thinks  of  her  voca- 
tion as  simply  a  way  in  which  she  can  earn  so  many  dollars  per 
week,  she  is  astray,  just  as  the  clergyman  is  astray  who  thinks  only 
of  the  salary  he  gets  for  helping  to  save  men's  souls.  Sickness  not 
only  brings  pain  and  weariness  to  the  patient.  It  brings  usually 
great  trouble  to  the  family.  In  many  a  family  they  do  not  know 
what  to  do,  or  are  unable  to  do  it.  The  sending  out  (or  a  nurse  is 
really  a  cry  for  help,  and  it  should  be  regarded  as  a  call  to  make 
things  better  in  the  afflicted  home  by  bringing  in  the  sunshine  of 
kindliness. 

The  nurse  goes  as  a  womanly  woman,  to  do  a  greatly  neede<l 
work  for  a  family  in  their  time  of  trouble.     She  is  better  able  to 

'I'urtol  ail  d'lilri'-s  in  the  Rmdiiulng  CLiLs;of  tbe  NcvIod  Trnlnlng  SobDOl  lor  Xunes.  Judo 


idb,Googlc 


Selections  and  Abbtracts.  567 

do  this  kinduess  because  she   has  beeo  trained.     She  fails  if  she 
does  not  make  that  home  the  better  for  her  comiog  into  it.     She 
is  to  be  a  gracious  presence  io  that  home  and  is  to  finiel 
in  such  a  way  that  she  will  carry  with  her  the  good- 
patient  and  of  all  those  interested  io  him.     She  may  m 
friends  of  all  those  to  whom  she  ministers. 
Tlien,  again,  the  nurse  should  have  tact. 

A  good  nurse  will  cultivate  that  graceful  tact  which  < 
to  adapt  herself  to  the  varied  circumstances  into  which 
may  bring  her.  She  is  to  be  in  homes  very  difFerentl; 
They  will  not  all  be  alike,  nor  will  all  be  model  homes, 
discover  in  some  things  which  she  oannot  approve,  an 
there  will  be  many  a  vexations  incident.  If  she  is  w 
she  will  soon  come  into  collision  with  some  one,  perhaps 
and  will  shortly  find  herself  in  the  way  of  all.  It  requ: 
deal  of  tact  to  live  even  for  a  few  weeks  in  some  housei 
biy  with  strange  people.  Even  when  the  nurse  has  the 
teutioDS  and  applies  herself  to  her  duties,  she  will  i>e  mis 
and  may  have  things  said  and  done  to  her  of  a  most 
character.  There  is  great  need  of  patience  and  of  a 
Btraint.  There  ia  never  anything  lost  by  avoiding  all 
of  irritation.  She  must  be  quiet  and  peaceable,  and  lei 
silence,  and  will,  in  most  cases,  win  hor  way  into  favor. 

It  is  a  hard  thing  to  describe  this  quality  of  adaptab 
1  have  called  tact.  Some  people  never  acquire  it,  and  s 
gain  it  only  after  long  experience  in  very  small  dcgr 
surely  worth  having,  and  hence  worthy  the  study  an 
every  nurse  who  would  succeed. 
A  good  nurse  muni  have  good  sense. 

The  good  uurse  will  never  lose  sight  of  the  (act  tha 
singular  connection  between  the  miud  and  the  body 
Ordinary  people  are  for  the  time  thrown  off  their  balai; 

The  patient  is  sick  in  body.  He  is  also  sick  in  mi 
not  himself  as  he  was  last  week,  not  himself  as  ho  will  1 
hence.  He  may  be  most  unreasonable  now.  "  lie  will  be 
irritable  after  awhile.     His   Ui^ual   good   t-euse  has  de 


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^68       The  Atlanta  Medicai.  and  Soroical  Joormal. 

Do  tu)t  let  your  good .  senss  leave  you.  He  will  add  tu  your  cares 
by  his  exbibition  of  ugly  traiU  wliich  in  healtb  he  may  maoAge  tn 
keep  dovn  or  out  of  sight  Sioknese  often  briDgs  a  strange  in- 
firmity of  vill,  eo  that  the  adoithas  sometimes  to  be  treated  like  a 
obitd;  coaxed,  implored,  expostulated  with,  eooouraged.  It  would 
be  hard  indeed  to  specify  the  vagaries  whidi  the  ordinary  sick  pa- 
tient may  manifest.  The  nurse  must  not  be  surprised  at  anything. 
She  will  find  some  of  her  patients  amiable,  patient  and  docile. 
She  will  find  others  just  the  reverse.  And  the  same  patient  may 
be  one  thing  to-day  and  another  to-morrow.  A  great  deal  will 
depend  upon  her  own  spirit.  She  will  have  to  bear  up  the  de- 
sponding, and  she  must  brighten  the  boure  of  depression.  She 
must  bring  the  sunshine  of  an  amiable  manner  into  the  sick-room, 
and  by  her  strong  and  hopeful  spirit  help  weaker  wills  to  keep  out 
of  the  depths. 
The  good  nurse  is  loyal. 

The  nurse  is  to  regard  herself  as  in  some  sense  the  confidential 
friend  of  the  family,  and  she  carefully  guards  the  family  secrets  as 
they  become  known  to  her.  She  may  find  the  skeleton  in  the 
closet,  but  she  shuts  the  door. 

These  three  professions,  the  law,  the  ministry  and  medicine,  take 
special  care  to  guard  professional  secrets.  A  lawyer  would  be  dis- 
graced if  he  revealed  the  private  aflairs  of  his  client.  The  physi- 
cian has  nut  the  right  sense  of  honor  who  will  not  guard  bis  pa- 
tient from  too  curious  observation.  The  clergyman  becomes  the 
trusted  custodian  of  family  matters,  and  is  a  mean  fellow  if  he  does 
not  keep  them  to  himself. 

The  trained  nurse  must  keep  to  herself  what  she  hears  and  sees, 
if  there  is  anything  that  comes  to  her  which  might  be  repeated  to  the 
disadvantage  of  the  family.  Her  lips  must  be  sealed  as  to  ihmily 
matters.     Sbe  is  to  see  as  not  seeing,  and  to  hear  as  not  hearing. 

It  is  one  element  of  success  in  a  nurse  when  she  gains  the  repu- 
tation of  being  discreet.  Sbe  must  be  discreet.  She  cannot  fail  to 
learn  something  in  a  few  weeks'  stay  in  a  house  that  may  make 
trouble  if  she  report  it.  But  she  is  not  to  report  it.  She  must 
lock  up  in  her  breast  the  knowledge  that  has  come  to  her. 


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Selections  and  Abstbacts.  569 

The  trained  nurse  ought  to  be  a  decidedly  religious  woman. 

Her  work  is  so  beuevolent,and  makes  audi  drains  upon  her  own 
nature,  that  I  cannot  see  how  one  can  go  on  year  by  year  doing  the 
duties  of  the  nurse's  calling  unless  she  is  actuated  by  re 
tivee. 

Do  not  mistake  me.  I  am  not  saying  anything  abou 
ism.  I  am  not  urging  any  one  to  be  an  adherent  oft 
faith  or  of  that,  but  the  ideal  nurse  will  carry  Christiai 
into  her  calling,  and  will  make  her  ministry  of  the  sici 
that  blessed  life  which  He  lived  who  went  about  doing 

A  nurse  has  opportunities  for  doing  good.  Her  dai 
her  daily  spirit,  her  daily  duties,  her  daily  aims,  all  mf 
trated  by  that  devotion  to  the  Master  Christ  which  will 
commonplace  things  into  holy  service.  She  can  serve  t 
serving  those  who  are  ill.  She  can  do  good  to  bodie 
in  His  name.  Her  opportunities  for  usefulness  are  ; 
bounded.  She  is  for  the  time  the  companion  of  those  n 
feebleness  rely  upon  her.  She  may  win  their  friendship, 
say  the  right  word  at  the  right  time.  She  may  inspire 
age  and  fan  the  feeble  hope  into  a  flame.  She  may  it 
the  departing  soul  as  it  prepares  to  wing  its  flight  ii 
unseen,  and  bid  it  go  forth  without  fear,  liecause  the  i 
opened  the  gates  of  life  to  all  who  trust  in  him. 

Ah,  the  religioHSDesB  of  the  vocation  of  the  nurse! 
then  something  reveals  it  to  us  as  never  before. 

A  friend  went  to  a  hospital  for  surgical  treatment  a  ; 
ago.  In  a  letter  written  after  his  recovery  be  describe 
riences.  He  says  that  as  he  walked  up  and  down  thecc 
had  glimpses  into  the  wards  where  lay  the  sick  and  t 
and  saw  the  tender  ministrations  bestowed  upon  them 
the  hallowed  presence  of  the  Good  Physician  began  to 
bim. 

If  the  gracious  Lord  were  here  as  once  he  was  in  Ga 
Judeo,  he  would  surely  be  drawn  by  his  tender  symp 
suficrers  to  visit  the  sick  and  the  maimed. 

And  later  on  the  patient  said  to  himself:  "Yes,  Lort 


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570       The  Atlanta  Medical  and  Suraical  Journal. 

of  tby  servants  in  this  house  are  doing  the  same  work  which  thine 
own  blessed  hands  did  when  thej'  were  laid  upon  the  sick." 

And  so  it  came  to  hiui  that  the  Ijord  was  present,  not  visibly 
present  as  once  he  was  in  homes  of  sickness  and  sorrow,  but  pres- 
ent in  the  persons  and  in  the  ministrations  of  his  servants. 

Is  not  the  vocation  of  a  nurse  deeply  religious,  if  thus  she  may 
be  a  representative  of  the  Divine  Master  in  tenderness  and  sym- 
pathy ? 

One  day  when  Benjamin  West  was  painting  his  great  picture  of 
Chrid  lie/ected,  a  friend  liap|)ened  to  call  and  see  him.  The  artist, 
after  the  friend  had  been  there  a  little  time,  said  :  "  You  can  do  nic 
a  good  turn  to-day.  I  have  reached  that  point  in  my  picture  where 
I  must  sketch  in  the  hands.  I  shall  be  greatly  pleasetl  if  you  will 
let  me  bind  your  hands  together  with  this  cord,  and  then  if  you  will 
stand  there  for  some  minutes  I  can  finish  that  i)art  of  my  picture." 

The  friend  readily  consented.  His  hands  were  tied  together. 
He  stood  in  the  place  designated. 

For  a  while  the  two  talked  together,  hut  the  artist  became  ab- 
sorbed in  his  work  and  the  conversation  stopped.  The  friend,  too, 
stood  there  in  silence.  He  had  no  remark  to  make,  uo  question  to 
ask,  for  had  not  the  great  thought  come  to  him  that  he  was  for  the 
time  representing  Christ? 

O  you  who  are  privileged  to  enter  this  blessed  calling,  the  days  are 
coming  when  the  sick  will  raise  their  eyes  gratefully  as  you  come 
near  them,  because  you  are  to  tlieni  the  representatives  of  the  mer- 
cilul  Christ. 


Should  the  General  Peactitioner  Receive  a  Per  for 
Referking  Cases  to  the  Si'Ecialist? 

Tt  may  seem  to  a  certain  few  that  such  a  subject  should  be  lefl 
out  of  print.  1  do  not  consider  it  a  delicate  ijuestion,  nor  one 
that  is  best  discu.ssed  mf>  ronn.  1  believe  that  in  a  certain  number 
of  cases  the  physician  should  receive  a  fee  for  referring"  cases  to 
the  S{>ecialist. 

The  genera]  practitioner  is  called  upon  to  render  every  kind  of 
medical  and  surgical  service.  If  he  sees  fit  to  send  certain  eases  to 
a  s|iecialist,  he  displays  a  uiaguaitiniity  unparalleled  in  other  fields 


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Selections  and  Abstracts. 

oi  labor.  We  will  admit  that  in  mauy  iiistauoes  Iiis  li 
equipment  are  inadequate  in  some  of  the  di'iiarlnieiitH  lu 
over  by  s|)eeialists.  The  advancement  of  mc(ficine  and 
made  it  ditticiilt  lor  any  one  man  to  keep  abreast  of  the 
He  freiincntly  recognizeii  tbat  hii^  knowledge  in  tiome  • 
ment  is  delicicnt.  He  In  honest  and  tcll.s  the  patient  so 
lient  is  sent  to  a  siieeialist.  There  are  many  instances 
]>raotitioner  has  fonnd  it  advisable  to  administer  to  his 
Keverai  days  before  it  is  possible  to  refer  him  to  a  s]^C(tiali^ 
ill  his  anxiety  for  the  welfare  of  his  |)atient  lie  may  ni 
visits  in  the  endeavor  to  cause  the  tatter  to  consult  llii 
or  may  lose  valuable  time  in  going  with  him  to  the  spei 
any  event,  be  expends  a  certain  amount  of  his  time  foi 
patient  will  nol  compensate  liim.  The  patient  and  bis  f 
long  looked  upon  him  as  tlieir  frieud  and  medical  advi 
never  think  of  paying  liiin  for  aught  but  actual  ]iroIc 
viees.  They  would  not  com^ider  such  services  prolessio 
would  gain  their  displeasure  if  lie  were  to  preijent  bis 
same.  In  case  he  has  treated  the  patient  lor  a  tew  da 
better  erase  any  and  all  such  charges  for  professional  se 
his  b<)okM,  lieeanse  the  patient  considers  that  lie  has  i 
benefit  from  his  ti-eutmeut;  that  his  ]>liysieian  did  not 
his  case  or  he  would  not  have  sent  bim  to  sonic  one  el» 
fore,  if  this  bill  is  pie.-*cnted  no  attention  is  paid  to  it,  : 
ment  is  ]iresscd,  the  next  time  a  physician  is  needed  soi 
is  called  in.  ^ow,  who  Is  to  compensate  this  physieia 
is  but  one  answer — the  specialist.  If  the  specialist  du 
bim  for  the  time  he  has  expended  no  one  else  does.  Th 
can  easily  learn  from  the  patient  the  extent  of  the  st 
dered  by  his  physician.  The  latter  should  then  be  c< 
accordingly. 

There  are  many  times  when  the  family  physician 
recommend  a  specialist.  He  is  not  called  upon  for  sc 
does  be  find  it  necessary  to  sec  that  the  [lalicnt  goes  wbei 
,  He  is  not  incoiiveuieuced  nor  doe«  be  spend  any  of  his 
the  ease.  Here  it  is  not  incumbent  upon  the  sjiccialisl 
practitioner  for  his  kindness. 


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572       The  Atlanta  Medical  and  Scrqical  Joubnal. 

Muny  an  obscure  practitioner  gains  standing  ani]  even  promi- 
nence ihi-ongh  the  specialist.  Specialists  to  whom  he  refers  cases 
make  it  a  point  to  speak  well  of  bim  whenever  the  opportunity  is 
afforded.  This  is  the  only  honorable  way  in  which  the  sj>ecialigt 
can  return  many  favors  and  acts  of  kindness  shown  him  by  the 
general  practitioner. 

We  all  make  mistakes,  even  the  general  practitioner.  What  he 
has  done  for  a  given  case  may  not  meet  with  our  approval.  A  hasly 
word  or  a  sign  of  disapproval  may  ruin  the  reputation  of  this  phy- 
sician in  the  eyes  of  the  patient.  Hence  many  cases  are  not  re- 
ferred because  of  some  such  former  experience.  Again,  the  time 
expended  on  a  case  has  been  considerable,  to  say  nothing  of  the 
mental  worry.  To  refer  the  case  may  mean  that  all  this  goes  for 
nothing.  The  man  to  whom  the  case  is  referred  forgets  to  even 
say  thanks.  A  few  such  experiences  tend  to  sour  the  general  prac- 
titioner against  specialists  in  general. 

The  object  of  this  paper  is  to  draw  a  closer  bond  of  union  be- 
tween the  general  practitioner  and  the  specialist;  to  call  the  atten- 
tion of  the  specialist  to  his  duty  whenever  it  is  plain. 

I  do  not  recommend  that  physicians  be  paid  a  stipulated  per- 
centage of  all  fees  received  from  cases  referred  by  them.  I  should 
consider  this  a  great  wrung.  What  I  do  advocate  is  that  when  a 
physician  has  expended  time  and  energy  in  getting  a  patient  to 
come  to  us,  or  has  prescribed  for  the  patient  without  compensation, 
it  should  be  our  duty  to  pay  the  physician  a  reasonable  fee. — Md- 
vilte  Blnck,  M.D.,  in  Colorado  Med.  Jour. 


r '      Early  DiAeNosis  of  Tuberculosis  of  the  Lungs. 

Probably  no  one  will  question  the  value  of  the  earliest  possible 
diagnosis  of  tubercle  in  the  lung,  for  it  is  then  that  help  can  most 
easily  be  given,  and  it  is  then  that  change  of  environment  gives 
the  best  hope  for  the  patient.  There  is  little  qnestion  that  the 
diagnosis  of  tuberculosis  of  the  lungs  is  often  made  by  the  pa- 
tient's family  before  it  is  recognized  by  the  attending  physician. 
Recognition  of  the  disease  in  this  stage  is  no  credit  but  shows  a 
most  careless  observer.     To  get  the  best  results  from  treatment  it 


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Selections  and  Abstracts.  573 

is  essential  to  recognize  the  pretubercular  stage  and  to  treat  the 
patient  before  the  physician  can  clearly  demonstrate,  even  to  his 
own  satJsraction,  the  undoubted  presence  of  the  disease.  This  is 
the  stage  when  the  tubercle  bacillus  cannot  be  shown  in  the  epu- 
tiim ;  in  feet,  the  patient  has  many  general  symptoms,  but  few  that 
call  attention  to  the  lung.  It  is  this  stage  that  is  so  oflen  treated 
for  simple  anemia,  lor  general  debility,  for  indigestion,  and  in 
women  for  amenorrhea.  Even  a  careful  physical  exploration, 
which  would  put  the  physician  on  his  guard,  is  rarely  made  at  this 
time,  as  the  symptoms  do  uot  warrant  it,  unless  the  routine  prac- 
tice of  examining  all  [)atients  carefulty  is  adhered  to.  Yet  a  pliys- 
ical  examination ~will  reveal  much;  percussion  shows  little  beyond 
a  [lossible  tenderuess  at  some  point  where  the  patient  has  had  pain 
previously.  It  is  believed  that  this  is  a  little  tubercle  forming  on 
one  of  the  pleural  surfaces,  and  that  the  pain  and  tenderness  are 
the  result  of  a  dry  pleurisy.  Infection  does  not  come  from  iiitia- 
lation  always,  but  from  infectionof  the  oral  cavity,  from  teeth,  breaks 
in  the  mucous  membranes  of  tongue,  etc.,  as  there  is  a  direct  lym- 
phatic counectiou  between  the  oral  cavity  and  the  stomach  of  the 
pleura.  Auscultation  shows  possibly  a  slightly  roughened  sound, 
the  very  faintest  of  friction  sounds  heard  only  after  a  full  inspira- 
tion when  the  patieiit-unconsciously  expires  a  little,  though  told  to 
bold  his  breath.  This  sound  hoard  only  at  one  point  is  important. 
Again,  a  hesitating  inspiration  or  expiration  on  one  side  should 
always  suggest  the  possibility  of  beginning  serious  lung  trouble. 
A  temperature  above  normal  in  the  evening,  no  matter  how  slight, 
which  is  constant,  is  an  importantsiga  ofearly  tuberculosis,  pro  vide<l 
the  morning  temperature  is  normal.  A  sub-normal  evening  tem- 
perature, while  less  frequent,  is  also  suggestive  of  trouble.  A  per- 
sistent cough,  which,  on  most  careful  examination  of  the  throat,  is 
found  due  to  trouble  in  tlie  throat,  no  matter  how  slight  it  may  be, 
should  always  demand  a  thorough  examination  of  the  chest  for 
possible  tnberculosis.  Of  course  early  examination  of  the  sputum 
should  be  made  fur  the  tubercle  bacillus  as  soon  as  there  is  any  ex- 
pectoration. In  a  word,  where  patients  complain  of  getting  tired 
easily,  of  slowly  running  down  and  losing  flesh,  make  a  careful 
physical  examination  of  the  chest,  even  if  there  is  no  cough  pres- 


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574       The  Atlanta  Medical  and  Surgical  Journal, 

cnt.     It  may  be  the  prefubereular  stage,  and  diagnosis  in  tbis  stage 
is  most  important  for  the  patient. —  Charleelon  Medical  Journal. 


Chkonic  Ulceration  (Corneal,). 

Mike  Kegan,  Stamford;  Irish;  first  *.een  June  8,  1K98.  Hsid 
been  under  treatment  for  three  week.s  in  a  New  York  liusjiital,  but 
the  disease  bud  cuntinned  slowly  progressing.  When  first  seen,  tlie 
ulceration  extended,  on  the  right  side  of  the  left  eye,  from  almost 
the  center  of  the  corner  to  and  slightly  over  the  sclerotic.  Snr- 
roniiiliDg  tis.snes  were  tremendously  inflamed,  aud  the  coujiiiicliva 
were  eceliyniosed,  I  ordered  as  the  first  apptiealion,  a  wet  Thiersch 
pack,  to  be  changed  every  two  hours.  After  forty-eight  hours  ilie 
intlummation  of  conjunctiva  had  almost  entirely  subsided,  and 
treatment  of  (he  ulcer  was  begun.  Patient  was  put  in  a  horJzoQ- 
lat  position,  and  one  part  hydruzone  in  two  of  sterilized  water  was 
applied  to  the  nicer;  alter  which,  buvinitie  pure  was  dropfied  on. 
Nurse  was  ordered  to  drop  bovinine  in  the  eye  every  two  hours, 
aud  every  uight  and  morning  (deanse  the  ulcer  with  hydrozoue  and 
water  as  before.  By  June  14tli,  patient  was  relieved  of  all  pain, 
which  until  that  time  !iad  been  extreme.  The  edges  of  tbe  uWr 
were  healing,  pushing  forth  healthy  points  into  the  center.  June 
l2yth,  the  nicer  had  healed  for  half  of  its  circumference,  and  on 
the  corneal  side  principally.  All  inflammatory  action  in  the  sur- 
rounding tissues  bad  subsided,  and  the  ulcer  had  assumed  a  tliur- 
oughly  healthy  appearance.  Bovinine  was  continuously  npjilied  as 
before  until  July  6th,  at  which  time  the  ulcer  had  healed  with  the 
exception  of  a  small  margin  between  cornea  and  sclerotic,  but  tbis 
was  in  a  healthy  condition  and  healing  steadily.  Bovinine  was 
now  applied  only  once  in  three  hours,  until  July  14tb,  when  tbe  cure 
was  complete  and  ease  discharged, — SoiinJ  Vkie  IluitpUal  litpoH. 


Velankkk's  I'n-Low-SLii*  Method  uf  Mercurial  Isu^c•^IO.^^ 

Dr.  It.  iloguer  describes  tins  new  procedure  of  the  Stocklndm 
proles:^or,  Dr.  E.  Velander,  for  the  ujijilieation  of  mercurial  oitil- 
ment.     He  considers  it  H>  be  praclical,  effective,  convenient,  aud 


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Sei,ect:ons  and  Abstuacts. 

clean.  Vclander  was  convinced,  some  years  ago,  that 
ciiry  in  an  ointment  is  al>sorl)eil  after  being  vaporized, 
tbercfore,  given  up  spreading  tlie  ointment  npon  the  * 
spreads  it,  instead,  upon  the  inside  of  a  small  pillow-co; 
is  bung,  upon  succeeding  days,  alternately  on  the  back  ai 
chest.  It  is  kept  in  position  by  ribbons  over  the  shou 
around  the  waist.  The  pillow-ease  is  made  of  cheap  cott 
and  one  of  the  external  faces  is  smeared  with  ointmei 
then  inverted  so  as  to  bring  the  ointment  on  its  inner  sui 
is  placed  in  jwsitiou  so  that  the  layer  of  cloth  upon  w 
ointment  is  spread  is  in  direct  contact  with  the  body, 
iin.smeared  side  protects  tlie  clothing.  Every  night  fresli 
in  spread  over  the  old  without  removing  this,  and  at  tl 
ten  days  the  pillow-case  is  tlirown  away  and  a  new  one  is 
Batlis  should  be  taken  twice  a  week,  and  the  skin  of  the 
baek  washed  every  night.  The  quantity  of  ointment  u 
is  six  grammes  (90  grains).  The  effect  of  the  treatmei 
rapid,  and  more  mercury  can  in  tins  manner  be  absor 
fewer  unpleasant  efl'eets,  such  as  stomatiti-s  etc,,  than  w 
otherwise  administered. — Jour.  American  Mctl.  Assoc. 

loDJNB    IN    OnsTINATK    VoMITtSO. 

According  to  the  Mr.dlval  Ncir^  f..r  July  16lh,  Stcill 
mends  the  following  prescription  : 

R     TiiiKliirBof  iodino 10  dr 

Diftilled  water 4  ou 

M. 

One  tablespoonful  to  be  taken  in  half  a  glassfid  of  ) 
water  between  meals. 


TURATMBNT   OF    IVY    PolRONINfi. 

The  Canada  Lancet  for  May  recommends  the  (ollowin; 
Keep  the  affected  parts  well  wetted  with  froshly-mado  li 
Take  a  tea.spoonful  four  times  daily  of — 

B     Fluid  extract  of  couth-grii's 4  drnc- 
.Sweet  spirit  uf  nitnr 1  ciiini 

Syrup  or  temuti 1        " 


idb,Googlc 


576       The  Atlanta  Medical  and  Surgical  Joornal. 

A  Painless  Bi.istee. 
The  Journal  des  praticiens  for  June  25(h  gIveB  the  TullowiDg : 

"   oi.To'if'b,a™u.  i  ■"  •"" "  "■'"'■ 

Cacao  butter 30       " 

Sparmacsti 80       " 

Mix  to  a  paste,  which  may  be  spread  od  lioen  or  diachyloo  plas- 
ter.    It  acts  like  the  cantharides  plaster. 

The  Relief  of  Fever  in  the  Tubeecdix>us. 
De  Renzi  {Clinica  modema,  June  29th)  advises  the  use  of  thy- 
mol, which  hafl  a  certaio  and  rapid  antipyrclic  effect  without  de- 
ranging the  digestion,  hut  rather  improving  the  condition  of  the 
stomach.  It  is  given  in  doses  of  four  catchets  daily,  each  contain- 
ing three  grains  and  three-quarters.  The  dose  is  augmented  until 
apyrexia  is  attained.  Between  ninety  and  a  hundred  and  6  ve  grains 
suffice  to  subdue  the  fever. 

Obedience. 

A  gentleman  who  was  suffering  severely  from  business  worries 
and  over-ansiety  generally,  was  attended  by  a  well-known  physi- 
cian, whose  chief  prescription  after  every  visit  was  a  most  solemn 
exhortation  to  take  things  easy  and  not  worry  about  anything. 

Ultimately  the  physician's  bill  came  iu,  and  proved  to  be  of 
even  more  than  generous  proportions.  Straightway  down  sat  the 
patient  and  wrote  preci.sely  as  follows: 

"  Dear  Dr.  B :  Your  account  of  the  1st  iost.  duly  to  hand, 

and  I  feel  sure  that  you  will  be  delighted  to  learn  that  I  am 
taking  things  easy  and  not  worrying  about  anything.  Very  sin- 
cerely yours." — Doctors'  Fadolum. 

Four  Chlorides — Good  Alterative. 

B    Areenici  cliloridi KT- j 

Amnion,  clitoriili 3  ij 

Tr.  rerri  c)ilori<li i ,^  iv 

Hydrantjri  cliloriiii gr.  iw 

Synipi 3iij 

Aqute  ad 3  W 

M.   8ig.    leoBpoonful  three  times  daily. 


^dbyGoOgle 


ATLANTA 

Medical  and  Surgical  Journal. 

Vol.  XT.  NOVEMBER,  1898.  No.  9. 

DUNBAR  ROY,  A.B.,  M.D.,       .  M.  B.  HUTCHINS,  M.D., 

BDITOB.  BUSINESS  UANASRR. 

ORIGINAL  COMMUNICATIONS. 


AMPUTATION  OF  BREAST:     TUMOR  OF  ORBIT: 

SUPERNUMERARY  DIGIT:     GUNSHOT 

WOUND  OF  ANKLE.* 

By  WM.  SIMPSON  ELKIN,  M.D., 

Proreaior  Operative   and  Cllnicftl  Surgery.  AtUota  College  of  PhjitclftDs  snd 

SurgeoDi,  Atlanta,  Qa. 

Our  first  patient  is  a  negro  woman,  aged  twenty^-three  years, 
single,  washerwoman,  family  and  personal  history  negative. 

About  three  years  ago  she  noticed  a  small  lump  or  nodule  in 
the  upper  and  outer  quadrant  of  the  left  breast,  which  has  grad- 
ually grown  until  it  has  attained  its  present  size — that  of  a  large 
orange.  The  tumor  is  circumscribed,  firm  and  elastic,  freely 
movable.  The  skin  ie  not  adherent  to  the  growth.  The  nipple 
is  not  retracted.  No  enlargement  of  the  axillary  glands,  and  no 
pain.  I  believe  we  have  in  this  case  an  adeno-fibroma,  and  I  have 
advised  its  removal.  Adeno-fibromata  are  the  moat  frequent 
benign   mammary   neoplasms,  and   when  removed  do   not  recur. 

knithera  Uedieol  College,  AUanU,  On.,  Uareb  ISCb.  UOi. 


^dbyGoogle 


578       The  Atlanta  Medical  and  Surgical  Journal. 

They  coosist  of  hypertrophied  connective  tissue  mixed  with  more 
or  less  glandular  structure,  and  differ  only  from  the  bypertropbied 
mamma  by  being  circumscribed  and  encspsulated. 

If  this  were  a  malignant  tumor  you  would  have  a  history  of  a 
more  rapid  development,  pain,  hard  nodular  mass  more  or  less 
movable,  adherent  skin,  retracted  nipple,  and  at  this  time  an 
involvement  of  the  adjacent  axillary  glands.  All  tumors  of  the 
breast,  whether  benign  or  malignant,  should  be  removed  as  early 
as  possible,  since  beuign  tumors  frequently  assume  a  malignant 
character.  It  is  not  always  necessary  to  sacrifice  the  whole  breast, 
snd  I  would  not  do  so  in  this  instance  if  the  tumor  was  smaller, 
and  did  not  occupy  so  much  of  the  gland.  Smaller  tumors  of 
this  character  may  be  dissected  out,  and  the  usefulness  of  the  breast 
retained. 

The  mammary  gland  of  the  female  is  situated  between  the  third 
and  fifth  ribs,  and  is  supplied  from  the  inner  side  by  the  second, 
third,  fourth  and  fifth  intercostal  branches  of  the  internal  mam- 
mary artery,  and  on  the  outer  side  by  the  acromio-thoracic,  long 
thoracic  and  external  mammary  arteries.  The  long  thoracic  and 
external  mammary  are  the  largest  arteries  that  supply  the  breast, 
and  consequently  give  more  hemorrhage  when  divided. 

Although  the  seat  of  this  operation  was  thoroughly  sterilized 
on  yesterday  afternoon,  and  has  since  been  enveloped  in  an  anti- 
septic dressing,  I  will  have  the  nurse  scrub  it  again  with  tincture 
of  green  soap  and  water,  and  then  wash  with  1  to  1,000  bichloride 
solution,  and  lastly  with  alcohol  or  ether. 

The  bowels  have  been  moved  by  a  saline  cathartic,  and  the 
patient  instructed  to  eat  a  light  breakfast.  Anesthesia  being  now 
complete,  the  patient  is  drawn  near  the  edge  of  the  table.  Shoul- 
ders  are  slightly  elevated  by  placing  a  pillow  or  sandbag  beneath 
them.  The  arm  of  the  affected  side  is  raised,  and  the  hand  put 
beneath  the  head.  The  operator  stands  on  the  affected  side,  and 
faces  the  patient  if  the  right  side  is  involved,  and  faces  the  lower 
extremity  of  the  opposite  side  if  the  left  breast  is  to  be  removed. 

In  amputations  of  (be  breast  the  incision  is  an  elliptical  one, 
the  middle  of  the  ellipse  being  opposite  the  nipple. 

As  this  is  the  left  breast,  I  begin  my  incision  on  the  lower  and 


^dbyGoOgle 


Clinical  Lecture.  679 

inner  side,  carryiDg  it  over  the  gland  pKralle)  to  the  lower  fold  of 
the  pectoralis  major  muscle,  terminating  it  well  above  the  upper 
ADd  outer  margin  of  the  breast-  A  similar  incision  is  made  id 
the  under  surface  of  the  mamma,  beginning  and  terminating  at 
the  same  points,  thus  completing  the  ellipse.  This  will  give  us 
sufficient  skin  to  cover  the  surface  after  the  breast  is  removed. 
The  incision  should  be  completed  at  once,  and  is  carried  through 
the  skin  and  3uper6cial  fascia.  We  stop  at  this  point  to  check 
.the  hemorrhage.  I  now  pull  the  breast  downward,  while  my 
assistant  retracts  the  skin  upward  and  inward,  and  divides  all  the 
tissues  down  to  the  peetoralie  mtyor  musole.  The  dissection  is 
carried  downward,  and  the  mamma  is  raised  from  the  muscles 
beneath.  As  the  hemorrhage  is  quite  extensive  we  wilt  apply  the 
«ompressioQ  forceps  and  ligate  these  arteries  before  proceeding 
further.  The  breast,  you  now  see,  is  dissected  well  up  from  the 
■chest  wall,  and  all  we  have  to  do  is  to  extend  the  lower  incision 
through  the  fascia  down  to  the  muscles,  completing  the  incision  at 
<he  upper  and  outer  border  below  the  fold  of  the  pectoralis  major 
muscle.  As  the  large  blood-vessels  enter  the  gland  at  this  point  I 
divide  them  last.  You  see  now  that  the  edges  of  the  incision  can 
be  easily  approximated,  and  we  have  a  straight  line  of  closure. 
The  hemorrhage  is  well  checked,  the  arm  brought  down  to  the 
side  of  the  chest,  and  the  wound  is  closed  by  the  introduction  of 
interrupted  silkworm-gut  sutures.  No  drainage  is  necessary.  A 
strip  of  iodoform  gauze  is  placed  over  the  line  of  incision.  Over 
this  we  place  sterile  and  bichloride  gauze,  absorbent  cotton,  and 
lastly  a  roller  bandage  is  applied  firmly  over  this  dressing.  The 
pressure  of  the  bandage  firmly  applied  stops  any  oozing.  It  is 
necessary,  by  a  few  turns  of  the  bandage,  to  secure  the  arm  of  the 
jiffected  side  to  the  chest  wall,  otherwise  the  movements  of  the  ' 
pectoral  muscles  would  disturb  the  healing  of  the  wound. 

If  the  temperature  remains  practically  normal,  the  dressings 
will  not  be  changed  until  seven  or  eight  days,  when  they  will  be 
taken  off  and  the  stitches  removed.  A  light  dressing  will  then  be 
applied,  and  in  two  weeks  the  patient  should  be  entirely  well. 

The  next  case  is  very  unique.  It  is  a  growth  involving  the 
left  orbit. 


^dbyGoogle 


580       Thb  Atlahta  Mbdical  and  Sorgical  Joprsal. 

Mattie  Ward,  aged  eighteea  years,  siogle,  black,  female,  washer- 
womaa. 

GraodpareDts  all  dead — cause  uaknowD.  Two  or  three  brothers 
and  siaters  died  when  very  small^-caase  of  death  not  known. 
Father  and  mother  alive  and  well  at  about  forty  years.  One- 
brother  and  three  sisters  living,  all  in  good  health — i^es  three  to- 
twenty-five  years. 

No  history  of  syphilis  or  gonorrhea  obtained.  Has  had  pneu- 
monia two  years  ago,  and  whooping-cough  at  five  years  of  age.- 
No  history  of  inflammation  of  eye  previous  to  beginning  of  this- 
trouble  obtainable.  Dates  trouble  from  time  of  whooping-cough, 
and  states  this  was  the  cause.  During  a  paroxysm  of  coughing, 
she  says,  her  eye  "popped  out."  Four  years  ago,  when  she  left 
her  mother,  eye  was  closed  and  b^inniog  to  bu]ge  some,  but  not 
very  much.  Has  been  slowly  growing  since  she  can  remember.. 
Has  about  doubled  in  last  two  years,  and  appears  to  be  growing- 
more  rapidly  now  than  formerly.  At  times  she  has  severe  neu- 
ralgia above  eye,  and  general  headaches,  which  she  does  not  seem- 
to  be  able  to  separate  intelligently.  She  sheds  tears  and  winks 
this  eye  with  the  other.  It  is  quite  sensitive,  so  much  so  that 
examination  is  not  satisfactory.  Tumor  is  cystic  or  semi-cystic, 
and  rounded.  Somewhat  larger  than  a  baseball.  Skin  seems- 
normal  except  for  some  large  veins  visible.  Bony  wall  is  bulged 
out  in  all  directions.  Nose  turned  to  opposite  side.  The  growth 
bulges  forward  about  two  and  one-half  inches.  Measures  ten 
inches  in  circumference  and  three  in  diameter,  and  has  the  feel  of 
a  cystic  or  semi-solid  tumor.  The  orbital  border  is  large  and 
flared  out,  the  nasal  bone  pushed  to  the  opposite  side  and-the- 
molar  bone  downward.  The  edges  of  the  lids  have  grown 
together,  and  it  presents  the  condition  of  ankyloblepharon. 
Ankyloblepharon  is  not  a  common  occurrence,  usually  exists  in 
children,  and  may  be  partial  or  complete.  This  tumor  may  be  the 
result  of  accumulation  of  tears  and  mucus  behind  the  lids,  the 
eyeball  being  forced  back  into  the  orbit.  Doctors  Calhoun, 
Stirling  and  Roy  of  this  city  have  each  examined  this  patient  and 
testify  to  the  unique  and  unusual  appearance  of  the  growth. 
They  are  inclined  to  the  opinion  of  malignancy. 


^dbyGoOgle 


Clinical  Lbctdeb.  581 

I  will  make  an  incision  in  the  line  of  the  palpebral  fissure,  sep- 
aratiag  the  upper  and  lower  lids.  The  lashes  of  the  lower  lid  are 
absent.  After  makinf^  this  incision  you  observe  the  round  and 
shining  appearance  of  the  growth,  which  I  take  to  be  its  capsule. 
On  opening  this  I  am  able  to  liberate  a  mass  of  tissue  resembling 
very  much  in  appearance  a  sarcoma.  A  careful  microscopical 
-eiamiaatioD  will  be  made  to  determine  the  exact  character.  I 
was  surprised  not  to  find  more  fluid,  as  it  gave  evidence  of  being 
more  or  less  cystic.  I  will  now  remove  the  capsule  and  other 
effected  tissue  if  possible,  check  the  hemorrhage,  and  pack  the 
■orbit  with  iodoform  ganze,  and  apply  external  antiseptic  dressing. 
In  a  few  days  I  hope  to  be  able  to  give  you  the  result  of  the 
cnicroscopical  examination. 


(The  accompanying  cut  shows  appearance,  of  tumor  before 
removal.  It  proved  to  be  a  myxosarcoma.  The  patient  made  a 
prompt  recovery  and  to-day,  six  months  after  operation,  is  per- 
fectly well.) 

The  third  case  that  I  present  is  a  young  boy,  aged  four  years. 
He  has  two  thumbs  on  the  same  band.  He  has  what  is  known  as 
«  supernumerary  digit.  Thb  condition  may  affect  not  only  the 
thnmb  and  fingers,  but  also  the  toes,  most  usually  iovolviug  the 
thumb  and  little  finger,  and  the  small  toe.  The  supernumerary 
'digit  may  be  attached  by  a  small,  narrow,  fibrous  band,  or  may 
tiave   its  own  phalanx,  and   sometimes  a  separate  metacarpal  or 


^dbyGoOgle 


5S2       The  Atlaitta  Mbsical  and  Sdboical  Journal. 

metatarsal  boD«.  They  are  most  usually  inherited  and  should  be- 
removed  as  early  as  possible.  The  operation  is  very  simple,  aod 
consists  ia  making  an  iocision  around  the  base  of  the  supernu- 
merary digit,  add  amputating  as  you  would  a  finger  or  toe.  If  the 
patient  is  young,  there  is  very  little  hemorrhage,  and  the  incision 
heals  readily. 

The  next  and  last  case  is  a  negro  man,  aged  forty-two  years,  mar- 
ried, carpenter.  He  states  that  he  was  shot  night  before  last,  the  ball 
entering  the  leg  on  the  inner  side  of  the  tendo  Achillis,  just  above 
and  behind  the  internal  malleolus,  passing  downward  and  lodging 
in  the  tarsal  or  metatarsal  bone  of  the  foot.  He  does  not  know 
the  size  of  the  ball,  but  states  that  he  was  shot  from  behind  at  a 
distance  of  about  thirty  feet.  It  would  he  unsurgical  to  probe  for 
this  ball,  and  I  would  only  direct  that  the  wound  of  entrance  be 
thoroughly  cleansed  with  an  antiseptic  solution,  and  dressedf 
instructing  the  patient  lo  go  to  the  hospital  and  remain  in  bed 
with  foot  elevated,  and  await  developments.  If  suppuration  takes 
place,  the  ball  can  be  more  easily  found,  and  then  can  be  removed. 
An  X-ray  may  be  made  to  ascertain  the  exact  location  of  the  ball, 
which  may  then  be  removed. 


MEDICAL  REMINISCENCES  OF  FORTY  YEARS  AGO. 

By  G.  G.  hot,  M-D, 
Atlasta,  Q±. 

When  typhoid  fever  first  developed  at  Tide  Water,  Virginia,  I 
have  heard  my  father,  Dr.  A.  G.  D.  Roy,  say  that  it  was  a  hard 
matter  to  diagnose  it  from  the  adynamic  forms  of  severe  malarial 
fever  not  uncommon  in  that  section,  and  the  two  diseases  requiring 
entirely  different  modes  of  treatment,  many  patients  were  lost 
that  might  have  been  saved  had  the  distinction  been  clearly  defined 
and  understood  by  the  physicians  then  and  the  treatment  changed. 
The  physicians  at  that  time  had  never  met  with  a  case  of  typhoid 
fever,  but  had  been  accuRtomed  to  treat  typhus  and  malarial  fevers- 
in  all  their  insidious  and  multiform  types,  which  required  (as  baa 


^dbyGoOgle 


Medical  Reminiscences  of  Fobtt  Ybars  Ago.        583 

been  called)  heroic  treatmtnt.  When  this  Dew  disease  appeared, 
they  thought  it  another  form  of  fever,  but  of  malarial  orif ' 
began  the  same  heroic  treatment;  the  result  was  their  patiei 
vived  only  a  few  days  under  that  treatment,  I  very  well  r 
how  my  father  told  me  he  began  the  treatment  successful 
species  of  practioal  indxiotion. 

In  a  certain  family,  one  of  the  best  neighboring  physi 
very  successful  practitioner  in  malarial  fevers  with  the  heroi 
had  eight  or  ten  cases  of  fever  among  the  negroes  od  the 
tion,  and  in  a  week  or  ten  days  every  one  died. 

My  father  was  then  called  to  attend  the  other  negrt 
members  of  the  &mi]y  with  the  same  fever;  and  learn 
mode  of  treatment  of  Dr.  G.,  who  attended  those  tha 
determined  to  try  the  opposite  plan  of  treatment — t.  e.  littl 
cine,  nourishment  and  stimulants,  and  leave  to  nature  th 
Under  this  treatmeot  ail  of  his  patients  recovered.  Then, 
first  time,  it  dawned  upon  the  physicians  in  that  section  tb 
had  a  new  fever  to  deal  with,  one  which  could  not  be  aborte 
career  shortened  with  quinine  and  calomel,  and  that  it  woul 
its  course,"  terminating  on  the  seventh  day,  or  on  some  mul 
that  number,  and  that  a  supporting  treatment  was  most  11 
bring  success.  Typhoid  fever  of  that  day,  it  appears  to  i 
more  severe,  but  more  successfully  combated  or  manage 
now.  I  don't  know  the  reason,  unless  it  is  that  manki 
physically  degenerated,  and  is  thereby  the  less  able  to  resi 
throw  off  diseases. 

It  appears  to  me  that  recovery  took  place  oftener  after 
brain  complications  and  intestinal  hemorrhage  then  than  no 

The  mode  of  treatment  was  somewhat  similar  then  an 
small  doses  of  calomel  were  given  to  stimulate  the  secre: 
the  liver,  at  intervals  during  the  progress  of  the  disease;  one 
to  one-sixth  grains  tonic  and  stimulating  doses  of  quinine, 
pentiue  emulsion  and  (what  will  strike  the  younger  memberi 
profession  with  holy,  horror)  fly-blisters  to  the  scalp  in  brai 
plications  and  over  the  abdomen  as  soon  as  e^itreme  ten 
developed. 

I    am    a    living  monument  to   this  plan    of  treatment. 


^dbyGoOgle 


584       Tbe  Atlanta  Medical  and  Surgical  Joukhal. 

aboat  thirteen  or  fourteeo  years  of  age,  after  a  week  or  two 
of  malaria,  daring  which  I  kept  up  and  attended  school,  though 
unfit  for  study,  I  took  my  bed  on  the  15th  day  of  July.  About 
the  20th  I  became  unconBciou8  and  have  no  recollection  of  any 
thing  that  transpired  until  late  in  the  following  September,  when 
I  regained  conscioueneas. 

During  this  time  my  scalp  was  shaved  and  a  blister  applied,  and 
as  soon  as  this  "dried  up  "  another  was  applied,  and  the  ecalp  was 
kept  a  running  sore  for  six  or  eight  weeks.  At  the  sanw  time  I 
■was  blistered,  cupped  and  leeched  over  tbe  abdomen,  and  these  were 
persisted  in  like  the  blister  .to  the  scalp.  I  do  not  mean  to  say 
that  I  was  cupped  and  leeched  on  tbe  blistered  surface,  but  the 
capping  and  leeching  were  nsed  alternately  with  the  blisters,  and 
T  bear  the  marks  of  the  scarificator  on  my  body  to  this  to-day. 

Now,  the  doctors  of  this  age  will  say,  that  I  must  have  been  a  horse 
or  a  mule  to  stand  such  crael  treatment,  but  without  it,  I  honestly 
believe  that  I  would  not  be  living  to-day.  My  Other's  rule  was  to 
have  me  given  two  to  four  tablespoonfuls  of  milk  and  musb  every 
two  hours,  day  and  night.  This  was  prescribed  as  medicine,  and 
given  with  tbe  same  regularity  when  I  conid  be  made  to  swallow* 
I  have  no  doubt  but  that  I  was  supported  by  rectal  administratioDa 
also. 

My  case  was  given  up  as  hopeless  by  my  &tber  and  all  tbe  other 
physicians  in  attendance,  but  my  old  colored  nurse,  all  these  long 
and  dreary  days  and  nights,  lay  by  my  bedside;  and  it  was  to  her 
that  tbe  first  dawn  of  returning  consciousness  was  revealed.  She 
told  me  that  one  night  at  12  o'clock,  when  my  father  bad  retired, 
beart-sick,  worn-out  and  hopeless,  that  I  spoke.  She  gave  heed  to 
the  sound  which  she  could  hardly  believe,  and  was  greatly  startled. 
I  recognized  her  and  said:  "Harriet!  I  am  as  hungry  as  a  wolf. 
Have  you  anything  to  eat  ?  "  She  said  :  "  No,  Marse  Gas !  Yon 
haven't  eaten  anything  for  a  long  time;  and  there  is  nothing  to  eat 
in  the  room."  I  then  said:  "Have  you  any  ice?"  She  gave  me 
a  piece,  and  said  I  cracked  it  with  my  teeth  f  like  a  pig  cracking 
corn." 

Of  course,  tbe  history  of  my  sickness  was  derived  from  my 
father  and  my  colored   nurse,  who  bad    nursed  me  when  a  baby. 


^dbyGoOgle 


Valub  of  Ibideotomt  ni  Blindness.  685 

There  was  a  mute  (deaf  aod  dumb)  gentleman  in  the  neighborhood 
who  was  very  fond  of  the  family,  and  especially  so  of  me.  He  was 
a  vigilant  and  competent  ouree  also.  I  was  told  he  would  come  to 
stay  with  me  nearly  every  night.  After  I  recovered  he  thought  he 
bad  a  good  joke  od  me.  By  his  language  of  signs,  he  thought  it 
very  fuony  to  tell  my  acquaintances  that  one  night  in  holding  the 
vessel  for  me  to  urinate,  the  urine  fell  upon  his  band  and  burnt 
him  80  badly  that  fae  dropped  the  vessel.  This  he  thought  was  a 
good  joke  on  me,  and  he  would  laugh  himself  inordinately  when 
telling  it. 

When  I  began  to  convalesce,  I  was  indeed  a  pitiable  object  to 
behold;  the  bones  of  my  ankles,  kuees,  htpe  and  elbows  were 
"through  the  skin."  I  had  forgotten  how  to  walk,  and  had  to 
learu  it  over  again  like  a  baby,  and  my  bald  head  made  me  an  ob- 
ject so  frightful  that  I  was  scared  of  myself  the  first  time  I 
looked  into  a  mirror,  and  did  not  repeat  it  for  many  weeks  after- 
wards. ' 

I  shall  continue  this  subject  in  the  oext  issue  of  The  Jodbnal, 
giving  some  of  my  early  experiences  in  treating  this  formidable 
disease. 


THE  VALUE  OF  IRIDECTOMY  IN   BLINDNESS,  RE- 
SULTING FROM  OPAQUE  CORNEA. 

Bt  a.  BETHUNE  PATTBB80N,  M.D., 
Atlanta,  Qa. 

The  following  cases  are  selected  from  a  number  of  similar  ones, 
illustrative  of  the  value  of  iridectomy  in  cases  of  blindness,  which 
have  resulted  from  opacity  of  cornea,  produced  by  ulcerative 
keratitis  (corneal  ulcers).  Only  the  worst  forms  will  be  included  in 
this  report,  where  the  healthy  corneal  tissue  is  nearly  supplanted 
by  the  formation  of  opaque  cicatricial  tissue. 

There  are  several  forms  of  ulceration,  which  have  a  tendency  to 
bring  about  this  condition  of  the  cornea. 

J,  W.,  aged  thirty ;  two  years  previous  to  his  coming  bad  a  sever^ 


icizibyG'OOgle 


586       The  Atlanta  Medical  and  Sdrqical  Jodbnal. 


form  of  inflanimatioD  which  left  htm  blind,  from  the  coDvereioD  of 
the  once  transparent  cornea  into  a  white  cicatricial  membrane,  com- 
plete in  right  eye,  so  that  there  was  not  the  slightest  bit  of  iria  visible, 
staphyloma  tons  and  with  history  of  recurrent  ulcerations.  I  lost  d& 
time  in  enucleating  this  contracted  and  chronically  inflamed  eye. 

The  cornea  of  left  eye  was  as  white  as  right,  more  perfect  ia 
outlines,  and  free  of  tenderness  and  hardness.  At  the  lower  mar-, 
gin  a  transparent  cornea,  possibly  a  little  more  than  a  millimeter  in 
width,  and  in  length  about  one-third  of  its  circumference. 

Three  months  aiter  enucleating  the  right  eye,  the  left  conjunc- 
tival sac  was  daily  irrigated  with  an  antiseptic  lotion,  and  an  anti- 
septic dressing  applied,  until  the  time  appointed  for  the  operation. 
The  iridectomy  was  done  under  thorough  antiseptic  precautions. 
There  was  no  inflammatory  action  in  the  track  of  incision,  and, 
therefore,  no  impairment  to  the  transparent  strip  of  cornea.  Through, 
this  narrow  slot,  this  unfortunate  and  unhappy  man  was  given  useful 
vision,  which  enabled  him  to  get  about  without  assistance,  and  was 
enabled  to  recognize  familiar  faces  at  about  fifteen  paces.  As  he  did 
not  know  his  letters,  no  accurate  estimate  of  vision  could  be  made. 

The  last  account  I  had  of  this  case  was  five  years  after  the 
operation;  at  that  time  there  had  been  no  diminution  of  vision- 
He  was  making  himself  useful  in  attending  to  stock  and  assisting 
in  work  that  did  not  require  accurate  eyesight. 

S.  P.,  aged  Dine ;  has  been  blind  from  infancy ;  history  of 
ophthalmia  neonatorum.  Both  cornea  was  a  dense  mass  of  white 
cicatricial  tissue;  could  only  distinguish  daylight  from  darkness. 

The  right  eye  presented  a  margin  of  transparent  cornea  below, 
or  at  its  lower  margin;  its  greatest  width  would  not  exceed  two  milli- 
meters. In  left  eye  there  was  a  transparent  line  of  cornea  occupy- 
ing the  upper  and  outer  quadrant,  showing  not  more  than  half  as 
much  of  the  dark  iris  as  its  fellow  eye ;  the  latter  I  selected  as  the 
one  best  suited  for  an  iridectomy. 

The  eye  was  prepared  for  operation  as  follows:  A  lotion  of 
boracicacid,  tiOeen  grains  to  the  ounce  of  water,  was  used  every  few 
days  to  irrigate  the  conjunctiva]  sac,  keeping  the  eye  bandaged 
with  antiseptic  gauze  and  cotton. 


^dbyGoOgle 


Valde  op  Iridkotomy  ih  Blisdness.  587 

The  iridectomy  was  done  while  under  the  influenc  of  chloroform, 
as  I  could  not  afford  to  take  any  risk  with  cocaia,  as  with  it  there 
is  always  a  sharp  pain  experienced  when  the  iris  is  seized  and 
excised  ;  therefore,  I  have  preferred  cblororurm  aueetbesia. 

The  iridectomy  proved  a  saocess;  it  gave  the  child  useful  vision, 
lam  unable  to  state  the  amount,  as  t  have  not  seen. the  patient 
since  his  recovery  trom  operation,  soon  after  which  he  was  removed 
to  his  home  in  an  adjoining  State.  The  last  account  I  had  of  him 
was  three  years  after  the  operation ;  there  had  been  no  deterioratioD 
in  vision,  as  well  as  mother  could  )udge;  be  was  making  some  head- 
way at  spelling. 

C.  D.,  aged  twenty;  dates  bis  blindness  &om  infancy;  both  cornea 
opaque ;  only  the  right  afforded  any  encouragement  for  operative 
interference,  and  really  I  entertained  very  tittle  hope  of  an  iridec- 
tomy doing  much  for  him,  as  the  point  at  which  the  brown  iris 
could  be  seen  was  semi-transparent. 

For  ten  days  the  eye  was  kept  bandaged  and  irrigated  every  other 
day  with  a  saturated  solution  of  boracic  acid. 

On  the  morning  of  the  operation  the  eye  wau  cocainized  and  the 
iridectomy  made.  I  was  careful  in  getting  away  a  good  bit  of  iris. 
There  was  no  inflammatory  reaction,  and  the  eye  soon  recovered 
from  the  operation.  I  kept  this  case  under  observation  for  six 
weeks;  at  the  time  of  his  leaving  oould  count  fingers  with  some  diffi- 
culty at  ten  paces;  this  amount  of  sight  enabled  him  to  get  about 
without  assistance,  and  made  him  a  more  useful  man  to  himself 
and  others. 

While  serving  as  assistant  iu  the  Royal  London  Ophthalmic 
Hospital,  I  on  one  occasion  drew  Mr.  Nettleship's  attention  to  a 
patient  whose  eye  was  in  a  similar  condition  tu  number  one  in  the 
above  report,  and  asked  what  he  thought  of  the  chances  of  an  iridec- 
tomy. He  replied  that  he  did  not  think  favorably  of  tbe  success 
of  such  an  operation,  that  the  good  effects  did  not  last  very  long, 
as  the  transparent  coruea  was  soon  invaded  by  gray  infiltration  from 
the  inscision  in  the  sclero-corneal  junction,  I  believe  my  success 
-in  preventing  this  infiltration  was  due  to  the  thorough  antisepsis 
iu  the  toilet  of  operation,  and   also,  especially  to  the  preparation 


^dbyGoOgle 


688       The  Atlanta  Medical  and  Sorqical  Jodbhal. 

the  eye  underwent  iu  rendering  it  aa  aseptic  as  possible   prior  to 
the  operation. 

From  my  experience  in  hospital  and  private  practice,  I  am  con- " 
vinced  that  a  very  large  per  cent,  of  blindnese  from  extensive 
leueomas  and  cicatricial  tissue  hsve  their  origin  in  gonorrheal  oph- 
thalmia; as  is  well  known,  this  is  a  disease  extremely  fatal  to  sight, 
especially  when  neglected  at  the  onset. 

In  ophthalmia  neonatorum  the  first  evidences  of  the  disease  is 
observed  about  the  third  or  fourth  day  after  birth.  As  a  prophylac- 
tic in  this  serious  complaint,  I  would  urge  upon  the  attention  of 
the  accoucheur  the  importance  of  making  inquiry  into  the  vaginal 
secretion,  whether  or  not  there  is  or  has  been  a  leucorrfaeal  discharge 
or  whites;  where  there  is  the  slightest  suspicion  of  such  unhealth- 
fulness,  no  time  should  be  lost  \ii  repeated  thorough  irrigations  of 
the  vagina  with  antiseptic  lotions,  thus  lessening  the  chances  of  the 
child's  eyes  becoming  affected  from  the  vaginal  secretion.  I  cannot 
lay  too  much  stress  upon  the  immediate  cleansing  and  disinfecting 
the  eyes.  It  would  be  a  safe  and  wise  precaution  immediately 
after  the  first  cleansing,  to  instill  into  the  eyes  a  drop  of  a  solution 
of  nitrate  of  silver,  ten  grains  to  the  ounce  of  water,  followed  by  a 
weak  solution  of  salt  and  water  to  neutralize  the  nitrate  of  silver. 
No  possible  injury  can  result  from  this  treatment  to  the  eyes  of  the 
new-born;  it  would  be  almost  a  sure   preventive  against  infection. 

The  cleansing  and  disinfection  of  the  eyes  of  the  inlaut  should 
be  done  by  the  physician,  aud  not  entrusted  to  the  nurse. 

507  Engliah-American  Building. 


L.  FsEYBERGEB  {TreotmeiU,  May  12,  1898)  has  treated  thir^ 
cases  of  incontinence  of  urine  with  fiuid  extract  of  rhus  aromatica, 
with  permanent  cure  in  eighteen  and  with  relief  in  ten  others. 
The  dose  employed  was  from  five  to  ten  minims  three  times  a  day 
for  children  from  two  to  five  years  old,  and  from  ten  to  fifteen 
minims  for  children  from  five  to  ten.  The  disagreeable  taste  can 
be  di^uised  by  aromatic  sirup. 


^dbyGoogle 


History  op  thb  Mbdical  ExAiimiNd  Board. 


HISTORY  OF  THE  MEDICAL  EXAMINING  BOARD 
OF  GEORGIA. 

Bi  E.  B.  ANTHONY,  M.D.,  GuiTPiir,  Ga., 
SecraUtf  of  the  Board. 

To  elevate  the  staDdard  of  medical  education  in  the  United 
States  has  beea,  for  the  past  thirty^  years,  the  great  aim  of  the 
leading  men  of  the  medical  profession  in  every  State  in  the  Union. 

Actuated  by  an  intense  devotion  to  science,  and  a  high  sense  of 
duty  to  the  public,  they  have  woriied  faithfully  to  devise  ways  and 
means  to  this  end,  and  to  make  the  doctorat«  conferred  by  our 
medical  colleges  worthy  of  the  respect  that  should  be  accorded  it 
by  the  members  of  the  other  learned  professions  and  by  men  of 
education  generally.  Logical  essays  and  eloquent  orations  from 
various  members  of  different  medical  societies,  whenever  and 
wherever  convened,  failed  for  years  and  years  to  point  out  the 
remedy  for  the  growing  evil  of  graduating  from  our  medical  colleges 
illiterate  and  incompetent  men. 

The  medical  journals,  in  editorials  of  no  uncertain  meaniugr 
condemned  and  opposed  this  prostitution  of  a  great  educational 
trust,  but  suggested  no  remedy.  Finally,  like  a  happy  inspiration, 
the  idea  came  to  some  one  to  surest  State  Medical  Examining 
Boards.  The  leading  countries  of  Europe,  Germany,  Austria,  Eng- 
land, and  others  had  Examining  Boards,  why  not  our  States?  This 
seemed  to  be  the  long  sought-for  remedy,  and  the  rank  and  Gle  of 
our  profession  in  every  State  of  the  Union  began  to  demand  laws 
of  their  State  legislatures  that  would  create  Examining  Boards, 
and  advance  the  cause  of  higher  medical  education.  Twenty-six 
States  have  succeeded  in  having  such  laws  passed,  but  in  many  in- 
stances only  afler  a  bitter  struggle. 

It  is  with  feelings  of  pardonable  pride  that  we  can  point  to 
Georgia's  name  on  this  "Roll  of  Honor."  It  gives  me  pleasure 
to  speak  of  the  great  aid  given  this  movement  by  the  medical 
journals  and  the  medical  colleges  in  our  State.  Their  assistance,  in 
bringing  about  these  sweeping  reforms,  recently  instituted  in  our 


^dbyGoOgle 


590       Tab  Atlanta  Mbdioal  ahd  Suegioal  Jodehal. 

State,  have  been  id  valuable.  It  gives  us  greater  faith  in  the  higher 
destiny  of  our  profession  to  know  that  every  physician,  of  aoy 
promiaeoce  in  Georgia,  hopefully  and  persistently  worked  for  the 
passage  of  this  law.  While  this  ia  true,  I  should  &il  in  justice  and 
in  courtesy  alike  to  several  worthy  gentlemen,  did  I  not  speak  mora 
particularly  of  their  efforts  in  behalf  of  the  enactment  of  this  law. 
To  the  untiring  energy  of  many  leading  members  of  the  profession 
in  Georgia,  the  unselfish  interest  of  Mr.  Fleming,  and  the  masterly 
manner  in  which  the  bill  was  managed  by  Mr.  Fouob^,  is  lai^ly 
due  the  passage  of  the  bill  by  the  legislature  of  1894.  While  the 
present  law  may  not  be  entirely  satis&ctory  to  some,  in  my  opinion, 
it  is  one  of  the  best  that  has  been  adopted  by  any  of  the  tweaty-siz 
States  that  have  Ezamiuing  Boards,  Has  the  execution  of  this  law 
by  the  gentlemen  appointed  for  this  purpose  by  th$  governor  been 
satisfactory?     We  believe  so. 

It  has  been  the  endeavor  of  the  members  of  (he  board,  in  the 
performance  of  their  duties,  to  be  governed  by  justice  aad  modera> 
tion.  Conservatism  and  charity,  in  the  enforcement  of  any  new 
law,  ever  appeals  to  the  better  sense  of  man.  It  takes  time  to  bring 
about  any  great  advance  in  religious,  political  or  scientific  reforms. 

Hence,  the  board  adopted  for  its  guidance  the  old  Latin  maxim, 
Jeatina  Unte.  We  have  made  haste  slowly,  but  we  feel  now  that 
the  experimental  age  or  stage  of  this  law  has  passed,  and  that  we 
would  fall  short  of  our  duty  did  we  not  make  our  examinations 
more  rigid,  and  grade  the  answers  to  questions  more  strictly.  It 
has  been  a  question  with  the  board  whether,  under  the  law,  we  bad 
the  right,  in  grading  the  papers  of  some  applioants,  to  take  into 
consideration  the  evidence  of  their  not  having  the  essential  ele- 
ments of  a  good  English  education. 

We  have  licensed  a  good  many  when  it  was  painfully  evident 
that  they  did  not  possess  this  qualification.  We  were  apprehensive 
that  we  might  overstep  our  authority  if  we  allowed  this  question  to 
influence  us  when  passing  upon  their  proficiency  in  the  medical 
branches,  and  besides,  beyond  doubt,  this  is  a  question  to  be  regu- 
lated by  the  medical  colleges,  which  should  have  certain  educational 
requirements  for  matriculation. 

Tbe  first   meeting  of  the  board  was  held  in  Atlanta,  January 


,„i,z.d  by  Google 


HiSTORT   OF   THE   MeDICAL   EXAMtKINQ   BoASD.  591 

2l8t,  1895,  the  following  geDtlemen  comprieiog  the  board: 
Dr.  A.  A.  Smith,  Dr.  James  B.  Baird;  Dr.  F.  M.  Ridley; 
Dr.  W.  A.  O'Daniel  aad  Dr.  E.  R.  Anthony.  Dr.  F.  M.  Ridley 
was  elected  president  and  immediately  resigned.  Dr.  A.  A.  Smith 
was  then  elected  president  and  Dr.  F.  M.  Ridley  secretary.  Id 
1896  Dr.  E.  R.  Anthony  was  elected  president  and  Dr.  W.  A. 
O'Daniel  secretary.  In  1897  Dr.  F.  M.  Ridley  was  elected  pres- 
ident and  Dr.  O'Daniel  secretary.  In  1896  Dr.  J.  B.  Baird 
resigned  as  a  member  of  the  board  to  accept  a  chair  in  the 
Southern  Medical  College,  and  Dr.  J.  C.  Olmsted  was  appointed 
by  the  governor  to  fill  the  vacancy.  In  1897  Dr.  Olmsted 
resigned  to  accept  a  chair  in  the  Southern  Medical  College,  and 
Dr.  J.  B,  S.  Holmes  was  appointed  to  fill  the  vacancy.  There  has 
been  no  change  in  the  personnel  of  the  board  since  then.  The 
■officers  of  the  board  at  present  are  J.  B.  S.  Holmes,  M.D.,  pres- 
ident, and  Dr.  E.  R.  Anthony,  secretary.  Since  the  organization 
■of  the  board  eighteen  sessioDS  have  been  held  and  382  applicants 
have  been  licensed  to  practice,  as  follows :  In  1895,  107;  in  1896, 
62;  in  1897,  106;  in  1898,  107.  AboiU  ten  per  cent,  of  all 
applicants  have  been  rejected.  In  future  the  proceedings  of  the 
sessions  of  the  board,  and  the  results  of  the  examinations,  giving 
the  number  of  applicants  from  each  medical  college  examined,  the 
number  licensed  and  the  number  rejected  and  the  percentage  made, 
will  be  published  in  The  Atlanta  Medical  and  Sdbgical 
JouBXAL.  This  plan  has  been  adopted  by  the  boards  of  several 
States,  and  we  believe  it  will  prove  beneficial.  The  creation  of 
examining  boards  in  so  many  States  has  compelled  the  medical 
colleges  to  elevate  their  standard  for  graduation  and  has  forced 
them  to  exercise  more  care  in  the  granting  of  diplomas.  Another 
good  eSect  of  this  law  is  that  it  deters  a  lai^  proportion  of  the 
incompetent  from  selecting  the  profession  of  medicine  as  a  life 
avocation.  "Without  any  desire  to  reflect  upon  the  proficiency  of 
the  earlier  classes  licensed  by  the  board,  we  must  say  it  has  been  a 
source  of  great  pleasure  to  the  members  of  the  board  to  observe 
the  improvement  each  year  has  shown  in  the  preparation  and 
fitness  of  the  applicants. 


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Th£  Atlanta  Medical  and  Surgical  Jodbnal. 


CANCER  VIEWED  AND  TREATED  FROM  THE  STAND- 
POINT OF  THE  GENERAL  PRACTITIONER, 
WITH  REPORTS  OF  CASES. 
Bt  BITTLE  C.  KEI8TEB,  A.M.,  M.D., 

SOPTH  BOSTOM,  Va. 

The  etiology  of  cancer  is  as  yet  very  obscure,  hence  I  shall  not 
Attempt  any  elaborate  elucidation  of  a  subject  that  is  now  agitating 
the  minds  of  the  scientific  world. 

Speculative  authors  tell  us  that  it  may  be  a  parasitic  disease, 
and,  hence,  may  partake  largely  of  the  etiology  of  tuberculosis. 

Various  forms  of  bacteria  have  been  observed  from  time  to 
time  in  carcinoma  by  carerul  investigators.  It  is  evident  that 
these  organisms  form  in  cancer,  and  it  is  probable  that  they  pro- 
duce  inflammatious  and  oecroses  in  the  tumor,  and  in  some  cases, 
possibly,  they  have  some  conoection  with  the  cachexia. 

Scheuerleo  reported  in  1887  a  caucer  bacillus  which  had  been 
obtained  by  culture.  The  bacilli  were  short,  and  were  capable  of 
developing  spores.  These  organisms,  when  inoculated  into  the 
mammary  gland  of  dogs,  produced  tumors  contaiuing  epithelial  cells. 

Professor  Sanfelice,  of  the  University  uf  Cagliari,  in  Sardinia, 
and  Professor  Roocali,  of  the  Uoiversity  Surgical  Clinic  in  Rome, 
in  1895  published  some  very  important  data  beariug  on  the  eti- 
ology of  caocer.  Their  remarkable  experimental  results  with  the 
blastomycetes,  as  the  active  agents  in  the  causation  of  cancer,  bas 
had  much  to  do  in  producing  a  revolution  of  ideas  on  the  pathoU 
ogy  of  this  fell  disease.  By  inoculation  with  these  cultures,  they 
have  produced  tumors  in  animals,  which  bear  the  strongest  pes- 
sibte  resemblance  to  those  ueoplasms  from  which  the  cultures  were 
ori^nally  made.  Without  going  so  far  as  to  say  that  this  can  be 
done  in  every  instance,  or  that  all  caucers  are  necessarily  of  para- 
sitic origin,  oue  is  justified  by  these  results  in  at  least  maintaining 
that  some  caucers  are  positively  of  parasitic  origin. 

The  presence  of  intracellular  organisms  of  quite  a  difierent 
character  from  bacteria  has  created  much  speculation  during  the 
last  few  years.     Since  the  anatomical  nature  of  cancer  is  better 


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Oamceb.  598 

understood,  it  is  known  that  peculiar  cell-like  bodies  are  a  charao- 
terietic  feature  of  the  disease.  These  bodies  were  supposed  to  be 
cells  undergoing  degenerative  changes.  Schutz  thinks  that  most 
of  the  questionahle  intracellular  structures  found  in  carcinomata 
should  be  regarded  as  due  to  leucocytes,  which  have  become  em- 
bedded in  the  cell.  Klebs,  after  careful  study  and  experiment, 
decides  that  there  are  no  positive  grounds  for  regarding  these  cells 
as  parasites.  He  sees,  in  the  presence  of  these  cells,  within  ihe 
epithelial  cells,  evidence  apparently  of  the  old  French  theory  of 
the  action  de  prSaence — the  leucocytes  exerting  a  fructifying  influ- 
ence upon  the  cancer-cells  aud  causing  them  to  multiply.  Many 
still  hold  to  the  old  idea  that  they  are  degenerated  epithelial  cells. 

All  attempt?  to  cultivate  these  cells  from  cancer  growth  appear 
to  have  failed,  and  the  number  of  cases  in  which  caucer  has  been 
inoculated  successfully  into  animals  is  exceedingly  limited.  Coun- 
cilman does  not  consider  these  structures  parasitic,  having  seen 
them  in  many  other  morbid  processes  as  well  as  in  cancer.  He 
does  not  think  the  J3arasitic  origin  has  yet  been  proven,  and,  on 
theoretical  grounds,  thinks  it  is  hardly  likely  to  be.  Park,  how- 
ever, tves  in  these  investigations  sufficient  to  encourage  the  hope 
that  surgeons  are  on  the  eve  of  great  discoveries,  which  will  settle 
the  question  of  the  origin  of  cancer. 

Caucer  is  said  to  be  less  common  in  tropical  than  in  temperate 
climates.  Haviland  proved  the  disease  to  be  most  prevalent  in 
damp  and  in  low-lying  districts  in  England.  It  is  said  to  be  less 
frequently  seen  in  Turkey,  in  Egypt,  and  in  the  West  Indies. 
Xegroes  are  generally  supposed  in  America  to  he  much  less  afflicted 
with  cancer  than  the  white  race.  In  England  statistics  show  that 
there  are  about  30,000  patients  suffering  at  all  times  from  cancer. 

According  to  Park,  the  mortality  of  caucer  is  larger  in  and  about 
western  New  York  and  the  adjoining  region  than  in  any  other  part 
of  the  United  States,  save  a  limited  area  in  California.  Shattock 
has  recently  called  attention  to  the  fact  that  caucer-like  tubercle 
may  repeatedly  show  itself  in  certain  houses.  This  author  reported 
a  series  of  four  cases  of  cancer  occurring  within  fourteen  years,  in 
persons  unrelated  by  blood  who  were  living  in  a  single  house. 

Powers  reports  the  history  of  three  housekeepers  who  slept  in 


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594       The  Atlanta  Medical  and  Subuical  Journal. 

saccesBiOD  for  several  yeara  id  the  same  liouse  aod  the  same  bed- 
room. The  first  lived  in  the  room  for  thirteeu  years  aod  died  of 
cancer  of  the  stomach ;  the  second,  after  a  residence  of  twenty 
years,  died  of  cancer  of  the  liver ;  the  third  died  at  the  end  of 
eight  years  of  cancer  of  the  breast  and  uterus.  They  were  all  in 
good  health  previous  to  the  time  of  their  installment  in  the  house. 

I  am  of  the  opinion  that  cancer,  like  tuberculosis,  where  there 
is  a  family  predisposition  to  the  disease,  requires  only  very  slight 
cause  to  light  up  the  disease.  A  slight  blow  on  the  breast  may 
produce  a  nidus  from  wbieh  cancer  may  develop.  This  is  equally 
true  of  other  localities  of  the  body,  as  the  lip,  the  tongue,  the 
larynx,  and  the  mucous  membrane  of  the  nose,  which,  by  being 
constantly  irritated  from  external  causes,  such  as  chewing  and 
smoking  tobacco,  the  disease  may  show  itself  sooner  or  later. 

Out  of  three  hundred  and  three  patients  who  were  suffering 
from  carcinoma  of  the  lip,  tongue,  nose  and  pharynx  (reported  by 
Williams,  Whitehead  and  Pennell),  sixty  per  cent,  used  tobacco, 
and  the  majority  smoked  a  pipe;  and  nineteen  per  cent,  had  had 
syphilis.  Other  local  causes  were  direct  injury  in  eleven  cases, 
ulcers  from  bad  teeth  in  thirty-seven,  ichthyosis  in  fourteen,  local- 
ized syphilis  in  fourteen,  and  glossitis  in  three — a  total  of  se%'enty- 
nine  cases  out  of  one  hundred  and  ninety-four,  or  forty  per  cent^ 
of  the  cases  (noted  by  Curtis)  as  due  to  local  causes. 

It  would  therefore  appear  that  local  irritation  played  a  very  im- 
portant part  in  the  etiology  of  the  disease. 

The  most  usual  situations  of  carcinoma  of  the  mouth  are  in  the 
cheeks  (where  it  ofien  appears  to  be  directly  due  to  ulceration  set  up 
by  rough  teeth)  and  in  the  floor  of  the  mouth.  In  both  of  these  local- 
ities, the  diEease  is  rapidly  fatal,  and  is  apt  to  return  after  removal. 

Carcinoma  of  the  tongue  is  one  of  the  most  intractable  forms  of 
the  disease,  probably  because  of  the  constant  movement  of  the 
organ,  its  liability  to  injury,  and  the  great  tendency  of  the  mouth 
to  sepRis.  The  general  health  is  very  soon  affected,  and  the  lym- 
phatic channels  are  usually  invaded  early;  in  fact,  Sachs  cites 
instances  in  which  they  were  involved  as  early  aa  five  weeks  after 
the  disease  was  noticed,  although  in  some  chronic  cases  the  glands 
may  escape  for  a  long  time.     In  filly-two  cases  they  were  the  only 


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Cakceb.  595 

glands  attacked,  while  five  times  the  infection  skipped  them  and 
appeared  in  the  cervical,  submental,  or  retromaxillary  glands. 
This  goes  to  prove  the  uncertain  course  that  the  disease  may  take; 
hence,  we  can  very  often  be  mistaken  in  locating  the  disease,  and 
are  tempted  to  remove  important  glands  simply  because  it  is  cus- 
tomary to  do  so- 

During  the  past  live  years  I  have  tried  to  keep  a  record  of  my 
cancer  cases,  some  of  which  I  beg  leave  to  report,  as  follows: 

Case  1. — A  young  lady,  seventeen  years  old,  whose  grand- 
mother died  of  carcinoma  of  the  uterus  at  the  age  of  forty-eight; 
one  aunt  and  two  uncles  are  victims  of  tuberculosis.  This  patient 
received  a  severe  blow  on  her  right  cheek  two  years  previous,  from 
which  she  suffered  intense  pain  for  several  months  afterwards. 
Eighteen  months  after  this  she  complained  of  a  swelling  of  the 
parotid  gland,  which  ■continued  to  grow  worse  until  an  abscess 
formed  and  was  lanced  by  her  family  physician.  The  discharge 
continued  several  mouths,  when  she  was  brought  to  me  for  consul- 
tation. On  examination  I  discovered  several  small  sinuses  in  the 
neighborhood,  of  the  right  parotid  gland  and  cheek-bone,  all  of 
which  were  discharging  a  watery  fluid,  which  was  very  offensive. 
The  submaxillary  gland  on  the  right  side  was  somewhat  enlarged. 
The  patient  appeared  to  be  in  good  health,  except  the  sallow  ex- 
pression about  the  face. 

I  advised  an  immediate  operation  with  the  knife,  but  the  father  of 
the  patient  objected  to  the  knife,  and  asked  whethera  milder  form 
of  treatment  could  not  be  substituted.  I  then  suggested  athorougb 
cauterization  with  the  electrocautery,  to  which  both  the  patient  and 
father  readily  assented.  After  a  careful  preparation  of  the  parts  I 
decided  to  try  caustic  potash  as  a  preliminary  step,  and  followed 
this  with  electrocautery,  which  1  did  very  carefully  and  thoroughly. 

Previous  to  operating  I  gave  the  patient  a  hypodermic  injection 
of  one-third  of  a  grain  of  sulpb.  morphia  and  a  sixty-fourth  of  a 
grain  of  sulpb.  atropia.  I  also  made  a  local  application  of  equal 
parts  of  shaven  ice  and  chloride  sodium.  The  patient  stood  the 
operation  well,  and  was  conversing  during  the  time  of  operating, 
and  was  able  to  return  to  her  home,  seven  miles  in  the  country, 
two  hours  later.     I  saw  the  patient  ten  days  after  this,  and  was 


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596       The  Atlanta  Medical  and  Surgical  Journal. 

delighted  to  find  the  wound  healing  very  kindly  by  gniDulatioD. 
The  only  drefaing  that  I  prescribed  was  a  twenty  per  cent,  solu- 
tion chloral  hydrate  in  diatiiled  water,  directing  the  parts  to  be 
kept  clean  and  moist  with  this  lotion.  The  wouud  healed  entirely 
in  twenty  days.  The  swelling  in  the  submaxillary  gland  also  sub- 
sided, and  the  patient  has  remained  well  up  to  the  present  writing, 
having  reached  the  three-year  limit. 

Case  2. — A  man,  thirty-eight  (38)  years  old,  married,  and  the 
father  of  seven  living  children;  some  tuberculosis  in  his  father's 
family;  his  grandfather  died  of  cancer  of  the  lace.  The  rest  of 
bis  family  history  was  uncertain.  He  stated  that  he  had  never 
suffered  from  any  form  of  venereal  disease  ;  this  statement,  bow- 
ever,  I  doubted  very  much.  Ue  complained  of  soreness  and  pain 
about  his  genital  organs,  and  stated  that  he  had  been  operated  upon 
about  six  months  previously  for  constriction  of  the  foreskin. 

Examiuaiion  of  the  penis  revealed  considerable  swelling  of  the 
entire  organ,  with  sloughing  and  oSensive  discharge,  covering  the 
glans-penis.  The  end  of  the  penis  was  very  large,  measuring  nine 
inches  in  circumference,  and  presented  the  appearance  of  a  cauli- 
fiower.  The  meatus  urinarius  was  almost  entirely  occluded,  the 
urine  dribbling  continuously,  causing  the  patient  additional  pain 
and  worry.  The  discharge  and  sloughing  of  the  glans-penis  was 
so  offensive  that  it  was  necessary  to  keep  antiseptic  dressings  ap- 
plied coiislantly. 

On  the  24th  of  April,  1897,  with  the  assistance  of  Dr.  T.  W. 
WilliarasoH,  of  Houston,  in  whose  neighborhood  the  patient  resided, 
I  amputated  the  penis  just  one  inch  from  the  juuctioD  of  the  pubes. 

In  performing  the  operation  I  did  not  follow  the  usual  method 
of  making  a  complete  circular  incision,  but,  after  putting  the  skin 
on  the  stretch,  I  made  a  sloping  incision  from  above  downwards 
and  outwards  through  the  corpora-cavernoso,  and  when  I  reached 
the  corpus- spongiosum  I  allowed  about  half  an  inch  space  to  inter- 
vene before  completing  the  incision,  thus  allowing  for  the  contrac- 
tion of  the  urelhra,  as  well  as  giving  better  shape  to  the  much- 
prized  but  mutilated  organ.  After  tying  the  arteries  I  made  two 
stitches  through  the  urethra  ou  each  side,  attaching  it  to  the  corpmt- 
spougiosum  to  prevent   further  contraction.      I  then  made  a  few 


,„i,z.d  by  Google 


Cancer.  597 

superficial  stitches  through  the  skio  and  corpora-cavernoso.  After 
inscrtiog  a  small  glass  tube  ioto  the  urethra  I  washed  the  parts 
with  a  solution  of  peroxide  of  hydrogen  (full  etreogth),  and  di- 
rected a  continuous  moist  application  consisting  of  the  following 
well-known  medicines:  bichloride  of  mercury,  four  grains;  pure 
glycerin,  four  ounces  ;  peroxide  hydrogen,  q.  s.  to  make  one  pint 
of  the  lotion.  This  was  applied  cnntiDiioiisly  night  and  day  by 
means  of  absorbent  cotton  for  the  space  of  eight  days.  I  removed 
the  stitches  on  the  eighth  day  and  found  the  wound  bealiug  very 
kiudly.  The  patient  having  failed  to  keep  the  glass  tube  in  the 
urethra  necessitated  my  having  to  enlarge  the  opening,  which  I  did 
on  short  notice  with  a  pair  of  sharp-pointed  scissors,  preceded  by 
a  local  application  of  a  ten  percent,  solution  of  cocain. 

Immediately  after  cutting  the  urethra  I  made  an  applicnition  of 
a  mild  solution  of  perchloride  of  iron  to  the  fresh  edges  of  the 
incision,  which  kept  them  from  healing,  thus  giving  the  patient  a 
fairly  good  meatus  urinarius. 

This  patient  made  a  good  recovery,  and  has  remained  entirely 
free  (rom  all  recurrent  symptoms  of  the  disease,  remarking,  when 
I  saw  him  last,  that  bis  greatest  regret  was  he  could  not,  as  in  for- 
mer days,  urinate  against  a  perpendicular  oi)ject. 

Case  3. — A  lady,  fifty-seven  (57)  years  old,  robust  and  appa- 
rently healthy;  family  history  uncertain  ;  mother  died  of  pulmo- 
nary tuberculosis;  one  sister  has  tuberculosis  and  possibly  carci- 
noma of  the  uterus.  This  patient  complained  of  a  lump  in  left 
breast,  with  considerable  tenderness  in  the  axillary  space.  On  ex- 
aminatioD  a  small  ulcer  on  the  outside  of  the  nipple  and  a  large 
mass  in  the  upper  portion  of  the  breast  were  readily  discovered; 
also  one  or  two  excavations  containing  fluid  or  pus  were  found 
slightly  protruding  under  the  skin  near  the  base  of  the  nipple. 
There  was  no  swelling  in  the  axillary  space  nor  of  the  cervical 
glands.  Some  tenderness  extended  above  the  breast  in  the  direc- 
tion of  the  axillary  space. 

With  the  efficient  assistance  of  Dr.  H.  C,  Beckett,  of  Scottsburg, 
who  was  the  family  physician  of  the  patient,  I  removed  the  entire 
breast  with  the  knife,  making  two  carefully  directed  incisions  from 
above  downwards,  afterwards  carefully  dissecting  every  trace  of 


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598       The  Atlanta  Medical  and  Surgical  Journal. 

sugpicious  tissue.  I  then  douched  the  entire  wouod  with  a  solution 
of  chloride  of  zinc  (1-40)  iu  warm  sterilized  water,  afler  which  I 
closed  the  wound  with  a  continuous  suture  of  aseptic  silk,  having 
previously  adjusted  a  suitable  drainage-tube.  After  making  an 
application  of  a  5  per  cent,  solutioo  of  aristol  and  collodion  on  a 
small  piece  of  iodoform  gauze  along  the  Hue  of  iacision  as  an  auti- 
septic  cement,  I  proceeded  to  apply  the  usual  dressing  of  iodoform 
gauze  and  carbolized  absorbent  cotton.  This  was  followed  by  a 
carefully -applied  bandage  around  the  entire  body.  Oo  the  fourth 
day  after  the  operation,  I  removed  the  drainage-tube,  and  on  the 
eighth  day  the  dressing  and  stitches,  and  was  not  surprised  to  find 
that  union  had  taken  place  by  first  intention  and  everything  in 
nice  shape.  This  patient  was  operated  upon  August  14th,  1893; 
and  I  am  happy  to  say  she  is  a  well  woman  to-day,  having  pa^ised 
over  the  three-year  limit  safe  and  free  from  recurrent  symptoms. 

Case  4. — Mrs.  O.,  a  lady  sixty-two  years  old  and  in  very  feeble 
health.  She  bad  carcinoma  of  lef^  breast  which  was  caused,  as  she 
stated,  by  a  severe  blow  from  one  of  her  grandchildren,  five  years 
previously.  The  family  history  of  this  patient  is  very  unfavor- 
able, her  grandmother  on  her  mother's  side  having  died  of  can- 
cer of  the  nose  and  face  in  her  sixtieth  year.  One  uncle  and  two 
aunts  died  of  tuberculosis.  One  brother  is  now  suffering  from  can- 
cer of  the  head  and  neck.  This  lady  was  refused  an  operation  by 
an  eminent  surgeon  in  Danville,  Va.,  on  account  of  her  infirmity 
and  general  bad  health. 

Three  months  after  this  she  applied  to  me  for  treatment.  I  ad- 
vised an  operation,  preceded,  however,  by  a  preliminary  course  of 
constitutional  treatment.  Five  weeks  after  this,  assisted  by  Drs. 
AVilliamson  and  Faulkner,  I  amputated  the  entire  breast  with  a  good 
portion  of  the  underlying  tissue  and  muscle,  which  looked  a  little 
suspicious.  I  also  cauterized  the  suspicious  parts  with  a  strong 
solution  of  chloride  of  zinc.  Having  adjusted  a  suitable  drainage- 
tube,  I  closed  the  wound  with  a  continuous  suture  of  aseptic  silk, 
and  applied  the  usual  dressing  of  antiseptic  gauze  and  absorbent 
cotton.  This  patient  made  an  uninlerrupted  recovery,  notwith- 
standing her  age  and  general  infirra'.ty.  She  was  operated  upon 
May  20,  1895,  and  up  to  this  writing,  slie  has  enjoyed  better  health 
since  the  operation  than  for  the  previous  five  years. 


z.db  Google 


Before  reporting  my  next  case,  I  desire  to  call  attention  to  the 
important  fact,  that  in  operating  fur  cancer  of  the  breast,  I  invari- 
ably leave  the  axillary  space  uninvaded,  notwithstaDding  the  fact 
that  the  practice  and  teaching  of  some  of  our  beet  modern  sut^ons 
on  this  subject  are  directly  contrary  to  these  views.  If  it  be  true 
that  cancer  partakes  largely  of  the  etiology  of  tuberculosis,  as  held 
by  many  able  writers  of  tbe  modern  schools,  it  must  necessarily 
be  trae  that  the  organisms  of  cancer  can  be  conveyed  from  one  part 
of  the  human  atrncture  to  any  other  part  with  as  much  ease  and 
facility  as  that  of  tuberculosis.  Hence  we  conclude  that  it  would 
be  worse  than  folly  to  enter  the  axillary  space  and  deprive  the 
body  of  important  glands,  at  the  same  time  knowing  that  the  can- 
cerous poison  may  be  doing  greater  damage  to  other  organs  and  in- 
fecting other  parts  of  the  human  structure.  Even  adinitting  the 
common  belief  that  cancer  is  conveyed  only  through  the  lymphat- 
ics, does  it  not  seem  unreasonable  to  remove  the  axillary  glands 
in  carcinoma  of  the  breast,  at  the  same  time  knowing  that  the 
other  neighboring  glands  within  tbe  thorax  and  the  great  number 
of  lymphatics  in  the  neck  and  face  may  be  infected  with  the  same 
poison?  I  therefore  conclude,  if  there  is  any  virtue  in  removing 
one  set  of  glands,  there  should  also  be  the  same  indication  for  re- 
moving any  or  all  of  the  glands  of  the  body;  for  inasmuch  as  the 
lymphatics  extend  through  the  whole  body  and  can  convey  a  poison 
to  any  part  thereof  with  about  as  much  facility  as  to  any  special 
part  or  locality,  I  cannot  think  it  is  clear  reasoning  or  good  surgery 
to  remove  the  axillary  glands  iu  the  operation  for  carcinoma  of  the 
breast,  and  at  tbe  same  time  leave  other  infected  glands  in  the  body. 

I  therefore  place  myself  ou  record  as  opposed  to  tbe  common 
practice  of  removing  the  axillary  glands  in  ordinary  cases  of  car- 
cinoma of  the  breast,  ouless  we  are  fully  convinced  that  the  cancer 
is  strictly  limited  to  these  special  glands  and  the  breast.  It  is  just 
as  much  the  duty  of  the  surgeon  to  remove  the  inguinal  or  pelvic 
glands  for  carcinoma  of  the  uterus,  vulva,  penis  or  scrotum.  The 
same  rule  applies  to  the  removal  of  the  submaxillary  and  sublin- 
gual glands  iu  epithelioma  of  the  lip,  nose,  tongue  and  larynx. 

Case  5. — This  lady  was  fifty-seven  years  old,  the  wife  of  a  dis- 
tinguished  Lutheran  minister  and   president  of  a  noted  college. 


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600       The  Atlanta  Medical  and  Surgical  Journal. 

Her  family  hietorj'  was  favorable  bu  far  as  I  could  ascerlaiD.  Sbe 
was  the  mother  of  four  children  none  of  whom  have  ever  shown 
any  indications  of  the  disease.  This  lady  consulted  me  about  the 
return  of  her  menses  and  her  profuse  leucorrhea,  as  she  termed 
them,  not  for  one  moment  thinking  that  she  was  then  sufTering 
from  any  form  of  malignant  disease.  She  was  apparently  in  robust 
health,  and  had  never  suffered  from  any  acute  [>ain.  In  making  a 
speculum  examioatioD,  I  readily  discovered  from  the  offensive  dis- 
charge and  its  peculiar  character,  as  well  as  from  the  exieroal  crater 
appearance  of  the  cervix  of  the  uterus,  that  this  was  a  carcinoma 
of  long  standing.  She  informed  me  that  she  had  suffered  from  re- 
peated hemorrhages  at  various  intervals  for  over  eight  months  pre- 
vious to  consulting  me.  She  also  stated  that  she  had  suffered  from 
a  profuse  watery,  yellowish  discharge  from  her  womb  for  about 
five  months.  On  examination,  I  found  that  this  discharge  con- 
tained lumps  of  putrid  flesh  varying  in  size  from  a  split  pea  to  a 
chestnut.  These  masses,  on  microscopic  examination,  proved  to 
be  caucer,  at  least  the  culture  products  correspond  to  those  usually 
given  and  described  in  our  text-books. 

After  two  weeks'  palliative  treatment,  consisting  of  curetting, 
and  packing  the  uterus  with  antiseptic  gauze,  and  the  use  of  gal- 
vanic electricity,  and  not  seeing  any  special  improvement,  I  de- 
cided to  give  the  patient  the  doubtful  advantage  of  a  more  radical 
form  of  treatment.  Accordingly,  I  wrote  to  her  husband,  who 
was  in  an  adjoining  State,  to  come  at  once  with  a  view  to  accom- 
pany his  wife  to  a  fii'st-class  hospital.  After  a  consultation  with 
the  husband  and  patient,  we  decided  to  go  to  Richmond  to  consult 
Dr.  Hunter  McGnire  as  to  the  propriety  of  subjecting  the  patient 
to  a  radical  operation. 

Dr.  McGuire,  who  is  always  honest  and  frank  toward  his  fel- 
low-physicians, did  not  he.sitate  to  express  his  opinion,  after  a 
thorough  and  careful  examination,  that  the  case  was  one  of  the 
very  gravest,  yet  possibly  an  operable  one.  The  husband,  who,  of 
course,  was  very  anxious  about  his  wife,  after  mature  consideration, 
decided  with  me  that  we  would  go  on  to  Baltimore  and  consult  an 
eminent  abdominal  surgeon  of  that  city.  After  a  cursory  examina- 
tion, this  eminent  surgeon  decided  that  the  case  was  a  favorable  one 


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Cakcer.  601 

for  an  operation,  aud  advised  complete  estirpalioa  of  the  uterus  by 
the  v&giual  route.  This  gentlemaii's  emiueDce  as  aa  abdomiuai 
snrgeoD,  aud  the  superior  advantages  of  the  world-renowned  hos- 
pital with  which  he  was  connected,  induced  me  to  submit  the  whole 
matter  to  Ihe  patient  and  her  husband,  thud  throwing  the  entire  re- 
spoDsibility  on  their  decisioD.  Tbey  were  not  long  iu  making  up 
their  minds  to  have  the  operation  performed. 

I  shall  forbear  giving  a  description  of  the  unfortunate  operation 
that  this  eminent  surgeon,  with  bis  stafi'  of  able  assistants,  per- 
formed, but  suEtice  it  to  say,  the  patient  died  with  a  mutilated 
ntenis  intact  and  a  severed  ureter  to  tell  the  tale  better  than  pen 
can  describe  it.  The  carcinoma  which  occupied  the  fundus  and  a 
large  portion  of  the  cervix,  was  left  unmolested  by  the  skilled  (?) 
operator,  ootwitfastandiug  the  fact  that  this  was,  iu  the  operator's 
opinion,  a  most  operable  case.  While  1  would  not  <letract  from  this 
eminent  surgeo's  reputation  as  a  gynecologist,  yet  I  must  frankly 
say  he  proved  himself  unpardonably  deficient  in  surgical  diag- 
nosis, as  well  af<  in  prognosis,  in  this  one  instance. 

My  past  five  years'  experience  in  the  treatment  of  this  fell  dis- 
ease convinces  me  thoroughly  that  radical  operations  for  carcinoma 
of  the  uterus,  after  twelve  naonths'  standing,  is  a  travesty  ou  modern 
surgery,  and  should  be  condemned  by  all  honest  surgeons  and 
physicians  who  have  at  heart  the  real  interest  of  our  prolession.  I 
might  go  a  step  further,  without  transcending  the  limits  of  good 
logic,  from  a  surgical  point  of  view,  and  say,  that  capital  operatioD 
for  the  treatment  of  any  malignant  disease  that  has  passed  the  pri- 
mary stage,  should  be  abandoned  and  condemned. 

Methinks  I  hear  you  ask,  What  shall  we  do  with  the  inoperable 
cases,  or  those  that  have  passed  beyond  the  primary  stage  ol  the 
disease?  In  reply,  I  would  say,  first  get  your  patient's  mind  com- 
posed and  free  from  the  horrible  forebodings  that  usually  accom- 
pany this  dread  disease,  by  building  up  the  nervous  system  with 
nerve  tonics,  such  as  strychnia,  phosphoric  acid,  and  electricity. 
This  should  be  followed  at  the  proper  time  with  reconstructive 
agents,  such  as  iron,  cod-liver  oil  and  hypo  phosphites,  etc.;  bro- 
mide of  arsenic,  iodide  of  calcium  internally,  and  carbid  of  cal- 
cium externally,  have  been  extensively  used  in   the  treatment  of 


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602       The  Atlanta  Medical  and  Surgical  Journal. 

this  disease.  LK)ca1  treatmeot  should  be  combined  with  the  consti- 
tutiooal,  aad  consists  of  hypodermic  injections  in  and  about  the 
diseased  structures  of  diluted  alcohol  and  bichloride  of  mercury  in 
the  strength  uf  one  to  five  hundred  (500)  or  one  to  one  thousand 
(1,000),  according  to  the  type  and  malignancy  of  the  disease.  I 
have  treated  successfully  a  large  Dumber  of  cases  in  the  primary 
stage  with  applications  of  caustic  potash  and  Marsden's  paste.  In 
properly  selected  cas4:s,  this  form  of  treatment,  in  my  judgment,  is 
superior  to  a  bloody  cutting  operation  with  the  knife,  and  I  find 
that  a  patient  will  readily  assent  to  this  form  of  treatment,  while 
he  would  otherwise  reject  the  knife,  and  thus  prolong  the  risk. 
Ivocal  anesthesia  is  a  very  important  adjunct  in  the  treatment,  and 
should  never  be  omitted  when  operating,  either  with  the  cautery  or 
knife.  I  don't  think  a  physician  is  ever  justifiable,  under  any  con- 
ditions, in  telling  a  patient  that  he  has  a  cancer.  I  have  seen 
patients  get  apparently  well  by  disabusing  their  minds  of  the  dis- 
ease without  any  treatment,  except  a  placebo  to  divert  the  mind. 

The  day  is  not  far  distant  when  coneervative  surgery,  aided  by 
electricity,  X-rays,  and  the  many  other  modern  agencies  in  use, 
will  sound  the  death-knell  of  bold  radical  surgery. 

In  conclusion  I  would  souud  a  note  of  warning  to  my  fellow- 
practitioners  against  sending  their  malignant  cases  off  to  the  bold, 
reckless,  salaried  hospital  surgeon  whose  reputation  is  gauged  by 
the  number  of  radical,  operations  performed  and  the  number  of 
females  unsexed,  instead  of  the  actual  number  of  cures  made. 

Far  better  for  the  patient,  the  family  physician,  and  the  medical 
professiou  at  large  to  keep  the  suffering  patient  at  home,  even 
though  his  days  on  earth  be  numbered,  than  have  him  sacrificed  in 
a  world- renowned  hospital  at  the  hands  of  the  reckless  surgeon 
whose  anxiety  fur  notoriety  is  greater  than  his  sense  of  right. 

It  is  a  sad  picture,  as  well  as  a  calamity  to  our  profession,  that 
so  many  of  our  fellow- mortals  are  to-day  being  sacrificed  on  the 
ope  rating- table,  whose  lives  might  be  prolonged  months,  and 
possibly  years,  under  a  rational  and  more  conservative  form  of 
treatment. 


Warren's  Surgical  Patholotsy  antl  Therapeutics. 
Tlip  InUrnntionnl  Annual,  1808 
Jour.  Auier.  Meil.  Assoc. ,  July  %  18'JS. 


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SOCIETY  REPORTS. 


CHICAGO  GYNECOLOGICAL  SOCIETY. 
Regular  meeting  held  September  18,  1898. 

The  President,  Dr.  Heory  P.  Newman,  in  the  chair. 

Dr.  Joseph  Price,  of  Philadelphia  (by  iovitatioD),  read  a  paper 
entitled  "  Abdominal  vs.  Vaginal  Section  in  Pelvic  Surgery." 

He  said  it  was  very  difficult  to  consider  some  of  the  opinions  of 
recent  adoption  by  sui^ons  with  a  judicial  temper  and  impar- 
tiality. These  difTerent  opinions  had  a  surgical  importance,  in 
that  problems  arose,  and  their  discussion  would  not  and  should 
not  down  until  they  were  satisfactorily  settled.  If  his  own  views 
were  distinct  and  had  something  of  a  dogmatic  ring,  it  was  because 
they  were  forced  upon  him  by  actual  experienoe  and  observation. 
Many  practising  the  vaginal  operation  had  the  impression  that  the 
ojieration  had  not  been  universally  adopted  because  physicians  did 
not  understand  it;  that  it  was  difficult,  dangerous,  or  impossible 
JD  their  hands;  that  it  required  for  its  successful  performance  a 
peculiar  aptitude,  a  special  training  and  adeptoess.  This  was  a 
mistake.  A  number  of  men  who  opposed  the  vaginal  operation 
had  done  it  successfully ;  their  mortality  had  been  quite  as  low  as 
thai  of  those  who  advocated  and  made  the  procedure  their  adopted 
one.  They  did  the  suprapubic  operatiou,  influenced  by  the  logio_ 
of  their  experience,  by  purely  surgical  and  pathologic  reasons,  and 
it  was  the  operation  of  their  choice  because  it  gave  the  most  com- 
plete results,  left  less  dangerous  or  annoying  sequelse,  and  less  risk 
of  the  necessity  for  repeated  operations.  By  the  suprapubic  route 
surgical  cleanliness  and  surgical  completeness  were  possible;  by 
the  vaginal  they  were  not.  The  difference  between  the  advocates 
of  the  abdominal  method  and  those  who  criticized  it  was  that  the 
advocate  spoke  according  to  his  knowledge  and  of  the  facts  which 
actual  clinical  experience  had  confirmed;  the  critic  according  to 
bis  failures,  disappointments  and  prejudices.    The  one  had  uniform 


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604       The  Atlanta  Medical  axd  Surgical  Journal. 

success  BustainiDg  him;  the  other  humiliating  failures  which 
inspired  and  gave  color  to  his  opioioos.  The  French  and  Belgians 
were  never  successful  in  doing  the  suprapubic  operation.  The 
successful  American,  English  and  German  operators  had  practised 
both  methods  for  years,  adopting  the  suprapubic  procedure  for 
tubal  and  ovarian  disease,  and  the  vaginal  route  for  malignancy. 
The  results  of  these  men  were  uniformly  good;  they  adapted  their 
operation  to  actual  pathological  conditions ;  they  operated  for 
actual  disease,  and  not  for  all  sorts  of  fancied  conditions,  or  for 
vague  nervous  disorders  due  frequently  to  emotional  susceptibility. 
He  said  it  was  eimply  amazing  bow  common  it  was  wilh  some 
operators  to  begin  two  distinct  operations  and  complete  neither. 
Good  operators  sometimes  made  a  free  opening  into  the  abdomen, 
inspected  and  backed  out,  and  then  attempted  the  vaginal  route 
and  abandoned  it  after  the  puncture  of  one  or  more  accumulations 
and  drainage.  The  relief  followiug  mere  puncture  and  drainage 
was  only  temporary.  The  drainage  of  one  or  more  pus-pockets, 
where  many  existed  in  a  large,  tortuous,  puriform  tube  or  tubes, 
and  where  we  had  one  or  more  ovarian  abscesses,  never  cured. 
The  only  cure  was  the  removal  of  the  diseased  member.  He 
thought  surgeons  need  only  appeal  to  actual  clinical  facts  in  the 
experience  of  some  prominent  vaginal  operators  to  show  how  dif- 
ficult and  incomplete  their  work  was  when  they  encountered  deep- 
seated  and  complicated  pathologic  couditions,  and  also  in  how  very 
many  cases  the  result  was  fatal.  In  relation  to  results  from  any 
procedure,  no  reliance  could  be  placed  on  the  statistics  of  men 
.who  selected  only  favorable  cases  for  operation  and  rejected  the 
unfavorable.  These  men  in  his  opinion  had  no  right  to  compare 
their  results  with  those  of  men  who  did  not  reject  the  desperate 
cases.  Imperfect  and  incomplete  work  by  the  abdominal  route 
was  a  feeble  argument  in  favor  of  the  vaginal.  The  fault  was  not 
in  the  procedure,  but  in  the  operator,  his  lack  of  wide  clinical 
experience  In  dealing  with  gynecologic  troubles  or  lack  of  sur- 
gical courage  to  complete  the  work  he  began.  The  removal  of 
pathologic  conditions  was  easier  from  above  than  from  below, 
because  the  structures  were  more  easily  defiued  and  lines  of  cleavage 
or  enucleation  were /ro?H  important  structures  aod  not  toward  them 


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Society  Reports.  605 

or  info  them;  there  was  uo  difficulty  in  Becuriiig  arteries,  as  they 
could  be  seen  aod  felt  pulsating  beneath  the  fiugere.  The  opera- 
tion was  precise;  it  could  be  made  mathematically  certain  in  ita 
limits;  the  incision  was  directly  under  the  eye  and  uuder  the 
absolute  control  of  the  Bngers;  it  wan  not  a  stab  about  in  the  dark 
among  vital  organs  as  in  the  vaginal  roule ;  it  enabled  the  easy 
freeing  of'  omentum  and  bowel  when  adherent,  and  the  repair  of 
all  disorganized  parta.     These  were  important  considerations. 

Careful  examination  of  statistics  coming  from  relinble  sources 
went  to  show  that  abdominal  pain  continued  in  very  many  eases 
operated  upon  by  the  vaginal  route  and  followed  too  many  imper- 
fectly, incompletely  and  iguorantly  operated  upon  by  the  supra- 
pubic method.  These  disagreeable  symptoms  complained  of  by 
patients  after  operation  were  nearly  always  the  result  of  leaving 
omental  and  intestinal  adhesions.  The  profession  was  too  prone 
to  talk  about  the  septic  uterus.  A  patient  with  a  septic  uterus 
was  very  ill  and  usually  died  speedily.  There  were  tew  things 
that  killed  a  woman  quicker  than  a  septic  uterus.  The  essayist 
was  daily  doing  sections,  and  while  dealing  with  all  sorts  of  com- 
plications and  adhesions,  dangerous  twists  and  contortions,  strong 
adhesions  or  fixation  of  crossed  viscera,  the  sigmoid  strougly  adhe- 
rent to  the  anterior  taoe  of  the  right  tube  and  broad  ligament,  the 
cecum  and  appendix  out  of  position  and  adherent,  he  could  not 
but  experience  a  sense  of  surprise  that  experienced  surgeons  (who 
have  in  the  past  done  good  abdominal  work)  could  forget  or  ignore 
the  lessons  of  their  experience  and  deliberately  extirpate  the  little 
healthy  uterus  and  pass  by  pathologic  lesions  and  complications 
constituting  the  real  and  only  source  of  trouble.  Surgery  would 
be  more  Judicious  and  successful  if  more  care  and  skill  were  exer- 
cised in  determining  definitely  the  trouble  for  which  operations 
were  performed  and  the  procedure  .<4trictly  adapted  to  actual  con- 
ditions. No  one  method  should  be  pursued  in  all  cases;  the 
symptoms  and  conditions  present  must  largely  guide  the  surgeon 
in  the  selection  of  a  procedure.  It  was  important  to  select  with 
great  care  the  cases  favorable  to  the  application  of  any  particular 
method.  Sinuses  were  juj^t  as  frequent  and  distrcstfing  in  the 
vaginal  vault  as  in  the  abdominal  incision.     Meuopause  nervous 


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The  Atlanta  Medical  and  Suroical  Joubnal, 


phenomena  were  about  the  same  id  both  procedures,  wheo  com- 
pleted. 

In  a  series  of  four  hundred  and  three  cases  of  vaginal  hysterec- 
tomy, including  about  all  conditions  for  which  it  was  done,  total 
general  prolapse,  etc.,  Jacobs  had  nine  fistulie  ailer  the  operations, 
yet  he  said  that  "  subsequent  fistula  were  exceedingly  rare."  He 
had  observed  five  inteetinal,  three  visceral  and  one  ureteral  fii^tulx. 
Further,  he  remarks  that  "in  most  of  the  cases  these  fistulse 
existed  prior  to  the  operation  ;  there  were  fistulous  passages  which 
extended  between  the  purulent  foci  and  some  part  of  the  intestine. 
These  passages  were  so  large,  and  with  walls  so  well  organized 
that  the  disappearance  of  the  purulent  pockets  did  not  suffice  to 
bring  about  the  subsequent  and  spontaneous  cure."  In  all  such 
cases  the  speaker  relieves  adhesions,  trims  and  repairs  all  lesions, 
with  the  most  pleasing  results,  without  any  of  the  sequelte  of  fistu- 
lous openings  given  by  Jacobs  as  following  the  vaginal  procedure. 

Dr.  Feruand  Henrotin  opened  the  discussion  with  a  paper  en- 
titled "The  Indications  for  Interference  by  Way  of  the  Vagina  in 
Pelvic  Diseases:  An  Answer  to  Dr.  Joseph  Price." 

At  the  outset,  he  held  that  the  vagina  route  was  a  proper  channel 
to  attack  pelvic  disease  in  women  in  certain  selected  cases  only. 
As  better  inspection  and  palpation  <if  the  pelvic  organs  could  be 
obtained  by  an  abdominal  incision,  it  was  conceded  that  all  patients 
to  be  operated  vaginally  must  present  special  indications,  and  that 
in  cases  of  doubt  the  abdominal  incision  was  most  proper.  In 
favor  of  vaginal  section  it  may  be  said  that  where  the  same  results 
can  be  obtained  vaginally,  this  route  should  be  accepted,  as  it 
avoids  the  abdominal  scar,  lessens  the  shock  and  is  much  less  fre- 
quently followed  by  hernia.  Although  one  of  the  first  to  advocate 
the  treatment  of  pelvic  afiections  by  way  of  the  vagina  in  selected 
cases,  he  was  most  willing  to  admit  that  this  method  was  not  so 
much  in  vogue  with  experienced  operators  as  it  wasthree  years  ago, 
and  for  very  good  reasons,  one  of  which  was  that  our  knowledge  of 
the  prevalence  of  appendicitis  in  conjunction  with  pelvic  trouble 
made  it  incumbent  to  operate  by  an  abdominal  incision  when  any 
degree  of  this  affection  was  even  suspected,  and  we  had  learued  io 


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Society  Reports,  607 

later  years  that  this  coadition  was  common.  The  primary  incision, 
whether  it  be  through  the  abdomen  above  the  pelvis,  or  ihrough 
the  vaginal  vault,  was  to  a  degree  always  an  exploration.  The  in- 
finite variety  of  iDtra-abdominal  complications  made  it  so.  This 
primary  incision  was  as  frequently  curative  by  way  of  the  vagina, 
and  even  more  frequently  so,  than  the  abdominal  cut.  This  was 
by  reason  of  the  ease  and  directness  of  drainage.  The  early  vaginal 
incision,  to  those  who  understood  it  and  had  the  skill  to  perform 
improperly,  was  the  ideal  of  conservative  surgery.  Thfs  incision, 
like  all  vaginal  operations,  was  only  applicable  to  selected  cases. 
By  early  vaginal  incision  was  meant  an  incision  that  cures  the 
localized  septic  pelvic  infection  in  its  very  beginning,  the  woman 
remaining  thereafter  not  only  symptomatically,  but  physiologically 
perfect.  It  was  particularly  applicable  to  the  treatment  of  acute 
ovarian  abscess.  This  disease,  he  believes,  is  more  common  by  far 
than  is  generally  supposed.  Its  most  general  cause  was  abortion 
and  trauma.  It  was  the  most  common  extra-uterine  form  of  pelvic 
sepsis  that  occurred  following  early  miscarriages,  criminal  abortion 
and  unclean  surgical  manipulations.  After  two  or  three  days  of 
'ever  the  presence  of  exudate  could  usually  be  recognized  at  the 
sides  or  behind  the  uterus.  This  meant  ovarian  abscesses  in  eight 
or  nine  cases  out  of  ten. 

Vaginal  hysterectomy  was  sometimes  advisable,  and  in  some 
cases  was  infinitely  superior  to  any  abdominal  operation  that  could 
be  performed  on  the  same  patient.  Experienced  operators  who 
were  equally  skilled  in  vaginal,  as  well  as  in  abdominal  work,  were 
doing  less  vaginal  work  now  than  they  were  two  years  ago.  At 
least,  this  was  his  belief;  not  because  vaginal  hysterectomy  was  not 
a  very  proper  and  sometimes  the  best  operation  to  be  performed  in 
certain  cases,  but  because  it  was  a  radical  operation  and  because  the 
field  of  allTadical  operations  had  been  much  restricted  for  the  last 
few  years.  Salpingectomy,  ovarian  resection,  vaginal  incision,  had  all 
done  their  share  in  the  salvation  of  scores  of  uteri.  While  abdominal 
operators  were  improving  their  methods  and  perfecting  their  results, 
the  vaginal  workers  were  developing  the  possibilities  of  the  vaginal 
incision,  and  be  claims  to-day  that  one,  if  not  the  greatest  of  mod- 
ern conservative  gynecologic  triumphs,  is  the  thoroughly  understood 
and  properly  performed  vaginal  section  in  selected  cases.    And 

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608       The  Atlanta  Medical  and  Sdrgical  Journal. 

there  are  many.  As  regards  vagioal  hysterectomy,  it  still  had,  in 
the  opinion  of  the  speaker,  a  perlectly  defined  position.  In  women 
necessarily  sterile  and  approaching  the  menopause,  where  bilateral 
perinlcrine  septic  disease  existed,  aud  was  situated  low  in  the  pelvis 
and  with  a  roomy  vagina,  particularly  in  those  with  extensive  and 
disseminated  suppuration,  who  were  low  with  septic  fever,  and 
esj>ec!ally  where  abdominal  wall  was  very  fat,  vaginal  hysterectomy 
was  slill  by  far  the  preferable  operation,  and  when  skillfully  per- 
formed, in  a  large  series  would  always  give  the  best  results.  To 
demonstrate  his  own  opinion  as  regards  selection,  Dr.  Henrotin 
presented  a  table  showing  the  frequency  of  vaginal  as  compared 
with  abdominal  incision,  and  the  character  of  the  intervention, 
from  which  it  will  be  seen  what  an  important  feotor  the  conservative 
operation  has  become,  and  frequently  be  believes  vaginal  section  ap- 
plicable. These  operations  were  performed  from  January,  1897,  to 
July,  1898.  Reference  is  made  only  to  such  as  were  done  for  clearly 
defined  {>elvic  disease,  and  the  list  does  not  include  abdominal 
operations  on  the  kidney,  liver,  gall-bladder,  appendix,  intestine 
(hernia),  or  any  miscellaneous  intra-abdominal  work  in  which  the 
internal  genitalia  wore  notinvolved.  Of  180 such o|ierations there 
were : 

ConeervBtive  operalionB  an  tba  adoeiie.  always  leaving  ovarian  tiESuei  iod 

uterua . -. ** 

Double  sslpingo-oOphoreclomy * 

Single  GHlpingooOphorectomj  for  ruptured  ectopic  gestation ^ 

Hjaterectomy  for  fibroids 'J 

Hysterectoniy  for  aepais ° 

Hysterectomy  forproUpa? * 

Miscellaneous  operatione  fur  nilhenons ;  oTsrian,  dermoid  and  intra-1igiin«n- 

toua  oyati;  Earcomas  and  hard  ovarian  tumora,  etc "' 


Early  Motion  for  recent  disease ,? 

Late  section  for  old  disease : '* 

Single  salpingo-oOphoreciomy j 

Section  for  large  ovarian  ryst.  and  its  removal  altpr  tapping . 

Section  (or  septic  ruptured  ectopic  gestation A 

Hyslerectomy  loraepais... : ^ 

Hysterectomy  for  flbroidi. , 

Hyslereclomy  for  cancer ^ 

Hysterectomy  for  prolapse ■ 

(I 
Vagi  no-abdominal  operaliODS  for  cancer,  4.     Total,  180. 

DiclzedbyGoOgle 


Society  Reportb.  609 

Dr.  Fraaklin  H.  Martin  eaid  that  the  best  all-ronnd  gyoeoologist 
was  the  one  who  Belected  the  operatioa  suitable  for  the  particular  case 
in  hand.  It  was  impossible  to  do  good  surgery  by  operating  supra- 
pnbically  or  by  the  vagina  in  all  cases.  It  was  his  belief  that  all  major 
salary  could  be  done  best  through  the  abdomen,  aa  a  rule,  while  all 
minor  surgery  could  be  done  by  the  vagina.  All  surgery  of  im- 
portance should  be  done  through  the  abdomen:  1,  because  the  sur- 
geon could  see  what  he  is  doing;  2,  he  could  do  what  he  wanted; 
and  3,  he  could  do  it  quicker.  The  cases  he  would  reserve  for  the 
vaginal  ronte  would  be  those  of  carcinoma  of  the  cervix  of  the 
proliferating  variety,  or  flat  cell  epithelioma  filling  up  the  vagina, 
but  which  seldom  extended  beyond  the  cervix  and  infected  the 
lymphatic  glands.  In  all  other  cases,  where  there  was  any  question 
as  to  cancer  involving  the  vagina,  he  would  remove  the  uterus 
from  above,  and  if  later  it  was  found  that  the  glands  were  diseased> 
he  would  remove  them  also.  Cases  of  double  pyoealpinx,  large 
fibroids,  cystomata  and  all  cases  of  extm-uterine  pregnancy  should 
be  dealt  with  supraupbically. 

Dr.  Henry  T.  Byford  held  that  to  operate  on  all  cases  either 
supra pubically  or  by  the  vagina  was  unreasonable.  He  believed 
that  jnst  as  efBcient  work  could  be  accomplished  by  the  vagina  as 
through  the  abdomen.  There  were  certain  pathologic  conditions 
in  the  bottom  of  the  pelvis  in  some  cases  that  could  not  be  operated 
as  well  from  above  as  from  below.  He  emphasized  the  importance 
of  carefully  selecting  the  cases  for  either  route. 

Dr.  James  H.  Etheridge  thought  the  discussion  had  the  appearance 
of  placing  the  advocates  of  the  two  operations  in  the  attitude  of 
rivals.  He  did  not  believe  this.  He  held  that  we  have  two  sepa- 
rate things  to  deal  with,  and  that  good  work  could  be  done  by  the 
vaginal  or  suprapubic  method  of  operating.  There  were  cases  in 
which  the  vaginal  route  was  applicable,  while  there  were  others  in 
which  the  abdominal  method  was  suitable,  and  the  wisdom  and  ex- 
perience of  such  men  as  Drs.  Price  and  Henrotin  could  define  the 
limits  of  those  cases  to  be  operated  upon  vaginally  and  those  that 
were  best  adapted  to  the  suprapubic  route.  A  strong  objection  to 
the  vaginal  route  was  that  operators  worked  largely  in  the  dark. 
Hemostasis  was  unsatisfactory  and,  added  to  this,  there  was  danger 


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610       The  Atlanta  Medical  and  Scroical  Joubnal. 

of  woundiDg  tbe  bowel.  He  had  seen  one  case  in  wbioh  death  was 
caused  from  woundiDg  the  bowel,  but  which  was  only  discovered 
post  mortem. 

Dr.  Reabeu  Peterson  said  that  any  cue  who  had  done  consider- 
able abdominal  work  must  have  seen  cams  that  he  dreaded  to  ap- 
proach by  tbe  suprapubic  route.  For  many  years  nearly  all  work 
was  directed  entirely  throngh  the  abdomen  in  dealing  with  the 
pathological  oonditions  under  discussion.  Each  method  had  its 
field  of  usefulness,  and  it  remained  for  gynecologists  to  select  their 
cases  and  choose  the  method  to  employ. 

Further  discuaeion  of  this  subject  was  deferred  until  tbe  next 
meeting. 

Dr.  Fmil  Kies  read  an  inaugural  thesis  entitled  "Results  of  the 
Extended  Operation  for  Carcinoma  Uteri." — JounuU  of  Amfriean 
Medic<d  AssocifUion. 


Fob  Syphilitic  Akthbitis. 
Id  cases  in  which  the  acute  local  pain  and  sensitiveness  preclude 
mercurial  inunctions  or  subcutaneous  injections,  it  is  recommended 
to  begin  with  internal  mixed  treatment  as  follows : 

K    H^rarg.  iodi  rabri p.  in. 

PotMul  iodi gr.  l»»i. 

Sharry  wine 3  t, 

AquK q.  e.  Bd,    3  vi. 

U.    Sig.    Two  tablupooufuU  a  day. — Ex. 


Foe  Psoriasis. 


The  following  internal  treatment  is  recommended  by  Brory  in 
conjunction  with  external  applications: 

B    Sodii  aneniat ..gr.  ^. 

Sodii  Balicylat -gr.  xlw. 

Sodii  bicarb ...3  ii. 

Hyr.  EapoDariEE 5  iv. 

Unct.  gSDtian.  comp.  >  ^  ■■ 

Syr,  aimplicis  /*" * 

H.    Sig.    One  tableBpoonfut  three  timee  a  day  at  mealUtne. — Jix. 


^dbyGoOgle 


CORRBSPONDBNCB. 


THE  PROGRESS  OF  MEDICAL  EDUCATION. 

Among  the  hopeful  signs  of  the  times  ia  the  medical  world  is 

-the  leseening  of  the  number  of  collies,  by  the  consolidation  of 

-one  or  more  reputable  schools  into  one.  This  has  been  done  in 
the  North,  West  and  South,  and  must  result  in  good  to  the  pro- 
fession if  the  causes  which  seem  to  operate  in  producing  these  coa- 

.flolidations  are  properly  taken  advantage  of. 

To  our  mind  there  are  many  advantages  to  accrue  both  to  the 

-college  and  students  by  these  consolidations. 

In  the  first  place,  the  rivalry  always  engendered,  to  a  greater  or 
less  extent — by  the  location  of  two  or  more  schools  in  the  same 

-city  or  even  in  the  same  geographical  section — presents  a  strong 
temptation  tu  receiving  students  not  strictly  in  accordance  with 
college  or  professional  ethics.  There  is  a  strong  temptation  for 
the  one  or  the  other,  or  both,  by  some  legerdemain  of  the  con- 
science, which  will  protest  against  the  charge  of  pcdpaUe  violation 
of  the  law  or  published  rules  of  their  catalogues,  to  underbid  for 
students.  It  has  been  too  often  the  case  that  some  special  favor  is 
granted  or  terms  so  made,  by  which  the  student  in  doubt  as  to 
which  school  he  will  select,  feels  that  one  has  offered  him  better 
terms  or  greater  inducements  than  the  other.  Now  this  is  not 
healthy  competition,  and   does  harm  both  to  the  school  and  the 

.student  by  compromising  what  is  known  to  both  as  an  ethical  law 
and  moral  obligation,  which  is  certain  to  breed  animosity  and 
strife  between  the  professors  and  the  students  of  the  two  schools, 
when  in  &ct  only  a  laudable  emulation  should  exist. 

In  the  second  place,  the  old  adage  "  in  union  there  is  strength," 

.should  be  as  applicable  to  college  consolidation  as  to  the  ordinary 
afiairs  of  life.  It  should  bring  a  concentration  of  mind  and 
energy  to  the  great  purpose  in  view— i.  e.,  the  more  thorough  edu- 

.cation  of  the  medical  student.    Without  the  accomplishment  of  this 


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612       The  Atlanta  Medical  asd  Surgical  Journal. 

end  these  coosolidatioDS  will  prove  of  do  material  benefit  from  an 
educational  standpoint.  If  tbey  are  only  for  pecuniary  gain,  and 
no  advance  is  made  in  the  liberal  and  thorough  education  of  the- 
stndent,  why,  it  is  only  a  sham,  a  fraad,  and  should  receive  the 
reprobation  it  deserves. 

Now  that  four  years  of  study  before  graduation  are  required  by 
most  of  the  reputable  colleges,  there  is  time  sufficient  allowed  the- 
student  (with  a  previously  fair  educatioD,  which  all  should  have)  to 
be  QROUNDED  in  the  elementary  basis,  the  solid  groundwork  of 
the  scieoce  of  medicine  upon  which  he  must  iu  the  future  rear  the- 
superstructure  of  the  magnificent  temple.  He  should  spend  two 
years  or  more  under  competent  and  faithful  instructors  in  the  dis- 
secting-room and  equally  as  long  under  the  same  conditioos  in  the- 
cbemical  laboratory.  I  have  mentioned  these  two  branchee- 
because  they  are  the  two  in  which  the  young  graduate  is  most 
deficient  when  he  goes  forth  to  enter  upon  the  active  and  practical 
duties  of  hie  profession.  This  is  especially  true  of  chemistry,, 
because  this  branch  caunot  be  learned  from  boofcs,  but  only  in  the- 
laboratory  under  compdent  and  painstoHng  instructors.  The 
instructor  himself  cannot  be  a  competent  teacher  or  demonstrator 
unless  he  speuds  a  good  part  of  his  time  in  his  laboratory  previous 
to  his  lecture  or  has  a  competent  assistant  to  prepare  bis  experi- 
ments or  make  all  analyses  for  bim  ia  the  presence  of  the  class, 
which  should  be  taught  practically  to  do  the  same. 

Then,  again,  two  years  are  not  too  long  for  the  branch  of 
materia  medica  and  therapeutics,  including  botany.  Not  only  tbe- 
commercial  and  botanical  history  of  all  vegetable  drugs,  with 
tbeir  remedial  properties,  should  be  mastered,  but  the  chemical 
composition  of  both  organic  and  iaot^oic  drugs  likewise. 

Pathological  anatomy,  with  the  practical  use  of  the  microscope^ 
can  be  pursued  with'great  advantage  by  oonsolidation  and  a  four 
years'  course. 

"  Everybody  who  is  anybody "  in  the  profession  nowadays  is 
a  surgeon  and  gynecologist,  and  any  graduate  of  a  consolidated 
four  years  medical  college  who  cannot  remove  an  appendix  or 
Bpay  a  woman  had  better  abandon  his  profession  and  go  to  raising 
four-cent  cotton.  AM  Old  Doctor. 


^dbyGoogle 


COBRGSPOKDBNCB.  61S 

Gbipfin,  6a.,  October  12,  1898. 
.Editor  Atlanta  Medical  and  Sargical  Journal: 

The  State  Medical  Examining  Board  met  at  the  Capitol,  in 
Atlanta,  October  11th.  Nine  applicants  applied  for  license,  with 
ithe  following  result: 

One — Long  Island  Medical  College,  85  per  cent.     Passed. 

One — Medical  College  of  Alabama,  82  per  cent.     Passed. 

One — University  of  Louisville,  71  per  cent.     Passed. 

One — Baltimore  Medical  College,  87  per  cent.     Passed. 

One — Atlanta  Medical  College,  75  per  cent.     Passed. 

One — Medical  College  of  Virginia,  82  per  cent.     Passed. 

One — Chicago  Medical  College,  58  per  cent.     Failed. 

One— Tufts  Medical  College,  66  per  cent.     Failed. 

■One— Loaisville  Medical  College,  67  per  cent.     Failed. 

Z  herewith  enclose  yva  copy  of  the  questions. 

Respectfully,  E.  R.  Anthony, 

Secretary. 

REGULAR  BOARD  OF  EXAMINERS. 
Atlania,  Ga.,  Octobbb  11,  1898.     * 
U&TSRIA  HEDICA  AND  THERAPEUTICS.— Br  Dk.  W.  A.  O'Daitikl. 

1.  Give  the  differential  diagnosis  between  poisoning  by  iodoform 
«nd  poisoning  by  iodine  and  iodides,  and  the  treatment  for 
iodoform  poisoning,  and  bow  does  iodoform  poisoning  usually 
•oeear? 

2.  Describe  chronic  lead  poisoning,  and  give  treatment  for  same. 

3.  Give  tbe  respective  dangers  to  be  anticipated  in  the  adminis- 
tration of  chloroform  and  of  ether. 

4.  Name  the  most  important  soporifics,  also  the  dose  and  physio- 
logical action  of  each. 

5.  What  is  the  dose  of  the  tincture  of  aconite,  and  its  therapeutics? 

6.  Give  the  physiological  action  Of  belladonna,  and  the  dose  of 
its  important  and  official  preparations. 

CHEMISTRY.— Da.  B.  R.  Ahthoht. 
1.  Name  a  univalent,  a  bivalent,  a  trivalent  and  a  quadrivalent 
element. 


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614       The  Atlanta  Medical  and  Suroical  Journal. 

2.  What  is  a  radical? 

3.  Write  BD  equation  illustrating  direct  decorapositioa.  Donblfr 
decomposition. 

4.  Give  me  tbe  formula  of  sodium  chlorid.  What  important 
function  does  it  perform  in  the  body? 

5.  What  is  the  reaction  of  normal  ttriae?  To  what  is  this- 
reaction  due? 

PHYSIOLOGY.— Db.  K.  R.  Avtbont. 

1.  Kame  the  five  digestive  juices  and  briefly  give  me  the  func> 
tioo  of  each. 

2.  Name  the  valves  of  tbe  heart,  describe  them  and  tell  what 
orifice  each  one  guards. 

3.  About  how  much  air  is  taken  into  the  lungs  in  an  ordinarr 
inspiration?  How  much  of  this  is  nitrogen  and  what  is  its  func- 
tion? 

4.  Name  the  various  excretions  of  the  body. 

5.  What  nerve  center  presides  over  all  the  essential  reflex  acta  o€ 
life  (digestion,  respiration,  circulation)? 

8UBGERY.— Db.  F.  M,  Bidlit. 

1.  (a)  What  is  a  fracture?  (b)  How  many  kinds?  (c)  Describe- 
each.  Differential  diagnosis  between  fracture  and  dislocation. 
Give  approved  treatment  of  fracture  of  upper  third  of  femur.  Of 
patella. 

2.  Give  symptoms  of  cerebral  concussion,  and  of  cerebral  com- 
pression.    Differential  diagnosis. 

3.  Give  muscular  guide  for  the  ligation  of  femoral  artery^ 
middle  third.     Of  ant.  tibial,  post  tibial.     Of  radial. 

4.  Give  approved  treatment  of  gunshot  wound  of  chest  (pene- 
trating.)    Give  approved  treatment  of  gunshot  wound  of  abdomen.. 

5.  Differential  diagnosis  between  chancre  and  chancroid  ?  Give- 
approved  treatment  of  each. 

ANATOMY.— Dk.  F.  M,  Bidlit. 

1.  Describe  elbow- and  hip-joints  and  name  possible  dislocatioD 
of  each. 

2.  Name  muscles  forming  quadriceps  extensor  femoris  and  give 
origin,  insertion  and  innervation  of  each. 


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Correspondence.  615 

3.  Name  bones  foraiing  orbital  cavity  and  give  their  articula- 
tions. 

4.  Give  retatioDB  of  ezternal  carotid  artery  and  Dame  its  braocbes. 

5.  Give  origin  and  distribution  of  bracbial  plexus. 

GYNECOLOGY.— Db.  J.  B.  S.  Holmw. 

1.  What  is  the  moet'  frequent  cause  of  metrorrhagia  after  the 
menopause,  and  how  would  you  treat  it? 

2.  Describe  prolapsus  urethrte,  state  what  it  might  be  mietakea 
for  and  the  proper  treatment  of  it. 

3.  Give  symptoms  and  treatment  of  acute  oystitis  in  the  female. 

4.  Define   membranous   dysmenorrhea  and  give  prognosis  and 
treatment. 

5.  What  is  vicarious  menstruation  and  how  should  it  be  treated? 

OBSTHTEICS.— Da.  J.  B.  S.  Holmes. 

1.  Give  symptoms  and  treatment  oi  phlegmasia  alba  dolens. 

2.  When,  how  and  in  what  doses  would  you  use  ergot  in  ob- 
stetrical practice? 

3.  State  the  most  frequent  cause  of  mastitis,  its  prevention  and 
treatment. 

4.  What  do  you  understand  by  inversion  of  the  uterus  and  how 
would  you  treat  it? 

5.  What  are  the  indications   for  the  induction  of  abortion  and 
what  are  the  best  methods  of  inducing  it? 

PBACTICB.— Dr.  A.  A.  Smith. 

1.  Give  symptoms  of  urticaria,  also  appropriate   treatment  for 
same. 

2.  Give  symptoms  and  treatment  of  cliolera  infantum. 

3.  What  are  the  differential  diagnostic  features  in  spasmodic  and 
membranous  croup? 

4.  Give  symptoms  and  treatment  of  acute  dysentery. 

5.  Give  differential  diagnostic  symptoms  in  the  eruption  of  scar- 
let fever  and  measles. 

6.  Give  prominent  symptoms  and  treatment  for  diphtheria. 

7.  Give  three  or  more  of  the  characteristic  symptoms  of  typhoid 
fever. 

8.  Give  period  of  incubation  in  measles. 


^dbyGoOgle 


EDITORIAL  NOTES  AND  COMMENTS. 


ne  BntlDcM  ofllM  at  Toa  JOVMIU.  !■  MB,  MM  Fltlen  Bojldlnf. 

The  Bdltorlkl  oUoe  ti  Boom  Ml,  Ml  Oruid  Opera  HonM. 

AddrcM  kU  BoMneaa  commuDlutloiu  to  Dr.  U.  B.  Bstchlm,  Msr. 

Make  remltUnoea  p«7able  to  TBI  An^tm.  Uidical  akd  8ijb»:cal  Joiixkai. 

Od  matlan  pertaJnlng  to  the  Xdltorlal  uid  Original  eommnnloatlons  addicM  Dr.  IWitw 
Bo;,  Onnd  Opera  Honae,  Atlanta. 

Beprlnti  of  origtmal  artlolea  vUI  be  tnmUhed  at  ouat  pTise.  Beqneata  for  the  tune 
Bhonld  alwara  be  made  on  tlie  manutctipt 

We  wUl  preMnt,  poat-pald,  on  raqueat,  to  each  ooattlbalor  of  an  original  article,  twcDtf 
(30)  marked  coptM  <X  Tni  JODkHU.  oontalnlng  aooh  article. 


DO  PHYSICIANS  KNOW  TOO  MUCH? 

THE  HoapiUU,  pnbllBbed  in  Loadon,  baa  quite  a  length;  edito- 
rial in  its  issue  of  August  20th,  the  substance  of  which 
might  be  well  edited  with  the  above  caption.  The  writer  takes  a 
decidedly  pessimistic  view  of  the  profession  of  medicine  and 
bemoans  the  fact  of  the  richness  of  the  materia  medica  "  which  is 
annually  poured  out  upon  him  by  the  maoulkcturing  chemist." 
There  is  a  great  deal  of  truth  in  what  he  says,  and  what  is  true  in 
Great  Britain  is  still  more  so  in  the  United  States.  For  the  ben- 
efit of  our  readers  we  quote  what  he  says: 

"  The  present  writer  has  a  grievance,  a  real,  determined,  angry 
grievance,  against  England,  Germany,  and  America.  These  are 
the  three  countries  which  deluge  medicine  with  physiology,  good, 
bad,  and  indifferent,  but  mostly  bad;  which  flood  it  with  litera- 
ture in  the  shape  of  medical  books,  with  no  soul  of  either  science 
or  practice  in  them,  and  which  '  evolute '  new  remedies,  not  by 
the  score,  but  by  the  thousand  annually,  not  one  of  which  in  fifty  is 
worth  even  so  much  as  a  second  thought.     The  inevitable  eflect  of 

DiclzedbyGoOgle 


Editorial.  617 

all  this  upon  the  average  tninds  in  the  profession  is  either  to  auflb- 
«ate  and  so  to  paralyze  them  with  what  appears  to  be  new  knowledge, 
or  else  to  so  disgust  the  practitioner  that  he  makes  up  his  mind 
never  to  read  at  all,  and  on  no  earthly  consideration  whatever  to 
'experiment  with  a  new  drug.  Medicine,  in  short,  is  swamped, 
drowned,  stifled,  and  paralyzed  by  innumerable  exploiters  within 
«nd  without  its  ranks;  exploiters  whose  only  object  is  the  shortest 
possible  cut,  not  to  fame  and  fortune,  but  to  notoriety  and  pelf- 
Now,  all  this  has  an  exaggerated  sound  about  it.  But  indeed  and 
indeed,  however  eza^eratedly  it  sounds,  it  does  not  express  one- 
tenth  part  of  the  miserable  truth.  The  steady  practitioner,  whose 
aim  is  to  supply  his  patients  with  the  very  best  resources  which 
the  science  of  the  times  can  afford,  finds  that  about  half  his  bosy 
hours  are  spent  in  the  brain-wearing,  and  wbat  should  be  quite 
unnecessary,  operation  of  separating  the  precious  from  the  vile. 
And  the  vile  is  so  very  vile,  and  so  overwhelmingly  preponderant, 
that  he  almost  wishes  himself  in  the  nether  world,  and  perma- 
nently joined  to  the  ranks  of  Sisyphus  and  Tantalus. 

"And  this  is  the  reason:  The  profession  is  swamped  with 
pedants ;  with  persons  in  the  consulting  and  special  ranks  who 
faave  a  little  money,  do  practice,  and  unlimited  leisure ;  and  these 
persons  find  their  only  consolation,  the  only  salve  of  their  disap- 
pointed self-love,  in  writing  and  reading  all  the  rubbish  which  is 
annually  poured  out  upon  the  profession,  and  so  in  persuading 
themselves  that  they  are  more  learned  and  scientific  than  their 
better  employed  rivals.  If  it  were  not  for  the  two  or  three  thou- 
sand intolerable  pedants  in  our  ranks  medical  life  would  be  worth 
living.  As  it  is — well,  a  wise  philosophy  makes  the  best  it  can  of 
the  inevitable. 

"  For  the  strong,  the  mentally  strong  and  resolute,  there  is, 
however,  a  remedy,  even  for  so  all-powerful  a  plague  as  the  epi- 
demic of  medical  books  and   new  remedies.     The  strong  have 

DiclzedbyGoOgle 


618       The  Atlanta  Medical  and  Surqical  Journal. 

learot,  wbat  all  diligent  atndentii  learn  in  time,  the  art  of  selec- 
tioD.  They  do  not,  and  tbej  will  not,  read  the  books  and  the 
papers  of  the  exploiter,  the  pedant,  and  the  notoriety-seeker.  The 
study  of  a  single  page  is  generally  quite  safficient  to  show  wbat  a 
book  is  made  of.  If  it  be  pedantically  expressed,  if  it  be  chai^d 
with  a  great  ubow  of  learning,  if  it  evinces  a  manifest  anxiety  to 
give  the  opinions  of  every  other  person,  living  or  dead,  who  has 
ever  written  upon  the  same  subject,  then  it  is  evident  that  it  is  a 
manufactared  book.  It  is  a  pretty  safe  canon  of  literary  criti- 
cism, especially  of  the  medical  order,  that  the  book  which  gives 
pablicity  to  everybody's  opinion  has  no  opinion  of  its  own  worth 
publishing.  How  much  of  other  people's  judgment  did  Lord 
Lister  express  when  he  was  working  out  the  antiseptic  system  of 
surgery  and  medicine?  It  was  a  frequent  boast  of  the  late  Sir 
Andrew  Clark,  almost  up  to  the  time  of  his  death,  that  he  had 
'never  written  a  book.'  What  we  need,  almost  more  than  any- 
thing else  at  the  present  moment  in  the  medical  profession,  are 
two  things:  First,  courageous  independence  of  mind  and  judg- 
ment; and,  secondly,  a  competent  capacity  for  selection.  Without 
these  our  practice  has  no  rules,  no  certainty;  it  varies  from  day  to 
day,  and  even  from  hour  to  hour ;  it  is  everywhere  and  it  is  no- 
where. With  them  we  shall  daily  place  at  the  disposal  of  all  our 
patients,  if  not  the  last  new  thing  in  drugs  or  the  latest  opinion  in 
bacteriology,  at  least  the  best  of  the  proved  resources  which  the 
science  of  the  times  affords." 


THE   QUARANTINE  QUESTION. 

YELLOW  fever  has  again  appeared  in  the  Southwest,  just  as  it  did 
one  year  ago.     Considering  the  disrupted  state  of  our  country 
through  the  recent  Spanish- Americ«n  war,  and  the  comming- 
ling together  of  the  United  States  and  those  countries  like  Cuba 


^dbyGoogle 


Ediiomal.  619» 

and  Porto  Bioo,  where  yellow  fever  is  nearly  always  rampant,  and 
coDsideriDg  also  the  severe  epidemic  we  bad  laet  year  and  the  very 
mild  winter  which  has  is  the  meantime  intervened,  we  are  not  sur- 
prised at  the  present  outbreak. 

Mississippi,  as  osual,  seems  to  be  bearing  the  brunt  of  the  epi- 
demic. New  Orleans  has  already  been  seriously  affected,  and  com- 
meroial  interests,  due  to  quarantine,  have  also  been  jeopardized. 
Mississippi  has  appealed  to  the  Federal  Government  for  aid  in  the' 
present  epidemic,  showing  the  inability  oi  the  authorities  alone  to 
cope  with  the  disease.  Such  an  appeal  but  forcibly  represents  the 
neceamty,  as  we  have  always  held,  for  a  national  quarantine  con- 
trol. Such  a  belief  is  in  nowise  a  reflection  upon  the  ability  of 
State  health  officers,  but  it  is  a  belief  in  the  better  extension  of 
quarantine  measures  when  under  national  control.  State  authori- 
ties, with  their  limited  means,  are  unable  to  carry  out  any  perfect 
system  of  quarantine^  and  when  it  is  attempted  there  is  frequently- 
a  clash  between  the  health  officers  representing  different  communi- 
ties of  the  same  State.  Yellow  fever  is  demoralizing  in  many 
respects,  and  it  is  too  serious  a  matter  not  to  be  dealt  with  in  the 
most  systematic  manner,  "Shotgun  quarantine"  is  not  the  proper 
kind,  bnt  is  even  evil  in  its  results.  Of  all  the  States  in  the  South, 
none  should  be  more  thoroughly  interested  in  the  question  of  quar- 
antine than  Mississippi,  and  yet  the  officials  from  that  State  one 
year  ago,  in  the  convention  assembled  to  discuss  and  devise  plans 
for  this  very  condition,  opposed  most  strenuously  the  idea  of  na- 
tional quarantine.  Experience  has  certainly  attested  the  fact  that 
Federal  control  and  regulations  in  quarantine  matters  is  by  far  bet- 
ter than  that  executed  by  State  authorities,  and  until  we  have  a 
national  quarantine  the  outlook  must  be  gloomy.  As  one  of  our 
^daily  papers  has  well  said,  "there  can  be  no  question  of  States' 
rights  in  this  matter,  as  is  so  much  feared  by  strict  construction- 
ists.    There  can  certainly  be  no  more   fear  of  the  loss  of  States' 


^dbyGoOgle 


€20       The  Atlanta  Mbdical  and  Sukgical  Joubkal. 

rights  io  controlling  an  epidemic  tban  there  is  in  briogiog  in  na- 
tional  aid  to  repair  its  ravages  after  it  has  passed  the  danger  point" 


THE  GEORGIA  MEDICAL  ASSOCIATION. 

IT  is  perhaps  a  little  early  to  beg^n  talking  about  the  next  meet- 
ing of  our  State  Medical  Association,  but  we  do  this  in  order, 
if  possible,  to  arouse  early  enthnsiasm.  The  next  meeting  will 
be  held  in  Macon,  Ga.,  and  it  will  be  the  celebration  of  its  fiftieth 
anniversary.  Macon  was  very  rightly  chosen  as  the  place  of  meet- 
ing, since  it  was  in  the  Central  City,  fifty  years  ago,  that  the  Asso- 
ciation was  founded.  We  expect  to  have  a  great  celebration  on 
that  occasion,  and  we  urge  now  upon  every  member  to  make  his 
preparations  preparatory  to  being  present.  Socially,  besides  many 
other  ways,  Macon  is  one  of  the  most  delightful  places  in  the  South, 
and  there  bae  never  been  a  meeting  of  the  Association  held  in  that 
city  but  what  all  present  wished  to  return  again.  Socially,  then,  we 
are  assured  of  the  success  of  the  meeting.  But  what  we  want  to  do  is 
to  have  a  program  of  medical  papers  which  will  be  worthy  of  the 
occasion  and  of  the  physicians  who  represent  the  old  State  of  Geor> 
gia.  Last  year  the  meeting  of  our  Association  was  not  up  to  its 
usual  standard,  and  this  was  largely  due  to  the  feet  that  the  place 
of  meeting,  Cumberland  Island,  was  too  far  away  for  the  majority 
of  physicians.  Macon,  however,  is  unusually  central,  and  the  fitll 
quota  of  membership  should  be  present. 


THAT  distinguished  Southern  surgeon  and  teacher.  Dr.  Floyd 
W.  McRae,  of  the  Atlanta  College  of  Physicians  and  Sar- 
geons,  has  been  placed  in  an  awkward  position,  by  the  Americin 
Medical  Association.  First,  he  was  elected  by  the  Association  to 
deliver  the  annual  address  in  surgery  at  the  Columbus  meetiag 

DiclzedbyGoOgle 


Editorial.  621 

next  year.  Next,  be  wae  declared  not  eligible  to  membership  un- 
less he  resign  his  professorship  in  the  co]lefi;e.  For  the  Associa- 
Hoa,  withoat  diseeotiiig  vote,  passed  the  resolutiou  declaring  that  do 
physiciaD  can  hereafter  be  a  delegate  in  that  body  who  is  a  member 
of  any  facalty,  or  a  graduate  of  any  college  which  does  Dot  reqnire 
a  four  years'  graded  course  of  instruction ;  aDd  the  announcement 
of  the  college  in  which  Dr.  McKae  teaches  is  outspoken  for  only 
three  years  t  This  eminent  Southern  teacher  is  not  the  only 
member  of  long  standing  who  will  be  affected — fully  40  per  cent, 
of  the  permanent  members  of  the  American  Medical  Association 
are  graduates  of  schools  which  will  next  year  (for  the  last  time) 
grant  the  degreeof"  doctor  of  medicine"  to  men  who  have  attended 
only  three  annual  courses  of  instruction.  The  meeting  at  Columbus 
next  year  will  be  a  miserable  failure  if  the  resolution  adopted  at 
Denver  be  enforced,  since  the  most  enthusiastic  workers  of  that  body 
are  from  the  South  and  West,  where  fully  Dine-tentbs  of  the  doctors 
are  graduates  of  "  three-year  schools."  If  the  resolution  had  read 
"after  1900"  instead  of  "hereafter,"  there  would  have  been  no 
trouble,  as  all  the  reputable  schools  of  the  country  are  to  require 
the  "four-year  course"  afber  the  next  sesuon. — American  Journal 
Surgery  and  Oyneeology, 


rB  Medical  Age,  in  its  Items  and  Notes,  has  this  to  say:  "The 
doctors  of  Sweden  never  send  bills  to  their  patients.  If  you 
have  occasion  to  call  a  physician  you  will  find  him  not  only 
skilled  in  his  profession,  but  a  highly  educated  and  honorable  gen- 
tleman. You  will  also  have  a  proof  of  the  honesty  of  the  Swedes 
and  their  friendly  confidence  in  each  other.  What  you  shall  pay 
is  left  entirely  to  yoor  own  choice.  The  rich  may  pay  him  liber- 
ally, whether  they  have  need  of  hie  services  or  not,  if  he  has  only 


^dbyGoOgle 


^22       The  Atlanta  Mbdical  and  Surgical  Journal. 

IbeeD  retained  hy  tbeiu.  The  poor  tnay  pay  him  a  small  sum  and 
the  very  poor  pay  him  nothing.  Yet  be  visits  the  poor  as 
&itbfully  as  he  does  the  rich.  A  similar  custom  prevailed  up  to 
rthe  middle  of  the  present  centnry  in  some  of  the  most  remote  por- 
lioDB  of  the  Highlands  of  Scotland.  There  the  doctor  collected 
his  entire  year's  bills  on  a  certain  market  day  in  summer,  getting 
perhaps  five  or  ten  pouuds  from  the  larger  farmers,  but  only  as 
many  shillings  from  the  poorer  crofters." 

What  an  ideal  life  must  be  that  of  the  Swedish  physician !  Think 
of  such  a  condition  of  affairs  existing  here  io  America !  We  fear 
that  such  a  degree  of  honesty  could  never  he  acclimated  in  this 
land  of  ours. 


IT  seems  as  if  the  H.  K.  Mulford  Co.,  of  Philadelphia,  have  been 
appropriating  a  good  deal  which  did  not  belong  to  them,  if  we 
may  jadge  from  the  Tka-apeuiie  Notet  issued  by  the  well-known 
firm  of  Parke,  Davis  &  Co.,  of  Detroit.  According  to  the  statement 
of  the  Philadelphia  firm,  the  antitoxin  manufactured  by  them  is  that 
which  has  been  adopted  by  the  California  State  Board  of  Health 
as  being  the  best  product  made,  and  therefore  to  be  used.  Now 
«omes  the  Parke-Davis  Co.,  who,  under  sworn  statements  from  the 
ex-president  of  the  California  Board  of  Health  and  the  present 
secretary,  state  that  the  Mulford  Co.  have  inserted  their  own  name 
in  the  place  of  Parke,  Davis  &  Co.  in  the  resolution  which  was 
really  passed  by  the  Board  of  Health. 

These  published  affidavits  certainly  place  the  Mulford  Co.  in  an 
unenviable  light,  to  say  the  least,  and  if  what  they  have  been  guilty 
of  is  true — and  it  certainly  looks  that  way — then  such  action  should 
be  condemned  in  folo  by  the  whole  profession. 


^dbyGoOgle 


NEWS  AND  NOTES. 


Db.  J.  W.  Duncan,  of  thia  city,  who,  after  a  very  severe  illness, 
-went  to  the  mouDtains  of  TeaneBsee  to  recuperate  his  lost  streogth, 
is  ag»n  at  the  post  of  duty. 


Dr.  Jaues  N.  Ellh,  formerly  of  Richmond,  Va.,  but  who  for 
the  last  two  years  has  been  studying  abroad,  has  located  in  Atlanta 
t»  engage  iu  the  practice  of  his  profession. 


De.  G.  G.  Roy  was  elected  as  councilman  from  the  Sixth  ward 
at  the  city  primary  on  October  5th.  This  the  same  as  an  election, 
and  Dr.  Roy  will  represent  his  ward  for  the  next  two  years. 


Dr.  L,  a.  Felder,  Secretary  of  the  Atlanta  Society  of  Medicine, 
has  accepted  and  entered  upon  the  duties  of  Contract  Surgeon, 
U.  S.  V.     Dt.  8.  A.  Visanska  has  been  appointed  Secretary  pro  tem. 


Db.  S.  G.  C.  Pinckney  spent  the  mouth  of  September  in  New 
York,  bis  old  home,  enjoying  a  well-earned  vacation.  He  also 
flpent  some  time  in  the  hospitals,  seeing  what  was  new  in  nervous 
diseases. 


Dr.  Park  Howell,  of  this  city,  who  has  been  acting  as  Assist- 
ant Surgeon  m  the  Volunteer  Army,  has  been  detailed  for  duty  at 
Santiago,  Cuba.  He  left  the  city  on  October  1st  for  his  new,  field 
of  labor. 


Db,  M.  a.  Purse  was  married  on  September  27th  to  Miss 
Josephine  Earnest,  daughter  of  Dr.  J.  G.  Earnest  of  this  cily. 
They  left  for  an  extended  trip  North,  and  the  best  wishes  of  The 
Journal  goes  with  them. 


Didiiiz'ed  by  Google 


624       The  Atlanta  Medical  and  Suhqical  Jouknal. 

The  Atlanta  Society  of  Medicine  is  id  a  more  flourishing  condi- 
tion than  ever.  It  now  occupies  elegant  new  rooms  in  the  English- 
American  building,  and  meets  regularly  every  first  and  third 
Thursdays  in  each  month.  The  profession  is  always  cordially 
invited. 


Th£  Atlanta  College  of  Physicians  and  Surgeons  has  opened  in 
a  most  flattering  manner.  It  already  has  over  200  stndents,  and 
many  more  are  expected  during  the  first  half  the  term.  Dr.  West- 
moreland opened  the  College  on  October  5tb,  with  by  operating  in 
the  amphitheater.  All  the  Clinics  are  held  daily  from  12  to  2  p.  h., 
except  that  of  Dr.  Dunbar  Roy,  which  is  held  on  Tuesdays  and 
Thursdays  from  3  to  4:30  p.  h. 


Dr.  J.  H.  Hall,  of  Milledgeville,  Ga.,  died  of  Bright's  disease 
in  that  city  on  September  20th,  1898. 


Dr.  B.  N.  Hereikq,  of  Decatur,  Ga.,  formerly  of  Clarkesville, 
Tenn.,  died  in  the  former  city,  September  19th,  at  the  age  of 
twenty-six. 


Died. — R.  L.  Y.  Long,  of  Newnan,  Ga.,  at  his  home  on 
October  Tth.^Dr.  Long  was  one  of  the  prominent*  physicians  in 
the  State. 


Drs.  Powbli,  &  Marchman,  of  Villa  Rica,  Ga.,  have  formed  a. 
partnership  in  the  practice  of  medicine  and  in  the  drug  business. 
Both  are  well-known  physicians,  and  the  combination  is  a  good 
one. 


Each  year,  the^Georgia  Legislature  has  among  its  membership 
a  number 'of  prominent  physicians  from  different  parts  of  the 
State.     In  looking  over  the  list  of  members  of  the  next  legislature^ 

DiclzedbyGoOgle 


Kews  and  Notes.  625 

'we  find  tbat  there  is  only  one  phjrsician  in  the  Senate,  Dr.  George 
C  Daniel,  of  Madison.  Id  the  House  of  Representatives  we  note 
ithe  followiog:  Dr.  E.  W.  Watkios,  of  Gilmer  county ;  Dr.  C.  H. 
Turner,  of  Rockdale  county;  Dr.  Geo^  C.  Erwin,  of  Towns 
■county;  Dr.  G.  W.  Drawdy,  of  Wayne  county. 


SiK  William  Hekey  Bboadbent  has  been  appointed  Physi- 
■ciau  Extraordinary  to  the  Queen,  in  succession  to  the  late  Sir 
Richard  Quain. 

The  Medical  BuUetin  informs  us  that  Dr.  Cowan,  of  Radford, 
Va.,  has  been  appointed  Professor  of  Operative  Surgery  and  Sur- 
-gical  Anatomy  at  the  New  York  School  of  Clinical  Medicine. 


De.  E.  Emmet  Reid,  according  to  the  Philadelphia  JftediocU 
.Journal,  of  the  Johns  Hopkins  University,  has  been  appointed 
Professor  of  Chemistry  and  Physics,  in  the  Medical  College  of 
•Charleston,  S.  C. 


Db.  Claudius  H.  Maetin,  of  Mobile,  Ala.,  one  of  the  Soutb's 
■^lifitinguished  surgeons,  and  a  man  who  has  occupied  a  prominent 
place  in  the  various  professional  deliberative  bodies,  died  in  tbat 
-city  on  October  3d. 

Db.  Kathbisa  Van  Tdssenbhock  has  been  appointed  to  the 
Professorship  of  the  chair  of  Gynecology  in  the  University  of 
Utrecht.  This  shows  that  the  women  are  coming  to  the  front  all 
-over  the  world. 


Db.  Jmo.  B.  Hamilton,  the  gifted  editor  of  the  Journal  of  the 
American  Medical  Association,  has  been  elected  to  the  presidency 
-of  the  Chicago  Public  Library.  We  have  no  doubt  hut  that  the 
library  will  flourish  just  as  the  Journal  has  under  such  able  man- 
agement. 


^dbyGoOgle 


626       The  Atlanta  Medical  ano  Surqical  Jottrkal. 

Mr.  Otto  Youno,  whose  aoa  recently  died  of  tuberculosis,  is 
buildiog  in  Chicago,  a  hospital  for  tuberculons  patients,  at  an  esti- 
mated cost  of  f  65,000.  It  will  accommodate  75  patients,  and  wil( 
be  provided  with  every  device  for  the  treatment  of  the  disease  by' 
modern  methods. 


Db.  Phineas  Connor,  of  Cincinnati,  is  a  member  of  the  Board 
of  Investigation  recently  appointed  by  President  McKinley,  for 
the  purpose  of  investigating  the  alleged .  mismanagement  of  the 
medical  department  during  the  recent  Spanish- American  war. 
Dr.  Keen  was  first  selected,  but  declined  to  serve. 


The  Baltimore  American  says  that  Porto  Rico  can  offer  no 
inducements  to  medical  men.  There  is  plenty  of  sickness  there,, 
but  each  native  practices  on  himself.  They  are  great  believers  in 
the  efficiency  of  herbs,  and  these  are  used  by  the  rich  and  poor 
alike.  The  editor  thinks  that  for  the  graduates  of  the  Eclectic- 
schools  this  is  indeed  an  £1  Dorado. 


Dr.  James  Tyson  has  been  elected  for  this  session  to  fill  the- 
Chair  of  Practice  of  Medicine  in  the  University  of  Pennsylvania. 
On  account  of  the  physical  iudisposition  of  Dr.  John  AsbuTSt,  ia 
the  same  institution,  Dr.  J.  William  White  will  have  full  chai^ 
of  the  Chair  of  Surgery.  It  seems  to  be  the  general  impresaioD 
that  Dr.  Tysun  will  fill  this  position  permanently. 


The  American  Medico-Surgical  BuUdin  says  that  some  unknown 
New  York  millionaire  has  made  a  gift  of  one  million  six  hundred 
thousand  dollars  to  Cornell  University  with  which  to  start  another 
medical  college  in  New  York  city.  Ijand  has  been  bought  oo 
First  avenue  and  Twenty-seventh  street,  and  plans  are  ready  for 
the  erection  of  a  six  hundred  thonsand-doUar  building. 


The  daily  papers  inform  us  that  Dr.  Wetmore,  Superintendent 
of  Insane  Asylum  at  Topeka,  Kansas,  has  tendered  his  resignation 


^dbyGoogle 


News  and  Notes.  627 

to  the  Governor  of  that  State.  Tbe  reason  given  is  that  the  man- 
agement is  incompetent  and  that  a  State  "joint"  exists  at  the 
asylum.  The  Doctor  further  charges  all  manner  of  inhumaQity  and 
debauchery  by  the  members  who  compose  tbe  State  Board  of 
Charities. 


The  American  Microscopical  Society,  at  its  recent  annual  ses- 
sion, elected  the  following  officers  for  theensuing  year:  President, 
Dr.  William  C.  Krauss,  of  Bu&lo ;  First  Vice-president,  Profes- 
sor A.  M,  Bleile,  of  Columbus,  O. ;  Second  Vice-President,  Dr. 
G.  C.  Huber,  of  Ann  Arbor,  Mich. ;  Secretary,  Professor  Henry 
D.  Ward,  of  Lincoln,  Neb.;  Treasurer,  Magnus  Pflaum,  of  Pitts- 
burg; Executive  Committee,  Professor S.  H.  Gage, of  Ithaca;  Dr. 
A.  ClifTord  Mercer,  of  Syracuse,  and  Dr.  V.  A.  Moore,  of  Ithaca. 


The  following  officers  were  elected  at  Nashville  of  the  Missis- 
sippi Valley  Medical  Association:  President,  Dr.Duocao  £ve,Na9b- 
ville,  Teno.;  First  Vice-President,  Dr.  A.  J.  Oobsner,  Chicago,  IH.; 
Second  Vice-President,  Dr.  J.  C.  Morfit,  St.  Louis,  Mo,;  Secretary, 
Dr.  Henry  E.  Tuley,  Louisville.  Ky.  (Ill  W.  Ky.  St.);  Treasurer, 
Dr.  Dudley  S.  Eeynolds,  Louisville,  Ky.  Next  place  of  meeting, 
Chicago.  Chairman  of  Committee  of  Arrangements,  Dr.  Harold 
N.  Moyer.  Time  of  meeting,  October,  1899,  date  to  be  determined 
by  tbe  executive  officers  and  the  Chairman  of  the  Committee  of 
Arrangements. 

The  following  are  the  officers  for  the  ensuing  year  of  the  Ameri- 
can Association  of  Obstetricians  and  Gynecologists : 

President,  Edward  J.  Ill,  M.D.,  Newark,  N.  J. ;  Vice-Presidents, 
Edwin  Ricketts,  M.D.,  Cineinnati,  Ohio,  and  A.  B.  Miller,  M.D., 
Syracuse,  N.  Y. ;  Secretary,  William  Warren  Potter,  M.D,,  Buffalo, 
N.Y.;  Treasurer,  X.  O.  Werder,  M.D.,  Pittsburg,  Pa.;  Executive 
Council,  A.  Vander  Veer,  M.D.,  Albany,  N.  Y. ;  L.  S.  McMurtry, 
M.D., Louisville,  Ky.;  W.E.  B.  Davis,  M.D.,  Birmingbam,  Ala.; 
John  Milton  Duff,  M.D.,  Pittsburg,  Pa.;  L.  H.  Dunning,  M.D., 
Indianapolis,  Ind.,  and  Walter  B,  Chase,  M.D.,  New  York. 


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628       The  Atlanta  Medical  and  Sdroical  Jodbnal. 

WeBTBRN    SUHGrCAL    AND     GyKBCOLOGICAL     ASSOCIATION. — 

The  eighth  anoual  meetiog  of  the  Western  Surgical  and  Gyne- 
cological AssociatioD  will  be  held  at  Omaha  December  28  and  29, 
1898.  Titles  of  papers  from  some  of  the  leading  surgeons  of  tbe 
West  are  already  in  the  bands  of  tbe  secretary  and  the  coming 
meeting  promises  to  be  the  most  interesting  yet  held.  The  local 
Committee  of  Arrangements  at  Omaha  is  actively  preparing  for 
the  entertainment  and  comfort  of  those  who  attend.  Surgeons  and 
gynecologists,  and  those  interested  in  the  progress  of  these  special* 
ties,  are  cordially  invited  to  affiliate  themselves  with  as.  Tbe 
secretary  will  be  glad  to  send  application  blanks.  Titles  of  papers 
should  be  sent  to  the  secretary  as  soon  as  possible,  but  not  later 
than  November  20,  to  insure  a  place  on  the  proj^ram.  Geo.  H. 
Simmons,  Secretary,  Lincoln,  Neb.;  D.  S.  Fairchild,  President, 
Clinton,  la. 


Are  There  Too  Many  Doctors? — Under  this  title  a  cor- 
respondence, signed  "Traveler,"  appeared  in  the  Poet  Digpaich  of 
September  22,  1898.  The  correspondence  was  in  answer  to  tbe 
query  of  a  young  man  in  a  previous  issue  of  the  paper  regarding 
the  advantages  of  a  "  Medical  Night  School."  Tbe  correspondence 
is  worthy  of  preservation.     Here  it  is : 

"  One  of  yonr  young  men  readers  seems  to  desire  the  advantages 
(?)  of  a  medical  night  school.  If  he  investigates  he  wilt  find 
that  there  are  now  two  doctors  for  every  one  required,  and  that 
many  medical  schools  are  the  bane  of  tbe  medical  profession  and 
the  laughing-stock  of  intelligent  people.  I  have  traveled  through 
Kansas,  Missouri  (including  St.  Louis)  and  Illinois,  calling  on 
physicians,  and  have  felt  only  regret  for  very  many  of  them.  The 
average  income  of  a  physician  is  not  that  of  a  good  clerk  and  his 
expense  is  much  heavier.  Many  doctors  of  ability  and  education 
leave  tbe  profession  each  year. 

"As  for  medical  schools,  Missouri  has  now  eighteen  (more  than 


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News  and  Notes.  629 

the  whole  of  Ruseia,  with  106,000,000  people),  and  if  the  jouDg 
mao  is  as  ambitious  as  his  signature  indicates,  he  will  not  find 
much  difficulty  in  getting  a  sheepskin  which  afterwards  will  appear 
to  him  like  the  proverhial  'white  elephant.'  'What  will  he  do 
with  it?' 

"  The  advice  of  all  conscientious   physicians   to    young   men, 
many  of  whom   are  utt«rly  unfitted   for  it,  who  desire  to  study  , 
medicine  should  be,  'don't.'     No,  we   dou't  need  more  medical 
schools,  but  we  do  need  fewer,  and  those  good  ones." — Medical 
Jieview. 


The  Southern  Sdboical  and  Gynecological  Associa- 
tion.— The  eleventh  annual  meeting  of  the  Association,  which  was 
announced  to  be  held  in  Memphis,  Teun.,  Tuesday,  Wednesday  and 
Thursday,  November  8th,  9th  and  10th,  has  been  postponed  till 
Tuesday,  Wednesday  and  Thursday,  December  6th,  7th  and  8tb, 
1 898,  on  account  of  the  quarantine  regulations  in  some  parts  of  the 
South.  The  Oayoso  House  has  been  selected  as  headquarters  for 
the  Association. 

The  following  is  a  partial  list  of  the  papers  to  be  read : 

1.  President's  Address,  Kiohard  Douglas,  M.D.,  Nashville, 
Tenn. 

2.  Gunshot  Wounds,  W.  E.  Parker,  M.D.,  New  Orleans,  La. 

3.  Electro-therapeutics  in  Medicine  and  Surgery,  James  McF. 
Oaston,  M.D.,  Atlanta,  Ga. 

4.  The  Normal  Position  of  the  Uterus  Defined,  A.  H.  Buck- 
master,  M.D.,  Charlottesville,  Va. 

5.  Abdominal  Opening  for  Intraperitonel  Surgical  Work,  Jos. 
Price,  M.D.,  Philadelphia,  Pa. 

6.  The  Choice  of  Material  for  Ligatures  and  Sutures  in  Gyne- 
cological Surgery,  L.  S.  McMurtry,  M.D.,  Louisville,  Ky. 

7.  Repair  in  Cases  of  Complete  Tear  of  the  Perineum,  Howard 
A.  Kelly,  M.D.,  Baltimore,  Md. 

8.  Conservative  Treatment  of  the  Diseased  Ovary,  Joa.  Taber 
Johnson,  M.D.,  Washington,  D.  0. 


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630       The  Atlanta  Medical  and  Surgical  Jodrnal. 

9.  Thoracotomy  for  Tumora  lavolviag  the  Ribs,  F.  W.  P&rbam, 
M.D.,  New  Orleans,  La. 

10.  The  Use  and  Abuse  of  Normal  Salt  SolutioD,  J.  W.  Bovee, 
M.D.,  Waahington,  D.  C. 

11.  A  Report  of  Fifty  Prostatectomies,  with  Remarks  on  the 
Treatment  of  Prostatic  Overgrowth  in  the  Aged,  Joho  P.  Bryeon, 

.  M.D.,  St.  Louis,  Mo. 

12.  Remarks  OD  the  Sut^ry  of  the  Gall-bladder  and  Bile-ducts, 
A.  V.  L.  Brokaw,  M.D.,  St.  Louis,  Mo. 

13.  Past  and  Present  Sui^ry  of  the  Gall-bladder  and  Bile- 
ducts,  Wm.  H.  Myers,  M.D.,  Fort  Wayne,  Ind. 

14.  The  Pelvic  Floor,  Its  Functions,  Injuries  and  Repair,  M.C. 
McGannon,  M.D.,  Nashville,  Tenn. 

15.  When  Should  we  Operate  for  Appendicitis?  A.  M.  Cart- 
ledge,  M.D.,  Louisville,  Ky. 

16.  Ureteral  Anastomosis,  Geo.  H.  Noble,  M.D.,  Atlanta,  Ga. 

17.  Ovarian  Cysts  as  a  Complication  of  Pregnancy  and  Labor, 
J.  W.  Long,  M.ri.,  Salisbury,  N.  C. 

18.  Incised  Wounds  of  the  Larynx,  Edwin  Walker,  M.D.,  Ev- 
ansville,  Ind. 

19.  Tubal  Pregnancy:  Primary  Rupture  into  the  Broad  Ligament, 
and  Secondary  into  the  Peritoneum;  Laparotomy,  Convalescence 
Complicated  by  Septic  Diarrhea  and  Metastatic  Abscess  of  the 
Liver,  R.  Matas,  M.D.,  New  Orleans,  La. 

20.  Removal  of  Partially  Descended,  Infected,  Strangulated 
Testicle,  Complicated  by  Hernia,  R.  R.  Kime,  M.D.,  Atlanta,  Ga. 

21.  The  Diagnosis  of  Tubercular  Peritonitis  and  Indications  for 
Sui^ical  Treatment,  W.  L.  Robinson,  M.D.,  Danville,  Va. 

22.  Foreign  Bodies  in  the  Esophagus,  with  Report  of  Cases, 
A.  Vander  Veer,  M.D.,  Albany,  N.  Y. 

23.  Penetrating  Wounds  of  the  Abdomen,  Floyd  W.  McRae, 
M.D.,  Atlanta,  Ga. 

24.  The  Management  of  Pregnancy  Complicating  Intra-abdom- 
inal Tumors,  with  Cases,  Rufus  B.  Hall,  M.D.,  Cincinnati,  O. 

25.  The  Rarity  of  Ovarian  Tumors  in  Negresses,  I.  S.  Stone, 
M.D.,  Washington,  D.  C. 


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News  and  Notes.  631 

26.  Tumors  of  the  Breast,  W.  F.  WeetmorelaDd,  M.D.,  At- 
lanta, Ga. 

27.  FenetratiDg  Wounds  of  the  Chest,  J.  B.  Murfree,  Murfrees- 
boro,  Tenn, 

28.  Surgery  of  the  Pelvic  Organs  without  Speculums  or  Re- 
tractors, W.  H.  Wathen,  M.D.,  Louisville,  Ky. 

29.  Report  of  a  Case  of  Splenectomy  for  Wandering  Hyper- 
trophied  Spleen,  Wyatt  Heflin,  M.D.,  Birmingham,  Ala. 

30.  Celiotomy  in  the  Treatment  of  Retruverted  Pregnant 
Uterus  when  Incarcerated,  Henry  D.  Fry,  M.D.,  Washington, 
D.  0. 

31.  Odds  and  Ends  in  Pelvic  Sui^ry,  Walter  B.  Dorsett,  M.D., 
St.  Louis,  Mo. 

32.  Treatment  of  Pelvic  loflammatioD,  Jas.  A.  Goggans,  Alex- 
ander City,  Ak. 

33.  Mechanical  Aids  in  Intestinal  Surgery,  J.  D.  S.  Davis,  M.D., 
Birmingham,  Ala. 

34.  The  History  of  Myomectomy,  Cbas.  P.  Noble,  M.D.,  Phil- 
.adelphia,  Pa. 

35.  Observations  upon  Cranial  Operations,  with  Report  of  Cases^ 
Wm.  Perrin  Nicholson,  M.D.,  Atlanta,  Ga. 

36.  Plastic  Surgery  in  Gynecology,  W.  D.  Hazard,  Jr.,  Nash- 
-ville,  Tenn. 

37.  Ventrofixation  for  Retrod isplace me nts  of  the  Uterus,  R.  J. 
Trippe,  M.D.,  Chattanooga,  Tenn. 

38.  Removal  of  Five-gallon  Ovarian' Cyst  from  Girl  Seventeen 
Years  Old,  R.  R.  Kime,  M.  D.,  Atlanta,  Ga. 

39.  Transpleural  Hepatotomyby  [t«section  of  the  Rib  and  Free 
Incision ;  Recovery,  R.  Malas,  M.D.,  New  Orleans,  La.| 

40.  Subject  to  be  announced,  W.  S.  Elkin,  M.D.,  Atlanta,  Ga. 

41.  Surgery  of  the  Stomach,  W.  E.  B.  Davis,  M.D.,  Birming- 
liam,  Ala. 

Members  of  the  medical  profession  are  cordially  invited  to  at- 
tend. Dr.  R.  B.  Maury,  of  Memphis,  is  chairman  of  the  commit- 
tee of  arraagements.  Richard  Douglas,  M.D.,  President;  W.  E.  B. 
Davis,  M.D.,  Secretary. 


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BOOK  REVIEWS,    PAMPHLETS,   EXCHANGES. 


BOOK  REVIEWS. 

[UontXbatloiu  aoUcltod  for  rarlaw.] 


A  Text-Book  of  Practical  Therapeutics:  With  especial 
Befereoce  to  the  Application  of  Remedial  Measures  to  Disease 
and  their  EmploymeDt  upon  a  Rational  Basis.  Sy  Hobart 
Amory  Hare,  M.D.,  Professor  of  Therapeutics  aud  Materia  Medica 
in  the  Jefferson  Medical  College  of  Philadelphia.  With  special 
chapters  hy  Drs.  Q.  E.  de  Schweinitz,  Edward  Martin  and  Barton 
C.  Hirst.  New  (seventh)  edition.  In  one  octavo  volume  of  770 
pages,  illustrated.  Cloth,  (3.75;  leather,  |4.50,  net.  Lea 
Brothers  &  Co.,  Philadelphia  and  New  York. 

The  fact  of  the  text-book  having  reached  its  seventh  edition  in 
80  short  a  time  after  its  first  appearance  is  an  unquestioned  evi- 
dence of  its  popularity,  and  this  popularity  is  the  very  best  evidence- 
^f  its  worth. 

The  writer  was  for  nineteen  years  Professor  of  Materia  Medica 
and  Therapeutics  in  a  reputable  coll^;«,  and  began  the  use  of  this 
excellent  work  with  its  first  edition — as  a  text-book — and  were  h& 
a  professor  for  the  next  twenty  years  to  come,  with  the  necessary  re- 
visions and  additions  of  the  author  continued,  which  have  been  up^ 
to  date  so  faithfully  done,  he  would  still  use  it. 

The  teacher  and  student  owe  Professor  Hare  a  debt  of  gratitude- 
for  his  efforts  in  their  behalf  in  the  field  of  materia  medica  and 
therapeutics,  especially  for  the  lucid  and  simple  manner  in  which 
he  applies  the  therapeutics  to  the  remedies  treated  of.  With  eacb 
remedy  he  gives  the  student  an  object-lesson,  in  the  disease  for  which 
it  is  applicable,  the  mode  and  dose  of  administration,  and  usually 
a  formula,  either  simple  or  compouud,  in  which  it  may  be  used. 
This  is  of  great  benefit  and  value  to  the  advanced  student  and 
young  practitioner,  and  the  recognition  of  this  fact  by  them  is  one 
cause  of  its  great  popularity.  As  a  teacher,  I  cannot  too  highly 
recommend  this  book  to  students,  and  as  an  active  practitioner  of 


^dbyGoOgle 


Book  Reviews.  68ft 

over  forty  years'  experience,  I  can  say  the  same  to  my  professional 
brothers — the  busy  doctor.  The  addition  in  the  seventh  edition  of 
the  colabore  of  such  learned  scholars  as  Drs.  G.  E.  de  Scbweinitz, 
Edward  Martin  and  Barton  C.  Hirst  has  enhanced  the  value  of 
tbe  book.  q.  o.  b. 


A  Manual  of  Otology.  By  Gorbam  Bacon,  A.M.,  M.D.,  Pro- 
fessor of  Otology  in  Cornell  University  Medical  College,  New 
York.  With  an  Introductory  Chapter  by  Clarence  J.  Blake^ 
M.D.,  Professor  of  Otology  in  the  Harvard  Medical  School, 
Boston.  In  one  handsome  12mo  volume  of  400  pages,  with 
109  engravings  and  1  colored  plate.  Cloth,  $2.00,  net.  Lea 
Brothers  &  Co.,  Publishers,  Philadelphia  and  New  York. 

This  Manual  of  Otology  is  before  us.  Asa  manual  it  will  no- 
doubt  meet  tbe  wants  of  a  great  many  students,  and  then  again,, 
what  is  a  great  desideratum  to  many  of  this  class,  it  is  not  an  ex- 
pensive book.  The  great  &ult  to  us,  however,  is  the  fact  that  it 
is  even  too  compact  for  a  manual.  Such  illustrations  as  are  given,. 
it  is  true,  are  most  excellent,  but  they  have  all  been  taken  from 
works  of  a  more  extensive  character,  and  even  most  of  these  repre- 
sent the  various  instruments  which  are  used  and  are  good  adver- 
tisements for  the  instrument- makers.  The  work  has  an  introduc- 
tion by  Dr.  Clarence  J.  Blake,  of  Boston,  Mass.,  one  of  the  foremost 
Otologists  in  this  country,  but  just  what  Dr.  Bacon  expected  to 
gain  for  his  work  by  this  three  and  a  quarter  page  introduction,  we 
fail  to  see.  We  hold  that  there  are  too  many  text-books  and 
manuals  published  -these  days,  and  in  many  cases  the  only  reason 
for  such  is  because  its  author  wishes  to  see  his  name  thus  associated 
in  print.  This  manual  is  an  excellent  compilation  of  tbe  present 
views  as  held  by  the  best  workers  in  Otology,  and  occasionally  the 
author  has  given  some  of  his  own  cliuical  experience.  Dr.  Bacon 
stands  high  ae  an  Otologist,  and  no  one  has  done  better  work  than 
he  has  at  the  New  York  Eye  and  Ear  Infirmary,  but  we  do  not 
think  that  be  has  added  much  to  his  &me  by  the  publication  of  bis- 
little  book.  It  is  a  safe  guide,  and  for  this  reason  can  he  recom- 
mended.    The  teachings  are  exceedingly  practical. 


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■  *34       The  Atlanta  Medical  and  Surgical  Journal. 

Practical  Diagnosis.  The  Use  of  Symptoms  in  the  Diagnosis 
of  Disease.  By  Hobart  Amory  Hare,  M.D.,  Professor  of  Thera- 
peutics and  Materia  Medica  in  the  Jefferson  Medical  College  of 
Philadelphia.  Third  edition,  enlarged  and  thoroughly  revised. 
Id  one  octavo  volume  of  615  pages,  with  204  engravings  and  13 
full-page  colored  plat«8.  Cloth,  $4.75,  net.  Lea  Brothers  &  Co., 
Publishers,  Philadelphia  and  New  York, 

Very  little  more  can  be  said  for  this  work  than  the  &ct  that  this 
is  its  third  edition  issued  in  the  space  of  two  years.  This  speaks 
for  itself,  and  shows  iu  what  value  it  is  held  by  the  medical  pro- 
fession. Dr.  Hare  is  an  exceedingly  practical  man,  besides  un- 
deratfinding  the  subject  thoroughly  from  a  scientific  standpoint,  and 
with  these  two  qualities  combiued,  he  has  produced  a  work  on 
diagnosis  which  is  unusually  attractive  and  instructive  in  character. 
It  is  a  companion  piece  to  his  work  on  "  Practical  Therapeutics," 
which  is  also  reviewed  in  this  issue,  and  with  these  two  books  in  his 
library,  a  physician  possesses  a  condensed  encyclopedia  of  all  those 
points  which  will  be  of  most  use  to  him  in  the  practice  of  medi- 
cine. This  work  has  been  received  with  great  &vor  in  Great 
Britain,  and  it  must  be  moat  gratifying  to  its  author  to  know  that 
his  English  cousins  appreciate  its  value.  In  the  tost  edition  a 
goodly  number  of  photographic  plates  have  been  added,  showing 
some  of  the  clinical  cases  in  Jefferson  College  Hospital  under  the 
author's  care,  and  this  bas  made  a  new  and  attractive  feature.  But 
above  all.  Dr.  Hare's  language  is  so  clear  and  put  with  such  striking 
force,  that  one  who  reads  must  understand  the  subject. 


A  Text-Book  op  Materia  Medica,  Therapeutics  and  Phar- 
macology. By  Geoi^e  Frank  Butler,  Ph.G.,  M.D.,  Professor 
of  Materia  Medica  and  Clinical  Medicine  in  the  College  of 
Physicians  and  Surgeons,  Chicago.  Published  by  W.  B.  Saunders, 
Philadelphia.     Price,  Cloth,  $4.00;  sheep,  $5.00. 

When  we  consider  the  fact  that  there  are  a  large  number  of  ex- 
cellent Text-Books  on  Materia  Medica,  written  by  men  who  are 
eminently  qualified,  and  the  fact  that  the  author  was  compelled  to 
issue  this  the  second  edition  of  his  work  within  two  years  after  its 
first  publication,  then  we  are  compelled  to  recognize  the  fact  thtt 


^dbyGoOgle 


Book  Reviews.  685 

Dr.  Butler  baa  f^iveo  to  the  profession  a  work  wbich  hae  been  duly 
appreciated.  Tbere  are,  of  course,  works  which  am  more  ex- 
haustive, but  for  the  student  we  must  commend  this  work  for  its 
oonctsenesB,  practicality  and  for  the  thorough  up-to-date  manner 
in  which  the  subjects  are  treated.  The  arrangement  of  the  book  is 
«mioeutly  practical. 

The  author  treats  first  of  Pharmacology  and  General  Therapeutics, 
followed  by  PhaTtnaceutioal  Preparations,  which  are  taken  up  in 
detail. 

Then  comes  Class  I. — Disease  Medicines. 

Class  II. — Symptom  Medicines,  and  finally  Topical  Remedies,  fol- 
lowed with  a  very  practical  discourse  upon  Prescriptions,  a  subject 
too  often  neglected  by  most  works  on  Materia  Medica. 


R.  L.  Polk  &  Co.'s  Medical  and  Surgical  Register  of  the 
United  States  akd  Canada.  Fifth  Revised  Edition.  R.  L. 
Polk  &  Co.     Detroit  &  Chicago. 

This  e<lition  of  a  well-known  work  is  now  oat,  and  is  extended 
in  its  scope  to  include  a  registry  of  the  physicians  of  the  Domin- 
ion of  Canada.  Everything  pertaining  to  location,  school  and 
graduation  of  all  kinds  of  doctors  appears  in  its  pages.  All  State 
medical  laws,  all  societies,  army  and  navy  medical  men,  in  fact 
almost  everything  suitable  for  a  directory  of  and  for  physicians  is  to 
be  found  in  this  book.  Errors,  such  as  refers  to  a  dead  medical 
journal  here,  are  to  be  found.  Where  the  pubishers  have  been 
notified  of  error  about  a  doctor  they  have  sent  out  correction  slips 
to  be  pasted  over  the  original.  We  consider  the  book  indispens- 
able. 


REPRINTS  RECEIVED. 


Endemic  Leprosy  in  Louisiana.  By  Isadore  Dyer,  Ph,B.  (Yale), 
M.D.,  New  Orleans. 

A  Rare  Form  of  Bone  Atrophy  following  an  Ununited  Frac- 
ture as  seen  by  the  X-ray.  By  Eugene  R  Corson,  M.D., 
Savannah,  Ga. 


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636       The  Atlanta  Medical  and  Suroical  Journal. 

The  Adirondacks  in  Winter  for  Tubercular  Patients.  By  Sar- 
gent F.  Snow,  M.D,,  Buffiilo,  N.  Y. 

Acute  Chloral  Demeatia  Simulatiug  Paretic  Dementia.  By 
Henry  W.  Coe,  M.D.,  Portland,  Oregon. 

A  Contribution  to  the  Surgery  of  Gastroptosie  and  Enteroptosis : 
Preparation  of  the  Patient  for  Operation.  By  Byron  B.  Davis, 
M.D.,  Omaha,  Neb. 

The  Advautages  of  Physical  Education  as  a  Prevention  of 
Disease.     By  Charles  Denison,  M.D.,  Denver,  Col. 

A  Clinical  Record  of  Two  Cases  of  Meniere's  Disease,  with 
Remarks  Thereon ;  Eighteen  Years  of  Personal  Observation  of 
Tuberculosis  in  Asheville,  N.  C.  By  John  Hey  Williams,  A.&I., 
M.D.,  Asheville,  N.  C. 

The  Aseptic  Animal  Suture;  Its  Place  in  Sui^ry.  By  Henry 
O.  Marcy,  M.D.,  A.M.,  LL.D.,  Boston. 


MAOAZINES  AND  EXCHANQES. 


The  Texas  Clinic  is  a  new  publication  from  the  ranks  of  the 
medical  profession  in  the  Lone  Star  State.  Its  first  issue  is  excel- 
lent, and  we  welcome  it  among  our  exchanges.  It  is  published  in 
Dallas,  Texas,  and  Dr.  J.  B.  Shelmire  is  its  editor. 


LangadaU  Lancet,  published  in  Kansas  City,  Mo.,  so  favorably 
known  for  the  last  few  years  among  our  exchanges,  announces  in 
its  September  issue  that  beginning  with  the  October  number  the 
name  of  the  Lancet  will  be  changed  to  The  Kansas  City  Lanad, 
and  will  be  edited  by  Dr.  Jno.  Puuton,  the  former  editor.  Dr. 
Langsdale,  retiring.  The  LangadaU  Lancet  has  always  been  wel- 
comed among  our  exchanges  as  a  most  excellent  medical  journal, 
and  ID  the  new  change  which  it  makes  we  wish  it  every  success. 


TTie  Ladies'  Hom&  Journal  for  October  is  replete  with  good 
things.  Among  its  contents  there  are  "Twenty  Bright  Stories 
about  Mark   Twain,"   "'Royal   Letters'  from  Napoleon,   Queen 

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Book  Keviewb.  687 

Victoria,  Napoleon  III.,  and  Emperior  William  I."  Besides 
these  the  practical  tbiDgs  diacuseed  for  the  benefit  of  borne  life  is 
well  worth  the  price  of  the  Journal.  It  is  certainly  the  publica- 
tion for  the  "  home  fireside." 

Our  Dumb  Animals  is  still  welcomed  among  our  exchanges  and 
brings  bright  home  fireside  obit>chat. 


We  are  in  receipt  of  the  New  York  Sunday  Times,  with  a  beau- 
tifully illustrated  supplement.  This  is  a  new  feature  of  this  -wide- 
awake paper  and  will  no  doubt  add  to  its  popularity. 


MAOAZlSB  NOTES. 


The  Living  Age,  in  its  issue  for  Octobar  1st,  is  to  begin  a  new 
serial  story,  translated  for  its  pages  from  the  French  of  Th.  Benl- 
zon  (Mme.  Blanc).  The  story  is  entitled  "  Constance "  and  it  is 
the  story  of  the  life  of  a  young  girl.  Important  ethical  questions, 
«specially  that  of  divorce,  are  touched  upon,  and  the  story  has  a 
high  moral  purpose.  The  translation  is  made  by  Mrs.  E.  W. 
Latimer,  and  is  authorized  by  Mme.  Blanc. 

With  the  first  number  for  October,  The  lAving  Age,  the  weekly 
eclectic  magazine,  which  for  more  than  fifty  years  has  been  a  favorite 
with  American  readers,  begins  a  new  series  and  appears  in  a  new 
and  attractive  dress,  suggesting  The  Atlantic  Monthly  in  the  clear 
legibility  of  its  page.  The  ^miliar  cover  is  to  be  retained,  but  it 
has  been  newly  engraved  and  otherwise  modernized. 

The  Living  Age,  being  a  weekly  magazine,  sufifers  somewhat  by 
-comparison  with  the  monthly  magazines  of  the  first  class,  if  the 
comparison  is  made  of  single  numbers.  But  The  Living  Age  actu- 
ally gives  a  larger  amount  of  matter  each  month  than  any  of  the 
monthlies.  Thus  Harper's  Magazine  contains  172  pages  each 
month;  The  Century,  160  pages;  Server's  Magazine,  128  pages; 
and  TTie  AKanlic  Monthly,  144  pages ;  while  The  lAving  Age  gives 
each  month  from  289  to  344  pages,  according  as  there  were  four 
or  five  issues. 

Florence  Bell's  "  Plea  for  the  Better  Teaching  of  Manners,"  in 
The  Living  Age  for  October  1st;  will  be  profitable  to  all  who,  as 
teachers  or  parents,  have  anything  to  do  with  the  training  of 
young  people. 


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SELECTIONS  AND  ABSTRACTS. 


SnonLD  We  Drink  at  Our  Meaub? 
'  la  ED  ioterestiug  and  somewhat  historical  article,  Dr.  C.  A. 
Ewald,  of  Berlin  {ZeiUehrifi  far  Kranhenpflege,  Medical  JJecord), 
discuEsee  thia  mooted  question  at  some  length.  He  considers  soup, 
because  of  its  small  percentage  of  nourishiug  material,  merely  as 
fluid;  he  states  that,  aside  from  what  is  directly  taken  as  drink, 
much  fluid  reaches  the  stomach  during  a  meal,  through  the  sauces 
and  from  the  water  percentage  (both  natural  and  by  cooking)  of 
the  meats,  vegetables,  etc.  Most  persons  feel  the  necessity  of  add- 
ing more  fluid  lo  the  megl  by  drinking  either  ordinary  water,  car- 
bonated waters,  or  alcoholic  beverages.  The  more  one  eat«,  gen- 
erally the  more  one  drinks,  and  the  greatest  eaters  are  the  greatest 
drinkers.  If  drink  be  prohibited,  the  amount  eaten  is  less;  indeed, 
on  the  above  very  greatly  depends  the  secret  of  the  "Schweinger 
cure"  for  obesity.  It  is  a  well-known  fact  that  if  the  appetite  is 
weak  and  the  mind  and  nerves  are  somewhat  relaxed,  a  drink  of 
water  will  excite  the  appetite  and  stimulate  both  brain  and  nerves; 
and  this  is  due  directly  to  the  fluid  and  not  to  the  alcohol  con- 
tained, for  we  And  these  facts  the  same  in  abstainers.  The  more 
fluid  in  the  way  of  drink  is  added  to  the  gastric  juice,  the  greater 
is  the  quantity  secreted,  heuce  the  greater  the  tax  upon  the  gastric 
glands.  Under  normal  circumstances,  however,  the  stomach  with- 
out detriment  accommodates  itself  to  a  range  of  large  quantities  of 
fluid.  Ewald  says  that  much  of  the  fluid  passes  into  the  intestine?, 
another  portion  is  absorbed;  hence  there  never  is  in  the  normal 
stomach  a  stagnation  of  large  quantities  of  liquid.  The  widfly 
accepted  belief  that  alcoholic  fluids  (not  taken  to  the  point  of  toi- 
ioity)  retard  digestiou  does  not  seem  to  be  borne  out  by  the  recent 
experiments  of  Chittenden.  Not  even  whisky  and  brandy  seem  to 
retard  digestion.  The  proteolytic  power  of  the  pancreatic  juice  is 
uninfluenced  by  small  quantities  of  alcohol>oontainiug  fluids.  The 
extraction  of  body-warmth  through  cold  drinks  the  writer  cooad- 


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Selections  and  Abstracts.  63* 

ers  as  very  much  overrated.  He  attributes  the  bad  eSecIs  of  such 
drinks  to  irritation  of  the  stomach  mucosa,  which  becomes,  there- 
fore, a  possible  starting-point  for  acute  or  chronic  iuflammatory 
conditions.  In  the  normal  stomach,  the  author  concludes,  not 
only  drinking  at  meals,  within  certain  limita,  does  not  interfere 
with  digestion,  it  e%'en  aids  this  process.  With  patients  suffering 
from  stomacb  or  other  diseases,  however,  the  case  is  diSereat. 
Drinking  ad  lUntuvi  cannot  be  allowed.  To  the  question,  Shalt 
patients  drink  nothing  with  their  meals?  Dr.  Ewald  answers  that 
he  sees  no  reason  why  small  amounts  of  fluid  should  not  be  al- 
lowed, excepting  to  patients  suffering  from  dilation  of  the  stomach. 
As  above  shown,  fluids,  and  particularly  alcoholic  and  carbonated 
fluids,  will,  eveu  in  limited  amounts,  aid  digestion  and  increase 
appetite,  and  will  more  than  counterbalance  the  so-called  effects  of 
drinking  at  meals,  viz.,  the  possible  slowing  of  digestion,  the  dilu- 
tion of  the  solid  constituents  of  the  meal,  the  overburdening  of  the 
stomach,  a  very  improbable  lowering  of  the  body  temperature, 
etc.  Even  admitting  that  such  effects  occur,  the  question  of  drink- 
ing before,  during  or  alter  meals  Dr.  Ewiog  considers  as  belonging 
to  the  hocus-poous  of  suggestion  therapy;  the  physiological  act  is- 
not  influenced  if  fluid  is  taken  one-half  hour  soouer  or  later.  The 
fluid  should  not  be  very  cold;  further,  we  must  follow  the  indica- 
tions of  the  disease  and  as  far  as  possible  the  wish  of  the  patient. 
^Naturally,  alcoholic  fluids  that  have  a  direct  local  irritating  effect 
will  be  withheld — e.  g.,  in  ulcer  of  the  stomach,  new  inflammatory 
processes,  necrosing  neoplasms.  Another  question  Is,  how  &r  sball 
we  allow  abnormally  increased  thirst  to  be  quenched,  as  in  dia- 
betes, fever,  and  some  chronic  diseases  ?  The  writer  answers  that 
the  thirst  should  be  quenched  with  as  little  liquid  as  possible.  This 
is  particularly  true  in  case  of  stomach  dilation,  when  the  patients 
have  the  tendency  to  drink  large  quantities,  partly  because  stomach 
absorption  is  very  slow  and  imperfect.  Moreo%'er,  though  this 
seems  paradoxical,  thirst  may  be  lessened  by  forbidding  water  as  a 
drink.  Then,  too,  thirst  very  often  depends  upon  dryness  of  the 
mouth  and  pharynx;  hence,  frequent  moistening  of  the  mouth 
and  gargling  will  often  lessen  thirst. — Dietetic  and  Hygienic  Gcaette, 


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€40        The  Atlanta  Medical  and  Surgical  Jodbnal. 

The  Steknomastoid  Tumors  of  Children. 

The  causatioD  of  these  little  tumors  has  been  the  subject  of  con- 
siderable discussion.  Id  these  discussions  the  peculiar  teudeocy  of 
the  human  mind  to  seek  an  explanation  for  any  phenomenon  in 
"the  soft  atmosphere  of  mystery"  has  been  clearly  apparent.  In- 
atead  of  seeking  an  explanation  based  upon  mechanical  laws  and 
obvious  facts,  some  minds  are  prooe  to  grope  after  the  strange  imd 
mysterious.  In  the  case  of  these  tumors,  an  explanation  based 
upon  mechanics  is  the  only  rational  one. 

They  are  discovered  usually  in  the  second  or  third  week  after 
birth,  and  as  smooth,  rounded,  bard  swellings  within  the  body  of 
the  sternomastoid  muscle.  They  can  be  moved  with  the  muscle 
from  side  to  side  only.  They  seem  rarely  to  be  painful,  but  when 
first  discovered  are  in  some  cases  sensitive  to  touch.  The  over- 
lying shin  is  neither  adherent  nor  discolored.  There  is  usually  a 
certain  amount  of  torticollis,  the  fece  being  turned  away  from  the 
tumor. 

The  causation  is  shown  in  part  by  the  frequency  with  which  they 
occur  after  difficult  or  instrumental  labor — in  other  words,  labor 
which  puts  a  particular  strain  upon  these  muscles.  Theyare  espe- 
cially common  after  breech  presentations,  two-thirds  of  the  cases 
being  associated  with  that  condition.  The  tumor  is  then  upon  the 
right  side.  When  following  bead  presentations  it  is  commonly 
found  on  the  left  side.  These  facts  are  clearly  explained  by  the 
common  mechanism  of  labor. 

In  a  highly  interesting  paper  on  wryneck  and  sternomastoid 
tumors  in  children,  in  a  recent  number  of  the  Birmingham  Medi- 
ccU  Review,  Dr.  Jordan  Lloyd  reports  twenty-six  cases;  of  these 
patients  fifteen  were  boys,  eleveu  were  girls.  In  the  case  of  six- 
teen the  right  side  was  involved,  in  ten  the  left  side.  The  author 
lays  special  stress  upon  the  importance  of  these  tumors  in  causing 
the  persistent  painless  form  of  wryneck  seen  in  children. 

Autopsies  upon  this  condition  have  not  been  large  in  number, 
but  have  been  sufficient  to  establish  quite  positively  the  histologi- 
cal condition.  Spencer  found  that  microscopical  sections  show 
clearly  that  there  was  rupture  of  the  muscular  fibers,  with  effusion 
of  blood.     Witzel  has  shown  that  subsequent  deformity  is  caused 


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Selections  and  Abstracts.  64l 

by  the  formation  of  contracting  fibrous  bands.  Delafield  and 
Prudden  say  that  when  muscle-fiber  is  ruptured  repair  usually 
takes  place  by  the  production  of  granulation  tissue,  wbich  gradu- 
ally becomes  converted  into  cicatricial  tissue,  thus  binding  the 
parts  together,  Lloyd  describes  the  swelling  in  the  later  stages  as 
consisting  of  bundles  of  white  fibrous  tissue,  blending  gradually 
with  normal  adjacent  muscle  fibers.  It  consists,  in  fact,  of  repara- 
tive material  in  the  course  of  organization,  and  is  thrown  out  in 
excess,  as  is  seen  in  other  parts  where  injured  muscles,  tendons  or 
bones  are  not  kept  at  rest  during  their  process  of  repair.  Holt 
describes  the  tumors  as  due  partly  to  blood  extravasation  and 
partly  to  infiammatory  products.  Like  Rotcb,  Jacobi  and  Davis, 
he  classifies  them  under  the  head  of  hematoma. 

These  little  tumors  disappear  spontaneously,  being  rarely  seen 
after  the  third  month.  They  require  no  treatment ;  surgical  inter- 
ference should,  above  all,  be  avoided.  They  are  of  no  serious  im- 
port, except  in  the  small  number  of  cases  in  which  they  are  fol- 
lowed by  torticollis,  due  to  contraction  of  the  muscle.  That  con- 
dition requires  appropriate  orthopedic  managemeut.— Arc^toes  of 
Pediatries, 


The  Tongue  as  a  Clinical  Guide  in  Disbabe. 

A  recent  number  of  the  Indian  Medical  Mecorder  gives  the  fol- 
lowing in  regard  to  the  tongue  : 

A  broad,  pallid  tongue,  with  a  loaded  base,  says  atony,  and 
refers  you  to  a  want  of  action  of  the  entire  viscera  below. 

The  remedial  agents  would  be  cathartics  and  tonics,  especially 
those  mild  but  effectual  in  character. 

A  shrunken  tongue,  pinched  in  expression,  indicates  functional 
inactivity  of  digestion,  and  requires  great  care  in  choice  of  food  as 
well  as  quantity.     In  this  condition  of  tongue  we  have  atony  also. 

It  is  the  tongue  of  advanced  fevers,  inflammations  of  the 
mucous  membranes,  and  want  of  assimilation,  hence  great  caution 
both  of  remedies  and  food.  Here  we  must  not  use  cathartics. 
Mild  aperients  may  be  carefully  used. 

A  contracted,  pointed  tongue,  with  dryness  and  dark  fur,  is  the 


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642       The  Atlanta  Medical  and  Surgical  JonnHAt. 

usual  tongue  of  typhoid  fever  and  other  low  grades  of  fever,  when 
all  thinking  minds  would  use  great  care  iu  the  treatment  and  food. 

The  dryness  or  moisture  of  the  tongue  denotes  the  extent  of  the 
disease  of  the  intestines,  and  will  point  us  iu  that  direction. 

A  fissured  tongue  points  to  the  kidaeys,  either  an  inflammation 
or  something  wrong  with  secretion. 

Yellow  coatings  are  usually  associated  with  morbid  liver  and 
want  of  biliary  secretions,  and  would  indicate  mild  hepatics  and 
tonics. 

Raised  papillse,  bright  red,  denote  irritation  of  ganglionic 
nerves  and  irritation  of  stomach,  especially  the  mucous  coating. 
Shows  exhaustion;  no  digestion,  and  needs  rest;  nux  vomica 
twenty  dro)>s,  and  the  food  to  be  warm  and  taken  in  small  quan- 
tities.    Bismuth  and  pepsin  aller  food. 

Broad,  thick  tongue,  papillse  not  visible,  but  looking  raw, 
denotes  a  septic  condition  of  blood,  and  favors  typhoid  fever. 
Indicates,  if  deep  red,  sulphuric  acid;  if  pale,  sulphite  of  soda. 
Liquid  food,  sipped  warm,  in  small  quantities. 

Deep,  dark  red  tongue  and  dark  coating  indicate  septic  condi- 
tion of  blood. 

Shades  of  dark  brown  and  black  denote  typhoid  condition  or 
septic  conditions. 

Pale,  dirty  fur  on  tongue  denotes  acidity,  and  a  septic  condition 
of  system;  indicates  sulphite  of  soda;  but  if  membranes  are  deep 
red,  sulphuric  acid  will  be  admissible,  because  it  would  show  an 
alkaline  condition  of  blood. 

Contracted,  pointed,  inability  to  hold  still,  and  drawn  to  one 
side  of  mouth,  denotes  trouble  with  the  nerves,  and  perhaps  the 
brain.     Requires  great  care  and  study  of  condition. 

Dry  tongue  always  demites  feverishness  or  inflammatory  condi- 
tion, affection  of  the  uerve-cent«rs  of  ganglia. 

Thick  tongue,  and  curved  edges  upward,  denotes  atony  of  the 
nerve-centers  of  ganglia,  reqiiiring  stimulants,  nus  vomica  or 
strychnine  and  quiniue. 

Pointed,  narrow  tongue  is  the  tongue  of  sluggish  condition  of 
digestion  and  assimilation  and  congestion,  especially  of  the  base 


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Selections  and  Abstracts.  64S 

of  brain.     RestlesBness  and  coDstant  change  of  positioa  are  usually 
prraent. — Medical  Age. 


The  Foramen  of  Winslow. 
Desirous  of  aidiog  as  far  as  possible  all  medical  students  who 
are  now  about  undergoing  the  severe  trials  of  memory  known  as 
first-  and  second-year  exanainations  in  anatomy,  we  publish  the 
following  poetic  and  at  the  same  time  accurate  description  of  aa 
iraportaat  and  diffioult  anatomical  region — one,  in  fact,  which  may 
be  described  as  the  central  point  about  which  abdominal  anatomy 
is  grouped,  or  as  the  key  to  the  situation.  With  regard  to  this 
feet  the  following  dictum  has  been  attributed  to  Hippocrates:  "The 
way  to  learn  anatomy  is  to  begin  at  the  foramen  of  WidsIow 
and  work  outward." 

Combining,  as  they  do,  accurate  anatomical  description  with  the 
true  lyric  touch,  these  verses,  which  have  lately  been  discovered 
unsigned  among  some  old  papers,  have  by  some  been  attributed  to 
our  own  poet  and  anatomist,  Oliver  Wendell  Holmes,  although 
this  theory  of  their  authorship  has  not  been  fully  confirmed. 
rut  forambh's  laukht. 
I'm  ft  poor  abused  roramen, 

After  Winstow  I  am  aarned, 
As  a  sticker  and  a  poier 

I  am  moet  unjually  famed. 
For  the  Btudents,  all  neglecting, 
Often  fail  in  their  delecting, 
Wbile  m;  owner  they're  diEsecting, 
Then  moit  raundly  am  I  blamed. 
I'm  apoor  abused  foramen, 

And  in  front  ol  me  is  tuclied 
Tbe  commiinig  cboledochu«,  whicb 

It  nothing  but  a  duct. 
Farther  fr-  nt  tbe  duodenum — 
Hepatic  arterj  between  'em — 
And  tbe  portal  vein,  you've  aeen  'em — 

But  if  not  you're  surely  plucked. 
I'm  a  poor  abused  foramen, 

And  I'm  bounded  on  the  back 
By  tbe  lower  vena  cava. 
For  I'm  just  before  its  track. 


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644       The  Atlanta  Medical  and  Surgical  Journal. 

Ths  right  ctub  of  the  diaphragm 
Then  helps  show  jrou  where  I  un, 
Am  I  guide  you  from  the  greater 

Over  to  the  leNeT  tac 
I'm  but  a  poor  foramen. 

And  the  lobe  Spigelii 
Is  kind  enough  to  localo  so'a 

To  form  the  top  of  me; 
The  veuel  that  I've  named  befora 
la  kind  enough  to  form  the  floor, 
JuBt  he  alone  and  nothing  more, 

Hepatic  artery  ie  he. 
How,  gentle  reader,  listen. 

Have  I  not  good  cause  for  sadness  ? 
Hf  descriptions  never  tally,  and 

They  drive  me  most  to  madness 
As  I  read  the  verbal  photographs 

That  pass  from  book  to  book, 
And  make  me  out  the  darndest  thing 

That  ever  looked  a  look. 
I  know  I  don't  deserve  it, 

I'm  A  simple  little  bole, 
And  the  thought  of  these  desoriptlons 

Harrows  up  my  very  soul. 

— Boston  MedixxU  and  Surgical  Journal 


Removal  of  Entibe  Stomach. 
In  the  Boston  Mtdical  and  Surgical  Journal,  May  5,  Brigham,  of 
San  Francieco,  reports  in  detail  a  "Case  of  Removal  of  the  Entire 
Stomach  for  Carcinoma;  Successful  Esaphago-duodeaostomy ;  Re- 
covery." The  operation  was  performed  on  a  woman,  aged  sixty- 
six  years,  who  had  complained  for  the  past  year.  She  bad,  how- 
ever, lieen  able  to  digest  her  food  until  Christmas  time,  when  she 
vomited  any  solid  food  taken.  The  operation  was  done  February 
28,  lasted  two  hours  and  a  quarter,  and  with  a  loss  of  blood  of  bat 
two  ounces.  He  saye:  "In  the  treatment  of  tbe  case  no  attempt 
had  been  made  to  predigest  tbe  nourishment  which  was  given  to 
the  patient.  The  precaution  was  taken,  however,  to  supply  ea^ly 
digested  food,  and  when  meat  was  allowed  it  was  cut  in  very  small 
pieces.  The  food  was  taken  slowly,  whether  liquid  or  solid.  It  is 
DO  hardship  for  the  patient  to  live  on  simple  food,  for  she  has  done 


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Selections  and  Abstbaots.  645 

so  all  her  life;  and  especially,  as  age  has  advaoced,  she  has  been 
obliged  to  eat  food  that  required  the  least  chewing.  The  food  was 
given  of  medium  temperature;  water  was  taken  as  it  came  from 
the  pipe,  and  wine  as  it  stood  in  the  room;  iced  cream,  of  which 
the  patient  was  particularly  fond,  was  taken  slowly  so  that  it  dis- 
solved in  the  mouth  before  it  was  swallowed.  A.t  first  everything 
was  too  salt;  as  the  patient  got  well  she  wished  salt  on  both  eggs 
and  oysters.  The  amount  of  flatus  in  the  bowels  was  enough  to 
cause  pain  only  a  few  times  in  the  early  part  of  her  illness.  The 
urine  has  been  normal  throughout.  Never  since  the  operation  has 
any  undigested  food  been  seen  in  the  movements  from  the  bowels, 
and  for  the  most  part  these  have  been  wholly  or  partly  formed. 
The  patient  has  vomited  but  a  few  times  since  the  operation — twice 
after  etherizations,  twice  after  some  lasative  had  been  given,  once 
after  the  button  left  its  place,  and  twice  after  coughing;  not  more 
than  six  ounces  at  any  one  time,  generally  much  leas.  On  three  or 
four  occasions  a  mouthful  of  food  would  be  regurgitated — an  oys- 
ter, some  shreds  of  meat,  or  a  few  teaspoonfuls  of  coffee.  As  a  , 
usual  thing  the  food  was  well  retained  and  well  digested.  Milk, 
which  would  sustain  most  patients  under  such  circumstances,  was 
not  liked,  and  an  important  food  was  thus  unavailable.  The  pa-  - 
tient's  skin  is  in  a  natural  condition,  without  any  dryness;  this 
may  be  due  to  the  thorough  washing  which  the  entire  body  has  had 
daily  since  the  operation.  The  symptom  which  gave  the  most 
anxiety  after  the  operation  was  the  restlessness,  which  was  unusu- 
ally marked.  This  was  without  doubt  the  result  of  the  surgical 
shock  which  was  caused  by  the  removal  of  so  important  an  organ 
as  the  stomach,  and  the  interfering  with  its  vessels  and  nerves.  The 
season  of  the  year  in  Califomia,  with  mild,  sunny  days,  and  the 
careful  and  constant  nursing,  are  among  the  factors  which  made 
the  operation  a  success.  The  age  of  the  patient  counted  for  some- 
thing also ;  the  effects  of  the  change  of  life  had  long  passed  by, 
and  there  had  been  for  many  years  an  even  condition  of  good 
health.  .  .  She  has  a  fine  color;  complains  of  nothing  so  far 
as  the  functions  of  her  body  go ;  eats  whatever  she  wishes ;  has  no 
pain  whatever;  is  of  a  very  cheerful  disposition.  She  is  out  of 
doors  most  of  the  day  from    10  till  5  o'clock,  taking  occasional 


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646       The  Atlanta  Medical  and  Surgical  Journal. 

walks  around  the  hospital  grouods ;  her  (emperature  and  pulse  are 
Dormal ;  she  sleeps  without  an  opiate.  Although  she  has  food 
every  three  hours  she  feels  hungry  at  times,  and  feels  that  she  could 
eat  twice  as  much  as  is  given  to  her.  She  is  gaining  in  weight, 
and  her  general  condition  at  the  present  time,  April  14,  seven 
weeks  after  the  operation,  is  satisfactory  in  every  respect." — /our. 
Am.  Med.  Asso. 


PRESCRIPTIONS. 
Vomiting  of  Pbeonancy. 

a     Ingluvin  „ gr.  x\. 

Ceroi gr.  i. 

Fulverls  ipeeBcusnhiB, gr.  v. 

Creosoti m.  y. 

H.  et  div.  in  chart.     No.  10. 

8ig.     One  powder  Uken  svery  bour  until  nausea  U  controlled. 

Catarrhal  Jausdice. 

K    Ammotiii  iodidi 3  i. 

Liq.  potassii  araeoitia g  es. 

Tincturio  oalumbai  , 3  W. 

AqutD  destil glsi. 

M.    Sig.    Teaspuonful  before  meaU. — Bartkolovi, 

Menorrhagia. 

B     Acidi  gallici gr.  it, 

Acidi  sulphurici  aromat m.  it, 

TinctuiiB  cinamomi g  ii, 

AqiimdObtil _3  "■ 

M.    Sig.     Onedoie;  take  every  four  liouri  until  bleeding  ceuts.   (Id  pro- 
fuse bleeding.) — Hazard.  • 

Amenorrhea. 

B     Tincturn  Terri  cbloridi 3  iii. 

Tinctiirie  cantharidia si. 

Tincturm  zuaiaci  ammonialEe 3  iw. 

Tinctum  sloes g  iv. 

Syrupi  simplieis q.  a.  »d.     J  tL 

M.    Sig,    Tableapoonlul  three  Uiuei  KAyf.—Dewtea, 

B     Eitracti  aloes 3  i. 

Ferri  eulpbatisezsiccatl J  ti. 

Asaltetid* 3  iv 

M.  ft.  pil.  No.  100. 

Sig.    One  pill  three  times  ai^y.—OoddeU, 


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Sblbotions  and  Abstracts.  647 

Delirium  Tremens. 

R    Potanii  bromidi 3  i. 

Chlomli* „g  it. 

Tincturm  digital  IB ,S  i. 

Tinctures  Cftpsici   i  i. 

Tinctum  zingibnris .5 1. 

SpirituiammoQiu'  nrom«tici 1  i. 

Sjrupi  Burantii  corlici  „4  i- 

Aqum .,q.  B.  ad.    g  viii, 

H.     Sig.     DoM,  a  tablespoon  rul—fieJ^evue  HospUal. 

Alopecia. 

B    Extracli  pilocarpi  fluidi g  i, 

Tincturae  csnthaHdis 3 ''• 

LiniDienli  lapooia q.  i.  ad.    g  iv. 

H.    Sig.     Kub  into  the  ecalp  dtMy.--Bart/u>l<»B, 

Ihtebcostal  Neuralgia. 
R    Chloratis,     -) 

Catnphora?.  J-aa t  \. 

Menlhalis,   J 
H.    diR.     Witb  a  br II* h  spread  a  la^ver  of  thia  mixture  (wbich  is  liquid) 
over  the  painful  part*.     Konew  toe  application  when  the  pain  reuppeara. — Dr.  S. 
Solit- Cohen. 

Painle-ss  Blister. 

B     Mentholig .,.., gr.  ii, 

Chloralis gr.  xx. 

Olei  thaobroraaii* gr.  xxx. 

Spermaceti „5  i, 

U.     Uaks  into  a  paste. — La  MMeeine  Modernt. 

Local  Anesthetic. 

B    Montbolw 31. 

CblorofoTmi  3  x, 

jRtherig    3  iv, 

H.    Sig.     U*e  a»  a  ipniy  over  Beld  or  operation.     Anesthesia  laiti  from 
two  to  iii  minute*. — LouinilU  Medical  Monthly. 

Vulvitis. 

B     Liquorii  plumbi  lubacetatia 3  i. 

Tinciune  hjoscjami S  ii. 

Aqute  eamphorw q.  b.  ad.     5 'ill. 

M.  et.  ft.  lotto.    Sig.     Appl;  coottantl;,  tepid,   with  lalurated  clotb. — 

Rheumatism — Chronic. 

B     L'quarii  potasaii  areenitia 3  'i' 

Potaisii  iodidi 3  ii. 

Syrupi  gimplici« 5  iii. 

M.    Sig.   TeaBpoooful  three  times  aday  in  water,  between  meaTa. — DeCotta. 

(la  the  treatment  of  rheumatism,  whether  acute  or  chronic, 

vegetable  cbolagogues,  such  as  enoaymiD,  leptaodrin,  podophyllin, 

etc.,  should  be  daily  administered  along  with  other  anti-rheumatic 

remedies. — EMitor.) — Medical  Standard. 


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648       I^HB  Atlanta  Mbdioal  and  Surqical  tfouBitAt. 
Ptyalism. 

B     Potauii  chloratia gr,  xvi, 

TiDcturte  ferri  chlorid) 5  Hat. 

Gljcerini g  i. 

AquM q.  ■,  ad.   g  ii. 

M.    Sig.    Teaspuonlul  io  water  svery  two  faoura. 

Lumbago. 

&    PoUuii  iodidi  gw. 

TlnctuTEB  opii  d«od 3  ii. 

SpirituB  iBvandulas  comp 3  I. 

Spiritui  letherii  nilrosi _5  M. 

AqucB  denillatEe ..§  lii. 

U.    Sig.    Take  two  tableapoonfula  twice  dail;.— Sir  B.  BrodU. 

Gout. 

E     Tincturee  colchici  wminig m,  jv, 

MagDsaii  orbonalls ,..,_gr.  vi. 

HagDuii   Bulphatis *„.,Kr.  xii. 

Aqua  men tb IB  piperiiK_ q.  s.  ad.    g  i. 

Flat  bauBtu8. 
Sig.     Kepeat  according  to  circumstaDcei. —  Universily  ffotpiial. 

Abthma. 

B     PoUsaii  iodidi f. g  iii. 

Exlracli  belladoDnie  fluidl 3  i. 

Extracti  lobeliie  fluid! , _3  ii. 

Bitracti  grindeliie  fluidi 3  iv. 

Q1  jcerini,  I  -  . 

AqaiB  dsBtillatfe,  /  " 3""" 

H.    Sig.  Take  a  teaspoonful  ever;  two,  three  or  four  houn,  a*  neceuar;.— 
Bartholow. 


ANTI8EPTIC  Fluid  (Seiler'b). 


R    Thymol,     \ 

Eucaljptol  r 

Hen  tool 

Olei  gaultheri 
Sodil  benzoati, 


'<    ) 
Sodii  boratis,      f  aa... 

II.  j 


Sodii  salicjlatiBj 

Glycerini ^  i*- 

AleoholiB„ .Tgl. 

AqiUB q.  I.  ad.    3  viii. 

Antiseptic  Fluid  Comp.  (Seilbh's). 

Antiseptic  fluid 3  i. 

Sodii  bicarbonatii,  1  _  . 

Sodii  boratiB  /"■ 3 '■ 

OlycBrini 3  i- 

Aqua _ q.  B,  ad.    g  iv. 

.    Sig.    Add  to  one  quart  of  water  and  use  si  a  dirinfectaul  wMh.— &■ 


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ATLANTA 

Medical  and  Surgical  Journal. 


"Vol. 

XV. 

DECEMBER, 

1898 

No.  10. 

DCNBiR  EOY, 

A.B., 

B. 

M.D., 

M. 

B.  HUTCHINS,  M.D., 

BCSINIIS8   MANAQBR. 

ORIGINAL  COMMUNICATIONS. 


THE  POSSIBILITIES  OF  PERFECTION  IN  ASEPTIC 
SURGICAL  TECHNIQUE  * 

Br  E.  C.  DAVIS,  A.B.,  M.D., 
Lecturer  on  DiieaMi  of  Chlldroa,  Southero  Usdicat  College,  Atlanta. 

Id  appearing  before  this  Association  to  present  a  paper  upon 
such  a  subject  as  has  been  chosen  I  almost  feel  incliDed  to  iatro- 
<luce  it  vith  an  apology,  for  I  cannot  promise  anything  new,  and 
fear  the  substance  of  this  paper  may  seem  trite  and  commonplace 
to  many.  I  am  encouraged,  however,  in  ray  efTorts  by  the  knowl- 
edge that  while  it  may  prove  uointeresling  to  some,  to  others,  now 
familiar  with  the  contents,  it  may  be  a  review  of  the  details  in 
such  a  mauDer  as  to  at  least  interest  them,  I  will  also  meDtton 
that  many  oE  my  opportuoities  for  investigating  this  subject  have 
i>eeD  due  to  the  counsel  of  Dr.  J.  B.  S.  Holmes  and  the  advan- 

•BMd  br  Utl*  befoie  the  Georgia  Medical  AsMclatloa. 


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650       The  Atlanta.  Medical  and  Surgical  Journal. 

tages  accruing  from  assisting  him  in  liis  surgical  operations  at  bis- 
private  hospital  for  the  past  three  and  one  half  yeara. 

The  developmental  stages  through  which  aseptic  surgery  has- 
passed  are  extremely  iuterestiug,  but  would  consume  too  much  time 
to  enter  upon  their  consideration  extensively ;  it  would  not  be  out 
of  place,  however,  to  mention  that  John  Hunter,  when  he  called 
attention  to  the  differences  in  behavior  of  subcutaneous  injuries  and 
those  in  which  the  skin  was  broken,  was  verging  close  upon  the 
priuciples  which  control  the  great  field  of  operative  surgery  to-day  ; 
and  when  Malgaigne,  profiting  by  this  observation,  performed  hie 
operations  upon  the  tendons  aubcutaneously  without  having  sup- 
puration, more  thought  was  still  directed  to  this  subject.  It  re- 
mained, however,  for  Lister  to  put  into  practical  use  the  suggesliou» 
formulated  by  Pasteur  and  other  eminent  workers  in  fermentative 
cbaoges.  He,  however,  believed  infection  to  be  conveyed  largely- 
through  the  atmosphere,  and  to  prevent  this  kept  the  carbolic  spray 
in  active  use  during  operations.  His  ideas  were  at  first  greatly 
ridiculed  by  the  profession  at  lai^,  but  hie  results  proved  conclu- 
sively the  improvement  which  he  bad  made,  and  when  Robert  Koch 
demonstrated  the  raicro-orgauisms  producing  infection,  and  made 
cultures  of  them,  the  link  of  evidence  was  complete,  and  the 
attention  of  investigators  was  turned  to  other  media  of  conveying 
these  micro-organisms  than  the  air.  It  was  found  that  the  air 
contained  but  a  small  number  of  germs  compared  with  a  mass  of 
decomposing  matter,  and  a  drop  of  pus  was  found  fairly  teeroing^ 
with  them,  containing  in  fact  several  millions.  Again  many  of  the 
germs  found  in  the  air  were  innocuous,  while  those  transported  by 
contact  were  more  often  infections.  The  discussion  concerning 
the  cause  of  infection  is  but  an  interesting  incident  in  history,  as 
to-day  all  accept  the  bacterial  origin  of  infection,  although  some  of 
the  English  surgeons  were  loath  to  yield  to  this  belief,  preferring 
to  call  ibis  dirt  rather  than  bacteria.  When  it  was  found  that  con- 
tact was  the  most  frequent  source  of  infection,  and  that  carbolic 
acid  was  a  very  weak  destructive  agent  to  these  germs,  then  Kocb 
constructed  the  following,  showing  the  effect  of  different  chemical 
agents  upon  the  growth  of  micro-organisms : 


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Possibilities  of  Aseptic  Surgical  TBcemQUK. 


Bichloridoof  mercury 

3wlhwa«d]»- 
ctir  hindered 

nS-  '"'"'■ 
1:1,600,000 
1:    888,000 
1:    100.000 
1;      80,000 
1;      76,000 
1:        6,000 
I:        6,000 
1:       6.000 
1.       6,000 
1:        8.800 
I:        2,600 
1:       2.600  o 
1:        2.600  0 
1;        2/100 
I:        2,000 
1:        1,600 
1:        1,600 
1:        1,400 
1:        1,260 
1:        1,260 
1:          680 
1:           260 
1:          200 
1:           100 

Growth  WM 
1^800,000 

Tbymol  

Oil  ot  turpentine 



Oil  of  clove* 

1:     1,000 

Iodine  _ 

S.licylic  Mid 

Hjdrocblorie  «cid_ 

UtmphoT  



1:     1.600 

1:     1.700 

ver  1;     1.260 

Bo^iypfi 

BOMX 

ver  1:     1.000 

Bromine 

Chlorine 



Quinine 

Chlomte  of  potauiam 

1:        626 

Chloride  of  wdlum  

Within  recent  years  there  has  not  been  given  a  sufficient  amount 
of  attention  to  the  conditioa  of  the  patient  as  a  causative  factor  iu 
iofectioD.  But  there  are  no  sui^ons  doing  active  work  without 
observing  that  the  conditions  of  certain  patients  seem  to  conduce 
to  suppurative  changes,  while  others  resist  the  invasious  to  a  sur- 
prising degree.  This  is  especially  noticeable  in  some  of  the  dis- 
eased conditions,  viz.,  diabetes  and  such  diseased  conditions  as  lead 
to  a  marked  retrograde  metamorphosia  of  the  tissues.  The  pa- 
tient's surroundings  may  also  contribute  its  quota  to  infection,  but 
the  causes  which  are  the  most  operative,  and  the  ones  which  to-day 
stand  paramount,  are  the  conveyauce  of  infection  through  lack  of 
cleanliness  of  the  patient,  and  especially  that  portion  of  the  patient 
where  the  incinion  is  to  be  made  and  its  immediate  neighborhood; 
personal  cleanliness  of  the  surgeon  and  his  assistants;  clean  instru- 
ments and  dressing ;  and   more  especially  clean   hands.     From  a 


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652       The  Atlanta  Medical  and  Sdboical  Journal. 

theoretical  Btandpoiot  the  attainmeDt  of  these  esseDtiah  is  readily 
possible,  but  when  we  apply  them  practically  we  eocouDter  diffi- 
culties which  oGcasioDally  lead  to  breaks  in  our  asepsis  in  spite  of 
all  our  care  aod  atteDtlou.  To  avoid  infection  we  must  keep  clearly 
in  mind  the  conditions  necessary  for  its  production, that  we  may  a' 
least  be  enabled  to  withdraw  one  or  more  of  these  conditions  in 
handliog  wounds.  The  conditions  necessary  for  infection  are  that 
we  must  have :  1.  The  presence  of  the  micro-organisms  capable 
of  producing  infection  ;  2.  The  proper  pabulum  for  its  growth  and 
development;  3.  Suitable  temperature  for  its  growth  and  repro- 
duction ;  4,  A  certain  amount  of  moisture.  Based  upon  these  con- 
ditions are  all  the  rules  of  aseptic  and  antiseptic  surgery,  and  the 
possibilities  of  withdrawing  absolutely  the  first  and  usually  the 
second  conditions  are  the  essentials  in  the  attainment  of  perfection 
in  aseptic  surgical  technique.  The  means  of  accomplishing  these 
results  may,  under  certain  conditions,  be  extremely  simple,  while 
under  others  are  often  very  complex  and  difficult.  Simplicity  in 
technique  should  be  the  aim  of  all  surgeons,  but  at  the  same  time 
thoroughness  should  never  be  sacrificed  in  our  efforts  to  appear  in 
fa^or  of  too  great  simplicity.  To  get  rid  of  the  micro-organisms 
we  have  two  methods  of  sterilization,  viz.,  chemical  and  mecban- 
ical.  By  the  former  we  mean  the  destruction  of  the  micro-organ- 
isms by  chemical  agents,  including  the  various  antiseptics  which 
flood  the  market,  and  often  lure  us  into  a  false  confidence  which 
may  lead  to  very  anuoying  results.  It  is  extremely  difficult  to  find 
an  agent  with  sufficient  bactericidal  influence  which  will  not  de- 
stroy the  tissues  when  directly  applied,  or  should  it  not  directly 
destroy  the  tissues  it  may  seriously  impair  their  functions,  so  that 
the  invasion  of  the  micro-organisms  soon  finds  an  unresisting  field 
and  an  eiccellent  nidus  for  its  growth  and  propagation. 

It  would  consume  too  mnch  time  and  space  to  enumerate  the 
various  chemicals  which  are  in  use  and  which  have  been  used;  the 
table  previously  given  will  show  from  an  experimental  standpoint 
the  values  of  these  agents,  both  as  to  their  ability  to  destroy  and 
to  inhibit  micro-organisms.  We  must  not  forget,  however,  that 
many  of  these  are  spore- producing  germs,  and  the  spores  are  much 
more  resistant  to  destruction  than  the  germs  themselves;  that  which 


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Possibilities  of  Aseptic  Suroical  Technique.        65S 

would  destroy  the  germ  may  have  little  effect  upon  itB  spore,  aod 
the  spore,  under  proper  surroundiDgB  and  conditiona,  develops  into 
an  active  germ.  Chemical  sterilization  is  applied  only  to  those 
ageals  or  parts  to  which  mechanical  is  inapplicable,  or  we  may,  in 
a  great  measure,  combine  the  two  when  practicable.  For  instance, 
in  cleancing  the  operative  field,  the  bands  of  the  surgeon  and  as- 
sistants, these  we  cannot  sterilize  by  boiling  or  exposure  to  suffi- 
ciently  high  temperature  t*  destroy  the  micro-organisms,  beoce  we 
must  depend  upon  cleansing  by  friction  and  chemical  agents.  Be- 
fore calling  your  attention  to  the  attainment  of  cleanliness  of  those 
parts,  I  wish  first  to  mention  some  essentials  connected  with  the 
preparation  of  the  patient  before  an  operation  is  begun.  In  the 
first  place,  the  patient  should  be  carefully  examined  as  to  respira- 
tory, circulatory  and  excretory  oi^ns,  also  as  to  habits,  in  addition 
to  the  organs  or  parts  that  are  to  be  operated  opon.  We  do  this 
in  order  that  we  may  determine  in  the  first  place  whether  the  pa- 
tient is  a  suitable  one  for  an  operation,  or  how  well  prolonged 
anesthesia  is  likely  to  be  borne,  and  to  formulate  an  idea  as  to  the 
promptness  and  completeness  of  restoration  after  an  operation. 
The  urine  should  be  carefully  examined,  as  should  the  lungs,  heart 
and  blood-vessels,  as  they  not  only  influence  ki^ely  the  prognosis, 
but  upon  this  we  base  our  preferences  for  certain  anesthetics. 
There  is  no  need  to  prohibit  anesthesia  in  a  patient  with  a  distinct 
cardiac  murmur,  provided  the  heart  acts  regularly,  and  the  volame 
of  the  puli<e  is  good,  and  the  btood-Tessels'  walls  are  in  good  con- 
dition. We  should,  however,  acquaint  the  husband  or  relatives 
with  this  condition  before  administering  the  anesthetic,  in  order 
that  DO  censure  may  be  heaped  upon  us  should  a  disastrous  result 
follow. 

The  patient  on  admission  should  be  given  a  good  bfith  and  cloth- 
ing changed  and  then  put  to  bed.  A  purgative  consisting  of  either 
castor^oil  or  salts  given  and  the  bowels  well  emptied.  If  the  case 
be  one  requiring  an  abdominal  sectinn,  on  the  night  preceding  the 
operation  the  abdomen  should  be  shaved,  and  thoroughly  cleansed 
with  soap,  hot  water  and  brisk  scrubbing  with  nail-brush,  {ollowed 
by  a  thorough  cleansing  with  alcohol,  then  covered  with  a  sterile 
towel,  which  should  be  carefully  fastened  to  prevent  slipping  dur- 


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654       The  Atlanta  Mbdical  and  Surgical  Joitrnal. 

iog  sleep.  On  the  tnoroiDg  of  the  operation  the  ouree  will  admia- 
ister  the  bath  to  tfae  patient  id  bed,  following  with  an  alcohol  bath. 

The  patient  is  aoeetbetized  in  the  room  which  she  is  expected 
to  occupy  after  the  operation,  and  carried  to  the  operating-room, 
thereby  avoiding  the  shock  produced  by  watching  preparations  for 
the  operation,  which  to  a  nervous  person  may  amount  to  a  very 
serious  condition.  The  anesthetist  should  be  one  skilled  in  such 
administrations,  and  one  in  whom  the  operator  imposes  great  oon6- 
dence,  else  his  thoughts  will  be  constantly  distracted  and  the  oper- 
ation interrupted  and  prolonged. 

When  anesthetized  the  field  of  operation  and  contiguous  parts 
should  again  be  cleansed  thoroughly  as  on  preceding  night,  with 
the  addition  of  a  solution  of  bichlor.  mercury  (I-2000tb)  followed 
by  ether.  Before  bringing  the  patient  into  the  operating-room  it 
is  advisable  to  cover  the  head  with  a  sterile  towel ;  then  after  the 
cleansing  above  described  the  entire  body  of  the  patient,  except 
small  space  to  be  operated  upon,  should  be  covered  with  sterile 
sheet  or  towels  and  sterile  gauze  placed  around  the  field  of  opera- 
tion. The  sterilization  of  the  instruments  and  dressings  can  be 
accomplished  absolutely  by  the  use  of  beat,  either  in  the  form  of 
superheated  steam  or  boiling  water,  or  by  dry  heat;  this  latter 
not  yielding  as  satislactory  results  as  the  other  two,  owing  to  its 
injurious  effect  upon  the  cutting  instruments,  and  the  lack  of  pen- 
etration into  the  thicker  dressings,  etc. 

Superheated  steam  is  the  plan  adopted  with  most  satis&ctory  re- 
sults, and  the  .one  in  use  at  the  Sanatorium  of  Dr.  Holmes.  The 
instruments  are  boiled  in  a  solution  of  sodium  carbonate  one  per 
cent.,  or  better  in  one  half  per  cent,  solution  of  sodium  hydrate,  as 
this  will  tarnish  instruments  less  than  any  oftbe  carbonates.  They 
should  be  boiled  in  this  solution  for  ten  minutes,  or  should  we  sus- 
pect a  contamination  from  the  spore-producing  germs,  it  would  he 
advisable  to  boil  tbem  twice,  allowing  twenty-four  hoars  to  inter- 
vene between  the  boilings,  unless  we  have  the  superheated  steam 
apparatus  which  will  destroy  absolutely  the  spores  as  well  as  the 
micro-organisms,  when  exposed  for  a   sufficient  length  of  time. 

The  instruments  should  then  be  transferred  to  the  sterilized  ves- 
sels in  which  they  are  to  be  kept  during  the  operation ;  it  is  best 


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POBSIBILITIBS   OF   ASBPTIC   SORQICAL   TECHNIQUE.  665 

to  immersfl  them  with  boiled  water,  or  if  the  surgeon  prefers,  they 
nay  remain  in  the  steriliser  until  ready  for  aee,  when  they  may  be 
spread  upon  sterile  towels.  Much  here  depends  upon  the  taste  of 
the  operator,  whether  he  likes  dry  or  moist  instruments.  The 
dressing  slioutd  nnt  be  exposed  to  the  air  until  ready  for  nse,  as  the 
^nger  from  contamination  is  greatly  increased  by  exposure. 

For  ligatures  the  most  satisl'aotory  results  have  followed  the  use 
-of  ailk,  for  in  this  we  can  be  sure  of  perfect  eterilizattoo  and  there 
is  not  likelihood  of  too  early  absorption.  Catgut  that  is  used  is 
sterilised  by  the  cumol  method,  popularized  by  Dr.  Howard  A. 
Kelly  and  Dr.  Clark  of  Johns  Hopkins,  and  is  undoubtedly  sterile, 
:but  somehow  I  early  obtained  a    prejudice  against  this  material, 

-and  use  it  without  the  same  confidence  which  is  g^ven  silk.     For 

■sutures  silkworm  gut  or  silk,  sometimes  catgut  (and  this  is  es- 
pecially applicable  where  buried  sutures  are  indicated),  in  theorder 
Darned.     The  silk  and   silkworm  gut  can  be  as  safely  boiled  as  the 

-dressing,  and  can  confidently  be  relied  upon  when  so  treated. 
We  then  oome  to  the  sterilization  of  the  hands,  and  here  it  is 

'that  most  of  the  defects  in  technique  oocur ;  there  is  yet  no  abso- 
lutely certain  means  of  cleansing  the  hands,  and  aotit  this  is  dis- 
covered we  will  always  be  exposed  to  risk  of  infection.    The  most 

-sads&otory  plan  so  fiir  suggested  is  that  of  Dr.  Weir,  of  New 
York,  who  recommends  first  the  cleansing  of  the  hands  and  arms 
to  elbows  with  soap,  water  and  nail-brush,  cleansing  the  spaces  nn- 

■der  and  around  the  nails  thoroughly,  then  repeat  the  cleansing  with 
above-named  agents,  after  which  cover  the  hands  and  arms  with  a 
paste  of  chlorinated  lime  and  water,  to  which  add  several  crystals 

-of  carbonate  of  sodium,  and  again  wash.  This  rapidly  liberates 
the  chlorine  in  a  nascent  state,  which  makes  it  quite  active  as  a 
germ  destroyer,  and  at  the  same  time  leaves  a  soft,  smooth  hand. 
Bichloride  of  mercury  (1-lOOOtb)  will  usually  neutralize  or  destroy 
the  micro-organisms,  but  so  often  leaves  a  rough,  fissured  hand  that 
it  is  being  lai^ly  discarded  by  sui^eons  doing  a  great  deal  of  oper- 
ating. Dr.  Jos.  Price  retains  quite  a  fondness  for  mustard  with 
plenty  of  soap  and  friction  with  good  nail-brush.  This  too  leaves 
«  good  surgical  hand  without  impairing  the  tactile  sensibilities.  I 
believe  after  all  there  is  more  to  be  derived  from  the  use  of  soap. 


^dbyGoogle 


656       Thb  Atlahia  Medical  and  Surgical  Jourhal. 

boiled  water  and  a  good,  stiff  brush,  used  ior  at  least  twenty  min- 
utes, after  the  nait  spaces  around  are  well  cteaBed,  than  from  alP 
the  chemical  agents  when  applied  without  previously  preparinfi;  the- 
hands  for  their  use. 

Everything  which  has  not  been  submitted  to  the  sterilizing  pro- 
cess must  be  considered  capable  of  prodncing  infection,  and  when 
touched  by  the  hand  should  lead  to  prompt  cleansing  of  the  bands ' 
again.  It  is  better  for  the  operator  and  astsistants  to  wear  a  wash- 
able suit  or  uniform  which  has  just  been  washed.  When  any 
doubt  remains  about  the  hands,  or  when  suppurating  wounds  have- 
been  recently  handled,  it  may  be  advantageous  to  use  rubber  glovea- 
that  have  been  sterilized,  or  cotton  gloves  that  have  been  boiled. 

Some  disadvantages  which  surround  the  attainment  of  perfection' 
lie  in  the  difficulties  in  the  preservation  of  asepsis,  even  after  its- 
primary  attainment.  We  must  forcibly  impress  upon-  each  one- 
present  that  it  is  safer  to  regard  every  object  not  sterile  as  capable- 
of  infection,  and  should  it  be  handled  or  touched  complete  steril- 
ization of  bauds  must  again  be  gone  through  with.  Again,  oper- 
ators and  assistants  are  forced  often  to  handle  suppurating  woands- 
and  to  treat  infectious  diseases,  and  to  make  examinations  of  parts 
ID  which  bacteria  are  prevalent;  in  such  cases  extra  care  should  be- 
givea  to  the  hands  and  clothing.  When  infectious  diseases  are- 
treated  it  would  be  advisable  to  expose  the  clolhing  worn  to  the- 
fiimes  of  formaldebyd,  which  is  used  iu  disinfecting  the  rooms,, 
then  neutralized  by  exposure  to  stronger  ammonia. 

The  vessels  for  sponges,  instruments  and  the  irrigators  should  all- 
be  exposed  to  a  sufficiently  high  temperature  for  a  long  enougb' 
time  to  destroy  the  micro-organisms.  If  this  be  impossible,  tben- 
they  should  be  washed  with  boiling  water,  tarpentiae,bich]or.  of  mer- 
cury (1— 1000th),  and  again  with  boiling  water.  In  all  operative- 
cases  we  should  have  just  as  few  assistants  as  are  necessary  for  the  - 
proper  performance  of  the  operation,  and  each  assistant  should 
clearly  understand  what  is  expected  of  him  and  attend  strictly  to 
that ;  we  must  see  that  the  precautions  are  thoroughly  carried  oat^ 
superintend  the  band  cleansing,  and,  if  any  doubt  exists,  take- 
sorapinga  from  hand  and  nails  and  inoculate  culture  tubes,  then  ex- 
amine the  result;  if  any  show  micro-organisma  of  suppuration,  then 


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Possibilities  op  Aseptic  Surgical  Technique.        657 

debar  this  assistant  frooi  the  operating-room  for  a  speciBed  period, 
as  is  doiie  in  some  of  the  eastern  hospitals. 

It  is  impossible  to  iocorporate  more  than  the  bare  framework 
of  this  extremely  importaot  subject  within  the  narrow  coofines  of 
a  paper,  but  I  wish  to  recapitulate  some  of  the  more  important  con- 
siderations in  this  paper,  viz.:  1.  Let  your  technique  be  extremely 
simple,  bat  at  the  same  time  thorough.  2.  Supervise  the  prepara- 
tion as  fiir  as  possible  yourself,  or  entrust  it  to  some  one  in  whom 
you  have  absolute  confidence.  3.  Handle  suppurating  wounds  or 
infectious  cases  just  as  little  as  possible,  and  when  handled  carry 
out  with  extreme  care  the  rules  of  sterilization.  4.  Pay  n^ore  at> 
tention  to  mechanical  sterilization  than  ever  before,  and  when  using 
cbemicaU,  especially  upon  the  hands,  be  sure  that  they  do  not  leave 
an  unsurgical  field.  5.  Observe  closely  the  hands  to  see  if  they 
are  free  from  abrasions  and  are  in  suitable  condition  to  be  thor- 
oughly cleansed.  6.  Scrupulously  avoid  if  possible  any  careless- 
ness in  the  technique,  in  the  preparation  and  throughout  the  oper- 
aUon.  7.  Take  sufScient  time  to  thoroughly  complete  the  operation, 
thereby  avoiding  in  many  cases  the  necessity  for  drainage,  but  do 
not  close  any  case  in  which  you  have  a  serious  doubt  as  to  advisa- 
bility of  drainage  without  draining. 

In  carrying  out  these  precepts  we  come  near  to  the  attainment 
of  perfection  in  technique,  hut  all  conscientious  surgeons  will  tell 
you  that  in  cases  in  which  as  far  as  tbey  know  alt  these  rules  were 
rigidly  enforced,  infection  has  followed  with  its  serious  results. 
The  surgeon  who  has  no  suppuration  and  no  fiitalities  is  one  not 
doing  many  operations,  or  else  he  is  the  prince  of  knaves  and  a 
worthy  successor  to  Ananias  of  biblical  record. 

There  are  some  factors,  with  whose  nature  we  are  yet  unao- 
qnainted,  capable  of  contributing  to  infection,  and  until  we  become 
familiar  with  them,  we  must  not  expect  perfection,  even  though  we 
seem  in  many  instances  to  approach  so  close  to  this  desired  goal. 

BIBLIOGBAPaY. 
The  Aseptic  Treatment  of  Wounds. — ^Schimmelbusch. 
Dennis's  System  of  Surgery. 

The  Evolution  and  Periection  of  Aseptic  Surgical  Technique. — 
L.  S.  McMurtry. 


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658       The  Atlanta  Medical  and  Surqical  Jodrnal. 


VACXJINATION  AND  ITS  SORES.* 

By  M.  B.  HUTCHINS,  3i.D, 
Atlanta,  Oa. 

I  should  like,  first,  to  say  something  about  the  method  which  I 
showed  the  Society  last  fall  of  vaccination  without  an  instrument, 
the  so-called  painless  method.  The  only  objection  to  it  is  that  it  is 
rather  slow;  and  I  found  that  I  was  fiiiling  in  a  good  many  cases,  Ail- 
ing more  than  I  should  and  more  than  other  people  who  were  trying 
the  method.  I  couldn't  account  for  it  until  I  received  a  circular 
from  one  of  the  vaccine  farms  saying  that  you  should  not  wet  the 
points  too  much.  Then  I  got  better  results.  Some  time  after  that 
demonstration  was  made,  I  had  a  case  in  the  office  to  vaccinate  and 
I  bad  liquor  potassse,  and  I  went  back  on  what  I  said  about  a  stick 
of  caustic  potash.  You  know  when  you  take  it  out  of  the  bottle 
it  begins  to  take  on  moisture.  Anyway,  I  took  the  stick  of  caustic 
potash  and  as  soon  as  a  little  moisture  began  forming,  I  touched 
one  or  two  spots  with  this  liquid,  and  smoothed  it  a  little  bit.  I 
immediately  took  a  little  piece  of  damp  cotton,  and  with  that 
method  I  succeeded  very  rapidly  and  well,  more  rapidly  than  in  any 
of  the  old  ways.  Where  you  wipe  off  the  deliquesced  potash  im- 
mediately, there  is  no  pain  and  no  injury  to  the  deeper  tissues. 
One  of  my  doctor  friends  told  me  one  night  that  I  had  not  put 
enough  on  him.  So  I  put  more  to  satisfy  him,  and  now  he  has  a 
nice  hypertrophied  scar  as  a  result;  and  be  wanted  some  more. 

You  gentlemen,  I  suspect,  have  had  more  experience  with  vacci- 
nation than  I  have  had,  but  I  have  had  some  experience  with  these 
old  sores  that  are  left  after  vaccination.  I  will  say  first  that  I  be- 
lieve as  soon  as  the  patient  has  had  slight  fever  and  the  inflamma- 
tory action,  which  so  frequently  takes  place  and  the  redness  begios 
to  subside,  that  the  vaccination  has  done  its  work,  and  consequently 
if  there  is  a  great  deal  of  inflammation  and  a  great  deal  of  sup- 
puration under  the  scab,  I  think  it  is  proper  to  remove  the  scab  and 
clean  the  sore  aud  heaX  it.     I  had  to  treat  a  little  boy,  and  I  have 

"Ksmarki  before  the  itlanU  Socletjr  of  Uadlelne,  Muob  IT,  IB»3,  «ltb  dlMulloa. 


^dbyGoogle 


TAccraATioN  AND  Its  Sorbs.  659 

seea  several  other  cases,  where  the  arm  or  leg  had  been  oegleoted 
for  eight  weeks  or  some  months.  I  don't  think  It  is  at  all  necessary 
tor  the  sore  to  be  allowed  to  run  its  course.  You  can  save  the 
patient  a  great  deal  of  discomfort  bj  not  doing  so.  I  saw  an  old 
woman  the  other  day  and  examined  her  arm  and  there  was  an  old 
scab  there  that  she  said  bad  been  there  for  about  eight  weeks. 

The  patient  may  scratch  or  rub  it,  or  the  clothing  rub  it.  And 
these  vaccination  shields  sold  in  drug  stores,  in  my  opinion,  do 
more  harm  than  good.  For  instance,  at  the  time  that  you  need  it 
worst  the  whole  area  around  is  very  much  inflamed.  Put  on  one 
of  these  shields,  and  as  likely  as  not  you  will  find  it  down,  perhaps, 
over  the  sore  the  next  time  that  you  look  for  it.  Dr.  Hurt  told 
me  that  be  bad  a  beautiful  sore  arm  on  a  patient  where  the  shield 
had  slipped  down,  inoculating  as  it  went.  Another  thing  is,  these 
vaccination  sores  are  kept  up  hy  constant  infection  and  reinfection. 
■Some  of  them  are  not  genuine  vacciaatioo  sores  at  all,  but  simply 
infected  ones.  In  some  cases  they  are  caused  by  some  oi^nio 
-change  in  the  virus  on  (he  point,  s<>  that  there  was  not  a  typical 
result,  and  in  some  other  casus  I  have  found  that  the  harm  resulted 
from  people  trying  to  treat  themselves.  They  don't  all  have  the 
same  symptoms.  In  some  cases  they  have  got  something  on 
that  they  can't  get  off,  and  in  some  other  cases  they  get  it  off  too 
often. 

As  regards  the  treatment  of  these  sores,  I  do  not  think  there  is 
-any  doubt  about  the  propriety  of  treating  them  as  soon  as  the 
patient  has  passed  the  acute  stage  of  vaccination.  I  don't  pretend 
to  try  to  tell  you  gentlemen  how  it  should  be  done  further  than  to 
give  my  little  experience,  and  to  call  your  attention  to  the  general 
principles  underlying  the  treatment  of  ulcera.  As  a  rule,  you  see 
these  cases  in  one  of  two  or  three  forms.  One  of  the  most  constant 
probably  is  an  old  ulcer  full  of  pus,  covered  over  with  a  dirty 
brown  scab.  In  other  oases  you  will  see  that  the  scab  has  been 
kept  offa  little  too  well  and  you  have  a  lesion  there  composed  of 
fuogating  grannlations.  Sometimes  that  is  all  the  matter;  there 
is  just  enough  exudation  to  give  you  a  crust  on  it  and 
give  it  the  appearance  of  a  sore,  and  it  goes  on  that  way 
ibr    months   and    months.      There    is   another    thing   you    will 


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660       The  Atlanta  Medical  and  Sdeoical  Joxirhal. 

sometimes  see  in  these  sores.  That  U,  owing  to  the  influence- 
of  opposing  organisms,  you  get  a  coagulation  over  these  ulcers- 
of  a  dead  membraoous  substance  which  interieres  with  the- 
formation  of  a  new  epidermis  and  cicatrization.  In  the  same  way 
you  get  something  very  much  like  coagulation — necrosis  from  the 
use  of  strong  antiseptics  in  the  treatment  of  these  ulcers  or  sores. 
You  get  a  coagulation  there,  a  something  that  interferes  as  much  as 
possible  with  the  healing  of  these  sores.  I  am  reminded  here  of  an- 
ulcer  on  the  ankle  that  I  treated  a  few  years  ago,  where  I  used 
ichthyot  until  I  bad  it  just  a  coagulated  membrane.  As  to  the- 
metbod,  there  is  little  to  say,     I  will  just  give  you  my  way. 

The  Bret  thing  is  to  remove  the  crust,  and  this  is  ofteu  very  easy^ 
because  it  is  hanging  by  the  slightest  attachment.  If  you  cannot 
get  rid  of  it  by  just  lifting  it  off,  it  can  be  soflened  up  usually  with 
some  antiseptic  oil.  Then  the  sore  is  cleaned,  usually  with  the- 
bichloride  of  mercury  solution.  I  have  found  in  the  treatment  of 
ulcers  that  it  is  better  not  to  use  hydrogen  peroxide,  where  you  can 
get  at  the  ulcer  and  clean  it  without  it.  If  you  have  a  very  great 
elevation  of  exuberant  tissue,  from  granulation  and  fungation,  yon- 
will  find  that  an  application  of  the  nitrate  of  silver  stick  will  often 
remove  it  in  one  day.  It  is  remarkable  bow  yielding  it  U  to  the- 
application  of  the  nitrate  of  silver  stick.  Where  there  is  just  an 
indolent  sore  with  a  slight  pellicle  over  it  and  no  effort  to  throw- 
out  a  new  epidermis  from  borders,  I  have  used  a  ten  per  cent,  ap- 
plication of  nitrate  of  silver  with  extremely  good  results.  You> 
will  find  at  first  that  there  is  a  good  deal  of  discharge  and  apparent 
aggravation,  but  you  will  find  a-  little  later  that  it  has  taken  on 
healthy  action.  I  have  used  various  kinds  of  applications.  In  some- 
of  these  cases  where  I  had  to  use  a  dry  powder  on  account  of  the 
discharge,  I  have  used  bismuth,  and  in  some  cases  calomel.  I  have 
a  prejudice  against  iodoform.  I  have  seen  bad  effects  from  it  very 
often.  The  next  thing  after  you  have  got  the  ulcer  thoroughly 
cleansed,  is  to  simply  apply  an  antiseptic  gauze,  preferably  bichlo- 
ride. The  best  method,  I  have  found,  though,  was  to  use  antiseptic 
or  aseptic  rubber  tissue. 

You  take  this  rubber  tissue  cut  into  very  narrow  strips  and  Ity 
it  on  over  the  wound,  like  the  planks  on  a  stable  roof.     This  per- 


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VACCraATION   AND   IxS   SOEES.  661 

mits  a  little  discharge.  I  have  had  a  great  deal  of  trouble  in  the 
treatment  of  wouads  from  the  dresetDg  Btloking  to  the  wound,  and 
you  frequeatly,  id  removiDg  the  dressing,  tear  the  epidertuis.  The 
advantage  of  the  rubber  ie  that  it  does  not  stick  to  the  wound,  and 
I  have  never  been  able  to  take  away  other  dressing  without  tearing 
the  epidermis,  more  or  lees.  As  soon  as  scarification  begins,  you 
can  frequently  get  a  beautifully  rapid  healing  by  simply  applying 
the  rubber  tissue  directly  to  the  wound,  in  these  narrow  strips. 
Sometimes  I  put  in  a  little  sterilized  cotton  first.  In  other  cases  I 
Just  put  the  rubber  tissue  directly  on  the  wound.  In  other  cases 
I  put  a  little  cotton  or  gauze,  and  theu  above  (bat  an  adhesive 
strip. 

In  some  cases  where  the  healing  baa  not  gone  along  rapidly 
enough,  I  have  found  that  an  application  of  these  narrow  strips 
right  over  the  sore  is  very  good,  and  in  that  way  you  get  a  rapid 
disappearance  of  the  fungating  granulations.  Of  course,  this  is 
just  a  general  idea  of  the  matter.  My  idea  in  everything  that  I 
have  said  is  to  impress  upon  you  my  belief  that  it  is  not  well  to 
allow  these  sores  to  run  on  afler  tbey  have  done  all  that  is  necessary 
for  the  vaccination  of  the  patient.  I  have  found  that  if  you  can 
^t  the  wound  protected  when  it  gets  ready  to  begin  skinning  over, 
when  the  wound  is,  say  one-fourth  of  an  inch  in  diameter,  you  can 
^t  a  rapid  healing  by  just  putting  a  little  of  the  tissue  over  it  to 
keep  it  from  being  rubbed. 

In  other  cases,  where  it  was  necessary  to  turn  the  patients  loose 
before  they  were  entirely  well,  for  instance  a  man  going  on  a  trip, 
I  simply  put  on  some  common  gauze  and  a  few  layers  of  the  tissue 
-over  that,  and  then  I  usually  found  that  the  patient  was  well  when 
I  saw  bim  again.  It  makes  an  uglier  scar,  from  pressure,  due  to 
remaining  on  long,  however,  than  it  would  otherwise.  By  the  use 
-of  this  rubber  tissue,  in  the  way  I  have  explained,  where  you  can 
keep  the  patient  under  your  hands,  when  the  epidermis  becomes 
formed,  you  will  find  a  very  pretty  scar. 

DiscuaaroN. 
2>r.  Crow:  I  have  not  very  much  to  say.     I  have  been  very  much 
interested  in  Dr.  Hutcbins's  talk,  and  think  it  is  on  the  right  line. 


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662       Thb  Atlasta  Medical  and  Surgical  Jodrnal. 

Eveiy  man,  who  is  a  geoeral  practitiooer,  baa  more  or  leas  of  tbew 
old  iadolent  sores  from  vaccination  to  treat,  especially  this  last 
year.  I  concur  in  everything  the  doctor  has  said.  I  have  not 
followed  exactly  the  plan  he  has  outlined  in  the  treatment  of  these 
sores,  bat  if  a  case  sbonld  come  under  my  observation  now,  I  think 
I  would  do  so,  as  it  is  probably  a  better  plan  than  the  one  I  used. 
Of  course,  in  the  first  place,  in  the  treatment  of  these  indolent 
sores,  you  clean  them  up  the  best  you  can.  My  plan  has  been  to 
use  the  borolyptol.  I  have  a  great  deal  of  confidence  in  the 
formalin;  I  think  there  is  two  percent,  in  it.  Using  that  as  a 
wash,  I  then  use  the  powdered  boracic  acid  and  bismuth.  I  have 
followed  the  plan  of  leaving  the  wound  open  as  far  as  possible 
where  there  is  an  abundance  of  secretion. 

Dr.  Haneoek:  In  regard  to  vaccination,  I  have  this  last  winter 
used  the  fluid  vacciue — it  comes  in  small  tubes.  Since  I  have  used 
that  I  have  made  very  little  scarification  usually,  and  I  have  had 
good  success  in  taking.  I  never  put  but  one  scar  on  an  arm. 
Some  people  vaccinate  in  three  or  four  places.  I  think  it  is  better 
to  put  but  one.  If  you  want  to  put  two,  put  one  on  one  arm 
and  one  on  the  other.  In  regard  to  these  old  sores,  I  have  used 
burnt  alum.  Of  course  you  call  it  a  technical  name  when  you  put 
it  on,  but  it  works  all  right  all  the  same.  It  works  a  good  deal 
like  nitrate  of  silver  does. 

J>r.  Hvbbard:  I  have  been  very  much  interested  in  the  doctor's 
talk,  because  I  have  had  some  of  these  old  sores  run  on  for  two  or 
three  months  and  kept  me  dressing  them,  and  ordinarily  people 
don't  want  to  pay  for  it.  I  agree  with  him  that  it  is  a  mixed  in- 
fection. I  have  found  that  this  bothers  me  most.  I  have  used 
carbolic  acid  and  cauterized  the  place.  I  have  found  that  these  old 
indolent  sores  occur  usually  in  scrofulous  or  anemic  persons. 
Take  a  healthy  person  and  they  are  not  usually  troubled  this  way 
much ;  it  is  usually  a  better  sore,  but  it  generally  heals  up  quickly. 
In  these  old  sores,  I  have  found  that  I  got  good  results  when  I 
used  carbolic  acid  or  8i>me  cautery.  As  regards  the  use  of  gause,  I 
usually  put  it  right  down  on  the  granulation.  Of  course,  in  some 
cases  the  granulation  was  below  the  surface,  and  then  I  used  rubber 
tissue,  as  the  doctor  says,  which  I  think   is  a  fine  thing.     Bnt  I 


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Vaccination  and  Its  Sores.  663 

doo't  use  it  as  he  does;  I  don't  cut  it  in  stripe.  It  prevents  the  dress* 
ing  from  sticking,  and  that  is  a  good  deal  gained.  I  have  wondered 
why  it  was  that  some  of  them  were  so  long  healing.  I  coaldn't 
account  for  it  even  on  the  ground  of  a  mixed  infection.  I  think  - 
thorough  antisepitis  is  the  plan,  and  I  tbink  it  meets  with  succesa 
usually. 

Dr.  Hood:  I  want  to  thank  Dr.  Uutchins  for  the  talk,  and  I 
tbink  I  will  profit  by  the  suggestions  made.  I  want  to  report  just 
one  case  of  an  old  sore.  I  was  called  to  see  a  patient  who  was 
suffering  from  pneumonia,  and  also  from  one  of  these  old  sores.  She 
bad  been  vaccinated,  she  said,  in  November,  and  the  sore  is  not 
healed  yet.  She  bad  neglected  it — simply  applied  borne  remedies. 
I  found  under  the  sore  a  culleotiou  of  pus.  It  was  very  sofl  and 
when  I  would  press  down  the  scab  the  pus  would  shoot  out.  I  re- 
moved that  scab  and  found  dark  looking  granulation  forming  there. 
I  have  had  three  or  four  of  these  cases  this  winter,  and  have  had 
some  of  them  elevated  above  the  skin  a  quarter  ot  an  inch.  I  took 
a  pair  of  scissors  and  clipped  this  off  and  used  pure  sulphate  of  zinc, 
and  then  applied  powdered  boric  acid,  and  they  healed  rapidly. 
That  is  almost  the  same  as  caustic.  I  thought  about  using  nitrate 
of  silver  at  the  time,  but  I  didn't  have  it,  and  I  use  the  sulphate 
of  zinc  in  its  place  and  found  it  very  successful.  I  had  one  case 
of  a  little  boy  who  was  vaccinated  in  December  and  had  infection; 
he  suflered,  I  think  from  se])tic  infection  and  had  eruptions  all  over 
his  body.  It  had  lasted  several  weeks — a  month  or  six  weeks.  I 
bad  to  sustain  him  with  stimulants  and  combat  the  infection  and 
finally  be  got  well.  I  want  to  ask  Dr.  HotchinB  his  mode  of  vac- 
cinating with  liquor  potassee.  I  soon  found  that  the  quickest  way 
I  could  adopt  was  to  take  a  little  wad  of  cotton  and  when  I  put  it 
on  to  rub  it  off  and  do  that  Trequently,  and  in  about  a  minute  I 
cleared  away  all  the  epidermis.  I  would  apply  it  and  wipe  it  off, 
apply  it  again  and  wipe  it  off.  My  experience  with  the  ulcers  is  a 
good  deal  like  the  others'  has  been — mostly  with  children  though, 
where  they  couldn't  keep  from  scratching. 

Dr.  Duncan:  As  regards  the  liquor  potasste,  I  like  it  very  much. 
I  have  been  more  successful  in  using  it  than  in  scarifying.  I  got 
a  better  idea  partly  from  Dr.  Hood  and  partly  from  failure  to  get 


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664       The  Atlanta  Medical  and  Sursical  Journal.  - 

good  results  by  just  puttiug  it  oo  the  arm.  In  the  way  be  describes 
you  get  results  very  quickly,  ia  less  thau  half  the  time  it  takes  by 
just  laying  it  od  the  arm.  As  regards  the  treatment  of  old  sores, 
I  am  inclined  to  differ  with  Dr.  Hutchins  as  to  iodoform  not  being 
a  good  (hiug.  I  have  never  used  it  much,  but  I  have  used 
hydrozone  or  pyrozone,  which  ia  about  the  same  thing.  Then 
I  put  on  a  very  small  amount  of  sulphate  of  hydrastis  and 
bismuth.  One  acting  as  an  astringent  and  antiseptic,  and  the 
bismuth  didn't  amount  to  much,  but  it  is  a  fine  thing  to  drees  a 
sore  with.  I  think  a  great  many  of  these  sores  are  due  to  oleaginous 
applications.  I  am  opposed  to  using  any  sort  of  oil  or  anything  of 
that  kind  about  the  vaccination.  I  think  those  who  have  used  no 
ointment  at  all  have  got  along  better  than  those  who  have  used  any 
ointment,  no  matter  bow  antiseptic  it  was.  I  have  made  inquiry  of 
those  who  came  to  me  for  treatment,  and  every  one  of  them  had 
been  using  some  kind  of  ointment — had  some  sort  of  grease  on  it. 
Consequently  I  came  to  the  conclusion  that  that  had  a  great  deal  to 
do  with  keeping  up  the  sore.  My  experience  with  the  bydrozoDe 
in  cleansing  the  arm  and  dressing  it  with  bismuth — the  next  time 
time  I  have  seen  the  patient  I  have  found  it  much  better.  I  have 
found  that  the  patient  would  be  better  before  he  left  my  oEBce — 
would  say  that  his  arm  felt  better.  Next  time  I  would  see  him,  it 
would  be  very  much  better.  Just  a  few  dressings  were  required 
in  all  the  cases  I  have  seen. 

Dr.  Hood:  I  have  had  the  arm  colored  to  the  end,  so  that  it 
looked  like  erysipelas,  and  felt  like  it.     Have  you? 

Dr.  Hutchina:  Yes. 

Dr.  ChUdg :  There  is  one  sort  of  ulcer  I  have  had  more  trouble 
with  than  the  kinds  that  have  been  mentioned.  That  is  the  deep 
ulcers  in  syphilitic  cases.  Two  young  men  came  to  me.  Both  had 
been  vaccinated,  and  bad  these  deep  ulcers.  I  treated  them  with 
iodide  of  potasb.  In  regard  to  what  Or.  Hancock  says  about  vac- 
cinating, I  don't  care  to  use  two  points  on  different  arms.  A  man 
goes  around  with  one  arm  in  a  sling;  that  ia  bad  enough.  He 
wouldn't  look  right  with  both  arms  in  a  sling.  There  is  no  uae 
crippling  a  man  on  both  arms.  And  as  to  vaccinating  in  several 
places,  my  teacher  taught  me  this;    Of  those  who  were  vaocioated 


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Vaccination  and  Its  Sore3.  665 

■^vith  one  poiot,  ten  per  cent,  had  varioloid;  of  those  vaccinated 
with  two  {wiuts,  five  per  cent.;  and  of  those  vaccinated  with  four 
jwints,  one-tenth  of  one  per  cent.  I  was  in  the  city  hospital  in 
Charleston  after  I  had  heen  vaccinated.  A  young  doctor  friend 
"who  had  been  to  the  fiower  show  came  up  to  me — I  won't  call  his 
name,  he  wasn't  sober.  He  said:  "Childs,  by  God,  I  have  been 
to  the  flower  show  with  the  prettiest  girl  iu  South  Carolina/'  and 
with  that  he  came  down  on  my  arm  and  knocked  the  scab  off  and 
almost  knocked  my  arm  off.  It  was  all  I  could  do  to  keep  from 
knocking  him  down.  He  didn't  know  it  was  sore  though,  I  sup- 
pose ;  he  didn't  know  anything,  he  was  too  drunk.  That  made  it 
a  long  time  getting  well.  In  regard  to  these  deep  syphilitic  ulcers, 
I  think  it  is  important  to  keep  the  arm  in  a  sling. 

Dr.  Hancock:  I  didn't  intend  to  convey  the  idea  that  I  vaccinated 
■on  more  than  one  arm  as  a  rule,  but  there  are  some  cases  in  which 
that  has  happened  to  me.  A  person  with  the  smallpox  came  in 
my  office  one  day,  and  my  driver  had  never  been  successfully  vac- 
cinated. I  vaccinated  him  on  both  arras  and  it  took  very  well  on 
both  of  them. 

Dr.  Champion:  I  haven't  anything  to  say  except  that  I  agree 
-with  Dr.  Duncan.  I  never  use  ointment  of  any  kind  on  a  sore.  1 
think  grease  iu  a  sore  anywhere  on  the  body  is  a  receptacle  for 
germs.  The  only  place  I  use  grease  is  in  passing  a  sound  iu  the 
penis. 

Dr.  Hutchivs:  I  want  to  thank  you,  gentlemen,  for  the  way  in 
which  yon  have  have  received  my  talk.  I  have  tried  to  impress  on 
the  students  in  the  college  not  to  know  formula,  but  that  they 
ought  tu  know  prtuciples.  That  is  the  way  with  these  sores.  Just 
whatever  you  find  is  best,  that  is  the  thing  to  use.  Now  as  to  what 
Dr.  Hancock  says  about  the  number  of  vaccinations.  Some  time 
Ago,  Dr.  A.  W.  Stirling,  who  was  educated  in  Edinburgh,  I  believe, 
published  a  paper  in  which  he  stated  figures  something  like  the 
figures  given  by  Dr.  Childs.  I  have  believed  iu  multiple  vaccina- 
tion since  that  time.  About  what  Dr.  Hubbard  says  about  the  sores 
taking  so  long  to  get  well ;  I  suspect* .they  were  worse  cases  than  I 
saw.  My  cases  averaged  about  ten  days'to  two  weeks  in  getting  well 
ander  the  treatment  I  used.     About  the  use  by  Dr.  Hood  ot  my 


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666       The  Atlanta  Medical  and  Surgical  Journal. 

liquor  potassee  method,  I  have  learned  somethiog  to-night.  Br 
putting  it  OQ  aud  rubbing  it  off  he  gets  rid  of  that  soa{)y  product 
-which  is  caused  by  the  fatly  secretion  of  the  skin  uniting  with  the 
liquor  potassre.  That  is  a  very  valuable  poiut.  Now  as  to  tliis 
peroxide  of  hydrogen  ;  that  in  my  owu  notion.  I  have  seen  un- 
satisfactory results  from  it,  and  I  doo't  like  to  use  it.  About  Dr. 
Childs's  syphilitic  vaccine  sores;  I  have  not  seen  any  of  them. 
The  idea  with  me  would  be  to  follow  the  same  principles,  hut  I 
would  use  some  form  of  mercury  on  these  sores.  My  ex]>erience 
has  been  that  it  is  best  to  use  mercury  locally  on  syphilitic  sorer-. 
I  agree  with  the  gentlemen  fully  about  ointmeut  uot  beiug  good 
for  sores,  but  if  you  have  an  ointment  that  is  eufficieutly  aotiseptic, 
itwillfrequentlydo  what  the  rubber  tissue  does,  and  you  can  use  it  on 
the  face  aud  elsewhere  where  you  cannot  use  the  rubber  tissue,  and 
it  will  do  the  work  very  well  indeed.  In  treating  these  syphilitic 
sores,  I  would  not  hesitate  to  use  ordinary  mercurial  ointmeut, 
either  aloue  or  with  other  things,  and  I  think  you  will  find  that 
you  will  get  a  good  effect  from  it. 

Dr.  Childs:  I  have  used  the  white  precipitate  ointment  on  these 
sores  with  good  results.  I  can't  concur  that  all  ointments  are  bad. 
There  is  not  anything  that  gives  better  results  in  some  cases  than 
boracic  acid  ointment  .  I  am  a  great  believer  in  boracic  acid  oint- 
ment, and  I  use  while  precipitate  ointment  on  these  syphilitic  sores.. 


HYDROGEN  PEROXIDE  IN  THE  TREATMENT  OF 
PUERPERAL  SEPSIS.* 

Br  JOHN  N.  UPSHUR,  M.D.,  Bichmond,  Va., 
Frofeasor  of  the  Practice  of  MeiJicine,  Medical  College  of  YirginJu. 

Two  principles  of  fundamental  importance  concerning  puerjwrar 
sepsis  are,  first,  that  in  these  days  of  advanced  asepsis,  puerpeml 
sepsis  should  not  ordinarily  occur,  aud,  second,  if  it  does  occur,  it 
should  be  treated  aseptically  rather  than  antiseptically.  An  excep- 
tion lo  the  first  principle  is  found  in  such  cases  as  are  autogenetic- 

■Read  beture  tbc  Rlchnioiid  Aeadem;  o(  Mi>d)clne  and  Surg«i7,  Oclolier  11.  INd. 


,„i,z.d  by  Google 


IIydroubn  Peroxide  in  Fuekperal  Sepsis.  667 

— a  class  of  eases  wbich,  although  their  existence  is  denied  by 
competent  authority,  the  writer  is  cooviDced  are  sometimes  encoun- 
tered. These  unpreveiitable  ones  are  exemplified  by  instances  of 
putrefaction  and  sitbscqnent  sepsis  occnrring  in  women  in  whose 
products  of  conception  life  has  been  extinct  for  several  weekj^. 

M'hen  sepsis  results  from  external  causes,  it  is  because  the  ac- 
conchenr  or  nnrse  has  failed  to  secure  surgical  cleanliness.  This  iu 
most  instances  is  highly  reprehensible.  It  is  true  that  in  the  hum- 
ble walks  oi  life  poverty,  filth  and  ignorance  are  powerful  factors 
in  the  causation  of  sepsis,  and  freqnently  triumph  in  spite  of  the 
physician's  most  watchful  care.  Elevation  of  temperature,  uot  de- 
pendent upon  some  easily  removable  or  transient  causes,  such  as 
constipation  or  the  first  secretion  of  milk,  but  associated  with  scanty, 
offensive  or  absent  lochia,  is  the  invariable  indication  that  infection 
has  taken  place,  and  that  prompt  clearing  of  the  uterine  cavity  is 
imperative. 

The  writer's  method  of  treatment  in  these  cases  is  to  first  irrigate 
the  interior  of  the  uterus  with  a  normal  salt  solution,  remove  sec- 
undines  or  other  retained  foreign  materials  by  means  of  tlie  sharp 
curette,  then  again  irrigate  freely  with  salt  solution.  After  thor- 
oughly drying  with  aseptic  cotlou  or  gauze,  hydrogen  peroxide  is 
applied  to  the  uterine  cavity  by  means  of  a  small  intra-uterine 
syringe  or  an  a|>p!icator  upon  which  is  wound  a  piece  of  aseptic 
gauze  or  absorbent  cotton  saturated  with  the  agent.  The  foam 
should  be  removed  and  fresh  applications  made  until  the  cessation 
of  foaming  gives  positive  evidence  that  the  uterine  cavity  has  been 
thoroughly  cleansed.  This  procedure  should  be  practiced  daily 
until  the  temperature  falls  to  normal  and  remains  at  that  point. 
This,  in  the  writer's  experience,  always  occurs  within  a  week. 
The  following  cases  are  illustrative  of  the  efficacy  of  this  mode  of 
treatment : 

Case  J. — Mrs.  H.,  aged  40,  in  her  seventh  labor,  as  the  result 
of  rigid  cervix  and  violent  uterine  contractions,  had  rupture  of  the 
uterus  in  its  long  diameter,  involving  four-fifths  of  the  thickness  of 
the  wall.  Mural  abscess  and  se{)sis  followed,  associatecf  with  pro- 
fuse, offensive  lochia,  the  color  of  dirty  dish-water.  On  the  fiflh 
day  the  uterus  was  above  the  pubis  and  spongy.     The  ordinarily 

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668       The  Atlanta  Medical  and  Sukoical  Journal. 

recommeodec]  treatment  was  practiced  without  improvement,  but 
on  the  eigbth  <Jay  the  method  above  detailed,  with  bydrogeu  per- 
oxide, etc.,  was  instituted  with  the  result  that  the  temperature 
immediately  fell  to  the  normal  poiot  and  the  patient  made  a  good 
recovery. 

Case  2. — Mrs.  D.,  delivered  of  her  third  child  two  months  pre- 
maturely. Baby,  much  emacial«d  in  coDsequcace  of  ioterference 
with  nutrition  from  placental  degeneration,  lived  twelve  hours. 
Within  the  first  five  days  the  temperature  ranged  from  101°  to  105° 
Fahr.,  and  the  usual  concomitant  symptoms  of  sepsis  were  present. 
On  the  sixth  day  after  delivery,  curettage  with  free  douching  of  hot 
salt  solution  was  practiced  and  the  usual  application  of  hydrogen 
peroxide  was  made.  Temperature  taken  half  hour  after  treatment 
showed  a  fall  of  one  degree,  while  on  the  seventh  day  it  was  nor- 
mal. From  this  date  on  convalescence  was  uuinterrupted  and  the 
patient  was  out  of  bed  as  early  as  though  no  complication  bad 
occurred. 

Case  3. — Mrs.  S.,  afler  rapid  delivery,  did  well  for  nine  days, 
when  the  usual  symptoms  of  puerperal  sepsis  appeared,  due  in  all 
probability  to  her  wretched  surroundings,  lack  of  proper  nursing, 
etc.  The  treatment  above  detailed  was  exhibited,  the  temperature 
promptly  returned  to  normal,  and  there  was  speedy  and  satisfac- 
tory convalescence. 

The  raiionaie  of  the  treatment  by  hydrogen  peroxide  is  that  this 
agent  causes  a  rapid  oxidation  or  superoxidatiun  of  effete  organic 
matter,  thus  completing  in  a  very  short  time  what  it  would  take 
the  unassisted  process  of  nature  a  dangerously  long  period  to  ac- 
complish. It  initiates,  but  infinitely  improves  and  accelerates  the 
eHortg  of  the  human  organism  to  remove  offending  foreign  [Date- 
rials.  The  advantage  of  this  agent  over  mercuric  chloride,  carbolic 
acid,  and  other  agents  that  act  chemically,  is  that  it  is  non-corrosive 
and  non-destructive  of  healthy  tissue.  Furthermore,  the  results 
obtained  from  the  use  of  hydrogen  peroxide  are  vastly  superior  to 
those  obtained  by  the  use  of  .any  other  agent,  so  that  the  wHter 
DOW  approaches  the  treatment  of  puerperal  sepsis  with  less  fear  of 
unfortunate  results  than  he  has  ever  before  experienced. 

SIO  We8t  Grace  Street. 


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Asthma  Dub  to  Intra-Nasal  Pressure. 


REPORT    OF    CASES   OF    ASTHMA  DUE    TO    INTRA- 
NASAL PRESSURE. 

Bi  LOUAN  M.  CBICHTON,  M.D., 
Ati,i.hta,  Qx. 

I  have  selected  from  my  record  of  asthma  patients  four  cases 
to  present  for  your  coneideratioD  this  evening;  two  of  these  are 
complete,  radical  cures;  two  are  incomplete,  the  last  two,  I  think, 
being  the  most  interesting  and  instructive. 

While  I  have  been  making  asthma  and  some  other  nasal 
reflexes  a  somewhat  S))ecial  study  for  the  past  few  vears,  and  have 
been  deeply  interested  in  them,  I  have  tried  to  keep  off  of  a 
hobby.  I  have  not  lost  sight  of  the  fact  that  many,  a  great  many 
cases  of  asthma  have  nothing  whatever  to  do  with  the  nose.  I 
have  endeavored  to  keep  clearly  defined  in  my  mind  the  condi- 
tions in  the  nasal  chambers  which  would  be  likely  to  cause  this 
distressing  disease. 

Many  cases  have  applied  to  me  for  treatment,  in  whom  I  did 
not  find  these  conditions;  these  cases  I  have  refused  to  treat,  and 
have  referred  them  to  their  family  physicians,  believing  the  pe- 
ripheral irritation  to  be  elsewhere  than  the  nose. 

These  conditions,  in  all  the  cases  I  have  handled,  have  been 
clear  and  unmistakable;  they  should  be  easily  recognized  by  the 
merest  tyro  in  nasal  surgery;  they  consist  in  malformations  of  the 
nasal  eeptnm  or  intra-nasal  growths  causing  pressure.  Many  mal- 
formations, although  they  may  produce  a  certain  amount  of 
obstruction  to  nasal  respiration,  do  not  cause  any  reflex  trouble; 
the  removal  of  such  malformations  will  be  followed  by  no  results, 
80  far  as  the  reflexes  are  concerned. 

It  has  been  my  observation  that  deformities  of  the  septum 
deflections,  exostoses,  etc.,  are  more  prone  to  cause  reflexes  than 
the  simple  fleshy  enlargements,  such  as  hypertrophied  turbinates, 
polypi,  etc. 

Case  1. — J.  H.,  boy,  aged  fourteen  years.  Referred  by  Dr. 
J.  A.  Childs.     Patient  tall,  fur  bis  age,  perfectly  healthy,  although 


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670       The  Atlanta  Medical  and  Suboical  Joornal. 

extremely  thin.  Has  suffered  from  asthma  since  childhood.  The 
attacks  fir  several  years  becoming  more  severe,  so  distressing  in 
fact,  that  many  nights  sleep  in  the  recumbent  posture  was  impos- 
sible. His  only  rest  was  obtained  by  kneeling  at  the  side  of  the 
bed  and  resting  his  bead  on  a  pillow. 

On  making  a  careiul  examination  I  found  my  jiatient  had  true 
hypertrophy  of  the  middle  and  inferior  turbinate  bodies  of  both 
sides,  the  bodies  pressing  tight  against  each  other,  as  well  as 
against  the  septum. 

To  the  uninitiated  I  would  like  to  explain  that  we  have  three 
forms  of  hypertropliy  of  the  turbinates — the  false,  the  beginning 
stages  of  the  true,  and  the  true.  We  apply  a  four  per  centj  solu- 
tion of  cocain  to  the  turbinate  io  question,  and  wait  ten  minutes. 
If  the  cocain  produces  complete  collapse  of  the  turbinate,  we 
have  a  false  hypertrophy;  if  only  partial,  the  beginning  true  ;  if 
to  no  appreciable  degree,  the  hypertrophy  is  considered  true. 

Finding  the  hypertrophies  iu  this  case  to  be  true,  I  advised 
operation. 

I  reduced  the  turbinates  completely  with  the  galvanocautery, 
and  ordered  a  soothing,  antiseptic  spray. 

Patient  was  discharged  four  years  since  and  has  not  had  an 
attack  of  asthma  during  the  four  years. 

Case  2. — Mr.  R.,  aged  twenty-one  years.  Referred  by  Dr. 
William  Owens  (at  that  time  a  medical  student). 

Mr.  R.'s  general  condition  was  excellent;  no  trouble  except 
asthma,  from  which  he  had  suffered  for  ten  years  or  more ;  was 
forced  to  spend  several  winters  in  Florida,  where  he  was  partially 
free  from  attacks.  The  seizures  were  violent,  distressing  and  of 
long  duration.  Made  a  careful  examination  of  the  nasal  chambers 
and  found  hypertrophy  (true)  of  the  middle  and  inferior  tur- 
binates on  left  side.  On  the  right  side  I  found  a  large  bony 
cartilaginous  projection  from  the  septum,  extending  across  the 
lumen  of  the  nasal  chamber  and  pressing  firmly  into  the  sulcus 
between  the  middle  and  inferior  turbinate  bodies.  At  point  of 
contact  the  raucous  membrane  was  exquisitely  sensitive. 

This  was  such  a  beautifully  marked  case  that  I  promised  the 
patient  a  cure,  something  I  seldom  do. 


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Asthma  I>ue  to  Intra-Nasal  Pbesscre.  671 

I  first  reduced  the  hypertmphied  turbiuates  with  the  galvano- 
<;actery.  I  removed  the  bony  cartilagiDotis  projection  with  the 
suw  aud  chisel,  meeting  witli  coDsiderable  hemorrhage,  on  account 
«f  the  large  size  ot  the  growth. 

I  discharged  patient  about  two  years  since.  He  has  had  abso- 
lutely no  return  of  the  asthma. 

Case  3. — Mrs.  M,,  aged  about  thirty-six.  Referred  by  Dr. 
"\V.  S.  ElkiD. 

Patient  a  largo,  vigorous  woman,  absolutely  healthy  with  the 
exception  ot  being  a  great  sufferer  from  asthma.  The  attacks 
were  especially  violent  iu  the  autumn,  many  nights  steep  in  the 
recumbent  posture  being  impossible.  Patient  had  taken  all  the 
remedies  in  the  catalogue,  \vith  only  temporary  relief;  was  forced 
to  seek  the  high  altitude  of  Roao  Mountain,  where  she  was  par- 
tially comfortable. 

I  found,  on  examination,  true  hypertrophy  of  the  middle  and 
inferior  turbinate  bodies  on  lett  side.  On  the  right  side  a  bony- 
cartilaginous  projection  from  the  septum,  extending  extirely  across 
the  lumen  of  the  nostril  and  pressing  tightly  between  the  middle 
«nd  inferior  turbinates;  the  mucous  membrane  at  point  of  contact 
was  exquisitely  sensitive. 

I  attacked  the  turbinates  first,  as  is  my  custom,  reducing  them 
sufficiently  to  relieve  all  pressure  and  to  give  perfect  breathing 
space.  I  then  removed  the  bony  cartilaginous  projection  from  the 
septum  with  the  nasal  saw  and  chisel. 

These  operations  were  performed  in  July,  August  and  Septem- 
ber, 1895.  The  result  of  the  work  seemed  all  that  any  one  could 
<lesire ;  patient  had  absolutely  no  indications  of  asthma  for  nearly 
two  years,  and  here  the  extremely  interesting  and  instructive 
record  begins:  In  the  fall  of  1897  patient  came  to  my  office 
much  distressed  and  worried,  saying  she  had  suffered  from  an 
attack  of  asthma  the  night  previous. 

Examined  the  nasal  chambers  for  some  point  of  prossnre,  to 
account  (or  this  unexpected  return  of  the  old  trouble.  Found 
both  nasal  chambers  seemingly  in  perfect  condition ;  tilting  the 
head  back,  I  brought  into  view  the  upper  middle  turbinate  area; 
here  I  found  polypoid  degeneration  of  the  turbinate  body,  causing 


^dbyGoOgle 


672       The  Atlanta  Medical  and  Surgical  Johrsal. 

the  body  to  press  tightly  against  the  septum.  Thioking  this  suffi' 
cieut  cause  for  the  asthmatic  attack,  I  tboroiigbly  refiaoved  the 
eulargement  with  the  galvaoo cautery.  Patieot  had  several  slight 
manifestatioDS  of  asthma  during  the  following  two  or  three  days^ 
they  then  ceased  entirely.  I  did  not  eee  patient  again  for  one 
year;  ehe  then  presented  herself,  reporting  an  attack.  Exam- 
ination revealed  an  hypertrophy  of  the  middle  turbinate,  imme- 
diately below  the  site  of  the  operation  of  the  year  before.  I  used 
the  ga  Ivan  oca  utery  at  this  point  aud  patient  had  no  manifestatioD 
of  asthma  for  a  week  ;  ahe  then  returned,  reporting  an  attack  tbe 
night  before.  Examination  showed  that  I  had  not  removed  the 
hypertrophy  sufficiently  and  that  there  was  still  marked  pressure 
between  tbe  middle  turbinate  and  the  septum.  I  cauterized 
very  thoroughly  at  tbis  point,  shrinking  tbe  turbinate  clearly  away 
from  the  septum.  Patient  had  several  sligbt  attacks  after  this, 
due  to  tbe  swelling  at  poiut  of  operation.  Since  that  time  she- 
bos  had  no  return  whatever. 

This  case  to  me  is-one  of  tbe  clearest  of  cause  and  effect  that  I 
have  ever  bandied. 

Case  4. — Mrs.  B.,  aged  twenty-five  years.  Brought  to  me  by 
her  husband,  a  student  iu  the  Atlanta  Medical  College.  Patient 
extremely  thio,  with  a  distressed  look  about  the  face.  Patient  had 
been  subject  to  asthmatic  attacks  for  some  seven  or  eight  year^. 
Had  lost  flesh,  Irom  one  huudred  and  fifty  pound  to  ninety-eight 
pounds.  The  seizures  for  the  past  few  years  had  been  extremely 
severe  aod  of  almost  daily  occurrence.  All  the  asthma  remedies 
were  tried;  none  seemed  to  give  relief  except  morphia,  so  mor- 
phia was  used  liberally,  with  tbe  usual  unhappy  result. 

Examination  revealed  almost  identically  the  same  condition 
found  in  case  3  ;  namely,  true  hypertrophy  of  tbe  middle  and 
inferior  turbinates  on  left  side  aud  a  bony  cartilagioou.s  projectioa 
from  the  septum,  passing  across  tbe  lumen  of  the  nasal  chamber 
and  pressing  firmly  against  the  lower  margin  of  tbe  middle  turbi- 
nate body. 

I  reduced  both  turbinates,  fnlly  relieving  all  pressure  and 
giving  free  breathtog  space,  theu  removed  the  bony  cartilaginous 
growth  with  saw  and  chisel.     The  asthmatic  attacks  ceased  almost 


^dbyGoOgle 


Some  Complications  in  Obstetrical  Practice.        673^ 

entirely.  Patieul  lived  out  of  the  city,  aod  had  to  come  in  twice 
weekly  to  my  office.  Duriag  these  visits  she  would  invariably 
buy  morphia.  Her  husband  stated  the  case  to  me  and  decided 
that,  as  she  was  practically  cured,  he  thought  it  best  to  stop  her 
visits  to  the  eity ;  in  this  I  agreed  with  him. 

Fourteen  months  after  this  patient  came  to  ray  office  and 
reported  that  she  had  had  only  three  or  four  slight  attacks  since 
the  last  time  she  bad  seen  me.  She  had  improved  very  much  in 
general  condition  and  had  gained  twenty>three  pounds  in  weight. 

I  will  say,  in  conclusion,  that  although  I  do  not  believe  all 
cases  of  astbraa  are  due  to  intranasal  pressure,  I  believe  a  great 
many  are,  and  that  in  a  disease  as  intractable  and  as  difficult  to 
handle  as  this,  the  nose  should  invariably  be  investigated  and 
examined  with  great  care. 


SOME  OF  THE  COMPLICATIONS  THAT  ARE  MET  WITH 
IN  OBSTETRICAL  PRACTICE.* 

By  WALTER  A.  CROWE,  M.D., 
Ati,anta,  Ga. 

In  the  short  paper  that  I  have  presumed  to  read  to-nigbt,  I  will 
give  the  results  of  ray  own  observations  aud  opinions,  based  on 
personal  experience  in  this  class  of  work;  aud  for  this  reason  I 
hope  to  elicit  a  free  discussion  and  opinion  from  the  fellows  of  the 
Society.  I  propose  to  discuss  the  mecbauical  managemeut  of  labor 
as  met  with  under  certain  conditions. 

For  the  obstetrician  to  render  a  safe  and  intelligent  service  in 
these  cases,  it  is  absolutely  necessary  that  he  should  have  a  clear 
conception  of  the  most  minute  detail  in  the  mechanism  of  labor, 
and  to  be  of  more  service  thau  that  of  an  ordinary  "granny,"  it 
is  imperative  that  he  should  make  a  correct  diagnosis  as  early  as 
possible  in  regard  to  both  presentation  and  position  ot  tbe  child. 
This  I  confess  is  not  always  an  easy  matter;  under  certain  condi- 
tions it  is  sometimes  a  most  difficult  task,  but  with  patience,  prac- 
•Keul  balore  the  Atlaota  Society  ol  Medicine. 


^dbyGoogle 


674       TuE  Atlanta  Medical  and  Surgical  Jodrnal. 

tice  and  perseverance  a  fairly  accurate  opinion  can  be  given.  The 
metbodn  used  in  diagnosis  are  abdominal  palpation,  vaginal  ex- 
amination (digital)  and  locating  the  fetal  heart  sounds. 

Abdominal  palliation  I  consider  among  the  most  important  of 
these  methods,  and  I  am  inclined  to  think  the  general  practitioner 
lias  not  fully  appreciated  the  amount  of  diagnostic  information  to 
be  gained  by  this  method  of  examination.  It  is  quite  difficult  for 
the  beginner,  which  is  also  true  in  auscultation. of  the  chest,  but  by 
perseverance  and  practice  we  are  soon  able  to  feel  and  hear  that 
which  we  would  otherwise  fail  to  recognize. 

The  most  favorable  time  for  abdominal  palpation  is  before  labor 
begins  or  during  the  interim  of  the  pains  in  the  early  stages.  The 
examination  per  vaginam  is  not  always  fiatislactory,  and  it  is  with 
extreme  difficulty  in  some  cases  that  we  can  learn  more  than  the 
presentation  without  giving  an  anesthetic  and  introducing  a  portion 
or  the  whole  band  into  the  vagina. 

Ill  about  20  per  cent,  of  the  vertex  presentations  the  occiput  is 
either  right  or  left  [wsterior,  and  in  from  95  to  98  per  cent,  of  these 
occi  pi  to-posterior  cases  the  occiput  will  rotate  to  the  front  and  then 
labor  progresses  normally.  The  conditions  that  favor  this  rotation 
to  the  front  are  flexion,  good  pains,  and  a  good  firm  pelvic  floor.  It 
is  the  counteracting  force  of  those  muscles  that  make  up  the 
pelvic  floor — viz. :  Levator  aui,  obturator  internus,  pyriformis,  and 
coccygeus — that  causes  the  occiput  to  strike  the  anterior  plane  and 
rotate  to  the  front;  otherwise  the  occiput  sinks  down  into  the  hollow 
of  the  sacrum, and  then  we  have  what  is  called  persistent  occipi to-pos- 
terior position,  which  then  becomes  a  very  serious  condition  to  both 
mother  and  child.  The  death-rate  to  the  child  runs  .from  10  to  15 
per  cent. J  and  it  is  almost  impossible  to  deliver  these  cases  without 
more  or  less  damage  to  the  soft  [larU  of  the  mother. 

These  cases  are  necessarily  stow  and  tedious,  and  are  very  trying 
to  the  strength  of  the  patient  if  left  alone. 

The  means  of  relief  that  we  have  at  our  disposal  is  either  high 
forceps  delivery, or  to  turn  and  deliver  by  the  feet.  Each  of  these 
measures  has  its  proper  place  and  is  justifiable,  but  I  am  loath 
to  recommend  the   indiscriminate  use  of  the  forceps,  especially  ia 


^dbyGoOgle 


Some  Complicatioss  is  Obstetrical  Practice.        675  • 

unskilled  bands,  where  tbe  possibility  of  doing  such  serious  damage 
is  so  great. 

I  am  iDclined  to  consider  version  as  the  safer  of  the  two 
methods  in  a  great  many  of  these  c-asea.  I  have  had  two  such 
cases  in  my  practice  in  the  last  few  months,  and  delivered  without 
any  trouble  whatever;  in  both  of  these  cases  the  membranes  had 
rugitured  and  waters  escaped.  This  is  not  always  possible  or  even 
advisable  on  account  of  the  possible  danger  of  rupture  of  the 
uterus,  but  in  cases  with  thin  abdominal  walls  and  leeble  iiterlDe 
-contractions  it  is  very  easy  to  perform,  and  with  less  risk  than  tbe 
high  forceps  delivery  in  this  same  class  of  cases. 

Rupture  of  the  perineum. — This  is  the  most  common  laceration  of 
the  birth-canal  and  leads  to  a  multitude  of  after  ailments  that  re- 
quire the  services  of  the  gynecologist  to  promise  any  hopes  of  re- 
lief or  cure.  All  tears  that  involve  more  thau  the  fonrchett«  should 
be  repaired  at  ooce,  and  while  satisfactory  results  can  be  obtained 
under  favorable  conditions,  still  I  am  confident  that  a  large  number 
of  these  cases  fail  to  get  the  satisfactory  union  of  muscular  structure 
that  is  so  essential  to  the  support  and  healthy  condition  of  the 
pelvic  organs. 

So  it  demands  our  most  careful  attention  both  in  prevention  and 
cure.  As  a  preventive  a  number  of  measures  have  been  suggested, 
such  as  support  of  the  perineum,  applicalion  of  hot  cloths,  etc., 
all  of  which  are  of  little  value  in  themselves.  I  believe  more  can 
be  accomplished  by  placing  the  woman  on  her  side  when  the 
head  begins  to  press  on  the  outward  parts,  so  as  to  keep  the  parts  in 
view,  then  by  proper  pressure  keeping  the  shortest  diameter  of  the 
]>resenting  |»art  within  the  outlet;  also,  by  retarding  too  hasty  de- 
livery, a  great  deal  can  be  accomplished,  but  from  my  observation 
I  am  inclined  to  the  opinion  that  more  tears  are  caused  from  tbe 
hasty  and  improper  delivery  of  the  shoulders  than  from  the  pas- 
sage of  the  head.  To  be  able  to  anticipate  and  correct  these  con- 
ditions marks  out  the  true  worth  and  ability  of  the  obstetrician, 
also  gives  to  the  patient  the  intelligent  service  that  is  justly  ex- 
pected of  any  one  who  assumes  the  responsibility  of  a  labor  ease. 


^dbyGoOgle 


SOCIETY  ^EPO^TS. 


ATLANTA  SOCIETY  OF  MEDICINE. 

The  Atlanta  Society  of  MediciDe  beli3  its  regular  meetiog  on  tht 
evening  of  November  3d,  in  tbe  Society's  rooms.  The  President, 
Dr.  W.  L.  Champion,  presided.  Tbe  first  paper  of  the  evening 
was  read  by  Dr.  \V.  A.  Crowe,  on  "Some  Personal  Views  on  the 
Management  of  Persistent  Occipito-Posterior  Presentations  (pub- 
lished elsewhere). 

Dr.  V.  O.  Hardon  opened  tbe  discussion.  The  speaker  said 
that  tbe  snbject  here  presented  was  a  very  important  one,  especially 
on  two  or  three  points.  His  views  differed  in  some  degree  from 
those  of  the  author  of  the  pa|)er.  He  agreed  fully  as  to  tbe  im- 
portance and  value  of  external  palpation  in  determining  the  posi- 
tion of  the  fetus.  In  the  large  majority  of  cases,  and  only  in 
those  where  the  abdomen  is  covered  by  a  large  amount  of  adipose 
tissue,  the  diagnosis  t>f  presentation  can  always  be  made.  Expe- 
rience and  education,  however,  are  necessary  in  order  to  obtain  the 
lactua  ei-udiltia.  He  examines  the  patient  before  and  during  labor. 
Yet  we  cannot  confidently  predict,  even  up  to  tbe  niuth  months 
what  will  be  the  position  when  labor  comes  on,  for  tbe  presenta- 
tion sometimes  changes.  This  was  illustrated  by  a  case  recently 
had  in  practice.  No  man  can  always  be  sure  as  to  position  of  the 
fetus,  even  with  the  best  landmarks.  We  cannot  always  locate 
perfectly  the  foutanelles  by  digital  examination,  nor  are  the  sutures 
always  distinct.  All  of  us  are  liable  to  error  by  digital  eiamion- 
tion,  and  bence  the  value  of  external  palpation.  This  latter  too 
is  valuable  in  changing  the  position  of  the  fetus  if  such  be  neces- 
sary. In  regard  to  occi  pi  to- posterior  positions,  such  produce 
long,  tedious  labors,  twenty-four,  thirty-six  and  even  forty-eight 
hours  in  duration.  Long  labor  is  dangerous  to  child  and  to  the 
mother,  especially  the  second  stage. 

How  can  labor  be  hastened? 


^dbyGoogle 


Society  Reports.  677 

1.  We  may  turn  and  deliver  by  breech.  This  increases  the  daa- 
ger  to  both  mother  and  child,  for  it  is  not  easy  of  performance, 
llis  own  experience  is  that  forceps  should  be  used  just  as  soon  as 
"we  6nd  out  that  the  occiput  will  not  rotate  to  the  front.  Even 
when  the  head  is  high  up  in  the  pelvis  we  should  use  the  forceps; 
using  traction  slowly  upon  the  rods  and  aiding  anterior  rotation. 
The  axis-traction  for<;epB  can  be  used  with  advantage.  But  when 
there  is  no  tendency  to  rotate,  then  we  will  have  a  long,  tedious 
labor  with  danger  to  both  mother  and  child,  and  of  rupturing  the 
perineum;  and  even  this  latter  can  be  limited,  for  such  a  rupture 
is  better  as  compared  with  the  danger  to  mother  and  child,  by  at- 
tempting version. 

2.  laceration  of  the  perineum.  Men  who  do  not  have  lacera- 
tions ID  their  practice  do  not  look  for  them.  The  great  desideratum 
is  to  delay  the  head  until  we  cau  obtain  the  shortest  diameter  tor 
the  passage — i,  e.,  the  sub-occipito-bregmatic.  You  caunot  support 
the  perineum  by  pressure,  and  such  a  theory  is  erroneous. 

3.  Rectal  expression,  during  the  intervals  of  pain,  is  an  excellent 
procedure,  and  one  which  the  speaker  frequently  used.  Laceration 
of  the  perineum  is  a  comparatively  light  thing  except,  of  course, 
when  it  is  extensive  and  down  into  the  bowel;  and  the  speaker 
would  not  sacrifice  mother  and  child  for  the  sake  of  the  perineum. 

Dr.  Kime.  This  is  a  very  practical  subject,  and  it  would  be 
strange  if  all  doctors  agreed  as  to  the  method  of  treatment.  He 
agreed  with  the  last  speaker  that  to  put  the  hand  into  the  uterus 
for  version  is  indeed  a  dangerous  risk.  It  is  all  right  when  the 
manipulations  are  external,  but  when  you  carry  yonr  hand  into  the 
uterus  and  therefore  a  possible  infection,  the  danger  is  increased. 
He  preferred  the  forceps,  even  though  there  was  more  opportunity 
for  rupturing  the  perineum.  He  did  not  believe  in  such  a  thing 
as  '*  support  to  the  perineum,"  and  this  was  the  view  held  by  the 
best  authorities.  He  believed  that  the  effort  to  support  was  fruit- 
less and  frequently  produced  just  the  condition  we  wished  to  avoid. 
He  believed  in  manipulating  the  child's  head  during  the  intervals 
of  pain,  and  trying  to  adjust  the  head  for  the  shortest  diameter. 
He  used  the  rectal  expression. 


^dbyGoOgle 


678       The  Atlanta  Medical  and  Suroical  Journal. 

Dr.  Love.  He  believed  in  studying  more  closely  external  ma- 
nipulation 80  as  to  become  familiar  with  its  use.  He  reported  a 
case  where  external  palpation  showed  its  efficacy.  He  thought 
that  physicians  were  too  much  afraid  of  the  use  of  foreejis.  He 
believed  in  their  more  frequent  use. 

Dr.  Amster.  The  speaker  related  a  case  showing  where  posi- 
tions of  the  fetus  sometimes  change  after  a  diagnosis  has  beeu  made. 
On  examining  the  case  iu  the  morning  before  labor  had  commenced 
he  found  a  breech  presentation,  and  when  called  at  five  o'clock  the 
same  adernoon,  labor  having  commenced,  he  f6und  the  head  pre- 
senting- He  uses  rectal  expression,  but  not  during  the  intervals. 
He  uses  it  with  the  pain  and  retards  too  rapid  progres^i  of  the 
child. 

Dr.  Gaston,  Jr.  The  speaker  had  been  pleased  with  the  remarks 
of  the  evening.  He  believes  that  support  of  the  perineum  dur- 
ing labor  is  unnecessary.  He  believes  that  the  passage  of  the 
shoulders  is  the  most  frequent  cause  of  laceration.  He  believes 
also  that  long  labors  are  frequently  salutary  in  causing  an  adjust- 
ment of  the  jiarts.  He  would  urge  the  necessity  of  retarding  the 
rapid  egress  of  the  shoulders. 

Dr.  Hood,  Speaker  never  has  had  a  rupture  from  head  but 
from  shoulders  of  child.  Finds  no  value  from  supporting  the 
perineum.  Has  not  had  much  difficulty  in  making  out  (be  presen- 
tation except  in  his  first  case,  where  he  put  his  finger  in  the  anus 
for  the  roouth. 

Dr.  Crowe  (in  closing)  said  be  was  glad  to  find  so  little  differ- 
ence between  the  views  of  the  various  speakers  and  himself. 

Dr.  Childs  read  a  short  paper  on  the  history  of  the  urethrascope 
and  the  cystoscope,  and  then  presented  a  new  cystoscope  which  he 
had  originated  and  which  had  just  beeu  made  for  him  by  Tre- 
mann  &  Co. 

NOTICE.— Thin  JOURNAL  and  TUE  INTBRNATIOSAL 
JOURNAL  OF  SVnGERY  one  year  for  92.00  cash. 


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CORRBSPONDBNCB. 


POSTPONEMENT  OF  THE  THIRD  PAN-AMERICAN 
MEDICAL  CONGRESS. 

International  Executive  Commission 
OF  THE  Pan-American  Medical  Congress. 
Office  of  the  Sechbtabv, 
Cincinnati,  November  6,  1898. 
Mv  Dear  Sir: — I  have  the  houur  to  aiiuotince  that  id  A|ml, 
1898,  I   received  from  Dr.  Jok*^-  Manuel  tie  los  Rios,  Chairman   of 
the  Committee  on  Organization  of  the  111  Pan-American  Medical 
Conftrews,  a  request  that,  in  consequence  of  the  then  existing  rebel- 
lion in  Venezuela,  no   definite  arraugement.s    be  made  at  that  time 
relative  to  the  meeting  of  the  Congreaa  previously  appointed  to  be 
held  in  Caracas  in  December,  1899, 

The  following  commuaication  relative  to  the  same  subject  is  just 
at  hand: 

Caracas,  Septeml)er  25,  1898. 
Dr.  Charles  A.  L.  Reed,  Secretary  of  the  Inlernational  Executive  Com- 
musion,  Cini^innati,  Ohio: 
Dbae  Sir: — After  having  sent  my  commnjiication  dated  April 
last,  I  find  it  to  be  my  duty  to  notify  you  that,  although  the  con- 
siderations pointed  out  in  it  have  already  ended,  our  country  has 
been  scourged  by  smallpox  which  has  taken  up  all  our  physicians' 
activities  and  time,  depriving  them  of  going  into  scientific  works. 
And,  as  that  state  of  mind  of  our  people  and  government  after  such 
calamities  as  war  and  epidemic  would  greatly  enterfere  with  the 
good  success  of  our  next  meeting,  I  beg  leave  to  tell  yon,  in  order 
you  will  convey  it  to  the  luteroational  Executive  Committee,  that 
our  Government  and  this  Commission  would  be  grateful  to  have 


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€80      The  Atlanta  Medical  asd  Sdroical  Journal. 

the  meetiDg  which  was  to  take  place  in  Caracas  in  Pecember,  1899, 
adjouroed  for  one  year  later.     I  am,  dear  Doctor, 

Yours  respectfully, 

The  President. 
[Sigued.]     Dr.  Jos£  Makdel  de  lob  Rios. 

In  accordance  with  the  request  of  the  Government  of  Venesuela, 
and  of  the  Committee  on  denization,  the  111  Pan-American 
Medical  Congress  is  hereby  postponed  to  meet  iu  Caracas  in  Decem- 
ber, 1900. 

For  the  International  Executive  CommiEsion. 

Charles  A.  L.  Reed, 
Secretary. 

KOTICE.-Thin  JOVBNAL  and  THE  IXTEBXATIOyAL 
JOURNAL  OF  SURGERY  one  year  for  SZ.OO  ea»h. 

For  Ivy  Poisoning. 
Keep  affected  parts  wet  with  freshly  made  lime-water.     Give  the 
following  mixture  iutemally: 

B    EiUtritici  fl 3  it. 

Spts.  etberi*  nitroii )  -  . 

Syr.  limoDU  /"' 3  '• 

H.     SIg.     One  teispoooful  four  times  a  day. — Ex. 

Removal  of  Freckles. 

1.  Apply  the  following  lotion  to  the  face  morning  and  eveuiDg: 
R     Zinci  lulphocarbolat _3  i. 

Glycerini -5  ii. 

M.    Sig.     External  aie. 

2.  Cover  the  freckles  every  other  day  with  the  following  oint- 
ment: 

B     Hjdrarg.  ammoniat  \ 

BUniuth  aubnltrat      (** 5 '■ 

Oifcerit  amjl„ 5  u. 

II.     Ft.  ungt.     8ig.     Bxtaroal  use.— Ibntwruiint— £1. 

NOnOB.— Thii  JOUKNAI.  and  THE  IHTKINATIONAL  JOUB- 
NAI,  OP  SVBOBBT  ono  ^mt  for  12.00  osali. 


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EDITORIAL  NOTES  AND  COMMENTS. 


Tba  BdbIdcu  oOIm  of  Tni  Jodbkil  Ib  SOB.  KM  PttMn  Building. 

Tbe  Sdltorlal  oIDce  U  Room  101.  <09  Grand  Open  Housa. 

AddresB  all  Biulness  eommanlotloiia  to  Dr.  U.  B.  Hutoliltia,  Ugr. 

Ukke  lemlttanaea  pajkUe  lo  The  Atlaijti  Medical  and  SnsaiCAL  JOUBNU- 

On  matti^n  perlalnlag  lo  the  Xdllorlkl  and  Origin*!  commonlc&tioiiB  addrew  Dr.  Danb^r 
Sor,  Grand  Open  Hoase,  AtUala. 

BeprlnU  of  original  artlclea  irlU  ba  furnished  at  ooat  piioc.  BeqnesU  tor  the  Buua 
•honld  aliini;s  be  made  on  the  moniucWjit. 

We  vUI  preMDt,  potl-pald,  on  request,  to  each  Dontrlbnlot  of  an  original  artlole,  tweo^ 
ilXf]  marked  coplea  of  The  Joubnai  ooaninlng  sueh  article. 


CHRISTIAN  SCIENCE  AND  DEATH. 

UNDER  this  editorial  c&ption  the  Boston  Medical  and  Surgical 
Journal  has  expressed  itself  in  no  uncertain  terms,  and  the 
views  thus  held  correspond  entirely  with  our  own.  The  era 
cf"&ds"  will  never  cease,  and  none  seem  so  mythically  winsome  as 
the  much  heralded  Christian  Science.  What  Boston  is  to  the 
North  as  a  center  for  this  peculiar  sect  of  people,  Atlanta  is  to  the 
South  in  a  similar  relation.  Strange  deluded  people  to  be  led 
away  by  such  strange  nonsensical  fanaticism!  But  "religious 
craze  "  is  the  most  common  of  all  insanities,  and  wejudge  that  there 
will  be  insane  people  as  long  as  the  world  shall  last.  Those  who 
-die  under  the  administration  of  the  Christian  Science  faith  believe 
that  such  a  death  is  that  of  a  martyr  and  the  survivors  go  on  re- 
joicing that  one  more  has  been  added  to  a  righteous  band.  Only 
in  the  last  month  lias  the  death  of  a  victim  been  chronicled  in  the 
daily  newspaper  right  here  in  Atlanta  who  refused  to  change  a 
"spiritual  administrator"  for  a  physician  in  good  standing.  The 
neighbors  raised  a  huge  cry  against  the  practice  of  such  barbarity. 


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682       The  Atlanta  Medical  ahd  Sdrgical  Jodrnal. 

but  his  family  declared  that  "  bis  spiritual  faith  was  overcome- 
by  physical  death."  ReceDtly  Mr.  Harold  Frederic,  the  author  of 
that  popular  oovel  "The  DamDatiou  of  Theroo  Ware,"  died  in 
Eoglaad  aud  was  treated  during  his  illness  by  oue  of  the  ChristiaD. 
Scientists.     We  present  below  what  the  Journal  says: 

The  very  recent  death  of  Harold  Frederic,  the  clever  noveliBt 
and  widely-known  London  correspondent  of  the  New  York  Timet, 
from  heart  disease,  for  which  he  bad,  uutil  a  few  days  before  his 
death,  received  " absent  treatment"  from  a  certain  Mrs.  Mills,  a 
Christian  ScieutisI,  has  attracted  very  general  attention. 

It  is  reported  at  the  inquest,  which  was  adjourned  till  Wednes- 
day, October  26lh,  Mr.  Frederic's  daughter  Kuth  said  her  father 
did  not  believe  in  doctors.  She  added  that  it  was  with  bis  consent, 
but  under  the  iuflueoce  of  others,  that  Mrs.  Mills,  a  Christian 
Scientist,  was  summoned  to  attend. 

Kate  Lyon,  a  member  of  the  Frederic  household,  testified  that 
the  deceased  had  asked  her  to  call  in  Mrs.  Mills,  and  the  latter 
came  to  the  bouse  and  expounded  the  system  followed  by  the 
Christian  Scientists.  On  the  following  day  Mr.  Frederic  dismissed 
the  doctors  who  had  been  in  attendance  on  him. 

Most  of  Mrs.  Mills's  treatment,  continued  the  witness,  was  what 
was  known  as  "absent  treatment."  At  the  request  of  frieuds  ot 
the  sick  man,  the  doctors  were  again  summoned,  but  the  patient 
informed  them  that  when  they  had  previously  been  attending  him 
he  had  not  followed  their  directions. 

During  this  same  month  of  October,  the  death  of  another  gen- 
tleman of  considerable  education  and  social  position,  Major  Cecil 
Lester,  Instructor  at  the  Sandhurst  Royal  Military  College,  occur- 
red in  England  whilst  under  the  "absent"  and  present  treatment 
of  another  female  Christian  Scientist,  a  Mrs.  Grant;  this  ca^  has 
also  attracted  much  atleotion,  and  is  the  subject  of  au  editorial  ia 
the  Lancet  of  October  15,  under  the  title  of  unchristian  nescience- 


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Editorial,  683 

From  the  medical  Boieoce  point  of  view,  the  two  cases  exhibit 
important  differences;  from  the  Cbriatian  Science  point  of  view 
they  were  alike  fit  for  the  practice  of  absent  treatment  by  persona 
who  knew  nothing  whatever  of  the  diiseases  from  which  the  patients 
eufTered,  and  who  evidently  considered  this  a  detail  of  no  conse- 
quence. 

In  each  case  there  was  an  inquest  which  verified  the  diagnosis 
and  justified  the  treatment  and  prognosis  of  the  medical  men  orig- 
inally summoned  to  the  patients. 

Frederic  was  a  self-educated,  self-made  man,  with  some  of  the 
contempt  for,  or  impatience  with,  the  conservative  experience  of 
the  past  which  that  class  of  man  is  apt  to  ealertain.  He  was  of 
fine  physique,  and  died  at  the  age  of  forty-two,  from  cardiac  and 
other  complications  supervening  upon  a  previous  attack  of  acute 
rheumatism.  The  post-mortem  examination  established  the  fact 
that  with  what  medical  science  would  call  proper  treatment,  he 
would  now  be  alive  with  an  excellent  chance  for  ultimate  recovery 
of  good  health. 

Major  Lester  suffered  from  tuberculous  peritonitis.  His  physi- 
cians told  the  family  there  was  little,  if  any,  hope  of  his  recovery, 
but  that  much  might  be  done  to  alleviate  his  discomforts.  Upon 
this  Mrs.  Grant  was  telegraphed  to,  and  she  commenced  her  treat- 
ment at  once,  before  seeing  the  patient,  "by  what  she  should  call 
taking  up  the  right  thought  of  the  omnipotence  and  love  of  God." 

In  Frederic's  case,  it  was  largely  the  patient  himself  who  in- 
sisted upon  Christiau  Science,  and  secretly  neglected  other  treat- 
ment when  originally  provided.  In  Major  Lester's  case  it  was  the 
friends  who,  learning  the  verdict  of  the  physicians,  cherished  the 
"rational  and  reasonable  hope"  that  there  might  be  something  in 
the  Christian  Science  treatment  which  would  lead  to  recovery.  At 
the  inquest  on  this  latter  case,  the  jury  added  to  their  verdict  riders 
expressing  their  entire  satisfaction  with  the  treatment  and  action  of 


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684       The  Atlanta  Medical  and  Subgical  Jodenal. 

the  physicianB,  and  "th^rsenseof  abborrence  at  tbe  so-called  treat- 
metit  of  the  deceased  by  Mrs.  Graot,  as  representiog  tbe  ChrietiaD 
Scientist  Society,  ia  Dot  asiiig  material  means  for  tbe  alleviation  of 
his  suffering." 

Tbe  contemplation  of  this  suflereir's  death-bed  leads  tbe  Lancet 
"  to  pass  briefly  in  review  tbe  reasons  given  by  tbe  exponent  of  the 
Christian  Science  treatment  for  the  hope  that  is  in  ChrisUao 
treatment — an  excellent  and  taking  phrase,  but  snrely  a  mis- 
nomer from  beginning  to  end.  Mrs.  Grant  told  tbe  jury  that 
she  gave  no  material  remedy  to  alleviate  the  pain.  Where 
was  tbe  treatment?  Mrs.  Grant  told  the  jury  that  she  had  no  ex- 
perience in  the  treatment  of  peritonitis ;  yet  she  commenced  her  ^ 
treatment  directlysbe  got  the  telegram  and  before  she  had  seen  the 
patient.  Where  was  the  science?  Mrs.  Grant  'taking  up  the  right 
thought  of  the  omnipotence  and  love  of  God,  told  the  jury  that  she 
did  not  believe  that  suffering  was  sent  by  God,  and  she  contended 
that  Jesus  Christ  never  seat  tbe  sick  to  physicians.  If  the  agony 
at  Calvary  for  man's  redemption  was  a  God-seot  reality,  and  if  the 
Miraculous  Healer  told  the  Pharisees  that  'they  that  be  whole 
need  not  a  'physician,  but  they  that  are  sick,'  wher«  is  the  Chris- 
tianity of  the  Christian  Scientist  ? 

"  Though  sufficiently  vital  to  demand  notice  we  have  no  desire 
here  to  labor  this  aspect  of  the  question.  We  feel  it  rather  to  be 
our  duty,  our  solemn  duty,  to  warn  Christian  Scientists  of  tbe 
grave  responsibility  which  they  incur  in  regard  to  tbe  health  and 
lives  of  their  fellow-beings'  We  must  point  out  that  their  methods 
of  so-called  treatment  are  ignorant  devices,  spurious  in  themselves, 
and  altogether  unscientific  and  opposed  to  common  sense.  The 
Christian  Scientist  talks  as  if  his  (merely  human)  activities  were 
set  in  motioD  and  pervaded  by  an  atmosphere  of  divine  potentiali- 
ties. Ip  an  almost  flattering  way  he,  as  it  were,  '  stands  in  *  with 
God,  or,  as  coroner  Eoumieu  bluntlyput itat  the  inquest,  he  'tries 


^dbyGoOgle 


Editokial.  685 

to  Qsarp  the  spedal  power  which  Christ  had.'  We  feel  it,  iurther, 
to  be  our  duty  to  point  out  that  apart  from  evilB  which  may  result 
to  individual  memhers  of  the  community  from  it,  the  Christian 
Science  treatment  is  neither  more  nor  less  than  a  Jin-de-aiicle  fad,  a 
drawing-room  cult,  and  that  it  is  the  counterpart  of  the  culpable 
negligence  which  has  brought  the  peculiar  people  of  the  less  educated 
claases  within  the  range  and  operation  of  the  criminal  law  of  the 
country." 


THE  BUBONIC  PLAGUE  IN  VIENNA. 

THIS  dreaded  disease  has  claimed  six  victims  in  the  Austrian 
capital  as  the  result  of  experimental  researches  in  the  labora- 
tory of  Prof.  Hermann  Nothnagle.  This,  indeed,  is  an  unfortunate 
occurrence,  especially  as  it  seems  to  have  occurred  as  the  result  of 
scientific  eiperimeots.  The  PhUadelpkia  Medicai  Journal  has  this 
to  say: 

"We  have  to  record  the  melancholy  intelligence  of  an  unfortu- 
Date  outbreak  of  bubonic  plague  in  the  Austrian  capital.  Some 
days  ago,  Herr  Barisch,  an  employee  in  Professor  Hermann  Noth- 
nagle's  laboratory,  while  participating  in  investigations  concerning 
the  plague-bacillus,  contracted  the  disease,  and  after  a  few  days'  ill- 
ness succumbed  on  October  8th.  The  excitement  occasioned  by 
the  announcement  of  this  death  was  only  augmented  by  the  addi- 
tional intelligence  that  the  two  nurses  who  had  attended  Herr 
Barisch  themselves  showed  manifestations  of  the  disorder.  Almost 
immediately  it  was  announced  that  Dr.  Franz  Herman  MUller, 
who  bad  been  assiduous  in  his  attentions  to  Herr  Barisch,  was 
attacked  and  became  very  ill,  and  that  the  wife  of  Herr  Barisch 
and  another  assistant  showed  symptoms  of  the  disorder.  Popular 
excitement  ran  high,  and  the  city  is  said  to  have  been  thrown  on 
the  verge  of  a  panic  by  the  death  of  Dr.  Mflller  on  October  23d. 


^dbyGoogle 


686       The  Atlanta  Medical  ahd  Soroical  JontHAL. 

As  we  go  to  prese  there  have  been  reported  six  cases  with  two  deaths. 
The  appreheosioQ  of  the  iohabitants  of  the  city  seems  not  to  have 
been  allayed  by  the  extraordiDary  precautioDs  taken  to  prevent  the 
spread  of  the  disease.  The  body  of  Herr  Barisch  was  securely 
wrapped  in  clothes  saturated  with  germicides,  placed  in  a  double 
coffin,  and  hermetically  sealed.  The  other  patients  were  placed  in 
an  isolation-building  and  are  attended  by  Dr.  Poech,  a  volunteer 
physician  and  two  Sisters- of  Charity.  Neither  egress  nor  ingress  is 
permitted.  Four  other  suspects  have  also  been  carefully  isolated. 
All  the  animals  used  for  experimental  purposes  in  Professor  Koth- 
nagle's  laboratpry  were  killed  and  cremated.  The  government 
appointed  a  committee  consisting  of  representatives  of  national  and 
municipal  bodies  to  devise  ways  and  means  to  prevent  the  spread  of 
the  disorder.  And  finally,  lest  they  should  be  taken  unawares,  a 
temporary  hospital,  consisting  of  several  detached  shedt<,  was  hastily 
erected  during  the  night,  behind  the  Infectious-diseases  Hospital. 

It  seems  that  constant  association  with  highly  virulent  bacteria 
does  beget  in  some  a  disregard  of  the  attendant  dangers,  and 
doubtless  afiter  an  investigation  of  the  facts  it  will  be  found  that  the 
outbreak  is  clearly  attributable  to  some  neglected  precaution.  This 
is  assuredly  not  as  it  should  be,  for  the  introduction  of  the  Asiatic 
scourge  into  Europe,  whether  through  the  ordinary  avenues  of 
commerce  or  as  the  result  of  scientific  investigation,  is  a  moat 
serious  matter,  and  in  either  instance  is  to  be  equally  deprecated. 
True,  the  disease  is  as  yet  limited  to  a  balf-dozen  cases  and  will  in 
all  probability  be  eradicated,  but  its  mere  presence  is  food  for 
serious  thought.  A  most  painful  feature  of  the  situation  at  present 
is  the  unscrupulous  and  uncompromising  attitude  of  the  antisemitic 
newspapers  who  are  accusing  the  Jewish  physicians  of  having  in- 
troduced the  plague  into  the  city.  It  is  feared  that  this  appeal  to 
the  worst  passions  of  the  mob-populace  may  result  in  plague  riots 
against   the  Jews  in  case  the  disease  spreads;  at  the  least,  it  may 


^dbyGoOglc 


Editohial.  687 

lead  to  a  serious  setback  to  the  scieotific  JDveatigation  of  the  dis- 
•order.  Dr.  Miiller  was  considered  quite  an  authority  od  the  plague. 
As  a  member  of  a  committee  coDsisting  of  himself,  Dr.  Albrecht, 
Dr.  GhoD,  and  Dr.  Poech,  appoiuted  by  the  Imperial -Royal 
Academy  of  Science,  be  proceeded  in  1897  to  Bombay  and  other 
points  ia  ludia  for  the  purpose  of  studying  the  plague.  The  com- 
mittee returned  some  mouths  ago  to  Vienna,  and  the  report  of  its 
members  has  been  noted  in  these  columns." 


DOKS  IT  PAY  A  PHYSICIAN  TO  STUDY? 

THERE  area  great  maayupa  and  doionain  a  physician's  life,  and 
to  them,  we  have  no  doubt,  the  doamt  seem  very  much  in 
preponderance.  It  ia  really  discouraging  to  the  close  student  of 
medicine  to  find  often  that  his  ability  which  must  necessarily  come 
AS  a  student  is  not  recognized  by  the  public,  but  the  '*  hail-felloir- 
-well-met,"  is  the  one  holding  the  highest  favor  in  the  public  eye, 
A  recent  editorial  in  the  Colorado  Medical  Journal  has  certainly 
put  the  truth  of  the  whole  affair  in  a  few  very  terse  sentences. 
It  says: 

"This  is  a  simple  question  which  apparently  has  but  one  answer, 
but  a  friend  of  ours  recently  took  the  negative  side  of  the  question 
and  this  is  about  what  he  said:  'No,  it  doesn't  pay.  The  people 
don't  want  a  physician  who  knows  things.  They  want  a  man  who 
belongs  to  their  church,  to  their  lodge,  a  bail-fellow-well-met.  He 
can  make  a  show  of  learning,  can  write  a  prescription  with  a  flourish, 
«an  assume  an  air  of  learuing,  and  that  is  all  that  is  needed.  The 
man  who  puts  in  his  time  at  his  books,  at  his  microscope,  in  hie 
laboratory,  gets  left,  and  the  physician  who  goes  past  his  books  and 
mixes  with  the  people,  is  the  man  who  coins  the  'wherewith.' 

"Occasionally  this  successful  man  needs  the  consultation-services 
«f  the  student,  but  just  as  often  it  goes  to  the  man  who  has  a  like 

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688       Tee  Atlanta  Medical  and  Suroical  Jodknal. 

successful  practice.  It  is  dollars  to  doughouts  that  the  physicUa 
with  a  great  big  practice  makes  but  few  dlsguoses  and  treats  symp- 
toms ODly.  Why  it  can't  pay  to  study  much.  Whom  can  it  pay? 
A  side-light  on  the  same  idea  came  to  me  the  other  day.  I  have 
been  for  years  using  my  microscope  and  with  many  a  case  it  haft 
given  me  some  severe  shocks.  It  has  in  Act  discouraged  me  with 
certain  cases  and  the  patient  has  felt  my  discouragement.  I  find 
that  I  am  using  my  microscope  less  than  I  formerly  did.  To  find 
an  abundance  of  tubercle  bacilli  in  sputum,  while  the  patient  seems 
in  the  best  of  health  and  spirits,  makes  me  down  in  the  moatb  and 
the  patient  finds  a  more  hopeful  doctor.  Casts  in  the  urine  always 
frighten  me,  and  I  warn  the  patient  until  he  gets  disconraged.  No, 
it  doesn't  pay  to  study  and  work  in  this  profession.  Specialists  are 
now  so  numerous  and  consultations  are  so  wanted  by  the  people^ 
that  I  don't  need  to  know  much  about  the  nervous  system,  nor 
about  the  alimentary  canal,  nor  about  the  ear,  nose  or  throat,  nor 
about  the  kidneys,  nor  the  heart  or  chest ;  and  in  hot,  unless  I  go 
to  the  country  to  practice,  it  is  a  waste  of  time  for  me  to  leara  new 
hctB  about  these  things.  If  I  get  a  section  of  a  tumor,  I  am  ex- 
pected to  turn  it  over  to  a  pathologist;  if  I  secure  some  peculiar  fluid, 
I  am  expected  to  send  it  to  this  man  or  that  man  for  analysis,  and 
thus  it  goes,  and  if  I  study  on  these  things,  I  only  confirm  the  re- 
ports which  I  receive.  Ko,  it  doesn't  pay.  I  can  get  ahead  better 
by  reading  novels  and  going  to  church  socials  and  balls.' 

"Our  friend  got  up,  lit  a  oigarette,  and  e&id:  '  Good-night,  I  am 
due  nowat  an  executive  committee  meeting  of 'The  Royal  Peacocks 
of  the  Purple  Shadow.'" 


THE  Tri-State  Medical  Association,  comprising  the  Slates  of 
Alabama,  Georgia  and  Tennessee,  held  its  annual  meeting  in 
Birmingham,  Ala.,  on  October  25th,  26th  and   27tb.     The 
meeting  was  well  attended,  the  largest  representation  beiog  fron 


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Editorial.  689 

Alabama,  as  was  to  be  naturall;  expected.  Dr.  George  S.  Brown, 
of  Birmingbam,  as  Chairmaa  of  the  Committee  of  Arrangemeots^ 
and  one  of  the  most  enthusiastic  members  of  the  whole  body,  called 
the  meeting  to  order. ' 

He  was  followed  by  Dr.  A.  T.  Henly,  Presideat  of  the  JeETersoo 
CoQDty  Medical  Society,  who  delivered  a  very  earnest  address  of 
welcome,  at  the  conclueioa  of  which  Dr.  J.  A.  Goggaos,  of  Alex- 
ander City,  the  Prestdeot  of  the  Association,  called  the  meeting 
formally  to  order. 

The  Secretary's  report  by  Dr.  Frank  T.  Smith  showed  the 
AssociatioQ  to  be  in  a  most  flourishing  condition,  and  after  the 
reading  of  this  the  reguUr  program  was  started. 

The  attendance  on  the  first  day  was  rather  small,  but  by  the 
second,  members  and  visitors  had  swelled  the  nnmbers  present  to  a 
considerable  degree. 

There  were  a  number  of  excellent  papers  read  during  the  meeting, 
and  altogether  the  progress  was  most  successful.  The  papers  elicited 
excellent  discussions.  The  social  features  of  the  meeting  added  much 
entertainment  and  pleasure  to  the  whole  aflair.  On  the  first  evening 
Drs.  Davis,  of  Birmingham,  gave  a  delightful  dinner  to  a  number 
of  the  visiting  physicians.  On  the  second  day  a  special  excursion 
was  given  to  Pratt  City,  the  pbysiciaas  being  the  guests  of  the 
Tennessee  Coal,  Iron  and  Railroad  Company  and  Dr.  R.  M.  Cun- 
ningham, of  that  city.  A  view  was  thus  afforded  of  the  immense 
new  steel  industry  in  this  portion  of  Alabama.  The  trip  was 
greatly  enjoyed.  At  night  a  general  reception  was  held  at  the 
Commercial  Club,  tendered  to  the  visitors  by  the  Jefferson  County 
Medical  Society. 

The  new  officers  elected  were  as  follows:  President,  Dr.  George 
A.  Baxter,  Chattanooga,  Tenn.;  First  Vice-President,  Dr.  M.  C. 
McGammon,  Nashville,  Tenn.;  Second  Vice-President,  Dr.  W.  D. 
Travis,  Covington,   Ga.;  Third  Yioe*President,  Dr.   George  S. 


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690       The  Atlanta  Medical  and  Suroioal  Journal. 

BrowD,  BirmiDgham,  Ala.;  Secretary,  Br.  Frank  T.  Smith,  Cfaat- 
tsDoogs,  Tenn.;  Treasurer,  Dr.  Cooper  Holtzclaw,  Chattanooga, 
Teon. 

The  next  place  of  meeting  will  be  Ohattaaooga. 


THE  loveEtigating  Committee,  appointed  by  the  Preaideat  of  the 
United  States  to  look  into  the  medical  matters  incident  to  the 
recent  Spanish-American  war,  is  now  making  a  tour  of  the  varions 
hospitals  and  camps,  and  trying  to  find  out  whether  there  was  mis- 
management of  the  medics!  department  during  the  war,  and  if  so, 
where  the  blame  should  be  put.  The  men  composing  the  commit- 
tee are  men  of  integrity,  and  will  no  doubt  try  to  do  their  dnty, 
but  we  cannot  see  the  necessity  for  the  existence  of  such  a  com- 
mittee. The  Lord  knows  the  poor  people  are  being  taxed  to  death 
for  the  furtherance  of  the  wishes  of  jingo  politicians,  yellow  jour- 
nalism, and  the  administration  in  office,  who  forced  upon  the 
American  people  the  war  which  is  now  assuming  the  shape  of  oae 
of  conquest,  with  no  limitation  as  to  what  the  dear  people  will 
suffer  who  have  absolutely  no  voice  id  the  matter.  The  expenses 
cluring  the  war  and  the  management  of  the  medical  department 
were  certainly  heavy  enough  without  giving  a  few  men  a  pleasure 
trip  at  the  expense  of  the  dear  people,  and  the  whole  affair  to  wind 
up  with  a  reception  and  an  ignominious  fiasco.  There  is  no  one 
who  believes  for  a  moment  that  there  will  anything  result  from 
this  Investigation  Committee's  work,  for  they  are  too  sensible  of 
the  administration's  feelings  to  wound  such  in  the  slightest  degree. 
The  future  condition  of  this  country  is  indeed  an  alarming  one 
to  our  miud,  since  the  dear  people  must  suffer  and  be  taxed  to 
death  in  order  to  further  the  interests  of  those  in  power,  and  those 
"  standing  in  close  touch  with  the  administration."  But  then  why 
should  such  views  be  expressed?  for  there  seems  to  be  no  remedy, 


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Editorial.  691 

and  the  "toiUtig  millions"  mast  grovel  for  a  living,  and  let  the 
*'  rich  grow  richer." 

The  United  States  is  now  made  up  of  every  nationality  in  the 
world,  and  with  such  an  admixture  of  races  who  can  doubt  but  that 
this  country  must  be  the  seat  of  continual  turmoil  and  strife.  Not 
satisfied  with  trying  to  govern  this  heterogeneous  mass  already 
witbiu  our  present  territorial  limits,  the  government,  aided  by 
"yellow  journalism"  and  jingo  politicians,  are  seeking  to  extend 
our  territory  in  order  to  create  still  greater  troubles  and  dissen- 
sions, to  allow  the  dear  people  to  pay  still  more  for  what  they  get, 
and  by  increased  taxation  to  let  them  aid  the  extension  of  rich 
men's  monopolies  to  El  Dorados  purchased  for  them  at  the  ex- 
pense of  American  blood.  Shades  of  our  fathers,  come  and 
help  us! 


AUSTIN,  Texas,  is   to  be   congratulated    upon  the   thoroughly 
scientific  and  sanitary  spirit  of  its  city  council.     This  body 
has  just  passed  a  measure  which  could  well  be  adopted  by 
other  municipal  governments.     We  give  the  ordinance  as  recently 
passed. 

The  following  ordinance  was  introduced  by  Mr.  Jeff.  McLemore, 
and  was  passed  by  the  city  council  of  the  city  of  Austin,  October 
3,  1898 : 
"An  ordinance  regulating  the  sale  and  use  of  cocaine  in   the  city 

of  Austin,  and  prescribing  penalties. 
"  Be  it  ordained  by  the  city  council  of  the  city  of  Austin  : 

Sectiom  1.  That  it  shall  be  unlawful  for  any  person  in  the  city 
of  Austin  to  sell  or  give  cocaine  to  another  except  upon  the  pre- 
scription of  a  regularly  practicing  physician,  certifying  that  he  has 
examined  such  person  professionally,  and  that  he  finds  such  person 
to  be  in  such  physical  condition  as  to  be  in  need  of  cocaine  as  a 
medicine. 

DiclzedbyGoOgle 


692       The  Atlanta  Medical  and  Surgical  Jourkal. 

"  Section  2.  That  it  shall  be  unlawful  for  any  peraoo  to  make 
mure  than  one  Bale  or  gift  of  cocaine  apOD  each  prescription  or 
pay  any  phyeiciaQ  to  give  a  prescription  to  another  without  mak- 
ing a  thorough  examination  of  such  person. 

"  SEonoN  3.  That  the  violation  of  any  of  the  provisions  of 
this  ordinance  is  made  an  offense,  and  for  each  violation  the  per- 
son offending  shall  be  fined  in  any  sum  not  less  than  (10  nor  more 
than  llOO. 

"  Section  4.  That  the  provisions  of  this  ordinance  shall  not 
apply  to  the  sale  or  gift  of  cocaine  to  a  regularly  practicing  phya- 
oiau  or  dentist,  or  to  the  admintstratioD  of  the  same  by  such  phy- 
sician or  dentist  persoDally." 


A  NEW  army  hospital,  the  largest  under  the  control  of  the  gov- 
ernment, is  to  be  constructed  of  Georgia  pine,  at  Savannah,  Ga-, 
at  a  cost  of  $150,000.  There  will  be  149  buildings,  all  designed 
and  constructed  with  a  view  to  permanency.  The  ground  plan  of 
buildings  will  be  rectangular,  with  covered  ways  connecting  all  of 
the  buildings  with  each  other,  and  with  the  administration-building 
in  the  center.  Each  of  the  four  sides  of  the  quadrangle  will  con- 
tain a  ward  with  a  capacity  of  250  beds.  Que  ward  will  be  devoted 
to  surgical  cases,  and  an  enclosed  passage-way  will  connect  it  with 
a  modern  opera^ng-room.  In  addition  to  the  general  wards  there 
will  be  private  rooms  for  the  accommodation  of  invalid  officers. 
An  unlimited  supply  of  artesian  water  will  be  provided.  Coal 
base-burners  will  supply  heat.  An  ice  factory  is  situated  within 
fifty  yards  of  the  site,  and  the  cost  of  ice  is  inconsiderable.  The 
officers'  quarters  will  be  of  two  stories.  The  dormitories  for  the 
nurses  and  the  hospital-corps  will  occupy  two  buildings.  The 
chief  sui^eon  will  have  a  private  residence. 


,„i,z.d  by  Google 


JWEWS  AND  NOTES. 


NOnOS.— ThU  JOn&HAIi   and  THB  HrFBRNATIONA.!.   JOUS- 
HAL  OF  BVKQE&Y  one  jrear  for  f  3.00  OMh, 


Dr.  F.  Bartow  McRae,  a  former  resident  of  Atlaota,  but  who 
moved  West  od  account  of  his  health,  died  \a  Texas  on  November 
16th.     Dr.  McRae  was  a  man  of  well-marked  ability. 


Dr.  F.  W.  McBab  paid  a  visit  to  New  York  during  the  month 
of  October.  We  believe  that  every  progressive  physician  shonld 
visit  a  great  medical  center  like  New  York  at  least  once  a  year. 


Dr.  H.  Scarboro,  of  Ellaville,  Ga.,  died  at  his  home  on  Sep- 
tember 8th,  1898,  at  the  age  of  86. 


In  Columbus,  Ga.,  September   11th,  1898,  Dr.  A.  A.  Sylvester, 
of  that  place,  died  at  the  age  of  64. 

The  Daili/  ConetUidion  reports  the  death  of  Dr.  J.  J.  Ingalls,  of 
Macon,  Oa.,  on  November  12th,  1898.  ' 


A   DEATH  from   sunstroke  occurred  in   the   first  week   of  this 
month  in  Akron,  Ohio. 


The  Atlantic  Medical  Weekly,  of  Providence,  R.  I.,  has  suspended 
publication  and  turned  over  to  the  Fhiladelphia  Medical  Journal  all 
of  its  subscribers  and  good  will. 


Tub  Grieg  Smith  Memorial,  the   new  operating  theater  at  the 
Bristol  (England)  Royal  Infirmary,  was  formally  opened  Septem- 

Diciiiized  by  Google 


694       The  Atlasia  Mediqal  and  Surgical  Journal. 

ber  30th,  by  Sir  William  MacCormac,  president:  of  the  Royal  Col- 
lege of  Sui^eons. 

The  new  buildiog  of  the  Medical  Department  <^f  the  University 
of  California,  at  the  corner  of  First  and  FaroasBus  avenues,  south 
of  Golden  Gate  Park,  San  Francisco,  was  opened  on  Saturday, 
October  22d,  with  appropriate  exercises. 


Tee  California  State  Board  of  Health  has  appointed  Dr.  C.  A. 
Buggies  president  of  the  Board,  to  visit  the  Hawaiian  Islands,  to 
learn  the  extent  of  the  presence  of  leprosy  and  report  measures  to 
prevent  its  introduction  into  California. 


The  Texas  Clinic  is  a  new  journal  published  at  Dallas,  Texa$, 
under  the  editorial  supervision  of  Dr.  J.  P.  Sbelmire.  It  proposes 
to  devote  itself  chiefly  to  clinical  reports,  but  it  will  also  have  in 
each  issue  an  article  from  some  well-knoivo  physician  in  a  medical 
center. 


The  following  consulting  staflf  has  been  elected  to  the  Craig^ 
Colony  for  Epileptics:  Dr.  George  M.  Gould,  consulting  ophthal- 
mologist; and  Dr.  Henry  Ling  Taylor,  consulting  ortbopedirt. 
Other  physicians  to  represent  other  departments  will  probably  be 
added  to  the  staff  in  January. 


Recently  published  statistics  show  that  there  has  been  a  re- 
markable increase  in  the  number  of  women  physicians  and  womeo 
dentists  in  the  United  States  during  the  past  thirty  years.  In  1S6S 
there  were  24  women  dentists  and  627  women  physicians,  while 
now  there  are  407  of  the  former  and  6,882  of  the  latter. 


NOTICE.-This  JOURNAL  and  THE  INTERNATION* 
AL  JOURNALOF  SURGERY  one  year  for  S2.00 cash. 


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News  and  Notes.  69& 

AvcoRDjSQ  to  the  Lancet,  during  the  course  of  the  coni(>!iment- 
ary  dinner  that  the  medical  profession  of  Great  Britain  and  Ire* 
land  tendered  Professor  Virchow  on  the  occasion  of  his  recent  visit 
to  Eogland,  an  anonymous  telegram  was  banded  to  the  illugtrious 
guest,  containing  the  following  words;  "  Get  thee  hence,  vile  vivi- 
sector!  England  spurns  thee!" 


The  following  are  the  officers  of  the  New  York  Obstetrical  So- 
ciety elected  at  the  annual  meeting,  October  11th:  President,  Dr, 
W.  R.  Pryor;  Vice-Presidents,  Dr.  Le  Roy  Broun  and  Dr.  Edwin 
B.  Cragin;  Recording  Secretary,  Dr.  Joseph  Brettauer;  Assistant 
Recording  Secretary,  Dr.  E.  E.  Tull;  Corresponding  Secretary, 
Dr.  George  W.  Jarman;  Treasurer,  Dr.  J.  Lee  Morrill ;  Patholo- 
gist, Dr.  George  C.  Freeborn. 


Poisoned  by  Toad8TOOL8.  —  Three  deaths  occurred  recently 
in  Trenton,  N.  J.,  from  eating  toadstools  supposed  to  be  mush- 
rooms. Five  other  members  of  the  same  family  are  seriously  ill 
from  the  same  cause,  but  are  expected  to  recover.  The  distinction 
between  mushrooms  and  toadstools  often  quoted  iu  the  country 
diflricts  is  apropos ;  "  Eat  them ;  if  they  kill  you,  you  will  know 
they  are  toadstools;  if  you  live,  they  are  mushrooms." — Ex. 


American  Academy  op  Railway  Surgeons. — The  following 
ofBcers  were  elected  for  the  ensuing  year:  President,  Dr.  W.  W. 
Grant,  Denver;  First  Vice-President,'  Dr.  J.  F.  Pritchard,  Mani- 
towoc, Wis.;  Second  Vice-President,  Dr.  J.  P.  Lord,  Omaha,  Neb.; 
Secretary,  Dr.  T.  B.  Lacey,  Council  Bluffs,  Iowa ;  Treasurer,  Dr. 
C.  B.  Kibler,  Corry,  Pa.;  Editor,  Dr.  Fred  J.  Hodges,  Ashland,  Wis. 
The  next  meeting  will  be  held  at  Omaha,  Neb.,  in  October,  1899. 
The  Committee  of  Arrangements  i^  J.  P.  Lord  (chairman),  T.  B. 
Lacey  and  Fred  J.  Hodges. 


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696       The  Atlanta  Mbdical  and  Suroical  Journal. 

The  following  oflicers  were  elected  at  the  Ifashville  meeting  of 
the  Mississippi  Valley  Medical  Association  :  PresideDt,  Dr.  Dun- 
can Eve,  Nashville,  Teun.;  First  Vice-President,  Dr.  A.  J. 
Ochsner,  Chicago,  111.;  Second  Vice-President,  Dr.  J.  C.  Morfit, 
St.  Louis,  Mo.;  Secretary,  Dr.  Henry  E.  Tuley,  Louisville,  Ky. 
(Ill  W.  Ky.  St.);  Treasurer,  Dr.  Dudley  S.  Reynolds,  Louisville, 
Ky.  The  next  meeting  will  be  held  in  Chicago,  October,  1899,  on 
a  date  to  be  determined  by  the  executive  officers  and  Dr.  Harold 
N.  Moyor,  the  Chairman  of  the  Committee  of  Arangements. 


Db,  W.  F.  Brunheb,  sanitary  inspector  of  the  Marine-Hospital 
Service,  has  made  his  first  report  from  Havana  since  the  war  began. 
He  says  that  the  city  is  even  more  filthy  than  it  was  before,  if  such 
a  tbiog  can  be  imagined.  There  is  not  a  great  deal  of  yellow  fever, 
simply  because  there  is  but  little  material  for  the  disease  to  feed 
upon,  but  pernicious  malaria,  dysentery  and  typhoid  fever  are 
prevalent.  The  deaths  for  the  week  ending  October  6th,  were  five 
hundred  and  thirty-six,  which  is  lai^er  than  for  any  single  weeic 
duriog  the  past  year.  There  are  stilt  some  reooDcentrados,  whose 
deaths  from  starvation  help  to  swell  the  roll  of  mortality. 


Virginia  Medical  Society. — At  the  annual  meeting  of  the 
Society,  recently  held,  the  following  were  elected  officers  for  the 
ensuing  year:  Dr.  Jacob  Micbeaux,  of  Richmond,  President;  Dr. 
B.  M.  Atkinson,  of  Staunton,  First  Vice-President;  Dr.  E.  C. 
Iievy,  of  Richmond,  Second  Vice-President;  Dr.  E.  T.  Brady, 
of  Abingdon,  Third  Vice-President;  Dr.  L.  jjangford,  of  Norfolk, 
Orator;  Dr.  L.  B.  Edwards,  of  Richmond,  Recording  Secretary; 
Dr.  J.  F.  Wynn,  of  Richmond,  Corresponding  Secretary ;  Dr.  R.  T. 
Styll,  of  Petersburg,  Treasurer;  Dr.  Hunter  McQuire,  of  Bicb- 
mond,  Chairman  Executive  Committee;  Dr.  W,  D.  Turner,  of 
Ferguson's  Wharf,  Chairman  Membership  Committee. 


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News  and  Notbs.  697 

Medical  Students  at  the  German  Universities. — Aooord- 
ing  to  official  statistics  the  number  of  medical  studeots  attending 
the  various  Germau  Universities  during  the  summer  semester  of 
1898  is  as  follows:  Munich,  1,416;  Vienna,  1,192;  Berlin,  1,0»0; 
Wiirzbnrg,  6«0;  Leipeic,  630;  Freiburg,  522;  Kiel,  428;  Gratz, 
417;  Erlangen,  414)  Breslau,  364;  Ziirich,  340;  Bonn,  337; 
Strassburg,  324;  Griefswald,  323;  Tubingen,  278;  Marbui^, 
274;  Heidelburg,  272;  Geneva,  270;  Konigsberg,  249;  Halle, 
246;  Giessen,  240;  Gottingen,  225 ;  Jena,  222;  Bern,  189;  Lau- 
t^anne,  145;  Basle,  141;  Rostock,  99. 


The  tomato  alarmists  are  at  their  old  tricks  again.  Dr.  Andrew 
Wilson,  of  London,  says:  "I  have  received  several  letters  of 
late,  reiterating  a  question  I  might  well  be  tired  of  answering, 
'Do  tomatoes  cause  cancer?'  But  for  the  fact  that  one  takes  a 
pleasure  in  stamping  one's  foot  on  a  misleading  statement  calculated 
to  prejudice  people  against  a  vegetable  food  which  is  entirely 
healthly  and  safe,  I  should  grow  weary  of  asserting  that  not  a  jot  or 
tittle  of  proof  has  ever  been  offered  in  support  of  the  outrageous 
statement  noted  above.  One  might  as  well  allege  that  cabbage 
causes  cancer,  for  there  would  be  no  more  proof  of  that  assertion 
than  there  is  proof  to  be  had  concerning  the  tomato  myth.  I  can 
only  repeat  that  the  tomato  te  an  excellent  vegetable  enough,  and 
may  be  partaken  of  by  those  with  whom  it  agrees,  without  any 
fear  of  its  vitiating  any  disease  whatever." — Medical  Record. 


Thomas  Greenwood  Kershaw,  leader  of  the  Christian  Science 
Church  of  Tacoma,  died  of  acute  pneumonia  on  November  12th, 
as  a  result  of  his  refusal  to  receive  medical  treatment.  According 
to  reports,  lie  was  a  man  of  the  highest  education  and  intelligence, 
and  until  identifying  himself  with  Christian  Science  was  one  of  the 
most  active  and  successful  business  men  of  Tacoma.     Since  em- 


^dbyGoOgle 


698       The  Atlanta  Medical  and  Sdboical  Jourkal. 

bracing  that  doctrine,  although  a  siifiEerer  bimself  from  a  broken 
hip,  he  had  devoted  his  entire  time  to  promulgating  his  &ith  and 
ministering  to  the  afflicted.  When  taken  ill,  Mr.  Kerehaw,  despite 
the  entreaties  of  his  family,  refused  to  see  physicians,  and  placed 
bimself  in  the  care  of  a  woman  Christian  Science  healer  in  Savan- 
nah, 111.,  who,  he  said,  was  able  to  relieve  "him  regardless  of  dis- 
tance. He  was  visited  by  several  of  bis  Christian  Science  followers, 
and  at  their  suggestion  he  rose  from  the  bed  and  took  a  step  for- 
ward. He  would  have  fallen  had  he  not  been  caught.  It  was 
then  found  that  he  was  dead. 


Db.  Koch's  Recent  Visit  to  Rome. — After  a  stay  at  Rome 
of  over  a  month,  engaged  in  malarial  researches,  Dr.  Koch  has 
returned  to  Berliu.  He  was  accompanied  by  bis  associates,  Dts. 
Ffeiffer  and  Kossel.  One  of  the  objects  he  had  in  view  in  visiting 
Rome  was  to  ascertain  how  &r  the  Italian  malaria  coincides  with 
the  tropical  form  of  the  same  malady,  and  he  has  satisfied  him- 
self ihat  in  fill  essentials  tbey  are  identical.  He  has  also  been  able 
to  indicate  properties  hitherto  unnoticed  in  the  pathogenic  germ 
of  malaria  as  found  external  to  man — properties  possessing  a -dis- 
tinct prophylactic  value  toward  limiting  the  diffusion  of  the  malady 
if  not  in  arresting  it  at  its  point  of  origin.  He  has,  however,  to 
supplement  this  part  of  his  researches  by  others  on  the  same  lines, 
and  with  this  object  he  intends  to  return  to  Italy  in  the  spring  of 
1899.  So  far  he  has  found  nothing  to  add  on  the  clinical  side  of 
the  subject ;  and  the  Roman  schools  do  not  disguise  their  satis&c* 
tion  at  this  frank  testitnony  to  the  practical  worth  of  their  pains- 
taking contributions  to  treatment.  They,  in  turn,  are  profiiae  in 
their  acknowledgments  of  Professor  Koch's  scientific  elucidation 
of  points  hitherto  left  obscure,  and  are  grateftil  for  the  impulse 
he  has  ^ven  to  the  investigation  of  problems  the  solution  of  which 
seems  now  "  within  measurable  distance." 


^dbyGoogle 


BOOK  REVIEWS,    PAMPHLETS,   EXCfiANQES. 


BOOK  REVIEWS. 

[VontiibuUou  Kllcltsd  for  nvii 


A  Clinical  TEatT-BooK  op  Medical  Diaonosi»  for  Physi- 
aAN8  AND  Studektb.  By  Oswald  Vierordt,  M.D.,  Professor 
of  MediciDe  at  the  Uoiversity  of  Heidelberg.  English  transla- 
tion by  Francis  H.  Stuart,  M.D.,  of  Brooklyo,  N.  Y.  Published 
by  W.  B.  Sauadere,  Philadelphia.  Price,  Cloth,  $4.00 :  Sheep, 
15.00. 

This  excellent  text-book  od  physical  diagnosis  has  just  been 
issued  from  the  well-known  publishing  house  of  W.  B.  Saunders. 
It  is  the  fourth  American  from  the  fifth  German  edition.  Its  first 
edition  was  issued  in  1888,  aod  ia  ten  years  four  others  have  been 
called  for.  This  attests  the  merits  of  the  book,  when  we  consider 
the  Dumber  of  excellent  works  on  this  same  subject.  The  book  is 
a  large  one  and  treats  very  exhaustively  the  diagnosis  of  every  dis- 
ease of  the  body  where  physical  signs  are  cousidered.  Some  ides 
may  be  obtained  as  to  the  scope  of  the  work  from  arrangement  of 
its  ooDtents. 

There  are  chapters  as  follows  : 

Chapter  I.  Introduction. 

Chapter        II.  Esaminatioo  of  Patients. 

Chapter      III.  Qenerat  Examination. 

Chapter      TV.  Examination  of  the  Respiratory  Apparatus. 

Chapter        V.  Examination  of  the  Circulatory  Apparatus, 
r   Chapter      YI.  Examination  of  the  Digestive  Apparatus. 

Chapter    VII.  Examination  of  the  Urinary  Apparatus, 

Chapter  VIII.  Examination  of  the  Nervous  System. 

The  last  chapter  on  nervous  diseases  is  unusually  clear  and  thor- 
ough, and  is  in  itself  the  value  of  the  whole  work.  The  methods 
for  diagnosis,  as  laid  out  so  explicitly,  are  quite  refreshing.  We 
commend  most  thoroughly  this  work  of  Dr.  Vierordt's. 


^dbyGoOgle 


700       The  Atlanta  Medical  and  Sdroioal  Journal, 

A  Manual  of  Venereal  Diseases.  By  James  R.  Hayden, 
M.D.,  Chief  of  Clioic  and  Instructor  in  QeDito-Urinaty  and 
Venereal  Diseases,  College  of  Physicians  and  Surgeons,  New 
York ;  Professor  of  Genito-Urinary  and  Venereal  Diseases  in 
the  Medical  Department  of  the  University  of  Vermont,  etc. 
New  (2d)  edition,  revised  and  entailed.  In  one  12mo  volume 
of  304  pages,  with  54  engravings.  Cloth,  f  1.50  net.  Lea-Brotb- 
ers  &  Co.,  Publishers,  Philadelphia  and  New  York. 

Though  a  manual,  and  Kence  condensed,  the  subjects  treated  are 
quite  fully  gone  into.  While  acknowledging  Neisser's  gonococcus 
as  the  cause  of  the  majority  of  cases  of  gonorrhea,  he  lays  stress 
uj>on  the  &ct  that  many,  indbtinguisbable  from  the  genuine,  cases 
are  due  to  infection  with  "innocent"  secretions.  He  appears  not 
to  favor  the  Janet  method  of  treatment.  It  is  not  yet  proven,  he 
saya,  that  Ducrey'a  bacillus  is  the  cause  of  cbancroid.  Many 
"chancroids"  are  simple,  Don-speci&c,  iofective  ulcers. 

Syphilis,  in  all  its  stages,  forms  and  locations,  is  very  thoroughly, 
though  concisely  described;  every  organ  and  tissue  which  the  db- 
ease  may  affect  being  mentioned,  with  the  symptoms  as  displayed 
by  the  part  involved. 

He  advises  no  mercurial  treatment  until  the  disease  is  thoroughly 
established,  and  considers  inuuctions  the  most  efficacious.  The 
intermittent  plan  of  treatment  is  followed.  The  "mixed"  treat- 
ment is  begun  with  the  second  year.  As  iodides  only  remove 
symptoms,  mercury  is  not  left  off  in  the  late  stages. 

The  book  ends  with  the  discussion  of  hereditary  syphilis. 

M.  B.  u. 


Pathology  and  Mobbid  Anatomy.  By  T.  Henry  Green,  M.D., 
Lecturer  on  Pathology  and  Morbid  Anatomy  at  Charing-Cross 
Hospital  Medical  School,  London.  New  (8th)  American  from 
the  eighth  and  revised  English  edition.  In  one  very  handsome 
royal  octavo  volume  of  600  pages,  with  215  engravings,  many 
being  new,  and  a  colored  plate.  Cloth,  $2.50  nd.  Lea  Broth- 
ers &  Co.,  Publishers,  Philadelphia  and  New  York. 

This  is  the  eighth  edition  of  this  work.  That  speaks  for  itself. 
It  has  probably  been  the  most  popular  test-book  on  pathology  and 
morbid  anatomy  that  has  ever  been  published.     The  reason  for  this 


^dbyGoOgle 


Book  Reviews.  701 

18  patent  when  the  volume  has  ooee  been  thoroughly  examiaed. 
The  arrangemeat  and  classifioation  of  the  subjects  are  most  excel- 
lent. Ten  7«ars  afi;o  the  reviewer  of  (bis  book  studied  it  as  a  text- 
book at  the  University  of  Virginia,  and  in  looking  over  it  now  in 
this  edition,  experience  and  study  aptly  show  the  value  of  the  book. 
The  language  is  clear  and  concise  and  the  illustrations  are  good 
We  shall  always  commend  thia  work. 


A  Primer  of  Psychology  and  Mental  DiseahEi.poh  Use  in 

TrAIKING-SCHOOLB    fob    AXTEHDAHra    AND     NuRSES   AND   IN 

Medical  Classes.  By  C.  B;  Burr,  M.D.,  Medical  Director  of 
Oak  Grove  Hospital  for  Nervous  and  Mental  Diseases,  Flint, 
Mich.;  formerly  Medical  Superintendent  of  the  Eastern  Michi- 
gan Asylum;  Member  of  the  American.  Medico- Psychological 
Aasociation,  etc.  Second  edition,  thoroughly  revised.  &J  x  ?{ 
inches.  Pages  ix-116.  Extra  cloth,  |1.00  net.  The  F.  A. 
DavisCo.,  Publishers,  1914-16  Cheriy  St.,  Philadelphia;  117 
W.  Forty-second  St.,  New  York  Qty ;  9  Lakeside  Building, 
218-220  8.  Clark  St.,  Chicago,  111. 

While  this  little  book  is  a  primer,  yet  it  deals  with  subjects  so 
intricate  that  even  its  pages  must  be  read  by  those  whose  mind  is 
given  to  much  thought.  In  the  first  edition  of  this  work  its  author 
dealt  with  psychology  and  were  lectures  delivered  to  the  Truning- 
scbool  Classes  in  Eastern  Michigan  Asylum,  hut  in  this  edition  a 
little  more  has  been  incorporated.  Part  I.  deals  with  Psychology, 
which  is  very  clear  and,  as  was  meant,  rudimentary  in  character. 
Part  II.  treats  of  Insani^,  and  Part  III.  treats  of  the  Management 
of  Cases  of  Inaanily,  especially  for  nurses  and  is  well  worthy  of 
consideration  by  physicians.  Part  IV.  is  a  lecture  delivered  to 
Training-school  Class,  and  is  "  Suggestions  as  to  What  to  Do  and 
What  to  Avoid  in  Caring  for  ^e  Insane." 


Lahdis'  Compbnd  op  Obstetrics.  Revised  and  edited  by  Dr. 
Wm.  H.  Wells,  of  Philadelphia.  Published  by  P.  Blakiston's 
Son  &  Co.,  of  Philadelphia.     Price  80  cents. 

It  is  almost  needless  to  refer  to  this  excellent  little  compend  of 
obstetrica  which  has  already  reached  its  sixth  edition.  It  is 
thorough  and  practical  throughout,  and  also  contains  some  good  il- 


^dbyGoogle 


702       Thb  Atlanta  Medical  and  Surgical  Journal. 

lustrations.  OF  course,  it  is  DOthing  but  a  "  qniz  compeod,"  and 
therefore,  intended  to  aid  students  in  preparing  for  examinations. 
There  oau  be  no  doubt  but  that  such  a  book  well  takes  the  place  of 
a  "quiz  master," 


A  Tbeatisb  on  the  Science  anb  Pbactice  of  Midww^by. 
By  W.  S.  Playfair,  M.D.,LL.D.,F.R.C.P.,  Emeritus  Professor 
o(  Obstetric  Medicine  in  King's  College,  London.  Examiner 
in  Midwifery  to  the  Universities  of  Cambridge  and  London. 
Seventh  American  from  the  ninth  English  edition.  In  one  very 
handsome  octavo  volume  of  700  pages,  with  207  engravings  and 
seven  full  page  plates.  Cloth,  13.75  net.  Lea  Brothers  &  Co., 
Publishers,  Philadelphia  and  New  York. 

It  is  hardly  necessary  to  review  such  a  well-kaowu  work  as  this, 
which  has  already  reached  its  seventh  American  and  ninth  Eng- 
lish edition.  It  has  been  a  standard  work  on  obstetrics  for  years, 
and  an  exceedingly  popular  text^book  in  medical  colleges,  and  we 
are  sure  that  the  present  edition  will  meet  with  the  same  genenl 
favor.  The  language  used  is  exceedingly  clear  and  explicit,  which 
accoants  in  a  large  measure  for  its  popularity  among  medical  stu- 
dents. The  arrangement  is  good,  and  it  must  still  continue  to  hold 
a  very  high  place  as  a  text-book. 


Treatment  op  Skin  Cancers.  By  W.  S.  Gottheil,  M.D.,  Pro- 
fessor of  Dermatology  at  the  New  York  School  of  Clinical 
Medicine;  Dermatologist  to  the  Lebanon  Hospital,  the  North- 
western and  West-Side  German  Dispensaries,  Etc.  Published 
by  TTie  Intemationaljoumal  of  Surgery  Company,  100  William 
Street,  New  York.     Price  |1.00. 

This  is  a  very  small  book,  giving  in  brief,  a  general  considera- 
tion of  the  subject,  but  chiefly  devoted  to  the  diagnosis  and  treat- 
ment The  illustrations  are  good.  The  little  book  is  estremely 
interesting.  Id  the  treatment  he  advocates,  for  most  cases, 
curetting  and  Marsden's  Paste,  following  much  the  line  of  A.  R. 
Robinson.  Whether  one  is  ready  to  adopt  the  author's  views  in 
full  or  not,  the  work  is  one  which  is  well  worth  having.  His 
opinion  of  the  treatment  is  that  held  by  quite  a  number  of  derma- 
tolo^sts,  as  opposed  to  the  surgeons'  preference.  h.  b.  h. 


^dbyGoOgle 


Book  Reviews.  708 

Manual  of  Diseases  of  the  Skin,  witb  aa  Analysis  of  Twenty 
Thousaod  Cooaecutive  Cases,  and  a  Formulary.  By  L.  Duocaa 
Bulkley,  A.M,,  M.D.,  Physician  to  the  New  York  Skin  and  Can- 
cer Hoapital;  Dermatologist  to  the  Randall's  Island  Hospital, 
etc.  Fourth  edition,  revised  and  enlarged.  G.  1*.  Putnam's 
Sons,  New  York  and  London.     1898. 

This  might  justly  be  called  a  primer  on  diseases  of  the  akin. 
Though  brief,  it  is  from  the  pen  of  one  who  has  had  years  of  large 
clinical  experience,  and  knows  well  his  subject.  The  book  could 
hardly  be  called  as  fully  up-to-date  as  some  others,  but  this  does 
not  necessarily  depreciate  it.  There  are  no  illustrations.  General 
considerations  and  a  formulary  complete  the  work.  The  manage- 
ment of  the  Bubjecte  is  one  which  will  appeal  forcibly  to  the  gen- 
eral practitioner.  M.  B.  H. 


The  Medical  News  Visiting  List  fob  1899.  Weekly  (dated, 
for  30  patients);  Monthly  (undated,  for  120  patients  per  month); 
Perpetual  (undated,  lor  30  patients  weekly  per  year);  and  Per- 
petual (undated,  for  60  patients  weekly  per  year).  The  first 
three  styles  contain  32  pages  of  data  and  160  pages  of  blanks. 
The  60-patient  Perpetual  consists  of  256  pages  of  blanks.  Each 
style  in  one  wallet-shaped  book,  with  pocket,  pencil  and  rubber. 
Seal  Grain  Leather,  $1.25.  Thumb-letter  ludez,  25  cents  extra. 
Philadelphia  and  New  York  :  Lea  Brothers  &  Co. 

Messrs.  Lea  Brothers  have  again  presented  us  with  a  complii 
tary    copy    of  their  "Visiting  List  for  1899."     Like  all  formei 
editions  the  arrangements  are  excellent. 


A  Pocket  Medical  Dictionary.  By  Geo.  M.  Gould,  A.M., 
M.D.,  of  Philadelphia.  A  new  edition.  Published  by  P. 
Blakistou's  Son  &  Co.,  Philadelphia.     Price  fl.OO. 

This  is  a  Pocket  Medical  Dictionary,  thoroughly  correct,  handy 
and  contains  over  21,000  words.  There  are  others,  but  this  is  the 
original,  for  Dr.  Gould  was  the  Brst  lexicographer  who  compiled 
such  a  useful  little  book,  and  which  has  met  with  such  unprece- 
dented success.  This  last  edition  has  been  entirely  revised  aud  will 
doubtless  be  more  popular  than  ever. 


^dbyGoOgle 


704       Thb  Atlanta  Medical  and  Sdrgical  Jocehal. 

Akbbican   Pocket  Medical  Dictionary  of  26,000  WoROa. 

B7  W.  H.  Newmao  DorUnd,  A  .M.,  M.D.     Published  by  W.  B. 

Saunders.     Price,  $1.25  net. 

This  is  aootber  pocket  edition  dictionary.  Tt  Is  excellent  and 
beantifully  gotten  up.  The  bindiog  and  the  paper  are  excellent, 
and  is  a  work  to  be  commended. 


Sadndbbs'    Question    CoHPENDi — Essentials    of    Materia 
Medica  and  THESAPEtiTics.     By  Henry  Morris,  M.D. 
Tbis  ia  the  fifth  revised  e4i^oD  of  this  well-known  compend. 

Saanders'  QoestioD  Compends  have  already  shown  their  merit  and 

therefore  need  no  farther  iatrodaotion. 


The  Physician's  Vibitino  List  for  1899.     Forty-eighth  year 
of  its  publicstion.     Published   by  F.   Blakiston's  Son  &  Co., 
Philadelphia. 
The  Visiting  List  for  1899  is  up  to  the  usual  standard  of  this 

well-known  house.    The  covering  is  exceedingly  durable  and  the 

paper  excellent,  besides  the  form  is  very  handy. 


RBPRIirrS  KBCEiVOi. 


Hydrotherapy  in  the  Treatment  of  Nervous  and  Mental  Dis- 
eases.    By  Frederick  Peterson,  M.D.,  New  York. 

Discussion  on  Hydrotherapy  before  the  German  Medical  Society 
of  New  York, 

Manifestations  of  Syphilis  in  the  Mouth. 

The  Dangers  ol  Specialism  in  Medicine.  By  L.  Duncan  Bulk- 
ley,  A.M.,  M.D.,  New  York. 

Deaths  (Ten);  Surgical  and  Causes. 

The  Dermal  Coverings  of  Animals  and  Plants. 

Serpents  and  their  Yenom  :  Copperhewj,  Coral  and  Rattlesnake. 
By  B.  Merrill  Bicketts,  Pb.B.,  M.D.,  of  Cincinnati. 

The  Surgical  Treatment  of  Uterine  Myomata.  By  H.  CVMarcy, 
A.M.,  M.D.,  Boston. 

Journal  of  Proceedings  of  the  National  Pare  Food  and  Drug 
Congress,  held  in  Washington,  D.  C,  March  2,  3,  4,  and  &,  lfl9S. 


^dbyGoOgle 


Book  Reviews.  705 

Modern  Tteatment  of  Tuberculosis.  B^  Charles  Denison,  A.M., 
M.D.,  Deuver,  Col. 

BulletiD  of  the  Johns  Hopkios  Uospita),  for  September  aud 
October. 

This  issue  is  filled  with  excelleut  articles  from  the  Anatomical 
Library  of  the  University.  It  is  a  pleasure  to  see  such  eminently 
scientifio  work  being  done  in  an  American  univeraty. 

A  Rapid  Treatment  of  Chancroid  and  Ulcerative  Syphilitic  Le- 
sions.    By  A.  H.  Ohmann-Bumeantl,  A.M.,  M.B,,  of  St.  Lonis. 


UTERAKy  NOTES. 


FoDR  HuNDB£D  PsETTY  HouES  AND  GARDENS. — How  general 
the  use  of  photography  is  coming  to  be  adopted  by  the  modern 
magaEiDe  as  a  means  of  illustration  is  ehowo  in  the  announcement 
of  The  Ladies'  Home  Jtnimal  that  it  is  about  to  publish  six  new, 
distinct  series  of  articles  which  will  include  not  less  than  400  pho- 
tographs. The  idea  of  the  magazine  is  to  present  one  hundred  of 
the  prettiest  country  homes  in  America  to  encourage  artistic  archtt 
teoture ;  one  hundred  of  the  prettiest  gardens,  to  enconrage  taste 
in  floriculture;  seventy  churches  decorated  for  festal  occasions  of 
a)l  kinds,  aueb  as  weddings,  Christmas  and  Easter  services,  etc.; 
aome  forty  of  the  prettiest  girls'  rooms  in  this  country ;  twenty-five 
flora]  porches  and  vine-clad  houses;  and  the  story  of  the  native 
wild  flowers  in  America,  told  in  seventy-five  photographs.  Over 
8,000  photographers,  in  every  part  of  the  country,  were  employed 
by  the  magazine  to  get  these  pictures,  and  several  thousands  of  dot- 
Iu8  were  paid  in  prize  awards  for  the  best  photographs.  The  choice 
was  made  out  of  over  10,000  photographs  received  by  the  magazine. 


LoHQFBLLOw  TO  BE  Illdstbatbd. — Last  year  Charles  Dana 
Gibson  illustrated  "  The  People  of  Dickens  "  for  The  Ladie»'  Home 
Joumai.  The  pictures  were  so  successful  that  this  year,  and  dur- 
ing next  year,  W.  L.  Taylor,  the  New  England  artist  who  has  made 
snch  rapid  strides  in  his  art,  will  illostrato  "  The  People  of  Long- 
fellow "—also  tor  The  LadieJ  Home  Joumai.  The  poems  selected 
are  "  The  Psalm  of  Life,"  "  Hiawatha,"  "  Evangeline,"  "  The 
Oonrtship  of  Miles  Standish,"  "  The  Children's  Hour,"  "The  Vil- 
lage Blacksmith,"  and  others. 


^dbyGoOgle 


SELECTIONS  AND  ABSTRACTS. 


The  Phesebvation  of  the  Hvmen. 

Howard  A.  Kelly,  M.D.  (American  Journal  of  Obatetrics) :  In 
Celsus's  "De  Medicina,"  written  about  the  time  of  Christ,  in  the 
«bapter  oo  calculi,  after  declaring  that  small  calculi  may  escape 
spontaneously  through  the  shorter  and  more  relaxed  urethra,  be 
says  that  in  most  cases  it  will  be  necessary  to  apply  the  same  meth- 
ods of  hooking  the  calculus  down  and  holding  it  against  the  neck 
of  the  bladder  while  incisiog,  as  in  men,  bat  he  adds  the  caution 
that  in  the  virgin  the  finger  must  be  introduced  per  anum,  ta  in 
the  male,  while  in  married  women  it  may  be  introduced  into  the 
vagina. 

Severin  Ptneau,  in  his  work  written  at  the  eod  of  the  sixteenth 
century  on  the  signs  of  virginity,  quotes  the  ancients  as  his  au- 
thority for  the  dictum,  "it  is  crimioal  to  rupture  the  hymen" 
("magnum  est  crimen  perrumpere  virginis  hymen"). 

And  such  has  been  the  attitude  of  the  profession  through  all  the 
centuries  of  the  past ;  honorable  men  have  carefully  guarded  as 
isacred  the  rights  and  the  interests  of  the  young  women  who  have 
trusted  their  persons  to  their  professional  care,  and  the  barrier 
which  nature  has  erected  at  the  vaginal  inttoitus  as  the  Bole  prima 
facie  evidence  of  virginity  has  been  preserved  iutact 

I  wish  now  to  ui^,  in  the  first  place,  that  it  has  remained  for 
our  day  and  generation,  at  a  time  when  the  study  of  the  diseases 
of  women  has  become  a  fashion,  for  practitioners  of  medicine  tu 
ruthlessly  disregard  all  moral  considerations  and  make  digital 
examinations  of  young  women  with  pelvic  pains  at  the  menstrual 
period,  or  those  presenting  any  abnormality  in  the  menstrual  flow 
or  complaining  of  a  leucorrhea. 

I  know  not  how  else  to  characterize  this  cacodhes  examinandi, 
this  reckless  habit  of  investigating  the  sexual  organs  of  young 
women,  than  as  a  species  of  rape. 

I  know,  for  example,  of  a  large  institution  in  our  city  entrusted 


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Selections  and  Abstracts.  707 

-with  the  education  of  young  women  irom  all  parts  of  the  country. 
In  Dumerous  instances  youog  girls  with  purely  functional  dysmen- 
orrhea are  taken  to  a  physician,  who  ezatnines  them,  inserts  specula, 
and  institutes  treatments  where,  as  I  have  bad  occasion  to  verify, 
there  is  actually  no  discoverable  local  disorder  whatever. 

Other  young  women  are  constantly  coming  to  me  from  a  dis- 
tauce  with  the  statement  that  they  have  "  ovarian  disease,"  or 
*'  tubal  disease,"  or  "  anteflexion  of  the  womb,"  who  are  perfectly 
sound,  and  who  ought  never  to  have  been  examined  at  all ;  and  I 
have  thus  to  record  in  my  case-book  in  numerous  instances  "  no 
pelvic  disease  "  or  "metrophobia  " — a  word  I  have  coined  to  des- 
ignate those  who  are  fully  assured  they  have  some  grave  "womb 
trouble,"  but  are,  Dotwithstanding,  perfectly  sound. 

Aside  from  all  the  hospital  cases  I  have  seen,  I  find  in  my 
private  case-book  the  records  of  twenty-eight  cases  with  no  pelvic 
disease  out  of  a  total  of  550  in  all,  about  five  per  cent. 

While  male  physicians  are  great  offenders  in  this  respect,  many 
of  the  women  who  practice  medicine  are  far  worse ;  indeed,  they 
often  seem  to  possess  no  conscience  whatever  in  dealing  with  these 
sacred  interests  of  their  own  sex. 

A  young  woman  with  a  natural  sense  of  shame,  but  utterly  guile- 
less of  any  knowledge  of  anatomy,  feels  that  it  is  easier  for  her  to 
speak  of  her  pelvic  discomforts  to  one  of  her  own  sex;  hut  the 
■woman  doctor  (with  many  noble  and  conspicuous  exceptions,  I  am 
happy  to  say)  then  feels,  on  her  part,  that  it  is  necessary,  in  order 
to  make  a  complete  investigation  of  every  case,  to  inspect  the  gen- 
itals and  to  insert  ber  finger  into  the  vagina;  she  generally  ends 
by  putting  in  a  speculum,  too,  and  tampons,  and  so  begins  a  never- 
ending  course  <ft  so-called  "treatments,"  during  which  the  natural 
dps  and  downs  of  health  encourage  the  trusting  victim  to  think  at 
first  that  the  "  treatments"  are  benefiting  her,  and  then,  when  the 
pains  recur,  that  there  surely  is  something  at  fault,  and  so  it  con- 
tinues for  years.  Sooner  or  later,  in  many  cases,  an  infection  is 
Introduced,  and  from  having  no  disease  at  all  she  is  inoculated  with 
a  salpingitis,  and  she  is  fortunate,  finally,  if  she  escapes  a  radical 
operation  removing  her  uterine  tubes  and  her  ovaries.  The  records 
of  this  country  within  the  past  twenty  years  would  show,  I  verily 


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708        The  Atlanta  Mbdical  and  Suboical  Jodrnal. 

believe,  thonsaods  of  Buoh  victims,  at  first  anneceBwrily  insulted, 
and  then  robbed  of  their  distiactive  organs  of  sex  for  imagiury 
ailments  or  diseases  acquired. 

Such  is  the  cbaracter  of  this  evil ;  of  its  extent  no  one  oan  do 
more  than  rougblj'  estimate.  My  own  ezperienoe  leads  me  to  oon- 
olude  that  these  vicions  praotioes  are  both  general  throughout  our 
country,  and  that  they  af^t  oor  young  womanhood  to  the  extent 
of  inflicting  an  unnecessary  injury  apon  many  thousands  yearly. 

In  case  an  examination  is  aetnally  necessary,  it  must  be  made  by 
one  who  is  thoroughly  competent  to  decide  at  onoe  whether  or  not 
there  is  any  disease  present,  and  who  will  be  able  to  proceed  at 
ODce  to  do  all  that  may  be  required  to  relieve  it.  By  dilatiag  a  ' 
cervix,  or  rupturing  a  lai^e  Graafian-follicle  cyst,  or  breaking  up 
adhesions,  oftentimes  all  can  be  done  at  once  which  it  is  possible  to 
do  at  all,  and  the  patient  will  be  spared  the  distress  of  useless-and 
endless  so-called  "treatments,"  which  consist  in  the  application  of 
drugs  to  the  vaginal  walls  or  to  the  cervix,  anatomical  structures 
distant  from  and  quite  distinct  from  the  supposedly  affected  organs, 

'I  would  urge  that  there  are  saUsfactory  methods  of  examining 
young  women  whicli  need  shock  no  sensibilities  and  which  inflict 
no  injury  npou  any  oi^n. 

In  the  first  place,  if  the  patient  has  not  been  examined  and 
treated  before,  and  an  examination  is  neceseaiy,  it  is  my  invariable 
practice  to  propose  to  do  this  tmder  atmipteU  anatketia,  in  this  way 
aeouring  a  perfect  relaxation,  with  every  fBcility  for  making  tiie 
minutest  investigation  which  it  is  poenble  to  make,  short  of  in* 
spection  through  an  abdominal  incision.  The  anesthetic  obviates 
the  inevitable  resistance  of  the  abdominal  walls,  and  the  examina- 
tion leaves  behind  it  no  disagreeable  memories. 

In  the  second  place,  when  the  patient  is  anesthetiEed  tht  exami- 
noHon  mMst  bt  conduoUd  through  the  rectum.  The  cervix  can  be 
easily  palpated  through  the  recto-vaginal  wall ;  and  as  for  the  body 
of  the  uterus,  the  ovaries,  and  the  tubes,  they  cannot  be  clearly 
palpated  in  any  other  way.  The  rectal  examination  is  therefore 
not  only  to  be  recommended  because  it  spares  the  bymen,  but  be- 
cause it  ia  aetually  inditpeiwaiU  to  a  thorough  mvatigation. 

I  have  ^own   on  another  occasion  that  the  most  minute  exan- 


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Sblbctioks  and  Abetracts.  709 

iaatioo  may  be  made  by  tbe  rectum  if  the  pelvic  organs  are  first 
skeletonised  by  putting  the  patient  in  the  knee-breast  position  to 
lei  in  the  air  and  so  getting  Hd  of  the  iDtestines.  After  doing  this 
the  examination  is  conducted  in  the  dorsal  position.  If  tbe  finger 
is  not  more  than  6.5  centimeters  in  circnmfereuoe,  it  may  often  be 
inserted  into  the  vagina,  slowly  and  with  extreme  care,  without 
rupturing  the  hymen;  ibis  is,  however,  not  a  good  rule,  for  the 
tactile  sense  of  many  men  seems  to  be  so  blunt  that  there  is  no  ap- 
preciation of  resistance  when  delicate  structures  are  being  investi- 
gated, and  barm  is  done  unwares. 

Ib  tbe  third  place,  if  it  is  necessary  to  dilate  and  to  curette  the 
uterus,  this  may  be  done  by  introducing  a  finger  into  the  rectum  and 
locating  the  cervix,  and  then  introducing  a  pair  of  tenaculum  for- 
ceps into  the  vagina  and  carefully  opening  them,  and  catching  the 
cervix  and  drawing  it  down  to  the  outlet,  where  it  may  then  be  di- 
lated and  curetted,  in  many  cases,  without  injuring  the  hymen. 


Some  Observations  on  Brain  Anatomy  and  Brain  Tumors. 

Dr.  William  C.  Krauss,  of  Buffiilo,  read  a  paper  at  the  ninety- 
second  annual  meeting  of  tbe  Medical  Society  of  the  State  of  Mew 
York,  Albany,  January  26,  1898,  with  the  above  title. 

He  called  attention  (1)  to  the  difficulty  in  remembering  tbe  gross 
anatomy  of  the  brain,  and  (2)  to  the  almost  universal  presence  of 
optic  neuritis  in  c^ses  of  brain  tumor. 

He  attempted  to  overcome  the  difficulty  in  regard  to  tbe  anatomy 
of  the  brain  by  formulating  the  following  rules,  which  are  some- 
what unique  and  original,  and  at  the  same  time  easily  remembered : 

RiJe  of  Two. — 1.  The  nerve  centers  are  divided  into  two  great 
divisions,  (1)  encephaton,  (2)  myelon.  2.  The  encepbalon  is  di- 
vided into  two  subdivisions  ,  (l)cerehrum,  (2)  cerebellum.  3.  The 
cerebrum,  cerebellum,  and  myelon  are  divided  into  two  hemis- 
pheres each,  (1)  right,  (2)  lelt.  4.  The  encepbalon  is  indented  by 
two  great  fissures,  (1)  longitudinal,  (2)  transverse.  5.  Into  these 
two  great  fissures  there  dip  two  folds  of  the  dura,  (1)  fatx  cerebri, 
(2)  tentorium  cerebelli.  6.  There  are  two  varieties  of  brain  mat- 
ter, (1)  white,  (2)  gray. 


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710       The  Atlanta  Medical  and  Shrqical  Journal. 

Rule  of  Three. — 1.  There  are  three  layers  of  membranes  sur- 
roundiog  the  brain,  (1)  dura,  (2)  araohooid,  (3)  pia.  2.  Each 
hemisphere  is  iodented  by  three  major  fissures,  (1)  sylvian,  (2)  ro- 
landic  or  central,  (3)  parieto-occipital.  3.  Three  lobes,  front&l, 
temporal  and  occipital,  on  their  convex  snr&ce  are  divided  into 
three  convolutions  each — superior,  middle  and  inferior,  or  first, 
second  and  third.  4.  There  are  three  pairs  of  basal  ganglia,  (1) 
striata,  (2)  tbalami,  (3)  quadrigemina.  5.  The  hemispheres  of  the 
brain  are  connected  by  three  commissures,  (1)  anterior,  (2)  medi, 
(3)  post-commissure.  6.  The  cerebellum  consists  of  three  porticos, 
(1)  right,  (2)  left  (hemisphere,  (3)  vermes.  7.  There  are  three 
pairs  of  cerebellar  peduncles,  (I)  superior,  (2)  middle,  (3)  inferior. 
8.  The  number  of  pairs  of  cranial  nerves,  in  the  classifications  of 
Willis  and  Sommeridg,  can  be  determined  by  adding  three  to  the 
number  of  letters  in  each  name ;  that  of  Willis  making  nine,  and 
that  of  Sommering  making  twelve,  or  the  name  containing  the 
more  letters  has  the  larger  number  of  pairs  of  nerves,  and  vice 
versa.  9.  The  cortex  of  the  cerebellum  is  divided  into  three  lay- 
ers of  cells,  (1)  granular,  (2)  Purkiuje's  cells,  (3)  a  molecular 
layer. 

Rule  of  Kve. — 1.  Each  hemisphere  is  divided  externally  into 
6ve  lobes,  of  which  four  are  visible,  (1)  frontal,  (2)  parietal,  (3) 
temporal,  (4)  occipital ;  and  one  invisible,  (5)  insula  (isle  of  Beil). 
Roughly  speaking,  the  visible  lobes  correspond  to  the  bones  of  the 
cranium  ;  that  U,  the  frontal  lobe  is  underneath  the  frontal  bone, 
the  parietal  lobe  beneath  the  parietal  bone,  etc.  2.  The  brain  cod' 
tains  five  veutricles,  of  which  four  are  visible — the  right  and  left, 
or  first  and  second,  the  third  and  fourth ;  and  one  invisible,  the 
fiflh,  or  pseudo-ventricle.  3.  The  cortex  of  the  brain  contains  five 
distinct  layers  of  ganglion  cells. 

Studying  carefully  one  hundred  cases  of  brain  tumor  in  which 
an  ophthalmoscopic  examination  had  been  made  for  the  presence  or 
absence  of  choked  disc  (optic  neuritis),  Dr.  Krauss  announced  tb& 
following  conclusions: 

1.  Optic  neuritis  i9  present  in  about  90  per  cent,  of  all  cases  of 
brain  tumor. 

2.  It  is  more  often  present  in  cerebral  than  in  cerebellar  cases. 

3.  The  location  of  the  tumor  exerts  little  infiueoce  over  the  ap* 
pearance  of  the  papillitis. 


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Selections  and  Abstracts.  711 

4.  The  size  and  nature  of  the  tumor  exerts  but  little  influence 
over  the  productiou  of  the  papillitis. 

5.  Tumors  of  slow  growth  are  less  incliued  to  be  accompanied 
with  optic  neuritis  than  those  of  rapid  growth. 

6.  It  is  probable  that  unilateral  choked  disc  is  indicative  of  dis- 
ease in  the  hemisphere  corresponding  to  the  eye  involved. 

7.  It  is  doubtful  whether  increased  intracranial  pressure  is  solely 
and  alone  responsible  for  the  production  of  an  optic  neuritis  in 
oases  of  brain  tumor. — Philadelphia  Med.  Journal. 


(From  the  Mtdical  iierieio,  St.  Louit,  Mo.,  February  26,  1898.) 
ObSEBVATIONS   upon   the   TitBATHENT   OF  SOHE   CaS£8   OF 

Neubasthenia.* 

Bt  Jerome  K.  Bauddv,  M.D.,  LL.D.,  8t.  Louib,  Mo  .  1 

Profeeaor  Nervous  and  Mental  Diseases,  and  of  Medical  Jurisprudence, 

Missouri  Medical  College. 

CLINICAL  BEPOET  MICROSCOPIC  REPORT 

Bt  C.  FiBCH,  M.D., 

St,  Louis,  Mo. 

That  chalybeates,  more  especially  the  organic  salts  of  iron,  con- 
stitute an  essential  indication  in  the  successful  treatment  of  some 
casea  of  neurasthenia,  especially  in  the  female,  where  functional 
menstrual  derangements  exist,  is  to  my  mind  an  indtsptUahle  fact. 
They  produce  conditions,  oftentimes  not  attainable  by  the  inorganic 
preparations  for  many  reasons,  which  experience  and  reflection 
clearly  demonstrate. 

Id  a  recent  clinical  stady  of  this  affection,  my  conclusion,  b& 
above  stated,  is  fully  justified  and  corroborated  by  the  microscopical 
blood  examinations  conducted  by  my  esteemed  and  skillful  friend  ' 
Dr.  C.  Fisuh.  That  cerebro-spinal  anemia  is  a  frequent  important 
ooDCOmitant,  if  not  an  essential  etiological  factor  of  nearastheniar 
I  hardly  think  admits  of  cavil. 

The  clinical  histories  of  appended  cases  were  compiled  by  my 
son,  Dr.  Keating  Bauduy,  chief  of  the  Neurological  Clinic  at  St. 
John's  Hospital,  under  whose  direct  supervision  the  investigations 
were  conducted.  That  the  ratio,  or  number  of  red  blood  corpus- 
cles, and  the  percentage  of  hemoglobin  were  deficient  in  the  normal 
standard  of  these  cases,  prior  to  the  treatment,  is  incontestable,  a» 


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712       The  Atlanta  Medical  and  Surqical  Journal. 

BbowD  by  the  luicroBCope.  Tbat  several  of  these  cases  to  be  eou- 
merated  sbowed  marked  improvement,  even  aft«r  one  or  two  weeks' 
treatment,  is  moreover  revealed  in  tbe  same  manner,  and  wbicb  for 
rapidity  of  effect  is  quite  au  exceptional,  if  not  a  startling  therapeutic 
result,  when  compared  with  some  of  tbe  prior  and  more  established 
methods  of  treatment.  Tbat  many  of  these  cases  presented  unmis- 
takable evidence  of  satis&ctory  improvement,  from  both  a  subjec- 
tive and  objective  standpoint,  was  quite  as  uotabte  as  the  permanent 
character  of  their  general  amelioration.  Tbat  the  ordinary  tonics 
had  in  t^ome  instancea  been  administered  with  neugatory  results, 
while  pursued  along  the  old  lines  of  authoritative  medication, 
seems  quite  manifest. 

My  only  esplaoatioa  of  the  surprising  resvUa  in  the  cases  herein 
cited,  where  tbe  usual  officinal  class  of  reme<1ies  had  formerly  b«ea 
iaefTectually  essayed,  was  the  superinductiou  as  is  so  frequently  the 
case  of  disturbed  digestion  and  assimilation ;  results  but  too  &miliar 
and  disappointlDg  to  professional  experience.  Aside  ftota  the  dis- 
turbances just  mentioned,  the  development  of  headache,  constipa- 
tion, etc.,  frequently  obviates  their  further  administration. 

When,  a  few  years  ago,  my  attention  was  called  to  Gude's  prep> 
aratioD  of  "Liquor  Mangano-Ferri  Peptonaiw,  Oude,"  (Pepto- 
Mangan)  so  extensively  used  and  highly  extolled  in  Germany,  with 
my  usual  antipathy  for  new  remedies,  I  reluctantly  gave  it  a  trial, 
anticipating  tbat  I  would  necessarily  have  to  combat  the  usual  dis- 
appointing effects  of  most  of  the  other  preparations  of  iron.  The 
results,  however,  were  indeed  a  eurpriae  to  mytt^,  for  the  concomi- 
tant deranging  sequels  were  so  slight,  tbat  but  in  very  few  instances 
in  my  extenaive  utilization  and  experience  with  this  special  pharma- 
ceutical preparation  was  I  obliged  to  discontinue  it.  My  experience 
having  led  me  to  believe  that  iron  and  manganese  in  combinatioD 
are  both  indicated  in  the  vast  majority  of  cases  of  neurasthenia, 
this  particular  remedy,  /  am  convinced,  unll  prove  a  great  boon  botiito 
the  patient  and  the  physician.  While  it  is  maiotaioed  by  some  that 
the  hemoglobin  of  tbe  red  blood  corpuscle  manganese  is  present,  as 
well  as  iron,  I  have  for  many  years  procured  results  with  a  com- 
bination of  both,  not  directly  obtainable  with  one  alone.  We 
know,  however,  tbat  manganese  gives  off'  oxygen  to  a  greater  de- 


^dbyGdogle 


Selections  and  Abstracts.  713 

gree  than  iroD,  anil  it  has  beea  argued  tLat  for  tbia  reason  its  id- 
ternal  exhibition  might  correspondingly  increase  assimilation. 

Dr.  Fiech'a  appended  microscopical  report  shows  that  the  increase 
in  the  percentage  of  hemoglobin,  in  many  of  this  series  of  cases, 
is  ftr  in  excess  of  the  proportionate  increase  of  the  red  blood  cor- 
puscles. Tkiafact  I  deem  of  greater  importance  as  to  the  efectiveneat 
of  the  medioine,  because  the  count  of  the  blood  corpuscles  is  to  a 
certain  extent  relative,  and  the  size  varies  greatly  in  ditferent  cases, 
and  for  other  reasons  the  same  amount  of  blood  plasma  contains 
difierent  numbers  of  red  cells;  hence  I  would  particularly  lay  stress 
upon  the  proportionate  increase  of  the  hemoglobin  as  the  more 
important  factor.  The  notable  and  aatonteking  improvement  of  these 
cases,  when  placed  upon  this  preparation,  led  me  to  their  closer 
scrutiny,  as  well  as  microscopic  observation.  Before  concluding, 
I  viiak  particularly  to  call  attention  to  the  fact  of  the  absence  of 
digestive  disturbances  and  necessary  consequent  interrereuce  in  the 
assimilation.  All  other  unpleasant  complicating  results  were  not- 
able by  their  absence.  Of  course  we  do  not  consider  the  remedy 
applicable  to  cases  of  lithemic  neurasthenia,  nor  in  any  manner  a 
apecijio  in  any  variety  of  neurasthenia.  In  many  cases  the  addition 
of  arsenic  and  strychnia  greatly  increases  the  efficacy  of  the  prepa- 
ration. I  must  also  take  cognizance  of  the  salient  fact  of  the 
rapidity  with  which  a  large  number  of  female  neurasthenics,  under 
our  treatment,  who  have  suffered  with  marked  functional  menstrual 
derangements,  have  attained  a  normal  condition  under  the  admin- 
iatration  of  this  moat  elegant  combination  of  iron  and  manganese. 

As  it  would  be  tedious  and  monotonous  to  present  an  exhaustive 
citation  of  a  multiplicity  of  clinical  cases,  T  have  confined  myself 
to  a  recital  of  a  few  typical  ones: 

CLINICAL  REPORT 
By  Kbatwo  Badduy,  M.D. 

Case  J . — Mrs.  S.,  aged  32  years> 
mother  of  three  children,  came  to  me 
in  a  pitiable  mental  condition,  and 
bad  in  her  arms  a  nursing  hydro- 
cephalic child,  five  months  old.  Her 
g  mental  depression  approached  a  type 


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714       Thb  Atlanta  Medical  and  Surgicai,  JouitHAt. 


L      BXIHIMAIIOM. 

(BcKloDliitDt  Treatmeat.) 

Due,  NoTBiaber  IT,  I8S7. 

Red  CorpUBClM. .  SHOOOO 

^emogliibln,  p«r  ctDt..         01 


Date.Juiiury  8.  irag 
Rnd  Corpiuclw       . , .  .(MaODO 
BeDinilobin,  per  cent  .  TG 

DttUTiaM  or  TaK4Tin.1T. .Oidays 

„.„       1  BeO  Corpiuclat  (In 


of  veritable  melancholia.  M;  first 
idea  was  to  advise  that  the  child  be 
weaoed,  and  then  place  her  iipoo  the 
Clascal  opium  treatment  for  metan- 
cholia.  This  was  her  third  child,  and 
like  all  mothers,  she  clung  to  the  life 
of  her  unfortunate  with  characteristic 
tenderness.  Therefore  she  bluntly 
insisted  upon  my  candid  opinion,  as 
to  whether  the  weaning  of  the  baby 
might  prove  &ta).  Knowing,  as  I 
did,  that  the  life  of  the  child  was  sim- 
ply a  question  of  a  period  of  short 
duration  in  either  case,  I  so  informed 
her;  nevertheless,  I  insisted  that  the 
best  hope  for  her  recovery  was  to 
wean  it.  This  she  refused  to  do,  and 
after  Dr.  Fiech  had  made  a  blood  ex- 
amination and  pronounced  her  highly 
anemic,  I  reluctantly  undertook  the 
case.  Aside  from  her  mental  depres- 
sion, physical  lassitude,  and  marked 
pallor,  the  "  casque  neurastbenique  " 
symptom  was  a  dominant  feature  in 
her  case.  Any  effort  to  perform  her 
usual  household  duties  produced  sen- 
sations of  cerebral  fullness,  and  pei^ 
sistent  pain  in  the  vertex.  She  even 
confessed  that  the  idea  of  suicide  had 
of  late  frequently  haunted  her.  Under 
the  administration  of  "Pepto-Man- 
gan,"  with  no  other  treatment,  afier 
the  short  period  of  fifty-two  days,  she 
was  discharged  fully  restored  to  her 
normal  condition.  Microscopic  re- 
port showed  a  relative  gain  in  nnmber 
of  red  blood  corpuscles  of  34  per  ceat; 
hemoglobin,  44.6  per  oeut. 


^dbyGooglc 


Selections  ako  Abstracts. 


Case  2. — Mrs.  Sioa,  aged  23  years, 
mother  of  two  childrea,  youDgest  six 
moDthsand  DursiDg.  About  the  fourth 
month  of  her  last  pregnancy  she  was 
troubled  with  dyspnea.  Gave  history 
of  instrumental  delivery,  followed  by 
puerperal  eclampsia.  Great  loss  of 
blood  during  birth  of  child.  Two 
months  later,  abscesses  developed  in 
each  breast,  and  patient  was  confined 
to  bed  during  a  period  of  ten  weeks. 
Case  presented  typical  maoifestatioDs 
of  neurasthenia,  also  characteristic  ap- 
prehensions,  with  preternatural  emo- 
tional mobility.  Constant  cephalalgia 
in  vertical  region,  persistent  parasthe- 
sia  in  extremities,  mouth  and  tongue, 
were  also  present.  She  was  intensely 
pale  with  every  appearance  of  pro- 
found anemia.  Aside  from  a  mild 
laxative  which  was  given  to  obviate 
constipation — an  obstinate  feature  in 
her  case — nothing  was  administered, 
save  "Pepto-Mangan."  After  a  period 
of  treatment  of  forty-nine  dnys  I  dis- 
charged her,  as  she  evinced  none  of 
the  symptoms  which  formerly  existed. 
A  notable  feature  was  the  correspond- 
ing improvement  of  the  child,  not- 
withstaading  the  fact  that  I  had  pre- 
viously insisted  uponitB  being  weaned, 
which  she  had,  nevertheless  contrary 
to  my  instructions,  continued  to  nurse. 
Microscopic  report  showed  a  relative 
gain:  red  blood  corpuscles,  19  [ler 
cent.;  hemoglobin,  27  per  cent. 


(BectnnlDg  of  Treatment.) 
Dale.  NoTember  SO,  II 

R«d  Corp  lECles » 

Heiu^globlQ,  peroenl.. 

BXIHIKATIOM. 

Dale,  December  U,  II 
HadCnnnuole'...        .  3£ 


imoslobin,  per  ct.     U 
id  Cbrpiuclea,  per 


idb,Googlc 


716       Tab  Atlanta  Medical  and  Sorgical  Journal. 


CABEnl. 
.    EXAMIlllTIOIt. 

(fieglDnlDE  o_r  Treatment.  )^ 

Bed  iJorpusoles    . 


Dale,  JODuarv  S!,  I8S». 
.«S1H»0 

TKEi-rkiiNT 57  dayi 


DdritIoh  _- 

<AtaomM.)  |Hi^g'|Vbl"n","ii;"ci," 
OUH       (  *^  tt-T>u»cI«,  per 


CABK  IV. 

(BeglnnlDgof  Treatmeot.) 

Date,  Norember  W,  18S7. 

Red  UorpuKlea .3S07OM 

HeinoKlobln,perceDC..         46 

n.      EZIHIHITIOH. 

Date,  December  17, 1SS7. 
Red  Oorpueolea 3200000 

III.    Eii.MT^TiOK.''"™'    * 

Date,  JaDuai?  i,  IBB§. 

Red  Corpusclea ffiBOOOO 

HemoElobln,  per  oeat. .  M 

IT.      Ex  AHl  NATION. 

Dale,  Jonuarj' 8,1898. 

Red  Corpusciee  3871*00 

Hemoglobin,  per  oeot..         08 

DnB^Tion  or  TiuiTHiNT. 41  days 

0*'M       1  Ked  Corpuocles  (fn 

(Ab«inte)  \  HiZg'Uii;-,;;r  ■«:.' « 

«*I"      jR^C«pui«!«.pBr 
(Rel.U»e)JH^''„^-^i-;— -J-    J» 


Case  3. — D.  G.,  aged  25  years, 
uomarried.  Suffered  from  nervous 
headache  ftir  past  year.  Vaso-motor 
disturbaDces  evidenced  hy  alternate 
fluBhinge  and  pallors,  heat  and  cold. 
Atonic  dyspepsia.  Irregukrity  of 
bowele.  Disturbed  sleep.  Depressed 
physical  couditioDjCorresponding  weak 
pulse.  Aftertaking"Pepto-Mang8n" 
fifly-seven  days,  reported  feeling  gen- 
erally improved.  Digestion  was  bet- 
ter, pulse  stronger  and  headaches 
greatly  diminished  in  inteusity.  Vaso- 
motor disturbances  disappeared.  Mi- 
croscopic examinatiou  showed  a  rela- 
tive gain :  red  blood  corpuscles,  1 1  per 
cent.;  hemoglobin,  15  per  cent. 

Case  4.— Miss  S.,  aged  28  years, 
presenting  many  of  the  well-defined 
symptomsof  neurasthenia,  wasinacoa- 
dition  of  profound  mental  and  physi- 
cal weakness.  The  history  showed 
that  since  our  great  cyclone  of  May 
27,  1896,  she  had  never  been  her 
normal  self,  and  was  unable  to  per- 
form any  sustained  mental  or  physical 
strain.  Dating  from  that  episode  she 
had  always  worried,  and  was  con- 
stantly the  victim  of  peculiar  forebod- 
ings, lusomnia  and  general  malaise 
were  cardinal  symptoms.  My  diag- 
nosis was  what  has  been  termed  "cy- 
clone neurosis,"  of  which  I  have  seen 
numerous  cases.  Menorrhagia  existed 
to  an  alarming  extent  fnr  which  I  ac- 
cordingly recommended  rest  and  the 
recumbent  posture  during  her  periods. 
Because  of  the  pronounced  insomnia, 
I  prescribed  a  nightly  dose  of  byoscy- 
amine  and  sulfonal  during  the  first 
week   of    treatment   as   a   hypnotic, 


^dbyGoOgle 


Sblectioks  and'  Abstracts. 


which  constituted  the  only  medicatiOD 
other  than  "  Pcpto-MangaD."  After 
having  taken  the  latter  for  fortyone 
days,  I  discharged  her  from  trE^atment, 
as  she  had  passed  her  last  menstrual 
period  after  a  normal  flow  of  three 
days,  her  pallor  having  given  way  to 
rosy  cheeks  and  her  physical  and  men- 
tal condition  heiog  entirely  satisfac- 
tory. Microscopic  report  showed  a 
relative  gain:  red  blood  corpuscles, 
38  per  cent.;  hemoglobin,  47  per  cent. 

Case  5. — Mr.  C,  aged  21  years, 
unmarried.  Highly  anemic,  very 
pale.  Anoresia  and  insomnia  per- 
sistent. Physical  condition  greatly 
depre»(ed.  Cardinal  feature  was  a 
sexual  bypochondrical  tendency.  Gave 
history  of  excesses  both  alcoholic  and 
sexual.  Aside  from  advice  as  to  the 
necessity  of  leading  a  moral  lile,  and 
absteining  from  all  stimulants,  gave 
DO  medicine  hut  "Pepto-Maugan," 
with  the  addition  of  arsenic  and 
strychnia.  After  fifty-seven  days  of 
treatment,  patient  was  much  benefited. 
Microscopic  report  showed  a  relative 
gain:  red  blood  corpuscles,  9  percent.; 
hemoglobin,  27  per  cent. 

Ca-se  6. — Mrs.  D.,  aged  36  years, 
married;  five  children.  Since  birth 
of  last  child,  eighteen  months  ago, 
has  been  in  state  oT  proTound  nervous 
prostration.  Previously  resisted  or- 
dinary tonic  and  constructive  treat- 
ment. Menorrhagia  was  the  dominant 
feature  of  the  case.  After  taking 
"  Pepto-Mangan  "  for  fifty-one  days 
patient  evinced  more  improvement 
than  during  auy  stated  time  through- 
out the  past  eighteen  months.  I^st 
meoBtruation  approached  the  normal 


CASK  V, 

ing  tit  TraiiUiwDt.) 

^^U,  SovemMr  W,  ISCIT. 

Rod  UorpUrclM  ..3070000 

UflrmiglubJD,  per  cent..  44 

I>i.«i.  Doeember  1*,  I8IIT. 

Rert  Corpuscles. I'OUXW 

HeiiiotjlobiD,  per  a«nt. .        4t 
III.    Ekahisation. 

Date,  jHdUftT]'  ■.  Itm. 

Ked  Corpuaolee .SMMono 

Htimuelubta.  par  cent. .         U 

D-Wr,  Jmnuiii7K,lgS§ 
Bed  CorpuKlei WIMJOO 

[BXtlOn  OF  Ta 

Oaim      1  *'*''  ^"'V^t*.  per 
lelBllve)  (HtuiOKli>blii,"p«'oi!    17 


CASE  TI. 

EXAHIHATIOH. 

(BeginolDE  of  Tmlmeni 
Date,  NoTember  it 

Red  Corpiucles 

Hrmogkib  n,  paroeot. 


Dale.  Decent  bar  tS 

KtdO.rpu.clM 

lemnglDUn,  ptroedt. 


HemoEloblD.  per  cent.. 

Date,  Juniurr  16. 

Red  ronnuclea 

Hemwlubn,  per  cent.. 
Ddkatior  ofTbiateint  .. 
Hath       I  ^^  UorpuMl. 
.''*'.''.  .  J     lOOO'aJ 


...Md»ya 

-, ■l:..m 

loclcblQi  perot.      B 
im  CorpoecM,  per 

HeniDgloi>ln,  per  cV. .      S 


^dbyGoogle 


718       The  Atlanta  Medical  and  Surgical  Jodrnal. 


CASE  vu, 

L      EXIHINIIIOM. 

(f)eiciiii><D;  or  Treatmenr.) 

I>ate,  Noiembitr  30,  isa7. 

Hed  Corvui'clcs SXIOOOO 

Ht-mnelobla,  perceuC.  SO 

It.     ElimlSATIO.N. 

Dal«.  December  14, 1§HI. 

Ked  Corpuscles.     3ei«K» 

nogiobln,  percept..         68 
orTBEmiNT.   ...14  days 

iKed  Curpuaclee  (In 
ICWISi «o 
Hemoglobin, perct..      S 
Q^ju      ^  Ued  (kirpuscles,  par 
<Kel..lve)   iHem^VcJw'.i.'i-i.Vcl-.:     is 


CASE  VIII. 

[Beginning  of  Treatmenl.) 
(mt?,  November  90,  ISUT. 

Hem>ii.-lobiD,  percent..         ii 

II.      BlAIIIIIATiaN. 

Dal?,  January  8.  Ittng. 
R<t1  Corpuscles.  ..   ,   .  31111)010 
Beiuogiobin,  per  cett.,         48 

Diits.  January  16,  IBW. 

Red  Corpuscles a-aWiWl 

HemoKlobln,  percent  .         61 

DuBATioN  or  Tbuth  EST .47  days 

(J.IK        (Hed  1  or.'utclesln 
(aosoiute}  iH-moglobin.perct..      9 

Qjjj,       I  Ked  Corpuscles,  per 
(Rclati™)  \  h™ 'globln;^Vci::    M 


flow.  Microscopic  report  showed  a 
relative  gain:  red  blood  corpuscles, 
13  per  cent.;  hemoglobin,  8  per  cent. 

Cau£  7. — Mrs.  J.,  aged  48  years, 
widow;  mother  of  a  large  family. 
Cardiual  feature  of  case  was  recurrent 
cephalalgia  at  intervals  of  several  days. 
This  case  reported  aa  improvement 
as  to  the  inteusity  aod  duration  of 
headaches,  after  the  period  of  fourteen 
days  of  treatment.  Only  two  blood 
examinations  were  made.  A  further 
opportunity  to  observe  this  patient  did 
not  preseut  itself,  in  conseqneoce  of 
her  falure  to  continue  the  treatment. 
Microscopic  examinatioD showed  a  rel- 
ative gain :  red  blood  corpuscles,  14 
per  cent.;  hemoglobin,  13  per  cent. 

Case  8. — H.  F.,  aged  18  years, 
school-teacher,  unmarried.  Symptom- 
atology of  neurasthenia.  Malaria  was 
a  complicating  feature.  Amenorrhea 
for  past  six  months  was  the  principal 
symptom  for  which  she  consulted  me. 
Aside  from  a  course  of  quinine  to 
eradicate  the  malarial  feature,  I  ex- 
clusively gave'Tepto-Mangau."  After 
forty-seven  days'  treatment  she  was 
apparently  much  improved,  her  men- 
ses having  ap[>eared  in  the  interim. 
Microscopic  examination  showed  i 
relative  gain:  red  blood  corpuscles, 
d  per  cent.;  hemoglobin,  22  per  cent 

Cabe  9. — Mrs.  L.,  aged  42  years, 
married,  throe  children.  Comes  from 
neuropathic  family,  one  uncle  an  epi- 
leptic.    Has  always  been  quite  deli- 


Diciiiized  by  Google 


SBLECtlOKS   AND   ABSTRACTS. 


caleand  anemic.  Since  siiddeD  death 
of  husband  has  Diaoifested  great  irri- 
tability of  tfimper.  Loses  control  of 
herself  upon  the  slightest  provoca- 
tion. Cries  easily,  but  not  melaDcbolic. 
Peculiarly  apprehensive  of  suddea 
death;  imagiDes  upon  retiring,  that 
she  will  never  awake;  parozyHmal 
attacks  of  anxiety,  and  fatigued  upon 
the  slighte(!t  exertion.  Anorexia- 
Habitual  constipation.  Sleeps  rest- 
lessly. Patient  although  still  very 
pale,  after  taking  "  Pepto-Mangan  " 
for  twenty-seven  days,  began  to  man- 
ifest a  general  improvement.  Micro- 
scopic report  showed  a  relative  gain  ; 
red  blood  corpuscles,  11  per  cent.; 
hemoglobin,  12  per  cent. 

Case  10. — Mrs.  P.,  aged  36  years, 
married,  no  children.  Family  history 
predisposed  to  tuberculosis.  Physi- 
cally in  good  health.  Since  cyclone, 
May  27,  1896,  when  her  house  was 
totally  destroyed,  and  she  narrbwly 
escaped  death,  she  developed  nervous 
headaches;  later  on  she  mauifested  a 
listless  and  apathetic  condition.  Sleeps 
excellently,  but  does  not  feel  refresh- 
ed upon  awakening.  Complains  of 
drowsiness.  Marked  irritability  of 
temper.  Appetite  fair,  but  nervous 
dyspepsia.  Boards  with  sister  as  she 
cannot  muster  courage  to  manage  a 
household  of  her  own.  After  taking 
"Pepto-Mangan"  for  twenty-five  days 
she  began  to  feel  much  brighter  and 
better,  but  still  occasionally  lapses 
into  her  former  indifferent  mood. 
Color  better,  and  nervous  dyspepsia 
greatly  relieved.     Microscopic  report 


CASE  IX. 

1.     EZAiriHATIOH. 

(Bc^uniDgofTraKineDt.) 
D&le.JaDuaryi.  ISM. 

Red  CorpuBole' 37IOODI) 

U^moglobln,  per  cent..         M 

tL      EuHINitTIOH. 

Onle,  January  21,  IKR. 

ftod  Corpiucles 1103000 

Hemofiloblii.  percent..         60 

DiLte.' Janoftry  £9, 1S9B. 

Red  CorpuscIiM 4IUUGO0 

HemoKlobiD.  per  cent..         M 

DnutiOK  orTBCiTHiMT .!!  day! 

niia       ( It^  Curiiuscles 
l"^""*  |HemoEl..bln.perM...     10 
nun      i  Bed  (Jurpusclei, 

ribit.uvi.1  {     poroepi II 

(Keiauvei  (  uamoglobin,  perot..    1* 


CASE  X. 
I.    EumHiTtON. 

( Begin  nlQK  of  Trealment.) 
Date,  Janiury  4,  1^. 
Hud  Uorpusclea SISWDO 

UemogluMa,  percent..  M 

n.      EUHIHUIOH. 

Date,  January  II,  IS9S. 

Hed  Corpuwlea 120000 

Hemoglobin,  per  cent...        ST 

III.  EXIHINATIOM. 

Date.  January  2!,  1898. 

Rod  (.'orpuKlei 3S0O0O 

UeoiwlablQ,  percent..  83 

IV.  EZAHlHATruR. 

kMte,  January  tR,  IgiK, 

Rfld  U>rpuuLe« 3160000 

UemoxloUn.  percent..         68 

DaiiiTTnii  OP  Trbithint. .iSdayn 

fi.T>       {  R^  Corpuscles 

Q^fg        <  Red  C.irpuMlee,  per 


idb,GoOglc 


720       Thb  Atlanta  Medical  and  Surgical  J'ournaL. 


CABB  XL 

I.      EKtHIKATIOH. 

(Bec^DDlng  of  Tremlment.) 

l>Kie.J*nDar;G,  18ffi. 

Bsd  CorpuKClBH. SJHtOO 

HemoKlabln.  percent..         SS 

Dutei  January  It,  IBRK. 
Red  l-^orpiuclea. ....... .1001000 

H«iu«lablD,  percent.  6ft 

nL     BUKIITATIOIl. 

Dkts,  Jknuarr  13,  1806. 

BodCorpu^im tcfiJCOO 

Htimofflobin,  peroetit.  71 

IV.    EUHl^ilTlaK. 

Dale,  Jaaiury  IB,  19M. 

Bed  UorD'Ocles 4inW00 

Hemnglobln.  per  cent.  711 

DmunoK  or  Tkbathiht  ...    St  dsja 

g^y,       (  Hod  CorpuBclea,  per 
{BalatWe]  j  HoroogloWn'.'perot!    II 


0A8E  III. 
I.     BXAHIMtnoN. 

(BectnniDK  of  Treatment.) 

Date,  Juiuarr  I8,UtS. 
BadOorpuMiaa....     ...1986000 

HemoslobtD,  per  cent. 19 

n.      EZJIHIHITION. 

Dkte,  Jutury  U,  ISM 

RedOorpuKlpi SIMOOO 

Hemoclabia,  per  ceoi..         U 
DUBATioii  or  TiuuTMaHT T  days 

Q^„       I  Bed  Corpuaclea  per 


showed  a  relative  gain :  red  blood  cot- 
puacles,  12  per  cent.;  hemoglobiD,  12 
per  cent. 

Case  11, — Mr.  M.,  aged  29  yeare. 
Family  history  tuberculous.  His  avo- 
cation was  that  of  a  "  boot-maker" 
during  the  past  few  years.  The  strain 
of  gambling  and  the  consequent  ex- 
citement and  worry  have  made  him  a 
nervous  wreck.  Jerky  and  fidgety 
at  all  times.  Inability  to  concentrate 
his  mind  any  time.  Suffers  from 
nightmares  and  phantasmagoria  dur- 
ing steep,  which  is  consequently  much 
disturbed.  Is  troubled  with  consti- 
pation and  greatly  impaired  digestion. 
Anorexia  marked.  Much  reduced  in 
weight.  Although  always  fatigued 
and  depressed,  he  constantly  walks  to 
relieve  his  pent-up  nervous  irritabil- 
ity. Dreads  to  be  alone  for  fear  some- 
thing may  happen  to  him.  After  ibe 
administration  of  "  Pepto-Mangaa  " 
for  twenty-four  days,  patient  reports  a 
general  improvement,  especially  as  to 
his  appetite  and  the  relief  of  bis  in- 
digestion.  Microscopic  report  showed 
a  relative  gain:  red  blood  corpuscles, 
11  percent.;  hemoglobin,  12  percent. 

Case  12.— A.  McG.,  aged  20  years, 
servant,  unmarried.  History  showed 
the  ordinary  "symptom-group"  of 
neurasthenia.  After  the  short  period 
of  seven  days,  having  taken  but  one 
bottle  of  "Pepto-Mangan,"  her  con- 
dition was  greatly  alleviated.  Mi- 
croscopic report  showed  a  relative 
gain:  red  bloodcorpuBcIes.S  percent.; 
hemoglobin,  8  per  oent. 


^dbyGoOgle 


ATLANTA 

Medical  and  Surgical  Journal. 

Vol.  XV.  JANUARY,  1899.  No.  11. 


DUNBAR  ROY,  A.B.,  M.D.,  M.  B.  HUTCHINS,  M.D., 

EDITOB.  BUBINESB  MANAOEB. 


ORIGINAL  COMMUNICATIONS. 


(Abalraet.) 

THE   TECHNICS  OF   THE  OPERATIVE  TREATMENT 
OF  INTESTINAL  OBSTRUCTION. 

Dr.  Frederick  Home  Wiggin,  of  New  York,  read  a  paper  with 
this  title,  it  being  a  contribution  to  the  discussion  of  the  general 
subject  of  "  Intestinal  Obstruction."  He  said  that  the  various 
conditions  for  which  operations  are  usually  demanded  are:  (1) 
Streogulation  of  the  gut  by  bands,  extensive  adhesions  or  aper- 
tures; (2)  volvulus;  (3)  intussusceptioD;  (4)  obstructions  due  to 
neoplasms;  (5)  compression  by  tumors  external  to  the  gut;  (6) 
obstruction  from  foreign  bodies,  such  as  gallstones  and  enteroliths ; 
and  (7)  obstruction  caused  by  fecal  masses. 

Where  the  case  is  one  of  acute  intestinal  obstruction  there  is 
but  little  time  for  preparation.  The  loose  pieces  of  furniture 
should  be  removed  from  the  room  selected  for  the  operation,  and 
sheets  wet  with  carbolic  acid  solution,  one  to  twenty,  or  bichloride 
solution,  one  to  five  hundred,  should  be  placed  over  the  carpet. 
Id  this  preparation  of  the  room  it  is  important   that  no  dust  be 


^dbyGoOgle 


722       The  Atlanta  Medical  and  Sdboical  Journal. 

raised.  The  instrumenta  are  boiled  for  ten  minutes  in  a  two  per 
cent,  solution  of  carboDSte  of  soda  and  then  placed  in  trays  ooo- 
tuning  sterilized  water.  The  towels  may  he  sterilized  iD  a  special 
sterili»r  or  by  boiling.  A  large  quantity  of  saline  Boluliou  (oae 
teaepoonful  of  common  salt  to  the  quart  of  water)  should  be  on 
hand,  and  a  wash-boiler,  after  thorough  cleansing,  should  be  filled 
with  water  which  has  been  sterilized  by  boiling  for  an  hour.  This 
water  is  then  rapidly  cooled  in  pitchers  surrounded  by  ice.  Where 
there  is  great  haste,  it  is  admissible  to  take  the  water  from  the  hot- 
water  faucet.  If  there  has  been  much  vomiting,  or  if  there  is 
considerable  abdomioal  distention,  it  will  be  well  to  follow  Kuss- 
maul'a  suggestion,  to  wash  out  the  stomach  with  saline  or  boric 
acid  solution.  If,  in  addition,  the  patient  is  much  prostrated,  and 
does  not  respond  well  to  the  ordinary  cardiac  stimulauts,  from  one 
to  three  pints  of  saline  solution  should  be  injected  into  the  veins. 
The  patient  having  been  anesthetized,  the  skin  over  the  field  of 
operation  is  treated  successively  with  the  following:  (1)  Green 
Boap;  (2)  hydrogen  dioxide;  (3)  lathered  and  shaved;  (4)  water; 
(5)  equal  parts  of  alcohol  and  ether;  (6)  ooe  to  five  hundred  bich- 
loride solution  in  alcohol;  and  (7)  sterile  water  or  saline  solu- 
tion. The  bladder  should  then  be  emptied  by  catheter.  When 
the  site  of  obstruction  cannot  be  definitely  located,  an  incision, 
four  inches  long,  should  be  made  through  the  right  rectus  muscle, 
between  the  umbilicus  and  the  pubes.  If  dbtended  coils  of  in- 
testine obscure  the  view,  they  should  be  aspirated  or  incised,  and 
the  wounds  so  made  clofed  by  suture,  and  the  parts  disinfected 
with  hydrogen  dioxide.  The  first  effort  of  the  operator  should  be 
to  find  the  cecum.  If  it  is  greatly  distended  there  is  good  reason 
to  believe  that  the  obstruction  is  in  the  colon,  but  if  there  is  little 
or  no  distention,  it  is  probable  that  the  stoppage  is  in  the  small 
intestine.  The  rectum  should,  of  course,  be  explored  prior  to  the 
abdominal  section.  Where  the  obstruction  is  supposed  to  be 
ID  the  colon,  the  hand  should  be  passed  over  the  entire  length 
of  the  large  bowel,  or  until  the  obstruction  is  found.  Where 
the  obstruction  is  suspected  to  be  in  the  small  intestinet,  the 
operator  should  look  along  the  brim  of  the  pelvis  and  in  the 
region  of  the  cecum  for  the  collapsed  portion   of  bowel,  and 


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Operative  Treatment  of  Intestinal  Obstruction.     723 

follow  this  dowD  to  the  obstmctioD.  The  various  hernial  orifices 
should  also  be  examined,  rememberiog  that  sometimes  two  forms 
of  obstruction  may  coexist. 

If  the  intestinal  obstruction  ie  caused  by  bands,  these  should  be 
ligated  on  both  sides  near  their  attachment,  and  removed.  If  a 
diverticulum  or  an  adherent  appendix  is  the  cause  of  the  trouble, 
these  portions  of  the  bowel  should  be  removed  in  the  ordinary 
manner,  and  the  opening  in  the  gut  closed  with  Lembert  sutures. 
According  to  the  writer's  experience,  when  volvulus  occurs  in  the 
small  intestine  it  is  not  only  safe,  but  desirable,  to  draw  the  intes- 
tine out  of  the  abdomen,  taking  care  to  keep  it  hot  and  moist  by 
wrapping  it  in  gauze  or  soft  towels  wrung  out  in  hot  saline  solu- 
tion. Where  an  intussusception  is  the  cause  of  the  obstruction, 
the  tumor  should  be  encircled  below  its  apex  by  the  finger  and 
thumb,  and  the  sheath  held  a  few  iuches  lower  down,  while  the 
apex  of  the  tumor  is  pushed  upward.  Traction  from  above  the 
tumor  should  not  be  employed.  If  the  intussusception  is  irre- 
ducible, the  following  method,  described  by  Mauosell,  is  recom- 
mended :  A  slit  is  made  in  the  iutussuscipiens  and  gentle  traction 
is  exerted  on  the  intussusceptum  until  its  neck  appears  outside 
the  opening  in  the  intussuscipiens.  The  base  is  then  transfixed 
with  two  straight  needles,  armed  with  horsehair,  and  the  intussus- 
ception is  amputated  one-fourth  of  an  inch  above  the  needle.  The 
sutures  are  now  passed  through  the  invaginated  bowel,  caught  up 
in  the  interior  of  the  bowel,  divided  and  tied.  The  invagination 
is  then  reduced,  and  the  slit  closed.  Thanks  to  modern  surgerj', 
most  neoplasms  causing  intestinal  obstruction  can  be  removed,  and 
naturally  such  a  course  is  preferable  to  colotomy.  Where  it  is 
ioadvisable  to  resect  the  portion  of  bowel  containing  the  growth, 
an  incision,  four  inches  long,  should  be  made  over  this  portion,  in 
the  direction  of  the  fibers  of  the  external  oblique,  and  the  bowel 
drawn  upward  until  its  mesenteric  attachment  is  on  a  level  with 
the  external  incision.  A  slit  is  then  made  in  the  mesentery  and  a 
glass  rod  is  passed  through,  and  iodoform  gauze  wound  around  the 
ends  of  the  rod.  The  rod  is  left  in  position  until  adhesions  have 
fonned,  vheD  the  gat  is  opened. 

When  the  intestinal  obstrnotioo  resnlts  from  the  pressure  of  a 


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J 


724       The  Atlanta  Medical  and  Surgical  Journal. 

D€oplasm  exterDal  to  the  gut,  the  new  growth  sbould  be  extirpated, 
but  if  this  is  not  possible,  a  fecal  fistula  must  be  establiBhed  above 
the  point  of  obstructioo.  GalUtoues  or  enteroliths  causing  ob- 
struction should  be  pushed  a  little  upward  or  downward,  and  theD 
removed  by  an  incision.  The  object  of  this  is  to  avoid  making 
the  incision  through  the  portion  of  the  gut  which  is  likely  to  have 
been  damaged  by  pressure.  Fecal  accumulations  causing  obstruc- 
tion are  best  removed  by  a  high  enema  of  saline  solution,  injected 
at  a  temperature  of  100°  F.  by  means  of  a  fountain  syringe  raised 
three  feet  above  the  palieut.  The  flow  should  be  intermitted  from 
time  to  time,  as  the  patient  complains  of  distention  or  colic.  The 
enema  sbould  be  retained  as  long  as  possible,  for  the  object  in  giving 
it  is  to  secure  the  softening  of  the  mass,  rather  than  to  stimulate 
peristalsis.  The  procedure  may  be  repeated  several  times,  and  its 
action  assisted  by  the  administration,  of  small  doses  of  calomel  and 
soda. 

When  the  gut  is  found  to  be  gangrenous,  in  a  case  of  intestinal 
obstruction,  an  end-to-end  anastomosis  should  he  effected,  and  for 
this  purpose  Dr.  AViggiu  prefers  his  modification  of  Maunsell's 
method.  The  modification  consists  in  doing  away  with  the  in- 
vagination and  the  slit.  The  portion  of  intestine  to  be  extirpated 
is  emptied  of  its  contents  by  pressure.  The  portion  to  be  re- 
moved is  then  isolated  by  clamps  on  either  side,  and  a  V-shaped 
iicision  is  made,  having  its  apex  in  the  mesentery.  The  mesen- 
t?nc  vessels  are  ligated  before  being  cut,  and  the  wound  in  the 
mesentery  is  sutured.  Afler  washing  the  divided  end?  of  the 
b:iwel  with  hydrogen  dioxide,  they  are  united  by  two  sutures  pass- 
ing through  all  the  intestinal  coats,  the  first  suture  being  at  the 
inferior  or  mesenteric  border,  and  the  second  directly  opposite,  at 
the  highest  point.  The  third  and  fourtb  sutures  are  passed  on 
either  side  half  way  between  the  first  two.  The  two  other  sutures 
are  passed  in  the  same  way,  the  needle  going  from  within  the  gut 
and  piercing  all  the  coats,  then  back  through  the  peritoneal,  mue- 
cular  and  mucous  coats  to  the  iuterior  of  the  other  segment  of  bowel. 
The  ends  are  then  tied  in  the  bowel.  This  process  is  continued 
until  all  the  sutures  but  one  or  two  are  passed.  For  the  latter 
Lambert  sutures  are  substituted.     If  the  sutures  have  been  properly 


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SouTHBRH  Surgical  and  Gtnbcological  Association.     725 

iDserted  and  tied,  the  peritoneum  will  dow  be  turned  in  and  tbe 
stitchee  hidden. 

The  operation  having  been  completed,  and  the  dressings  applied, 
tbe  patient  is  placed  between  the  folds  of  a  warm  blanket  and  only 
a  little  warm  water  allowed  by  mouth  for  the  first  twelve  or 
eighteen  hours.  Then  a  few  drachm  dosea  of  liquid  peptonoids  are 
given  at  ibtervals  of  twenty  minutes,  and,  if  well  borne,  peptonized 
milk  is  added.  Tbe  tendency  is  to  give  too  email  quantities  of 
food  at  too  frequent  intervals.  Tbe  bowels  are  moved  on  tbe 
third  or  fourth  day  by  small  doses  of  calomel  and  soda. 

In  closing  Dr.  Wiggin  laid  great  emphasis  on  tbe  fact,  that  the 
prognosis  in  this  class  of  cases  depends  more  upon  the  promptness 
with  which  surgical  treatment  is  instituted  than  upon  any  other 
factor. 


THE  SOUTHERN  SURGICAL    AND   GYNECOLOGICAL 
ASSOCIATION. 

Proceedings  of  the  Eleventh  Annual  Meeting,  Held  at  Memphis,  Ten- 
nessee, December  6,  7,  and  S,  1898. 

Tbe  Association  met  at  the  Gayoso  Hotel,  under  the  presidency 
of  Dr.  Richard  Douglas,  of  Nashville,  Teno. 

Prayer  was  oBered  by  Bishop  Gailor. 

Dr.  Alexander  Erskine,  of  Memphis,  delivered  an  "Address  of 
Welcome  "  on  behalf  of  tbe  local  profession,  which  was  responded 
to  by  President  Douglas. 

After  the  disposal  of  routine  busiuess,  the  scientific  session  was 
opened  by  a  paper  by  Dr.  William  E.  Parker,  of  New  Orleans,  La., 
entitled : 

GUNSHOT   WO0ND8. 

He  described  the  hospital  conditions  in  Cuba  and  the  wounds 
seen  by  him  made  by  the  modern  bullet.  He  spoke  of  some  ex- 
periments, made  under  tbe  direction  of  Major  and  Surgeon  L.  A. 
LaGarde,  of  the  regular  army,  as  to  the  relative  penetrating  pow- 
ers of  the  Mauser,  Krag-Joi^nsen  aud  Springfield  rifles. 

Dr.  F.  W.  McBae,  of  Atlanta,  followed  with  a  paper  on 


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726       The  Atlanta  Medical  and  Surgical  Journal, 
penetbatikg  wounds  of  the  abdomen,  with  repobtb  op  cases. 

At  the  outset,  the  essayist  referred  to  a  resolution  passed  uubd- 
imously  by  the  Associatioa  at  its  NashTille  meeting  in  1896,  to  the 
effect  that  in  all  oases  of  penetrating  wounds  of  the  abdomen  it  is 
the  duty  of  the  surgeon  to  make  an  exploratory  incision  so  as  to 
definitely  determine  whether  the  viscera  have  been  injured  or  not. 
Since  then  a  few  able  surgeons  have  dissented  from  this  opinion. 
The  propriety  of  surgical  interference  in  cases  of  penetrating  gno- 
sbot  wounds  of  the  abdomen  will  depend  on  ooe  of  three  things; 
(1)  The  general  condition  of  the  patient,  (2)  dangerous  internal 
hemorrhage,  (3)  wounds  of  the  stomach  or  intestines  large  enough 
to  permit  extravasation. 

Dr.  McRae  <juoted  from  contributions  to  this  subject  by  Senn, 
Nunez,  Wioslow,  Budinger,  Vaughan,  Woolsay,  Robson,  Chauvel, 
Mtcbaux,  Klemm,  etc.,  and  said,  from  the  conflict  of  opinion  and 
advice  given  by  these  and  various  other  sui^eons,  one  is  at  a  loss 
to  know  just  how  to  proceed  in  many  cases.  His  own  convictiooe, 
based  on  sixteen  cases  which  he  narrated,  are  positive.  While  be 
has  the  greatest  admiration  and  respect  for  the  surgical  opinions  of 
Senn,  he  should  be  recreant  to  bis  convictions  were  be  to  accept  the 
proposition  of  non-interference  laid  down  by  Senn  in  bis  recent 
contributions  to  the  subject.  In  most  of  the  cases  which  have 
come  under  bis  observation,  where  grave  lesions  of  the  abdominal 
viscera  have  existed,  the  symptoms  of  internal  injury  were  practi- 
cally nil,  and  the  positive  sigus  of  grave  damage  almost  entirely 
absent. 

In  conclusion,  he  reiterated  his  iirm  conviction  that  every  case 
of  penetrating  wound  of  the  abdomen,  where  there  is  reasonable 
doubt  as  to  the  injury  of  the  abdominal  viscera,  should  be  subjected 
to  at  least  an  exploratory  operation.  This  enables  the  surgeon  to 
either  be  absolutely  sure  that  no  injury  has  been  done  to  the  vis- 
cera, or  to  repair,  as  far  aa  possible,  such  injuries  when  they  exist. 
The  mortality  following  a  simple  exploratory  operation,  pa-  ae,  is 
so  small  as  not  to  weigh  against  the  much  greater  mortality  that 
necessarily  follows  the  expectant  plan  of  treatment,  lu  the  cases 
he  had  seen,  the  general  and  local  sigus  have  been  so  misleading 


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SouTHEKN  Surgical  and  Gynecoloqical  Association.     727 

and  enigmatioal  that,  prior  to  the  operation,  a  conclusioo  od  his 
part  as  to  internal  conditious  would  have  been  eutirely  guesswork. 

THE   PRACTICAL  UANAQEHEKT  OF  BULLET- WOUNDS  OF   THE 
ABDOMINAL  VISCERA. 

This  p&]iir  was  read  by  Dr.  Horace  H.  Grant,  of  Loubville, 
Ky.  Observation  and  experience  with  operators  coming  frequeoUy 
in  contact  with  this  lesion  have  determined  that  penetrating 
wonnds  of  the  abdomen  demand  laparotomy  at  the  earliest  poaable 
moment  afler  diagnosis  and  thorough  inspection  of  the  entire  re- 
gion endangered.  It  is  established  that  not  only  is  the  mortality 
in  untreated  wounds  of  the  abdomen  almost  one  hundred  per  cent. 
where  the  intestines  are  perforated,  and  very  high  in  wounds  of 
the  solid  visoera,  bnt  it  becomes  less  promising  every  advancing 
hour,  until  by  the  second  day  peritonitis  sets  in  and  destroys  the 
hopefulness  of  the  prospect.  Within  the  past  two  years  the  speaker 
has  operated  upon  four  cases.  In  each  case  the  patient  was  seen 
early,  in  no  case  later  than  four  huurs.  In  three,  resection  of  the 
intestine  was  necessary.'  Three  of  these  patients  recovered ;  the 
fourth  died  from  septic  peritonitis,  due  to  the  escape  of  a  large 
quantity  of  fecal  matter  before  operation.  Autopsy  disclosed  a 
perfect  intestine. 

These  three  papers  were  discussed  together. 

Dr.  W.  L.  Robinson,  of  Danville,  Va.,  said  he  has  seen  a  good 
many  cases  of  gunshot  wounds  of  the  abdomen,  and  nearly  all  of 
them  died,  either  with  or  without  operation.  Early  operative  in- 
terference  might  save  some  of  them. 

Dr.  G.  S.  Brown,  of  Birmingham,  said  he  know  of  several 
cases  oi  gunshot  wonnds  of  the  abdomen  that  occurred  in  and 
around  Birmingham,  that  recovered  without  operation.  Person- 
ally he  had  operated  on  five  cases,  one  of  which  recovered.  In 
this  case  there  was  no  perforation  of  the  intestine.  Undoubtedly, 
diarrhea  and  starvation,  mentioned  by  Dr.  Parker,  iu  his  paper, 
have  sotnething  to  do  with  the  favorable  results.  The  intealiDefl 
are  most  liable  to  be  perforated  when  full. 

Dr.  Willis  F.  Westmoreland,  of  Atlanta,  said  the  results  of 
gunshot  wounds  of  the  abdomen  on  the  battle-field  should  not  be 


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728       The  Atlanta  Medical  and  Surgical  Jourkal. 

compared  wiih  those  met  with  io  civil  life.  It  is  not  a  questioD 
of  operatiog,  so  far  as  fatal  results  are  cooceraed,  but  the  maoaer 
in  which  the  operation  is  done. 

Dr.  W.  E.  B.  Davia,  of  Birmingham,  thought  that  Dr.  Parker's 
paper  was  not  au  argument  against  operative  procedures  for 
abdomiual  wounds.  Surgeous  on  the  battle-field  do  oot  have  the 
same  facilities  for  operating  on  penetrating  wounds  of  the  abdo- 
men that  they  do  in  civil  practice,  and  which  are  necessary  for  the 
proper  care  of  cases.  If  a  man  sustains  an  injury  to  the  intestine, 
if  his  abdomen  is  not  opened,  death  may  be  expected.  In  twenty 
or  more  cases  operated  on  by  bim  and  his  brother,  all  of  the  cases 
died  that  were  seen  twenty-four  hours  alter  the  injury.  This  is 
not  an  ai^ument  against  operative  interfereuce,  but  against  late 
operation.  Statistics  impress  surgeons  with  the  importance  of 
early  operation. 

Dr.  George  A.  Baxter,  of  Chattanooga,  believes  it  is  not  nec- 
essary in  many  instauces  to  open  the  abdomen  in  cases  of  gunshot 
wounds,  and  cited  a  number  of  cases  that  recovered  without  ope- 
rative interference. 

Dr.  John  T.  Wilson,  of  Sherman,  Texas,  advocated  early  opera- 
tion in  cases  where  the  surgeon  is  convinced  that  perforation  has 
taken  place.  The  character,  technique  and  rapidity  of  the  opera- 
tion are  very  important.  Id  operatiug,  the  intestines  should  be 
exposed  as  little  as  possible. 

Dr.  W.  L.  Kodmau,  of  Louisville,  said  that  while  he  had  pursued 
the  practice  of  operating  on  penetrating  gunshot  wounds  of  the 
abdomen  for  the  last  ten  years,  after  bearing  the  paper  of  Dr. 
Parker  and  reading  the  recent  contributioos  of  Seoo  and  others, 
he  thought  whether  he  as  well  as  other  surgeons  may  not  have 
gone  too  far  in  operating  on  so  many  of  these  oases;  at  the  same 
time,  he  does  not  wish  to  be  understood  as  advocating  a  masterly 
inactivity  where  the  environments  for  operative  interference  are 
favorable. 

Dr.  Westmoreland  said  that  given  a  case  of  perforation  of  the 
iotestlne,  particularly  where  there  is  extravasation  of  contents, 
instead  of  being  masterly  inactivity  it  is  criminal  inactivity  for  a 
surgeon  not  to  operate. 


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SottTHERN  SdRGIOAL  AND  GyWBCO LOGICAL  ASSOCIATION.      729 

Dr.  Parker,  in  closiog  the  discussion  on  his  part,  said  tliat  he 
had  tried  to  make  a  clear  distinction  between  the  plan  of  treat- 
ment of  gunshot  wounds  of  the  abdomen  met'with  on  the  battle- 
field and  those  encountered  in  civil  life.  He  ia  strongly  opposed 
to  laparotomy  on  the  battle-Seld  on  account  of  the  conditions  that 
exist.  In  civil  life,  however,  the  thing  to  do  in  cases  of  gunshot 
wounds  of  the  abdomen,  is  to  got  in  and  out  of  the  belly  as  soon 
as  possible  consistent  with  good  work. 

Dr.  McRae  believes  that  a  large  proportion  of  the  operations 
undertaken  for  gunshot  wounds  of  the  abdomen  late  will  terminate 
faUlly. 

Dr.  Grant  stated  that  practically  all  cases  operated  on  after 
twenty-four  hours  perish.  It  is  impossible  to  diagnosticate  perfo- 
ration of  the  intestioes  with  any  degree  of  certainty.  If  a  patient 
is  seen  within  eight  or  ten  hours  af^er  the  receipt  of  a  gunshot 
wound  of  the  abdomen,  under  ^vorable  surroundings,  whether  the 
bullet  has  penetrated  or  not,  the  skilful  sui^eou  will  not  hesitate 
to  make  at  least  an  exploratory  operation,  because  it  would  not 
burt  the  patient,  but  would  probably  save  his  life. 

THE   TREATMENT  OF  COMPLCTE   BUPTDBE   OF  THE   PERINEUM   BY 

DIS8ECTIKO    OUT    THE  8PHINCTBB    MUSCLE    AND    IT8 

DIBECT    UNION    BY    BUKIED   8UTURES. 

Dr.  Howard  A.  Kelly,  of  Baltimore,  Md.,  read  a  paper  on  this 
subject,  in  which  he  said  the  results  of  the  best  methods  of  the 
treatment  of  complete  tears  of  the  perineum  are  not  entirely  satis- 
factory in  a  large  percentage  of  oases.  The  control  over  liquid 
motions  and  flatus  is,  as  a  rule,  not  secured  immediately,  and  it  is 
usually  necessary  to  encourage  the  patient  by  telling  her  that  she 
"  will  have  to  learn  to  control  the  muscle  in  the  course  of  time." 
Such  a  control,  more  or  less  perfect,  is  gained  in  course  of  several 
months.  This  defect  in  our  present  procedures  is  due  to  a  faulty 
approximation  of  the  sphincter  ends  which  lie  buried  in  a  pit,  and 
are  therefore  difficult  to  bring  into  accurate,  firm  apposition  by 
sutures  embracing  a  considerable  quantity  of  tissue  surrounding 
the  sphincter  ends.  Dr.  Kelly  proposes  therefore  the  deliberate 
dissection  and  freeing  of  the  sphincter  ends,  drawing  them  out 


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780       The  Atlanta  Medical  and  Sdroical  Jodrnal. 

about  oDe  and  a  half  centimeters  from  the  tissues,  cuttiog  off  the 
scarred  ends,  aud  effecting  a  direct  union  of  the  freshened  ends  by 
two  or  three  buried  catgut  sutures.  He  was  ted  to  do  this  opera- 
tion by  his  experience  in  a  case  which  bad  been  operated  upon  six 
times  with  a  result,  which,  judged  by  superficial  appearances,  was 
perfect,  and  yet  the  patient  bad  no  control  over  her  bowel  fuoc- 
tions.  He  made  a  semi-lunar  incision  around  the  anterior  periph- 
ery of  the  anus  and  found  the  right  sphincter  end  buried  in  scar 
tissue  in  the  median  line,  while  that  of  the  left  side  was  ectopic 
and  attached  out  under  the  ischial  tuberosity.  The  sphincter  ends 
were  united  directly  by  buned  catgut  sutures,  and  the  sbin  wound 
closed  and  union  took  place  per  primam.  In  addition  to  these 
buried  catgut  sutures  a  splintiug  suture  of  silkworm  gut  is  passed 
through  the  middle  of  the  sphincter  near  the  edges  of  the  wound 
and  on  up  through  the  septum  splinting  the  ends  together  and 
taking  the  tension  off  the  catgut.  He  has  since  taken  the  hint 
given  by  this  case  and  adopted  a  similar  procefjure  in  six  cases  of 
complete  tear  of  the  perineum  due  to  confinement.  Two  addi- 
tional cases  were  operated  upon  by  Dr.  "W".  W.  Uussell  and  one  by 
Dr.  Kamsey.  In  each  instance  there  was  a  surprising  difference 
between  the  new  and  older  methods,  noted  at  once  in  the  earliest 
stages  of  the  convalescence,  and  the  patient  was  immediately  con- 
scious of  perfect  control  of  her  functions.  The  bowels  should 
never  be  locked  up. 

Great  care  must  be  taken  not  to  leave  any  dead  spaces  in  closing 
the  remainder  of  the  wound  in  the  usual  way,  in  order  to  avoid  ail 
risk  of  infecting  the  buried  sutures.  He  only  recommends  this 
operation  to  those  who  possess  considerable  skill  in  doing  plastic 
operations  and  in  securing  a  snug,  accurate  adaptation  of  the  parts. 

In  the  discussion,  Drs.  George  H.  Noble,  of  Atlanta,  and  J. 
Wesley  Bovee,  of  Washington,  D.  C,  added  their  testimony  to  the 
usefulness  of  the  method  described  by  Dr.  Kelly,  bnt  certaio  fea- 
tures of  the  technique  of  which  they  modified. 

Dr.  Lewis  S.  McMurtry,  of  Louisville,  Ky.,  read  a  paper  on  "The 
Treatment  of  Cancer  of  the  Uterus." 


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SouTHERM  Surgical  and  Gynbcological  Association.     781 

DISCUSSION. 

Br.  William  L.  Rodmao,  of  LouiBville,  asked  the  members  to 
give  their  experience  relative  to  the  frequency  of  cancer  in  the 
black  and  white  races.  He  was  rather  surprised  to  hear  of  the 
infrequeocy  of  the  disease  in  the  negro  woman.  According  to  the 
last  census  statistics  of  Billings,  cancer  of  the  uterus  is  more  com- 
mon at  all  ages  in  the  black  than  iu  the  white  race.  This  is  also 
the  experience  of  Matas,  who  has  examined  the  records  at  the 
Charity  Hospital  in  New  Orleans.  Au  examination  of  all  deaths 
recorded  by  the  Health  Department  at  Louisville  for  tlie  past  thirty 
years  corroborated  the  same  view, 

Dr.  Ernest  S.  Lewis,  of  New  Orleans,  stat«d  that,  while  he  had 
□ot  observed  a  very  marked  difference  in  the  relative  immunity  of 
negro  women  to  cancer  of  the  uterus,  still,  if  his  experieuce  is  not 
at  fault,  he  thinks,  owing  to  their  UDcleauliness,  their  mode  of 
living,  and  to  the  more  frequent  accidents  to  which  they  are  sub- 
ject during  labor,  they  are  particularly  prone  to  cancer  of  the  uterus. 
With  regard  to  the  results  of  all- operations  for  cancer  of  the  uterus, 
he  indorsed  everything  Dr.  McMurtry  had  said.  He  could  only 
recall  one  case  of  vaginal  hysterectomy  for  cancer,  that  lived  for 
eight  years,  after  which  the  disease  returned,  and  the  patient  finally 
died.  The  disease  is  so  liable  to  return  that  he  considers  any  opera- 
ration  as  palliative,  and  he  believes  that  would  be  the  result  of  the 
abdominal  operation  advocated  by  Dr.  McMurtry,  particularly  iu 
advance  cases;  and  if  cases  are  met  with  in  the  incipiency  of  the 
disease,  in  his  opinion  as  much  could  be  accomplit<hed  by  the 
vaginal  as  by  the  abdominal  operation. 

Dr.  Virgil  O.  Hardon,  of  Atlanta,  said  that  duriug  his  seven 
years'  counectioo  with  the  Grady  Hospital,  be  had  reason  to  be- 
lieve that  vaocer  of  the  uterus  was  more  frequent  la  negro  women 
than  in  white  women.  He  has  been  led  by  his  experience  in  the 
treatment  of  uterine  cancer  to  the  same  conclusion  as  that  reached 
by  the  essayist,  except  he  had  been  led  to  go  further.  He  has  op- 
erated for  cancer  of  the  womb  by  vaginal  extirpation,  by  the  ab- 
dominal method,  and  by  the  combined  method,  and  he  has  never 
yet  operated  upon  a  case  where  recurrence  did  not  take  place  sooner 


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732       The  Atlanta  Medical  and  Sdrgical  Joubnal. 

or  later,  aod  for  this  reason  he  has  lost  all  confideoce  io  operative 
measures  as  a  means  of  efiectiDg  a  permanent  cure.  However,  he 
has  no  doubt,  on  theoretical  grounds,  that  if  cases  are  seen  sufG- 
ciently  early,  a  permanent  cure  might  be  effected  by  surgical  inter- 
ference. 

Dr.  Howard  A.  Kelly,  of  Baltimore,  remarked  that  he  was  as- 
tounded at  the  trend  the  discussion  had  taken,  because  be  had  seen 
dozens  of  cases  of  cancer  of  the  uterus  that  had  remained  well  for 
a  number  of  years  after  having  undergone  surgical  intervention, 
removing  the  uterus  either  by  vagina  or  by  the  abdomen.  He 
finds  carcinoma  of  the  uterus  as  frequently  in  negroes  as  in  white 
women. 

Dr.  J.  Wesley,  Bovee,  of  Washington,  D,  C,  said  that  his  ex- 
perience in  the  radical  treatment  of  cancer  of  the  uterus  has  been 
more  satisfactory  than  what  he  had  been  hearing  to-day.  He 
knows  of  a  good  many  cases  upon  which  he  has  operated  that  have 
gone  oD  for  three  years  or  more  without  a  recurrence  of  the  dis- 
ease. He  has  done  three  operations  after  (be  manner  described  by 
Werder  in  the  American  Journal  of  Obstetrics  of  last  winter,  and 
he  is  much  pleased.  In  each  case  he  adopted  the  abdominal  rather 
than  tbe  vaginal  route,  believing  a  more  radical  operation  coald 
be  performed  by  this  method.  He  has  great  hopes  for  the  future 
treatment  of  cancer  of  the  uterus  by  complet«  abdominal  hyster- 
ectomy, undertaken  early. 

Dr.  William  L.  Robinson,  of  Danville,  said  that  when  the  parts 
have  become  infected  beyond  the  uterus,  no  dissection,  however 
extensive,  would  ever  remove  the  cause.  When  the  disease  has 
extended  beyond  the  uterus,  he  believes  it  is  beyond  the  power  of 
any  surgeon  to  thoroughly  remove  it.  Therefore,  uolesBan  opera- 
tion could  be  done  very  early,  he  would  not  advise  the  removal  of 
the  uterus. 

Dr.  W.  E,  B.  Davis  was  profoundly  impressed  with  the  position 
taken  by  Dr.  Lewis  as  to  tbe  ultimate  outcome  of  cases  of  csncer 
of  tbe  uterus,  believing  his  position  is  correct.  There  is  no  inaa 
in  America  who  has  had  a  larger  experience  in  the  treatment  ot 
cancer  of  the  uterus  than  Dr.  Lewis,  of  New  Orleans ;  and  the  pro- 


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SouTHEKN  Surgical  and  Gynecological  Association.     738 

fessioD  were  ffttnitiar  with  bie  great  Bkill  as  a  surgeoD,  hence  his 
esperieoce  regardiog  uterioe  cancer  was  certainly  valuable. 

Dr.  McMurtry,  in  closing  the  disouBsion,  said  he  could  not  in- 
dorse the  rosy  view  that  Dr.  Kelly  takes  with  reference  to  the  ulti- 
mate results  of  the  operative  treatment  of  cancer  of  the  uterus. 
He  knows  that  Kelly's  work  in  this  direction  has  been  extensive 
and  that  his  reports  are  siucere  and  reliable.  But  there  are  a  great 
many  surgeoos,  workiug  in  the  same  line,  who  have  done  thorough, 
faithful,  skillful  work  in  the  radical  treatment  of  uterine  cancer, 
who  doubt  the  future  confirmation  of  Dr.  Kelly's  views. 

pbebident's  address. 

This  was  delivered  by  Dr.  Kichard  Douglas,  of  Nashville, 
TenD.  He  made  a  departure  from  the  usual  or  stereotyped  ad- 
dresses, and  selected  for  his  subject  Acute  General  Peritonitis. 
Before  considering  his  subject  proper,  he  spoke  of  the  growth  of 
the  Association  and  the  excellence  of  its  scientific  work,  saying 
that  the  Association  owes  its  existence  and  high  staading  to  the 
'  inde&tigable  efforts  of  Dr.  W.  E.  B.  Davis,  the  permanent  sec- 
retary. 

A  bacteriological  classification  of  peritonitis  is  beset  with  many 
difficulties,  and  while  the  speaker  is  free  to  admit  that  for  all 
practical  purposes  peritonitis  is  of  bacterial  origin,  yet  there  occurs. 
a  respectable  percentage  of  cases  in  which  the  most  rigid  exami- 
nation fails  to  disclose  the  presence  of  micro-organisms.  Hartmann 
and  Moreau  report  in  detail  such  a  case  recently.  Of  one  hundred 
and  ten  cases  bacteriologically  classified  by  Flexner,  there  were 
twelve  cases  which  he  was  obliged  to  consign  to  the  idiopathic 
group.  It  is  true  that  in  all  of  these  patients  there  existed  con- 
ditions predisposing  to  peritonitis^  such  as  cardiac,  renal  or  hepatic 
disease.  In  the  intensely  septic  mycotic  form  of  peritonitis  their 
absence  may  be  accounted  for  by  the  fulminant  type  of  the  disease^ 
death  occurring  from  intoxication  before  the  colonies  of  bacteria 
are  well  established.  Any  effort  to  individualize  the  effect  of  a 
specific  bacterium,  to  connect  its  presence  with  a  definite  patho- 
logical phenomenon  and  characteristic  symptomatology  is  as  yet 
iulile.     Mikulicz  avers  that  all  fornis  of  peritonitis  run    the  same 


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784       The  Atlanta  Mbdical  and  Sorqicai;  Joprnal. 

clinical  course  regardless  of  the  bscteria  that  cause  it.  There  is  a 
law  laid  down  by  Maioz  to  the  effect  that  if  the  peritonitis  is  of 
intestinal  origin,  the  colon  bacillus  will  show  it;  if  it  is  of  uteriDe 
origin,  that  is,  connected  with  abortions  or  labor,  we  will  find  the 
streptococcus.  It  is  asserted  that  the  colon  bacillus  constitutes 
nine-tenths  of  the  bacteria  of  the  digestive  tract,  the  colon  is  its 
natural  habitat,  but  its  behavior  upon  gaining  entrance  to  the 
peritoneal  cavity  depends  upon  many  circumstances,  and  this 
bacillus  has  many  morphological  conditions,  many  forms  and 
stages.  The  constancy  of  its  presence  in  peritouitis,  since  the 
demonstrations  of  Welch  and  others  of  its  capacity  of  transmigra- 
tion through  the  bowel,  has  led  many  to  attach  to  it  great  signifi- 
cance as  an  etiological  factor,  but  its  association  with  other  forme 
of  micro-organisms  renders  the  first  projwsition  of  MaIoz  null  and 
void.  If  we  interpret  Maloz's  law  correctly,  the  absence  of  strep- 
tococci would  eliminate  the  possibility  of  peritonitis  being  of 
puerperal  origin.  In  rebuttal  of  this  idea,  Dr.  Douglas  quoted 
from  Winckel,  who  says,  "Kroenig  examined  all  parts  of  the 
uterus  of  a  woman  dead  from  infection  and  found  not  only  the 
superficial  thrombi  at  the  placental  site  thickly  filled  with  bacteria, 
but  also  the  serous  lining  of  the  peritoneum."  This  case  shows 
that  a  woman  may  have  a  peritouitis  following  abortion  without 
streptococci,  and  it  further  shows  that  the  colon  bacillus  without 
an  intestinal  lesion  may  produce  a  fatal  peritonitis.  No  doubt  too 
much  importance  has  been  ascribed  to  the  colon  bacillus,  and  it  is 
interesting  to  note  that  Tavel,  who  was  among  the  first  to  empha- 
size the  pathogenic  powers  of  the  bacillus  coli  communis,  thinks 
now  the  bacillus  of  minor  importance  in  the  etiology  of  periton- 
itis. He  holds  further  that  the  very  name  ot  the  bacillus  coli 
should  be  con^dered  merely  a  collective  name  of  many  varieties 
of  bacteria. 

No  better  ai^umeat  against  ttacteriologioal  classification  can  be 
adduced  than  the  words  of  Simon  Flezner,  who  says :  "In  order 
that  pathogenic  bacteria  introduced  directly  into  the  peritoneal 
cavity  may  cause  a  peritonitis,  general  or  circnmscribed,  evanes- 
cent or  fatal,  the  normal  conditions  of  the  peritoneum  must  in 
some  way  be  modified."     It  is  olear,   then,  that  in  the  bnmin 


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SouTHRBN  Surgical  and  Gynecological  Association.    735 

beiog,  as  id  experimeatal  aoicaalB,  some  other  conditiou  than  the 
mere  presence  of  pathogeoic  mioro-orgauisme  in  the  sbdomiDal 
cavity  is  necessary  in  order  that  peritonitis  may  be  produced. 
Bacteria  alone  and  unaided  by  physical  conditions  are  compar- 
atively innocuous. 

Restricting  coosideration  entirely  to  acute  general  peritonitis,  it 
occnrs  from  traumatic  or  consecutive  causes.  Under  the  head  of 
tranmatic  peritonitis  is  embraced  all  infective  inflammatioDs  arising 
from  wounds  of  the  peritoneum,  whether  accidental  or  operative, 
peuetratiDg  or  noD-peoetrating.  Consecutive,  secondary  or  symp- 
tomatic peritonitis  may  be  subdivided  into  (1)  peritonitis  by  con- 
tJDuity,  and  (2)  perforative  peritonitis. 

Traumatie  Peritonitig.  Under  this  head  all  forms  of  peritonitis 
must  be  embraced  that  are  due  primarily  to  a  trauma.  The 
destruction  of  tissue,  the  retention  of  blood-clots  and  natural 
secretions,  prepares  a  suitable  soil  for  microbic  invasion,  and  this 
essential  infecting  element  may  be  introduced  from  without  as 
through  penetrating  gunshot,  stab,  or  operative  wounds,  under 
which  circumstances  it  is  usually  a  poly-infection,  the  strepto- 
coccus predominating.  There  are  also  contusions  of  the  abdomen 
without  an  external  wound  which  so  injure  and  lower  the  resist- 
ance of  the  tissue  as  to  favor  the  migration  of  the  iDtestiaal  micro- 
o^anisms  and  their  infection  of  the  general  cavity. 

Secondary  Ferittmitie.  The  supervention  of  acute  general  peri- 
tonitis, as  secondary  to  preexisting  disease  processes,  embraces  in 
its  etiology  infective  inflammation  not  only  of  all  intraperitoneal 
viscera,  but  all  oi^ans  or  tissues  contigoous  thereto,  and  it  does 
not  appear  to  him  to  he  too  broad  if  there  be  included  within  its 
scope  those  peritonitides  of  hematogenic  or  metastatic  origin,  for 
it  is  well  established  that  the  specific  germs  of  diphtheria,  scarlet 
fever,  pneumonia  and  erysipelas  have  produced  acute  general  peri- 
tonitis. 

Peritonitis  by  continuity  is  the  uninterrupted  extension  of  the 
inflammation  from  an  infected  area  to  the  peritoneum,  and  is  accom- 
plished by  the  iovading  army  of  mioro-oi^nisms  through  the 
lymphatics,  blood  channels,  or  by  direct  penetration  of  tissues. 
The  reactionary  inflammation  which  determines  the  localization  or 


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736       Thk  Atlanta  Medical  and  Subqical  Journal. 

diffuBioa  depends  upon  tbe  virulence  of  the  bacteria,  the  resifitaoce 
of  the  tissues,  and,  what  is  too  frequently  overlooked,  the  indi- 
vidual resistance  of  the  patient.  Puerperal  peritonitis  of  strep- 
tococcus origin  conspicuously  illustrates  inflammation  by  con- 
tinuity. 

Perforative  peritonitis  is  the  next  subdivision  of  secondary  peri- 
tonitis. The  sudden  opening  of  a  focus  of  suppuration  and  the 
discharge  of  its  contents  into  the  peritoneal  cavity,  whether  it  be 
from  hepatic  abscess,  a  pus  tube  or  mesenteric  gland,  is  a  true  illus- 
tration of  perforative  peritonitis;  yet,  the  inflammation  and  sys- 
temic infection  following  is  not  necessarily  so  conspicuous.  Tbe 
duration  of  (he  primary  disease,  the  virulence  of  the  micro-organisms, 
the  preparedness  of  the  peritoneum  by  fortifications  of  adhesions, 
the  general  condition  of  tbe  patient,  are  all  circumstances  which 
may  modify  and  circumscribe  tbe  peritonitis.  It  is  more  common 
for  perforative  peritonitis  to  occur  as  a  result  of  ulceration  of  the 
wall  of  some  of  the  hollow  viscera  as  in  peptic  ulcer,  typhoid  and 
dysenteric  intestinal  ulceration,  duodenal  and  appendicular  ulcera- 
tion. 

Tbe  conclusions  that  may  be  drawn  from  an  etiological  study  of 
peritonitis  may  be  thus  summarized :  Traumatic  peritonitis, 
especially  the  post-operative  variety,  is  essentially  a  grave  condi- 
tion, not  only  because  there  is  immediate  or  primary  inoculation  of 
the  peritoneum,  but  the  conditions  are  all  favorable  for  germ  cul- 
ture and  dissemination.  Peritonitis  by  continuity  may  become 
general  and  prove  rapidly  fatal,  but  this  is  not  the  rule  except  in 
puerperal  cases.  Contrary  to  tbe  expressed  opinion  of  more  than 
one  writer,  there  is  nothing  peculiar  about  the  peritoneum,  or  the 
cecum,  or  appendix,  or  the  true  pelvis  which  accounts  for  the  more 
frequent  localization  of  infiammation  ia  these  regions  than  in  other 
areas  of  the  abdomen .  The  method  of  invasion,  the  activity  of  tbe 
process  and  resistance  of  patient  alone  determine  the  local  or 
general  type  of  peritonitis.  Visceral  perforation,  whether  traumatic 
or  pathological,  is  an  ideal  condition  for  germ  culture  and  the 
elaboration  of  toxius.  Their  rapid  absorption  and  general  diffiision 
throughout  the  peritoneum  sufficiently  explain  the  grave  state  into 
which   the   patient  is  precipitated.     It  may  be  asserted  that  tbe 


,„i,z.d  by  Google 


Southern  Subgioal  and  Gtnecoloqioal  Association.    737 

clinical  course  and  pathological  ezpreaBioa  depend  largely  upon 
the  nature  of  the  exciting  cause,  the  character  of  the  preexisting 
disease  or  injury,  and  the  mode  of  iDvasion, 

Without  attempting  to  furmulate  any  definite  pathological  classifi- 
cation of  general  peritonitis,  and  to  adapt  each  to  its  special  cause, 
he  prefers  to  direct  his  efforts  to  simplifying  and  dispelling  the  con- 
fusion that  exists.  He  accepts,  with  slight  reservation,  the  now 
almost  universally  conceded  idea  that  acute  general  peritonitis  is  and 
must  be  septic,  that  is,  of  bacterial  origin.  But  be  maintains  that 
surgeons  do  not  understand  each  other,  nor  have  they  all  a  clear 
conception  of  what  is  meant  by  septic  peritonitis.  It  has  been  a 
race  tor  life  between  the  practical  surgeon  and  bacteriologista  as  to 
who  should  claim  the  honor  of  oamiog  the  patbotogical  phenomena 
in  this  great  serous  bursa.  He  maintains  that  the  surgeon  is  alone 
competent  to  define,  classify  and  prognosticate  the  protean  types  of 
this  disease,  That  men  are  honest,  paiustaking  and  accurate  goes 
without  saying,  yet  how  can  surgeons  rpconcile  the  report  of 
McCosb's  last  series  of  eight  cases  ot  general  septic  peritonitis  and 
six  operative  recoveries  with  the  experience  of  Senn  "of  many 
cases  of  diffuse  septic  peritonitis  without  a  single  successful  result?" 
The  answer  certainty  is  not  in  ibe  superior  skill  or  special  technique 
ot  the  operator,  but  it  is  to  be  found  in  an  analytical  study  of 
McCosb's  cases;  six  of  them  were  purulent  peritonitis  and  two 
serous  peritonitis,  not  the  class  of  cases  referred  by  Senn  at  all. 
Tietze  defines  diffuse  septic  peritonitis  to  be  "that  form  of  peri- 
tonitis in  which  there  is  little  or  no  exudate,  severe  symptoms  of 
intoxication  and  terminating  rapidly  fatally." 

Some  tour  years  ago,  Dr.  Douglas  reported  eight  cases  of  general 
peritonitis  sulijected  to  operation,  with  four  recoveries  and  four 
deaths.  He  dealt  with  them  ail  as  cases  of  geueral  septic  peritonitis 
from  a  misconception  of  the  term.  Two  of  them  only  properly 
belonged  to  this  class  and  they  termiuated  fatally.  The  others  were 
cases  of  geueral  purulent  peritoDitis,  with  two  deaths  and  four  re- 
coveries. He  is  very  well  pleased  with  bis  percentage  of  recoveries 
yet,  but  dittgudted  with  bio  claasifiuation.  He  did  not  discriminate 
between  ditluue  septic  peritoiiiti-t,  the  patients  dying  in  twelve 
hours  with  pr-'found  toxemia  aud  dry  peritoneum  after  perforation 


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738       The  Atlanta  Medical  and  Scesioal  Jodrhal. 

of  appendix,  aocl  one  of  perforation  with  enormons  pamlent  effu* 
aioQ,  but  mild  symptome  of  sepsis.  This  error  of  his  is  the  com- 
mon one  with  the  profession,  and  it  is  the  outcome  of  an  attempt 
to  classify  peritonitis  by  the  character  of  exudate. 

The  etiological  classification  of  peritonitis  places  it  as  subsidiary 
to  the  primary  lesion  that  produces  it,  and  its  practical  import  is 
its  local  origin.  A  painstaking  investigation  into  the  clintcal  his- 
tory will  usually  determine  the  origin  or  structure  primarily 
involved.  The  symptoms  and  physical  signs,  if  the  case  is  seen 
sufficiently  early,  will  still  further  aid  in  incriminating  the  part 
under  suspicion.  This  valuable  diagnostic  evidence  does  not  con- 
form to  any  stereotyped  expression;  the  symptomatology  of  peri- 
tonitis is  as  varied  as  its  causes.  By  the  presence  of  any  striking 
symptom,  or  group  of  symptoms,  physicians  cannot  arrive  at  a 
decision  in  a  doubtful  case,  but  from  the  whole  picture  they  must 
form  conclusions. 

Dr.  Geoi^  H.  Noble,  of  Atlanta,  read  a  paper  on 

UBETERAL  ANASTOUOeiS. 
He  gave  an  analysis  of  thirty  cases  collected  from  literature,  and 
divided  them  into  two  classes:  First,  ureteral  anastomosis,  or 
union  of  the  ureter  end  to  end  or  end  to  side ;  second,  ureteral 
implantation  into  the  bladder.  July  2,  1896,  the  essayist  Hgated 
the  ureter  with  the  ovarian  vessels  and  Fallopian  tubes  in  a  case  of 
large  extraperitoneal  fibroma.  This  was  the  very  first  ligature  ap- 
plied in  doing  the  hysterectomy.  The  bladder  end  was  split  about 
three-eighths  of  an  inch,  as  much  of  the  mucous  membrane  as  oould 
he  drawn  out  was  cut  away ;  then  the  upper,  or  kidney  end,  of  the 
ureter  was  invaginated  into  it,  using  a  mattress  suture  for  the  pur- 
pose. The  split  was  then  closed  with  fine  sutures,  making  a 
snugly-fitting  cuff  around  the  opposing  end,  with  no  mucosa  in- 
tervening. Small  silk  was  used  to  stitch  the  raw  edge  of  the  inferior 
segment  around  and  to  the  sides  of  the  upper  section.  A  peritoneal 
cuff  was  thrown  around  the  joint  thus  made  and  the  ureter  buried  be- 
hind the  peritoneum.  The  entire  work  was  conducted  with  the  aid 
of  a  ureteral  catheter,  which  had  been  introduced  through  the 
ureter  into  the  bladder  and  drawn  out  of  the  urethra  with  a  p»ir 


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SOUTHERB  BimaiCAL  AND  OTBEOOLOalCAL  ASSOOtATION.      789 

of  forceps.  The  apper  end  was  passed  into  the  kidney  end  of  the 
ureter.  This  served  a  useful  purpose,  the  entire  maoipulation  being 
greatl;  facilitated  and  preventing  obstruction  of  the  areter  by 
crowding  down  the  cut  end  of  the  mucosa  just  below  the  line  of 
union.  This  case  had  suffered  from  absorption  of  pus  for  a  num- 
ber of  weeks  from  double  pyosalpinz,  was  emaciated  and  thor- 
oughly septic.  Her  temperature  just  before  going  upon  the  opera- 
ting-table was  103°,  and  had  been  running  equally  as  high  for  the 
.time  she  had  been  in  the  hospital,  and  perhaps  longer.  Her  pulse 
was  130  per  minute,  weak  and  thready.  Thus  this  anastomosis 
was  done  under  unfavorable  conditioBS,  but  was  successful. 

In  October,  1898,  he  did  a  successful  resection  of  the  left  ureter 
in  ft  case  of  extraperitoneal  extension  of  sarcoma  of  the  ovary.  About 
one  and  a  half  inches  of  the  duct  were  removed  and  ends  uuited  as 
above.  The  peritoneum  was  stripped  from  the  entire  left  half  of 
the  pelvis.  The  bladder  was  separated  from  tbe  upper  portioD  of 
the  vagina,  and  also  from  the  horizontal  ramus  of  the  pubio  bone, 
and  drawn  up  to  left  side  to  the  ileo-pectineal  line  to  cover  or  bury 
the  ureter,  and  fastened  with  a  silk  suture.  In  this  instanoe  tbe 
ureteral  cathetec  was  introduced  on  the  stilette,  and  being  stiffened 
by  it  passed  directly  out  of  tbe  nrethra  from  the  ureter ;  thus  the 
use  of  forceps  was  necessary  to  fish  it  out  of  the  bladder.  Ab- 
dominal and  vaginal  gauze  drains  were  used.  There  was  no  leakage. 

Dr.  Noble  said  that  there  are  several  features  necessary  to  suc- 
cess in  doing  ureteral  anastomosis  aside  from  thorough  asepsis. 
{1)  Perfect  coaptation  or  iuvaginalion.  This  must  be  done  in  such 
a  way  that  no  mucous  membrane  can  slip  between  the  two  ends  of 
the  areter.  (2)  The  ureteral  artery  should  be  preserved  in  its  con- 
tinuity to  the  ends  of  the  ureter.  If  this  vessel  be  destroyed  . 
-when  the  ureter  has  been  dissected  loose  from  its  attachments,  it 
will  perish  beyond  the  point  where  it  ceases  to  receive  its  blood 
supply.  Tbe  ends  of  the  ureter  should  be  cut  back  to  tbe  point 
where  the  artery  is  intact  lest  under  diminished  blood  supply  and 
tension  it  should  perish.  All  strain  or  tension  must  be  relieved. 
Should  union  occur  by  first  intention,  the  parts  will  separate  as 
soon  as  tbe  sutures  cut  out  or  are  released.  (2)  There  must  be  no 
obstruction  to  the  flow  of  urine. 


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740       The  Atlanta  Medical  and  Suhqical  Joubnal. 

CABdlfOMA.  OF  TEE   BBEABT. 

Dr.  Willia  F.  Westmorelaii<l,  of  Atlanta,  read  a  paper  on  thig 
subject,  io  which  he  s^d  that  carcinoina  now  presents  even  a  more 
serious  problem  than  formerly,  on  aceouot  of  ita  rapid  iucrease. 
The  proportionate  mortality  from  cancer  is  four  and  a  half  times 
frreater  now  than  half  a  century  ago.  No  other  disease  can  show 
anything  like  such  an  immense  increase.  According  to  statistics, 
two  out  of  every  five  cases  of  carcinoma  in  the  female  are  of  the 
breast.  Over  three-fourths  of  all  the  tumors  occurring  in  the 
breast  are  carcinoma.  Or,  to  be  exact,  of  637  tumors,  over  503, 
or  83.20  per  cent.,  were  carcinoma,  leaving  only  107,  or  16.79  per 
cent.,  representing  all  other  forms  of  neoplasms.  The  author  dis- 
cusses the  etiology  of  the  disease  at  considerable  length.  Speaking 
of  the  pathology,  he  said  there  was  no  subject  in  surgery  about 
which  such  divergent  opinions  are  held.  There  is  a  wide  variation 
in  the  malignancy  of  carcinoma,  some  proving  fatal  tn  leas  than  a 
year,  a  few  others  taking  ten  or  fifteen  years.  He  divided  the  va- 
rieties of  carcinoma  Into  scirrhous  and  medullary  or  encephaloid. 
The  former  has  au  average  duration  of  life  of  about  thirty  months, 
the  latter  of  about  twelve  mouths.  When  it  is  considered  that  the 
skin  and  pectoral  muscles  are  involved  in  nearly  every  instance  io 
this  disease,  the  surgeon  can  easily  see  the  philosophic  reasoning  upon 
which  Halstead's  operation  is  based.  The  essayist  follows  the 
Halstead  method  in  carcinoma  of  the  breast.  He  believes,  how- 
ever, Dr.  Blondgood  was  the  first  to  demoastrate  the  advantages  of 
completely  cleaniog  out  the  postero-tnternal  sub-scapular  r^on 
by  the  supra-clavicular  route.  The  results  of  the  Halstead  op- 
eration, in  the  opinion  of  the  essayist,  depend  upon  the  ability 
of  the  individual  0|ierator,  his  earliness  in  seeing  the  case,  and  his 
closeness  in  following  Halstead's  technique.  This  operation  not 
only  requires  surgical  skill  and  experience,  but  a  proper  respect  for 
the  magnitude  oi  small  ibiugs.  In  the  opinion  of  Dr.  Westmore- 
land, no  surgeon  will  make'a  satisfactory  operation  on  his  first  fev 
oases.  He  finds  that  with  each  case  he  operates  more  satisfactorily. 
The  operation  does  not  present  the  seriousness  that  its  magnitude 
would   lead  us  to  believe.     He  has  operated  six  times  before  his 


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Southern  BuBaicAL  akd  Gynecological  Asbooiation.    741 

class  at  a  public  olioic,  and  transferred  the  patients  afterwards,  at 
times  quite  a  distance,  to  their  homes.  In  his  first  operations  he  had 
some  shock  from  exposure,  but  this  is  easily  controlled  bj  placing 
hot  towels  over  the  exposed  surfaces.  There  is  practically  no 
blood  lost  in  a  properly  made  operation.  It  is  better  to  complete 
the  operation,  grafting  incloded,  at  one  sitting.  When,  for  any 
reason,  this  is  not  practicable,  the  cleaning  out  of  the  supra-clavicu- 
lar region  and  the  grafting  can  he  made  at  a  second  operation. 
When  grafting  ie  done  at  a  second  operation  he  finds  it  better  to 
remove *the  granulations.  This  is  best  done  by  curetting.  In  two 
of  his  cases  it  was  necessary  to  remove  the  sub-scapular  nerves, 
and  in  another  to  resect  the  axillary  vein.  No  unpleasant  se- 
quela followed  in  either  case.  He  has  operated  upon  over  fifty  cases 
of  carcinoma  since  he  began  surgical  work,  and  he  has  always 
cleaned  out  the  axilla  and  stripped  the  muscles  in  each  case.  He 
has  been  making  Halstead's  operation  since  its  introduction.  He 
does  not  know  the  results  in  the  majority  of  these  cases.  Two  of 
them,  however,  came  back  to  him  with  later  recurrence,  one  with 
a  carcinoma  of  the  femur  five  years  after  operation,  no  local  return  j 
the  other  with  a  local  return  in  the  cicatrix  nine  years  afterwards. 
This  case  died  in  a  short  time  from  metastasis.  He  feels  quite 
sure  that  these  were  not  independent  new  growths.  There  is  always 
one  rule,  that  the  more  malignant  the  case  the  greater  the  blood 
changes. 

The  primary  object  of  the  paper  was  to  point  out  the  iact  that 
a  careful  clinical  examination  of  each  case,  a  record  of  the  local 
conditions,  the  type  of  tnmor,  the  blood  changes,  whether  or  not 
there  was  marrow  infection,  the  family  history,  and  the  length  of 
time  it  had  existed,  would  not  only  give  definite  taot«  upon  which 
to  base  a  prognosis,  but,  if  published  with  each  case,  would  give 
all  surgeons  a  record  of  infinite  value  for  comparative  purposes. 
The  following  officers  were  elected  for  the  ensuing  year: 
Pre«den( — Dr.  Joseph. Taber  Jobuson,  of  Washington,  D.  C 
Vioe-Pretidenta — Drs.  F.  W.  Parham,  New  Orleans,  and  W.  L. 
Robinson,  Danville,  Va. 

Secretary — Dr.  W.  E.  B.  Davis,  Birmingham,  Ala. 
Treasurer — Dr.  A.  M.  Cartledge,  Louisville,  Ky. 


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743      The  Atlanta  Medigal  akd  Subqical  Jouiuial. 

To  fM  mcanoy  in  the  CounoU — Dr.  L.  McLane  Tiffiiny,  Balti- 
timore,  Md. 

Place  of  meetiof;,  New  Orleans ;  time,  to  be  determined  by  the 
Secretary  with  advice  of  the  CouDcil. 

After  the  preseDtation  and  adoption  of  lesolatiooe  of  thaokB, 
the  AsBociatioD  adjourned. 


The  Teeatmekt  op  Feactdees. 

Dr.  W.  L.  Estes  (IntemaiwtuU  Journal  of  Surgerg)  says : 

First.  Unless  a  fragment  is  threatening  to  break  through  the 
skin  it  should  never  be  reduced  except  by  the  physician,  and  then 
only  when  the  parts  can  be  kept  in  permanent  apposition. 

Second.  Men  carrying  an  injured  person  should  not  keep  step, 
as  the  jar  ia  greater. 

Third.  Strychnia  should  be  given  for  shook,  morphia  for  pun, 
but  no  alcohol. 

It  is  very  rarely  necessary  to  make  a  patient  go  through  the 
double  agony  of  temporary  and  permanent  setting  of  the  broken 
bones. 

In  simple  fracture  gentle  rubbing  of  the  ends  vill  assist  in  getr 
ting  rid  of  shreds  of  tissue  which  are  invariably  caught  there. 

Nowadays  a  surgeon  will  rarely  be  satisfied  that  a  bone  is  prop- 
erly set  until  verified  by  the  X-rays. 

Plastic  splints,  preferably  plaster  of  Paris,  are  the  best  apparatus. 

No  simple  fractures  require  constant  confinement  to  bed,  except 
of  the  innominata  and  upper  third  uf  the  femur. 

Do  not  wait  for  the  swelling  to  disappear  before  putting  on  a 
permanent  dressing. 

*A  welt-applied  splint  with  good  apposition  of  the  fragments 
should  not  be  removed  too  early.  Proper  time  for  massage  is  two 
or  three  weeks  afler  fracture  of  upper  extremities  and  four  or  five 
weeks  for  lower  extremities. 


HOnOX.— ThU  JOURNAI.   and  THB  XNTXSNATIONAL  JOUR- 
NAL OF  SUSOEBT  one  y»ar  fiir  92.00  oaab. 


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CORRBSPONDBNCB, 


Lone  Gbove,  Texas,  December  15,  1898. 
Dr.  IhtnbarRoy: 

Dear  Sib. — I  am  just  in  receipt  of  the  December  namber  of 
your  Journal,  for  which  pleaae  accept  thanka.  I  am  a  native 
Geoi^iau ;  bora  equidistant  between  Monticello,  in  Jasper  county, 
and  Covington,  in  Newton  county,  26th  June,  1830.  The  "cold 
Saturday,"  in  1834,  is  about  my  first  recollection.  The  "falling 
of  the  stars"  in  1833  (November)  was  a  little  too  early  for  me — 
only  from  hearsay.  Have  been  a  practitioner  of  the  healing  art 
since  1856 — forty-two  years.  Your  Dr.  Tomlinson  Fort,  of  Mil- 
ledgeville,  in  Fort's  Practice,  gave  me  my  first  correct  ideae  of 
typhus  and  typhoid  fevers.  He  placed  it  with  other  exanthe- 
mata and  turned  the  attention  of  the  profession  of  that  era  to  the 
peculiar  affection  of  the  glands  of  the  smalt  intestines.  What 
changes  in  the  supposed  etiology  and  treatment  of  diseases  in 
general  since  that  [time  [  The  Woodbridge  treatment  aborts  it? 
cuts  it  short  (  ( ?)  not  much),  and  because  I  cannot  be  forced  to 
adopt  this  modern  £ad,  *'Tray,  Blanche  and  Sweetheart"  have  all 
been  on  my  track  and  have  cast  me  into  the  fiery  furnace  of  their 
hottest  displeasure.  However,  in  patience  I  have  possessed  my 
Boul,  as  in  the  case  of  Galileo,  who  invented  the  telescope;  I  still 
stick  to  my  belief,  all  the  modern  disciples  of  .^^ulapius  to  the 
contrary  notwithstanding.  As  surgeon  in  the  war  between  the 
States  I  considered  it  fortunate  that  our  medical  armament  con- 
sisted of  spirits  turpentine,  blue  mass,  opium  and  quinine  o&ly. 
The  hypodermic  syringe  and  the  various  preparations  of  oo(d-iar 
were  unknown.  The  turpentine  emulsion,  with  pleniy  of  waier 
and  proper  diet,  enabled  me  to  help  through  the  crisis  of  this 
disease  scores  of  patients  who  would  have  died  under  the  modern 
treatment;   at  least  so  I  think. 


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744       Thb  Atlanta  Mbdioal  abd  Surbioal  Journal. 

There  are  several  items  io  your  Joubnal  1  can  heartily  oom- 
mend.  * 

With  your  old  pbyaiciaoB  of  thirty  years  ago  I  was  once  veil 
acquainted.  Ford,  of  Augusta ;  Hon.  Dr.  Miller,  Fears,  Shack- 
leford,  and  many  others,  most  of  whom  have  joined  the  silent 
majority.  Does  my  old  frieud  aud  chum,  ColoDel  Israel  Putoun, 
still  live  ?  If  so,  remember  me  kindly  to  him  when  you  see  him. 
By  the  way,  what  think  you  of  our  proposed  "  Law  to  regulate 
the  practice  of  medicinei  in  Texas"?  Too  cumbersome,  too  wordy. 
One  board  of  medical  examiners  to  meet  quarterly  at  the  capitol 
would  have  been  suffioieat,  I  think.  I  doubt  its  passing  the 
Legiislature. 

You  are  at  liberty  to  use  this  letter  or  any  part  of  it  as  you 
like.  I  write  it  in  great  bodily  pain.  I  suppose  that  I  have 
cancer  of  the  rectum,  growing  out  of  hemorrhoidal  tumors,  from 
which  I  have  suffered  for  near  half  a  century. 

Wishing  you  a  pleasant  Christmas,  a  happy  new  year,  and  suc- 
cess for  your  Jourhal,  I  am, 

C.  a  Reeves,  M.D. 

[Note. — It  gives  tis  pleasure  to  publish  this  reminiscent  letter 
of  Dr.  Reeves.  We  wish  there  were  others  of  the  "old  school" 
who  would  do  likewise  and  give  the  readers  of  The  Journal 
some  ideas  from  "ante-bellum  days."] 


Local  Application  in  Gout. 

PotasBii  lodi  )  _  , 

Liniment  Bnponis    J       3 

01.ca>puti> 

01.  cari         ;** -S". 

SpirituBrtCt q.  i.  sd.     3  ""• 

Sig.    4PP^7  <"'  "'"t  '"d  cover  with  a  protective. 


NOTICE.-Thls  JOURNAL  and  THE  INTERNATION- 
AL JOURNAL  OF  SURGERY  one  year  for  S2.00caBh. 


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EDITORIAL  NOTES  AND  COMMENTS. 


the  BnilsaM  offle*  of  Thi  Jottkhil  !■  m,  *W  Fltten  Bolldlns. 

n»  KdllorlBl  office  U  Koom  tOl,  MS  Gnuid  Open  Eoiue. 

Addreu  tn  Bu»lnew  oommniiic&UoiiB  to  Dr.  H.  B.  Bntohiiu,  itft. 

Ifkke  MmlttoDOH  p»7*ble  to  Thi  Atlamta  Uidical  ahd  Soksical  JodbkUi. 

On  matUn  psTMlnlng  (o  the  Idltorlal  eDd  Original  oommiinloaUonl  addreM  Dr.  Dunbar 
ttof,  Orand OperaBonte,  Atlanta. 

OeprlnU  ot  original  artlelM  irlll  ta  tnrnUhed  at  eoit  prloe.  Beqoeati  lor  tbe  Bama 
Aonld  alvafi  be  made  on  tht  manu*cripl. 

We  wlU  pTOtent,  poet-paid,  on  nqaeit,  to  each  oontrlbntor  ot  an  original  artlol*,  twentr 
(SO)  marked  ooplai  o(  Thb  JouBnu-AontalnlngsDoh  artlol*. 


THE  NATIONAL  QUARANTINE  CONVENTION  AT 

MEMPHIS. 

THIS  ConvenrioD  of  representatives  from  tbe  South  edcI  South- 
west recently  held  a  very  satisfactory  meetiog  in  Memphis  to 
consider  the  question  of  quarantine. 

The  Boston  Medical  and  Surgical  Journal  haa  written  an  edito- 
rial on  the  work  accomplished  by  this  meetiog,  and  we  could  do 
DO  better  than  quote  what  it  says : 

**The  Memphis  Quarantine  Convention,  to  which  reference  was 
made  in  the  last  issue  of  the  Jownat,  ought  to  bring  us  within 
measurable  distance  of  a  settlement  of  tbe  vexed  question  of  the 
nature  and  limits  of  tbe  quarantine  service  of  the  country. 

"Tbe  call  for  tbe  meeting,  issued  by  the  Memphis  Chamber  of 
Commerce,  was  addressed  to  those  only  who  were  in  favor  of  a  com- 
prehensive control  of  qnaraDtioe  under  the  authority  of  the  National 
Government,  and  thus  were  cleared  away  many  of  the  diEBculties 
which  have  hitherto  beset  such  conventions. 

"  Nearly  one  hundred  and  fifty  delegates  were  present,  represent- 


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746       The  Atlanta  Mbdical  and  BimaicAL  Jovknal. 

ing  States,  cities,  commercial  organizatioDS  and  aome  of  the  great 
railroad  systemB  of  the  Southwest,  Though  many  medical  meo 
wwe  present  aa  delegates  from  the  various  public  health  authorities 
of  the  country,  still  the  physicians  were,  upon  this  occasion,  in  a 
minority.  The  South  was,  naturally,  more  fully  represented  than 
the  North,  and  the  State  of  Mississippi,  which  suffered  more 
severely  from  the  effects  of  yellow  fever  panic  than  did  any  other 
Southern  State  during  the  reoeut  epidemic,  had  the  largest  delega- 
tion of  all. 

"  The  men  composing  the  delegations  are  distinguished  in  many 
walks  of  life.  The  very  efficient  ChairqaaQ  of  the  meeting  was 
Gen.  Luke  E.  Wright,  of  Memphis,  formerly  Attomey-GeDeral  of 
his  State.  At  the  head  of  the  Mississippi  delegation  was  ex-Gov- 
ernor Shands,  professor  of  law  in  the  University  of  Mississippi. 

"Ex-Governor  Bullock,  of  Georgia,  was  an  active  and  influential 
participant  in  the  work  of  the  body,  both  id  committee-room  and 
OD  the  floor  of  the  Convention,  and  was  ably  seconded  by  the  very 
capable  Mayor  of  Atlanta,  Mr.  Collier.  The  Chairman  of  the 
Louisiana  representation  was  a  very  promiuent  member  of  the 
Cotton  Exchange  of  New  Orleans,  and  though  he  had  been  in- 
structed by  that  organization  to  resist  the  attempts  of '  the  doctors' 
to  ohtRiD  possession  of  the  administration  of  quarantine,  was  able 
to  support  heartily  and  ably  the  resolutions  which  were  finally 
adopted. 

"Under  the  euei^tic  direction  of  the  Chairman  of  the  Conven- 
tion, DO  time  was  lost  in  the  usual  and  useless  discusuons  npon  the 
nature  and  proper  treatment  of  yellow  fever,  for  he  discovered  the 
happy  expedient  of  relegating  several  papers  upon  these  subjects, 
together  with  an  exhaustive  [statement  of  our  duty  to  the  new 
possessioDS  of  the  United  States  beyond  the  seas,  to  the  evening 
sessions  of  the  Convention,  while  the  sub-committees  of  the  meet- 
ing were  at  work  upon  the  matters  referred  to  them. 


^dbyGoogle 


Editobial.  747 

'*  For  a  proper  oonsidenitioD  of  the  difficulties  which  attend  such 
Conventions  as  this,  in  Southern  States,  it  should  always  be  re- 
membered that  yelloto  fever  is  the  one  disease  always  present  in  the 
minds  of  the  Sonthem  people  when  the  question  of  quarantine  is 
under  discussion,  and  it  is  quite  apparent  that  this  collection  of 
men  offered  no  exception  to  the  rule.  A  considerable  number  of 
those  present,  especially  among  the  representatives  of  the  transpor- 
tation companies,  would  undoubtedly  have  preferred  to  vote  for 
some  measure  which  gave  absolute  power  to  the  general  govern- 
ment in  times  of  yellow  fever  epidemic  and  to  stop  there,  rather 
than  to  go  on  with  the  oonsideration  of  a  general  system  for  the 
protection  of  the  public  health.  It  was  well  therefore  for  Dr. 
Hamilton,  one  of  the  delegates  from  Illinois,  to  call  the  attention, 
as  he  did,  of  the  Convention  to  the  necessity  of  a  wider  view  of  the 
great  subject  of  the  spread  of  preventable  diseases  other  than  yellow 
fever.  Dr.  Hamilton's  complete  familiarity  with  the  work  of  the 
Marine  Hospital  Service  gives  to  his  opinions  upon  a  national  pub- 
lic health  service  great  value — a  value  which  has  not  been  essen- 
tially diminished  by  the  apparent  uncertainty  as  to  the  disinterested 
quality  of  bis  utterances  upon  this  subject, 

"He  represents  the  recorded  opiuions  of  the  great  medical  asso- 
ciations of  the  land  and  of  the  most  influential  public  health  or- 
ganizations, and  they  are  all  id  favor  of  some  national  organization^ 
intelligent  enough  to  comprehend  the  great  problems  presented  by 
preventable  diseases,  and  strong  enough  to  use  all  the  power  of 
the  general  government  in  case  of  need,  to  control  the  spread  of 
pestilence. 

"The  Convention  devoted  two  days  to  the  consideration  of  the 
question  of  the  best  form  of  national  denization,  and  as  a  result  of 
their  deliberations,  adopted  the  resolutions  which  we  have  already 
printed. 

"  These  resolutions  were   prepared  by  a  committee  consisting  of 


^dbyGoOgle 


748       Thb  Atlanta  Mbdical  akd  Svbsical  Jodkhal. 

one  delegitte  from  each  State  represeDted  in  the  Convention ;  this 
Committee  waa  presided  over  bj  ex-Governor  Shanda,  of  Mississippi, 
and  was  again  not  under  the  control  of  the  medical  profession,  and 
-was  able  to  come  to  a  unanimous  report.  The  report  was  adopted 
by  a  vote  of  136  to  4,  and  was  then  upon  motion  of  a  member  of 
the  minority  made  unanimous. 

"Those  of  our  readers  who  are  &miliar  with  the  proceedings  of 
a  quarantine  convention  in  a  Southern  city  will  understand  how 
important  a  result  has  been  reached  by  this  united  report. 

"For  the  general  interest  of  scientific  medicine  it  is  to  be  hoped 
that  some  agency  may  now  be  established  for  a  wise  and  patient 
investigaUon  of  the  one  preventable  exotic  disease  which  is  of  more 
consequence  than  any  other  to  this  country.  It  is  true  that  now 
and  again  officers  of  some  of  the  medical  services  of  the  govern- 
ment at  Washington  have  been  sent  into  the  tropics  for  brief  periods 
of  time  to  study  yellow  fever,  but  thus  far  we  have  gained  little  by 
such  efforts,  and  cannot  hope  to  do  so  until  such  studies  can  he 
carried  on  under  the  direction  of  a  well-established  department  of 
government  which  shall  not  he  compelled  to  fight  for  its  esiBteoce 
at  every  session  of  Congress — as  was  the  case  with  the  National 
Board  of  Health. 

"The  conditions  which  can  meet  the  requirements  of  the  resolu- 
tions of  the  Memphis  Convention  are  substantially  those  of  the 
so-called  Spooner  Bill,  now  before  Congress,  for  the  creation  of  a 
Bureau  of  Public  Health  with  a  commissioner  at  its  head  aided  by 
a  council  composed  of  a  delegate  from  each  State.  The  council 
would  serve  many  useful  purposes :  It  would  unit«  the  activities  of 
the  various  States  in  health  matters,  it  would  bring  about  an  im- 
mediate connection  between  the  authorities  of  the  States  and  the 
office  at  Wasbingtoa;  every  member  of  the  council,  having  had 
experience  in  public  health  administration  in  his  own  State,  would 
be  a  useful  counsellor  in  the  new  hoard ;  and  finally  would  exercise 

DiclzedbyGoOgle 


Editorial.  749 

a  most  important  fuDOtion,  in  procuring,  each  in  hia  own  State,  that 
support  on  the  floor  of  Congress  which  is  essential  to  the  satisfactory 
maintenance  of  a  public  department,  a  support  which  cannot  easily 
be  refused  to  one  who  can  speak  with  authority  among  the  oon- 
stitnents  of  the  reBpective  members  of  Congress.'* 


HYGIENE  IN  SHAVING  AND  HAIR-DEESSING 

PARLORS. 

IT  has  always  been  remarkable  to  as  thai  more  skin  diseases  are 
not  contracted  in  barber-shops  or  at  least  can  be  traced  to  this 
source,  and  yet  if  the  truth  were  known  we  believe  that  there 
are  even  more  than  are  known.  The  unhygienic  manner  in  which 
the  large  majority  of  these  shojM  are  managed  would  certainly 
eeem  to  make  tbem  "contagion  shops"  for  various'  skin  diseases. 
For  the  good  of  the  public  we  believe  that  men  should  be  edu- 
cated to  see  the  error  of  being  attended  in  barber-ebops  by  men 
who  themselves  look  uncleanly  and  use  instruments  which  pass 
over  a  hundred  faces  in  one  day  without  even  being  cleaned.  If 
these  shops  are  to  be  patronized,  and  there  is  no  doubt  but  that 
they  always  will  be,  then  such  frequenters  should  have  their  own 
razor,  and  brush  and  soap.  We  believe  that  every  man  who 
shaves  should  learn  to  shave  himself,  lor  it  is  in  that  case  always 
done  better  and  is  &r  more  cleanly.  In  an  ediiorial,  the  Canadian 
Medical  Record  reviews  the  action  of  the  board  of  health  of  the 
province  of  Quebec,  and  the  views  there  expressed  are  certainly 
worthy  of  cousideratioo.     It  says : 

"The  board  uf  health  of  the  province  of  Quebec  has  issued  a 
circular,  and  cauxed  it  to  be  published  in  the  newspapers  (a  copy 
of  wbicii  we  give  helow),  which  in  a  commendable  manner  aims 
at  miiigtiting  a  well- recognized  source  ol  danger  in  regard  to  the 
spread  of  inlectiuno  diseases.     The  dangers  &•  which   persons  are 


^dbyGoOgle 


750      Tbb  Atlanta  Medical  Ain>  Surqical  Jodbkal. 

exposed  ID  the  manDer  indicated  hj  the  circalar  are  not  appre- 
ciated  by  people  geoeratly,  aod  a  single  publication  in  the  daily 
papers  is  hardly  sufficient  to  educate  the  ordinary  mind  to  the  real 
danger  incurred  by  their  barber  using  the  same  instraments  pro- 
iniecuousty  without  proper  cleansing.  It  will  only  be  when  the 
public  demand  the  changes  indicated,  that  barbers  will  take  the 
oeoeseary  precautions  and  carry  out  the  directions  so  scientifically 
tabulated  in  the  circular.  A  properly  edacaled  pablic  will  go 
farther  than  the  barber*8bop.  They  will  inquire  whether  the 
restaurant-keepers  disinfect  the  eating  utensils  which  are  used 
several  times  daily  by  different  people.  Whether  dentists  render 
aseptic  the  instruments  which  enter  a  dozen  or  more  mouths  each 
day.  Danger  on  these  lines  lurks  ou  all  sides ;  even  the  sacred 
book  in  our  court-houses  may  be  the  medium  of  conveying  disease 
from  one  month  to  another,  and  the  parched  wayfarer  who  may 
<]uencb  bis  thirst  at  a  public  fountain  may,  unconsciously,  with  the 
refreshing  waters  imbibe  specific  contagion  from  the  drinking-cup. 
We  heartily  indorse  the  action  of  the  board  in  sounding  this 
warning  note,  and  hope  they  will  not  cease  their  agitations  with 
tbe  i»<eseDt  e£Forts,  but  will  continue  to  rouse  the  community  in 
regud  to  the  great  dangers  that  insidiously  lurk  and  claim  victims 
who  are  unconscious  of  the  existing  perils. 

'^  Beyond  all  doubt,  any  one  who  patronizes  a  barber  or  hair- 
dresser, whose  establishment  is  open  to  all  comers,  runs  great  risk  of 
becoming  infected  with  disease,  from  the  razor,  shavin^brush, 
scissors,  clipper,  comb  or  hair-brush  having  been  previously  used 
on  a  eick  person  or  even  on  a  corpse. 

"  That  the  chance  of  contagion  is  much  less  when  the  establish- 
ment is  well  kept,  we  most  willingly  admit;  that  the  danger  of 
infection  is  minimized  in  first-class  establishments,  we  also  con- 
cede, but  tbe  truth,  nevertheless,  obliges  us  to  declare  this : 

"At  tbe  present  moment,  in  the  whole  province  of  Quebec,  there 


^dbyGoogle 


Editorul.  751 

is  not  a  Biogle  barber  or  faairdresaer  wbo  can  honestly  say  tbat  bis 
instrnments  ar«  absolutely,  completely  aod  ecieatifically  safe  is 
regard  to  the  possibility  of  ooDveyiog  iofectioD. 

"  Bbould  a  barber  or  bairdresser,  recognizing  the  danger  of 
transmitting,  by  the  use  of  his  instruments,  certain  inlectioos  or 
parasitic  diseases,  amongst  which  may  be  mentioned  the  most  ter- 
rible, and  at  the  same  time,  perhaps,  most  frequently  met  with 
disease,  syphilis,  be  willing  to  take  the  necessary  antiseptic 
measures  and  to  offer  to  bis  customers  a  guarantee  of  the  most 
minute  cleanliness  conscientiously  carried  out,  be  may  rest  assured 
of  an  immense  increase  of  bis  clientele,  as  the  people  of  this 
province  are  now  thoroughly  aroused  to  the  necessity  of  taking 
preventive  measures  against  contagious  disease  in  all  forms. 

"  What  then  should  be  done  to  put  hair-dressing  parlors  in  a 
desirable  hygenic  condition  ? 

"The  board  of  health  of  the  province  of  Quebec,  which  has  the 
supervision  and  care  of  the  public  health  in  this  province,  thinks 
it  opportune  to  make  public  the  conclusions  of  a  report,  duly 
approved  by  it,  which  prescribes  the  best  means  of  avoiding  the 
dangers  which  necessarily  arise  from  the  use  in  common  of  the 
razor,  shaving-brush,  scissors,  clipper,  comb  and  hair-brush." 


IN  the  December  3d  issue  of  the  FkUadelphia  Medteal  Journal 
there  appears  the  following  notice  which  will  explain  itself: 
"For  reasons  set  forth  in  another  column,  this  Journal  will, 
on  and  after  December  Slst,  discontinue  all  exchanges  with  other 
journals.  Publishers  and  mailing  clerks  wil]^kindly|  bear  this  in 
mind,  aod  from  the  date  mentioned  oease  to  mail  us  their  journals 
on  account  of  exchange.  The  business  manager  of  the  Journal 
will  soon  remit  the  regular  subscription  price  for  the  journals 
desired  by  us  for  1899." 

This  action  of  the  PhUadelpkia  Medical  Journal  is  indeed  a  new 


^dbyGoOgle 


752       The  Atlanta  Medical  and  Sorsical  JomutAL. 

departure  in  journalism  and  yet  those  who  have  watched  the  pecu- 
liar idioeyncraeies  of  the  general  get-ap  of  this  jonrnal  could  not 
be  surprised  at  this  suddenly  manifested  eccentricity.  The  owtives 
of  the  management  of  thia  journal  may  CMiaisly  be  the  best  in  the 
world,  but  we  do  not  think  that  it  has  shown  good  judgment  in 
this  one  act.  In  extenuation  of  this  peculiar  change,  the  editorial 
management  says:  "If  the  exchange  courtesy  is  extended  to  a 
score,  it  is  asked  by  hundreds  of  others,  until  each  finds  that  he  is 
spending  a  large  amount  of  money,  perhaps  a  thousand  dollars 
annually,  in  sending  out  his  own  copies  and  for  which  be  receives 
several  hundred  journals,  the  greater  number  of  which,  in  his 
special  field  of  work,  are  worthless."  This  is  the  apology.  We 
have  yet  to  see  the  time  when  we  cannot  choose  our  own  friends, 
'and  we  had  sooner  select  those  journals  with  which  we  wished  to 
exchange  than  to  show  discourtesy  to  all  by  isolating  ourselves  to 
"single  blessedness."  It  is  true  that  there  are  a  great  many 
exchange^  received  which  are  worthless  and  could  show  no  just 
cause  for  existence,  but  journals  as  individuals  certainly  have  the 
right  to  select  their  own  friends.  .Of  course  every  journal  which 
is  backed  by  ready  cash  can  afford  to  publish  its  pages  for  the 
delectation  of  its  own  editorial  staff,  hut  we  think  that  the  broad 
principles  of  professional  courtesy  should  be  an  attribute  of  every 
medical  periodical,  even  though  its  height  of  perfection  could  never 
be  attained  by  others. 


AT  the  recent  Quarantine  Conveution  held  in  Memphis,  com- 
posed of  representatives  from  all  the  Southern  States,  the 
following  resolution  was  unanimously  adopted  as  express- 
ing the  views  of  those  present: 

"The  committee  ou   resolutions,  after  careful  consideration  of 
the  many  valuable  resolutions  offered  by  the  various  members  of 


^dbyGoOgle 


Editokial.  758 

the  conveotion,  have  decided  upon  the  following  as  embodying 
the  ideaa  expressed  in  the  majority  of  the  said  resolutions: 

"Therefore,  That  for  the  purpose  of  protecting  and  improving 
the  general  health  of  the  people  of  the  United  States,  co-ordinat- 
iog  and  barmouizing  the  action  of  the  State  and  National  sanitary 
authorities;  framiDg  regulations  for  the  treatment  of  infected  ves- 
■sels  and  material  at  all  infected  or  suspected  foreign  ports  of  ship* 
ment;  preventing  UDoecessary  interference  with  commerce,  the 
United  Stated  mail,  or  through  traffic  by  land  or  water,  and  for 
adopting  a  uniform  system  of  quarantine  for  all  ports  in  this  coun- 
try; be  it 

"Mesoived,  Tbat  there  be  established  oa  a  broad  and  compre- 
iiensive  basis  a  National  Bureau  of  Public  Health  in  the  Depart- 
ment of  the  Treasury  of  the  United  States,  that  the  administration 
■of  aU  the  public  health  functions  now  exercised  by  authority  of 
the  United  States  be  placed  in  the  hands  of  this  Bureau. 

"2.  That  the  sanitary  authorities  and  commercial  interests  of  the 
.several  States  of  the  Union  be  brought  into  immediate  relations 
with  the  Bureau  and  be  given  a  due  share  in  the  power  aud  respon- 
sibilities ol  the  central  board  through  the  agency  of  an  advisory 
•council  consisting  of  one  member  from  each  State,  to  be  appointed 
by  the  authorities  of  the  several  States." 


SPEA.KINO  of  the  "absorption  treatment"  of  cataract  reminds  us 
of  the  suit  for  damages  recently  instituted  by  a  patient  who 
had  lost  both  eyes  while  an  inmate  of  the  celebrated  "Bemis 
Sanatorium."  This  "Bemis  Sanatorium"  is  advertised  most 
especially  in  the  weekly  and  monthly  popular  periodicals,  and  ap- 
peals to  the  laity  for  support  by  holding  out  to  them  most  marvel- 
ous cures  for  every  eye  disease  without  the  use  of  the  knife.  Such 
an  advertisement  touches  a  popular  chord,  because  most  people 


^dbyGoogle 


754       Thb  Atlanta  Medical  and  Subqical  Journal. 

have  a  dread  of  the  word  "  operation,"  and  like  the  majority  of  the 
negro  race,  they  had  rathar  lose  the  whole  eye  than  to  submit  to 
aa  operatjoii  of  painless  character.  Even  as  Jar  south  as  Atlanta^ 
we  have  run  across  patients  with  fully  ripeoed  cataracts  who  are- 
wholly  content  with  the  use  of  the  "eye  vapor"  furnished  from- 
the  above  institution,  and  are  fully  convinced  of  its  curative  effect* 
with  all  the  child-like  &ith  of  a  Christian  scientist.  Recently  a 
patient  who  was  at  the  sanatorium  to  have  his  cataract  absorbed, 
developed  gonorrheal  ophthalmia,  and  as  a  result  lost  his  eye.  It 
was  found  that  there  was  a  case  of  this  ophthalmia  which  had  come- 
for  treatment,  and  the  physician  in  charge  had  used  the  same  med- 
icine dropper  on  the  other  patients,' and  had  thus  conveyed  the 
contagious  material.  This  shows  the  scientific  character  of  the 
institution!  When  the  patient  consulted  a  physician  outside  of 
the  institution  and  found  out  the  real  condition  of  his  eyes  there 
was,  of  course,  "blood  on  the  moon."  As  a  result  of  this,  we  be- 
lieve he  has  instituted  a  suit  for  damages  to  the  amount  of 
$20,000,  but  so  &r  the  result  of  it  has  not  been  learned. 


THE  heralding  of  new  remedies  as  a  cure-all  for  eye  diseases, 
and  as  for  that  matter,  for  every  portion  of  the  human  anat- 
omy, occurs  now  almost  daily.  We  have  received  pamphlets  from 
time  to  time  from  the  Walker  Pharmacal  Company,  extolling  a 
new  remedy  called  by  them  "  Cineraria  Martima,"  for  the  cure  of 
cataract  by  gradual  absorption.  The  "absorption  treatment"  of 
cataract  is  an  old  fake,  and  every  now  and  then  crops  out  in  a  new 
guise.  Recently  Dr.  J.  Ellis  Jennings,  of  St.  Louis,  decided  to 
consult  the  Walker  Company,  and  with  their  aid  and  permi^ion 
to  give  the  remedy  a  thorough  test.  He  found  this  pharmacal 
company  located  above  a  Homeopathic  pharmacy,  and  in  charge 
of  a  Homeopathic  physician.  The  doctor  stated  his  mission  and 
asked  to  be  given  some  new  facta  concerning  this  wonderful  rem- 


^dbyGoOgle 


Editorial.  755 

€dy.  He  stated  to  the  gentleman  in  charge  that  such  reports  ae 
bad  been  seat  out,  usually  mere  statements  of  the  patient,  could 
not  be  relied  upon  and  were  of  no  value.  As  the  circular  stated 
that  "leading  phjrgicians  and  ophthalmologists  were  using  the  prep- 
ration  with  generallf  good  succesB,"  he  asked  to  see  a  report  from 
an  ophthalmologist.  They  had  none.  He  then  asked  if  they 
would  he  willing  to  furnish  him  with  a  quantity  of  the  drug  so 
that  he  could  test  its  value  in  a  number  of  selected  cases.  After 
consultation  they  refused  to  grant  his  request.  In  conclusion  Dr. 
Jennings  states,  "  that  so  &r  aa  I  could  learn  there  is  no  evidence 
that  Cineraria  Martima  is  of  any  value  as  a  curative  agent  in  cata- 
ract, and  from  the  action  of  the  Walker  Chemical  Co.,  they  evi- 
dently are  not  anxious  to  have  tbe  drug  properly  tested." 


DB.  Frank  S.  Bourns,  who  was  eommissioned  on  General  Mer- 
ritt's  staff,  and  s^led  on  the  first  transports  for  Manila,  in 
tbe  Philippioe  Islands  during  tbe  summer,  is  now  Major 
and  President  of  the  Board  of  Health  of  that  Philippine  city. 
Dr.  Bourns's  former  residence  in  the  Philippine  Islands  and  his 
ability  to  speak  the  language  of  these  islands,  in  addition  to  his 
marked  executive  ability  both  as  a  physician  and  as  an  army  man, 
has  made  his  services  invaluable  to  the  commanding  General,  and 
hence  we  are  not  surprised  to  hear  that  the  doctor  has  been  placed 
in  entire  charge  of  the  Medical  Department  of  Manila  and  is  the 
President  of  the  Board  of  Health.  He  writes,  however,  that  he 
is  very  anxious  to  return  to  Atlanta  to  resume  bis  old  work,  as  he 
is  heartily  tired  even  of  his  exalted  position  in  tbe  Pacific  islands. 
Now  that  the  United  States  will  come  into  the  possession  of  these 
islands  there  may  .be  yet  higher  honors  in  store  for  Dr.  Bourns, 
and  Atlanta  may  yet  lose  him  as  a  citizen. 


^dbyGoOgle 


756       The  Atlanta  Msdical  and  Sukqical  Jouonal. 

WB  wififi  to  call  attention  to  the  spleadid  offer  that  tbta  Jodb- 
NAL  makea  to  ita  BubBcribera  for  the  comiog  year.  We 
will  aend  to  each  caah  subscriber  this  Journal  and  the 
International  JourruU  of  Surgery  for  the  one  aubacriplion  price  of 
two  dollars.  Thia  is  a  splendid  offer  for  any  phymcian  who  wishes 
to  read  the  best  literature  on  medicine  and  sui^ry.  Id  the  com- 
ing year  we  expect  to  make  thia  Journal  more  tnterestiDg  than 
ever,  not  only  by  its  original  arUcles,  but  by  articles  taken  from 
other  journals  in  every  department  of  medicine.  This  is  the  oES- 
cial  organ  of  the  State  Medical  Examining  Board,  and  will  give 
the  queationa  and  the  list  of  successful  candidates  after  each  exami- 
nation. We  expect  to  report  the  proceedinga  of  the  Atlanta 
Society  of  Medicine  and  to  give  medical  items  from  all  over  the 
State.  We  ask  all  of  our  frienda  to  send  ua  items  of  interest  and 
we  will  cheerfully  publish  them. 


THE  following  officers  were  elected  in  the  Atlanta  Society  of 
Medicine  for  the  year  1899  : 

President— Dr.  W.  S.  Goldsmith. 

Yice-Preaident — Dr.  Katherine  Collins. 

Secretary — Dr.  Claude  A.  Smith. 

Treasurer — Dr.  E.  Van  Goidtanoven. 

Librarian — Dr.  Mike  Hoke. 

The  Society  has  alao  inatituted  a  movement  for  the  thorough  or- 
ganization of  a  medical  library,  and  in  the  next  issue  we  will 
apeak  more  at  length  in  regard  to  this. 


NOTICE.-Thrs  JOURNAL  and  THE  INTERNATION- 
AL JOURNAL  OF  SURGERY  one  year  for  S2.00  cash. 


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NEWS  AND  NOTES. 


HOnOE.— This  JOUBNAL  uid   THE    INTSBNATIONAL  JOUB- 
HAL  OF  8ITBOKBT  ono  ywt  tor  92.00  OMh. 


In  Dr.  Hutchina'  article,  page  658,  Hoe  10,  read  "had  no,"  for 
"had."     Page  661,  line  6,  " cicatrizatioo,"  for  " scarifieation" 

Dr.  T.  H.  Huzza,  of  this  city,  died  laBt  montb  in  the  New 
York  Hospital  as  a  result  of  appendicitia.  Dr.  Huzza  as  a  student 
at  college  made  one  of  the  most  brilliant  records  that  has  ever  been 
koovn.  For  a  number  of  jears  he  assisted  Dr.  Battey,  in  Rome, 
Ga.,  at  his  private  infirmary. 


Dk.  Henby  C  Doughty  died  at  his  home  in  Augusta,  Ga., 
last  mouth  at  the  early  age  of  26.  It  is  supposed  that  Dr.  Donghty's 
death  was  the  result  of  tuberculosis,  produced  by  the  inbahitioii  of 
these  germs  through  his  work  at  the  college  laboratory. 


Db.  L.  W.  Pitchford,  of  Estaboga,  Ala.,  died  od  Sunday, 
November  27th,  of  typhoid  fever.  Dr.  Pitchford  was  an  alumnus 
of  the  old  Soathem  Medical  College. 


That  excellent  journal,  7^  LouisvilU  Joumai  of  Medicine  and 
Surgery,  has  reduced  its  subscriptiou  price  from  two  to  one  dollar  a 
year.  This  seems  to  be  the  policy  of  a  great  number  of  medical 
journals  for  the  coming  year. 


JUDOE  Miller,  of  Louisville,  has  handed  down  his  decision  in 
the  injunction  case  of  Drs.  Moody  &  Kelly  against  Drs.  Warthen, 


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758       The  Atlanta  Mbdigal  and  SuaaicAL  Journal. 

Boyd  and  Cochrane,  of  the  Kentucky  School  of  Medicine.  The 
Judge  has  decided  that  the  election  of  the  latter  named  geutlemen, 
Dra.  Wartben,  Boyd  and  Cochrane,  to  the  positions  claimed  by  tbem, 
was  valid  and  therefore  he  dismissed  the  injuDction.  It  is  said 
that  the  case  will  be  carried  to  the  Court  of  Appeals. 


SOTICE.—TM9  JOVBNAL  and  3HB  INTESNATIONAL 
JOUBIfAL  OF  SUBOBBT  one  year  for  $2.00  caeh. 


The   odor   of  onions   may   be  removed  by    eating  a  sprig  of 
parsley. 


A  SPRAINED  ankle  kept  in  hot  water  for  twenty-fonr  hours  will 
heal. 


A  LEADING  physician   says  that  pepper  is  deadly  poison  to  the 
system. 


PowDEBED  chalk  and  orris  root  is  one  of  the  best  deotiinces 
known. 


As  MANY  as  4,061  muscles  have  been  counted  in  the  body  of  a 
moth. 


A   STRONG  solution  of  borax,  applied  twice  a  day,  will   cure 
ringworms. 


An  authority  says  that  the  growth  of  children  takes  place  en- 
tirely when  they  are  asleep. 


It  is  a  strange  fact  that  injuries  to  the  tongue,  whether  of  man 
or  animal,  heal  more  quickly  than  those  of  any  other  part  of  the 
system. 


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Nbws  and  Notes.  760 

Glycerine  aud  lime  juice  is  very  good  for  preveating  dandrnff, 
«nd  16  DourishiDg  to  the  hair. 


A  DBOP  of  oil  of  cloTCB  on  a  piece  of  cotton  applied  to  the 
4ootb  twice  a  day  will  care  tootbache. 


A  IJTTLE  spirits  of  camphor  pat  ia  the   water  will  prevent  the 
-faoe  from  looking  greasy  in  hot  weather. 


More  cases  of  consumption  appear  among  needle-makers  and 
file-makers  than  among  any  other  class  of  laborers. 


lTOTICE.~This  JOUBJTAL  and  THE  INTESNATIOITAL 
■JOVENAL  OF  8UEOBBT  one  year  for  $2.00  cash. 


The  Government  has  commemorated  the  sacrifice  of  the  first 
American  soldier  on  Cuban  soil,  by  naming  the  general  hospital 
attached  to  Camp  Hamilton  at  Lexington,  Ky,,  the  John  Blair 
-Gibbe  Hospital. 


The  trustees  of  Columbia  University  have  established  in  the 
College  of  Physicians  and  Surgeons  a  scholarship  to  be  known  as 
the  O'Dwyer  Scholarship,  in  recognition  of  Dr.  Joseph  O'Dwyet's 
professional  labors. 


Professor  R.  H.  Chittenden  has  been  appointed  to  succeed 
Professor  Geo.  J.  Brush,  who  has  recently  resigned  his  position  as 
-director  of  the  Sheffield  Scientific  School,  aud  accepted  an  appoint- 
ment as  Professor  Emeritus. 


The  Sternberg  Hospital  at  Camp  Thomas,  Chiokamauga  Park, 
vas  closed  November  14th.     The  twenty-eight   patients   in   the 


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760       The  Atlanta  Mbdical  and  Surgical  Journal. 

hospital  were  sent  to  Fort  Thomas,  Ky.,  and  the  medical  corps 
transferred  to  the  hospital  at  Savannah. 


Ft.  Monroe  will  soon  he  ooe  of  the  most  important  militaiy 
hospital  stations  in  the  country.  The  hoapital  is  named  tbe- 
Josiah  Simpson  Hospital,  and  has' during  the  past  four  months- 
accommodated  1,S00  sick  and  wounded  soldiers,  of  whom  about 
600  still  remain.  It  is  now  proposed  to  increase  the  capacity  of 
the  hospital  to  2,500  beds  by  the  erection  of  five  additional 
buildings. 


Db.  MIaby  H.  Murray  has  been  appointed  by  the  New  York 
Board  of  Health  medical  inspector  of  the  twelve  public  schools  ia 
the  third  ward  of  the  borough  of  Queens,  New  York  City.  Dr. 
Murray  is  a  graduate  of  the  Woman's  Medical  College  of  the  city 
of  New  York,  and  served  as  interne  in  the  hospital  and  dispensary 
for  one  year.  She  is  the  first  woman  honored  with  an  appointment 
on  the  staff  of  school  inspectors. 


President  Low  of  the  Columbia  University  has  issued  an 
order  approved  in  &  meeting  of  the  faculty  of  the  College  ot 
Physicians  and  Surgeons,  prohibiting  smoking  or  spitting  about 
the  corridors  or  in  the  rooms  of  the  buildings,  except  in  the- 
retiring-room  and  a  designated  part  of  the  disseoting-room.  The 
majority  of  men  who  smoke  expectorate,  and  as  this  is  now 
regarded  not  only  as  a  filthy  habit  but  as  ooe  which  encourages- 
the  spread  of  disease,  the  new  order  will  donbtlese  work  a  ftvor- 
able  reform  in  the  h&bits  of  the  medical  students. 


The  president  of  the  board  of  manners  of  Craig  Colony  offers- 
a  prise'  of  $100  for  the  best  contrtbution  to  the  pathology  and 
treatment  of  epilepsy,  originality  being  the  main  oondition.     The 

DiclzedbyGoOgle 


News  and  Notes.  761 

prize  is  opeo  to  uDiversal  competitiou,  but  all  maDuscripta  miiBt 
be  submitted  in  Eoglisb.  AH  papers  will  be  passed  upoo  by  a  com- 
mittee to  consist  of  three  members  of  the  New  York  Neurological 
Society,  and  tbe  award  will  be  made  at  the  auDual  meeting  of  the 
board  of  maaagers  of  Craig  Colony,  October  10,  1899.  Manu- 
scripts should  be  sent  to  Dr.  Frederick  Peterson,  4  West  Fiftietb 
street.  New  York  City,  on  or  before  September  1,  1899. 


The  announcement  of  the  birth  of  a  son  to  the  Duchess  of 
Aosta  is  declared  to'be  another  triumph  for  Dr.  Schenck,  tbe  embry- 
ologist,  who  recently  announced  hisdiscovery  of  the  secret  of  sex,  or 
the  principles  which  regulate  the  production  of  male  children.  The 
Duchess  of  Aosta  is  said  to  have  been  a  patient  of  Dr.  Schenck^ 
and  to  his  careful  treatment  is  due  the  birth  of  an  heir  to  tbe  ItaliaD 
throne.  Tbe  Duchess  of  Aosta  is  the  third  woman  of  high  rank 
to  demonstrate  the  efficacy  of  Dr.  Schenck's  treatment.  The  first 
was  tbe  Archduchess  Frederick  of  Austria,  and  the  second  the 
Countess  of  Warwick.  It  is  stated  that  Dr.  Scbeock  has  been  in 
attendance  upon  a  number  of  royal  women  who  desire  to  bear  sons- 
for  the  inheritance  of  great  titles. 


General  Wood  is  indefatigable,  in  sun  and  rain  alike.  The 
result  of  his  labors  is  apparent  in  every  branch  of  the  service — 
civil  and  military.  Tbe  patients  are  reaping  tbe  result  in  better 
attendance  and  improved  food  and  cooking.  People  who  have 
lived  here  a  lifetime  are  unable  to  understand  the  extraordinarily 
low  death-rate,  averaging  for  October,  up  to  date,  ten  a  day.  During 
tbe  same  period  of  last  year  tbe  deaths  aver^^d  183  a  day.  The- 
300  prisoners  in  Santiago  prison  will  in  future  be  made  to  work  on 
building  roads  for  the  city.  The  rock  will  be  faauled  over  the- 
railroad  from  the  Songo  quarries.  It  will  be  delivered  at  the  rate 
of  forty  cents  a  ton,  and  tbe  railroad  officials  have  offered  to  de- 


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762       Thb  Atlanta  Medical  and  Surgical  Journal. 

liver  500  toDS  of  rock  free  as  their  sbare  of  the  work  of  improviDg 
the  city.— Aew  York  WorU. 


Since  1872  the  Mt.  Sinai  Hospital,  New  York,  has  occupied  its 
preseot  qaartersat  Sixty-sixth  street  and  Lezingtoo  aveoue.  For 
more  than  ten  years  the  present  structure  has  proven  ioadeqaate  to 
tlie  demands  made  upon  it,  and  a  year  ago  the  directors  of  the  hos- 
pital decided  to  huild  a  nt^w  aod  more  modem  structure.  A  site 
was  purchased  on  Fifth  avenue,.embracing  the  entire  square  bounded 
1>y  One  Hundredth,  One  Hundred  and  First  streets,  Madison  and 
Fifth  avenues,  with  the  exception  of  three  city  lots.  Voluntary 
subscriptioDS  are  sought  to  defray  the  cost  of  the  buildings,  about 
-$350,000  having  been  collected  up  to  this  time,  we  are  informed. 
It  is  proposed  to  spend  twice  this  sum  for  the  building,  which  is  to 
he  equipped  as  a  modern  scientific  hospital  in  tbe  fullest  sense  of  the 
term.  Ground  will  shortly  be  broken,  and  it  is  expected  that  the 
new  hospital  will  be  occupied  by  1900. 


Cramer  {CeniraXb.  fur  Gyn&kol.,  October  1,  1898)  reports  a 
-case  of  fatal  poisoning  from  tbe  use  of  three  pints  of  one  per  oenL 
solution  of  lysol  as  a  uterine  douche.  Several  cases  of  death 
following  the  injection  of  pure  lysol  have  been  reported,  while  in 
three  instances  its  application  upon  skin  wounds  has  resulted 
fatally,  but  so  far  as  known  this  is  the  first  fatal  case  from  the  use 
-of  a  diluted  solution  of  lysol.  The  uterine  injection  was  made 
immediately  after  the  birth  of  tbe  placenta  but  was  suddenly 
interrupted  by  the  oullapae  of  the  patient.  She  recovered  from 
tbe  collapse,  however,  only  to  die  ten  days  later  with  symptoms 
similar  to  those  of  oarbolic-acid  poisoning.  Cramer  reckoned 
that  a  quantity  of  lysol  equal  to  seven  minims  of  the  drug  may 
bave  found  entrance  to  the  venous  circulation.  The  value  ot 
uterine  injections  depends  not  so  much  upon  the  disinfecting  power 


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News  and  Notes.  76S 

^f  the  fluid  osed  as  it  does  upon  the  meobanical  cleansing.  Hence, 
the  imporlance  of  having  the  antiseptic  fluid  as  weak  as  possible 
in  case  irrigation  is  employed  after  childbirth.  Indeed,  for  this 
purpose,  many  prefer  normal  salt  solution  to  any  disinfectant. 


The  lessons  of  nome  of  onr  recent  wars  ought  to  be  instructive 
to  those  who  have  the  respooshility  of  placing  a  number  of  armed 
citizens  in  the  field.  Hitherto  the  lessons  of  war  have  been  dis-  . 
regarded,  though  the  teachings  have  been  most  emphatic.  Disease 
kills  more  than  the  sword.  This  appears  to  be  the  inevitable  course 
of  wars.  It  was  written  in  large  letters  in  the  Franco- Prussian 
var,  and  more  fearfully  still  in  the  Crimean  war.  Since  then  in 
the  Spanish-American  war  the  ravages  of  yellow  fever  have  been 
appalling,  and  now  we  learn  that  a  telegram  from  Alexandria  states 
that  the  men  who  have  returned  from  the  Kile  continue  to  die  like 
■flies,  from  enteno  fever,  contracted  possibly  through  the  use  of 
tinned  beef,  and  certainly  aggravated  by  immoderate  indulgence  in 
■cheap,  nasty  spirits  at  fifteen-peace  a  bottle,  the  men  having  ac- 
cumulated money  in  their  pockets.  The  return  states  that  every 
hed  in  the  great  hospital  at  Raseltin  is  occupied,  besides  which  dozens 
of  deaths  occur  weekly,  and  it  is  believed  that  ten  per  hundred  of 
ihe  British  troops  on  the  Nile  are  already  affected.  The  disease  is, 
moreover,  following  the  troops  into  Crete.  When  tinned  beef  is 
freeb  it  is  all  right,  but  big  tius  rapidly  spoil  before  the  contents 
are  consumed.  The  mortality  during  the  whole  campaign  is  proti- 
ably  less  than  the  subsequent  deaths  from  enteric  fever. —  Tke 
Scalpel. 


OsE  of  the  gunners  of  Admiral  Schley's  fleet  is  said  to  have 
lost  his  reason  as  a  result  of  the  naval  battle  of  July  3,  with 
Cervera's  squadron.  He  is  now  in  St.  Elizabeth's  Insane  Asylum, 
Washington,  D.  C,  undergoing  treatment.     The  patient's  trouble 


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7Si       The  Atlanta  Medical  and  Surgical  Journal. 


began  with  conoussioD  of  the  brain,  caused  by  the  detonatioD  of 
the  heavy  guns  fired  during  the  fight.  This  is  regarded  aa  an 
unusual  case.  The  report  set  forth  that  eight  of  the  ten  casualties- 
upon  tbe  American  ships  in  the  battle  of  Santiago  were  ruptures 
of  the  ear  drums,  caused  by  the  terrific  cannonading.  One  of 
the  cases  was  tbat  of  Lieutenant  Harrison  of  the  Oregon,  who 
stuck  his  head  out  of  a  turret  just  as  a  thirt«en-inch  rifie  was 
fired.  The  noise  and  shock  of  the  explosion  lacerated  the  drum 
of  both  ears,  and  for  a  time  he  was  totally  deaf.  Under  the  care-, 
ful  treatment  of  the  naval  surgeons  he  is  gradually  recovering  hi» 
hearing  and  will  in  all  probability  be  as  well  as  ever  in  a  few 
more  months.  All  the  other  men  who  were  similarly  afi'ected 
have  been  cured  and  have  returned  to  their  ships  for  duty. 
During  the  fight  at  Mauila  there  is  no  record  of  any  of  Admiral 
Dewey's  men  receiving  injuries  of  this  sort.  The  explanation  of 
this  is  simple.  The  gunners  on  battleships  are  accustomed  to 
plug  their  eara  with  cotton  to  protect  them  before  firing  begius^ 
but  at  Santiago  there  was  no  chance  for  precautions  of  this  kind. 
The  men  were  on  deck  for  inspection  at  the  time  the  enemy  was 
discovere<l  issuing  from  the  harbor,  and  they  simply  rushed  to- 
their  guns  and  began  blazing  away  without  thought  of  cotton  or 
anything  else.  At  Manila  the  men  were  all  prepared  for  the 
fight,  every  precaution  having  been  taken  to  prevent  injury  to  ear 
drums,  etc. 


The  Southern  Medical  College  Association  met  at  Memphis, 
Tenn.,  December  5,  prior  to  the  meeting  of  the  Southern  Surgical 
and  Gynecological  Association,  and  after  considerable  discussion, 
it  was  decided  to  increase  the  course  of  study  from  thr«e  to  four 
years.  It  is  well  known  that  the  question  of  making  the  course 
four  years  instead  of  three  has  been  before  the  association  for  two 
years,  but  it  has  been  passed  from  time  to  time,  in  order  tbat  to- 


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News  and  Notes.  765 

radical  a  move  migbt;  be  fully  di»cu88ed  by  all  the  Acuities  that 
are  to  be  affect«d.  Dr.  Sinclair  of  Memphis  present^  the  matter 
first  at  the  meeting  of  the  association  in  Atlanta,  and  since  then 
from  time  to  time  it  has  been  discussed  jrequently  among  each  of 
the  faculties  in  the  association.  At  the  meeting,  only  two  of  the 
thirteen  colleges  in  the  association  iailed  to  send  representatives 
to  the  conference.  On  account  of  the  change  to  the  four-year 
course,  it  was  necessary  to  introduce  a  number  of  amendments  to 
the  constitution  and  by-laws  of  the  association,  but  none  of  them 
was  passed,  because  it  is  the  rule  that  such  amendments  shall  lie 
over  for  one  year.  This  is  for  the  purpose  of  giving  the  delegates 
an  opportunity  to  present  plans  for  whatever  changes  are  contem- 
plated in  their  respective  fsculUes  before  final  action  is  taken. 
The  delegates  present  were :  Drs.  S.  S.  Crockett,  of  the  Univer- 
sity of  Nashville ;  W-  E.  B.  Davis,  of  the  Birmingham  Medical 
College;  Christopher  Thompkins,  of  the  Virginia  Medical  Col- 
lege at  Ricbuiond ;  Ernest  B.  Lewis,  of  Tulane  University,  New 
Orleans ;  O.  C.  Savage,  and  Richard  Douglas,  of  the  Medical 
Department  of  Vanderbilt  University  of  Nashville;  T,  H.  Wood, 
of  the  University  of  Tennessee,  at  Nashville;  Campbell  of  the 
Tennessee  Medical  College,  at  Knoxville;  G,  A.  Ketohum,  of  the 
Alabama  Medical  College  of  Mobile,  and  A.  G.  Sinclair,  of  the 
Memphis  Medical  College.  The  University  of  the  South  was  to 
have  been  represented  by  Dr.  J.  S.  Cain  of  Nashville,  but  he  sent 
■a  proxy  in  the  person  of  Dr.  Savage,  The  only  two  colleges  in 
the  association  not  represented  were  the  Te^ias  Medical  College  of 
Oalveston  and  the  Southern  Medical  College  of  Atlanta.  The 
other  absentee  from  the  list  of  thirteen  was  the  Bessemer  Medical 
College  of  Bessemer,  Ala.,  and  it  is  no  longer  in  existence. — 
Journal  of  A.  M.  A. 


^dbyGoogle 


BOOK  /REVIEWS,    PAMPHLETS,   EXCHANGES. 


BOOK  REVIEWS, 

[OootributlDU*  KiUolMd  tor  rarlew.] 


Human  Anatomy.  A  Complete  Systematic  Treatise.  B;  va- 
rious authors.  IncludiDg  a  special  seetion  od  Surgical  aud 
Topographi<-al  Anatomy.  £dited  by  Henry  Morris,  M.A.  aud 
M  .B.,  Iiondon,  Senior  Surgeon  to  Middlesex  Hospital ;  Examiner 
in  Surgery  in  theUniversity  of  London;  Member  of  the  Council, 
and  Chairman  of  the  Court  of  Examiuers  of  the  Koyal  College 
oi  Sui^eoDs  of  England ;  Honorary  Member  of  the  Medical 
Society  of  theCounty  of  New  York.  Illustrated  byseven  hun- 
dred and  ninety  wood-cuts,  the  greater  part  of  which  are  original 
and  made  expressly  for  this  work  by  a  special  artist.  Over  200 
printed  in  colors.  Second  edition,  revised  and  enlarged.  P. 
Blakistou's  Son  &  Co.,  1012  Walnut  Street,  Philadelphia,  1898. 
Price,  16.00. 

We  are  glad  to  see  that  this  book  is  gradually  gaining  favor  in 
this  country,  for  the  texts  are  concise  and  plain. 

This  edition  has  been  completely  revised,  and  many  new  cuts 
added.  Many  of  these  are  photographed  from  ori^nal  dissections 
in  the  museum  of  the  Royal  Ctfllege  of  Surgeons,  the  Hunterian 
Museum  and  the  museum  of  St.  Bartholomew's  Hospital.  These 
cuts  have  theadvantage  over  those  made  diagrammatical ly,  in  that 
the  student  can  get  a  better  Idea  of  the  relation  of  the  different 
structures.  A  special  feature,  too,  is  the  mode  of  coloriug  (he 
cuts,  the  origin  of  muscles  being  marked  in  red  lines,  insertion 
in  blue  and  ligaments  in  dotted  black  lines.  The  description  of 
these  cuts  printed  at  the  end  of  the  pointers  is  in  different  types 
for  the  different  structures,  so  one  can  see  what  one  wants  at  a 
glance. 

_  A  short  space  is  also  devoted  to  the  development  of  bones ;  the 
epiphyseal  lines  of  the  long  bones  are  shown  in  wood-cuts,  made 
specially  for  this  book. 

The  articles   on  each  section  of  the  body  have  been  written  by 


^dbyGoOgle 


Book  Reviews.  767* 

men  emiDeDtly  fitted  for  the  work  asBigned  them.  While  each  19- 
personally  respoosible  for  the  part  assigned  him,  the  articles  have 
been  read  by  ooe  or  two  of  the  other  authors,  so  that  it  may  be 
ooDsidered  that  each  article  has  received  their  approval. 

J.  J.,  c. 


Practical  Ubinalysis  and  Ubiitary  Diaonobis:  A  Manual 
for  the  Use  of  Physicians,  Surgeons,  and  Students.  By  Charles- 
W.  Piirdy,  M.D.,  LL.D.  (Queen's  University);  Fellow  of  the 
Royal  College  of  Physicians  and  Surgeons,  Kingston;  Professor 
of  Clinical  Medicine  at  the  Chicago  Pout-Graduate  Medical 
School.  Author  of  "Bright's  Disease  and  Allied  Affections  of 
the  Kidneys";  also  of  "  Diabetes:  Its  Causes,  Symptoms,  and 
Treatment."  Fourth  revised  edition.  With  numerous  illus- 
trations, including  Photo-engraving  and  Colored  Plates.  In 
One  CTOwn  octavo  volume,  365  pages,  bound  in  extra  cloth,. 
t2.50  net.  The  F.  A.  Davis  Co.,  Publishers,  1914-16  Cherry 
St.,  Philadelphia;  117  W.  Forty-second  St.,  New  York  City; 
9  Lak^ide  Building,  218-220  S.  Clark  St.,  Chicago,  III. 

This  excellent  work  has  now  reached  its  fourth  edition.  As  a 
practical  work  on  Urinalysis  and  Urinary  Diagnosis,  it  is  probably 
one  of  the  best  in  the  English  language.  It  is  thoroughly  up  to 
date,  and  each  portion  of  the  work  is  exceedingly  clear  and  con- 
cise. The  author  has  divided  the  book  into  two  parts.  Part  I. 
Analysis  of  Urine.  In  this  is  treated  General  Consideration  as  to 
Color,  etc.,  of  Urine;  Composition  of  Normal  Urine;  Proteids; 
Carbohydrates ;  Abnormal  Urine ;  Urinary  Sediments ;  Anatom- 
ical Sediments ;  Gravel  and  Calculus.  Part  II.  Urinary  Diag- 
nosis, Treating  of  Diseases  of  the  Urinary  Organs  and  Urinary 
Disorders;  Urine  in  other  Diseases;  Examination  of  Urine  for 
Life  Insurance.     It  is  a  most  excellent  work. 


A  Text-Book  of  Pathology.  By  Alfred  Stengel,  M.D.,  In- 
structor in  Clinical  Medicine  in  the  University  of  Pennsylvania^ 
etc.  Published  by  W.  B.  Saunders,  Philadelphia.  Price,  Cloth, 
14.00;  Half  Morocco,  16.00. 

Dr.  Stengel   has  given  us  a  most  excellent  work  on  Pathology,, 
and  as  a  text-book  on  this  subject  it  must  commend  itself  to  all 


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768       The  Atlanta  Medical  and  Surgical  Journal. 

teacbem.  The  work  is  from  the  pen  of  a  practical  clinical  teacher, 
and  aa  9uch  shows  these  landmarks  throughout  its  pages.  The 
author  goes  well  into  the  minute  microscopical  details  of  various 
pathological  conditions,  and  yet,  he  gives  just  what  is  needed,  and 
nowhere  is  there  a  mark  of  verbosity.  In  his  preface  the  author 
states,  "except  id  a  few  instances,  discussion  of  methods  of  ex- 
amination has  been  omitted,  because  it  seemed  unwise  to  increase 
.the  size  of  the  book  with  matter  that  is  appropriately  presented  in 
epecial  works  on  technique.  For  similar  reasons  the  author  has 
decided  to  exclude  pathology  of  the  skin  and  the  oi^ns  of  special 
sense."  The  author  was,  no  doubt,  wise  in  this  arrangement,  for 
as  it  is  the  book  is  sufBciently  lai^,  just  as  it  is.  The  work  is 
divided  into  Part  I.,  General  Pathology,  and  Part  II.,  Special 
Pathology.  The  illustrations  are  good,  and  the  cuts  beautifully 
executed.  Id  fact,  these  latter  make  the  most  attractive  features 
of  the  book,  which  is,  indeed,  an  important  item. 


Kino's  American  Dispensatory.  New  edition.  Entirely  re> 
written  and  enlai^ed.  By  Harvey  W,  Felter,  M.D.,  Adjunct 
Professor  of  Chemistry  in  the  Eclectic  Medical  Institute,  Cin- 
cinnati, O. ;  Co-editor  Locke's  Materia  Medica  aud  Therapeu- 
tics ;  President  Ohio  State  Eclectic  Medical  Association,  etc; 
and  John  Uri  Lloyd,  Pb.M.,  Professor  of  Chemistry  and 
Pharmacy  in  the  Eclectic  Medical  Institute,  Cincinnati,  O.; 
formerly  Professor  of  Pharmacy  in  the  Cincinnati  College  of 
Pharmacy;  Ex-President  of  the  American  Pharmaceutical 
Association;  Author  of  the  Chemistry  of  Medicines;  Drugs  and 
Medicines  of  North  America;  Etidorhpa;  etc.  Two  vol- 
ume edition,  royal  octavo,  each  volume  containing  over  950  pp. 
with  complete  indexes.  Cloth,  '|4.50  per  volume  post-paid. 
Sheep,  $5.00  per  volume  post-paid.  Volume  I.  now  ready. 
The  Ohio  Valley  Co.,  Publishers,  Cincinnati,  O. 

The  first  volume  of  King's  Dispensatory  has  been  received. 
This  volume  is  exceedingly  well  gotten  up  and  well  arranged. 
The  various  subjects  contained  in  a  dispensatory  are  clearly  and 
accurately  described,  and  it  is  a  work  which  will  prove  of  great 
value  in  the  Pbarmaoeutioal  Laboratory.  We  oongratnlate  the 
authors. 


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Book  Revibw8.  769 

The  Cahe  op  the  Baby.     By  I.  D.  Crozier  Griffeth,  M.D. 

This  book  13  a  desideratum  loog  needed.  Maoy  books  have  been 
written  purporting  to  give  the  information  this  does,  but  as  a  rule 
by  men  uniit  either  by  experience,  medical  knowledge  or  scientific 
attainment  to  do  justice  to  the  subject,  and  its  precepts  often 
doing  harm  instead  of  good. 

The  author  of  this  book  is  fully  competent  for  the  task,  and 
has  given  one  that,  from  its  simplicity  of  language  and  waut  of 
technical  phraseology,  cannot  only  be  understood  and  appreciated 
by  every  intelligent  mother  and  nurse,  but  gives  iacts  and  lessons 
well  worthy  the  study  of  physicians— old,  middle-aged  and  young. 

It  should  be  a  t«xt-book  in  every  medical  college  where  the  lile 
and  health  of  children  are  considered,  and  that  should  be  done  in 
every  college. 

He  takes  the  baby  in  utero  and  carries  it  through  all  of  its 
periods  of  exisience  until  it  is  able  to  take  care  of  itself. 

Every  young  woman  expecting  to  become  a  mother  should  read 
it  carefully.  She  will  find  in  its  pages  much  valuable  information 
she  never  dreamed  of,  observance  of  which  will  calm  much  of  the 
anxiety  and  dread  of  which  she  is  possessed  and  teach  her  how  to- 
conduct  herself  so  as  to  avoid  unnecessary  pain  and  danger,  To- 
the  monthly  nurse  the  book  is  invaluable.  It  gives  rules  for  the 
management  of  the  mother  during  confinement  and  until  she  is 
safely  through  this  ordeal,  besides  full  and  explicit  directions 
for  the  care  of  the  child  in  all  of  its  details  until  able  to  care  for 
itself.  He  gives  much  attention  to  the  care  of  the  sick  baby  and 
lays  down  many  simple  but  excellent  rules  for  its  management, 
both  as  preventive  and  curative  suggestions  and  aids. 

I  very  cordially  recommend  "The  Care  of  the  Baby"  to 
mothers,  nurses  and  physicians. 

It  is  published  and  for  sale  by  W.  B.  Saanders,  925  Walnut  St.^ 
Philadelphia.  a.  o.  b. 


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770       The  Atlanta  Mbdical  and  Spbqioal  Jouekal. 

HisTOLOQY,  NoBUAL  AND  MoBBiD.  By  EtlwRTd  K.  DuDham, 
M,D.,  Profesaor  of  General  Pathology,  Bacteriology,  and 
Hygiene,  in  the  University  and  Bellevue  Hospital  Medical 
College,  New  York.  Id  one  very  handsome  octavo  volume  of 
448  pages,  with  S63  illustratione.  Cloth,  $3.26,  net.  Lea 
Brothers  &  Co.,  Publishers,  Philadelphia  and  New  York. 

As  is  stated  in  the  preface  to  this  book,  the  author  intends  it 
more  as  an  elementary  work  than  an  exhaustive  treatise  on  the 
subject  of  normal  and  morbid  histology.  As  such  the  author  has 
succeeded  most  admirably,  and  the  student  will  find  it  a  most 
excellent  ready  reference  book  for  the  library.  The  illustrations 
are  all  that  could  be  desired,  and  they  are  taken  from  other 
standard  works  or  monographs,  thus  greatly  enhancing  the  value 
of  the  book.  The  reproduction  of  these  different  cuts  has  been 
most  beautifully  executed,  and  we  must  admire  the  excellency  of 
the  same.  Professor  Dunham  Js  to  be  congratulated  upon  the 
production  of  this  book. 


Hygiene  op  the  Voice.     By  Thos.  F.  Bumbold,  M.D.,  of  St. 
Louis,  Mo.     Published  by  Witt  Publishing  Co.,  St.  Louis. 

This  is  8  most  excellent  little  hook,  neatly  gotten  up  by  a  man 
well  known  as  a  laryngologist.  It  is  clear  and  practical.  While 
not  written  especially  for  medical  men,  it  nevertheless  oontaius  a 
great  deal  of  useful  infornation  to  such.  The  author  says  in  his 
preface  as  to  the  contents  of  the  book :  "  No  medical  treatment 
is  recommended,  except  a  few  simple  remedies  for  temporary 
relief,  and  those  only  of  such  a  character  as  would  not,  under  any 
circumstance,  be  harmful,  however  taken."  He  says  further, 
which  is  every  bit  true :  "  My  long  experience  teaches  me  that 
none  but  medical  men  should  attempt  the  treatment  of  voioe- 
u^rs."  This  little  brochure  will  prove  of  special  value  to  public 
singers  and  speakers. 


^dbyGoOgle 


Book  Reviews. 


REPRINTS  RBCBIVED, 


Farther  Observations  Regardiog  the  Use  of  the  BoDe-olsmp  in 
Unaoited  Fractures,  Fraoturea  with  Malunion,  and  Recent  Frac- 
tures with  a  Tendency  to  Displacement.  By  Clayton  Parkhill, 
M.D.,  Denver,  Col. 

Eeflei  or  Nervous  Cough,  Due  to  ElongatioD  of  Uvula,  Follic- 
ular Pharyngitis,  Hypertrophy  of  Pharyngeal  Tonsils,  etc.,  with 
Cases.     By  Joseph  A.  MuUan,  Houston,  Tex. 

Successful  Treatment  of  Diphtheria  as  Compared  with  Anti- 
toxin.     By  Jno.  H.  Coughlin,  M.D.,  N.  Y. 

The  Medico-Legal  Aspects  of  Hypnotism.  By  Sydney  Kuh, 
M.D.,  Chicago. 

Transillumination  of  the  Stomach  with  Demonstration  on  the 
Person. 

Gastroptosis. 

Chronic  Catarrh  of  the  Stomach, 

Intestinal  Anto-intozication.  By  Cbas.  D.  Aaron,  M.D., 
Detroit. 

A  Form  of  Primary  Nasal  Diphtheria. 

"  Grains  of  Fsperience  "  Gleaned  from  Eye  and  Ear  Practice. 
Hemorrhagic  Glaucoma — Beport  of  a  Case  with  Micro-Photo- 
graphs. 

A  Review  of  the  Pathological  Conditions  Affecting  the  Lingual 
Tonsil. 

Some  Severe  Cases  of  Tobacco  and  Quinine  Amblyopia. 

Rodent  Ulcer  of  the  Lids  Occurring  in  a  Patient  Twenty-three 
years  of  Age. 

An  Auxiliaty  Skirascope.  By  E.  C.  Ellett,  M.D.,  Memphis, 
Tenn. 

Natural  Immunity  of  the  Mucous  Membranes  of  the  Respi- 
ratory Tract- 
Early  Diagnosis  of  Whooping-Cough.  By  H.  L.  Wagner,  M.D., 
Ph.D.,  San  Francisco. 


^dbyGoOgle 


SELECTIONS  AND  ABSTRACTS* 


Bill  Nye  akd  the  Nurses. 

I  have  just  been  sent  to  the  hospital  for  twenty  days. 

My  pbysiciaD  did  it. 

He  did  it  with  an  analysis. 

Anybody  who  amounts  to  anythinf;  nowadays  gets  analyzed. 

Sometimes  you  find  casts,  sometimes  yuu  find  maple  sugar,  and 
sometimes  you  find  acids,  oxides,  paint,  oils,  varnish,  white  lead, 
borax,  albumeo,  lime,  hair  and  cement.  In  these  cases  the  patient 
should  be  placed  under  a  strict  diet,  or  be  will,  in  the  course  of  his 
life,  become  a  corpse. 

I  go  into  details  about  this,  because  a  false  impression  got  out  a 
few  weeks  ago  to  the  effect  that  I  came  here  for  another  purpose. 
A  reporter  came  to  see  me  and  I  sent  word  to  him  that  I  was  then 
out  on  the  operating-table  in  such  a  position  that  I  could  see  no 
one,  while  an  elderly  surgeon  was  engaged  in  removing  a  porous 
plaster  received  during  the  war. 

I  was  not  serious  in  saying  this,  but  unfortunately  I  have  the 
reputation  for  absolute  veracity  and  seriousness,  so  that  the  state- 
ment got  into  the  papers  as  bonafide,  and  caused  American  securi- 
ties to  go  down  two  points  in  one  day. 

I  like  it  very  much  here. 

Saturday. — Another  little  cripple  boy  named  Charlie  comes  af- 
ternoons to  play  with  me.  We  have  a  set  of  building  blocks  and 
can  make  most  anything. 

Yesterday  the  Chicago  Ladies'  Society  for  the  Prevention  of 
Good  came  to  see  us  and  gave  me  a  kiss  and  a  red  apple. 

The  lady  who  kissed  me  was  the  vice-president  of  the  society, 
and  hurt  me  when  she  strained  me  against  her  breast-pin.  I  hate 
a  woman  who  cannot  control  herself  that  way. 

I  went  and  took  a  dose  of  medicine  to  take  the  taste  out  of  my 
mouth. 


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Selections  and  Absthaots.  773 

To-morrow  we  bave  an  operatioD  here  in  m^  ward.  A  large 
lady  from  La  Salle  will  be  removed  from  a  Hungarian  tumor. 

The  medical  students  will  be  here  and  see  the  operation.  The 
best  student  for  1894,  wbo  has  been  neither  abnent  nor  tardy,  will 
get  the  tumor. 

I  have  to  diet  very  closely,  or  I  may  gradually  have  a  diabetic 
tendency.     I  get  a  slice  of  toast  every  day  and  a  thermometer. 

The  rules  are  very  strict.  Patients  are  requested  not  to  die  in 
the  bouse. 

Some  of  the  nurse-girls  are  perfectly  lovely.  They  are  very 
pretty  and  kind-hearted.  I  like  to  have  one  of  them  hold  me  up 
in  my  little  cot  while  I  am  drinking  my  koumiss  at  night 

Sunday,  3  p.  m. — An  analysis  to-day  shows  more  casts,  fibrin, 
gelatin,  and  some  zinc  and  copper.  The  chemist  also  discovers 
that  in  1853  I  fell  from  an  apple  tree  and  tore  my  panties  in  two 
places.  He  also  says  that  I  will  be  unhappy  with  my  third  wife. 
She  will  be  unhappy  also. 

Last  evening  we  had  a  concert  and  operation  at  the  hospital- 
Yesterday  afternoon  the  North  Side  Ladies'  Society  for  the  Pre- 
vention of  Good  paid  us  a  visit.  I  crawled  under  the  covers  and 
remained  in  a  rigid  attitude,  giving  them  a  sort  of  stiff,  as  a  par- 
tially idiotic  friend  of  mine  said  afterward. 

The  general  secretary  spoke  as  she  passed  by  something  about 
"  kissing  him  for  his  mother,"  but  as  she  started  to  rai&e  the  sheet 
from  my  face  I  bit  her  a  little  in  sportive  mood,  and  she  gave  a 
shrill  and  echoing  scream.  I  do  not  mind  being  an  invalid,  but 
charitable  societies  must  not  press  me  to  their  bosom.     It  hurts. 

Monday,  4.  p.  m. — Temperature  two-fifths  of  one  degree  above 
normal.  Pnlse  regular,  but  sluggish.  Have  got  all  my  business 
arranged,  even  to  terms  for  shipment  home.  Ate  scraped  raw 
beef  for  breakfast,  using  rear  quarter  of  Colorado  steer,  with  pep- 
per and  salt  on  same.  Acute  gastritis  seems  to  be  one  ot  the  fea- 
tures of  disease.  I  have  to  eat  simple  things  like  raw  bullocks 
and  keg  oysters. 

Another  chemical  and  microscopic  analysis  was  made  yesterday 
of  sputum,  showing  traces  of  nicotine  and  other  poisons.  Adieu, 
kind  friends,  I'm  going  home.     A  sweet  young  novice,  wbo  is 


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774       The  Atlanta  Medical  and  Sorgical  Jodhnal. 

traioing  for  a  nnrse,  took  my  pulse  this  a.  h.  Took  quite  «  while 
to  find  it,  bat  I  did  not  murmur  or  repine.  I  am  trying  to  learn 
to  love  everybody,  for  to  that  bourae  to  which  my  obemist  eay* 
that  I  am  going,  I  should  carry  with  me  no  enmities,  no  bttteness. 
Ta,  ta,  vain  world,  begone — 

Ah,  here  comes  the  other  rear  breadth  of  the  bullook !  Pass  me 
the  salt,  please,  and  Bee  that  my  grave  ia  kept  occasionally  squirted 
on  during  the  dry  weather.  I  have  left  a  small  fund  for  the 
purpose. 

The  life  here  at  the  hospital  is  delightful,  and  while  I  am  fiiding 
away  it  is  a  joy  to  have  loving  hands  bathing  my  little  hot  footies 
and  maaicuring  my  knobby  brow. 

The  Stockyards'  Flower  Mission  paid  us  a  visit  this  A.  m.  and 
left  a  big,  wet  cauliflower  on  each  breast.  ; 

One  large  porterhouse  lady,  with  a  blue  badge  on  her  flank  laid 
a  bige^-plant  on  my  pillow,  and  when  I  sung  out  cheerily,  "Cut, 
cut,  cudat  cut!"  she  cursed  me  bitterly  and  called  me  a  great, 
coarse  thing. 

-She  was  right.  I  ought  not  to  frolic  on  the  crumbling  edge  of 
a  long,  dank  grave. 

Good-bye,  wicked  world.  After  December  you  will  have  to  pay 
your  own  taxes,  so  the  chemist  says,  for  traces  of  one  lung,  also 
floating  island  and  ice  oream  were  found  in  this  last  analysis.  Do 
not  mourn  for  me,  kind  friends,  and  choke  and  sob  and  make  your- 
selves sick.  It  will  be  vaio.  Just  live  as  I  have  done,  so  that 
you  may  come  where  I  am  at.  Live  upright  lives  and  run  the 
lawn  mower  about  every  ten  dayso'er  my  humble  grave  during  the 
summer.  That  is  all  you  can  do.  Weep  not.  lu  me  you  have 
lost  a  man  who  can  never  be  replaced,  but  never  mind — the  world 
will  have  to  drag  on  somehow.  I  couldn't  be  here  all  the  time. 
Anybody  with  a  particle  of  sense  must  have  seen  that  I  couldn't 
live  forever. 

While  penning  the  above  words  a  messenger  boy  has  come 
swiftly  in  with  a  note  from  the  chemist.     He  says  in  his  note  : 

"  We  regret  that  an  error  was  made  in  your  case  by  our  assist- 
ant, who,  in  the  rush  of  business  here  at  the  college,  has  got  your 


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Sblsctiohb  and  Abstbacts.  775 

•nalysia  somewhat  confused  with  that  of  the  justly  celebrated  race 
horee,  Nancy  Hanks.  We  anfortuaately  got  the  sputa  mixed. 
On  going  over  your  case  again,  we  find  that,  whereas  there  are 
sigDB  of  glauders  in  the  Hanks  analysis,  you  are,  as  a  matter  of 
foct,  almost  too  healthy.  You  have  phenomenal  health  and  eeem 
free  from  tendency  to  pleuro-pDeumoaia,'tbrush  and  epizootio,  while 
in  the  Hanks  case  there  are  tubercles  present  and  signs  of  bots. 

'*  Abstain  from  pie  in  large  quantities  and  avoid  night  air.  We 
hardly  kaow  what  to  suggest  for  you  to  use  in  place  of  the  night 
air,  after  dark,  but  you  must  not  use  night  air.  Wear  heavy  Nor- 
wegian woolen  socks  duriog  the  oold  weather  and  do  not  think  too 
much.  You  are  proae  to  overthink  yourself.  Go  carefully  in  this 
direction  and  you  will  live  to  be  a  burden  to  your  friends. 
Wishing  you  good  fortune  and  regretting  the  confusion  of  your 
case  with  that  of  Hanks,  we  beg  to  enclose  our  hill  and  to  wish 
you  well." 

So  to-day  I  leave  my  kiad  little  ourses  in  their  sweet  and  neat 
attire.  Qood-hye,  girls,  I'm  goiug  home  where  they  know  me. 
No  one  there  will  count  my  fevered  pulse  in  the  still  watches  of 
the  night.  No  one  there  will  put  a  nice  hot-water  bag,  (hat  feels 
like  a  Mexican  hairless  dog,  at  my  feet. 

I  wring  the  hand  of  the  superinteadent  with  reluotaut  haste,  and 
leave  the  hospital  with  regret  at  2  p.  m. 

Seriously,  what  a  blessing;it  is,  when  we  are  weary  of  work  and  the 
gastric  functions  go  on  a  sympathetic  strike  and  the  solar  plexus  goes 
away  and  sits  down  on  a  stone  pile  to  weep  over  the  situation  ;  when 
you  are  in  that  state  of  pneumogastric  flunk  where  even  you  have  to 
threaten  your  digester  with  arrest,  and  liver  sulks  in  a  corner,  and 
Old  Man  Gastric  buttons  up  the  coating  of  your  stomach  and 
looks  sour,  what  a  godsend  that  one  can  go  to  one  of  these  cosy  cor* 
ners,  out  of  the  current  of  whoop  and  hurrah,  and  eat  raw  steak 
and  be  sort  of  made  much  of. 


Nerve  Fatigue  op  School  Childeek. 
Dr.  R.  C  Soeidt,  of  the  Fraoklio  and  Marshall  College,  pre- 
sented a  voluminous  address  {Public  Health,  July)  on  the  hygiene 
of  school-atteodaooe,  before  the  flTth  annual  meeting  of  the  Asso- 


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776       The  Atlanta  Medical  and  Surgical  Jodrnal. 

ciated  Sanitary  Authoritiea  of  PeDDsylvania  (vide  Journal,  June 
18,  1898,  p.  1469),  id  which  he  urged  an  ampler  protection  of  the 
health  of  the  overworked  children  of  the  public  schools.  He 
ai^ues  against  the  afternoon  session  as  being  unnecessary  confine- 
ment, if  the  pupils  have  a  long  and  properly  arranged  morning 
session.     The  following  are  some  of  his  conclusions : 

1.  I  am  convinced  that  the  eslhesiometer  is  the  proper  instm- 
ment  for  the  measurement  of  &tigue. 

2.  My  tentative  experiments  with  American  boys  prove  a  supe- 
rior normal  strength  of  their  mental  vigor  under  favorable  condi- 
tions of  the  atmosphere. 

3.  Unfavorable  conditions  of  the  atmosphere  show  an  unusually 
large  percentage  of  abnormal  fatigue  of  the  nervous  system. 

4.  I  attribute  this  condition  to  the  utter  lack  of  systematic 
open-air  exercise. 

5.  I  advocate  such  exercises  for  children  as  a  prime  necessity, 
because  the  foundations  of  a  healthy  and  useful  life  are  laid  be- 
tween the  seventh  and  fifleenth  years,  hut  never  afterward. 

6.  Training  of  all  the  functions  of  the  physical  organism  ahoald 
precede  instruction,  because  it  will  develop  the  necessary  mental 
strength. 

7.  Children  should  be  classified  according  to  their  individual 
characteristics,  and  stress  should  he  laid  upon  the  development  of 
their  weakest  organs,  in  such  a  way,  however,  as  to  leave  plenty  of 
room  for  individualization. 

8.  Such  exercise  should  take  place  every  afternoon,  and  should 
be  continued  until  the  limit  of  normal  fatigue  is  reached. 

9.  The  exercises  should  be  grouped  iuto  muscular,  cutaneous 
and  respiratory. 

10.  All  these  exercises  should  be  essentially  exercises  of  the 
nervous  system,  to  lead  to  a  proper  development  of  character. 

The  writer  holds  that  it  is  not  learning,  primarily,  but  health  and 
character  should  be  the  watchword  of  our  schools  ;  first,  training, 
then  instruction,  the  sequence  of  a  rational  educational  policy. 
Pedagogics,  as  a  science,  should  therefore  no  longer  be  based  upon , 
philosophy,  but  upon  physiology  and  hygiene.  The  chief  ftctor 
in  every   school   board  should  be  the  well-trained  physician,  and 


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Sblbctionb  and  Abstbacts.  777 

thephyeiciaD  only.  His  iavestigatioDS  carried  od  for  a  number  of 
years,  have  led  him  to  tbe  firm  convictioD  that  the  AmericaD  boy  is 
the  superior  of  the  boy  of  any  other  natiouou  the  lace  of  the  globe ; 
he  is  worthy  of  special  coDsiderations  because  bis  training  will  io  the 
end  produce  the  superior  man,  for  only  during  the  years  of  boyhood, 
from  tbe  seventh  to  the  fourteenth,  fifteenth  and  sixteenth  year,  can 
training  be  made  successful;  it  neglected  then  it  will  forever  re- 
main neglected.  Considering  the  large  number  of  heterogeneous 
branches  now  taught  in  our  public  schools,  and,  at  the  same  time, 
the  intense  interest  in  all  sorts  of  ill-directed  physical  exercises 
manifested  by  both  girls  and  boys,  we  conclude  that  tbe  endurance 
for  every  specific  activity  can  be  but  small,  while  the  sum  total  of 
all  the  energies  consumed  is  rather  larger  than  in  former  ages; 
however,  the  mere  external  exhibition  of  ability  is,  in  the  case  of 
children,  not  by  any  means  the  absolute  criterion  for  tbe  sum  total 
of  living  forces  within  the  human  organism.  Let  us  abolish  after- 
noon instruction.  No  matter  bow  vigorous  the  nervous  system 
may  be,  the  brain  ought  not  to  be  taxed  while  in  the  process  of 
growth,  while  digestion  is  going  on.  Under  unCavorable  external 
conditions  abnormal  fatigue  will  prevail  throughout  the  whole  af- 
ternoon, and  in  tbe  course  of  time  tbe  brain  will  become  unfit  for 
mental  work.  Afternoon  instruction  is  therefore  absolutely  unhy- 
gienic Teachers  are  unanimous  in  pronouncing  afternoon  mental 
work  a  failure  in  the  majority  of  cases.  One  long  morning  ses- 
sion, with  a  number  of  recesses,  ought  to  suffice.  Let  that  in- 
struction be  rational,  let  it  be  largely  object  teaching ;  do  not  ov- 
erfeed children  with  grammar,  which  presupposes  mastery  of  speech 
and  the  power  of  developed  thought.  The  brain-cells  required  for 
such  work  are  as  yet  imperfectly  developed,  and  the  natural  result 
is  a  mechanical  memorizing  resembling  (he  training  of  a  parrot. 
How  different  the  effect  of  the  introduction  of  tbe  various  me- 
chanical arts.  They  appeal  at  once  to  the  various  organs  of 
sense,  and  through  tfaem  to  the  intellect.  Large  playgrounds 
should  be  provided  in  every  city,  and  every  schoolhouse  should  be 
joined  by  a  lai^  roof-covered  area,  equipped  with  the  most  im- 
portant apparatus  necesiary  for  physical  training  for  both  summer 
and  winter.     The  authorities  ought  to  see  to  it  as  much  as  possible 


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778       The  Atlanta  Medical  and  Subqigal  Jotibnal. 

that  each  child  ie  given  the  opportubitj  to  develop  ita  iodividoal 
iDcliDatioDs,  for  in  the  nature  of  the  case,  and  oecesaarily  so,  olasa* 
room  work  has  a  leveliog  tendency ;  its  laws  are  those  of  a  liberal, 
sometimes  even  of  an  illiberal,  despotism  ;  a  child  becomes  one  of 
a  dozen  and  nothing  more,  and  the  only  virtue  practiced  is  that  of 
obedience,  which  it  should  have  acquired  at  home.  On  the  play- 
grouod  the  development  of  individuality  ought  to  be  given  a 
chance,  but  always  under  the  control  of  the  wiser  parent  or 
teacher. 


The  Use  op  Midwifery  Forceps, 
J.  M.  Munro  Kerr,  M.B.,  CM.,  F.F.P.S.,  Glasgow  (Laneet, 
September  24tb,  1898),  enters  a  protest  against  the  present  day 
teaching  of  applying  the  blades  of  the  obstetric  forceps  with  ex- 
clusive reference  to  the  transverse  diameter  of  the  maternal 
pelvis: 

"  The  author  takes  exception  to  the  general  teaching  of  the 
present  day  in  this  country  that,  so  long  as  the  blades  of  the  for- 
ceps are  applied  transversely  as  regards  the  maternal  pelvis,  it 
does  not  matter,  or,  at  least,  it  need  not  be  considered  how  they 
are  disposed  as  regards  the  head  of  the  child.  This  is  a  departure 
(a  Continental  importation)  from  the  older  teaching  of  obstetri- 
cians in  this  country,  who  from  Smellie'e  time  until  quite  recently 
laid  great  stress  upon  the  importance  of  applying  the  blades,  both 
of  the  straight  and  double-curved  forceps,  with  a  due  considera- 
tion not  only  of  the  pelvis,  but  also  of  the  diameters  of  the  fetal 
head.  The  present  day  teaching  is  without  doubt  largely  due  to 
the  writings  of  Dr.  Barnes,  who,  in  hia  'Lectures  on  Obstetric 
Operations,' maiutaios  that  while  with  the  straight  forceps  'the 
bead  determines  the  manner  of  applying  it,'  continues,  '  but  with 
long  forceps  it  is  the  pelvis  that  rules  the  application.  The  posi- 
tion of  the  head  may  be  practically  disregarded.  We,  of  course, 
are  only  concerned  here  with  the  double-curved  foroepe. 

"  Writing  on  the  application  of  the  forceps.  Dr.  Playfeir  and 
Dr.  Galabin,  in  their  respective  text-books  on  midwifery,  express 
themselves  as  follows ;     (I  quote  Irom  them  because  their  text- 


^dbyGoogle 


SiLKonoira  Am  Abstracts.  779 

books  are  the  two  mo6t  popular  Id  the  various  medical  schools  of 
this  oouDtry.)  Br.  Playfair  writes  :  '  It  is  admitted  that  in  the 
bigh-forcflpa  operation  the  blades  must  be  introduced  in  the  trans- 
verse diameter  of  the  pelvis  without  relation  to  the  position  of 
the  head.' 

"  Dr.  Galabin  writes :  'Accordingly,  it  is  now  the  usual  plan, 
even  if  straight  foroeps  are  used,  not  lo  pay  much  regard  to  the ' 
position  of  the  bead,  but  apply  the  blades,  one  at  each  side  of  the 
pelvis.  In  the  case  of  the  long  curved  forceps,  it  is  generally 
taught  that  the  blades  should  be  applied  at  the  sides  of  the  pelvis 
without  regard  to  the  position  of  the  head.  The  positiou  of  the 
head  should,  however,' be  exactly  determined  in  the  first  instance, 
not  BO  much  that  any  great  difference  in  the  position  of  the  blades 
should  be  aimed  at  in  oousequenue,  but  rather  that,'  etc. 

"  It  may  be  taken,  then,  from  these  quotations,  that  the  general 
teaching  and  practice  in  this  country  in  applying  forceps  is  to 
uonsider  only  the  pelvis  of  the  mother,  and  to  apply  the  blades 
always  in  the  transverse  diameter.  Now,  I  consider  such  teaching 
unwise  and  incorrect.  It  is  unwise,  because  it  tends  to  encourage 
carelessness  from  its  lack  of  exactness.  In  applying  the  blades  of 
the  forceps  both  the  child's  head  and  the  pelvis  of  the  mother 
should  be  considered  ;  and  when  an  operator  commences  to  exert 
traction,  not  only  should  he  know  how  the  blades  are  lying  with 
regard  to  the  maternal  pelvis,  but  also  how  they  are  lying  with 
regard  to  the  head  of  the  child.     It  is  also  incorrect. 

Dr.  Flayfair  says,  speaking  in  vindication  of  the  teaching  of 
applying  the  blades  of  the  forceps  always  in  the  transverse  diam- 
eter of  the  maternal  pelvis,  that  he  agrees  with  Dr.  Barnes,  who 
points  out  that  "do  what  we  will,  and  attempt  as  we  may  to  pass 
the  blades  in  relation  to  the  child's  bead,  they  find  their  way  to 
the  sides  of  the  pelvis.' 

"  But  such  a  statement  as  the  above — and  please  observe  it  is  a 
very  generally  expressed  one — is,  if  one  only  thinks  of  it  for  a 
moment,  tantamount  to  saying  that  the  forceps  is  an  instrument 
over  which  we  have  not  complete  control;  that  one  ot)erator  will 
grasp  the  head  as  well  as  another ;  that  all  the  operator  has  got  to 
do  is  to  introduce  one  blade  to  one  side  and  the  other  to  the  other 


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780       The  Atlanta  Medical  and  Surgical  Journal. 

side  of  the  pelvis,  when  the  blades  pass  beyood  his  coatrol  and 
adjust  themselves  to  the  fetal  head  io  the  best  direction  possible, 
fiut  further  proof  of  the  iocorreotoess  of  the  statemeot  and  gen- 
eral teaching  will  be  found  clinically.  It  will,  I  think,  be 
admitted  by  all  who  have  had  much  experience  in  obstetric  prac- 
tice that  a  head  which  was  causing  very  great  difBcuIty  in  extrac- 
tion may  sometimes  be  easily  delivered  by  altering  the  grasp  of 
the  forceps.  Now  that  is  not  because  with  the  previous  grasp  the 
operator  was  exerting  traction  in  a  wrong  direction,  for  before 
readjusting  the  inetruinent  every  operator  would  make  attempts  at 
traction  in  every  possible  direction.  Neither  is  it  because,  ou  the 
first  occasion,  the  blades  of  the  forceps  were  not  applied  in  the 
transverse  diameter  of  the  pelvis.  The  reason  is  simply  that  certain 
grasps  of  the  head  are  better  than  others.  In  each  case  there  is 
one  grasp  better  and  safer  for  mother  and  child  than  all  others. 
The  better  grasp,  however,  is  not  likely  to  be  secured  by  applying 
the  blades  of  the  forceps  to  the  sides  of  the  pelvis,  and  trusting 
to  the  chauce  of  their  adapting  themselves  to  the  most  favorable 
diameter  of  the  head.  Much  more  likely  is  it  to  be  obtained  by 
applying  the  blades  in  a  certain  diameter  of  the  child's  head 
which,  after  due  consideration  of  the  case,  the  operator  believes  to 
be  the  best. 

"Now  a  word  or  two  with  regard  to  the  application  of  the  for- 
ceps at  the  outlet,  at  the  brim,  and  in  flat  pelves. 

"1.  At  the  outlet — Here,  the  long  axis  of  the  head  having 
rotated  into  the  conjugate  diameter  of  the  pelvis,  the  blades  can 
as  easily  be  applied  with  reference  to  the  diameters  of  the  fetal 
head  as  with  reference  to  the  diameters  of  the  maternal  pelvis. 
When  straight  forceps  were  in  use  for  this  operation  they  were 
always  applied  with  reference  to  the  child's  head,  and  Dr.  Barnes 
still  recommends  that  method  of  applying  them,  as  may  be  seen 
from  the  quotation  I  have  already  given. 

"  2.  At  the  brim — Here,  in  spite  of  all  one's  efforts,  it  is  nearly 
always  impossible  to  grasp  the  fetal  head  bi-parietally.  The 
grasp  must  be  more  or  less  oblique  in  most  cases.  What  I  main- 
tain, however,  is  that  by  considering  the  fetal  head  and  applying 
the  blades  deliberately  to  it  as  nearly  as  pos^^ible  in  the  bi-parietal 


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Selections  and  Abstracts.  781 

diameter  a  leB8  oblique  grasp  is  obtaioed,  ooe  which  will  less  often 
slip  and  one  wbicb  will  require  leas  frequently  to  be  altered  thau 
if  the  blades  as  recommeDded  are  simply  introduced  into  the 
transverse  diameter  of  the  pelvis,  traction  exerted,  and  the  grasp 
of  the  head  never  considered. 

"3.  In  flat  pelves — In  such  cases  it  is  of  the  very  highest  im- 
portance that  the  fetal  head  be  deliberately  grasped.  In  flat  pelves, 
when  the  long  axis  of  the  fetal  head  lies  very  nearly  in  the  trans- 
verse diameter  of  the  pelvis,  the  application  of  the  blades  of  the  for- 
ceps  in  the  transverse  diameter  of  the  pelvis  without  reference  to 
the  head  results  in  one  of  the  three  following  grasps :  (a)  the  head 
is  grasped  directly  in  the  antero-posterior  diameter — a  very  rare 
occurrence;  (b)  it  is  grasped  very  nearly  bat  not  quite  in  the 
antero-posterior  diameter,  also  a  rare  occurrence ;  in  such  cases 
there  is  often  the  mark  of  the  tip  of  one  blade  just  above  the  eye; 
and  (o)  the  head  is  grasped  quite  obliquely,  one  blade  is  to  the 
side  of  the  occiput  and  the  other  blade  to  the  side  of  the  forehead. 
This  is  by  far  the  most  usual  grasp  obtained. 

"  What  I  maintain  here  is  that  if  one  applies  the  blades  of  the 
forceps  as  is  now  generally  taught,  one  cannot  tell  which  of  the 
above  three  grasps  of  the  bead  one  will  get;  it  is  entirely  a 
matter  of  chance  as  far  as  the  operator  is  concerned.  Surely 
there  is  something  wrong  in  a  teaching  into  which  the  element  of 
chance  enters,  especially  when  it  is  quite  unnecessary  that  it 
should  do  so.  To  avoid  it  the  operator  has  simply  first  to  satisfy 
himself  as  to  whether  in  a  particular  case  it  is  better  to  grasp  the 
bead  antero-posteriorly  or  obliquely,  and  then  deliberately  to 
apply  the  blades  to  the  child's  head  in  the  one  or  the  other  direc- 
tion. That  deliberate  grasping  of  the  child's  head  was  the  general 
teaching  of  obstetricians  up  till  thirty  years  ago,  only  they,  of 
course,  approved  only  of  the  'oblique  grasp,' as  they  considered 
the  antero-posterior  one  very  dangerous  to  the  child.  Into  the 
question  of  which  of  the  two  'grasps'  is  the  better  I  will  not 
enter  at  present.  I  will  only  say  that  in  certain  cases  the  one, 
and  in  certain  cases  the  other,  appears  to  me  the  safer  for  child 
and  mother,  and  that  the  indications  for  the  one  or  the  other  will 
be  found  in  the  variety  of  flat  pelvis  one  is  dealing  with. 


^dbyGoogle 


782       The  Atlanta  Medical  and  Bubsical  Jouenal. 

"  In  ooncIusioD,  I  would  only  add  that,  although  the  teaching  I 
have  been  here  condemning  is  very  general,  I  know  it  is  not  nni- 
versal.  Dr.  Miloe  Murray,  in  bis  most  able  paper  at  the  annual 
meeting  of  the  British  Medical  .^issoeiation,  the  other  day,  referred 
to  the  matter  and  advocated  a  deliberate  grasp  of  the  head  in  fiat 
pelvis,  and  other  teachers  in  Edinburgh   and  elsewhere,  do  the 


AubvulSCE  Classes — A  Beiautiful  Fad. 

With  the  coming  of  the  summer  the  voice  of  the  lecturing 
physician  on  "  First  Aid  to  the  Injured"  was  silent  in  the  land; 
and  evidently  with  his  devotees  it  is  out  of  hearing,  out  of  mind, 
otherwise  some  of  his  precepts  would  have  been  put  into  practice 
when  occasion  required,  as  it  has  frequently  during  the  past  few 
months.  Perhaps,  however,  we  are  ceosuiing  without  just  cause, 
so  we  pause  to  ask  a  question  ;  "What  has  been  taught  in  these 
'Ambulance  Classes?'"  Has,  for  instance,  the  rescuing  and  the 
resuscitating  of  the  drowning  been  made  the  subject  of  lecture  and 
study?  If  so,  passing  straoge,  is  it  not,  that  any  should  perish,  judg> 
ing  by  the  enormous  attendance  accredited  to  these  classes.  In  fact, 
half  the  population  seeme  to  have  been  seized  with  a  longing  for  a 
wider  sphere  of  usefulness.  Pity  'tis,  that  the  fancy  has  taken 
such  a  morbid  direction.  The  public  press  has  kindly  chronicled 
long  lists  of  those  who  have  "passed  the  necessary  examinations." 
Here  may  we  venture  another  question:  "What  are  the  graduates 
qualified  to  do?"  Are  their  qualifications  simply  to  stick  a  pin  in 
a  bandage,  without  causing  the  oftentimes  ungrateful  subject  of 
their  ministrations  to  "^see  stars?  "  One  would  be  inclined  to  pity 
the  long-suffering  physicians  who  have  so  courteously  given  their 
time  to  a  cause  eo  apparently  useless.  Are  these  classes,  that  have 
been  the  fad  of  the  past  two  winters,  needed  ?  They  have  been 
attended  alike  by  all  grades  of  society,  from  the  ladies  of  Toronto, 
the  Y.  M.  C.  A.  men,  etc.,  down  t*)  the  housemaids.  Perhaps  the 
wisest  thing  the  physician  can  do  is  to  bow  the  mi^uided  ladies 
back  into  the  social  circles,  which  they  so  gracefully  adorn,  or  pray 
for  a  new  fad  to  become  epidemic. 


^dbyGoOgle 


Sblbotiohs  and  Abstracts.  788 

As  for  these  Guild  clasBes,  what  is  the  use  of  pbyaioians  botberiog 
themselves  to  talk  to  housemaids  f  Little  caa  be  accomplished 
except  a  cheapening  of  the  dignity  of  the  medical  men  themselves. 
As  for  the  young  met)  mentioned,  possibly  better  results  might  be 
obtained,  as  few  "  boys  grown  tall "  trouble  themselves  to  listen  to 
lectures  or  learn  anything  unless  they  intend  to  make  some  prac- 
tical use  of  the  knowledge  attained.  However,  we  think  these 
classes  are  not  needed,  and  too  often  the  truthfulness  of  the  good 
old  maxim  has  been  proven — "Little  knowledge  is  a  dangerous 
thing." 

We  do  not  wish  lo  censure  sweepingly,  as  there  are  several 
classes  in  our  community  to  whom  lectures  upon  "  First  Aid  to  the 
Injured"  should  be  given;  for  instance,  railway  men,  steamboat 
employees,  and  all  such  as  are  exposed  by  reason  of  their  occupa- 
tion to  unusual  danger. 

Nevertheless,  we  are  firmly  of  the  opinion  that,  thoughtlessly, 
perhaps,  a  number  of  our  physicians  are  lowering  the  standard  of 
the  medical  man  by  freely  imparting  to  the  laity  too  much  medical 
knowledge.  If  this  fad  continues  it  may  soon  come  into  vogue  to 
consult  one's  patients  as  to  what  they  would  prefer  as  an  antidote 
to  poison,  or  perhaps,  in  a  ease  requiring  surgical  treatment,  a 
serious  argument  may  occur  between  physician  and  patient,  the 
latter  feeling  his  superior  knowledge,  owing  lo  his  having  been  a 
*'  grad  "  of  the  ambulance  class  of  the  winter  of  '89. 

As  physicians,  let  us  remember  where  we  put  ourselves  v/b  must 
slay.  Already  the  wise  worldlings  engaged  in  other  prefessions  . 
are  laughing  at  our  prodigal  liberality;  so  let  us,  ere  it  is  too  late, 
keep  the  knowledge  that  it  has  taken  years  of  study  to  acquire,  im- 
parting it  cheerfully  only  to  those  who  intend  to  espouse  our  noble 
calling  as  a  lifework,  We'have  already  cast  our  bread  to  feed  the 
stranger,  for  have  we  not  given,  with  scarce  a  protest,  the  name 
"Doctor,"  to  be  framed,  ohromo-like,  to  enhance  the  barndoors  of 
quaokdom  ? — Canadian  Journal  of  Medicine  and  Surgery. 


Physiciak's  Accounts  akd  the  Law, 
A  recent  issue  of  the  Philadelphia  Polyclinic  contains  an  article 
by  Dr.  W.  G.  Porter  and  an  editorial  by  Dr.  S.  Solis-Cohen    on 


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784       The  Atlanta  Medical  and  Surgical  Journal. 

"Does  a  Physician's  Book-Account  Constitute  a  Legal  Claim," 
which  is  most  timely,  important  and  surely  worthy  the  notice,  if 
not  the  deepest  concern  of  the  general  profeeston.  The  case  in 
question  was  briefly,  a  physician,  living  in  same  house  with  patient, 
presented  a  bill  upon  the  death  of  patient  against  the  estate.  The 
lawyer  representing  the  estate  said  that  the  physician  must  prove 
his  bill  to  the  satisfaction  of  the  auditing  judge.  It  was  asserted 
that  many  of  these  visits  were  social.  The  physician  had  kept  an 
ordinary  visiting  list  and  ledger. 

"The  judge  refused  to  allow  the  attending  physician  to  go  on  the 
stand  and  swear  as  to  the  truthfulnessof  his  account,  but  ruled  that 
the  bill  must  be  proved  by  the  evidence  of  a  third  party,  or  the  pro- 
duction oD  bis  part  of  what  he  called  a  book  of  original  entry — 
that  is,  a  book  in  which  each  visit  is  entered  with  the  amount 
chai^d  therefor,  so  much  for  a  day  visit,  eo  much  for  a  night  visit, 
so  much  for  a  vaccination,  so  much  for  a  confinement,  etr.  As 
under  this  ruling  neither  the  visiting  Hat  nor  ledger  are  considered 
books  of  original  entry." 

Again : 

"  Within  a  few  days  the  same  judge,  in  the  same  court,  if  he  is 
correctly  reported,  rejected  the  claim  of  another  physician  fot  pro- 
fessional services  to  a  decedent,  from  May  2,  1S8S,  to  November, 
1893 — 596  visits,  at  (1.50  each,  (894.  '  All  of  this  claim,  prior 
in  date  to  May  11,  1893,  was  barred  by  the  statute.  How  many 
visits  were  paid  between  May  11,  1893,  and  November  27,  1893, 
.  was  not  shown.  The  physician's  books  were  produced,  but  they 
were  not  books  of  original  entry,  in  any  technical  sense,  and  were 
clearly  inadmissible.'  And  thus,  after  five  years  and  a  half  of 
faithful  service,  the  physician  received  his  reward — 'nothing' — and 
this  is  law,  if  it  is  not  equity."  • 

These  two  extracts  need  no  comment  to  show  how  few  physician's 
accounts  could  be  collected  if  this  ruling  of  the  courts  will  stand. 
Physicians  are  proverbially  poor  bookkeepers  and  collectors,  but 
if  this  is  the  condition  imposed  by  the  law  it  behooves  all  to  "  turn 
over  a  new  leaf." 

In  the  same  journal  according  to  Mr.  A.  F.  Curtis,  of  the 
Philadelphia  bar: 


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Selections  and  Abstkacts.  tSS 

"  In  order  to  make  an  entry  of  charge  admissible  as  evidence  it 
must  be  properly  dated,  be  made  against  a  definite  person,  show  a 
definite  service  to  that  perflon,  or  to  one  for  whom  he  is  legally 
responsible,  and  must  have  stated  terms  of  money  a  definite  charge 
for  the  service.  Moreover,  the  entry  must  have  been  made  not 
later  than  the  day  after  the  service  was  rendered." 

To  live  up  to  these  strictures  will  impose  more  work  or  more 
expense  on  an  overburdened  profession,  yet  in  these  days  when 
people  delight  in  and  purposely  boast  of  "  beating  "  the  doctor,  a 
word  of  warning  is  necessary  that  we  may  protect  ourselves  in 
substantiating  honest  claims  and  due  recompense  for  labor  and  ser- 
vices often  too  freely  and  cheerfully  rendered. 


The  Ubtne  a8  a  Diaonostic  Factor. 

Dr.  Kernode  {Tri-State  Med.  Jour.,  p.  369,  August,  1898)  con- 
cludes an  article  with  the  above  title,  with  the  following  succinct 
rules,  first  formulated  by  Dr.  Formad  and  verified  by  many  inves- 
tigators : 

1.  Sediment  in  the  urine  has  no  significance  unless  deposited 
within  twenty-four  hours. 

2.  Albumen  in  the  urine  does  not  indicate  kidney-disease  unless 
accominnied  by  tube-casts.  The  most  fatal  form  of  Bright's  dis- 
ease— contracted  kidney — has  little  or  no  albumen. 

3.  Every  white  crystal  in  urine,  regardless  of  shape,  is  a  phos- 
phate, except  the  oxalate-of-lime  crystal,  which  has  its  own  pecul- 
iar form ;  urine  alkaline. 

4.  Every  yellow  crystal  is  uric  acid  if  the  urine  is  acid,  or  a 
urate  if  the  uriue  is  alkaline. 

6.  Mucous  casts,  pus,  and  epithelium  signify  disease  of  the  blad- 
der (cystitis)  or  other  parts  of  the  urinary  tract,  as  determined  by 
variety  of  epithelium. 

6.  The  urine  from  females  can  often  be  differentiated  from  the 
urine  of  males  by  finding  in  it  the  tesselated  epithelium  of  the 
vagina. 

7.  Hyaline  casts  (narrow),  blood,  and  epithelial  easts  signify 
acate  catarrhal  nephritis.     There  is  much  albumen  in  this  condition. 


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786       14111  Atlanta  Mbdical  and  Sdrqical  Journal. 

8.  Broad  hyaline  casts  aod  epithelial  dark-green  graaules  and 
oil-casts  signify  chronic  catarrhal  nephritis.  At  first,  much  albu- 
men ;  later,  less. 

9.  Hyaline  and  pale  granular  casts,  and  little  or  no  albumen, 
signify  interstititial  nephritis. 

10.  Broad  casts  are  worse  than  narrow  casts,  for  the  former  sig- 
nify a  chronic  disease. 

11.  The  urine  should  be  fresh  for  microscopical  examination,  as 
the  micrococci  will  change  hyaline  casts  into  granular  casts,  or  de- 
vour them  entirely  in  a  short  time. 

12.  Uric  acid  may,  in  Trommer's  test  for  sugar,  form  a  perox- 
ide of  copper,  this  oAen  misleading  the  examiner  ioto  the  belief 
that  he  has  discovered  sugar.  Thus  when  urine  shows  only  sugar, 
other  methods  of  examination  must  be  used — preferably  the  lead 
test. 

13.  The  microscope  gives  us  better  ideas  of  the  exact  condition 
of  affairs  in  examination  of  urine,  than  the  various  chemical  tests. 


Utehike  Codqh. 

Schaefier  (Centralbl.  fur  Oyndkologit,  1893,  No.  31)  concludes  as 
follows : 

"1.  In  those  predisposed,  such  as  neuropaths  and  suSerers  from 
genital  diseases  (especially  during  meustruatioD  and  pregnancy), 
cough  may  at  times  be  induced  by  isolated  contact  with  tbe/omu 
vagina. 

"2.  In  those  so  predisposed,  pathological  processes  which  involve 
the  broad  ligaments,  and  especially  Douglas'  pouch,  may  cause 
reflex  cough,  just  as  they  cause  reflex  acue  and  hyperemesis.  In 
the  latter  conditions  abnormal  fermentation  and  auto-iuoculatioo 
are  probably  also  preseat. 

"  3.  In  those  predisposed  to  cough  as  above  stated,  irritation  of 
the  lower  third  of  vagina  and  vulva  can  occasion  only  local 
reflexes — nothing  remote,  such  as  a  cough,  can  occur. 

"4.  Uterine  cough  is  produced  by  irritation,  on  one  side,  of 
the  utero'vaginal  libers  of  the  hypogastric  plexus  which  supply 
the  fornix  vf^ime  and  oollum  ut«ri,  and,  on  the  other  side,  the 


^dbyGoogle 


Selections  and  Abstracts.  787 

spermatic  plexus,  hemorrhoidal  nerves  and  ganglia  imbedded  in 
the  broad  ligament  which  supply  the  fundus  uteri  and  ovaries. 

'*  5.  Irritation  which  affect  the  nervous  pudendus  are  at  first 
localized  in  their  reflex  effects. 

"  6.  Reflex  phenomena  may  be  (a)  essential  physiological 
reflexes  iu  remote  motor  and  vaso-motor  territories,  which,  through 
the  neuropathic  basis  are  easily  set  in  motion;  (6)  radiation  in  the 
case  of  neuropaths,  where  resistance  is  weakened;  (o)  irregular 
radiation  in  high  degrees  of  neuropathy. 

"  7.  Cases  of  tuberculous  habitus,  or  predominance  of  stomach 
symptoms,  play  a  separate  part  in  the  genesis  of  nervous  cough. 

"  8.  Local  treatment,  especially  by  pessaries,  acts  promptly 
when  pathological  conditions  are  complicated,  as  in  the  case  of 
retroflexion  and  prolapse,  etc." 


Psoriasis. 


J.  V.  Shoemaker  (Pa.  Med.  Jour.,  August,  1898)  observes  that 
psoriasis  of  the  scalp  does  not  cause  baldness.  The  causes  of  this 
disease  are  from  within,  and  can  generally  be  traced  to  some  mor- 
bid condition  of  the  blood  or  disturbance  of  the  nervous  system. 
The  author  has  found  that  the  rheumatic  or  gouty  diathesis  fre- 
quently underlies  ao  attack.  Local  measures  are  of  secondary  im- 
portance, and  internal  management  depends  upon  the  origin  in 
each  case.  In  all  cases  the  patient  must-  be  placed  under  the  most 
favorable  hygienic  conditions.  If  the  cause  lie  in  disturbance  or 
lesion  of  the  nervous  system  remedies  exercising  a  beneficial  and 
nutritive  influence  upon  nerve>tissue  are  indicated.  Electricity, 
static  or  galvanic,  will  he  found  valuable.  Massage,  moderate  ex- 
ercise, baths,  diaphoretics,  and  the  salicylates,  iodides  and  sulphur 
in  cases  depending  upon  rheumatic  diatheais  are  appropriate  agents. 
The  bowels  and  kidneys  must  act  normally.  Drugs  which  disar- 
range digestion  will  do  more  harm  than  good.  Locally,  loose  the 
scales  by  the  use  of  water,  oil,  a  poultice  or  a  general  hath.  Oint- 
ments of  tar,  carbolic  acid,  creosote,  turpentine,  sulphur  or  sali- 
cylic acid  may  be  used.  Chrysoharin  and  pyrogallol  are  powerful 
agents,  but  have  conspicuous  disadvantages,  q. 


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788       The  Atlanta  Medical  amd  Surgical  Journal. 

MATERIA  MEDICA  AND  THERAPEUTICS. 

Fastiko  in  the  Tbeathekt  of  Infectious  Diseases. 

De  DomeDicis  (Wiener  Med.  Freaae,  May  1st,  1808)  is  a  stroog 
believer  in  tbe  old  doctrioe  of  fasting  in  fevers,  and  hia  zeal  has 
earned  for  bim  the  name  of  the  "  hungry  doctor"  among  the  laity 
of  Naples.  Taking  pneumoDiaas  an  example,  be  has  made  a  study 
of  140  cases  from  this  point  of  view.  A  specific  virus  and  ex- 
posure to  cold  are  not  enough  in  themselves  to  cause  pneumonia. 
Tbe  third  factor  is  a  bad  state  of  the  gastro-iotestinal  canal,  and  a 
resulting  condition  of  auto- intoxication  which  lowers  tbe  vitality 
of  the  patient,  and  increases  tbe  virulence  of  tbe  pneumococcus. 
The  author,  therefore,  washes  out  the  stomach  in  these  cases,  and 
then  administers  intestinal  disinfectants,  and  this  procedure  is  fol- 
lowed by  a  fast  of  several  days,  or  even  of  a  week,  in  certain  cases. 
In  other  words,  the  author  believes  that  the  deadly  agency  in 
pneumonia  comes  from  the  specific  toxins  as  much  as  from  products 
in  the  intestinal  canal.  It  would  appear  that  the  author  does  not 
use  his  fosting  therapeutics  unless  there  is  some  special  evidence  of 
gastro -intestinal  auto-intoxication.  He  mentions  arthritis  as  an- 
other form  of  disease  eminently  suitable  for  fasting. 


ExTEACT  OP  Supba-eenal  Oapsule. 

Corona  (La  Riforma  Medusa,  May  18th,  1898)  gives  the  results 
of  his  investigations: 

"I.  Supra-renal  extract  is  toxic,  and  the  constituents  are  of  a 
nature  opposed  to  one  another. 

"  II.  It  is  lethal  in  small,  repeated  doses. 

"III.  It  is  cumulative  in  action. 

"IV.  It  acts  upon  the  heart,  first  exciting,  and  tfaeu  paraly- 
zing it. 

"V.  It  has  no  notable  action  upon  the  formed  elements  of  the 
blood. 

"VI.  After  time  its  action  modifies  the  pigment  of  the  skin  (in 


DiclzedbyGoOgle 


Selbctiohs  and  Abstracts.  789 

frogs,  etc.),  causing  it  to  clear  up,  probably  ihrougb  its  operation 
upon  the  cbromatophores  wbich  contract  Btroogly. 
"VII.  Extirpation  of  both  capsules  is  fatal." 


Relationship  between  the  Medioinal  Dose  and  the  Pbcu- 

LIABITIES  OF  THE  GbOWISO  ObGANISM. 

Troitsky  {Jahrbvoh  fur  Kinderkeilhmde,  1898,  April  I5th),  after 
a  very  elaborate  study  of  this  subject  from  every  poiot  of  view,  gives 
bis  conclusions  as  follows: 

1.  Our  increasing  knowledge  of  the  anatomy,  physiology  and 
chemistry  of  the  growing  organism  gives  tbe  practitioner  the  right 
to  demand  similar  progress  in  posology. 

2.  New  data  are  recognized  in  the  etiology,  course,  diagnosis  and 
prognosis  of  disease,  and  cannot  be  ignored  in  the  treatment. 

3.  The  peculiarities  of  the  circulatory  organs,  blood,  digestive 
organs,  nervous  system,  skin,  body  weights,  should  furnish  data 
for  proper  dosage. 

4.  The  following  substances  have  not  been  particularly  studied 
with  respect  to  the  growing  organism:  Preparations  of  iron  and 
lime,  alkalies  and  acids,  salts  of  alkalies,  sodium  benzoate  and 
salicylate,  tbe  expectorants,  quioia,  potassium  iodide  and  phos- 
phorus. 

6.  The  number  of  years  must  be  revised  as  a  guide  to  dosage, 
because  metabolism,  resorption  and  excretion,  rapidity  of  circula- 
tion, specific  gravity,  blood  pressure,  etc.,  do  not  always  bear  a 
constant  relationship  to  age. 

6.  The  increments  of  growth  influence  the  increments  of  dosage 
to  such  way  that  the  latter  must  be  diminished  at  various  periods. 

7.  Age,  body  weights  and  rate  of  growth  are  the  three  factors 
from  which  an  arithmetical  mean  should  be  determined  in  selecting 
a  dose. 


The  oil  of  sassafras  will  destroy  all  varieties  of  pedicuU  and 
their  ova  with  a  single  application.  Care  must  be  taken  to  prevent 
its  coming  in   contact   with   mucous    membranes.     Any   burning 


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790      The  Atlaitta  Medical  akd  Subgical  Journal. 

from  this  cause  can  be  allayed  in  a  few  mioutes  by  pouring  on  olive 
oil. — Medical  Brirf. 


Internal  Trrathent  of  Ubethritis. 

By  Frank  Lydston,  M.D.,  American  Text-Book  of  Genito-  Urinary 
Diaeaaea: 


B     Liq.  poUMil 40 

fill*.  coraibK „ 30 

Ol,  gaultfaerla- 

Bit,  gWoyrrbizB,  fl _ 16 

SkCChMlD 96 

Huo.  ftcacin,  q.  a.*d 120 

Sig.:  A  teupoODful  every  two  or  three  hourt. 


66   (mi.) 
(q.  e.) 


Foe  PauBiTDS. 


B    Menthol 4 

Cerat.   (imp _ 60 

01.  •mygdalB  dale _ 80 

AccarKilic „ 4 

PuW,  cine  osid  _ 60 

After  cleADBiag  the  parte  appi]'  night  and  morning. — C.  B.  Keltey  (PAUa- 
delphia  Mtdiail  Journal) , 


For   hoarseoesB  in  singers  and  speakers  Botey  commenda  the 
followiog; 

B    Cooain.  bvdrochlor    It        (gr.  it.) 

Stricb.  Mlph „ 04      (gr.l.) 

Aq,  deiUllat  90|  {|iU.) 

Spray  throat. 
And: 

B    Cocain.  hydrochlor. _ 104  (gr.  |.l 

Tr.  aeoniti 86  (m.  x.j 

White  lugar  Mid  mar«hmallow_ ., |         (q.  >■) 

Ft.  pastillaa  No.  Ixxx.     S.    To  diHolve  In  the  mouth.— OaiUmd'*  Utdteul 
Uonlhly. 


^dbyGoogle 


Selections  and  AbsteacTS.  iQi 

Dyspepsia  Cube  Recommended  by  C!oe. 

i^llv.  rh« 81  (Jii.) 

Bit.  geotiMi,  fl „ 12  iSiil-j 

Aq.  mentb.  pip 226  (Iviu) 

Sod.  bicarb 24|  (371) 

.  Sig. :    A  teupoonful   half  an   hour  before  meali. — LovitvitU  Medical 


Treatment  of  Tapeworm. 
The  following  19  credited  to  E.  Cbamberlin ; 

B    Alcohol  contaiDiDg  10  per  cent,  ot  chlorobrm  ....  _ 8  pftrtt. 

Recti  Bed  oil  of  turpentine „1  _..    .  „_,. 

Etbereal  eitraot  of   male  fern _ |  «ciu  part.. 

Glycerin 16  part*. 

II.  Haifa  teatpooDlul  to  be  taken  every  hour.  Bafore.beginDtDf  the  um 
of  thU  mixture  the  patient  ibould  take  cutor  oil  or  magneaium  tulphate,  and  aa 
■oonaiB  purgative  effect  ii  produced,  the  mixture  maybe  taken.  For  very  joung 
•ubjectt,  for  example,  children  two  jeart  old,  the  formula  ma;  be  modified  aa 

R     Alcohol  containing  10  [Mr  cent  of  chloroform \ 

Rectified  oilol  turpentine _ j-each  2  parta. 

Bitiact  of  male  tern  ...: „ J 

Qljcerin  „ 16  parta. 

H.  Sig.:  A  teaipoonful  every  hour. 


Solouon's  Mixture  for  Infantile  Contdlsions. 

B    MoMhi Ifi  (gr.  vil.) 

Onm  acacia 2  (3**.) 

Aq.  ftBDiculi I 

Syr,  aurant.  cort U.  S0|  (gi.) 

H.  Slg.:  A  taaapoonhil  every  hour  or  two, — Sea  YorkMedieal  JmirruU. 

Injections  during  the  Acute  Staqeb  of  Uhethkiti8  for  a 
Sedative  Astringent. 

B    Plumbi  acetatii, |26(gr.iv,) 

Viniopii 8  (51!* 

Aqu»  roue,  q.  a.  ad 16 1         (I^O 

Slg. :  Inject  thm  timei  daily. 
Thic  ii  to  be  followed  by  a  bichloride  of  mercury  injection  (lolutlon   1  to 
16,000),  in  oombisation  with  a  amall  amount  of  glycerin. 


^dbyGoOgle 


Tbb  Atlanta  Medical  and  Surqical  Journal. 
In  the  Lateb  Stages  of  Gonobbbba. 

a     Terebinth,  alb -  i  I            (ji.) 

Res.  podoph 03(gr,  i«.) 

Gftinpbar-inotiDbroin  _ 4            (^i.) 

H.,  et  ft.  pill  No.  SO. 

Sig. :    One  pill  four  tiroe*  •  day. 


To  Allay  Chobdee  and  Sexual  ExcrrA.BiLiTY. 


B    Git.ergotw.  fl.  ... 

Tr.  gelMmii 

FottMii  bromidi  „ 

Tr.  bjoacfsnii 

SjT.  auranlii,  q.  i. 


Big. :    To  b«  taken  at  b«dtime. 


S2     (m 
82(gr.i 


Dubinq  the  Stationary  Stage  op  TJbethbitis  the  follow- 
ing IS  More  Sebviceable. 

B    Zinci  aulpb.  (acetat), - I    (gr.  zii.) 

Morph.  Bulpb „ 65  (gr.  i.) 

Glycerin _. 80  (Si. 

Aqure  row »0|  (anU) 

Sig.:    Injection. 


Fob  boiU  L.  Duacan  Bulktejr  commeDda  the  followiog  for  local 

application : 

E     Acid,  carbol |8-.66fgr.T..x.) 

Ext.  ergot 4-8  (S  i-ij.) 

Pulv.  "myli 4  ,3  iU 

Zinci.  o«di  4  (3ij.) 

TJng,  aqu»  roi« 80|  (3  "iU-) 


Ointment  fob  Vaeicose  Ulceb. 

B    Ac.  dirbolici - 

Ac.  borici 

Camphone ; 

Ichthyol 

0].  am^gdaln  dulc 

Ung.  EiDci  oxidi 

M.  Sig.:    For  exteroBl  UM. — OaiUard'i  MtditalJotintal. 


(3"0 

(3ii») 

13  "■) 

(3'.) 


idb,Google 


ATLANTA 

Medical  and  Surgical  Journal. 

■Vol.  XV.  FEBRUARY,  1899.  No.  12. 


DUNBAR  ROY,  A.B.,  M.D.,  M.  B,  HUTCHINS,  M.D., 

KDITOK.  BnSIHBSS  MAMAOBB. 


ORIGINAL  COMMUNICATIONS, 


SUPRAPUBIC  CYSTOTOMY  FOR  STONE,  WITH 
REPORT  OF  TWO  INTERESTING  CASES.* 

By  WM.  8.  GOLDSMITH,  M.D., 

I.«cturer  on  Gen i to-urinary  Diseaees  and  Sjphilia,  Atlanta  College  of 

PhjBicians  and  Surgeons. 

The  operation  ol  suprapubic  cystotomy  is  of  suSicieDt  age  to 
«Dtitle  it  to  ao  honorable  aotit^uity,  though,  in  coinmoa  with  other 
operations  of  merit,  has  suffered  lapses,  during  which  time  other 
methods  for  the  removal  of  vesical  calculi  have  been  introduced. 
Pierre  Franco,  in  1556,  first  performed  this  operation  as  a  means 
of  extricaUog  himself  from  an  embarrassing  dilemma.  An  unsuc- 
cessful attempt  to  remove  a  stone  from  a  child  by  the  perineal 
route  induced  him  to  open  the  abdomen  and  explore  the  bladder 
from  above.  The  patient  recovered,  but  the  surgeon  condemned 
the  method.  The  real  inventor  of  the  operation  was  Roussetus, 
who  never  performed  it.  In  1590  be  published  a  work  on  Cseaa- 
rean  section,  in  which  was  given  an  elaborate  and  accurate  descrip- 

•Presldeat'B  Annual  Address  before  the  AtlsnU  Society  of  Medicine,  Jsdiutt  S,  IBM. 


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794       Thb  Atlanta  Medical  and  SvEoiext  Journal. 

tion  of  all  the  pelvic  orgwM-  He  described  minutely  the  princi- 
ples  aad  tecbniqwe  of  suprapubic  cystotomy,  and,  among  other 
things,  corrected  the  prevailing  idea  that  wounds  of  the  bladder 
were  necessarily  fatal. 

At  thin  period  the  operation  was  performed  in  an  expertmenta) 
manner  by  many  surgeons,  but,  owing  to  the  meager  literature  on 
the  subject  and  its  slight  encouragement,  nothing  was  done  towards 
its  advancement  until  the  Douglas  revival  in  1718.  Thornton  of 
Bristol,  indorsed  the  procedure,  and  in  1727  wrote  a  valuable 
treatise,  in  which  he  detailed  an  account  of  fiTteeo  eases.  He  was 
the  first  author  to  direct  attention  to  the  importance  of  the  inser- 
tion of  the  urachus  in  the  bladder  as  a  landmark  in  outlining  the 
boundary  of  the  prevesical  space  and  in  determining  the  presence 
of  the  peritoneum.  This  guide,  as  relating  to  the  latter,  is  not 
altogether  infallible,  as  occasionally  the  peritoneum  folds  around 
the  urachus,  dipping  down  on  each  side,  and  almost  completely 
obliterating  this  space.  The  subsequent  history  of  the  operation 
shows  a  steady  decline  in  favor.  The  advent  of  Listerism  and  the 
tremendous  impetus  given  by  Garson  and  Petersen,  upon  the  intro- 
duction of  rectal  distention  as  a  means  of  elevating  the  bladder  to 
the  extent  of  lengthening  the  suprapubic  space,  placed  the  method 
upon  a  firm  foundation,  which  has  broadened  and  developed  into 
a  position  approaching  the  ideal.  The  position  and  condition  of 
the  bladder  are  important  elements  to  be  considered  in  the  tech- 
nique of  the  operation.  In  children  and  early  adult  life,  we  are 
favored  by  the  high  position  of  the  organ,  and  by  its  usual  good 
condition.  As  age  advances,  the  bladder  descends  lower  in  the 
pelvis,  and  structural  changes  are  much  more  likely  to  occur. 
tiuch  circumstances  contribute  lately,  of  course,  to  the  favorable 
termination  of  the  case,  and  statistics  bearing  upon  tfais  subject 
should  be  based  upon  classifications  of  periods  of  ten  years  of  the 
patient's  age. 

I  shall  not,  at  this  time,  take  up  the  relation  of  bypertropbied 
prostate  to  stone  in  the  bladder,  a  theme  in  itself  fertile  and  fasci- 
nating. In  this  connection  I  believe  every  one  will  agree  that 
the  extraction  of  the  stone  will,  in  a  great  measure,  remove  the 
cause  of  the  hypertrophy  and   conduce,  if  the  necessity  arises,  to 

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Suprapubic  Cystotomy  for  Stone.  796 

the  rapid  and  easy  bmiliarity  of  catheter  Hfe.  Rectal  distention, 
as  one  of  the  accredited  t^^nts  looking  to  the  revival  of  this  oper- 
ation, has  had  many  worde.of  commeodatioD  and  not  a  few  of  coa- 
demnatioD.  The  majority  of  operators  have  abandoned  its  use, 
and  the  minority,  but  for  force  of  habit,  could  do  aa  well  without 
it.  There  is  really  very  little  to  be  gained  by  rectal  distention,  as 
practically  the  same  results  can  be  obtained  by  other  aids,  simple 
and  easy  of  application.  The  distention  of  the  bladder  with  air, 
as  suggested  by  Bristow,  and  further  elaborated  by  Tilden  Brown, 
is  practioed  to  some  extent  in  the  North.  To  my  mind  the  ideal 
distention  is  by  a  fluid  medium,  antiseptic  in  character.  Boro- 
clyceride  or  the  normal  salt  solution  are  admirable  ageuts.  Not 
a  few  surgeons  prefer  to  operate  without  any  kind  of  distention, 
either  vesical  or  rectal,  utilizing  the  Trendelenburg  position, 
claiming  that  increased  operating  area  more  than  offsets  the  incon- 
venieuce  of  non-distention. 

The  question  of  immediate  closure  of  the  bladder  in  selected 
cases  is  of  much  interest,  since  its  adoption  tends  to  greatly  shorten 
the  period  of  convalescence  and  gives  us  a  closed  cavity  which 
drains,  as  nature  intended,  through  the  urethra.  The  cases  to 
which  immediate  and  complete  suture  it  applicable  are  many, 
much  greater  in  fact  than  the  average  man  accepts.  I  think  every 
bladder,  except  those  containing  embedded  stones  and  those  of  the 
ulcerative  class,  should  be  closed  tight.  One  of  the  objections  to 
this  method  occurs  in  old  men,  in  whom  the  bladder  is  very  low 
in  the  pelvis,  the  walls  thickened  and  its  cavity  greatly  lessened. 
If  this  particular  type  is  uot  closed,  certainly  the  organ  should  be 
anchored  in  such  a  manner  that  the  opening  for  drainage  is  fixed 
and  staple.  It  is  reasonable,  therefore,  that  if  the  iocisinu  is  accu- 
rately sutured,  union  will  almost  certainly  occur,  provided  proper 
urethral  drainage  is  secured.  In  one  of  the  cases  I  shall  briefly 
discuss  this  evening  good  union  obtained,  in  spite  of  a  wound 
practically  lacerated  in  character.  The  bladder  walls  were  so 
friable  that  in  making  slight  traction  with  catch  forceps  pieces  of 
the  entire  wall  would  be  torn  away.  In  my  other  case,  an  ideal 
one  for  immediate  closure  from  the  standpoint  of  age,  position 
snd  condition  of  bladder,  I  was  forced  to  anchor  and  drain  on 


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796       The  Atlanta  Mbdical  and  Suroical  Jodrhal. 

aooouDt  of  oozing  und  esteosive  traumatiem  iocident  to  the 
removal  of  ao  embedded  stooe.  HaviDg  outlined  the  principles 
and  expressed  an  opinion  on  some  of  the  mooted  poiate  connected 
with  this  operation,  I  shall  report,  without  detail,  two  recent 
cases.  • 

Male,  aged  61,  came  to  me  the  latter  part  of  November  for 
operation  for  hemorrhoids.  General  condition  fair,  but  the  rectum 
was  so  irritable  that  a  week's  local  treatment  and  rest  were  advised. 
The  hemorrhoids  began  to  appear  twenty  years  ago,  and  as  usual 
every  suggested  remedy  was  tried.  The  bladder  symptoms  ap- 
peared five  years  ago  and  had  grown  steadily  worse.  I  suspected 
atone  and  made  several  incomplete  explorations,  but  excessive 
irritation  prevented  a  satisfactory  examination.  The  urine  was 
loaded  with  mncus,  very  little  pus,  albumeu,  tube  casts  and  innu- 
merable bacteria.  This  combination  of  circumstances  for  the 
moment  brought  matters  to  a  standstill.  Finally,  on  December 
4th,  from  sheer  necessity,  I  operated  on  the  hemorrhoids.  While 
under  ether,  the  stooe'Searcher  confirmed  my  tears,  and  one  week 
later  I  removed  two  stones.  I  closed  the  bladder  with  silk,  using 
the  mattress  suture.  The  abdomen  was  also  closed  with  silk,  ex- 
cept at  the  lower  angle,  where  I  left  a  small  opening  for  drainage. 
Some  provision  for  drainage  should  always  be  made,  when  the 
bladder  is  closed.  I  was  fearful  of  leakage  in  this  case,  which 
occurred  on  the  seventh  day  upon  the  removal  of  the  catheter  for 
a  few  hours.  The  replacement  of  the  catheter  and  its  retention 
for  an  additional  week,  gave  ample  time  for  a  firm  union  to  occur. 
The  bladder  was  irrigated  daily  for  two  weeks  with  a  1  to  6000 
permanganate  of  potash  solution.  Subsequent  to  the  withdrawal 
of  the  catheter,  irrigations  every  third  day  have  been  practiced. 
The  interesting  feature  of  the  case  is  this:  that  oftentimes  the 
reflexes  from  the  rectum,  particularly  incident  to  hemorrhoids,  are 
directed  to  the  bladder  and  deep  urethra,  thus  making  and  distorl- 
ing  symptoms  of  grave  conditions  in  oue  or  both  localities. 

The  second  case  is  that  of  a  male,  aged  23.  Complained  of  blad- 
der trouble  from  early  childhood.  Fur  the  past  six  years  has  had 
frem  two  to  four  attacks  of  subacute  cystitis  a  year.  He  came  to 
me  on  the  18th  of  December;  general  condition  poor.     He  lived 


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Suprapubic  Cybtotomt  for  Stonb.  797 

ID  Soath  Georgia  and,  of  course,  id  a  malarial  sectioo.  I  pDt  him 
OD  quioine  and  salol  opoo  arrival,  and  advised  the  free  adminis- 
tration  of  Litbia  water  and  lemooade.  Nourishing  and  stitnulat- 
iag  diet  vas  instituted.  Yielding  to  the  most  pitiful  importnoi- 
liee  for  relief,  I  operated  on  the  24th.  A  stone  firmly  embedded 
in  the  base  of  the  bladder  was  discovered,  and  a  tedious  and  pro- 
longed effort  required  for  its  removal.  The  condition  of  the  vesi- 
cal mucous  membrane,  after  the  neoessarily  harsh  manipulation, 
did  not  warrant  the  complete  closure  of  the  bladder.  I  sutured 
the  upper  half  of  the  incision  and  anchored  the  lower  half  to  the 
abdominal  wall,  passing  my  suture  through  the  muscular  coat  of 
the  bladder  and  carrying  it  through  the  recti  and  skin.  A  wick 
of  sterile  gauze  was  inserted  to  the  bottom  of  the  cavity  and  a 
catheter  fastened  in  the  urethra,  I  believe  in  using  drainage 
both  ways,  as  there  can  never  occui*  snch  a  thing  as  too  much 
drain^e.  The  catheter  was  retained  only  twenty-four  hours,  on 
account  of  urethral  irritation.  At  the  same  time  a  rubber  drainage 
tube  was  substituted  for  the  gauze.  Reaction  from  the  operation 
was  rapid  and  satis&ctory  and  no  untoward  symptoms  occurred 
until  the  third  day,  when  marked  malarial  toxemia  was  manliest. 
A  temperature  of  105  was  brought  down  to  102  by  calomel  and 
rectal  enemata  and  the  infusion  of  one  and  one-half  quarts  of  nor- 
mal salt  solution.  Quinine,  iron,  arsenic  by  the  mouth,  hypoder- 
mics of  strychnine,  and  daily  infusions  of  the  salt  solution,  together 
with  liberal  quantities  of  alcohol,  prolonged  (he  life  of  the  patient 
until  the  sixth  day,  when  be  died.  This  case  illustrates  the  pecu- 
liar disposition  of  malaria  and  the  deadly  toxin  involved.  Noth- 
ing could  have  arrested  this  poison  and  no  one  could  have  antici- 
pated the  result. 

The  mortality  of  suprapubic  cystotomy  is  about  nine  per 
cent.,  and  when  we  consider  that  the  most  aggravated  cases  are 
sabjeoted  to  this  operation,  it  is  another  evidence  of  its  safety  and 
simplicity. 


VOnOB.— ThU  JOVRNAI.   and  THB  INTESNATIOHAL  JOUK- 
HAI.  OF  aiTBOXBT  ana  yamx  for  «1.00  OMh. 


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798       Thb  Atlanta  Medical  and  Surgical  Journal. 


THE  DIAGNOSIS  OF  PREGNANCY  * 

By  VIEGIL  O.  HASDON,  M.D., 
Atlanta,  Ga. 

The  subject  upon  which  I  shall  speak  to-night  is  an  old  one. 
It  is  as  old  as  the  human  race.  It  is  probahle  that  Eve,  when 
pregnant  with  Abel,  availed  herself  of  the  experience  of  her  pre- 
vious pregnancy  in  making  a  diagnosis  of  her  condition.  Or  if 
we  adopt  the  Darwinian  theory  we  may  reasonably  assume  that 
our  simian  ancestoni,  those  anthropoid  apes  whose  blood  is  sup- 
posed to  course  through  the  veins  of  all  of  us,  made  use  of  their 
recently  developed  intellectual  faculties  to  determine  the  meaning 
of  the  symptoms  which  arose  when  conception  occurred.  From 
that  time  to  the  present  this  question  has  agitated  the  minds  of 
pregnant  women  and  of  men  whose  business  it  is  to  care  for  preg- 
nant women.  Since  the  question  has  thus  been  studied  for  six 
thousand  years,  or  six  million  years,  as  the  case  may  be,  it  would 
seem  presumptuous  in  me  to  appear  before  you  to-night  with  the 
expectation  of  saying  anything  new.  But  even  though  all  has 
been  said  that  can  be  oaid,  it  is  sometimes  profitable  for  us  to 
pause  and  sum  up  our  knowledge,  to  take  account  of  stock  as  it 
were,  in  order  to  see  where  we  stand.  It  is  my  purpose  to  thus 
sum  up  our  present  knowledge  of  the  diagnosis  of  pregnancy  and, 
perhaps,  to  elicit  some  discussion  on  the  subject  which  shall  bring 
out  the  views  of  other  men  and  correct  my  own,  where  they  shall 
prove  erroneous. 

This  subject  is  one  which  interests  the  whola  profession.  It 
is  not  the  specialist  alone  who  is  concerned  in  it.  Even  the 
oculist  has  occasion  to  treat  albuminuric  retinitis  due  to  preg- 
nancy, and  the  dermatologist  sees  cases  of  chloasma  uterina  aris- 
ing from  the  same  cause.  In  the  majority  of  cases  the  physician 
is  not  called  upon  to  make  an  early  diagnosis  of  pregnancy. 
Women  who  have  borne  children  before  are  sufficiently  familiar 
with  the  symptoms  to  be  able  to  recognize  the  condition  when  it 
•An  addru*  deUTorad  befora  the  AtlanM  Sooletj  of  Medloiae. 


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Thb  Diagnosis  of  Pregnancy.  799 

arises,  aad  even  women  who  are  totally  iuexperieoced  in  such  mat- 
ters are  usually  content  to  wait  until  the  symptoms  become  unmis* 
takable.  Nor  is  it  in  tbe  later  months  of  pregnancy  that  we  are 
called  upon  to  make  a  diagoosie,  when  the  patient  has  reached  the 
filth  or  sixth  month,  when  her  abdomen  has  eulai^ed  to  such  au 
extent  that  her  condition  is  obvious  to  every  passer-by,  and  when 
the  fetus  has  foretold  its  adveut  by  lea[>iug  in  its  mother's  womb. 
There  is  no  need  for  the  physician  to  confirm  the  diagnosis  which 
the  mother  has  already  made  for  herself.  But  when  the  timid, 
shrinking,  tearlul  maiden,  who  has  loved  "not  wisely,  but  too 
well,"  comes  to  us  with  a  story  of  having  missed  her  menses  from 
taking  cold  aud  hopes  against  hope  that  by  an  examination  we  may 
confirm  her  diagnosis  of  the  causation  of  her  amenorrhea,  it  is  then 
that  our  decision  assumes  vital  itnportaDce.  Or  when  the  newly 
married  bride  who  has  been  looking  forward  to  a  year  or  more  of 
social  enjoyment  finds  her  prospects  of  pleasure  thwarted  by  the 
prospect  of  pregnancy,  then,  also,  our  opinion  is  eagerly  sought. 
Or  when  au  inheritance  of  an  estate,  or  a  title,  or,  possibly,  even 
a  crown,  hangs  upon  the  question  of  pregnancy,  then,  again,  the 
question  is  a  momentous  one. 

Since  the  diagnosis  of  pregnancy  present?  no  difficulties  after 
the  early  months  have  passed,  I  shall  confine  my  discussion  to 
those  symptoms  which  present  themselves  at  a  time  when  tbe  ques- 
tion may  be  considered  a  doubtful  one.  The  first  symptom,  as  a 
rule,  which  attracts  attention  aud  which  leads  to  a  suspicion  of 
pregnancy  is  the  cessation  of  menstruation.  This  is  looked  upon 
by  the  laity  as  strong  evidence  of  a  pregnant  condition,  and  rightly 
so.  When  a  woman  has  been  regular  in  her  menstruation  all  her 
life,  and  when  this  function  suddenly  ceases,  especially  if  she  be  a 
woman  who  has  a  right  to  be  pregnant,  this  symptom  furnishes 
strong  presumptive  evidence,  and  yet  it  has  its  fallacies  from  two 
)K>intB  of  view.  In  the  first  place,  women  not  infrequently  men- 
struate after  conception  has  taken  place,  and  it  is  a  matter  of  com- 
mon observation,  which  I  have  frequently  had  occasion  to  verify 
in  my  practice,  that  when  conception  takes  place  just  before  the 
menstrual  period,  that  period  occurs,  though  in  a  modified  form^ 
being  diminished   in  quantity  and  duration.     Not  only  may  men- 


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800       Thb  Atlanta  Medical'  and  Sdbqical  Joubnal. 

struation  occur  a  siogle  time  imnie(liatel7  after  oonoeptioa  bas- 
takeD  place,  but  it  may  occar  once,  twice,  thrice,  or  even  more. 
Cases  are  reported  io  which  meDstruation  has  persisted  all  dnriDg- 
pregnaaoy.  I  have  always  beea  somewhat  skeptical  ia  regard  to 
such  case9,.being  iucliaed  to  attribute  the  flow  of  blood  to  other 
causes.  Od  the  other  hand,  women  frequently  &il  to  menstruate  who- 
are  not  pregnant.  Anemia,  depressing  chronic  diseases  of  any  kind, 
any  condition  where  the  lose  of  blood  is  interfered  with  by  nature 
as  a  conservative  process,  may  cause  menstruation  to  &il  to  appear. 
Depressing  emotions,  such  as  grief,  and  even  a  fear  of  pregnancy 
in  a  woman  who  has  do  right  to  be  pregnant,  may  cause  this 
symptom.  Cessation  of  the  menses,  therefore,  cannot  be  consid- 
ered an  evidence  of  pregnancy  except  in  the  presence  of  other 
corroborative  indications. 

A  second  early  symptom  of  pregnancy,  which  is  of  value  in  mak- 
ing a  diagnosis,  is  the  so-called  morning  sickness.  The  term  is  « 
misnomer,  because  in  my  experience  the  nausea  of  pregnancy 
occurs  as  frequently  at  other  times  of  the  day,  or  even  of  the  night, 
as  in  the  moroing.  This  is  by  no  means  a  conclusive  sign  of 
pregnancy,  since  nausea  closely  similar  to  it  may  occur  in  other 
conditions.  Reflex  disturbances  of  the  stomach  may  arise  from  a 
diseased  condition  of  the  womb,  as  well  as  of  other  organs.  Yet^ 
in  the  majority  of  cases,  the  nausea  of  pregnancy  is  charauleristic 
in  the  fact  that  it  is  not  accompanied  by  constitutional  disturb- 
ances. There  is,  however,  one  diseased  condition  which  may  give- 
rise  to  a  nausea  so  closely  simulating  that  of  pregnancy  as  to  be 
easily  mistaken  for  it,  I  refer  to  the  nausea  which  accompanies- 
uremia.  The  distinction  between  the  two  is,  of  course,  to  be 
made  by  an  examination  of  the  urine.  The  nausea  of  pregnaotT' 
occurs  in  some  cases,  if  we  may  judge  from  the  statements  of 
physicians,  as  early  as  the  first  week.  As  a  rule,  however,  it  is 
not  until  after  a  suspicion  of  pregnancy  has  been  excited  by  the 
failure  of  menstruation  that  the  nausea  makes  its  appearance.  In 
the  majority  of  oases  the  nausea  consists  simply  of  a  discomfort, 
which,  though  severe,  entails  no  serioue  consequences.  The 
patient  is  able,  in  spite  of  the  nausea,  to  retain  sufficient  nourish- 
ment to  support  life.     There  is,  however,  a  class  of  cases  in  which 


^dbyGoogle 


The  Diaqnosis  of  PREanANcir.  801 

the  nausea  assumes,  from  the  very  beginning,  an  entirely  different 
type.  It  is  aooompanied  by  bo  great  an  amount  of  physical  and 
mental  depression,  such  rapid  impairment  of  strength,  with  the 
development  of  such  high  temperature  and  so  feeble  and  rapid  a 
pulse,  that  the  picture  presented  by  it  is  characteristic.  This  form 
of  nausea  is  distinctly  pernicious  in  type  and  tends  to  a  fatal 
result.  It  ia  in  this  class  of  cases  that  interruption  of  pregnancy 
becomes  necessary  in  order  to  save  lil'e.  It  ts  this  class  of  cases, 
also,  which  so  closely  simulate  nausea  from  uremic  poisoning. 
These  cases,  fortunately,  are  rare.  Since  nausea  simulating  that 
of  pregnancy  may  arise  from  other  oanees,  it  is  obvious  that  this 
symptom  is  not  a  conclusive  one.  It  is  only  when  taken  in  con- 
nection with  other  symptoms  that  it  is  of  value.  In  the  absence 
of  other  symptoms  it  can  lumish  no  positive  evidence. 

The  symptoms  which  I  have  referred  to  are  subjective  symp- 
toms which  can  be  discovered  by  the  patient  herself  and  which 
lead  her  to  suppose  that  conception  has  taken  place.  There  is 
another  group  of  symptoms,  objective  in  character,  which  appear 
early  in  pregnancy,  and  which  are  of  as  great,  if  not  greater,  value 
than  the  subjective  ones.  The  first  of  these  is  the  change  in  the 
consistency  of  the  neck  of  the  womb  by  which  it  loses  its  normal 
hardness  and  becomes  soft  and  compressible.  The  well-known 
saying  of  Goodell  is  doubtless  familiar  to  all  of  you.  He  says: 
"  If  the  cervix  is  hard  like  your  nose,  the  woman  is  not  pregnant. 
If  it  is  soft  like  your  lips,  she  is  pregnant."  This  symptom  can 
be  detected  as  early  as  the  be^nning  of  the  second  month,  and  is, 
in  my  judgment,  the  most  valuable  of  the  early  signs.  Another 
symptom,  which  can  be  discovered  by  examination  in  the  early 
months,  is  the  change  in  the  color  of  the  mucous  membrane  of  the 
vagina  and  the  cervix.  The  mucous  membrane  loses  its  normal 
rosy,  pink  tint,  and  becomes  changed  to  a  dark,  dusky  purple. 
This  change  is  due,  of  course,  to  the  physiological  congestion 
produced  by  pregnancy.  This  congestion  extends  not  only  to  the 
deeper  blood-vessels,  but  to  the  capillaries  which  course  through 
the  superficial  layers  of  the  mucous  membrane.  The  change  of 
color  is  most  pronounced  in  the  ^uoous  membrane  of  the  vesti- 
bule, but  can  be  detected  over  the  whole  v^ina  and  the  cervix. 


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802       The  Atlanta  Medical  and  Suegical  Journal. 

It  is  mucb  more  marked  in  some  oases  than  in  others,  but  I  have 
never  seen  a  pregDaot  woman  in  whom  it  could  not  be  detected 
after  the  first  month.  Ita  constancy  makes  it,  therefore,  a  valna- 
ble  indication  of  pregoancy,  but  its  valne  is  somewhat  impaired 
by  the  fact  that  a  similar  discoloration  may  arise  from  any  diseased 
condition  which  produces  conjestion  of  the  pelvic  blood-vessels. 
I  have  frequently  seen  it  accompanying  fibroid  tumors.  It  is  not, 
therefore,  a  conclusive  sign,  but  is  of  great  value  as  corroborative 
evidence. 

Another  class  of  ague  which  develop  early  in  pregnancy  are 
the  changes  which  take  place  in  the  breasts.  As  early  as  the  end 
of  the  first  month,  and  sometimes  even  earlier,  the  breasts  become 
turgid  and  enlarged,  the  areola  around  the  nipple  becomes  deeper 
in  color  and  is  elevated  above  the  surrounding  surfa::e  of  the 
breast.  The  superficial  veins  become  visible  and  can  be  traced 
as  blue  lines  in  the  skin.  Yet  these  changes  may  occur  when 
pregnancy  does  not  exist.  I  have  seen  them  all,  combined,  more- 
over, with  the  presence  of  milk  in  the  breast,  in  a  woman  who 
had  never  been  pregnant. 

There  are  several  other  signs  which  have  more  or  less  value  as 
curroborative  evidence  of  the  existence  of  pregnancy,  but  their 
value  is  slight,  either  because  they  develop  late  in  pregoancy,  or 
because  by  themselves  they  have  little  signi  licance.  Those  which 
I  have  mentioned  are  the  ones  upon  which  reliance  is  to  be  placed 
in  making  a  diagnosis.  No  one  of  them  is  conclusive,  and  it  is 
ouly  when  two  or  more  are  associated  together  that  we  can  make 
even  an  approach  to  a  positive  diagnosis.  Even  although  all  be 
present,  a  diagnosis  cannot  be  absolutely  certain,  for  there  are 
CDoditions  other  than  pregnancy  in  which  all  of  them  may  exist. 
We  are  forced,  therefore,  to  the  conclusiou  that  in  the  early 
months  of  pregnancy  it  is  impossible  to  make  an  absolutely  posi- 
tive diagnosis;  that  is  to  say,  a  diagnosis  that  we  would  be  willing 
to  swear  to  in  a  court  of  law.  Yet  when  several  of  the  signs  are 
grouped  together,  the  picture  is  sufRciently  complete  to  enable  ns 
to  assure  the  patient  of  a  strong  probability  of  pregnancy.  Where 
momentous  Issues  are  at  stake,  however,  it  is  safer  for  us  to  reserve 
our  judgment  and  await  further  developments.     Fortunately  it  is 


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Abortiom;  Its  Pkevbntion  and  Teeatment.  808 

not  often  that  s  positive  diaguosia  becomes  oecessaiy  in  the  early 
moDtbe,  and  by  the  time  later  symptuma  establish  the  diagnosSa 
beyond  a  doubt,  the  woman  will  already  have  made  a  diagnosis 
for  herself.  It  is,  therefore,  my  rule  during  the  6rst  three  months 
ot  pregnancy,  when  consulted  by  a  patient  for  the  purpose  of  deter- 
mining this  point,  to  reserve  my  opinion,  to  avoid  committing 
myself,  and  to  wait  for  time  to  render  a  verdict  from  which  there 
«au  be  no  appeal. 


ABORTION;  ITS  PREVENTION  AND  TREATMENT.* 

By  W.  MONROE  SMITH,  M,D., 
Atlanta,  Ga. 

By  abortion  is  generally  meant  the  expulsion  of  the  ovum  before 
the  formation  of  tbe  placenta,  which  is  complete  at  the  end  of  the 
third  month.  But,  in  this  paper,  I  desire  to  include  by  tbe  term 
abortion  the  expulsion  of  the  fetus  during  the  first  three  or  four 
months  of  gestation. 

Tbe  study  of  tbe  method  of  conception,  development  of  the 
ovum  and  its  membranes,  the  reception  of  tbe  ovum  by  the  uterus, 
tbe  formation  of  the  decidua  and  nourishment  of  tbe  ovum,  is  of 
the  most  intense  interest,  but  does  not  belong  to  the  domain  of  this 
paper,  and  will  not  be  discussed. 

Abortion  in  all  of  its  phases  is  a  condition  which  every  general 
practitioner  must  treat,  and  there  is  nothing  which  tbe  physician 
encounters  that  is  dreaded  more  by  the  young  doctor  than  is 
abortion. 

From  personal  experience  abortion  is  very  frequent — i.  c,  rela- 
tively speaking.  Abortion  is  thought  by  some  writers  to  occur 
some  time  in  tbe  life  of  almost  every  married  woman.  Some  wo- 
men abort  frequently.  It  occurs  most  frequently  in  women  who 
have  borne  several  children,  but  is  by  no  means  rare  in  primiparie. 

Prediaposing  causes  of  abortion  may  be  either  fetal,  maternal  or 
paternal. 
•Pftpar  nad  bafore  tbe  AtJanU  Soclsty  of  II 


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804       The  Atlanta  Medical  and  Sdbqical  Jouenal. 

MaterDal  causes  may  be  endometritis,  retrodisplacemeat  of  the 
uterus,  laoeratioD  of  cervix  with  iDflaramatiou,  excessive  coitus, 
coughiDg,  falls,  blows,  diseases  of  the  decidua,  syphilis,  febrile 
aflectioDB  from  tbe  eruptive  diseases  or  from  typhoid  or  malarial 
poisons,  etc.' 

The  paternal  causes  are  syphilis  and  excessive  coitus. 

Petal  causes  are  diseases  of  the  appendages  (amnion,  chorion,  . 
oorl-placeota).  The  most  frequent  fetal  cause  of  aborrion  ia  per> 
haps  Byphi,litio  degeneration  of  the  villi,  which  cuts  off  the  nour- 
ishment of  the  ovum,  causing  its  deatb«nd  expuluon.  When  once 
the  attachment  of  the  ovum  to  the  uterus  has  been  rendered  inse* 
cure  from  any  of  these  numerous  causes,  accidente  which,  in  tbe 
absence  of  the  predisposing  condition  would  be  insignificant, 
suffice  to  terminate  the  pregnancy. 

Changes  in  tbe  ovum,  other  than  rupture  and  escape  of  tbe 
amniotic  fluid,  rarely  lead  at  once  and  directly  to  abortion. 

The  exciting  causes  which  induce  uterine  contractions  and  ex- 
pulsion of  tbe  ovum  reside,  for  the  most  part,  in  the  maternal 
system. 

When  the  predisposing  causes  have  operated  to  weaken  tbe  at- 
tachment of  the  ovum  to  the  decidua,  anything  which  determiuea 
tbe  blood  current  to  the  uterus  is  liable  to  produce  extravasation* 
of  blood  around  tbe  ovum  and  thus  awaken  uterine  contractions. 

Because  of  this  fact,  patients  predisposed  to  above  should  be 
surrounded  with  every  precaiuioo  during  the  periodic  menstrual 
congestion,  which  not  even  pregnancy  altogether  suspends. 

Fevers  from  any  cause,  inflammatory  condition  of  the  genital 
oi^ns,  excessive  coitus,  valvular  heart  disease,  obstructions  to 
the  circulation  of  tbe  lungs  and  liver,  hot  foot-baths,  may  each 
lead  to  rupture  of  the  decidual  vessels. 

Most  frequently,  however,  rupture  follows  jars  to  the  body  from 
coughing,  falls,  railroad  journeys,  from  vomiting,  violent  exercise 
and  the  like. 

Symptoms :  As  the  detachment  and  expulsion  of  the  ovum  oan- 
□ot  possibly  take  place  without  rupture  of  the  decidual  and 
placental  vessels,  hemorrhage  becomes  the  constant  and  necessary 
result  and  symptom  of  every  abortion.     In  the  first  few  weeks  the 


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Abobtion;  Its  Pbbvbntion  and  Teeatmbnt.  805 

syiDptoms  resemble  an  obstrusive  sod  profuiie  meDStruation. 
After  the  second  month  there  are  usually  prodromal  symptoms,  as 
fultnesB  and  wei){ht  in  the  pelvis,  sacral  paiDS,  frequent  micturi- 
tion, periodic  labor  pains,  with  some  watery  discharge.  These 
symptoms,  with  history  of  cessation  of  the  menses  and  some  hem- 
orrhage, suggest  a  threatened  abortion.  If  the  hemorrhage  be 
slight,  it  may  cease  and  the  pregnancy  go  on  undisturbed.  But 
oflener  the  hemorrhage  increases  in  amount  and  uterine  contrac- 
tions set  in  and  the  uvum  is  expelled. 

Usually  during  the  first  few  weeks  of  pregnancy  the  ovum  and 
the  membranes  are  expelled  entire. 

Where  abnormal  adhesions  attach  the  vera  and  serotina  to  the 
uterus,  retained  portions  of  the  membranes  may  remain  after  the 
ovum  has  been  expelled. 

In  another  class,  and  this  is  the  rule  after  the  third  month,  the 
fetal  membranes  rupture,  and  the  fetus  escapes  with  the  liquor 
amnii.  The  retained  portions  may  soon  follow  the  expulsion  of 
the  fetus.  But  it  frequently  happens  that  the  uterus  becomes 
inert  or  retracts,  the  os  closes  and  period  of  repose  follows.  This 
constitutes  an  incomplete  abortion. 

Most  frequently  hemorrhage  continues  until  the  retained  mem- 
branes are  expelled,  but  sometimes  the  hemorrhage  ceases  for  days, 
or  weeks,  and  then  reappears.  If  the  membranes  remain  any 
length  of  lime,  putrid  decomposition  is  quite  likely  to  set  in  and 
<^use  septic  inliection,  and  sometimes  produces  death. 

The  diagnosis  is  based  upon  pain,  hemorrhage,  dilatation  of  the 
<.-ervix  and  decent  of  the  ovum.  When  the  ovum  can  be  felt 
thi-ough  the  os,  the  diagnosis  is  certain.  It  is  hardly  probable 
that  a  polypus  would  be  mistaken  for  an  ovum. 

Prognosis  should  usually  be  good,  if  the  case  is  properly  treated. 
If  the  case  is  neglected  or  improperly  treated,  the  hemorrhage 
may  cootiuue  and  the  patient  die  from  acute  anemia,  or  septic 
infection  may  set  in  and  close  the  scene. 

Preventive  treatment  consists  in  carefully  considering  the  cause 
that  predisposes  to  abortion  and,  so  far  as  practicable,  in  remov- 
ing it. 

Women   who    frequently  abort  should    keep  the    bed    during 


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806       Thb  Atlanta.  Mbdioal  and  Sdesioal  Jouknal. 

each  lueDetrual  period.  If  there  be  retroflexion  or  retroversion 
of  the  uterus,  it  should  be  replaced,  aod  a  properly  fitting  pessary 
introduced. 

Lacerated  and  iaflamed  cervix  should  be  properly  treated. 

Where  abortion  has  occurred  several  times,  and  lo  the  absence 
of  other  reasonable  cause,  syphilis  may  be  suspected,  and  the 
iodides,  with  mercury,  should  be  administered. 

If  abortion  threatens,  patient  must  be  kept  in  bed,  uterine  and 
nervous  sedatives  freely  given.  In  my  bauds,  morphine  has  given 
me  the  best  results  as  a  nervona  sedative.  Yibumun  is  highly 
recommended  by  some  writers  as  a  specific  in  threatened  abortion, 
bnt  it  often  causes  nausea  and  vomiting,  for  which  reason  I  have 
abandooed  its  urte. 

I  have  used  aletris  quite  often  as  a  uterine  sei^ative  and  tonic 
ID  this  condition,  and  have  been  uniformly  pleased  with  the  re- 
sults. It  seldom,  if  ever,  causes  nausea  and  vomiting.  But  re> 
gardless  of  the  most  careful  and  skillful  treatment,  abortion  wilt 
often  occur, 

Wheu  abortion  becomes  inevitahte,  as  evidenced  by  pain,  con- 
tinued and  free  hemorrhage,  dilatation  of  the  cervix  and  decent 
of  the  ovum,  the  treatment  should  be  that  which  will  promptly 
empty  the  uterus.  If  the  uterus  does  not  promptly  empty  itself, 
especially  if  hemorrhage  is  considerable,  the  cervix  should  be 
dilated,  and  the  ovum  and  membranes  removed  with  the  finger  or 
dull  curette. 

Ciiloroform  is  given  if  necessary,  or  ether  if  preferred.  If, 
for  any  reason,  the  uterus  cannot  be  emptied  at  once,  and  hem> 
orrhage  is  threatening,  the  vagina  should  be  thoroughly  packed 
with  absorbent  cotton  made  into  tampons,  first  soaked  in  two  per 
cent,  solution  of  carbolic  acid  and  squeezed  dry.  Tampons  should 
he  tied  together  with  cord,  to  facilitate  removal.  The  tampons 
may  he  left  in  place  ten  or  twelve  hours  if  necessary ;  but,  where 
choice  can  be  had,  it  is  much  preferable  to  at  once  empty  the 
uterus,  wheu  all  anxiety  for  patient's  safety  should  be  over. 

In  incomplete  abortion  the  uterus  should  he  thoroughly  curetted 
with  dull  curette,  and,  it  hemorrhage  is  troublesome,  should  be 
packed  with  iodoform  gause  for  twelve  or  twenty-four  hours.     In 


^dbyGoOgle 


Retinal  Buroert  in  Crobs-Ete.  807 

all  cases  where  the  uterus  is  emptied  artifioially  it  should  be  done 
uuder  the  most  strict  asepsis  and  thoroughly  drenched  with 
bichloride  or  other  good  aotiseptic  hot  solutiou. 

The  after- treat  me  Dt  consists  in  rest  in  bed  and  attention  to  such 
details  as  coutribute  to  the  comfort  of  the  patient.  Ei^t  may 
be  given  to  aid  retraction  of  uterus  and  assist  involution.   • 


RETINAL  SURGERY  IN  CROSS-EYE  OR  STRABISMUS. 

By  a.  BETHUNE  PATTERSON,  U.D., 
Ati<anta,  Ga. 

I  deem  a  clearer  idea  of  the  indications  in  strabismus  or  cross- 
eye  essentia,  from  the  fact  that  the  impression  is  general,  not. only 
with  the  Isity  but  the  profession  as  well,  that  the  cutting 
and  setting  back  of  a  muscle  to  the  degree  of  straightening,  or 
apparently  straightening,  the  eye  is  all  that  can  be  desired,  from 
an  operative  standpoint. 

What  19  to  be  understood  by  the  word  "  cure,"  as  applied  to 
cross-eyes  ? 

It  is  not  only  straightening  the  eye  and  relieving  the  deform- 
ity, but  going  a  step  further  and  restoring  its  normal  function 
of  seeing  or  operating  with  its  fellow. 

It  is  a  fallacy  to  presume  that  this  physiological  function  takes 
place  as  soon  as  the  eye  regains  its  apparent  normal  position. 
That  this  statement  may  be  clearly  understood,  it  is  requisite  that 
we  first  understand  the  conditions  essential  to  normal  or  binocu- 
lar vision. 

In  the  first  place,  each  eye  receives  the  image  of  the  object 
observed,  their  refractive  conditions  being  equal.  While  there 
are  two  images,  only  one  appears,  caused  by  the  exact  overlap- 
ping. We  speak  of  (bis  phenomenon  as  fusion  of  images;  but  if 
one  eye  turns  either  in  or  out,  however  slightly,  double  images 
will  manifest  themselves;  the  greater  the  deviation,  the  greater 
the  separation  of  the  images.  When  slight,  the  images  are  nearly 
together;  if  the  distance  is  considerable,  the  image  of  the  deviat- 
ing eye  will  not  be  observed  unless  carefully  looked  lor.     As  a 


,„i,z.d  by  Google 


son       The  Atlanta  Medical  and  Bueqical  Journal. 

geaeral  thing  the  deviating  eye  quickly  learns  to  ignore  or  sup- 
press its  image,  a  wise  provision  of  nature,  as  double  images  are 
annoyiag  and  confusing. 

The  eye  is  carried  in  or  out  by  the  combined  action  of  several 
muscles.  Limited  space  deters  me  from  entering  into  a  discossioD 
of  the  action  of  the  extraneous  muscles  of  the  eyeball,  individu- 
ally or  colle<;tively. 

In  previous  articles  I  have  condemned  the  indiscriminate  tenot- 
omies of  the  internal  recti  muscle  in  convei^nt  squint.  I  have 
pointed  out  the  evils  of  the  operation,  and  the  fallacy  of  operating 
merely  to  improve  the  appearance. 

I  have  for  years  contended  that  no  surgical  operation  should  he 
resorted  to  until  the  refraction  was  understood,  all  errors  corrected, 
and  atropin  given  a  tsir  trial;  that  is,  whenever  the  peculiar  con* 
ditions  call  tor  this  course  of  management.  This  treatment 
proved  successful  in  a  la^  percentage  of  cases,  especially  in  the 
very  young,  when  taken  in  hand  as  soon  as  the  squint  appeared. 

Fifteen  years  or  so  ago,  it  was  the  rule  with  operators  to  advise 
a  postponement  of  surgical  interference  until  the  squint  became 
fixed,  and  the  child  reached  a  more  matured  age.  Experieoce 
has  taught  us  that  delays  in  these  cases  are  hazardous.  Children 
should  be  placed  under  treatment  as  suon  as  the  squint  is  observed, 
and  every  effort  made  to  correct  the  deviation  before  resorting  to 
tenotomy,  as  this  operation  alone  is  never  successful  in  reinstat- 
ing binocular  vision,  which  is  the  indication  I  regard  as  by  far 
the  most  important.  But,  on  the  other  hand,  the  setting  back  the 
muscles  certainly  greatly  complicates  the  case,  so  fax  as  binocular 
vision  is  concerned. 

Only  recently  the  attention  of  s  few  operators  has  been  turned 
to  the  matter  of  restoring  to  the  deviating  eye  the  faculty  of  work- 
ing with  its  fellow.  Heretofore  the  sule  aim  has  been  to  straighten 
the  eye,  and  thereby  overcome  the  deformity,  which,  by  no  means, 
invariably  proved  successful. 

It  is  essential  that  the  horizontal  and  vertical  meridians  of  the 
eyes  be  kept  in  their  normal  relations,  otherwise  binocular  viuon 
would  be  unobtainable. 

It  is  the  rule,  that  when  the  internal   recti  is  severed,  that  the 


^dbyGoOgle 


Rbtisal  Sdkqbrt  in  Cboss-Eye.  809 

eye  immediately  rotates  upou  its  axia,  aud  turns  upwards  (hyper- 
tropia).  This  turaiog  up  is  usually  one  of  the  complications  of 
the  convergent  squint,  and  becomes  more  accentuated  after  tenot- 
omy. 

Mr.  Nettleship  used  to  say,  when  doing  an  operation  for  conver- 
gent squint:  "Always  tell  the  parent,  before  you  oyerate,  that 
you  expect  the  eye  to  turn  up  a  little.  If  you  ueglect  to  do  so, 
they  are  apt  to  return  and  inform  yon  of  this  turning."  This 
complication  renders  binocular  vision  more  difficult  and  tedious  to 
obtain.  This  upward  turning  must  be  corrected  before  fusion  of 
images  can  result.  Eyes,  after  tenotomy,  are  uever  in  a  normal 
positiou,  however  much  they  appear  to  be. 

How  is  binocular  vision  to  be  determined? 

I  have  stated  that  straightening  the  eye  does  not  insure  physio- 
logical usefulness.  Then  how  are  we  to  know  when  the  eye  be- 
comes cognizant  of  its  image?  There  are  two  tests.  One  is  sim- 
ple and  easily  made  thus:  Take  some  reading- matter  where  the 
lines  extend  across  the  page,  hold  it  at  the  usual  reading  distanccr 
then  hold  a  pencil  or  penholder  vertically  four  or  five  inches  in 
advance  of  the  reading-matter.  It  will  be  observed  that  none  of 
the  letters  will  be  obscured  by  the  pencil,  if  binocular  vision 
exists;  but  if  only  one  eye  is  doing  the  work,  some  of  the  letters 
will  be  obscured,  which  will  necessitate  the  removal  of  pencil  or 
moving  of  the  head  to  see  obscured  letters.  If  this  experiment  is 
being  made  by  one  who  possesses  binocular  vision  and  desires 
proof  of  the  above  statement,  he  has  only  to  close  one  eye  to  find 
a  few  of  the  letters  obscured  by  the  pencil. 

Another  test,  the  name  of  which  has  escaped  my  memory,  con- 
sists of  six  letters  stained  on  glass,  alternate  red  aud  green.  Now, 
of  course,  either  eye  would  perceive  the  red  and  green  letters; 
but  place  before  the  right  eye  a  red  glass,  which  does  not  admit 
the  passage  of  green  rays,  and  a  green  glass,  through  which  red 
rays  do  not  pass,  before  the  left  eye,  and  if  the  normal  physiologi- 
cal condition  is  present,  both  red  and  green  letters  will  be  ob- 
served; but  if  only  one  eye  is  doing  the  work,  and  that  be  the 
right  eye,  then  only  the  red  letters  will  be  seen,  because  nothing 
green  can  be  seen  through  the  red  glass,  and  no  red  object  can  be 


^dbyGoOgle 


810    I   The  Atlanta  Medical  and  Shroical  Jodbital. 

observed  through  green.  If  only  the  left  eye  is  doing  the  work, 
only  the  green  letters  will  be  seen.  I  prefer  the  latter  test,  as  no 
errors  can  arise  in  making  it.  This  test  is  made  at  a  distance  of 
fifbeen  or  twenty  feet.  Place  the  colored  letters  in  front  of  a  win- 
dow, candle  or  gas-jet. 

I  have  sLioceeded  in  establishing  binocular  vision  in  only  a  few 
cases  where  the  muscle  had  been  set  back  by  tenotomy.  It  is 
apropos  to  state  that,  owing  to  the  tediousness  of  these  cases,  and 
the  time  and  patience  required,  very  few  cases  of  this  character 
are  undertaken.  These  patients  must  go  through  life  possessing 
two  good  eyes,  normal  in  acuteoess,  and  using  only  one. 

The  only  way  to  avoid  this  very  undesirable  condition  of  afiatrs 
is  to  steer  clear  of  tenotomies,  and  rely  upon  the  operation  of 
shortening  the  so-called  weak  muscle. 

In  a  future  article  I  propose  to  take  up  the  operation  of  short- 
ening a  muscle,  and  the  methods  used  in  restoring  binocular 
vision. 

507  English-American  Building.   . 


WHAT  KIND  OF  SHOES  WE  SHOULD  WEAR.* 

Br  G.  P.  BOBINSON,  M.D., 
Atlanta,  Ga. 

I  want  to  say  just  a  few  words  in  regard  to  the  abuse  that  exists 
in  regard  to  the  covering  of  our  children's  feet,  and  am  anxious  to 
gain  your  cooperation  and  assistance  in  doing  away  with  the 
present  narrow  and  so-called  fashionable  shoe.  I  hope  you  will 
call  the  attention  of  parents  to  the  bad  shape  of  the  ordinary  shoe 
now  worn,  and  the  possibilities  uf  deformity  and  pain  in  the  foot  as 
the  little  ones  reach  maturity. 

Dr.  Dean  has  shown  that  the  infant,  instead  of  being  flat-footed, 
as  is  ordinarily  taught,  has,  on  the  contrary,  the  arch  well  formed. 
The  anatomy  of  the  foot  allows  it  at  this  age  to  easily  bend  up 
against  the   tibia  on   account  of  the  laxity  of  the  tendo   achillis. 


•A  t&II  delWered  before  the  Atlanta  Society  of  Medicine,  Jana 


^dbyGoogle 


"What  Kind  of  Shoes  "We  Shodld  Wear.  811 

«nd  tbe  stretchiagof  the  plantar  fascia  gives  it  a  strong  resem- 
blance to  flat-foot.  As  the  child  begins  to  walk,  the  ioterDal  arch 
begins  to  break  down,  which  lasts  until  the  third  year.  The  arches 
of  both  feet  break  equally.  When  they  do  not  break  down  they 
are  presumably  of  light  weight.  From  the  third  year  oa  the  arob 
is  rebuilt,  one  foot  improving  before  the  other,  the  female  building 
before  the  male;  at  the  eighth  year  the  adult  type  is  complete. 

These  facts  should  all  be  borne  in  mind,  especially  the  ease  with 
which  the  arch  is  broken  down,  and  that  it  is  a  physiological  &ct.  A 
child  should  not  be  forced  to  walk  prematurely;  they  will  try  their 
feet  and  walk  suGBciently  of  their  own  accord  for  physiological  de- 
velopment. Training  children  to  turn  out  their  toes  puts  the  arch 
in  such  position  that  the  muscles  give  it  the  least  support. 

The  phalanges  of  the  great  toe  do  not  point  naturally  toward  the 
-outer  border  ot  the  foot ;  common  as  this  condition  is  in  the  adult, 
it  begins  in  the  child's  first  shoes.  Infant's  and  children's  shoes 
should  be  rights  and  lefts,  and  should  be  broad  enough  at  the  toes 
not  to  compress  either  the  great  or  little  toe.  The  shoes  should  be 
-comfortable  and  leave  eufGcient  room  for  development,  and  not 
-crowd  the  great  toe  toward  the  median  line  or  interfere  with  the 
proper  elasticity  of  the  foot.  The  elasticity  of  our  step  depends  on 
the  firm  pressure  on  the  great  toe  and  the  raising  of  the  body  on 
it  as  support.  Hence,  any  interference  in  the  normal  position  of 
the  great  toe  may  be  seen  iu  the  walk. 

The  ordinary  child's  shoe  on  the  market  is  symmetrical  and 
equidistant  from  the  median  line.  This  shape  crowds  either  the 
great  toe  toward  the  outer  line  of  the  foot  or  the  little  toe  toward 
the  median  line,  or  it  crowds  the  great  toe  outward  and  upward, 
causing  that  distressing  condition  known  as  hammer-toe.  I  have 
made  some  tracings  of  feet  of  children  who  have  run  bare-footed 
much  of.  their  life.  You  will  notice  how  straight  the  great  toe  is. 
The  inside  line  of  the  foot  is  nearly  straight,  widening  inward 
slightly  at  the  great  toe.  Ifyoudrawastraightliue  through  the  heel 
and  instep  and  then  carry  that  line  straight  through  the  plantar 
surface  of  the  foot,  you  will  find  that  line  runs  nearly  parallel  with 
the  inside  line  of  the  foot.  Notice,  also,  the  apparent  slight  curve  in 
the  whole  foot.     In  quite  young  children  you  will  notice  the  great 


^dbyGoOgle 


812       The  Atlanta  Medical  and  Surgical  Journal. 

breadth  at  the  toes.  This  fact  should  be  borne  in  mind  in  buyiog 
shoes  for  very  young  children.  Be  sure  to  get  ample  width  at  the 
toes,  the  inside  Hue  of  shoe  should  be  straight.  The  ordinary  in- 
put's shoe  sold  has  no  right  or  left,  nor  are  the  lines  right.  A 
line  drawn  through  the  center  of  the  heel  and  shanic  (instep)  of 
the  shoe  and  continued  ou  through  the  shoe  will  be  found  to  be 
equidistant  and  symmetrical  throughout.  This  is  very  badlorlhe 
young  growing  foot.  This  same  fault  is  also  seen  in  the  pointed 
shoe  of  older  children.  I  have  talked  with  Mr.  Carlton  and  he  has 
put  in  a  line  of  shoes  of  much  better  shape.  I  sincerely  hope  the 
profession  will  advance  this  missionary  work  as  far  as  lies  in  their 
power,  and  let  our  little  children  grow  to  adult  life  with  their  teet 
in  their  natural  and  normal  shape,  and  not  pinched  and  crowded 
into  misshapen  shoes,  causing  torture  but  little  short  of  such  as 
Chinese  children  endure. 

308  Englisk-Ameriean  Building. 


The  Centralblatt  far  CAirur^  publishes  an  article  by  S.  Kofmann 
describing  a  method  of  producing  local  anesthesia  by  producing  a 
local  anemia  by  the  application  of  an  elastic  tourniquet.  He  re* 
ports  several  cases  in  which  the  results  were  quite  satisfactory. 
Foreign  bodies  were  removed  from  the  hand.  Ingrowing  nails 
from  the  toes.  Tumorsremoved,absces6esopened,etc.  Heclaims 
to  be  so  pleased  with  the  method  that  he  now  rarely  operates  on 
the  extremities  in  any  other  way.  The  extremity  is  raised,  the 
elastic  ligature  applied  and  the  operative  area  cleaned.  The  con- 
striction should  be  complete  and  the  anemia  marked,  the  skin 
white  and  bloodless.  The  cases  reported  mention  complaints  of 
pain  due  to  the  constriction  of  the  elastic  ligature,  which  the  writer 
seems  to  consider  as  unimportant.  The  operation  must  not  be  begun 
at  once  after  the  application  of  the  tourniquet,  but  time  must  be 
allowed  for  the  anemia  and  anesthesia  to  appear. 


yOTICB.—  This  JOURNAL  and  TUB  INTEBNATIOSAZ, 
JO  VBNA  L  OF  S  VR  GBR  T  one  year  fw  $1. 0  0  cash. 


,„i,'z.d  by  Google 


CORRBSPONDBNCB. 


London,  January  1,  1899. 

I  will  give  briefly  some  observations  I  think  will  be  of  interest 
to  the  general  practitioner  as  well  as  the  specialist. 

I  find  that  the  specialist  of  Loudon  is  very  conservative,  not 
venturing  into  untried  methods. 

In  acute  middle-ear  inflammation,  at  the  ontet  of  the  attack; 
Dr.  Dundaa  Grant  treats  by  application  of  either  hot  fomentations 
or  by  irrigations  with  boiled  water  as  hot  as  can  be  borne,  either 
plain  or  normal  salt  or  boric  acid  2  per  cent.,  together  with  in- 
stillations of  sedative  drop  of  cocain  or  opium  or  a  small  quantity 
of  chloroform  on  a  pad  of  cotton  over  the  ear. 

If  pain  is  severe  leeches  to  the  tragus.  If  membrane  is  bulging 
a  free  incision  should  be  made  in  posterior  inferior  quadrant. 

In  general  aperients  are  advisable.  Tincture  aconite  ia  small 
doses  often  repeated,  pbenacetine,  etc. 

Suppurative  inflammation  of  the  middle  ear  is  an  exaggerated 
form  of  acute  catarrh,  and  should  be  treated  similarly ;  but  if  there 
be  deep-seated  pain,  especially  over  the  mastoid,  cold  should  be 
applied  but  not  continued  longer  than  forty-eight  hours,  as  the 
more  important  symptoms  are  masked  by  which  you  are  to  judge 
of  the  necessity  of  operative  interference.  In  all  these  cases  you 
should  suspect  adenoids  as  being  a  factor  in  its  causation,  and  when 
found  removed  after  the  acute  subsidence.  My  attention  was  espe- 
cially called  to  the  fact  of  the  general  omission  of  specialists  to 
look  for  adenoids  in  adults.  I  have  seen  a  number  of  adults  oper- 
ated oo  with  quite  an  improvement  not  only  to  their  hearing  but 
also  to  their  general  condition.  While  the  adenoids  are  very  small 
an  acute  coryza  causes  them  to  enlarge  three  or  four  times  their 
dormant  size,  and  in  this  way  setting  up  the  irritation  that  fre- 
quently causes  the  roiddle-ear  involvement. 

Tubercular  laryngitis  is  receiving  its  share  of  attention  in  IjOu- 


^dbyGoOgle 


814       The  Atlanta  Medical  and  Scroical  Jodenal. 

don,  and  the  best  resulte,  according  to  Mr.  Lenox  Brown,  are 
obtained  before  the  ulcerative  stage  sets  it  by  the  intra-tracheal 
injections  of  50  per  cent  guaiacol  in  almond  oil,  either  in  the  hy- 
peremic  or  anemic  form. 

After  ulceration,  cocainize  thoroughly  and  curette  every  point 
of  ulceration,  and  rub  full  strength  lactic  acid  in  with  a  rigid 
brush  every  two  days.  The  curettage  is  to  be  repeated  before  each 
application  of  lactic  acid. 

Internal  administration  of  guaiacol  carb.  or  ferri  and  manganese 
in  anemic  persons.  W.  C.  Warren,  M.D. 


CLoauRE  OF  Vesico-Vaqinal  Fistula  Following  Vaoinal 
Surgery.  (Chae.  P.  Noble,  Philadelphia.  Read  before  Phila- 
delphia Obstetrical  Society,  October,  1898.) 
Dr.  Noble  reports  a  case  where  a  vesico-va^nal  fistula  fol- 
lowed vaginal  hysterectomy  for  carcinoma  of  cervix.  The  opening 
into  the  bladder  easily  admitted  three  fingere,  through  the  vesico- 
vaginal septum,  the  fistulous  opening  extending  up  to  posterior 
wall  of  the  vagina  above  the  level  of  the  vagina.  The  right  edge 
of  the  vaginal  wound  was  infiltrated  with  cancer,  rendering  the 
operation  technically  moat  difficult,  and  we  would  believe  un- 
justifiable. It  was  necessary  to  dissect  the  bladder  loose  from  the 
vagina  in  front  and  also  from  the  subperitoneal  connective  tissue, 
as  well  as  from  the  broad  ligaments  about  the  insertion  of  the 
ureters.  This  was  difficult  on  account  of  the  fixed  condition  of  the 
parts,  and  from  the  fact  that  the  vagina  was  contracted  by  post- 
climacteric atrophy.  The  fistula  was  closed  with  a  fine  running 
catgut  suture  reinforced  with  interrupted  silkworm  gut.  The 
blander  was  drained  with  a  Sims  self-retaining  silver  catheter. 
The  sutures  were  removed  on  the  tenth  day,  but  leaking  continuiog, 
the  catheter  was  used  for  five  weeks,  resulting  in  perfect  closure. 

Noble  reports  two  other  similar  cases  showing  the  value  of 
prolonged  drainage  of  the  bladder  in  the  closing  of  fistula,  in 
one  of  which  the  bladder  was  invaded  by  the  malignant  growth 
and  was  opened  with  a  curette.  A  drainage  catheter  resulted  in 
closure  of  the  opening  in  ten  days. — McLaren.    . 


^dbyGoOgle 


SOCIETY  REPORTS. 


REGULAR  MEETING  OF  THE  ATLANTA  SOCIETY 
OF  MEDICINE. 

Atlanta,  Ga,,  Jauuary  19,  1899. 

The  meetiog  was  called  to  order  by  the  FreaideDt,  Dr.  "VV.  8. 
Goldsmith. 

The  following  members  were  present :  Drs.  Champion,  Chilrle, 
Crawford,  DuDcan,  Goldsmith,  Hardoo,  iintchins,  Kime,  G.  P. 
RobiDsoo,  Dunbar  Roy,  W.  MoDroe  Smith,  Claude  A.  Smith, 
Stirling,  VanGoidtsnoven. 

The  minutes  of  the  previous  meeting  were  read  aod  approved. 

The  application  for  membership  of  Dr.  C.  C.  Geer  was  read  and 
referred  to  the  Executive  Committee. 

Dr.  W.  Monroe  Smith  read  a  paper  upon  "  Treatment  of 
Abortion." 

DISCUBSION. 

Dr.  Hardon:  There  is  very  little  left  for  me  to  say,  as  I  think 
Dr.  Smith  has  covered  the  ground  admirably,  and  his  views  coin- 
cide with  my  own.  In  case  of  premature  expulsion  of  the  ovum, 
I  think  that  there  is  no  other  treatment  after  the  abortion  becomes 
inevitable  than  the  complete  dilatation  of  the  cervix  and  emptying 
of  the  womb.  This,  of  course,  means  an  operation,  but  it  is  en- 
tirely devoid  of  danger  if  properly  and  thoroughly  done.  If  it  is 
not  properly  done  there  is  a  great  deal  of  danger;  but  since  any 
operation  or  procedure  is  to  be  judged  only  by  the  results  when 
properly  done,  therefore  I  think  it  is  the  most  satisfactory  treat- 
ment. It  has  several  advantages.  In  the  first  place,  as  Dr.  Smith 
has  said,  it  saves  time,  not  for  the  physician,  but  for  the  patient, 
and  lessens  her  suspense  and  anxiety.  As  Dr.  Smith  says,  the 
plan  of  tamponing  the  vagina  involves  a  delay  of  from  twelve  to 
twenty-four  hourf  if  we  get  suitable  results,  and  this  is  doubtful. 


^dbyGoOgle 


816       The  Atlanta  Medical  and  Susgical  Journal. 

If  we  control  the  bemorrbage  thoroughly  we  must  pack  the  vagina 
to  its  utmost;  and  the  first  time  a  physician  tries  it  he  is  astooiahed 
at  the  amount  of  cotton  necessary,  as  from  one  to  two  pounds  will 
be  needed  to  absolutely  pack  the  vagina.  This  amount  left  for 
twenty-four  hours  gives  more  pain  than  arises  from  the  abortion. 
Another  objection  is  that  it  is  not  easy  to  do  it  thoroughly,  as  it 
will  often  happen  that  the  blood  will  escape  and  the  hemorrhage 
go  on.  These  are  serious  objections ;  the  pain  and  delay  are  seri- 
ous, and  that  we  cannot  be  sure  of  controlling  the  hemorrhage  is 
equally  serious. 

By  dilating  the  cervix  and  thoroughly  removing  the  contents 
we  know  when  it  is  empty.  Unless  we  explore  the  entire  womb  we 
can  never  be  sure  that  it  is  completely  empty.  I  make  it  a  rule 
never  to  treat  a  case  of  abortion  without  exploring  with  my  finger 
and  fiudiug  whether  it  is  thoroughly  emptied.  At  the  same  time, 
if  we  are  going  to  pass  the  finger  into  the  uterus,  it  is  very  little 
more  of  an  operation  to  pass  in  the  curette  and  curette  thoroughly, 
and  I  irrigate  at  the  same  time  the  curetting  is  going  on.  I  have 
often  read  that  the  best  instrument  for  emptying  the  womb  is  the 
finger,  but  I  have  not  found  this  to  be  so.  It  is  hard  to  grasp 
fragments  with  the  fingers  and  you  are  apt  to  do  damage.  I  pre- 
fer the  double  curette.  In  regard  to  the  antiseptic  solution,  I 
always  use  the  bichloride  solution.  I  have  seen  only  one  case  in 
which  there  was  unpleasant  results  from  the  use  of  the  bichloride 
,and  it  was  then  used  in  the  strength  of  1— 2000th.  It  should  not 
be  used  so  strong.  I  use  l-5000th,  and  have  never  seen  any 
trouble  with  this.  I  compliment  Dr.  Smith  upon  the  excellence 
of  his  paper. 

Dr.  Stirling:  This  question  is  hardly  one  in  which  I  have 
any  special  interest,  but  I  can  remember  having  the  pleasure  of 
attending  a  good  many  of  these  cases.  I  arise  to  ask  a  question. 
In  (hose  days  it  seemed  the  difficulty  was  that  the  cervix  would 
not  dilate,  but  it  would  close  and  you  could  not  tell  whether  the 
fetus  was  expelled  or  not.  I  have  heard  lately  that  cocain  ap- 
plied would  open  it,  and  I  arise  to  ask  if  this  is  the  e.'tperience  of 
any  one  here? 

Dr.  Duncan:     I  don't  think  I  have  anything  to  add  to  what 


^dbyGoOgle 


Society  Reports.  817 

lias  beeD  gaid.  Dr.  Smith  says  he  prefers  morphine  as  a  nerve 
«edative;  I  thiok  we  all  do  that,  but  I  would  not  discard  the  vi- 
burnum prunirolinm.  It  has-  acted  well  with  me,  and  have  not 
had  the  nausea  which  he  mentioos.  Id  regard  to  the  curette,  I 
have  had  great  difficulty,  as  Dr.  Hardou  says,  id  removing  the 
ovum  with  the  fiDger,  but  I  prefer  to  use  this  as  I  am  not  familiar  . 
with  the  use  of  the  curette.  I  have  succeeded  with  the  finger  in 
«very  iustaDce,  although  it  is  difficult  in  some  cases.  I  have  not 
had  the  esperieuce  with  the  curette  that  others  have  had  and  I 
hesitate  to  use  it.  The  dull  curette  I  consider  safe  but  the  sharp 
curette  I  do  not,  and  the  finger  is  perfectly  safe  when  properly 
used.  The  plan  of  dilating  the  cervix  is  the  correct  thing  when 
the  abortion  is  inevitable. 

Dr.  Kime:  This  is  a  subject  in  which  all  practitioners  are  in- 
terested. I  was  very  much  interested  in  the  paper  and,  in  the 
main,  agree  with  it,  but  I  cannot  say  that  I  agree  that  morphia  is 
the  best  to  prevent  the  expulsion  of  the  fetus.  -The  combination 
which  has  given  me  the  best  success  is  codeine,  bromides  and 
liquor  sedans.  When  I  fail  with  this  then  I  empty  the  uterus. 
The  objection  that  I  have  to  morphia  is  that  it  makes  them  sick 
and  constipates  the  bowels,  but  with  the  other  you  get  not  only 
the  nerve  sedative  of  the  bromides  hut  you  get  the  narcotic  effect 
of  the  viburnum.  I  cannot  say  that  I  fully  agree  on  the  question 
of  tamponing  the  vagina  to  prevent  hemorrhage.  My  experience 
has  not  been  as  unfortunate  as  that  of  the  doctors  who  have  spoken. 
However,  1  do  not  advocate  it  as  routine  work.  Here  in  the  city 
we  are  in  easy  reach  of  all  the  necessary  instruments,  etc.,  for  di- 
lating the  cervix  and  curetting,  but  it  is  not  so  with  the  majority 
of  the  country  and  general  practitioners.  When  you  get  out  eight 
or  (ea  miles  into  the  country  you  have  to  resort  to  something  else 
when  you  do  not  have  the  instruments  with  you.  In  cases  in  which 
the  abortion  is  inevitable  I  do  not  think  anything  is  better  than 
the  tamponing.  I  take  a  strip  of  gause  and  carry  it  up  into  the 
cervix  and  then  put  in  a  small  amount  of  cotton.  I  do  not  pack 
the  vagina  full,  and  have  never  used  more  than  a  quarter  of  a  pound, 
but  have  always  controlled  the  hemorrhage  with  this. 
■     As  to  the  question  of  using  the  curette  or  the  finger,  I  have  found 


^dbyGoOgle 


818       The  Atlanta  Mbdical  and  Surgical  Journal. 

that  I  could  do  better  with  the  iDstruaieut  thao  with  the  finger.  I 
have  found  the  ordiaaiy  sponge- holding  forceps  excellent  to  remove 
any  particles  and  then  I  curette  the  placental  site. 

As  to  irrigation,  I  have  been  in  the  habit  of  usiog  the  bichloride 
solution,  and  I  have  not  seen  any  trouble  following  it,  as  there  is 
very  little  risk  in  a  solution  of  1-4000,  which  is  the  strength  I  use. 
I  have  always  used  a  tittle  camphorated  phenol  for  24  to  48  hours, 
and  this  acts  as  a  stimulant  as  well  as  an  antiseptic.  While  speaking 
on  the  liue  of  infection,  I  would  say  that  I  believe  that  90  per  cent 
of  inlections  are  of  putrid  infection  and  not  septic  infection  after 
abortion. 

Two  little  instruments  have  been  called  to  my  attention  for  re- 
moving the  contents  of  the  uterus  afler  abortion,  and  I  think  they 
are  better  for  the  general  practitioner  than  the  curette.  I  have 
used  them  in  several  cases  and  have  had  good  results,  except  in  one 
or  two  cases  where  there  was  abnormal  condition  of  the  uterus.  I 
have  not  been  in  the  habit  of  using  the  irrigator  curette,  as  it  inter- 
feres with  the  delicacy  of  touch. 

Dr.  W.  Monroe  Smith  (closing  the  discussion):  In  regard  to  the 
use  of  cocain  to  dilate  the  cervis,  1  have  never  had  that  suggested 
before  and  have  never  used  it  in  my  practice.  I  have  used  the  di- 
lators, which  act  on  the  same  principle  as  a  pair  of  forceps  and 
which  is  introduced  into  the  cervix  and  then  by  pressing  the  handles 
the  blades  are  separated. 

I  heartily  agree  with  the  method  of  passing  the  finger  into  the 
uterus  to  be  sure  that  it  is  empty,  and  I  have  found  it  a  good  pre- 
caution. I  have  used  the  liquor  sedans  with  very  nice  results  and 
do  not  remember  a  case  with  nausea,  but  I  have  had  nausea  in  two- 
thirds  of  the  cases  where  I  have  used  simply  the  viburnum,  and  as 
nausea  is  a  frequent  cause  of  abortiou,  I  have  avoided  using  it. 
Codeine  is  good,  and  where  I  find  the  nausea  in  some  people,  I 
then  use  the  codeine,  but  my  experience  with  it  has  been  (bat  it 
constipates  the  bowels  about  as  badly  as  any  other  preparation  of 
opium. 

The  President  stated  that  Dr.  Butler  would  be  unable  to  be 
present  to  read  his  paper  upon  "Traumatic  Aneurism,"  but  that 


,„i,z.d  by  Google 


Society  Rbpokts.  819 

Dr.    G.  P.  RobiDBOD    would   read   a   paper    upon    "Footwear  of 
Children." 

DISCUSSION. 

Dr.  Rardon:  I  have  nothiog  to  say  about  shoes,  but  would  like 
to  relate  an  iocident.  Yesterday  I  was  in  the  house  of  a  physician 
and  his  wife  spoke  about  sufiTeriog  a  great  deal  with  her  feet.  I 
glanced  down  at  her  foot  and  saw  that  she  wore  a  long  narrow 
shoe,  iDOre  like  a  tooth-pick.  I  called  her  attention  to  the  shoe, 
but  it  was  impossible  (o  convince  her  that  her  trouble  was  due  to 
the  shoes,  and  I  suppose  she  will  go  on  wearing  such  shoes.  It 
convinced  me  as  much  as  any  one  case  could  convioce  one.  We 
see  cases  often  and  I  hope  the  paper  of  Dr.  Robinson  will  lead  to 
good  results. 

J}r.  Stirling:  I  have  nothing  to  say  except  to  thank  Dr. 
Robinson  for  his  kindness  in  informing  us  where  we  can  obtain 
these  common-sense  shoes,  and  am  glad  that  one  store  will  have 
them. 

Dr.  Sutchins:  This  paper  is  something  that  is  very  interesting 
for  one  who  has  to  buy  shoes  for  children.  Some  people's  feet  are 
naturally  easy  to  fit  and  they  can  get  a  shoe  that  is  comfortable  from 
the  start.  I  have  found  that  I  can  get  a  shoe  in  the  store  that  will  fit 
me  better  than  to  have  one  made.  In  the  case  of  my  little  girls, 
oue  of  them  is  very  easily  fitted  and  it  is  no  trouble  to  get  a  shoe 
that  is  comfortable  and  fits  perfectly,  while  with  the  other  one,  it 
is  difficult  to  get  a  comfortable  shoe.  As  regards  the  appearance 
and  shape  of  shoes,  people  go  by  the  custom  and  not  by  what  is 
best  for  them. 

Dr.  Kime:  This  is  a  question  in  which  we  are  all  interested, 
especially  if  we  have  corns.  I  have  long  since  adopted  a  common- 
sense  shoe,  but  in  my  younger  days  I  did  not  have  quite  such  good 
judgment.  In  children  it  is  the  formative  stage  and  they  should  be 
fitted  properly  then.  I  think  this  is  a  step  in  the  right  direction, 
but  so  long  as  it  is  the  fashion  to  wear  a  sharp-pointed  toe,  it  is 
bard  to  get  the  people  to  wear  a  sensible  shoe ;  but  it  is  not  so  hard 
to  start  the  fashion  for  children,  and  we  should  direct  our  attentiou 
to  this. 


^dbyGoOgle 


820      •  The  Atlamta  Medical  ahd  Sdrgical  Jouknal. 

Dr.  Van  Ooidtvnoven:  I  arise  to  thaDk  Dr.  Robinsoo  for  his 
paper,  and  hope  he  will  have  it  published. 

Dr.  Duncan:  I  thiDk  the  paper  is  very  opportune  if  children  will 
wear  shoes,  but  I  think  the  pareote  should  think  of  how  much 
happier  and  better  off  they  would  be  if  they  did  not  wear  shoes 
until  seven  or  eight  years  of  age.  They  would  have  less  colds  and 
would  be  healthier  every  way.  When  they  wear  shoes  they  get 
their  feet  wet,  and  let  them  stay  wet,  and  thus  they  take  cold.  I 
knew  a  preacher  who  would  not  put  shoes  on  his  children  UDtil 
they  were  four  or  five  years  of  age.  It  was  remarkable  how  well 
they  kept,  but  after  this  age  every  one  had  colds.  I  really  believe 
that  the  wearing  of  shoes  is  injurious  to  children,  not  only  from  the 
shape  of  the  shoes,  but  by  keeping  them  off  the  ground. 

Dr.  Robinson:  I  think  it  would  be  a  good  thing  to  let  the 
children  run  bare-toot  sometime,  hut  it  would  be  rather  bad  this 
time  of  the  year. 

The  reason  I  brought  up  this  paper  was  on  account  of  the  in- 
fluence the  physiciaos  might  exert  over  the  mothers.  Mothers  will 
do  almost  anything  for  their  children,  and  if  you  convince  them  of 
the  injurious  effects  it  will  not  be  difficult  to  get  them  to  change. 
The  people  in  New  York  and  Boston  are  taking  a  sensible  view  of 
this  matter,  and  are  wearing  only  the  broad-loed  shoe.  The 
dealers  cannot  sell  these  narrow-toed  shoes.  All  that  is  neeessary 
is  a  little  missionary  work  on  the  part  of  each  oue  of  the  profes- 
sion. 

RELATION    OP    CASES. 

Dr.  Crawford:  A  case  of  some  interest  came  before  me  some  two 
or  three  weeks  ago.  It  was  a  tooth  in  the  left  nostril.  The  party 
was  about  33  years  of  age,  and  came  to  me  with  some  nose 
trouble.  I  esamioed  the  nose  and  found  a  granular  mass  in  the  floor 
of  the  left  nostril.  I  put  a  little  cocaine  on  it  and  took  a  scalpel 
and  prized  it  open  and  found  an  ivory  looking  substance,  and  de- 
cided it  was  a  tooth.  I  had  never  seen  such  a  thing  in  that  posi- 
tion before,  and  I  showed  it  to  some  dentists,  and  they  found  that 
I  was  correct.  With  my  bistoury  I  cut  through  the  granular 
mass,  and    with   a    pair   of  artery    forceps,  was  able    to  lift   the 


^dbyGoOgle 


HociETT  Reports.  821 

tooth  out.  It  was  nearly  the  original  size,  and  it  vraa  driven  from 
its  natural  position  into  the  nose.  He  said  that  some  fourteen  years 
ago,  be  had  fallen  against  the  mantel,  and  struck  his  tooth  and 
knocked  it  out,  but  could  uot  find  it.  One  point  of  interest  was 
the  force  that  was  necessary  to  drive  this  tooth  through  the  small 
socket  and  up  into  the  nostril.  Evidently  this  had  given  him  a 
great  deal  of  trouble.  Perhaps  he  did  not  notice  the  condition  very 
much,  but  he  said,  however,  that  he  had  gone  to  a  specialist  some 
ten  years  before  for  this  trouble,  but  failed  to  detect  this  tooth  then. 
The  root  of  the  tooth  was  in  perfect  order,  but  the  body  was  more 
or  less  decayed  or  broken  off. 

Dr.  Hutekins:  A  case  was  brought  to  me  last  week  from  the 
country  by  a  doctor,  and  he  and  every  one  believed  it  to  be  malig- 
nant. The  patient  had  extracted  a  left  molar,  wisdom  tooth,  and 
there  grew  from  this  a  soft  sessil  growth.  The  doctor  bad  been 
burning  this  down  and  it  grew  back  very  rapidly.  It  was  supposed 
to  be  a  sarcoma.  I  broke  offa  piece  of  the  growth  very  easily  and 
bad  it  mounted,  and  I  would  say  that  I  got  all  sorts  of  malignant 
diagnoses,  which  illustrates  how  hard  it  is  to  diagnose  a  sarcoma 
under  the  micro3co|)e  without  the  cliaical  history.  At  first  glance 
under  the  microscope,  it  looked  as  if  it  was  a  small,  round-celled 
sarcoma.  There  were  all  kinds  of  growth  of  the  mucous  membrane. 
I  simply,  finally,  made  a  diagnosis  of  polypoid  growth  of  the  gum^ 
and  curetted  thoroughly,  and  I  think  the  patient  will  get  well. 
There  was  no  evidence,  clinically,  of  sarcoma.  One  thing  that 
seemed  to  impress  the  doctors  in  the  country  was  that  the  patient 
had  had  a  polypoid  growth  in  the  cheek,  and  they  were  inclined  to 
attribute  this  growth  to  the  one  inside. 

Another  case  I  was  undecided  whether  it  was  gumma  of  the 
tongue  or  sarcoma.  I  have  not  yet  diagnosed  it.  The  patient  has 
a  large  ulcer  which  has  been  cultivated  by  the  use  of  nitrate  of 
silver.  The  patient  objected  to  an  operation,  and  under  the  use  of 
iodides,  dtc,  is  getting  better.  However,  the  case  is  still  sub  judiae. 
The  iodide  is  being  used  as  an  aid  to  diagnosis.  If  it  was  a  gumma, 
of  course  would  expect  more  than  one.  It  is  a  very  muched  mixed 
up  case. 


^dbyGoogle 


EDITORIAL  NOTES  AND  COMMENTS. 


Ttie  Boslness  office  of  Thi  JoCbHaL  is  SCC.  SO*  Fltten  Building. 

The  EilltorUl  office  IB  RoomB  401, 109  Grand  Opera  House. 

Address  &11  Business  communication b  to  Dr.  M.  B.  Hutcblna,  Ugr. 

Make  remlciancei  parable  to  the  Atlahii  Hedicil  xvd  BuBoicAt  JouKNU* 

On  matter!  pertaining  to  the  Editorial  aud  Original  oonununlcatloni  addrea  Dr.  Dunbar 
Ror.  Grand  Opera  Housa,  Atlanta. 

Keprinta  ot  original  articles  will  be  tumlsbsd  at  oo«t  price.  Beqaeats  tor  the  same 
should  alwajs  be  made  on  the  manutcript. 

We  will  present,  post.pald,  on  request,  lo  each  contributor  ol  an  OTlglnal  article,  twenty 
|3U)  marked  copies  ot  Thi  JoDBHALOontalnlngsuch  article. 


BAR  DISEASE  AND  LIFE  INSURANCE. 

THIS  subject  has  recently  been  handled  by  Dr.  P.  M.  McBride, 
of  Edinbui^h,  in  an  article  read  before  tbe  British  Medical 
Association.  The  subject  is  a  timely  one  and  has  been  very  rarely 
considered  in  its  relationship  to  life  insurance.  We  canuot  fully 
agree  with  Dr.  McBride  in  many  of  his  deductions,  but  be  has 
certainly  presented  much  food  for  thought.  We  believe  that  he  i« 
too  extreme  in  hie  views  in  rejecting  persons  for  insurance  who 
show  certain  lesions  of  the  ear.  For  instance  we  find  these  words, 
"thus  I  would  certainly  reject  a  case  in  which  polypi  or  granula' 
tions  were  present."  Such  a  statement  as  that  could  not  be 
allowed  to  go  unchallenged.  After  all,  Dr.  McBride  speaks  from 
his  own  personal  experience,  and  perhaps  such  a  pathological  con- 
dition may  be  always  serious  in  Edinburgh,  but  this  certainly  does 
not  apply  to  this  section  of  the  country.  The  presence  of  polypi 
or  granulations  in  the  middle  ear  does  not  indicate  that  the  ear 
itself  is  destroyed  much  less  that  it  is  likely  to  prove  fatal  to  life. 
Ears  of  this  nature  are  always  a  menace  to  their  possessor  and  yet 


^dbyGoOgle 


Editorial.  828 

we  have  seen  such  a  coodition  cured  time  and  agaia  and  a  useful 
aural  appendage  restored.  We  do  uot  think  that  such  a  sweeping 
statement  should  be  made,  but  rather  hold  such  an  applicant  in 
abeyance  until  it  is  seen  whether  or  not  the  pathological  condition 
can  be  removed.  Many  excellent  risks  would  otherwise  be  de- 
barred from  a9tive  life  iosuraoce  should  such  ideas  be  adhered  to. 

Then  again  we  read  the  following  statement  from  the  same 
article:  "The  presence  of  diseased  bone  is  of  course  an  absolute 
bar  to  acceptance,  while  the  same  is  true  of  cholesteatoma  of  the 
middle  ear."  This,  too,  should  be  qualified,  for  there  are  cases  of 
suppurative  otitis  media  which  can  be  cured,  and  these  same  cases 
may  at  the  beginning  show  some  diseased  bone.  Here  again  an 
applicant  should  not  be  rejected  until  it  is  seen  whether  or  uot 
such  an  ear  is  curable.  No  broad  absolute  statement  like  the 
above  should  be  made.  In  concluding,  Dr.  McBride  sums  up 
certain  points  well  worthy  to  be  known: 

"There  are,  however,  a  considerable  number  of  cases  in  which 
none  of  these  complications  exist — in  fact,  where  we  have  only 
perforated  membrane  through  which  pus  is  discharged.  Tn  esti- 
mating such  cases  we  must  be  guided  by: 

"1.  The  Perforation. — If  it  be  small  and  high  up  in  the  mem- 
brane the  risks  are  greater  than  if  it  be  large  and  lower  down. 

"2.  The  Amount  and  Character  of  the  Discharge. — If  this  be  in 
very  large  quantity,  and  more  particularly  if  it  be  copious  and 
fetid,  the  case  should  be  rejected. 

"3.  The  Social  Position  and  Habits  of  the  Paiient. — I  cannot 
but  lay  very  great  stress  upon  this  point,  for  in  my  experience 
fatal  cases  of  ear  disease  are  relatively  far  more  common  among 
the  poorer  classes,  in  whom  there  is  generally  a  tendency  to  neglect 
a  discharging  ear  so  long  as  no  paiufui  symptoms  arise. 

"Given  a  case  of  uncomplicated  ear  suppuration,  what  are  the 


^dbyGoOgle 


824       The  Atlanta  Medical  and  Sdrgical  Journal. 

objective  cbaracteristics  which  m&ke  us  take  a  relatively  iavoreble 
view  of  the  case? 

"Id  the  first  place  the  discharge  must  be  small  in  amount  and 
not  fetid.  A  source  of  fallacy  must  be  guarded  against  here.  We 
sometimes  meet  with  very  large  perforations  amounting  to  destruc- 
tion of  almost  the  whole  tympanic  membrane,  in  which  there  b 
only  a  small  amount  of  pus  secreted,  and  do  very  marked  fetor  is 
detected  by  the  superficial  observer.  In  these  cases,  however,  a 
bent  probe  introduced  into  the  attic  of  the  tympanum  will  be  found 
extremely  offensive  when  removed.  Again,  in  some  cases  of  per- 
foration of  Shrapnel's  membrane  the  discharge  may  for  a  time  be 
almost  sweet;  bat,  again,  a  probe  introduced  can  be  made  t«  re- 
veal the  fallacy.  There  is,  however,  another  farm  of  middle-eur 
suppuration,  in  which  the  perforation  is  of  a  fair  size  and  usually 
in  the  lower  part  of  the  membrane,  the  dischai^  is  slightly,  if  at 
all,  fetid,  and  may  be  muco-purulent  in  character,  and  olten 
ceases  for  long  periods  after  appropriate  treatment.  In  these 
cases,  I  think  we  may  say  that  there  is  a  minimum  of  risk.  Again, 
when  a  discharge  has  lasted  for  many  years  without  ever  causing 
pain,  when  it  has  remained  small  in  amount,  and  when,  altbougb 
untreated,  it  has  not  given  rise  to  granulations,  the  conditions 
seem  to  me  relatively  favorable." 

"I  have  not  attempted  to  give  a  complete  account  of  ear  disease 
in  its  relation  to  life  insurance,  but  rather  to  indicate  some  of  the 
points  which  seem  to  me  deserving  of  consideration.  I  leave  it  to 
those  who  are  statisticians  to  decide  how  far  the  figures  which  I 
have  adduced,  meager  as  they  are,  can  be  utilized  to  arrive  at  any 
definite  conclusion  as  to  the  dangers  of  suppurative  ear  disease, 
more  especially  when  they  are  considered  together  with  the  un- 
doubted fact  that  some  forms  are  very  much  less  likely  than  others 
to  lead  to  dangerous  complications." 


^dbyGoOgle 


SO-CALLED  CHRISTIAN  SCIENCE. 

SINCE  the  uutimely  death  of  Harold  Frederic,  in  England,  who 
was  at  that  time  under  the  medical  care  of  a  woman  Christian 
Scientist,  the  medical  journals  have  been  teeming  with  para- 
graphs condemning  the  practices  of  this  sect  of  people.  In  the 
case  of  Frederic,  it  was  ascertained  from  a  court  of  inquiry  that 
his  life  might  have  been  saved,  or  at  least  much  prolonged,  had 
he  received  rational  scientific  treatment  from  a  reputable  physician. 
The  English  papers  especially  are  very  severe  in  their  criticisms, 
aud  this  seems  to  be  the  general  sentiment  also  on  the  continent. 
The  St.  James'  Gazette,  published  in  London,  is  very  pronounced  in 
its  ideas.  It  says:  "  Apart  altogether  from  this  individual  case,  ' 
which  has  resulted  in  the  lose  of  a  liTe  of  much  promise,  we 
trust  that  the  prominence  now  given  to  the  methods  of  the  enter- 
prising American  ladies  who  are  making  a  fat  living  out  of  the 
weak-minded  and  crednlous,  will  result  in  their  receiving  system- 
atic treatment  at  the  hands  of  the  criminal  ioTestigation  depart- 
ment and  the  director  of  public  prosecutions.  The  vulgar  quack, 
or  vender  of  '  charms,'  is  watched  and  moved  on  by  the  police, 
and  there -is  no  reason  why  these  people,  simply  because  they  add 
blasphemy  and  pseudo-science  to  the  old-lashioned  procedure, 
should  flourish  unchecked.  In  France  or  Germany  they  would 
find  themselves  in  prison  or  across  the  frontier  in  a  week,  and  we 
trust  there  is  some  equally  effective  weapon  in  the  hands  of  our 
own  police." 

This  is  severe,  hut  to  all  intelligent  thinking  people  it  is 
deserved. 

The  Standard,  the  Daily  News,  the  Morning  Post,  Oraphie,  and 
fjeader,  all  prominent  English  papers,  demand  "  summary  punish- 
ment for  the  i>eopte  who  caused  llarold  Frederic's  death,"  and 
some  few  of  the  editorial's  contain  remarks  which  are  anything  hut 

J 

DiclzedbyGoOgle 


826       Thb  Atlanta  Medical  asd  Surgical  Journal. 

flattering  to  this  country,  from  which  this  "  pagan  euperstitioD "  ia 
supposed  to  have  been  imported. 

The  Medical  Newg  informs  us  that  "  for  the  second  time  wtthiD 
two  weeks,  a  CinciDnati,  Ohio,  jury  convicted,  and  a  Ciucinsati 
judge  has  fined,  a  practitioner  of  'Christian  Science/  who  had 
been  arrested  on  the  ohai'ge  of  violating  the  State  law  which  for- 
bids any  but  duly  licensed  doctors  to  treat  the  sick  for  hire," 

Since  the  time  of  Frederic's  death,  more  than  half  a  doeeo 
other  deaths  have  been  reported,  which,  in  all  human  probability, 
stood  an  ezcelieut  chance  for  recovery  under  the  appropriate  care 
of  a  physician. 

Even  in  Atlanta,  the  death  of  one  man,  who  would  not  call  in 
a  regular  physician,  but  continued  under  tbe  administration  of 
one  of  the  attaches  of  tbe  Christian  Science  sect,  brought  forth 
loud  cries  of  indignation  from  the  neighbors  around.  Surely  it 
is  time  for  physicians  to  take  a  prominent  stand  against  such 
iniquitous  and  uncivilized  proceedings!  But  there  is  another 
aspect  of  the  subject  which  we  wish  to  speak  of,  and  which,  in 
itself,  is  a  partial  guarantee  for  the  safety  of  the  public :  Tbe 
Atlanta  Christian  Science  church  has  grown  so  large  that  their 
present  quarters  are  inadequate,  so  that  they  are  now  erecting  a 
temple  to  meet  these  demands.  Atlanta,  as  the  Mecca  of  Christian 
Science,  is  to  the  South  what  Bo.^ton  is  to  the  North.  Id  the 
church,  as  we  understand  it,  there  are  a  number  of  "  administers," 
who  are  delegated  with  the  power  of  healing  physical  suffering, 
and  these  "administer,"  either  in  the  church  or  at  the  homes  of 
the  patient.  This  administration  is  not  entirely  gratuitous,  for  it 
is  one  of  the  ways  for  raising  funds  for  the  sustenance  of  tbe 
church,  but  more  especially  for  the  "administrator." 

The  charges,  as  we  bear,  are  one  dollar  for  each  "  administra- 
tion," and  some  of  them  even  have  offices,  just  as  regular  practic- 
ing physicians.     Now  this  is  totally  in  violation  of  tbe  State   law 


^dbyGoOgle 


Editokial.  827 

governiog  the  practiciog  pbysioian,  which  clearly  sayB  that  such 
"  niuet  be  a  graduate  of  a  regularly  incorporated  medical  college  in 
good  staQding,  and  must  have  stood  an  examination  before  the 
Slate  Medical  Examining  Board,  and  have  received  a  license  from 
such  before  they  can  practice  in  the  State."  This,  of  course,  ia 
applicable  only  to  those  who  receive  fees  for  their  services.       * 

The  Christian  Scientist  charges  one  dollar  for  his  or  her,  usually 
her,  "administration,"  and  in  doing  so  violates  the  laws  of  the 
State,  and  is  punishable  with  Gne. 

Still  this  practice  goes  on  right  in  the  oity  of  Atlanta,  and  the 
State  authorities  have  not  interfered.  This  should  be  brought  to 
their  attention  by  the  State  Medical  Examining  Board,  and,  as 
in  Cincinnati,  steps  taken  for  its  correction. 

"  A  word  to  the  wise  is  sufficient." 


THE  Atlanta  Medical  and  Surgical  Journal  has  now, 
more  than  ever,  entered  the  fifld  of  progressive  activity. 
We  refer  to  its  past  achievements,  in  giving  to  the  profession  one 
of  the  best  and  cleanest  medical  periodicals  in  the  South,  with  a 
feeling  of  laudable  pride.  Our  pages  have  never  contained  any- 
thing which  the  most  ethical  physician  could  not  commend. 
Such  will  be  our  policy  in  the  future.  We  are  a  guarantee  for 
every  advertisement  found  in  the  pages  of  The  Journal,  for  we 
have  taken  none  for  whom  we  cannot  make  this  statement  with 
the  greatest  feeling  of  security.  Our  readers,  therefore,  need  never 
doubt  the  ethical  character  of  the  contents  of  this  Journal.  In 
addition  to  this,  we  wish  to  announce  that  the  yearly  subscription 
price  has  been  reduced  to  one  dollar.  This  does  not  mean  a 
cheapening  in  the  character  of  the  contents  of  The  Journal,  but 
it  means  that  we  wish  to  have  more  readers,  who,  perhaps,  are  not 
able  to  pay  the  former  subscription  price  during  these  hard  times. 
The  size  ot  The  Journal  has  nowhere  been  reduced,  and  when 


^dbyGoOgle 


828       Thb  Atlanta  Medical  and  Surgical  Joubkal. 

we  say  this,  it  means  that  our  expenses  are  the  same  as  before,  and 
yet  we  are  going  to  give  to  the  profession  this  same  journal  for 
ju>it  one-half  the  price  as  previouslj'.  At  the  first  meeting  of  the 
Atlanta  Society  of  Medicine,  in  January,  a  resolution  was  unani- 
mously  adopted  making  this  Joubnal  the  official  organ  of  that 
society.  This  meaDS  that  all  the  papers  read  and  all  the  discus* 
sions  and  proceedings  of  that  body  will  be  published  by  us.  This 
society  seems  now  in  the  beginning  of  a  wave  of  prosperity,  and 
its  proceedings  will  be  very  instructive  and  interesting  to  all  the 
readers  of  The  Joubnal.  Discussions  of  any  medical  subject  are 
always  instructive.  ■  We  will  also  print  alumni  notes  in  regard  to 
the  College  of  Physicians  and  Surgeons,  and  the  old  and  new 
graduates  will  always  find  a  medium  through  which  and  irom 
which  information  can  be  conveyed. 


SEVERAL  weeks  ago  tb«  daily  newspapers  were  filled  with 
notices  concerning  a  remarkable  operation  of  restoring  vision 
to  a  blind  person  by  the  implantation  of  a  piece  of  the  cornea 
of  a  rabbit  into  that  of  the  patient.  This  operation  was  performed 
by  Dr.  C.  B.  Kohler,  of  Minneapolis,  Minn.  While  reading  these 
garbled  newspaper  reports,  we  knew  that  the  roseate  results 
depicted  were  not  likely  to  be  realized.  Like  the  paper  read  by 
Dr.  Murphy,  of  Chicago,  on  a  new  cure  for  consumption,  we  did 
not  wish  to  pass  judgment  on  it  before  seeing  the  original  paper. 
We  knew  of  the  various  trials  which  have  been  made  by  ophthal- 
mologists all  over  the  world  to  accomplish  just  that  one  thing 
wliich  the  daily  papers  stated  had  been  accomplished  by  Dr. 
Kohler.  We  have  seen  it  tried  by  such  eminent  men  as  Fucbs 
of  Vienna,  and  Von  Hippel,  of  Halle,  the  latter  having  originated 
the  trephine  which  is  now  used  in  attempting  the  operation,  and 
by  both  without  success.     We  have  just  read  Dr.  Kohler's  original 


^dbyGoOgle 


Editokial.  829 

article  on  the  operatioD,  published  for  the  first  time  in  the  Medical 
Dial  of  Minneapolis,  and  like  the  true  physician  that  he  is,  he 
deplores  the  newspaper  notoriety  that  he  has  obtained,  and  sives 
the  real  merits  of  the  operation.  The  doctor,  however,  is  to  be 
congratulated  on  even  the  amount  of  success  obtained,  as  it  is 
more  than  others  have  obtained.  The  trouble  has  been  that  the 
operation  is  usually  successful  for  a  few  weeks,  but  this  condition 
does  not  last.  We  trust  that  in  Dr.  Kohler's  case  the  results 
thus  far  obtained  may  be  lasting,  yet  he  closes  his  article  with  this 
sentence:  "As  it  now  appears,  the  question  of  sight  is  decidedly 
an  uucertain  quantity." 


THE  Atlanta  Society  of  Medicine  has  oi^nized  for  the 
year  1899  with  renewed  vigor.  The  officers  for  this  year 
were  given  in  the  last  issue,  and  these  names  in  themselves  in- 
sure an  active  organization.  A  new  feature  of  the  society,  con- 
templated for  some  time,  but  just  now  begun  to  he  put  into 
active  operation,  is  the  oi^nization  of  a  medical  library  for  the 
use  of  the  members  and  visiting  physicians  who  reside  outside  of 
the  city.  A  recent  law  passed  by  the  society  requires  one-half  of 
the  collected  dues  for  each  year  to  be  placed  to  the  fond  used  in 
increasing  the  completeness  of  the  library,  and  this,  besides  vol- 
untary subscriptions,  will  certainly  form  a  most  excellent  nucleus 
for  the  formation  of  a  medical  library.  The  society  now  has  a 
large,  beautiful  room  in  which  to  meet,  situated  on  the  tenth  floor 
of  the  English- American  building,  and  the  meetings  for  this  year 
promise  to  be  most  excellent.  We  take  the  liberty  here  to  ask 
all  medical  journals  who  will  to  kindly  send  us,  gratuitously,  a 
copy  of  their  journal  to  be  placed  on  the  table  in  the  library,  and 
we  also  ask  the  publishiog  houses  and  authors  of  medical  works  to 
aid   us  with  complimentary  copies  of  their  works.     Such  can   be 


^dbyGoOgle 


880       The  Atlanta  Medical  and  Siirqioal  JomtKAL. 

fteot  to  the  librarian,  Dr.  Michael  Hoke,  Eoglish- American  build' 
ing,  Atlanta,  Qa.,  and  a  full  appreciation  of  the  same  will  b« 
acknowledged. 


THERE  should  be  some  law  to  prevent  plsgiarism,  we  mean 
especially  JD  medical  jourDaliem.  Every  day  we  see  medical 
journals  who  start  off  their  "Original  Articles"  with  an  article  by  a 
prominent  physician  or  surgeon,  and  when  you  have  read  it  through, 
there  is  absolutely  no  mark  which  would  indicate  it  to  be  more  than 
an  article  "written  expressly"  for  that  journal.  To  the  majorily 
of  readers  such  is  the  impression,  yet  the  editor  or  physiciao 
who  looks  over  a  large  number  of  journals  will  readily  recognise  il 
as  taken  from  some  other  medical  periodical.  There  would  be 
some  extenuation  for  such  decrepide  did  they  "give  honor  to  whom 
honor  was  due,"  but  instead  of  that  they  wish  to  delude  their 
readers  by  placing  such  an  article  in  a  prominent  place  and  calling 
it  original.  Journals  which  are  so  puny  that  medical  ineu  will  not 
furnish  them  articles  from  their  own  pen,  "  should  Ibid  their  teat 
and  silently  steal  away,"  or  they  should  organize  a  mutual  aid 
society  for  the  dissemination  of  the  virtues  found  in  Ayer's  Perry 
Chectoral. 


rB  2'ri-Staie  Malioal  Journal  and  Prai^itioner  in  its  Christmu 
garb'  of  colored  halos  reminds  one  more  of  a  weekly,  secular, 
illustrated  periodical  than  the  somber  pages  of  a  medical 
journal.  Nor  are  we  far  wrong  if  the  interior  pages  are  examined. 
Besides  having  a  number  of  excellent  medical  articles,  it  also  con- 
tains two  very  pleasing  little  sketches  which  would  prove  enter- 
taining to  any  layman.  The  first  entitled  "  Faithful  Unto  Death," 
is  from  the  pen  of  Br.  G.  Frank  Lydston,  of  Chicago,  and  like 
some  of  his  other  sketches,  it  is  written  in  the  doctor's  happiest 

DiclzedbyGoOgle 


Editorial.  881 

vein.  The  other  is  called  "Dr.  Jim's  Atlauteaa  Tumor,"  by  Dr. 
W.  B.  Outteo,  and  is  also  an  amasing  sketeb.  We  are  glad  to  see  a 
pbysician's  lileraiy  ability  maDifentod  id  other  ways  than  in  the 
production  of  medical  brochures,  and  the  writiugs  of  Dr.  Weir 
Mitchell,  aad  lately  of  Sir  Graiager  Stewart,  certaiuly  stamp  the 
medical  profesaiou  as  coutaiuing  literary  lights  among  its  member- 
ship. 


IN  the  death  of  Dr.  Jobo  B.  Hamilton,  of  Chicago,  III,,  the  medi- 
cal profession  of  the  United  States  has  lost  one  of  its  most 
valued  members.  Dr.  Hamilton  had  unusual  <jualities  of 
executive  ability,  and  coupled  with  this  was  tbe  possession  of  a  mind 
filled  with  extensive  learning.  At  tbe  late  Quarantine  Conveution 
held  in  Memphis,  Tenn.,  his  words  and  advice  were  listened  to  with 
marks  of  exceptional  interest,  because  on  this  one  subject  especially 
was  he  an  authority  well  versed  in  every  detail.  It  was  perhapsas 
editor  of  The  Journal  of  the  American  Medical  Association  that  his 
signal  ability  was  most  marked,  both  in  its  editorial  columns  and 
on  tbe  door  of  tbe  Association's  auuual  meetings.  It  has  been 
largely  through  his  own  individual  work  that  this  journal  has 
achieved  such  pheaomenal  success.  Personally,  Dr.  Hamilton  was 
was  one  oi  the  most  agreeable  and  magnetic  men  that  it  has  ever 
been  our  pleasure  to  meet.  We  deeply  regret  his  untimely  death 
at  tbe  very  noontide  of  his  activity. 


WE  can  certainly  unite  heartily  with  tbe  Pennsylvania  Medical 
Journal  in  paying  a  parting  tribute  to  the   Philadelphia 
Polyclinic.    This  little  journal  was  always  a  welcome  visitor 
on  our  exchange  table  because  its  contents   were  always  clean,  in- 
teresting and  thoroughly  scientific.    Dr.  Cohen,  as  editor,  is  certainly 
to  be  congratulated   on  the  favorable  comments  which  have  been 


^dbyGoOgle 


832       The  Atlanta  Medical  and  Surgical  Journal. 

paid  thin  little  periodical.  In  the  future  its  interests  will  be  allied 
with  those  of  the  Philadelphia  Medical  Journal,  and  we  have  do 
doubt  of  the  substantial  aid  the  latter  will  receive. 


THB  first  number  of  a  new  medical  Journal  is  before  us.  It  is 
The  St.  Paul  Medical  Journal,  published  monthly  in  St.  Paul, 
Minn.  It  has  a  staff  of  excellent  assistant  editors  and  col- 
laborators of  wide  prominence.  We  do  not  know  when  we  have 
received  a  medical  journal  whose  general  appearance  was  so  pleasing. 
We  welcome  it  among  our  list  of  exchanges  and  wilt  look  forward 
with  pleasure  and  profit  to  its  monthly  reception. 


rE  North  Carolina  Medical  Journal  has  begun  the  twenty-second 
year  of  its  existence  under  new  management.     The  new  edi- 
tors and  proprietors  are  Drs.  Robert  L.  Gibbons,  Robert  D. 
Jewett  and  W.  H.  Wakefield,     la  the  future  it  will  be  published 
in  Charlotte,  N.  C.     The  first  issue  under  the  new  manageoient  is 
excellent,  and  we  extend  our  best  wishes  to  the  editors. 


w 


E  note  with  pleasure  the  following  order  in  reference  to 
Dr.  Grandy,  our  former  colleague  in  the  editorial  depart- 
ment of  The  Journal : 

hbadauabtbrs  u.  s.  forces, 
Oahf  Onward, 
Savannah,  Ga.,  January  6, 1899. 


The  following  appointment  is  hereby  announced ; 

Luther  S.  Orandy,  Major  Sd  Georgia  Volunteer  Infantry,  to  be  Ohief  Sur. 
geon. 
By  command  of  Ool.  Bemer. 

J.  M.  KiiCBRouoB,  Jb., 
lat  Lieut,  and  AasiBtant  Adjutant-General. 

OFFICIAL : 


^dbyGoOgle 


NEWS  AND  NOTES, 


Dr.  E.  C.  Loyd,  of  Flat  Creek,  Ga.,  paid  The  Jodrkal  a 
visit  daring  the  moDtb. 


Dr.  a.  F.  Gbiqos  lias  removed   from  West  Poiot,  Ga.,  to  At- 
lanta, and  located  bis  ofBce  in  the  Prudeotial  building. 


Dr.  W.  a.  Chisolm,  who  moved  to  Waco,  Texas,  from  At- 
lanta, in  1897,  committed  suicide,  according  to  tbe  daily  papers, 
on  January  16th,  from  an  overdose  of  strychnine. 


Db.  Faust,  of  Denham,  S.  C,  has  moved  to  Flovilla,  Ga. 


Dr.  J.  T.  LoNQiNO  has  been  elected  mayor  of  Fairburn,  Ga. 


Dr.  B.  M.  Patterson,  of  Macon,  Ga.,  died  in  that  city  on 
January  7th,  at  the  age  of  65. 


Ah  epidemic  of  meningitis  is  said   to   have  prevailed  in  and 
around  Albany,  Ga.,  during  the  montb  of  January. 


Dr.  R.  T.  Dozier  has  again  been  elected  as  mayor  of  £ 
Ga.    The  Saaser  people  evidently  know  a  good  citizen. 


A  BOY,  eight  years  of  age,  bled  to  death  from  a  broken  tooth 
in  Decatur,  Ga.,  on  January  20th.  The  condition,  hemophilia, 
was  hereditary  in  his  &mily. 


^dbyGoOgle 


884      Thb  Atlanta  Medical  and  Surgical  Journal. 

Wanted. — By  a  pbysiciaa  of  five  years'  experience,  a  location 
where  there  is  room  for  a  doctor  and  a  chance  to  make  a  living. 
Married.     Address  box  111,  Monroe,  Ga. 


An  evangelist  named  PulKam  haa  recently  held  "religious 
fervor"  meetings  in  Wayerose,  Qa.,  and  during  these  a  number  of 
people  are  said  to  have  gone  off  in  a  trance,  lasting  twenty-four 
hours.  One  is  said  to  have  been  a  bride  of  two  days,  which,  in 
ber  case,  makes  it  excusable. 


Sewanee  Medical  College,  Tennessee,  University  of  the 
South,  graduated  last  sessiou  fifty-five  students  in  medicine  and 
twenty-four  in  pharmacy. 


Db.  Labkin  Smith,  health  officer  at  Nashville,  Tenn.,  was 
recently  presented  with  a  handsome  silver  tea  service  by  his  asso- 
ciates in  the  city  health  oSBce. 


Dr.  Padl  Paquin  has  resigned  his  position  as  secretary  of  the 
State  Board  of  Health  of  Missoari.  He  resigned  to  take  chai^ 
of  a  hospital  in  North  Carolina. 


It  is  reported  in  the  daily  papers  that  Mrs.  Julia  Speuoe,  of 
Claiborne  county,  Tennessee,  aged  63,  has  just  cut  four  front 
teeth.     She  has  been  toothless  for  six  years. 


Db.  Jno.  Gditeras,  Professor  of  Pathology  in  the  University 
of  Vii^inia,  has,  according  to  reports,  resigned  this  chair  to  accept 
the  Chair  of  Medicine  in  the  University  of  Havana. 


The  Talladega  Medical  Association   held  its  annual  : 
Talladega,  Ala.,  on  January  10th.     A  most  excellent  program 
was  rendered.     Dr.  Jno.  T.  Dixon  was  elected  president. 


,„i,z.d  by  Google 


Nbws  and  Wotbs.  835 

The  annual  session  of  the  Medical  Department  of  Kentucky 
Univereity  began  on  January  2d,  1899,  under  unusually  favorable 
auspices.  On  December  Slst,  the  following  gentlemen,  formerly 
proresBore  in  the  Kentucky  School  of  Medicine,  were  elected  full 
professors  in  Kentucky  University  df  their  respective  departments: 
Professor  J.  B.  Marvin,  B.S-,  M.D.,  LL.D.,  Professor  of  Principles 
and  Practice  of  Medicine  and  Clinical  Medicine;  Professor  J.  M- 
Holloway,  A.M.,  M.D.,  Professor  of  Sui^ery  and  Clinical  Surgery; 
Professor  C.  W.  Kelly,  CM.,  M.D.,  Professor  of  Anatomy;  Pro- 
fessor 8.  E.  Woody,  A.M.,  M.D.,  Professor  of  Chemistry  and  Dis- 
eases of  Children.  Kentucky  University  on  January  1st,  cele- 
brated the  100th  anniversary  of  its  foundation  ;  it  being  originally 
Transylvania  University. 


It  is  officially  announced  that  the  New  York  Cancer  Hospital 
will  hereafter  be  known  as  the  General  Memorial  Hospital. 


A  NEW  medical  journal,  called   the  Medical  Dial,  has  made  its 
first  appearance.     It  is  issued  monthly  in  Minneapolis,  Minn. 


Pbofessor  Rontoen,  of  X-ray  fame,  has  resigned  bis  appoint- 
ment at  the  University  of  Worzhurg  to  accept  the  Professorship 
of  Physics  in  the  University  of  Leipsic. 


Paor.  Philip  Knoll,  Professor  of  Experimental  Pathology 
at  the  German  University  of  Prague,  is  to  succeed  to  the  Chair  of 
Experimental  Pathology  in  the  University  of  Vienna,  made  vacant 
by  the  death  of  Professor  Strieker. 


The  Sixth  International  Otological  Congress  will  he  held  in  Lon- 
don, on  August  8,  9,  10, 11  and  12,  1899,  under  the  presidency  of 

DiclzedbyGoOgle 


836       Tee  Atlanta  Medical  and  Sdrqical  Jodenal. 

Dr.  Urban  Pritchard,  Professor  of  Otology  at  King's  Coll^, 
LondoD, 


A  BOARD  of  officers  will  be  ooDveoed  at  the  United  States 
Marine  Hospital,  Chicago,  III.-,  February  14tli,  1899,  for  the  pur- 
pose of  examining  candidates  for  admission  to  the  grade  of  asebt- 
ant  surgeon  in  the  United  States  Marine  Hospital  Service. 


It  bas  been  said  that  the  hospitals  of  Paris  are  in  an  unsanitary 
condition  and  lack  accommodations  sufficient  to  meet  the  demands 
made  upon  their  resources.  As  a  result  of  recent  esamioation, 
the  superintendent  of  the  charitable  institutions  of  Paris  asserts 
'bat  it  would  require  at  least  (10,000,000  to  put  the  hospitals  of 
that  city  tn  proper  condition. 


A  CHARGE  of  six  ceots  for  medicines  or  for  sui^ical  dressings  is 
now  being  made  in  the  out-patient  department  of  the  London 
Hospital.  It  is  found  that  those  who  can  afford  this  nominal 
charge  give  it  willingly,  the  sum  being  remitted  in  the  case  of 
those  really  unable  to  pay  it.  Five  thousand  dollars  a  year  will 
be  made  by  the  adoption  of  this  plan. 


The  daily  papers  report  the  successive  deaths  in  Metropolis, 
111.,  of  a  whole  family  from  pneumonia.  Dr.  H.  Y.  Mangum,  the 
head  of  the  &mily,  was  iirst  to  succumb,  and  twenty-four  hours 
later  his  daughter.  Three  days  later  his  wife  also  died,  and  bis 
youngest  son  wa^  buried  the  following  day,  and  later  the  graod- 
mother  died.     The  eldest  son  alone  survives. 


XOTICB.—TM8  JOURNAL  and  2HE  IKTEBSATIOKAL 
JOURNAL  OF  aUROBRY  one  year  for  $1.00  caah. 


^dbyGoogle 


Nbws  and  Notes.  837 

M.  Joseph  has  recently  observed  three  cases  of  "  razor  chsDore," 
and  RoBeothal  states  that  he  almost  always  has  one  case  at  least  of 
extragenital  chancre  in  his  service.  An  abrasion  of  the  skin 
seems  to  be  a  necessary  preliminary  to  infection;  a  razor  out,  a 
crushed  finger,  burnt  mouth  or  something  of  the  kind.  lufection 
is  not  necessarily  derived  front  the  barber  shop,  but  may  follow  a 
kiss  on  the  cut  spot  later,  "although  the  number  of  barber's 
assistants  constantly  undei^ing  specific  treatment  certainly  indi- 
cates some  danger  in  the  shops." — Derm,  ^ft,,  November,  1898. 


Db.  Hjcnby  Scuheitzer,  an  expert  chemist,  has  analyzed  a 
quantity  of  packages  of  80*called  phenacetin  ;  these  samples  were 
found  to  be  mixtures  of  acetanilid  with  flour,  starch,  sugar,  bicar- 
bonate of  soda,  chalk  and  citric  acid.  Acetanilid  costs  fifty  ceot« 
a  pound,  while  phenacetin  costs  eighty-five  cents  an  ounce.  Ac- 
cording to  the  New  York  Board  of  Health,  other  drugs  largely 
adulterated  are  citrate  of  magnesia,  bisulpbate  of  quinin,  cream  of 
tartar  and  acid  phosphates.  The  inference  is  that  in  using  these 
drugs  one  should  make  sure  that  he  has  procured  the  genuine 
arfiole. 


NOTICE.-This  JOURNAL  and  THE  INTERNATION- 
AL JOURNAL  OF  SURGERY  one yearforSI.OO cash. 


SAei[£S  worn  by  army  surgeons,  says  the  Medical  E^card,  have 
a  history.  A  great  many  people  do  not  know  why  army  surgeons 
wear  green  sashes.  It  is  not  so  much  an  insignia  of  rank  as  it  is 
a  protection  to  the  wearer.  According  to  the  code  of  war,  sur- 
geons are  never  shot  or  taken  prisoners.  To  deliberately  shoot  a 
surgeon  while  he  is  wearing  his  sash  is  considered  a  violation  of 
the  code,  pnnishable   by   death.     Because  of  this   provision,  sur- 


^dbyGoOgle 


838       Thb  Atlaitta  Medical  and  Suroical  Jodonal. 

geons  of  one  army  never  refaae  to  look  after  the  wouoded  of  the 
other  army  if  it  is  possible  for  them  to  do  so.  Dnriag  the  civil 
war  it  was  often  the  case  that  after  a  battle  the  Geld  hospitals 
would  coDtaio  almost  an  equal  number  of  men  dressed  in  blue  and 
gray.  The  Federal  army  had  the  best  sui^eons  and  the  best 
stores,  and  a  wounded  Confederate  considered  himself  in  great 
luck  if  he  was  removed  to  a  Federal  hospital  to  be  cared  for  by 
Federal  surgeons  and  physicians. 


A  ViCTiu. 

O  the  grip — 

The  terrible  grip ! 
I'm  wondering  still  if  he'll  get  me  this  trip  1 

If  he'll  cough  me  to  glory 

And  finiBh  my  story — 
The  grip — the  terrible  grip! 

O  the  grip — 

The  terrible  grip  1 
I'm  wondering  still  if  he'll  founder  the  ship  I 

Or  still  keep  a-body 

A-taking  his  "  toddy" — 
The  grip — the  terrible  grip ! 

O  the  grip  I— 

(Ain't  it  time  for  a  "  nip?  " 
Be  sure  that  the  hour — the  minute  don't  slip !) 

I'm  almost  as  lucky 

As  folks  in  Kentucky, — 
So,  here's  to  the  grip— to  the  grip  I 

— F.  L.  Stanton,  in  Atlanta  Comtih 


NOTICE.-Thls  JOURNAL  and  THE  INTERNATION- 
AL JOURNAL  OF  SURGERY  one  year  for  SI.OO  cash. 


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BOOK  RBVIEWS,    PAMPHLETS,   BXCi 


BOOK  RBVtEWS. 

{OontrlbaUODa  MUaiMd  tar  ravli 


The  Phonendoscope  and  its  Practical  Ai 
With  37  illuatratioDS.  By  Prof.  Aurelio  Biaachi 
tor,  of  Parma,  Italy.  Translated  by  A.  George  '. 
M.D.,  of  Philadelphia.  Published  by  George  1 
Sod,  of  Philadelphia. 

This  little  book,  like  the  one  on  "  Autscopy  of  tb< 

the  men,  women  aad  children  of  the  present  day  an 
would  have  been  cleaner,  healthier  and  better  mort 
and  physically.  If  they  had  been  taught,  and  had 
sons,  iiot  to  say  daughters,  for  daughters  have  not 
much  of  [anything  in  this  line,  the  differeuce  betw 
and  sensuality,  we  would  have  had  in  this  day  a  n 
instead  of  a  race  composed  so  very  largely  of  nenrasi 
book  is  clean,  true,  plain  epoken,  but  not  too  plain, 
scientific.  It  ought  to  be  read  by  physicians,  laymen 
Men  and  women  sin  ignorantly ;  the  consequence  o 
visited  upon  the  third  and  fourth  geueration.  But  si 
is  written  and  they  may  read,  there  is  no  more  exi 
ignorance. 


Oethopedtc  Lectubeb.  By  Dr.  A.  Sydney  Robert 
This  book  is  a  collection  of  articles  by  the  lat 
Roberts,  on  clob-foot,  Pott's  disease,  knock-knee,  bo 
orthopedics,  flat-foot]  and  chronic  articular  osteitis  i 
Joint,  edited  by  James  K.  Young.  It  was  prep 
Young,  the  pupil,  friend  and  successor  of  Dr.  Rober 
tribute  to  the   memory  of  one  whose  intellectual 


^dbyGoOgle 


840       Thb  Atlanta  Mbdical  and  Surgical  Journal. 

the  slightest  difficulty,  and  that  loo  without  subJectiDg  the  patient 
to  pain.  We  are  even  enabled  to  bear  the  coDtractioa  of  a  miiscle 
under  the  iafluence  of  the  electric  current.  Theo,  again,  any 
number  of  tubes  going  to  the  ear  can  be  attached  to  the  phonen- 
doecope,  and  tluie  several  can  listen  at  the  same  time,  which  would 
be  very  valuable  fur  bedside  instructioa.  The  author  also  speaka  of 
"comparative  auscultation,"  meaning  the  use  of  two  instruments 
over  different  areas.  For  instance,  we  might  Usteu  at  the  same 
lime  to  respiration  in  both  lungs,  and  thus  note  the  differences 
in  the  two  sides.  The  author  gives  numerous  photographic  illus- 
trations showing  the  uses  of  the  instrument,  and  for  one  who 
wishes  to  perfect  himself  in  the  use  of  the  phouendoscope,  it 
would  certainly  be  advisable  to  obtain  this  book,  which  is  the  only 
authorized  translation.     The  price  of  the   book  is  only  fifty  cents. 

1  mwunuanngeniiii  ne'u  gee  me  this  trip  I 
If  he'll  cough  me  to  glory 
And  flnish  my  story — 

The  grip — the  terrible  gripl 

O  the  grip — 

The  terrible  gripl 
I'm  wondering  still  it  he'll  founder  the  ahip  I 

Or  Htill  keep  a-body 

A-taking  his  "  toddy  "— 
The  grip— the  terrible  grip ! 

0  the  grip ! — 

(Ain't  it  time  for  a  "  nip?  " 
Be  sure  that  the  hour — the  minute  don't  slip  I) 

I'm  almost  as  lucky 

As  folks  in  Kentucky, — 
So,  here's  to  the  grip— to  the  gripl 

— F.  L.  Stafton,  in  Atlanta  ConmUution. 


NOTICE.-Thls  JOURNAL  and  THE  INTERNATION- 
AL JOURNAL  OF  SURGERY  one  year  for  SI.OO cash. 


I 


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Book  Reviews.  843 

Medicine,  sad  the  author  now  has  issued  it  ia  hook  form,  making 
it  therefore  a  moch  more  handy  work  of  reference-  The  sub  eel 
has  heen  most  thoroughly  treated  from  every  standpoiot,  and  sucti 
thoroughness  is  well  attested  by  the  long  hihliography  which  we  find 
at  the  finis.  The  subject  is  also  well  illustrated  by  photographs  oi 
'oaticnts  who  have  suffered  from  acromegaly,  and  in  this  way  the 
*l^-thor  has  succeeded  in  placing  before  the  profession  not  only  a 


TheSexdal  Instinct.     By  Dr.  James  Foster  Scott.     Published 
by  E.  B.  Treat  &  Co.,  New  York. 

If  "The  Sexual  Instinct,"  by  Dr.  James  Foster  Scott,  had  been 
one  of  the  "classics"  found  upon  the  shelves  of  the  libraries  of 
the  past  generations  and  read  by  the  men  and  women  of  past  days, 
instead  of  the  "Confessions  of  Rousseau"  and  the  "Decameron," 
the  men,  women  and  children  of  the  present  day  and  generation 
would  have  been  cleaner,  healthier  and  better  morally,  mentally 
and  physically.  If  they  had  been  taught,  and  had  taught  their 
sons,  not  to  say  daughters,  for  daughters  have  not  been  taught 
much  of  [anything  in  this  line,  the  difference  between  sexuality 
and  sensuality,  we  would  have  had  in  this  day  a  race  of  giants; 
instead  of  a  race  composed  so  very  largely  of  neurasthenics.  The 
book  is  clean,  true,  plain  spoken,  but  not  too  plain,  practical  and 
scientific.  It  ought  to  be  read  by  physicians,  laymen  and  women. 
Men  and  women  sin  iguorantly ;  the  consequence  of  such  sin  is 
visited  upon  the  third  and  fourth  generation.  But  since  this  book 
is  written  and  they  may  read,  there  is  no  more  excuse  for  such 
ignorance. 


Orthopedic  Lectubeb.     By  Dr.  A.  Sydney  Roberts. 

This  book  is  a  collection  of  articles  by  the  late  A.  Sydney 
Roberts,  on  club-foot,  Pott's  disease,  knock-knee,  bow-legs,  spinal 
orthopedics,  flat-foot]  and  chronic  articular  osteitis  of  the  knee- 
joint,  edited  by  James  K.  Young.  It  was  prepared  by  Dr. 
Yoting,  the  pupil,  friend  and  successor  of  Dr.  Roberts,  solely  as  a 
tribute    to    the    memory   of  one   whose  intellectual   attainments. 


^dbyGoOgle 


840       Thb  Atlanta  Mbdical  and  Surgical  Jodrnal. 

the  slightest  diflBculty,  and  that  too  without  subjeotiDg  the  patieut 
to  pain.  We  are  even  eoabled  to  hear  the  eoutraction  of  a  miiscle 
under  the  influence  of  the  electric  current.  Then,  again,  any 
number  of  tubes  going  to  the  ear  can  be  attached  to  the  phonen- 
doacope,  and  thjis  several  can  listen  at  the  same  time,  which  would 
be  very  valuable  fur  bedside  instruction.  The  author  also  speaks  of 
"comparative  auscultation,"  meaning  the  use  of  two  instrumen' 
over  different  areas.     For  instance,  we  might  listen  at  the 

uue   lays  me   ouim  uunu   iwlu  lue  .ti.i.u^  ..ijui,  ..   i._  jocom- 

plisbed  its  purpose.  It  shows  the  character  of  the  man,  and  t«lts 
what  he  was  better  than  could  shalts  of  marble  and  mounds  of 
earth.  Hoeb. 


The  Medical  News  Pocket  Fobmdlaby.  By  Dr.  E.  Q. 
Thornton,  ofPhiladelphia.  Published  by  Lea  Brothers  &  Co., 
Philadelphia. 

This  little  pocket  formulary  ia  neatly  gotten  up  in  leather,  and  in 
many  reepects  resembles  the  appearance  of  the  Medical  News  Visit- 
ing List  Afl  a  general  thing  we  are  opposed  to  such  books,  be- 
cause it  is  apt  to  make  a  physician,  especially  if  it  be  a  young  man, 
fall  into  mechanical  habits.  We  brieve  in  every  physician  study- 
ing his  cases  and  making  his  own  prescriptions.  This  little 
book,  however,  is  intended  more  as  a  riaumi  of  the  prescriptions 
which  have  recently  been  found  by  various  physicians  to  be  effica- 
cious in  certain  maladies.  For  instance,  it  is  impossible  for  the 
busy  practitioner  to  read  or  see  reference  to  every  good  article 
which  has  been  written  during  the  year,  and  yet  there  may  have 
appeared  some  remedy  of  exceptional  value  which  he  would  desire 
to  use.  Dr.  Thornton  has,  in  this  tittle  pocket  formulary,  culled 
all  the  good  remedies  from  recent  literature  and  put  it  into  this 
little  compact  form.     As  such  his  book  has  distinct  value. 


Acromegaly.  An  Essay  to  which  was  awarded  the  Boylston 
Prize  of  Harvard  University  for  the  vear  1898.  By  Guy  Hins- 
dale, A.M.,  M.D.,  of  Philadelphia'  Published  by  \Vm.  M. 
Warren,  Detroit.     Price  $1.00. 

As  the  explanatory  sentence  states,  this  work  of  86  pages  was  a 
prize  essay,  first  published  serially  in  the  monthly  medical  journal, 


^dbyGoOgle 


Book  Reviews.  843 

Medicine,  and  the  author  now  has  issued  it  io  book  form,  making 
it  therefore  a  much  more  handy  work  of  reference.  The  Bub  ect 
has  been  most  thoroughly  treated  from  every  standpoiut,  and  sucP 
thoroughness  is  well  attested  by  the  long  bibliography  which  we  find 
at  the  finis.  The  subject  is  also  well  illustrated  by  photogntpbe  oi 
patients  who  have  suffered  from  acromegaly,  and  in  this  way  the 
author  has  succeeded  in  placing  before  the  profession  not  only  a 
Tery  valuable  treatise  on  this  subject,  butalso  an  exceedingly  entet^ 
taining  one. 


A  Text-Book  of  Mechano~Th£bapy  (massage  and  medical 
gymnastics).  Elspecially  prepared  for  the  use  of  medical 
students  and  trained  nurses.  By  Axel  V.  Grafstrom,  B.Sc., 
M.D.,  late  lieutenant  in  the  Boyal  Swedish  army,  late  house 
physician  city  hospital,  Blackwell's  Island,  New  York,  with 
eleven  pen-and-ink  sketches  by  the  author.  Published  by  W. 
B.  Saunders,  925  Walnut  street,  Philadelphia.     1899. 

This  little  book  will  prove  to  be  of  considerable  aid  to  the  med- 
ical student  and  nurse,  in  acquiring  the  rudiments  of  a  very  im- 
portant branch  of  therapeutics.  The  author  has  adopted  the  sys- 
tem practiced  by  the  Royal  Gymnastic  Central  Institute,  Stock- 
holm, Sweden,  as  a  basis  for  the  text,  with  slight  modifications. 
The  pen-and-ink  sketches  are  very  appropriate  aud  instructive. 
We  can  recommend  the  work  as  being  a  reliable  guide  to  the 
beginner.  s. 


Transactions  of  the  American  Orthopedic  Association. 
Twelfth  session.  Held  in  Boston,  Mass.,  May  17,  18  and  19, 
1898. 

If  any  one  should  think  that  ortho])edics  does  not  occupy  a 
prominent  place  as  a  distinct  specialty,  he  would  very  readily  dis- 
cover his  mistake  after  reading  these  transactions  and  seeing  the 
presentation  of  fifty-four  such  able  paiwrs.  This  volume  of 
transactions  is  the  best  we  have  ever  had  the  pleasure  to  review, 
and  each  contribution  shows  profound  and  practical  study.     Some 


^dbyGoOgle 


844       The  Atlanta  Medical  and  Siiboical  Jodrhal. 

of  tbe  papers  are  well  illustrated,  which  is  always  an  entertaining 
feature.  This  association  is  certainly  to  he  commended  for  the 
good  work  it  is  doing. 


Messbs.  Lea  Bbothebs  &  Co.  announce  the  early  publication 
of  The  Practice  of  Obatdrica.  By  American  Avthora.  They  an- 
nounce that  it  will  be  a  work  of  exceptional  value.  Professor 
Charles  Jewett  is  tbe  editor. 


MAQAZINB  NOTES. 


The  Scientific  American  continues  to  be  filled  with  good  things. 
Some  of  its  recent  illustrations,  amplified  by  means  of  tbe  text, 
have  been  exceediugly  interesting  and  instructive.  When  placed 
upon  tbe  table  in  our  reception  room  it  is  always  read  with  avidity. 

The  Ladies'  Home  Journal  for  January  could  scarcely  be  im- 
proved upon.  There  were  some  delightful  ubaracter  sketches 
contained  in  this  issue  and  the  illustrations  were  exceedingly  inter- 
esting.    This  is  certainly  the  journal  for  the  family. 


REPRINTS  RECEIVED. 


Coloring  Matter  and  Ferments.  By  J.  F.  Peavy,  M.D.,  Ashe- 
ville,  N.  C. 

Thrombosis  of  tbe  Lateral  Sinus,  Dependent  upon  Suppurative 
Otitis  Media,  with  Report  of  Cases. 

The  Sequelce  of  Middle  Ear  Suppuration,  with  Report  of  Cases. 
Both  by  Edward  B.  Deneh,  M.D.,  New  York. 

Diseases  of  the  Ear  as  a  Specialty.  By  Emil  Annberg,  M.D., 
Detroit,  Mich. 

The  Sixth  Annual  Report  of  the  Sheppard  Asylum,  Balti- 
more, Md. 


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Book  Kbtiews.  846 

Studies  on  the  Healiog  of  Wounds,  with  Special  Refereace  to 
the  Iodine  Preparations.  By  Professor  N.  Zuntz  and  Dr.  Ernst 
R.  W.  Frank. 

The  Radical  Cure  of  Inguinal  Hernia  by  Fowler's  Method,  with 
Report  of  Cases.     By  H.  O.  Walker,  M.D.,  Detroit. 

Tweuty-ninth  Annual  Report  of  the  New  York  Ophthalmic 
and  Aural  Institute. 

The  Relation  of  Suppuration  to  Shortening  of  the  Limbs  in 
Tuberculous  Diseases  of  the  Hip  Joint.  By  Russell  A.  Hibbs, 
M.D. 

Some  Remarks  about  the  Study  of  Medicine  in  (Sermany.  By 
Emil  Amberg,  M.D.,  Detroit. 

Chronic  Inflammation  of  the  Pharyngeal  Tonsil,  with  Little  Hy- 
pertrophy.    By  Charles  N.  Cox,  M.D.,  Brooklyn,  N.  Y. 

Mechanical  and  Sui^ical  Treatment  of  Fractures  of  the  Neck  of 
the  Femur.     By  Arthur  J.  Gillette,  M.D.,  St.  Paul,  Minn. 

Some  Sources  of  Failure  in  Treating  Lachrymal  Obstructions. 
By  LeartuB  Connor,  A.M.,  M.D.,  Detroit. 

Caries  of  the  Teeth  and  Diseases  of  the  Stomach ; 

The  Early  Diagnosis  of  Cancer  of  the  Stomach  ; 

Diarrhea  and  Bacteria.     By  Charles  D.  Aaron,  M.D.,  Detroit. 


HOTIOB.— ThU  JOUBNAL   and  THB  INTERNATIOHAX   JOUK- 
HAL  OF  SUHaBBT  ona  Toar  for  91.00  caab. 


Announcement  of  Impohtance  to  Every  Physician. 
Messrs.  Lea  Brothers  &  Co.  announce  for  publication  in  March, 
1899,  the  first  volume  of  "Progressive  Medicine,"  a  new  annual 
which  will  be  issued  in  four  handsome  octavo,  cloth  bound  and 
richly  illustrated  volumes  of  about  400  pages  each.  The  several 
volumes  will  appear  at  intervals  of  three  months.  In  this  age  of 
unusual  progress,  so  rapid  is  the  advance  iu  all  departments  of 
medical  and  surgical  science  tliat  the  need  for  condensed  summa- 


^dbyGoOgle 


846       The  Atlanta  Medical  and  Sueoical  Journal. 

ries  which  shall  keep  the  practitioner  up-to-date  at  the  least  poa- 
Bible  ezpeDditure  of  valuable  time  has  become  imperative.  Maoy 
attempts  in  the  way  of  Year-Books,  Retrospects  aod  Abstracts 
have  been  made  to  meet  this  growing  need,  but  in  nearly  all  of 
these  the  process  of  condensing  has  not  been  preceded  by  a  sifting 
of  the  good  from  the  useless,  and  consequeotly  the  reader  is  pre- 
sented with  a  mass  of  information  from  which  he  must  select  with 
care  and  study  the  items  which  are  uueful  and  reliable. 

What  the  busy  physician  needs  to-day  is  a  well-told  tale  of 
medical  progress  in  all  its  lines  of  thought,  told  in  each  line  by 
one  well  qualified  to  cull  only  that  matter  worthy  of  his  attention 
and  necessary  to  his  success.  He  needs  material  which  shall  teach 
him  all  that  the  master  ot  his  specialty  knows  of  the  year's  work. 

It  is  with  the  object  of  presenting  only  such  readable  and  useful 
material  that  these  volumes  are  published,  and  every  contributor 
to  the  pages  of  Progressive  Medicine  will  say  what  he  has  to  say  in 
an  original  narrative  form,  bo  that  every  statement  will  bear  a 
personal  imprint,  expressing  not  only  the  views  of  the  author 
cited,  but  the  opinion  of  the  contributor  as  well. 

To  insure  completeness  of  material  and  harmony  of  statement, 
each  narrative  will  receive  the  careful  supervision  of  the  General 
Editor,  Dr.  Hobart  Amory  Hare,  whose  reputation  will  every- 
where be  acknowledged  as  ensuring  practical  utility  in  a  high 
degree.  Those  associated  with  Dr.  Hare  in  the  production  of 
"  Progressive  Medicine "  include  a  brilliant  gathering  of  the 
younger  element  of  the  profession,  well  representing  the  class  which 
is  so  energetically  contributing  to  make  modem  medical  history. 

With  the  appreciation  of  the  self-evident  utility  of  such  a  work 
to  all  practitioners,  the  publishers  are  enabled  to  ask  the  very 
moderate  subscription  price  often  dollars  for  the  four  volumes. 

The  publishers  offer  to  send  full  descriptive  circulars  and  sample 
pages  to  those  applying  for  them. 

yOTZCE.—Thts  JOURNAL  and  THE  INTERN ATTOIfAL 
JOURNAL  OF  SUMOERX  one  year  fitr  9i-0n  «a9h. 


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SELECTIONS  AND  ABSTRACTS. 


QuiNiN  IN  Malabial  Hehoolobinuria. 

From  time  to  time  we  read  articles  in  which  the  aseertioD  ia 
made  that  the  admiDistratioD  of  qumin  diiriog  the  exieteoce  of 
hemoglobioiiria  in  malarial  iaTectioa  aggravates  the  symptom. 
Id  fact,  it  is  held  by  some  writers  and  practitiODers  that  qtiinio  will 
produce  this  conditioa  Id  malarial  fever.  While  this  view  is  sus- 
tained by  some  who  practice  medicioe  in  malarial  districts,  it  can  be 
positively  stated  that  the  vast  majority  of  practitiouere  id  those  dis- 
tricts do  not  hold  to  any  such  belief. 

As  we  have  increased  our  knowledge  concerning  the  nature  of 
malarial  fever  and  the  plasmodium  which  produces  it,  to  that  extent 
have  these  vagaries  once  propounded  and  upheld  been  refuted.  At 
a  time  when  malarial  fever  was  believed  to  be  due  to  carbonic  acid, 
organic  material,  effluvia,  paludism,  and  various  other  theories  de- 
void of  proof,  and  at  a  time  when  bacteriology  and  pathology  had 
not  been  established  upon  irrefragible  evidence,  many  plausible 
theories  were  set  up  only  to  be  dissipated  by  the  scathing  light  of 
definite  knowledge  established  by  the  study  of  these  two  branches 
of  medicine.  Bacteriology  has  taken  malarial  fever  from  the  cate- 
gory of  diseases  of  unknown  cause  and  placed  it  forever  among  the 
infective  diseases.  Pathology  has  shown  us  the  condition  existing 
during  the  life  of  the  patient. 

In  malarial  fever  we  have  come  to  study  the  internal  organs  and  we 
find  that  the  spleen  is  enlarged,  soft  and  congested,  the  blood-vessels 
being  filled  with  red-blood  cells  in  all  stages  of  disintegration, 
leucocytes,  blood  pigment  and  the  plasmodium  in  various  stages  of 
development.  In  the  liver,  congestion  is  the  rule,  producing  a 
stagnation  of  the  portal  circulatioa  and  a  deficiency  of  bile,  while 
the  kidneys  may  be  enlarged,  but  in  most  cases  show  do  evidences 
of  parenchymatous  or  interstitial  change. 

In  the  kidney  of  malarial  hemoglobinuria,  Thayer,  Pellarin, 
Kierner  and   Kelsch  have  shown  a  condition  bordering  on  a 


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848       The  Atlanta  Medical  and  Sorqical  Jodrnal. 

pareDchymatouB  degeneration  with  interetitial  bemorrhagee  and 
blood  corpuecleB  in  the  tubules,  yet  tbis  condition  is  frequently 
found  in  other  conditions  than  malarial  fever  and  in  which  quinin 
may  be  used  with  impunity  without  producing  hemoglobinuria. 

It  should  be  remembered  that  it  is  not  alone  from  the  study  of  the 
internal  organs  that  our  knowledge  has  been  obtained  regarding  tbie 
subject,  for  the  plasmodium  has  become  more  bold  and  exhibits 
itself  in  the  peripheral  circulation.  Here  then  its  cycle  can  be  oh* 
served  and  studied — first  is  the  small  hyaline  segment,  with  a  rota- 
tory twisting  and  branching  movement,  next,  as  the  flattened  yel- 
lowish or  hyaline  cell  of  many  sizes  and  shapes,  and  last,  as  the 
full-grown,  vigorous  organism  containing  fine  masses  of  hemoglobin, 
which  has  been  derived  from  the  red-blood  cell  set  free  by  the 
necrobiotic  process  engendered  by  its  toxin. 

With  each  paroxysm  there  is  set  free  in  the  circulating  medium 
more  hemoglobin,  which  must  be  stored  in  the  organs  whose  duty  it 
is  to  receive  it.  The  internal  viscera  have  no  choice  but  to  receive 
its  repository  and  when  it  is  thrown  off  they  receive  the  legacy  of 
its  coloring  agents  which  remain  in  the  intracellular  tissue.  Briefly, 
this  may  be  said  to  be  a  summary  of  the  morbid  anatomy  of  malarial 
fever,  which  also  includes  hemoglobinuria  of  malarial  origin,  which 
must  be  considered  a  symptom  and  not  a  distinct  entity.  It  should 
also  be  remembered  that  the  bright  red  urine  observed  is  not  always 
a  hematuria.  In  fact,  a  hematuria  is  the  rare  exception,  for  hemor- 
rhages, of  whatever  nature,  are  uncommon  in  all  varieties  of  mala- 
rial fever.  It  is  the  blood  coloring  matter,  and  not  the  red-blood 
corpuscles,  which  produces  the  glow  in  the  cheek  in  the  fastigium 
of  the  fever,  and  its  absence  which  denotes  the  pallor  of  a  cachexia. 
But  in  the  later  stages  ot  a  congested  kidney  blood  corpuscles  may 
be  present. 

Why  the  hemoglobinuria  of  malarial  origin  has  been  singled  out 
among  all  the  other  varieties  and  stated  to  be  increased  by  the  use 
of  quinin,  is  not  clear.  Thus  we  have:  1,  paroxysmal  hemo- 
globinuria, and  2,  toxic  hemoglobinuria,  including  that  due  to 
chlorate  of  potash,  carbolic  acid,  uaphtbol,  carbon  dioxid,  and  the 
poisons  of  infectious  fevers,  yellow  fever,  scarlet  fever,  typhus  fever 
and  malarial  fever. 


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Selections  and  Abstracts.  849 

The  rules  of  logic  by  which  some  eadeavor  to  prove  the 
sequence  of  eveots,  from  the  adminiatration  of  quinin  to  the  pro- 
daction  of  hemoglobinuria,  are  not  oircumscribed  within  the 
boundary  of  therapeutics ;  no  such  proof  exists.  Preponderating 
evidence  plainly  shows  that  quinin  in  the  latest  doses  will  neither 
lead  to  a  hematuria  nor  a  hemoglobinuria.  It  neither  causes  a 
necrobiosis  of  the  red-blood  corpuscles,  nor  causes  a  congestion  of 
the  kidneys.  Thus,  Baillio  reports  two  soldiers  who  took  three 
drams  of  quiuin,  producing,  in  both  cases,  cramps  in  the  epigastric 
region,  accompanied  by  vomiting,  paleness  of  face,  dilated  pupils, 
irregular,  slow  pulse,  ringing  of  the  ears,  syncope,  and  death  in 
one  case,  while  in  the  other  the  symptoms  gradually  disappeared. 
Briquet  reports  a  case  in  which  a  man  took  fifly-five  drams  of 
the  salt  without  the  production  of  hemoglobinuria  or  hematuria, 
and  Guersent  has  observed  a  woman  who  became  deaf,  dumb  and 
blind  after  having  taken  ten  drams  of  quinin  sulphate  within  a 
few  days. 

The  foremost  physicians  who  practice  in  malarial  districts  are 
not  afraid  of  quinin.  If  four  grains  of  quinin  every  four  hours 
will  not  break  up  a  chill,  ten  and  fifteen  grains  are  given  with 
impunity  and  without  producing  a  hemoglobinuria;  and  if  litteen 
will  not  suffice  in  a  case  of  pernicious  fever,  thirty  grains  are  fre- 
quently given  hypodermically. 

The  exact  chemic  composition  of  the  toxin  produced  by  the 
Plasmodium  malariee  is  unknown.  That  it  is  actively  poisonous  . 
is  beyond  doubt.  Thus  a  small  amount  of  blood  from  a  patient 
suffering  with  malarial  fever  has  been  obtained  and  transfused  into 
another  patient,  with  the  result  that  a  malarial  fever  has  been 
produced.  The  urine  of  a  patient  suffering  from  malarial  fever 
has  been  found  to  be  more  toxic  immediately  after  the  paroxysm 
than  tiefore  it.  The  rupture  of  the  enveloping  membrane  of  the 
affected  red-blood  corpuscle  marks  the  onset  of  the  paroxysm  and 
the  chill.  Fever  is  only  the  reaction  of  the  system  to  expel  the 
poisonous  material. 

Having,  therefore,  the  two  factors,  quinin  and  toxin,  in  the 
blood  concurrently,  which  one  will  be  most  patent  in  the  produc- 
tion of  hemoglobinuria?    The  toxin  of  malaria  causes  a  hypertrophy 


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850       The  Atlanta  Medical  and  Surgical  Jouhral. 

of  the  spleeo,  which  will  destroy  the  red-blood  globules,  will  cause 
a  chill,  and  being  poisonous,  may  irritate  the  kidoeys,  while  quinin 
baa  never  been  proven  to  be  the  etiologic  &ctor  id  any  of  these 
GODditioDs,  and,  therefore,  must  be  tbe  least  causal  agent  in  the 
production  of  a  symptom  for  which  it  should  be  used, — Journal  of 
the  American  Medical  Aeeocialion. 


TfiBATMEMT   OF    TeTAMUS    BY  MeANS  OP    InTEACEREBRAL 

Injection  op  Antitoxin. 

In  an  editorial  abstract  which  appeared  in  tbe  Journal  a  few 
weeks  ago,  reference  was  made  to  the  interesting  story  of  Koux 
and  Borrel  conceraing  the  relation  of  tetanus  toxin  to  nerve-cells. 
It  will  be  recalled  that  when  the  toxin  is  injected  directly  inUi  the 
brain  a  peculiar  form  of  tetanus,  which  Rouxand  Borrel  call  cere- 
bral tetanus,  results.  The  symptoms  are  characterized  by  psychic 
excitement,  intermittent  convulsions,  motor  disturbances  and 
polyuria,  and  depend  upon  the  fixation  of  the  ganglion  cells.  It 
will  also  be  remembered  that  Wasserman  and  Takaki  were  tbe  first 
to  make  experiments  that  called  the  attention  of  investigators  to 
this  peculiar  affinity  of  tbe  tetanus  toxin  for  the  nerve-cells,  inas- 
much as  they  showed  that  tbe  same  intimate  union  between  toxin 
and  nerve-cells  occurs  when  bits  of  nerve  substance  and  toxin  are 
mixed  together  outside  tbe  body.  Roux  and  Borrel  also^sbowed 
that  injection  of  antitoxin  into  animals  affected  with  cerebral  tetanus 
has  no  effect,  because  the  antitoxin  does  not  have  the  same  affinity 
for  tbe  nerve-cells  as  the  toxin,  does  not  therefore  come  in  contact 
with  tbe  poison,  and  proves  entirely  powerless  against  the  poison 
that  hasalready  been  fixed  by  the  nerve-cells.  This  they  considered 
to  be  one  of  the  principal  reasons  why,  in  man  as  well  as  in  animals, 
subcutaneous  or  intravenous  injections  of  antitoxin  in  tetanus  so 
often  ia\\.  Tbe  antitoxin  may,  of  course,  neutralize  the  toxin  <ur- 
culatiog  in  the  blood,  but  in  order  to  accomplish  most,  the  anti- 
toxin  should  be  placed  where  the  toxin  is  acting;  of  forty-five 
tetanized  guinea-pigs  treated  with  intracerebral  injectioDS  of  anti- 
toxin, thirty-five  recovered,  whereas  seventeen  treated  with  subcuta- 


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Selections  and  Abstracts.  851 

neous  abtitoxiD  injectioDS  all  died,  excepting  two.  Theory  and 
esperiments  seemed  to  agree  beautifully. 

The  striking  results  obtained  in  aoinials  have  justified  the  intra- 
cerebral injection  of  antitoxin  id  man.  Inasmuch  as  it  may  be 
considered  that  this  form  of  treatment  would  afford  the  patient  the 
only  chance  possible,  he  should  have  the  benefit  of  it,  although  it 
might  be  objected  that  the  risks  connected  with  this  treatment  are 
numerous. 

In  an  article  containing  a  risumi  of  the  reports  of  cases  treated  by 
means  of  intracerebral  iojections  of  tetanus  antitoxin,  Rambaud*' 
finds  that  the  risks  are  in  reality  trivial.  If  the  intracerebral  injec- 
tion is  made  in  a  neutral  area,  us  for  instance, in  the  frontal  lobes,  the 
results  of  the  trauma  are  reduced  to  the  minimum.  Uuder  all  cir- 
cumstances the  injury  caused  by  the  insertion  of  a  fine  hypodermic^ 
needle  into  the  brain  is  triflings  the  quantity  of  serum  introduced 
is  small,  and  when  introduced  slowly  no  undue  compression  needs 
to  be  caused.  Hemorrhage  from  the  pia  and  dura  can  be  readily 
avoided,  and  the  button  of  bone  removed  being  preferably  small, 
healing  takes  place  rapidly.  At  the  same  time  as  intracerebral  in- 
jections are  the  most  effecient  mode  of  treatment,  it  is  nevertheless 
necessary,  for  the  reasons  already  alluded  to,  to  employ  intravenous 
and  subcutaneous  injections  of  antitoxin,  in  order  to  neutralize  the 
toxins  circulating  in  the  blood  and  that  which  is  continuously  being 
secreted  ftt  the  site  of  the  injury. 

The  first  human  case  treated  in  this  manner  occurred  only  two 
months  after  the  publication  of  Roux  and  Borrel's  researches.  Of 
the  twelve  cases  which  have  now  been  treated  by  this  plan,  three 
have  occurred  in  this  country,  the  first  being  one  published  in  the 
New  York  Medical  Journal  for  December  17,  1898,  by  Charles  A. 
Church,  of  Passaic,  N.  J.  Recovery  took  place.  Rambaud  refers 
to  two  more  cases,  one  of  which  died  from  tetanus.  In  the  other 
of  these  cases,  in  which  the  tetanus  developed  ten  days  after  a 
laparotomy,  the  tetanic  symptoms  subsided  after  intracerebral  and 
subcutaneous  injections  of  antitoxin,  but  death  resulted,  apparently 
from  anemia,  nephritis  and  sepsis,  the  fatal  issue  taking  place 
eleven  days  after  the  complete  disappearance  of  the  tetanic  mani- 

*Mnr  York  Uadlol  JouTiul,  Deounbu  IT,  ISBB. 


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852       The  Atlanta  Medical  and  Scbgical  Jouekal. 

festatioQS,  which  were  of  the  bulbar  type  ot  tetanuB,  and  cooEe- 
cjuently,  according  to  Roux  and  Sorrel's  teaohiag,  of  bad  prognostic 
omeo.  Id  these  two  cases,  one  may  therefore  be  said  to  have  re- 
covered under  this  mode  of  treatment. 

The  most  delicate  part  of  the  operation  in  intracranial  injection 
is  the  injection  itself.  It  is  necessary  to  have  a  very  perfect  syringe, 
which  must  be  absolutely  aseptic.  In  order  to  make  it  possible  to 
inject  the  antitoxin  slowly,  drop  by  drop,  Rambaud  has  constructed 
■a  syringe  which  holds  3  c.c,  the  rod  of  which  fits  a  thread  inside 
the  cap,  BO  that  the  injection  can  be  made  by  a  screwing  motion  of 
ihe  thumb-piece.  The  head  of  the  needle  is  of  conic  shape,  in  order 
to  fit  the  trephine  hole  made  in  the  skull.  The  trephine  used  in 
Bamhaud's  cases  bad  a  crown  whose  diameter  was  about  7  mm. 
The  cone-shaped  head  of  the  needle  makes  it  possible  to  firmly  fix 
the  needle  in  the  trephine  hole ;  between  the  needle  and  the  syringe 
is  a  flexible  rubber  tube  connection.  With  this  arrangement  there 
is  no  risk  of  the  needle  moving  aft«r  it  has  been  properly  inserted. 
The  injection  should  be  made  in  from  ten  to  twelve  minutes.  The 
-cone  of  the  needle  is  provided  with  a  groove  so  as  to  afford  passage 
to  any  fluid  which  might  otherwise  cause  compression. 

It  would  eeem  that  this  mode  of  treatment  of  tetanus,  the  mor- 
■tality  from  which  is  yet  very  large,  even  when  treated  promptly  by 
means  of  the  ordinary  subcutaneous  or  intravenous  injections  of 
antitoxin,  would  merit  an  extended  trial.  The  actual  Asults  of 
the  intracerebral  injections  of  antitoxin  can  only  be  fully  detei^ 
mined  when  a  large  number  of  cases  have  accumulated.  It  may 
also  be  allowed  to  indicate  that  in  all  probability  a  single  intra- 
.cerebral  injection  of  tetanus  antitoxin  will  not  always  suffice  to 
neutralize  the  toxin  fixed  in  ganglion  eel  Is,  scattered,  perhaps,  over 
4  large  part  of  the  brain.  It  may  be  found  neccessary  to  make 
several  injections  into  the  brain  in  various  places. — Journal  of  the 
Amei-ican  Medical  AesociaiUm. 


Pneumonia  in  Childben. 
Pneumonia  in  childhood   has  of  late  been  deeply  occupying  the 
attention  of  pediatrists,  and   without  doubt  much   good   has  been 
«ffected  by  the  interchange  of  opinions,  and   by  the  ventilation  ot 


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Selections  and  Abstracts.  85S 

the  subject  generally.  At  the  meetiag  called  together  by  the 
chairman  of  the  pediatric  section  of  the  New  York  Academy  of 
Medicine,  many  points  in  connection  with  the  treatment  of  the 
disease  were  made  clear  which,  up  to  that  time,  had  been  decidedly 
misty.  When  the  fact  is  considered  that  pnenmonia  is  one  of  the 
most  deadly  maladies  to  which  children  are  prone,  it  cannot  be 
denied  that  the  time  had  come  for  a  certain  consensus  of  opinion 
to  be  arrived  at  in  regard  to  its  treatment.  But  before  touching 
on  the  subject  of  treatment,  it  may  be  as  well  to  refer  briefly  to 
the  light  that  has  been  thrown  on  the  etiology  of  the  disease  by 
means  of  the  researches  of  bacteriologists.  This  phase  of  the 
matter  has  been  extremely  well  set  forth  in  an  article  contributed 
to  the  Edinburgh  Journal  of  August  26tb,  by  Dr.  James  Car- 
michael,  physician  to  the  Edinburgh  Royal  Hospital  for  Sick 
Children,  who  says: 

"  Bacteriology  has  contributed  largely  to  our  knowledge  of  the 
disease.  The  rdle  which  micro-organisms  play  in  the  disease  is 
certainly  a  very  important  one,  as  without  doubt  the  toxemia  re- 
sulting from  their  growth  and  development  would  appear  to  be 
not  only  the  main  factor  in  the  production  of  the  constitutional 
symptoms,  but  often  the  principal  cause  of  danger  to  life.  Recent 
bacteriological  investigation  shows  that  quite  a  number  of  organ- 
isms are  found  associated  with  this  disease.  Netter  gives  the  bac- 
teriology in  forty-two  cases — in  twenty-five  primary  cases.  Fried- 
lander's  capsuled  coccus  or  pneumobacillus  was  found  in  ten,  strep- 
tococcus in  eight,  staphylococcus  in  five,  Fr&okel's  capsuled  coccus 
in  two.  In  seventeen  of  the  cases  there  was  mixed  infection  thus: 
In  five  poeumococcus  and  streptococcus,  five  streptococcus  and 
stapblyococcuB,  three  streptococcus  and  capsuled  coccus,  two 
poeumococcus,  streptococcus  and  stapblyococcus,  one  pneumococcus 
and  capsuled  coccus.  Mosny  and  Ketter  both  agree  that  in  cases 
marked  by  lobular  distribution,  streptococcus  was  usually  met 
with  alone  or  with  pneumococcus,  whereas  those  in  which  the 
distribution  was  lobar,  catarrhal  and  fibrinous  variety  combined, 
one  or  other  of  the  forms  of  pneumococcus,  either  Frankel's  or 
Friedlander's  organisms,  were  generally  found  alone.  Other 
investigators  who   have  studied   the  different  forms  of  pneumonia 


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S54       The  Atlanta  Medical  and  Surqioal  Joorhal. 

have  arrived  at  tbe  coDclasioD  that  it  is  no  one  oi^nism  that 
-causes  the  disease,  but  two  aod  sometimes  more.  Thus  plainly 
proving  that  the  pneumonia  of  childhood  caoDOt  be  regarded  as  a 
specific  disease,  seeing  that  various  organisms  produce  the  patho- 
logical changes  in  the  lung  tissues." 

The  foregoing  may  be  said  to  be  a  short,  up-to-date  present- 
tnent  of  the  germ  theory  of  pneumonia  in  children,  and  woald 
appear  in  the  main  correct.  The  next  forward  step,  then,  is  to 
discover  a  really  reliable  antitosin,  but  until  this  is  done  we  must 
ourselves  sift  the  different  modes  of  treatment  at  present  practiced, 
and  learn  from  the  experience  of  others  in  order  to  arrive  at  a  sat- 
isfactory conclusion.  At  the  meeting  of  the  pediatric  section, 
referred  to  above,  some  definite  opinions  were  expressed,  and  from 
the  views  of  the  majority  of  the  speakers  we  can  form  our  own 
Judgment  as  to  the  most  beneficial  and  widely  practiced  methods 
of  treatment.  For  example,  it  was  agreed  on  all  hands  that  rest 
and  complete  isolation  is  absolutely  necessary ;  that  careful  nurs- 
ing is  one  of  the  most  important  considerations,  and  the  opinion 
-was  unanimons  that  effective  ventilation  is  essentual.  The  meeting 
was  opposed,  on  the  whole,  to  the  active  use  of  drugs,  and  few  voices 
where  raised  in  favor  of  stimulants,  while  hot  poultices  were  con- 
demned in  toto.  On  the  question  of  bathing,  opinions  differed 
most  widely.  Kot,  however,  so  far  as  the  beneficial  eGfects  of 
baths  themselves  are  concerned,  but  with  respect  to  their  tempera- 
lure.  Some  advocated  baths  as  high  as  100  F.;  others  deemed 
70  F.  a  heat  better  calculated  to  produce  the  wished-for  results, 
while  one  speaker  advised  the  employment  of  the  wet-sheet,  cooled 
by  ice.  The  large  majority  of  the  speakers  deprecated  extremes 
of  either  heat  or  cold,  but  recommended  the  adoption  of  a  middle 

To  refer  again  to  Dr.  Oarmichael's  article.  In  very  severe 
cases,  with  much  cyanosis,  he  suggests  the  inhalation  of  oxygen, 
the  small  patient  lying  under  a  tent,  and  states  that  in  many  cases 
he  has  known  the  treatment  to  be  of  signal  benefit.  In  infantile 
pneumonia,  many  physicians  in  Great  Britain  assert  that  belladona 
acts  like  a  charm.  There  would,  however,  seem  to  be  some  diver- 
sity of  views  in  this  country  and  Great  Britain  as  to  the  efficacy 


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Selections  and  Abstracts.  855 

of  the  drug  treatment  of  poGumoaia  in  children.  The  judgment 
of  medical  men  here,  as  evidenced  by  the  expression  of  their 
opinions  at  the  meeting  of  the  pediatric  Rection,  is  distinctly 
against  active  medication.  In  Great  Britain,  on  the  other  hand, 
the  coneervative  treatment  still,  to  a  lar^  extent,  holds  away.  As, 
however,  the  study  of  children's  diseases  as  a  specialty  has  been 
more  closely  and  for  a  far  longer  period  pursued  in  America  than 
in  the  United  Kingdom,  we  may  claim — without  laying  ourselves 
open  to  the  charge  of  undue  presumption — to  be  more  fitted  to 
pass  an  authoritative  opinion  on  the  matter.  The  pediatric  section 
deserves  the  thanks  of  every  medical  man  for  the  able  manner  in 
which  the  whole  subject  was  placed  before  them. — Pediatrics. 


The  Excision  op  Carbuncles. 

Mr,  Rusfaton  Parker  (Bi-ittsh  Medical  Journal,  November  26th) 
again  calls  attention  to  the  subject  of  the  complete  extirpation  of 
carbuncles.  The  ordinary  methods  of  palliative  expectation  and 
excision,  in  his  opinion,  in  which  Sir  James  Paget  in  his  Clinical 
Lectures  seems  to  concur,  show  no  advantage  of  one  course  over 
the  other.  The  two  principal  features  of  carbuncles  are  (1)  pain 
and  (2)  liability  to  septic  poisoning.  Incision,  he  asserts,  does 
not  relieve  the  pain,  and  does  nothing  to  prevent  or  arrest  septic 
poisoning.  It  is  a  severe  o]>eration,  requiring  an  anesthetic,  and 
is  it^If  liable  to  be  followed  by  septic  poisoning  through  uewly 
opened  channels. 

The  case  is  quite  different,  he  continues,  with  extirpation,  whichi 
however  extensive,  is  not  a  much  more  severe  operation  than  in- 
cision. But  what  a  contrast  io  the  result !  Ask  a  patient  the  day 
after  extirpation  what  he  thinks  of  it,  and  he  replies,  "I  feel  no 
pain  whatever,  only  a  little  weak";  "I  ieel  as  if  a  load  had  been 
taken  off  me."  The  pain  resided  in  the  inflamed,  stretched,  and 
infiltrated  integuments,  which  in  thorough  extirpation  are  all  re- 
moved, leaving  only  a  wound  in  healthy  tissues.  The  same  applies 
to  septic  [Kiisoning,  which  at  first  is  geuerally  quite  local  and  con- 
fined to  the  afiected  tissues.  When  these  are  removed  the  poison- 
ous focus  has  gone. 


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856       The  Atlanta  Medical  and  Surgical  Jotibnal. 

The  extirpation  of  carbuncle  by  excisioD  and  acraping,  accord- 
iDg  to  the  texture  of  the  afkct«d  tissues,  is  just  as  rational  as  the- 
excieioQ  of  tuberculous  glands,  the  sorapiog  of  lupus,  and  the  re- 
moval of  sloughs,  while  experience  amply  proves  its  value.  Among 
the  twelve  cases  hitherto  reported  by  him,  two  were  in  women, 
situated  on  the  ftce;  the  rest  were  in  men.  In  one  or  two  cases 
the  relief  to  pain  was  not  complete,  and  this  he  attributes  to  ia- 
sufficient  thoroughness  in  the  excision.  If  the  carbuncle  is  very 
soil  there  may  be  a  temptation  to  rely  on  thorough  scraping  alone, 
and  80  to  leave  some  of  the  disease  behind.  It  is  advisable  to 
remove  all,  and  to  thoroughly  cut  away  with  knife  or  scissors 
what  can  not  be  scraped. 

He  then  reports  five  more  cases,  of  which  one  proved  fatal. 
This  he  attributes  to  not  critically  watching  the  sore  to  detect  any 
reappearance  of  the  oarbuncular  process,  and  not  removing  thor- 
oughly all  recognisable  diseased  parts.  Diseased  spota  he  touches 
with  pure  carbolic  acid  which  effectually  renders  them  aseptic  and 
is  at  the  same  time  anodyne. — JVew  York  Medicai  Journal. 


Antistbeptoooocus  Sebum  in  Chancboid. 

Mr.  James  Moore,  F.  R.  C.  S.  Edin.  (Britigh  Medical  Journal, 
November  26th),  states  that  during  the  past  eight  months  he  has 
used  antistreptococcus  serum  in  forty-eight  cases  of  acute  inflam- 
matory bubo,  and  in  only  seven  cases  did  suppuration  occur.  He 
records  two  very  interesting  cases.  From  his  experience  with  an- 
tistreptocoocus  serum  in  venereal  sores  and  their  complications,  he 
has  arrived  at  the  following  conclusions: 

1.  While  recognizing  the  great  importance  of  early  local  anti- 
septic treatment  of  the  chancroid,  he  believes  that  if  five  cubic  cen- 
timeters of  the  serum  are  injected  subcutaueously  into  each  ingui- 
nal region  in  cases  -in  which  inflammatory  bubo  is  likely  to  develop, 
it  will  prove  a  good  prophylactic  measure,  and  assist  in  healing 
the  chancroid. 

2.  If  inflammatory  bubo  has  already  developed,  and  the  acute 
inflammatory  symptoms  have  not  been  present  more  than  forty- 
eight  hours,  ten  cubic  centimeters  injected  into  the  inguinal  region 


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Selections  and  Abbthacts.  iS6i 

corresponding  to  the  inflamed  gland  will  cause  reeolution  in  the 
majority  of  cases. 

3.  If  there  is  evidence  of  pus  formation  the  serum  may  possibly 
limit  the  extension  of  the  suppuration,  but  in  this  class  of  cases 
his  results  have  been  aoytbing  but  satis&ctory. 

4.  The  serum  should  always  be  injected  into  the  area  drained 
by  the  infected  gland,  preferably  the  right  and  left  inguinal  region. 
He  has  not  seen  good  results  by  injecting  it  into  remote  areas. 

5.  In  phagedenic  ulceration  complicating  venereal  sores  this 
serum  would  appear  not  ionly  to  neutralize  the  toxins  in  the 
blood,  but  also  to  bring  about  a  healthy  condition  of  the  ulcer.— 
New  York  Medical  Journal. 


Faradaism  in  Dilatation  of  the  Os  Uteri. 

Dr.  Jeanoie  W.  Martioe  (Journal  of  EUciroth^apeuiica,  Decem- 
ber) describes  a  dilator,  similar  to  Nott's  dilator,  which  is  connected 
with  one  pole  of  afaradaic  battery  by  one  terminal,  and  by  another 
with  a  targe  pad  which  is  placed  on  the  abdomen.  The  anesthetic 
effect  of  the  fine  wire  faradaic  coil  are,  according  to  tbe  author,  of 
material  assistance. 

Dr.  Martine  says  : 

"  I  have  used  this  instrument  in  a  variety  of  cases.  I  wish  to 
mention  one  class  where  the  physician  does  not,  as  a  rule,  consider 
divulsion  necessary.  I  mean  in  subinvolution  complicated  with  en- 
dometritis ;  here  divulsion  causes,  first,  drainage.  Secondly,  it  acts 
as  massage  and  sets  up  a  better  circulation.  The  electricity  helps 
us  here  by  its  stimulating  properties  more  than  its  aneetbetio  effects, 
as  the  uterus  is  rarely  sensitive  in  subinvolution.  My  eteotrioal 
dilator  is  one  of  my  best  friends  in  nearly  all  cases  of  uterine  disease, 
and  it  can,  of  course,  be  used  with  the  galvanic  as  well  as  faradaic 
currents,  and  I  have  yet  to  see  a  case  so  sensitive  that  I  could  not 
dilate  by  its  judicious  use.  It  is  indeed  simply  wonderful  bow  the 
long,  fine  wire  coil  of  an  Eogleman  faradaic  battery  will  benumb 
the  parts  so  that  little  or  no  distress  is  felt.  I,  however,  give  my- 
self plenty  of  time  in    treating  sensitive  subjects  and  only  do  very 


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858       The  Atlanta  Medical  and  Sdrqical  JodrnaL. 

little  at  each  treatment.  One  important  point  I  vr'ish  to  mention : 
Tlie  anesthetic  eff^t  of  electricity,  &rada)8m  at  least,  is  only  felt 
while  the  current  is  turned  on,  and  this  is  the  objection  to  using 
graduated  sounds,  much  pain  being  caused  by  withdrawing,  turn- 
ing off  current,  and  reintroducing  a  latger  size.  Theoretically  why 
this  is  the  case  I  cannot  say  ;  practically  I  know  it  to  be  so  ;  but 
the  instrument  I  have  described  allows  current  to  flow  while  we  are 
dilating  and  overcomes  that  difficulty." 

This  procedure  might  be  worth  a  trial  in  stricture  of  the  urethra, 
though  the  catalytic  properties  of  the  faradaic  current  are  slight  as 
compared  with  those  of  galvanism. — New  York  Medical  Journal. 


Solomon  Eight  Again. 
The  India  Lancet  for  November  16th  quotes  the  following: 
"In  Notes  and  Queriee,"  says  the  New  York  Times,  "there  is  a 
story  quoted  written  by  Mir  Muhammad  M'asum  in  1660.  An 
exiled  prince  meets  a  man  who  is  carrying  what  are  designated  as 
'  hahku  tubes.'  Looking  at  the  man,  the  prince  discovers  that 
just  as  long  as  the  man  holds  the  hakku  tubes  his  entire  interior 
economy  is  visible.  The  prince  at  once  purchases  the  tubes.  Com- 
ing to  Ghuzoi,  be  finds  a  patieut.  The  King  of  Ghuzni  is  suSer- 
iug  from  dyspepsia.  There  is  good  reason  for  the  king  feeling  so 
uncomfortable,  for  when  the  hakku  tubing  is  applied,  it  is  dis- 
covered that  the  patient  had  swallowed  not  less  than  two  water 
snakes.  Headers  will  then  please  observe  that  the  X-rays  have 
been  anticipated.  The  original  of  the  story  is  found  in  Elliot's  Sin- 
tory  of  India  by  its  own  historians.  After  a  while  we  may  discover 
that  Noah's  ark  had  water-tight  bulkheads  and  twin  screws."—- 
New  York  Medical  Journal. 


MuecDLAB  Atbophies  op  Htstebical  Obigin.     (H.  JDuBois- 
-     These  de  Paris.  Five  Original  Observations.    Revue  Neuroiogique, 
October  30,  1898.) 

Muscular   atrophies  of  hysterical  origin    frequently   follow  a 
hemiplegia  or  traumatism,  but  they  may  appear  without  apparent 


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Selections  and  Abstracts.  859 

cause.  They  are  simple  atrophies.  They  usually  affect  the  muscles 
generally,  hut  may  attack  particular  groups.  They  begin  abruptly 
and  reach  their  maximum  condition  with  great  rapidity,  remaining 
stationary  for  a  time  and  gradually  disappearing  with  the  disap- 
pearance of  the  phenomena  which  have  provoked  them  (paralysis, 
contractures,  etc.) 

They  are  always  accompanied  by  hysterical  symptoms,  especially 
bemianesthesia,  anesthesia  of  ocular  and  pharyngeal  mucous 
membranes  and  the  hysterical  pupil.  They  are  sometimes  accom- 
panied by  fibrillary  tremors.  The  RD  does  not  appear  in  the  most 
marked  cases. — Biggs. 


Local  Anesthesia. 


Dr.  Bagot  (Journal  des  praatidena)  considers  that  the  tonic  action 
of  sparteine  on  the  heart  combats  the  depressant  effect  of  cocain, 
while  aiding  (he  local  anesthestic  effect  of  the  latter.  He  recom- 
mends  the  following  in  each  powder: 

HjdrochloTide  of  cocain... J  grain. 

Sulph&te  o(  (parteiDe Igraio. 

For  use,  dissolve  one  powder  in  either  fifteen  or  twenty  drops  of 
boiled  water  at  the  time  of  injection.  Begin  with  the  weaker  solu- 
tion. Fifteen  drops  are  injected  in  the  line  of  operation  on  one 
side  of  the  small  tumor  to  be  removed ;  after  waiting  seven  or  eight 
minutes,  the  other  half  on  the  other  side.  At  the  end  of  some 
moments  he  commences  the  operation  on  the  first  side  injected,  and 
by  the  time  that  is  finished  anesthesia  is  complete  on  (he  other 
side, — New  York  Medical  Journal. 


A  Tropical  School  of  Mbdicine  in  liONoox. 
Our  usually  accurate  contemporary,  the  Philadelphia  Medical 
Journal,  in  its  issue  for  December  24th,  has  a  paragraph  with  this 
heading.  London,  we  are  informed,  is  a  pretty  "  hot''  place — in 
fact  quite  "sultry"  In  some  respects  j  but  for  all  that,  it  is  some 
degrees  north  of  the  Tropic  of  Cancer.  A  School  of  Tropical  Medi- 
cine is,  however,  what  we  believe  our  coutemporary  to  mean. — 
New  York  Medical  Journal. 


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860       Ths  Atlahta  Medical  and  Suboical  Joormal. 
The  Uses  and  Effects  of  Mangakifebous  Iron  Peptone. 
Bv  Db.  Jclics  Hbitzmakn,  Viekna. 

The  employmetit  of  iron  preparations  both  in  essential  aoemia 
(chloroeis)  and  in  the  symptomatic  forms  of  this  affection  pro- 
duced by  severe  losses  of  blood,  dates  from  the  earliest  times. 
Long  before  the  chemical  relation  of  this  effect  was  knowo,  these 
remedies  were  administered  on  the  ground  of  pure  empirical  ex- 
perience. 

When  Hannon  pointed  out  the  high  significance  of  manganese, 
as  well  as  of  iron,  with  regard  to  the  absorption  of  oxygen  by  the 
blood,  and  when  this  discovery  was  confirmed  by  Rueble,  efforts 
were  made  to  produce,  by  combinatioD  of  both  remedies,  prepara- 
tions which  would  best  fulfill  the  therapeutic  indications  in  all 
directions. 

Former  attempts  of  this  kind  failed  to  give  the  desired  results. 
The  aim  was  to  combine  both  metals  in  such  a  form  as  would  enable 
them  to  be  absorbed  throughout  the  entire  extent  of  the  alimentary- 
canal,  and  at  the  same  time  be  devoid  of  disagreeable  taste  which 
would  prevent  their  prolonged  administration.  After  a  series  of 
experiments  made  in  this  direction  I  found  in  the  preparation 
discovered  by  Br.  A.  Gude  {Pepto-Mangan — Gude)  a  remedy 
which  fulfilled  the  above  requisites,  and  can  recommend  it  most 
heartily. 

Pepto-Mangan — Gude  is  a  clear,  dark,  wine-red  fluid,  having 
an  agreeable,  non-metallic,  astringent  taste.  The  latter  property 
gives  it  a  great  advantage  over  other  similar  preparations,  for  the 
remedy  is  always  taken  with  pleasure,  and  may  therefore  be  ad- 
ministered for  a  long  time  without  exciting  the  disgust  of  the 
patient.  No  irritation  of  the  stomach  is  produced,  nor  is  the  diges- 
tion disturbed  in  the  least  respect ;  indeed,  as  regards  the  latter,  a 
stimulation  of  the  long-absent  appetite  could  be  demonstrated  within 
a  short  time. 

The  Pepto-Mangan — Gude,  usually  mixed  with  some  water,  is 
prescribed  io  doses  of  two  or  three  dessertspoonfuls,  increased  to  an 
many  tablespoonfuls  per  day.  An  especially  agreeable  manner  of 
administration  is  by  addition  of  cold  atilk^  whicb  then  Assumes  ^ 


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Selections  asd  Abstracts.  861 

light  chocolate  color  and  agreeable  taste.  Prescribed  id  this  form 
we  obtain  from  this  preparation  everything  that  could  be  expected 
from  a  remedy  for  anemia.  The  Pepto-Mangan — Gude  may  also 
be  mixed  with  white  and  sweet  wines,  excepting  the  red  wines 
which  contain  tannic  acid,  and  an  occasional  change  in  the  manner 
of  administration  is  sometimes  of  advantage,  especially  in  the  case 
of  children. 

The  diet,  during  the  use  of  this  preparation,  should  consist  of 
milk,  meats — especially  ham — fowl,  soft-boiled  eggs,  and  other 
easily  digested  foods.  On  the  other  hand,  sour  and  iatty  foods,  red 
wines  and  raw  fruits  are  to  be  avoided. 

The  remedy  is  to  be  administered  forsnumherof  weeks,  especially 
in  cases  of  chlorosis,  but  in  the  case  of  young  girls  up  to  12  years 
of  age  it  is  best  to  commence  with  a  daily  dose  of  two  teaspoonfuls 
(ten  grammes).  In  adults  the  dose  of  the  Pepto-Mangan — Glide 
may  he  increased  in  a  few  days  to  one  tablespoouful  twice  or  thrice 
daily,  or  even  to  ten  or  twenty  grammes.  The  preparation  should 
be  well  protected  from  the  light,  and  preserved  in  a  cool  place  in  a 
well-stoppered  bottle. 

I  have  employed  the  Pepto-Mangan — Gude  with  much  success 
both  in  chlorosis  and  in  cases  of  anemia  in  girls  and  women  due  to 
loss  of  blood,  menorrhagia,  metrorrhagia,  inflammation  of  the  pelvic 
organs,  peri-  and  parametritis,  or  prolonged  leucorrhea.  In  almost 
every  instance  I  observed  within  a  short  time  increase  of  appetite, 
improved  nutrition,  healthier  color  of  the  face,  and  increase  of 
weight.  I  was  surprised  to  learn  how  ranch  more  readily  the  Pepto- 
Mangan — Gude  was  taken  than  similar  preparations,  without  ill 
eflTects  even  after  protracted  use. 

To  illustrate  my  remarks  I  will  cite  a  few  cases : 

I  will  first  report  a  case  of  chlorosis  treated  with  this  remedy, 
which  was  under  constant  observation.  The  patient,  a  schoolgirl 
aged  16,  began  to  menstruate  one  year  ago,  hut  after  appearing  regu- 
larly for  three  periods  the  flow  suddenly  cea!>ed,  probably  in  conse- 
quence of  mental  over-exertion,  and  symptoms  of  chlorosis  soon 
developed.  The  various  preparations  of  iron  were  tried,  but  were 
either  not  well  borne  or  excited  so  much  disgust  that  they  were 
discontinued  by  the  capricious  patient.    A  milk  cure  was  prescribed, 


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862       Thb  Atlanta  Medical  and  Sdrqical  Journal. 

but  followed  for  only  &  abort  time.  When,  however,  I  resorted  to 
the  Pepto-Maogan — Gude,  I  was  surprised  to  find  that  (he  prl  look 
it  williogly  aad  that  it  was  well  borne.  She  made  a  rapid  recovery, 
aod  after  the  use  of  two  bottles  had  regained  her  former  healthy 
color,  while  her  strength  and  menstruation  returned. 

Case  II. — A  married  lady,  aged  24,  had  acquired — apparently 
of  abortion  at  a  very  early  period — an  intense  peri'  and  parametritis 
with  exudation  of  the  size  of  a  child's  bead.  The  latter  disap- 
peared almost  completely  under  suitable  treatment  and  rest,  so  that 
only  a  slight  induration  was  present  in  the  parametrium  after  three 
weeks.  Owing  to  the  considerable  anemia  and  loss  of  appetite, 
however,  the  patient  recovered  very  slowly,  and  for  this  reason  I 
ordered  the  Pepto-Mangan — Gude.  A  few  days  after  its  use  the 
appetite  reappeared,  recovery  ensued  rapidly,  and  five  weeks  later 
her  health  was  completely  restored. 

Case  III. — A  married  lady,  aged  30,  had  sufiered  from  leucor- 
rhea  due  to  catarrhal  iuflammation  of  the  vagina  for  two  years, 
and  although  the  local  trouble  had  been  much  relieved  she  cou- 
tinued  pale  and  weak.  As  her  chlorotic  daughter  at  the  time  was 
taking  the  Pepto-Mangan — Gude  with  marked  benefit,  I  advised 
her  also  to  try  this  preparation.  She  followed  my  advice,  aod  after 
fourteen  daysthe  weak,  sluggish,  and  pale  woman  seemed  as  if  traus- 
formed.     She  has  since  regained  her  former  health. 

These  few  cases,  which  were  under  continued  observation,  will, 
confirm  what  has  been  said  above  regarding  the  manner  of  applica- 
tion and  effect  of  the  Pepto-Mangan — Gude.  I  regard  it  as  super- 
fluous (o  cite  other  cases,  since  a  few  closely  observed  cases  teach 
more  than  a  host  of  superficial  observatiuns. 

On  the  ground  of  my  experience  I  consider  myself  warranted  in 
directing  the  attention  of  physicians  to  this  remedy,  and  feel  con- 
vinced that  further  trials  will  give  equally  favorable  results.  Even  in 
cases  where  local  treatment  is  necessary  the  Pepto-Mangan — Gude 
will  prove  a  valuable  auxiliary  in  our  treatment. — AUgemetne  WetVr 
medizinische  Zeitinig,  xxxvi. 


NOTICE.-TMh  JOURXAL  amt  THE  INTERSATIOSAL 
tfOVRNAL  OF  SVnQEHV  one  year  for  $1.00  me^ 


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Selections  and  AbstkactS.  868 

Catheters  and  Cystitis. 

By  R.  N.  MiYMBti),  M.D,,  New  Yoek, 

Formerly  President  of  the  Colorado  State  Board  of  Medical  Examiners 

and  Lecturer  in  Pathology  and  Clinical  Medicine, 

University  of  Colorado,  etc. 

It  is  well  known  that  when  it  is  necessary  to  use  a  catheter  of 
usual  cODstnictioD — that  is,  with  the  ordinary  fine  perforations  as 
an  inlet  thereunto — it  does  not  work  readily  or  satis&ctorily,  or 
subserve  fully  the  results  expected  from  it. 

Examples  of  such  unsatisfactory  operations  are  seen  where  there 
is  a  good  deal  of  mucus  present  in  the  bladder,  such  mucus  being 
apt  to  surround  or  He  upon  the  end  of  the  catheter,  clogging  or 
stopping  the  apertures  thereof  and  preventing  the  ingress  of  fluids 
to  be  drawD  off;  again,  when  sediment  or  calcareous  matter  is  pres- 
ent, it  clogs,  even  sometimes  filling  in  part  or  completely  the 
apertures,  with  conse<inent  failure  of  the  catheter  to  fully  perform 
its  functions.  Such  failures  are  especially  apt  to  happen  in  nearly, 
if  not  quite,  all  forms  of  chronic  diseases  of  the  bladder,  and  not- 
ably so  in  cystitis. 


My  object,  therefore,  is  to  present  a  catheter  that  is  reliable  and 
efficient  in  operation  when  the  use  of  a  catheter  is  indicated  in  all 
coDditioua  and  diseases  of  the  blfjdder.  In  this  instrument  the 
danger  of  clogging  or  failure  to  perform  its  functions  is  obviated, 
and  ita  interior  may  be  readily  made  aseptic,  and  bits  of  mucus 
that  usually  clog  an  ordinary  catheter  may  be  readily  drawn  off. 

This  catheter  is  of  very  simple  construction,  being  tubular,  with 
the  curve  of  an  ordinary  instrument,  and  open  at  the  end  for  an 
inlet.  For  the  closure  of  this  open  end,  and  for  the  easy  insertion 
of  the  catheter,  as  well  as  for  other  purposes,  a  bulbous  or  rounded 
head  is  used,  prefeiably  solid,  and  attached  to  one  end  of  a  wire. 


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864       The  Atlanta  Medical  and  Surgical  Journal. 

paesiDg  through  the  body  or  tube  aod  projecting  at  its  rear  or 
outlet  end. 

This  coDStructioD  forms  a  very  efficient  catheter  having  an  area 
of  opening  so  large  as  to  greatly  obviate  the  danger  of  cloggiog, 
for,  if  mucus  should  lodge  against  the  open  end,  the  working  of 
the  head  back  and  forth  upoD  its  seat  would  cut  away  the  obstruct- 
ing bits  of  mucus  and  permit  them  to  pass  through  the  tube. 

With  this  instrument  there  should  be  no  hesitancy  in  using  ni- 
trate of  silver,  iodine,  corrosive  sublimate,  carbolic  acid,  or  hydro- 
gen solutions  in  the  bladder,  as  any  of  these  solutions  can  be  readily 
drawn  off  or  neutralized,  thus  preventing  poisoning  from  absorp- 
tion, or  preventing  rupture  from  gases  that  form  in  the  bladder. 

Regarding  the  treatment  of  cystitis  with  the  employment  of  this 
catheter,  presuming  that  we  have  a  typical  case,  with  ropy,  viscidi 
and  tenacious  mucus,  the  membrane  thickened  and  possibly  ulcer- 
ated, and  in  deep  folds — "  ribbed,"  as  it  were — we  begin  the  treat- 
ment as  follows: 

1.  Inject  a  quarter  of  a  grain  of  cocain  dissolved  in  a  drachm 
of  water  into  the  membranous  portion  of  the  urethra. 

2.  Anoint  the  latest  hard-rubber  catheter  that  can  be  well 
passed  into  the  bladder,  and  increase  the  size  one  number  each 
week  until  the  urethra  is  normal  in  size. 

3,  Begia  with  dilute  hydrogen  solutions — preferably  hydrOEOne 
— one  part  to  twenty  of  lukewarm  water,  using  this  solution  freely, 
especially  when  employing  the  large  siite  catheter.  If  the  small 
size  is  used  at  the  beginning,  I  recommend  the  use  of  only  two  or 
three  ounces  at  a  time  until  removed  by  the  return  tlow.  This  can 
be  repeated  until  the  return  flow  is  clear  and  not  "foaming," 
which  indicates  that  the  bladder  is  aseptic. 

4,  Partly  fill  the  bladder  with  the  following  solution:  tincture 
of  iodine  compound,  two  drachms;  chlorate  of  potassium,  half  a 
drachm;  chloride  of  sodium,  two  drachms;  warm  water,  eight 
ounces.  Let  it  remain  a  minute  or  so  and  then  remove.  This 
treatment  should  be  used  once  or  twice  a  day. 

Where  I  suspect  extensive  ulceration  I  recommend  once  a  week 
the  use  of  from  ten  to  twenty  grains  of  nitrate  of  silver  to  the 
ounce,  and  neutralize  with  chloride  of  sodium  solutions. 

This  treatment  carried  out  carefully  will  be  satisfactory,  as  there 
is  no  remedy  that  wilt  destroy  bacteria,  fetid  mucus,  or  aaocuUted 
calcareous  deposits  like  hydrogen. 


^dbyGoOglc 


idb,Googlc 


idb,Googlc 


Glycerinated  Vaccine 


(P..  D.  &  Co.) 


BACTER10LOOICAU.V  AND  PHVSIOtOOICALLY  TESTED 


ApplTlQtt  tlie  Vwdna  to  pMlenfa 


icod  of  tJlB 

„  __. y  meun  of 

»  ,mmU  nibW  bolb  wblch  Is  hmilBhed 
wKb  taatt  pkekua  oC  teo  tubes.  The 
Vicoiva  la  utpUed  directly  trom  Ite  lube 
(a  Um  pMlgot'B  UID  (or  wbalsnr  portloa 
of  tba  bod]'  tochoaai  u  the  itte  c4  la 


Pleue  nentloa  tb'*  JovmftlT 


Gltoeiihatxd  TAOcnra  ii  mpUe  vacdn*— the  pulp 
of  oowpox  Tcalcles  iniied  with  pure  glycerin  for  Ihn 
dMTT)ctk»i  of  Ute  oompoimtlTely  lew  itrei^ooocci  or  other 
bactwlB  Hkdyto  be  preaent  despite  the  moat  careful 
DunipulstJOD  of  the  Tmccbie-produciiis  aiilm»L  Olycerln 
is  not  a  powerful  Kermldde;  but  itiB  powerful  enough,  u 
we  h&TB  ftbuzulalitly  demonstmtad  In  our  BacterlDlaglcal 
I^borKtoiT,  to  render  germ-fm  In  a  short  time  the 
ncduetaiiikkihliioarhaodslt  isnppUed.    Horaorer,  It 


!  tested  with  taberouUn.    As 

,  aiBughtsred  u  sood  u  t 
collected,  snd  a  careful  Inspeotlon  of  the  a 


dlanae  ue  f ouitd  the  n 


" Points"  are  Unreliable 
and  Unsafe. 


It  Is  &  noteworthj'  fact  that  m 
lune  gBHnUy  Ignored  tboae  Riles  of  tlgid  nirglcalaaeiBli 
whlcb  have  beea  reoagnlzed  Cor  years  as  absiriutely 
necmeaiy  when  the  pbysidsn  deslns  to  make  a  break  In 
the  healthy  skb  of  his  patlenL  As  a  result,  septic  In- 
fection after  Tncdnstlon  has  been  commraily  tnet  with  in 
general  practise.  The  object  of  tbe  product  now  MIered 
by  us  is  to  produce  infectioa  with  pure  cowpoz  and  to 
aToid  (he  Boree  and  sloughs  which  naturally  follow  the 
use  of  vaccine  material  carelessly  prepared  and  often 
loaded  with  the  argauiiims  of  ord^iory  pus. 

In  IBM  tbe  Columbus  Uedical  Laboratory  of  Chicago 
made  a  careful  examination  of  eleven  different  Tarietlea 
of  TBcdne  "points,"  made  by  as  many  manufacturer*,  and 
only  one  was  found  to  be  free  from  bacteria  and  blood, 
cells.    Of  the  rest,  several  were  decidedly  unfit  for  use. 

But.  notwithstanding  all  our  aseptic  methods,  vacdne, 
like  otha"  mcdst  physiological  products  no  matter  bow 
carefully  prepared  and  protected.  Is  Uabie  to  deteriorate 
afteracertain  pertod  of  time.  Par  this  reason  weaffli 
tbe  data  of  ahlpneat  la  each  package,  and  anthorJEe  tl 
drug  trade  to  give  fresh  VjmcniE  in  e    ' 


iQ  good  faith. 


Parke,  Davis  &  Co., 


Qray's(^lycenne']ponic(^omp. 


(Olycarln,  Sherry  Wine,  OentiEa.  TaruuEam,  Pboapborlc  Add,  CvnlnatlvM.] 

Formula  DR.  JOHN  P.  GRAY. 

Neutralizes  Acidity  of  the  stomach  and  checks  fer- 
mentation. 

Promotes  appetite,  increases  assimilation  and  does 
not  constipate. 

Indicated  in  Phthisis,  Bronchitis,  Anaemia,  Malnu- 
trition, Melancholia,  Nervous  Prostration,  Catarrhal 
Conditions,  General  Malaise. 

THE  PURDUE  FREDERICK  ca. 
Writs  for  suDpira.  No.  15  Murrsy  Street,  New  York. 


THL    IHOtCATIONS  FOHTHL  Uit  OF  > 

DOLOMObIC  IL 

ARCTHCSAMCASTW  W5 

roRThtusLonctiTtii  n 

rOf\H5WiyTlHHAL  U 

'  One  of  the  Dolomol  Compounds  which  iUustraies  very  fordbfy 
the  advantages  of  these  Dusting  Powders  over  ointments  as  app&- 
cations  in  Diseases  of  the  Skn. 

Vtff*1'^£^  "The  diKoloratiof)  «nd  the  diicomfoct  ot    pure  IchttTal 

tad  khthyol  ointmoit  art  avMde4,  *ad  br^c  tu-Aaea  d 
^^T  the  body  can  be  covered  with  thii  powder  wtthoot  iDH» 

'<^9lSxK«A2&4&3^*^  ''/>  TeaicDcinf  or  diffiturtnt  tfac  patient.'* 


^^-s^-^-^/ 


^^^zZ^  ""Kb'S.'S?^'"'        PULVOLA  CHEMICAL  CO 

,^  .-'BSKlSSr^'  'W  William  Si     Ne«  Virt 

PULVOl  A  PREVEWTSH^CURCS  (WTf/fTfilM 


SYR.  HYPOPHOS.  CO.,  FELLOWS 

Contains  the  Essential  Elements  of  the  Animal  Organization — PoUsh  and  Liroe 

The  OxidlslnerAgrdntS — Iron  and  Manganese ; 

The  TonlOS — Quinine  and  Strychnine ; 

And  the  Vitalizing^  Constituent — Phosphorus;  the  whole  combined  in  the  iorm 
of  a  Syrup  with  a  Slightly  Alkaline  Reaction. 

It  Differs  In  Its  Effeets  from  all  Analogous  Preparations;  and  it  possesses 
the  important  properties  of  being  pleasant  to  the  taste,  easily  borne  by  the 
stomach,  and  harmless  under  prolonged  use. 

It  has  Gained  a  Wide  Reputation,  particularly  in  the  treatment  of  Pulmonary 
Tuberculosis,  Chronic  Bronchitis,  and  other  affections  of  the  respiratory  organs. 
It  has  also  been  employed  with  much  success  in  various  nervous  and  debilitating 
diseases. 

Its  Curative  Power  is  largely  attribuUble  to  its  stimulant,  tonic,  and  nutritive  prop- 
erties, by  means  of  which  the  energy  of  the  system  is  recruited, 

its  Action  Is  Prompt ;  it  stimulates  the  appetite  and  the  digestion,  it  promotes 
assimilation,  and  it  enters  directly  into  the  circulation  with  the  food  products. 

The  prescribed  does  produces  a  feeling  of  buoyancy,  and  removes  depression  and 
melancholy ;  hcnre  lite  preparation  ie  oj  great  valw:  in  the  treatment  of  meTitat  and 
nervotiit  affections.  From  the  fact,  also,  that  it  exerts  a  double  tonic  influence,  and 
induces  a  healthy  flow  of  the  secretions,  its  use  is  indicated  in  a. wide  range  of 


diseases. 


NOTICE-CAUTION. 


The  success  of  Fellows'  Syrup  of  Hypophosphites  has  tempted 
certain  persons  to  offer  imitations  of  it  for  sale.  Mr  Fellows,  who 
has  examined  samples  of  several  of  these,  finds  that  tlO  tWO 
of  them  are  identical^  and  that  all  of  them  differ  from  the 
original  in  composition,  in  freedom  from  acid  reaction,  in  suscepti- 
bility to  the  effects  of  oxygen  when  exposed  to  light  or  heat,  in 
the  property  of  retaining  the  strychnine  in  solu- 
t'iOtif  and  in  the  medicinal  effects. 

As  these  cheap  and  inefficient  substitutes  are  frequently  dispensed 
instead  of  the  genuine  preparation,  physicians  are  earnestly  re- 
quested, when  prescribing  the  Syrup,  to  write  "Syr.  Hypophos. 
JFellows.*' 

As  a  further  precaution,  it  is  advisable  that  the  Syrup  should  be 
ordered  in  the  original  bottles;  the  distinguishing  marks  which  the 
bottles  (and  the  wrappers  surrounding  them)  bear,  can  then  be 
examined,  and  the  genuineness — or  otherwise — of  the  contents 
thereby  proved. 

jtfedieal  Xi^ttera  may  be  addressed  to !  i    ViCKWiC 

Mr.  FELLOWS,  48  Vcsey  Street,  New  York 

PliMHi  ■ADtlon  thli  JonnutL  


DISEASES  OF  WOMEN  AND  ABDOMINAL  SURGERY. 

Constructed  and  equipped  in  accordance  with  the 

latest  views  of  the  best  surgeons. 
GEO.  H.  NOBLE,  M.D., 
131  and  133  South  Pryor  St.,  Atlanta,  Oa. 


Fle«»a  mnnUop  thli  Journal. 


-T  U  C  CONSULT  ANTB. 

3.  PiBdkatj.  ■(.D.,N<rmDto. 


'ATLANTA  EETBEAT,.-:^ 


Td,  >!.□.,  Drag  HoUU. 


r.  Oalhann,  >CD.,  BTe,br,X<H 

A  PRIVATE  HOSPITAL         '■ 'k^SS^J'-"' ^"""^ '^ 


For  Medical  i  Surgical  Cases. 

WITH  SPECIAL  PROVISIONS  FOR 
C.  C.  STOCKARD,  M.D.,  Supt.,  io3  w«iton  str**L 

hleue  tlentlon  tblt  Joarnal.  ATI.AHTA,  OA. 

DR.  cm.  E.  J.  SMITH'S  PRIVATE  SANATORlDfi. 

For  the  cars  u>d  UeaCnieaC  ot  Diseases  of  the  Nsrraui  Sfsleiii,  Cbesl.  Stomach,  and  all 
coadltlODs  lUiiallT  beneflunl  under  Hanatorlum  managemeDc,  Tbe  liuUMte  is  ttuiniasUr 
equipped  wltb  modarn  appliances. 

Maasage,  Swedish  Movements,  Electricity  and  Hydro- 
Therapy  of  All  Forms.    Rest  Cure,  tohott  Troatment. 

Pneamatlc  Cabinet,  lobalatlan  ot  Hedlaal«d.  Compreated  and  Bailned  Air,  OSTKen  Gm,  Mc. 

Dletarf  adapted  to  eacb  indWidual  caitei  based  apoD  ezaot  cb«mloal  analrMa  ot 

stomach  oontatita^ 

TRAINED  NURSES. 

Matron,  Nlrs.  A.  NI.  Smitti.  QiaduaiaBt.  Oeorie's  Hospital,  London;  lA ;«■'■ 
eipertence  in  Hasso-iCtectro-HfdrDtbetafiy. 

CONSULTING  STAFF  OF  PROMINENT  SPECIALISTS. 

For  further  Intormalloo  addroB  Dr.  CmjVS.  E.J.  SMITH, 

„  ,,   ,  BO  OUnrolt  St.,  AtUnt*.  a». 

Please  mentliMithUJDunial. 


^  SANMETTO  genitourinary  diseases. 

^     k  Sclwtific  BlMilng  ol  TniB  Smtal  uj  Saw  MmiHo  Ib  i  Pleisart  Arwillc  ftfcMi. 
'y  A  Vitalizing  Tonio  to  the  Reproductive  System. 

f  SPtCIALLY  VALUABLC  >N 

■f         PROSTATIC  TROUBLES  OF  OLD  M  EN-I RRITABLE  BLADDER-  « 

<,  CYSTITIS-URETHRITIS-PRE-SENILITV. 


^ 


y    OOSEr-Oni  Tiaipooiifui  Four  TlfMt  ■  Bar.  OD  CHEM.  CO.,  NEW  YORK.    ^ 


DYNAMITE 


Is  an  Anniliilatx>r 

So  is  Nitroglycerin.     It 

BREAKS  UP  ASTHMA 

Almost  Magically. 
Combined  with  Strychnine  and  Morphine  it 
is  the  most  successful  because  the  most  ra- 
tional physiological  treatment  of  the  asthmat- 
ic paroxysm. 

The  attack  is  Jugulated  at  Once. 
Our  Hypodermic  Tablets  of 

Nitroglycerin 1/100  gr. 

Strychnine  Sulph 1/100  gr. 

or 

NitroRlycerin 1/GO  gr. 

Strychnine  Sulph 1/80  gr. 

or 

Nitroelycerin 1/60  gr. 

Strychnine  Sulph 1/60  gr. 

Morphine  Sulph .  .1/20  gr. 

Are  most  earnestly  recommended. 
Free  Samples. 

SHARP  &.  OOHME 

CH.e.OO  .ALTIMOR.  „.«  YORK 

■  rteua  amitlon  tbli  Jonnwl. 

TO  THE  MEDICAL  PROFESSION. 

"H.  V.  C." 

Hayden's  Viburnum  qumpound 

Tha  SUndard 

Always  safe  and  reliable  for  the  suppreseion  of  all   PAIK, 
SPASMS  AND  CONVULSIONS.     NO  SEQUEL.^ 

Specially  recommeDded  in  CRAMP,  COLIC,  INERTIA  AND 
TEDIOUS  LABOR. 

Greatly  superior  to  ERGOT. 
For  all  information,  addresii 

NEW  YORK  PHARMACEUTICAL  CO., 

Bedford  Springs,  Maps,  i 

FlMM  muUoa  (bl*  Jonnial.  OOQIC 


PRIVATE   SANATORIUM 

OF 

Wm.  Simpson  Elkin,  M.D. 
Hunter  P.  Cooper,  M.D. 

FOR 

GENEBAL  and 

OETHOPEDIO 

SURQEBT. 

Modern  (our-story  '(-ranite  and 
bilck  building,  fitty-two  rooms. 
Heated  by  hot  water.  Lighted 
by  ekctricity  and  gss.  Perfect 
pIniubiDg  and  ventilaiioD.  All 
rooma  have  sunny  esposure. 
Besident  house  surgeon,  and  best 
trained  graduate  nurses.  Modern 
operating    room     and    complete 

sterilizing  apparatus.  ^--  ■ 

Address,  .iz.db,  CjOOglC 

DRS.  ELKIN  &  COOPER.  Atlanta,  Ga. 


f^%  I         ^^\  ^^\  ^^\  ^AEANSadiminution  of  th«nomber 

'  CJ  ^^_  ^^J  ^^J  ^^J  of  the  fundamental  red  corpuscles;  * 

I  a  reduced  percenta^  of  oxy^n-cany-  { 

i     _^_       -^^  _       _  — Bu  _^  ^^^_    ^     inghaemoglobin.andasaconsequence,  \ 

.    ^^^  W     ^  %  ^  t^  P^r       I       ^r         '  diminished  resisting  power  ^;ainst  / 

I         ^^^     T     ^HB  I  \       I  I         more  serious  disease.  i 

f  PeptO'Mangan  "  Gude  "  supplies  these  deficiencies.     It  furnishes  { 

I  Organic  Iron  and  Manganese  to  the  blood  elements,  increases  the  ( 

I  haemoglobin,  and  restores  to  the  blood  its  normal  germicidal  potency.  J 

I  LiTiRALiv  "builds  BLOOD"  in  cake*  op  ( 

I  tnaemia,  Chlorosis,  ImenorrhiBa,  Rickets,  Btiglit's  Disease,  etc.  I 

'  Send  for  samples  and  reports  of  "blood  counts."  etc.  ' 

)  To  usore  the  proper  filling  o  your  prescriptions,  order  Pepto-Maitg«n  "Gnde"  ( 

I  in  originoJ  bottles  ( 1  xi),    It'a  never  sold  in  bulk.  j 

I  M.   J.    BREITENBACH    COMPANY,  I 

Sol*  Agents  for  Unllsil  SIttos  ■!»  CirmIi,  f 

BS-B8   WARREN    ST.,   NEW   YORK.  J 


ifk'k'hifk'^^  "k  "k  'k'kitiriritif'^'k'k  ^'k'k'k'k'^'^^'k  ^"^irlckifkit 

I  Laxative  Logic  | 

* 


To  indace  catharsis  without  the  objectionable  scquala;  common  to 
majority  of  laxatives,  no  remedy  responds  to  the  need  of  the  physician 
with  more  satisfaction  and  celerity  than  SYRUP  OF  FIGS.  As  made  by 
the  California  Fig  Syrup  Co.  frotn  the  highest  grade  Alexandria  Senna. 
SYRUP  OF  FIGS  has  achieved  a  potency  and  recognition  as  an  agent  o! 
established  therapeutic  worth.  There  is  no  preparation  that  simulates 
Nature  so  well  in  its  effect.  No  other  is  better  suited  to  the  permanent 
relief  of  intestinal  inactivity,  a  functional  derangement  directly  respon- 
sible for  the  condition  described  as  constipation.  Its  gentle  effect  upon  the 
intestinal  mucous  membrane  and  the  natural  peristalsis  which  follows  the 
administration  of  SYRUP  OF  FIGS  gives  to  it  a  unique  value  as  alaxative. 
and  suggests  its  adaptability  to  women  and  children  because  of  its  agreeable 
taste  and  persuasive  action.  It  is  invaluable  to  persons  who  through  in- 
firmity or  occupation  are  committed  to  a  sedentary  life.  It  is  simple,  safe 
and  reliable,  and  possesses  the  particular  merit  that  its  use  does  not  induce 
the  cathartic -taking  habit,  and  in  all  cases  where  a  laxative  is  indicated  it  is 
a  help  and  not  a  hindrance. 

srcoML  arraftoATtom  t»  amoatBr  nnmat. 

••  Syrop  of  PiBI  '■  is  never  sold  in  bulk.     It  retmili  at  fifty  cents  a.  boltif, 


•A***********************************- 


PlMMowatlaa'Uii*  JoanMl, 


Budapest,  January  27th,  1898. 

CERTIFICATE. 

At  the  request  of  tlie  Apenta  Company  of  Budapest, 
I  hereby  certify  to  them  that  I  have  for  a  considerable 
time  repeatedly  examined  the  ApCflta  SpriflgS 
at  Ofen  (Budapest)  and  the  filling  of  the  water,  which 
were  placed  under  my  scientific  supervision,  and  that  I 
have  become  convinced  that  the  working  is  conducted 
very  satisfactorily  from  a  hygienic  point  of  view. 

I  have  also  satisfied  myself  by  repeated  personal 
investigations  that  the  ApGllta  Water  as  despatched 
is  constant  in  its  chemical  composition. 

Royal  HungaTian  MmisUrial  CauticUlor;  Dirtclor  af  Iki  Hygienic  Italitutt  of  lie 
Budapest  Univcrnty;  Knight  of  the  Austrian  Order  of  the  Iron  Crown;  LL.D. 
Cambridge;  Honorary  Member  Sanitary  InstHttte  of  Great  Britain,  Ktr*l 
Institute  of  Putiit  Health,  etc. 


SOCB  BXPORTBRSi 

THE  APOLLINARIS  CO.,  Ltd.,  London. 


Ileue  mention  tbls  Journal, 

(viil) 


D,t„db,Googlc 


HYDROZONE 


la  THE  HOST  POWEEPUL    ANTISEPTIC   AMD  PUS   DESTROYBi 
HARMLESS   STOIDLANT  TO   HEALTHY   GRANULATIONS. 


IS  THB  MOST  POWTKRPUL  MRALINQ  AOHNT  KNO^STM. 

THKsa  Reuidiis  curb  all  Diseases  caused  bv  Germs. 

Successfully  used  in  the  treatment  of  Diseases  of  the  Nose,  Throat  and  Chest : 

''i  DIPHTHERIA,   CROUP.   SCARLET   FEVER.  SORE  THROAT.  CATARRH 

OF  THE  NOSE.    OZ(ENA,    HAY  FEVER,    LAQRIPPE.  BRONCHITIS, 

r  ASTHMA,  LARVNQITIS,  PHARVNQITIS,  WHOOPING  COUQH.  Etc. 

8md  hr  free  S40-pai|a  book  "Treatment  of  DIseueB  oeused  by  Germs,"  ooirtalnlH 
reprint*  of  120  lolentKlo  arUclea  by  leading  oontrfbutora  to  nedloal  literature, 
lyalclaiis  remttting  BO  i 

HydroEone  U  pat  n 
ledinm  uid  larm  site  bot 
tiers,  gold  BDdblae  bonl 
UlyuoKOue   is  pnt  op  only  in  4-01.,  S-oi.  uid 
l6-oz.   bottlcE  bearing  Bveliow  label,  white  and  black 
'-_   letters,  red  and  bine  border  with  mj  signatnre, 

HarcbaDd'S  U^e  BaUuni  cures  all  inflamma- 
tory and  contagions  diaeaiet  of  the  eyes. 

Oharles  Marohand,  57-59  Prinoe  St.,  New  York. 

.   SoM  by  hading  DruggblE.  A-mH  Imttatkni.  ^  Mentlan  thi*  Publiottoa. 


Produces  rapid  Inoraase  In  Flesh  and  Strength.. 


IT  IS  ECONOMICAL  IN  USE  AND  CERTAIN  IN  RESULTS. 

II  VDROLKIII^HydrMWJ^II)  li  nut  ■  rimpk  tIktUam  «Maa  ot  otan  aurtj^  b«  a  >j*» 
•o^.   ftaew(latHtodlfBTip>tot^)toof  tatty  fooda,  and  la  thuelnbhfacmhm  tmi,  nrnJOr  eamtwW 


»hthl«l«.  Tub«roulo«l«,  C«f  rrh,  Coupti,  Sorofula,  Chloroal*, 
I  DabHIty,  . 


tlU  MCn  FN  THE  UIIITEJ. STATES. MS_rULTON  STIWBT,  %,^ 

PItaae  menUcai  thJa  Journal.  (jx 


ROBINSON'S  HYPOPHOSPHITES, 

NUTRlTl^B.    TONIC    «L.TERWTmB. 

A  FlTOBITE  BEHEDT  1M  THE  TBEATMEKT  Of 

PtTLMONART  PHTHISIS, 

BRONCHITIS,  SCROFULOUS  TAINT, 

OENERAL  D^BIIiITY,  Eia 

8llinaliite»  DIge»UaD  and  promolea  ABSlmllnllDD. 


foauvLAB, 


6 


BMhfiuldounceoontalDS: 

Hj'pophMphlleSoda. 2    gnlns. 

iron.. '.v. '.v.'.  ■,'.'.".■.■.■.■,■,■.■.*.■  .;.",■ 
"  Quinine 


DoMiOoetotourtlulddnwliros.  eTz/BOTTLES  SO  CM.  ~  PINT  BOTTLES  SI.OO. 

Thl8  preparallon  doei  not  preclplule,  reUina  all  the  salW  In  perfect  solution. 

N.  B.— Ph^iclana  vill  And  s  combination  of  our  Hypophosphlteg  with  our  Wine  CtXB  will  jleld  mou 
hmppr  results,  »Uent8  receiving  tbe  Immedi&te  BtlmulBtlng  elTect  ol  the  Wlne*Dd  pemuuieDt  tonic  dMt 
oflfieSynip.   Prlee,  Wine  Cooa.  Pint  Battl«*,  tl  00. 

MANUFAOIUHE  ALSO 

ark'  STeiy  Valuable  ComblnalloQ. 


HvpODheaphiMS  with  Wild  Ch«rry  Bark'  are 
Llme\luia»  ojld  Pobstn.  Valuable  Dlgeallve  AEenl. 
PhOKDhOrle  EInilr.  SodlOed  lomi  CbenilcBl  Pood. 
kllxlr  Paraldahyd.  Hypnotic,  sedative.  Anodyne. 


Phocphorle  ^iHilr  - 

kllxlr  Paraldahyd.  Hypnotic,  sedative.  Anodyne. 
Wine  C00«.  Nerfe  stimulant. 

And  PInxner'a  Albumlrtata  Iron  Preparation*. 

8peol^  ROBINSON'S  <n  prescrlbTni.    For  Sale  by  Dnigglsla. 

I?,OBIIsrSOIT-i=El'X'TElT  CO.,  i.«,r>rM. 

7Vl<inufaoturing  pbarmaoists, 

Interesting  Pamphlets  sent  to  PrKlltlouers,  on  Application.  LOUISVILLE.    KY. 

Ple«>e  meiiilon  thu  Jnii-i'iil 

MEDICAL  ITE3I8— CONTINUED. 


New  Orleans  Polyclinic. — Physiciana  will  find  the  Poly- 
cliuic  au  excelleut  means  for  posting  tbemeelves  upon  modern  prog- 
ress in  all  branches  of  medicine  and  surgery.  Tbe  specialties  are 
fully  taught,  particularly  laboratory  work  The  Twelfth  Annual 
Session  opens  November  24th,  1898.  For  further  information, 
address  New  Orleans  Polyclinic,  P.  O.  Box  797,  New  Orleans,  Lm. 


*'l  have  used  Dolomol-Acetanilid  25  per  cent,  in  a  case  of  can- 
cer of  the  breast  after  operation  with  very  happy  results,  as  it  not 
only  relieved  the  pain  but  produced  healthy  granulations  and 
rapid  healing.  I  have  had  phenomenal  success  with  Dolomol- 
Resorcin  in  popular  acne."  A.  J.  Millbr,  M.D., 

Columbus.  Ohio. 


^dbyGoOgle 


What  "THE  LANCET"  says  about 

I  Scott's  Emulsion  of  Codliver  Oil. 

[From  THE  LONDON  LANCET,  Feb.  26th,  1898.] 

"  The  valfle  of  the  hypophosphites  combined  with  cod-liver  oil,  especially  in 
I  wasting  diseases  and  in  deljilitated  conditions,  is  well  known.  In  addition  to  these 
constituents  the  above  preparation  (Scott's  Emulsion)  contains  also  glycerine, 
which  is  well  recognized  as  assisting  very  materially  in  the  absorption  of  oils  and 
fats.  We  have  examined  the  preparation  with  care  and  find  that  it  fulfills  all  the 
requir.'^ir-ents  and  presents  all  the  conditions  of  a  very  satisfactory  emulsion.  .  In 
appearance  and  consistence  it  is  not  unlike  cream,  and  under  the  microscope  the 
fat  globules  are  seen  to  be  of  perfectly  regular  size  and  uniformly  distributed.  In 
fact,  the  preparation  microscopically  examined  presents  the  appearance  of  cream. 
So  well  has  the  oil  been  emulsified  that  even  when  shaken  with  water  the  fat  is 
slow  to  separate,  the  liauid  then  looking  like  milk.  The  taste  b  decidedly 
unobjectionable  and  is  pleasantly  aromatic  and  saline.  We  had  no  difficulty  in 
recognizing  the  presence  of  the  hypophosphites  in  an  unimpaired  state.  The  emul- 
%  sion  Keeps  well  even  when  exposed  to  wide  changes  of  temperature.  Under  the 
circumstances  just  described  the  emulsion  should  prove  an  excellent  food  as  well 
as  a  tonic." 

SCOTT  &  BOWNE,  Chemists,  New  York. 


[lenttoa  lb  Ik  JoumaJ. 


Absolute  Protection. 

'(The  beat  liquid  diBiafectaut  for 
use  in  isolating  iurpctious  patieDts 
ID  private  houses  is  the  corubiDation 
commercially  known  as  '  Piatt's 
Chlorides.'  Covering  the  doorway 
with  sheets  kept  damp  with  the  so- 
lution affords  absolute  protection. 
Twelve  years'  use  in  my  practice 
bas  proven  it  reliable  in  all  re- 
spects." 
Frederick  W.  Winger,  M.D. 

President  of  the  Board  of  Health. 

Bradford,  Pa.,  Dec.  1st,  1898. 


I  HAVE  used  Peacock's  Cbionia 
ind  find  it  very  effective.  I  shall 
:ODtinne  to  prescribe  it  in  my  prac- 
ice.       A.  P.  Dalrymple,  M.D.  ^ 

New  York,  N.  Y. 


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luta  OBCOtltr-  TbToogn  Iti  ou  we 
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t  aa  lons.aDd  not  one  peraon  aver  empi 
not  thla  snfficient  endoratmcnl  of  l> 
MKS.  3.  V.  WHITB,  Praaidcn 


:  IN  BROOKLYN  HOHS  FOK  COK3UHPT1VBS. 
.nodoileaa,  col o He tl  liquid;  ■  powerful  dlalnrecUnt  and  prompt 
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manufactured  by  Henry  B.  Piatt,  Piatt  St.,  New  York. 


MEDICAL  ITEMS— CONTINUED. 


Phdritds  in  Pregnancy. 
"A  certain  remedy  (Medical  Council,  Ed.)  for  the  relief  of  this 
complication  is  not  knowo,  though  it  has  been  claimed  from  time 
to  time  that  such  has  been  discovered.  The  truth  of  the  matter 
in  this  connection  is  that  the  pruritus  is  not  always  depeudent 
upon  the  same  cause.  In  this  connection  it  may  be  advisable  to 
nake  a  trial  of  the  various  Dolomol  Compounds  that  coatain  the 
drugs  commonly  employed.  They  come  in  powder  form  and  are 
a  great  improvement  over  the  liquid  or  oily  preparations  of  the 
same  drugs.  Dolomol-Acid  Carbolic  5  per  cent.,  Dolomol-Men- 
thol  5  per  ceot.,  and  Dolomol -Icb thy ol  10  per  cent.,  suggest  them- 
selves, knowing  what  we  do  of  the  curative  effect  of  the  drugs  in 
this  condition.  It  may  not  be  possible  to  strike  the  very  one  yon 
need  the  first  time,  but  out  of  the  long  list  manuiactured  surely  the 
right  one  can  be  found  for  each  case." 

*""  DiclzedbyGoOgle 


"  The  greatett  therapeutic  diaoovery  of  the  age,  and  of  the  ogee,  m  tha^ 
where  we  cannot  produce  good  blood  zoe  can  introdwse  it." 


What  is  Hsematherapy? 

A  Kew  Thing — and  a  Xew  Xame  which,  though  literally  translated 
(Blood  Treatment),  may  not  convey  to  every  one  a  definite  idea.  It  is  a 
treatment  which  consistB  la  oppOBing  to  a  conditina  of  disease  the  very 
power— gfood  and  sufficient  Blood — tnat  would  naturally  prevent  it,  that 
would  still  cure  it  spontaneously,  and  that  actually  does  cure  it  spon- 
taneously, wherever  the  blood-making  work  of  the  system  is  perfectly 
«flBcient;  and  therefore  also  teill  cure  it,  if  a  deficiency  of  the  vital  ele- 
ment be  supplied  from  without,  under  proper  medical  treatment.  • 
'  That  Blood  is  such  a  power  as  here  described,  is  an  undisputed  physio- 
_     ,  A  Film  or  Bovinin :  logical  fact.      Its    transmission   from    one 

ihowto,  th.  Bi«,d.oorp«d«  inuct.  abated  organism  to  another,  for  the  pur- 
pose of  supplying  a  defect  in  the  latter,  is 
the  substance  of  the  Blood  Treatment ;  and 
How  to  Do  this,  in  different  cases,  is  the 
form  or  description  of  the  same.  Blood 
may  be  taken  from  a  healthy  bullock 
(arterial  blood — elaborated  with  due  scien- 
tific skill) ;  or  it  may  be  obtained  in  the  well- 
attested  living  conserve  known  as  bovinine, 
from  any  druggist;  and  maybe  introduced 
into  the  veins  of  the  patient  in  either  of  four 
ways,  that  may  be  most  suitable  to  the  case : 
viz. :  by  the  mouth  and  stomach;  bv  injec- 
tion, with  one-third  salt  water,  high  up  in 
uioro-phot«i.|A»>d  *^®  rectum ;  by  hypodermioal  injection ;  or  by 

br  Prof.  R.  R.  AndrawB,  M.D.  topical  application  to  any  accessible  lesion. 
THE  CUBE  OP  PULMONARY  CONSUMPTION 
is  one  of  the  latest  and  most  wonderful  developments  of  Blood  Power-^ 
inlo^duced  mainly  by  the  mouth,  find  sometimes  also  b^  spraying  bovin- 
ine into  the  trachea  by  an  atomizer.  Everv-  week  of  judicious  internal 
blood  treatment,  with  proper  medical  and  hygienic  care,  has  resulted  in 
steady  improvement  as  to  all  symptoms,  with  scarcely  an  instance  of 
check,  much  leas  of  relapse,  until  complete  apparent  cure,  and  that  in 
the  more  advanced  stages  of  the  disease.  As  further  examples,  may  be 
moitioned :  Aneemia,  Cnolera  Infantum,  Typhoid  Fever,  Heemorrhagic 
Collapse,  and  many  other  of  the  most  dangerous  and  aggravated  diseases. 

IN  SURGERY:  A  CHRONIC  ULCER, 
of  no  matter  how  long  standing  or  obstinate  find  fi^^avated  character, 
(»n  be  cured  with  certainty— at  least,  the  first  instance  of  failure  has  yet 
to  be  heard  of — by  constant  application  of  bovinine  to  the  wound  with 
proper  surgical  treatment  and  sterilization.  Such  cases  are  usually  cured 
jn  nom  four  to  six  weeks.  So  of  traumatic  injuries  of  all  kinds;  carbun- 
cles, fistulas,  abscesses,  and  even  gangrene. 

NUMEROUS  CLINICAL  REPORTS 
of  well  known  Physicians  and  Hospitals,  where  the  Power  of  Supplied 
Blood  is  constantly  relied  on  as  a  cardinal  factor  in  the  cure  of  disease 
and  support  of  surgery,  are  at  the  service  of  every  practitioner  who 
deeires  to  keep  up  with  the  progress  of  his  profession,  find  may  readily 
be  obtained  (including,  of  courde,  the  technique  and  subsidiary  treat- 
ments pursued)  by  applying  to  * 
THE  BOVININE  COMPANY,  75  West  Houston  Street,  New  York. 
T.wwwnaa^  KILBS  *  00.,  Ko&tnftl,  SoU  Agenta  for  th«  Dominioa  of  Ouutda. 
Flaoa  MantloD  toll  Joamal.                                  (xiii' 


MEDICAL  ITEMS—CONTINUED. 


UPBRAIDIKO   THE   DOCTOH. 

Dr.  Samuel  Wolf,  pbyaiciaii  to  the  Philadelphia  Hospital,  and 
Neurologist  to  the  SatoaritaD  Hospital  of  Philadelphia,  presents 
among  others,  a  case  which  ie  of  special  value  at  this  time.  He 
says:  "The  entire  experience  of  the  writer  with  Aotikamnia  is 
Dot  confiaed  to  the  series  of  cases  on  which  this  paper  is  based, 
although  its  previous  use  had  been  limited  to  a  few  prescriptions, 
and  those  in  cases  where  it  was  given  after  the  usual  routioe  bad 
been  exhausted.  Tt.  is,  howevCT,  to  a  striking  result  in  one  of 
these  instances,  that  the  incentive  to  investigate  more  fully,  is  to 
be  largely  attributed.  A  man  of  42,  in  the  course  of  an  attack 
of  la  grippe,  was  enduring  extreme  torture  from  the  pain  of  a 
trigeminal  neuralgia.  The  second  ten-gr^in  dose  of  Antikamnia 
gave  such  complete  and  permanent  relief,  that  my  patient,  a  drug- 
gist of  large  experience,  upbraidingly  asked  me,  "  Why  didn't  you 
prescribe  this  remedy  before?" 


Twenty  Years'  Experience. 
"Having  had  twenty  years'  experience  with  'Piatt's  Chlorides' 
during  my  administration  as  health  officer,  and  always  finding  the 
preparation  efBcient,  I  can  heartily  recommend  it." 

James  G,  Hunt,  M.D., 
Pres,  of  the  Northern  Branch  N.  Y.  State  Medical  Assu. 
Utica,  N.  Y.,  Dec.  10th,  1898. 

A  New  Treatment  (f  £?)  for  the  Drug  Habits 

RESULTANT  FROM  THE  USE  OF  OPIUM,  MORPHINE, 
COCAINE,  THEIR  SALTS  AND  DERIVATIVES,  gjjaiasg'- 

ThU  treatment  consists  of  ■  series  of  prescriptions  dbpenAcd  and  prcecribed  bj 
the  physician.  The  formula  of  the  several  therapeutic  agencies  of  this  treatment  is  gladly 
presented  to  the  prescribing  physician,  and  at  no  time  In  the  course  of  treatment  does  Um 
physlclaa  lose  sight  of  his  patient.'  The  object  of  this  Association  is  to  present  to  tbe 
profession  (and  the  profession  only)  an  ethical  and  scientific  treatment  for  an  annoying  class  ct 
patients.  Clinical  reports  on  lile.  Sample  treatment,  suf&cieni  for  one  patient  for  lo  days, 
and  further  particulars  ujKin  application. 

Address  ST.  PAUL  ASSOCIATION,  220  Broadway,  New  York 

HMtM  meatloatbla  Journal. 


,db,  Google 


SPECIAL  OFFER. 


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Siryctmine.  Spartlae.  Nltro-ClTcerine  ind  Cactus. 

For  One  Dollar 

We  will  send,  postpaid,  3.00a  Alola  Oomp. 
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For  One  Dollar 

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Snlpli.  Onuililaa,  H  Eratnesch. 
For  One  Dollar 

We  wlJI  send,  postpaid,  i.ooo  Szpeotorant 

Orannle*.    contalniiiE    SineulairiDe    Nl  irate. 
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vided this  adverllsemenl  In  The  Atlanta  Medi- 


Ljoi 


^  If  yoa 


s  write  oa  for  apeolal 


piioae  belore  b 

DETROIT  ALKtLOIDAL  SIUNULE  CO., 

DETBOra,  If  lOH. 

Pleaae  mentlnn  (bin  Jnui^nl 


Svapnia 
is  always 


reliable 


"I  use  the 
preparation 
called 
'  Svapnia,* 
which  is  al- 
ways reliable. 
It  contains  a 
standard  of 
3;    ten  per  cent  of  morphia,  and 
■^    the  alkaloids  codeia  and  nar- 
'"'    ceia.    The  other  narcotic  alka- 
tjf    loids,  thebaine,  narcotine  and 
papaverine,  are  removed." 

CHAS.  HENRY  BROWN,  M.D„ 

W  W«lt  lath  Straot.  N*w  York. 

^  Sample  smt  upon  rtceipi  o/pro/fssion- 
a;  a!  card.  Soldby  druggtsts  geaerallji. 
^         The  Cmas.  N.  Cbittentom  Co., 


MEDICAL  ITEMS— CONTINUED. 


FlKULAX 


CoDtaina  Pimenta,  Oleum  Cassiie,  Ext.  Cascarie  Sag.,  Magnesia  Gravis, 
Sulphurie,  Rhamnus  Frangula,  Ext.  Glycyrrhizje,  Ext.  Sennfe  Fluidum, 
Zingtberis,  CiuDamomum,  Cardamomum,  Myristica,  Fious  Celestia  et 
Chocolsta. 

Fikulax  is  put  up  in  boxes  contaiDing  12. 

Dose. — For  Adults — One  tablet  at  bedtime  and  one  at  ten  o'clock  the 
following  morning,  if  necessary.  Then  one  or  a  half  one  at  bedtime  each 
night  for  ten  days,  and  then  as  occasion  requires! 

J^or  Children — One  at  bedtime  and  a  half  one  at  ten  o'clock  the  follow- 
iDg  morning  if  necessary.  It  is  well  for  a  child  to  take  a  half  one  each 
night  until  regularity  is  established. 

;.  Fikulax  does  not  interfere  with  other  medicines,  and  like  our  other  prod- 
ucts (Arsenaiiro  and  Mercauro),  is  advertised  to  the  medical  profession  ex- 
clusively. Chas.  Koome  Parmele  Co.,  Selling  Agents,  3ti  Piatt  St.,  New 
York. 


(XV) 


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MEDICAL  ITEMS— CONTINUED. 


DOLOMOL-ICHTHVOL,  10  Pbr  CeNT.   IN   WeEPIKG  EczeMA. 

Dr.  H.  U.  Sievers,  Tama,  la.:  "I  had  occasioD  to  use  Dolomol- 
Icbthyol,  10  per  cent,  on  a  bad  case  of  weeping  eczema  coveriDg 
the  t&ce,  upper  extremity  and  trunk  in  a  child  three  weeks  old; 
one  of  the  most  serious  cases  I  have  ever  met  with,  and  on  which 
I  had  tried  numerous  preparations,  as  zinci  ozidi,  bismuth,  aristol, 
etc.,  and  with  internal  treatment  of  calomel  and  soda  for  they 
mostly  originate  from  disturbance  of  digestive  oi^ns.  I  dusted 
the  surface  over  with  Dolomol-Ichtbyol,  10  per  cent,  and  covered 
the  same  with  antiseptic  gauze,  for  it  was  impossible  to  dress  the 
child.  There  was  not  a  drop  of  serum  after  the  first  dressing,  and 
in  three  days  a  healthy  crust  had  formed  which  the  nurse  removed 
after  a  few  days  by  inunctions  of  sweet-oil.  I  discharged  the 
patient  in  one  week  from  the  first  dressing." 


The  usefulness  of  good  Hypophoephites  in  Pulmonary  and  Stru- 
mous aBections  is  generally  agreed  upon  by  the  profession. 

We  commend  to  the  notice  of  our  readers  the  advertisement  on 
page  z  of  this  number.  "Bobinson's  Hypopbospbites,"  also 
"  Robinson's  Hypophosphites  with  Wild  Cherry  Bark"  (this  is  a 
new  combination  and  will  be  found  very  valuable)  are  elegant  and 
uniformly  active  preparations;  the  presence  in  them  of  quinine, 
strychnine,  iron,  etc.,  adding  highly  to  their  tonic  value. 


NOTIOI!.— This  JOURNAL  and    THS    INTKBBATIONAI.  JOUB- 
NAX  07  SirsaXKT  one  jmt  tor  (1.00  oasb. 


I  TAKE  great  pleasure  in  offering  my  testimony  to  the  great 
value  of  Cactina  Fillets  in  oases  of  weak  and  irregular  action  of 
the  heart.  I  have  used  tbem  for  four  years,  and  have  never  been 
disappointed  in  them.  They  not  only  stimulate  the  heart,  but  im- 
prove that  organ  permanently.  I  find  them  very  useful  in  all 
cases  of  typhoid  fever  and  pneumonia. 

Kent,  Ind.  C.  B.  Matthews,  M.D. 


vi) 


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JtJtJtJtJtJtJtjtjtjtjItjMjItJItjtJItJIt 


ANEMIA 


The  Irrational  HethAd  of  treating  anemia  la  b;  administration 
of  iron :  treating  the  symptom  iastead  of  the  cause. 

Under  iron  medication  the  blood  of  anemic  patients  may  contain  one 
and  a  half  times  the  normal  amount  of  Iron,  and  the  hiemoglobin  so  far 
from  Increasing  may  even  diminish. 

Apart  from  the  deficient  luemoglobin,  the  chief  symptom  in  anvmia 
is  disturbance  of  the  nutritive  functions.  This  is  the  direct  cause  of 
the  deficiency  of  hiemoglobin  in  the  blood. 

The  Rational  Treatment  seeks  to  restore  the  perverted  nutHtive 
functions,  by  inhibiting  the  growth  of  the  micro-organisms  which  give 
rise  to  fermentative  changes  in  the  gastro-intestinal  tract ;  by  destroying 
the  various  paludal  organisms  which  infect  the  blood  and  cause  destruc- 
tion of  the  red  blood  cells,  and  by  toning  up  the  vital  energies  of  the 
tissues.  Digestive  ferments  or  highly  nutritive  foods  only  exert  tempo- 
rary stimulating  effects. 

The  Medlrament  which  acts  moat  advantageously  in  this  form  of 
treatment  in  Quaiaquin,  a  chemical  combination  of  guaiacol  sulphonie 
acid  and  quinine. 

Guaiacol  aulphonic  acid  exerts  an  inhibitory  action  on  the  organisms 
which  cause  fermentative  disturbances  in  the  intestinal  tract.  The 
quinine  eliminates  the  paludal  organisms  which  destroy  the  red  blood 
cells,  and  also  exerts  its  well-known  recuperative  effect  on  the  system 
in  general. 

GnaiaqnlD  does  not  give  rise  to  toxic  phenolic  bodies  in  the  organ- 
ism, and  it  is  perfectly  soluble  in,  and  misclble  with,  the  digestive  fluids. 

Full  literature  on  the  treatment  of  anfemia,  typho-malaria  and  other 
Bimilar  affections  on  application. 

HcKESSON  &  ROBBINS,  New  York. 


j)tj»j$jlljlijHjtjltjtjtjtjtjljltj»jtjtjtjit 


I  Jt  I       Fleaae  meDtUm  tbb  Joaroal. 


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CArauLEs 


>.53A  IJtaem,  $2^ 

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'    54C100    "  I5JXI 

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V  42IA  40  lii„«U,  $  4-7S 
'   42IC100    "  1020 


Oo;reap9iul«iia>  Ballaltal.    S*nd  tor  Llata  wad  SBOiples. 

"The  Pioneer  American  Capsule  House  " 

H.  PLANTEN  &  SON,  (estuushed  ib36.)  NEW  YORK. 

Hanafaoturen  of  over  400  TarietiM  of  Filled  (uad  Empty  Oaptalea. 


ADVERTISERS'  INDEX   TO  ADVERTISEMENTS. 


Antikamoia  Chemical  Co 

Arlington  Chemical  Co (cove 

Battled;  Companv 

Battle  Creek  SHoitariuQi  Healtli 

Food  Co CO 

California  Fig  Kyrup  Co 

Chaa.  Roome  Parmele  Co_ „  c 

Cbicaico  Policlinic  and  Hospital... 

Daniel,  Jno.  B 

Detroit  Alkaloidal  Granule  Co.... 

Dre.  Elkin  4  Cooper^ 

pjiiBOn  Mfg.  Co X 

Electro  Medical  Mf|?.  Co 

Fairchild  Bros.  &  Foater, (cove 

Fellows,  James  1 

Franklin  Ft'g  House 

Henry  Pharmacal  Co... 


mbert  Pbarmacaf  Co...  . 
Laufchlin  Manufacturing  ( 

LeclHoche  Battery  Co 

Marchand,  Charles 

McKphsod  &  Bobbins- 

Medical  Items  ...x,  si,  xii, : 

Meilin's  Food  Co 

Morningside  Retreat , 

M.  J.  Breitenbacb  Co 

Kew  York  Pbarmacal  Co.... 


New  York  Pbarmacentical  Co t 

Nol.le,  Geo.  H.,  M.D iv 

Od  Chemical  Co iv 

Parke,  Davis  &  Co i 

Pean>ck  Cliemical  Companv..- xs 

Pliillipa Chemical  Co .'.....cover! 

Phillipa,  I xivii 

Planten  A  8on iviii 

Plait,  H.  R Xii 

Piilvola  Chemical  Co ii 

Hobinflon-Peitet  Co.„ x 

Scott  ABowne xi 

Sharp  k(  Dobme- T 

Smith,  Chas.  E  J.,  M.D.. it 

■'^t.  Paul  Amociation xiv 

Stockard,  C.  C__ ir 

Sultan  Drag  Co__ xi 

The  American  Fermest  Co vi 

The  Apolinarie  Co viii 

The  Rovioine  Co liii 

Tlie  Charles  N.  Critunton  Co  _ii.  xv 

Tlie  Pneumschemic  Co xxiv 

The  Purdue  Frederick  Co.- —ii 

'J'lit!  University  and  Bellevne 

Hoep.  Med.  College  - zxit 

Univ>TBity  of  the  South xxH 

Wheeler,  T.  B ..-xxi 


UE  CAN'T  EKSUUE  CHANGES  AFTER  20TH  raKrAR;^,^)o|(^ 


ECTHOL, 


NEITHER 
ALTERATIVE  NOR  ANTISEPTIC 
IN  THE  SENSE  IN  WHICH  THOSE 
WORDS  ARE  USUALLY  UNDER- 
STOOD. IT  IS  ANTI-PURULENT, 
ANTI-MORBIFIC  "A  CORRECTOR 
OF  THE  DEPRAVED  CONDITION 
OF  THE  FLUIDS  AND  TISSUES. 

aAMPLC  <ia-oz.)  BOTTLE  SENT  FREE  ON  RECEIPT  OF  3B  CT8. 

FORMULAl-ActWe  principles  K>DiA  "^'^ 

of  Echlnacia  and  Thuja.  PAPINE 

BATTLE  &  GO., c.a%,  St.  Louis, Mo.,U.S.A. 


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Chionia  uf"t'^''Tl°^' 

Under   its  use  the   Hepatic 

Secretions  resume  their  normal  function,  hence, 

it  is  the  remedy  for  constipation,  as  it  does  not 

dispose  the  bowels  to  subsequent  costiveness. 

Dose— K)ne  fluid  drachm  three  times  a  day. 


Peaeoek'sBFomides§i 


All  Forms 


Congestion. 


Definite  Strength.    Absolute  Purity. 

Dose — One  or  two  fluid  drachms,  in  water, 
three  or  more  times  a  day,  as  indicated. 


PEACOCK  CHEMICAL  CO., 

112  N.  SMond  St.,  SL  Loul*.  36  BMinghall  SL,  LAiHton. 


Seng 


Indicated    in    Stomach    Derani 


It  increases  the  flow  of   the 
fuices,   thereby   causing   the   stomach  to    do  its    own 
work^    without    the    aid    of    artificial    digestants. 
Dose — One  or  more  teaspoonf uls  three  timet  a  day. 

CACTI N A  FILLETS.  The  heart  regulator. 

Dose— One  Filtet  everr  ho«r,  or  leas  often,  a*  ttqaistd. 
SULTAN  DRUG  CO.,  St.  Louis  and  London. 


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This,  That  and  the  Othcf 


San^low  I 


A  WiBtar  Remedy 

niat  OodolD*  hftd  ma  especlul  effect  In  CMsa  ot 
iMrvona  oougba,  Siiid  thkt  It  was  oapttble  ot  cod- 
trolUng  oxoeaalve  eo\igh\aK  In  varlouB  lung  aSsc- 
tloiUi  wM  noted  before  Its  trae  physloloilcal 
action  was  understood.  Later  It  was  olear  liutt 
ai  a  nervouB  calmallre  was  duo,  as 
sBji.  to  Its  apaclal  action  on  the  pneu- 

~CodeiDO  Btaods  apart  from  the  rent  of  Ita 
gToup,  In  tbat  It  does  not  arrest  secretion  Id  the 
reaplra(or7  and  Intestinal  tracta.  In  marked 
coDtraallalt  In  this  respect  to  morphine.  Moi> 
phlne  dries  the  maoous  membrane  ot  the 
lesplratoiT  tract  to  snch  a  decree  tiiat  the  condi- 
tion la  often  made  worse  by  Its  aae;  while  Its 
effect  on  the  Inteetlnal  uact  Is  to  piodnce  con- 
stipation. Theresrenoneot  these dlBagTeeable 
•ffecta  atUndlns  tiie  ns« of  Codeine. 

Antlkamnla  bos  stood  tbe  teat  of  thomnsta 
eipertmental  work,  both  In  the  laboratorj  and  In 
actval  practice:  and  Is  now  KCnerall;  aooepted 
as  the  safest  ana  surest  of  the  ooal-tar  products. 

"Antlkamnla  and  Oodelne  Tablets."  «ach 
containing  *V  gralna  Antlkamnla  and  H  grain 
eulph.  Oodelne  afford  a  *eiT  desirable  mode  of 
exhibiting  tbcM  two  Talnable  drugs.   The  pro- 

Srtlous  are  those  most  frequently  Indicated  In 
e  Tarlons  neuroses  of  (he  tbroal,  as  well  aa  the 
coughs  Incident  to  lung  affections. 


Hu  Jmtnul  vf  tke  A 


HontKomeTT.H.D.ofOblcago,  nil.   Hlsplanot 
treatment  in  acute  Inflammation  of  the  prostate 

Eland  Is  to  waah  out  the  abscess  (-•i'»'  •■'>> 
ydrogenperoild,  give  colons  hot  v 

and  hot  hip  balhs  frequently,  avoU. , 

Internally  and  advise  carelest  the  padentstralL 
at  stool  or  during  micturition.  Ob  the  theory 
(bat  toxins  are  celataed  la  the  circulation  and 
within  the  gland  and  to  prerent  de«eoeratlon  In 
the  gland  substance,  he  administers  iritlcum 
repena  or  flold  extract  tritlpalm  freely,  com- 
bined with  sum  arable  or  flaxseed  Infusion. 
Alongwlth  these  remedies  the  mineral  waters, 
partloularlrrioby  wlUi  cltrat«  ot  potash,  go  well 
together  Hydrsteotohloral  or  this  salt  oom- 
blned  with  antlkamnla  are  the  very  bestanodyne 
remedies  U>  control  pain  and  apssms  ot  the  neck 
oflbe  bladder.  Tbese  pharraaoolovio  or  medi- 
cinal remedlPsare  the  moat  logical  to  use  In  his 
judgment,  while  extemHiiy.  applloatlona  of  a 
Inunction  of  10  or  20  per  con t  Iodoform,  Is— '- 
as  well  aa  of  mercury,  are  also  of  value. 


lanollne. 


Migraine— (Catarrbal.) 


OrowB  In  Favor 

Aa  the  years  go  by  there  Is  one  druit  that  con- 
stantly grows  In  favor.  To  ihe  physician  of  the 
Transmlulsalppl  region  It  Is  prubably  doubtful 
It  It  Is  naCBSsary  to  say  tbat  this  remedy  Is 
Bntlkamulai  as  all  have  used  It.  Hut  Increasing 
eiperleucedemonstrateslts  adaptabUlty  to  con- 
ditions other  than  at  first  advised.  Itia  notably 
of  value  In  ovarian  and  other  pelvle  pain.  R 
yOD  have  not  tried  It  In  Ibis  clHsa  ot  oases,  do  so. 
.  Jomal  Surf  cry  0*4  OiFMMl. 


Wheeler's  Tissue  F*bospbates^ 


Wheeler's  Compound  Elixir  of  Phosphatea  and  Oallsaya. 

Tonlo,  for  the  treatment  of  OoneuT — ■'—   " ■•'•'-  " — * 

DeUUt      ■ 


hosphat 
optfon, 


,_    _ e  food  and  Nutritlva 

Bronobltla,  Scrofula  and  all  torniB  ot  Nervou" 


i.SPO,;  Sodium 


fhoaphateNai.HPO.;  Ferrous  FhoaphaU',  Fe..  aPO^iTiihydrogen  Phosphate,  H.PO,, and 
tbe  active  prlDclplea  ol  Oalluiya  and  Wild  Cheny. 
Tbe  special  indication  of  Ibis  comblnallon  of  Phosphates  In  spinal  alTectlons.  oaries,  ne- 


hoi,  opium,  tobacco  hablla,  gestation  and  Is 


l/hj/iioiogteal  reitaratlte  In  aeiual  debility,  and  ajt  used  up  oondltlons 
(em,  should  receive  the  careful  attention  of  good  therapeutists. 

NOTABLI  PROPIBTII8.-A8  reliable  In  dyspepsia  as  quinine  In  agur.  Secures  the 
largest  percentage  of  beneUt  In  consumption  and  all  waatmg  diaeasea  Sj,  drltrmiitine  (lit 
prr/MfiHircMionandiuHnllaHfm  D//aod.*  When  using  It,  Ood-Llver  Oil  ma;  be  taken  with- 
out repugnanoe.  It  renders  success  possible  In  trestlng  chronic  dlseaapg  of  women  snd 
children,  who  take  It  with  pleasure  for  prolonged  periods,  a  factor  evipntlKl  tn  Tnslni&le 
the  good  will  of  the  patient.    Being  a  Tissue  Oonstnictlye,  It  Is  the  b. 

hlbltlng  It  In  any  possible  morbM  oondlUon  oi  tta 
use  the  tollowlns: 

B,  Wbeeler'gO^ssne  Phosphates,  one  bottle;  Liquor  Stryohnla.  halt  fluid  drachm. 

It.  In  Dyspepsia  with  Oanatlpatlon,  all  forms  of  nerve  prostration,  and  oonstltutloni  ot 

Doai— For  an  adult,  one  tablespoonful  three  timet  a  day,  after  eating;  from  seven  M 
twelve  years  of  age,  one  dessertspoonful:  from  two  to  seven,  one  teaspoontul;  for  Infants, 
Irom  flve  to  twenty  drops,  according  lo  age. 

prepared  at  the  Ohemlcal  Laborafor;  oT  T.  B.  Wheeler,  U.D.,  Montreal,  P.  Q. 

□  put  up  In  pound  bottles  only,  and  sold  by  aildruggtilsaton* 


esultlng  from 


desirable. 


n  this  Journal. 


,db,  Google 


CHICAGO  POLICLINIC  AND  HOSPITAL. 

A  CL1IV1CA.L  SCHOOL  FOR  FKACTITIONEBS  OF  MEDICI5E. 

IiBlruction  conttnues  tbroUEbout  the  year.  Tbe  InstltutLon  la  thorough];  equIpHd  for 
p«t  graduftta  iDdruction  In  all  branches  of  Medlclno  and  Surgery.  UnaqtuJed  Hoaplul 
fulliilcs;  kbuDd&Dce  of  clinical  maUrlal.  Eicelltat  adrantuca  tor  Laboratory  met. 
Surgery.    Pnr  iDTarmaclanortae  aiiDOUEoeiBei]l,ap[>)Tto 

DB.  F,  HENBOTIN,  Seqi,  ive  OMo^rO  AtMIIU. 


THE  UNIVERSITY  AND  BELLEVUE  HOSPITAL  MEDICAL 
COLLEGE. 

TVe  union  of  Ihe  Hedioal  DepartiDeot  of  Ibe  New  York  UniTunily  and  the  Belleroe  Bi»- 
iltal  Medical  Collie,  prokecled  Id  1897,  baa  been  coDtammaled.   The  tiro  medlea)  acboola 
ited.  and  wlQi  >r^t]y  iDcreaHd  facilities  and  an  enlarged  faculty,  will  Ih  onodncted 


aa  the  Medical  Department  of  llie  New  York  UnlTenity. 

Tbe  SeMlon  beglb*  oa  Hondaj,  October  S,  18W,  and  oootlDuea  for  ihlrty-two  weeks.  At- 
tendiDoe  on  four  counea  ot  lectures  la  required  for  graduation.  Oraduatee  of  otiier  accnd- 
Itad  Hedlcal  College*  are  admitted  to  adraneed  standing.  Btudeaia  who  hare  aUendrd  one 
full  roKuiar  oourse  at  anotber  accredited  Hedlcal  CoUive  are  admitted  as  seoond-year  stn- 
deota  without  medical  examination.  Studenia  are  admTttad  u>  advanced  •cai'dlDg  eltberoo 
approied  credantialt  from  other  Medical  Colleges  or  after  examination  on  the  snbiecla  em- 
braced In  the  curriculum  of  this  Oollege. 

Ilii  detigned  to maki  Ihii pre-emtneiiUji  a  mAooI  ofpradiM  mall^lnc,  trndtheeoune  oftuttme- 
Hon  hat  (Mcn  armnpnl  kfUA  thit  purpote  eoiutaiUly  (a  rbu. 

Tbe  annual  circular  for  l«e-9,  glTlng  full  details  of  tbe  ourrlculum  for  the  four  Teat*, 
tbe  regent's  requirements  for  matriculation,  requlremeata  forgraduailoD,and  otber  Informa- 
tion, will  be  published  In  June,  18S9.  Address  Ba:b«rt  Ii«Pevr»,  OorreaiKiiidliia  BaoT»- 
tUT,  2«th  Bt.  and  First  Ave.,  New  York  City. 

Please  mention  this  Joumsl. 

DEPARTMENTS  OF  MEDICINE  AND  PHARMACY 

University  of  the  South, 

SEWANEE,  TENNESSEE. 
Summer  And  Fill  Orkdaating  Scboola  of  Medicine  and  Pharmac]'. 

Situated  on  the  Cumtwrland  Plateau  2,300  feet  above  aea  level.  The  Uedi- 
cal  Department  will  open  its  preltniinary  course  May  18th,  and  ita  Besalar 
Conise  June  22d,  IS99.  It  ia  iu  strict  accoid  with  State  Boards  and  College 
law  requirements. 

Thoae  mat ricu latins:  in  Medicine  after  1898  will  be  required  to  attend  four 
courses  of  lectures  before  graduation.  PreviooB  matricafatcs  can  gradnate  as 
before  in  three  conisee,  until  1902. 

Delightful  and  healthy  climate,  with  tbe  best  equipment  and  facilitiesat 
reasonable  rates,  are  the  inducementa  offered.  Students  taking  partial  or 
unofficial  coorses  will  receive  liberal  reduction  in  rates. 

FACULTY. 

J.  8.  Cain,  M.D.,  Practice  and  Pathology;  C,  Piggot,  M.D.,  Chemiitryi  J.  B. 
Mjrfree,  M.D.,  Surgery;  W.  B.  Hail,  M.D.,  Materia  Hedica  and  Physiolt^y ) 
T.  a.  Wood,  M.D..  Eye,  Ear  and  Nose;  W.  B.  Youob,  M.D.,  Gyn»cologv;  L.P. 
Barbour,  M.D.,  Obetetrica;  William  Egleston,  M.D.,  Anatomy  ;  John  M.  Ba«, 
M.D,,  Pediatrics;  W.  L.  Nicbol,  M.D.,  Inatrumental  Obstetrici;  Samuel  S. 
Brig^s,  H.D.,  Minor  and  Operative  Surgery;  W.  D.  Haggard,  Jr..  M.D..  Gyne- 
cological tjurgery;  Oeorgo  Bruce  Thomae,  M.D.,  Pathology;  with  a  complete 
faculty  in  Pharmacy  and  a  full  corp*  of  leututers  and  demonatraton. 

For  Catalogues  and  fnrtber  information  address 

J.  8.  OAIH,  H.D.,  Dwn. 
Nashville,  Tenn.,  antil  May  Ist,  afterwards  at  Sewanee,  Tenn. 

Please  mention  this  Journal. 

'""'  DiclzedbyGoOgle 


...THE  FRANKLIN... 

PRINTING  AND  PUBLISIUNG 

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OBO.  W. 

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ppinters.  Binders  and  Eleetrotypers. 

LAW  BOOK  PUBLISHERS. 

Blanlc  Boolcs  Nlade  to  Order. 

.    .  PBTSICUR8'  AND  DENTISTS*  FBlNTlKe  1  SPECULTI .    • 


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Each  Diachm  Comtaiix 

Photo-Chioh.  lion,  1-8  (r 

Bt-CHLOB.  Hbkcuit,  1-US  (I 

CHLOKmBAMKHIC,  1-280  IT 

Caluava  AlX.  COKDIAL. 

AsJUTAHT  TO  lODinn^ 

12  01.  Bottle,  fl.00. 


:e  CHLOF 


^COOHIZAHCE  4 
WLTBEATC  TONI 

>ULAR  srrMi 


Do*>— 1  to  2  dnchHi. 


RI-IODIDE 

HENRY'S 

-UQ.  BAU-lODUIBl- 

^     SYNERGY     4 

ALTERATIVE. 

IILITIC.    ANTI-R 


?  AlOHATTC  CoiDt 


:0-LITH 


DIURETIC. 

a,  YCT  NON- 


ro  grukt  to  drachiH, 


HENRY  PHARMACAL  COMPANY. 


LOUISVILtE.** 


THE  NE  PLUS  ULTRA  ACHIEVEMENT. 

MULTIPLE  COMMINUrER  AND  AIR  RECEIVER  COMBINED. 


DB.  ROBERTSON'S  LATEST  AND  MOST  UNIQUE  INVENTION. 

The  era*t  uiccets  al  tbe  Multiple  UommlouU 
me»naof  traBUDgdlaeKKaotttaemplrKiory 

■Dd  middle  e»r  hot.  oaied  »  wld»<pr«ad  ' 

%  mire  oompaot  and  ]tm  eiipeoM —  ■- 


uoryornoa 
doiiua  for 


The  adTaolue*  of  Ih 
>Dd  obTloui.    We  mulie 


■tjlea  snd  Blzeo  wltli  Irom  two  to  aicbt  TuofUlai 
globe*,  amogcd  either  Id  I1i»,  u  oh  .wd  Id  tbeillBo- 
mUon,  or  In  olrcalar  form.  Tb«  air  rvaetrtn  atoo 
■re  of  Tiu-loua  Blie»— frum  flre  to  fortf  gallo— 
upuslt;  to  suU  purchaMT.  Kach  appaiMoa  fi  fliMd 
wltb  our  reiulauag  vaiTv  for  aoonr*tBl7  ooBlrolUnc 
the  prewure,  aud  with  a  Mpar«t«  valve  and  connaB- 
lion  for  iprav  tube*,  etc.,  mo  that  It  can  be  uaed  far 
aojr  purpoae  tor  which  compreaaed  air  U  applied. 

OUB  nCPSOTBS  TIBBATUra  TAI.VB 
can  be  attached  to  an;  of  these  InatnunenU.  TbI*  to 
tbe  ool;  Ihorouxhly  sclenllBc  meaoa  of  treatlag  ilie 
lalerau  ear,  eliber  by  liiOaUon  of  TibratoiT  mae- 

sace.    Tbe  force  and  dni»tlon  of  o — "■  ' ' —  "- 

under  absolute  control,  and  a  rate  of 
per  mlDute  cam  be  reached. 

HBTHODB  AHD  rO&MULA, 


THE  PNEUNIACHEMIC  CO., 

120  Longworth  Street,  CINCINNATI,  OHIO. 


GL 


LINE 


Ni  !RH 

An  AOodlne,  Antiseptic,  Non-hTHatlng,  aeanahig;  Sohitlon  for  tlw  Treatment  of 
DiseoMd  Mucoua  Membrane,  particularly  Naoal  CatAirfa. 

The  best  representative  of  its  claes,  in  my  opinion,  is  Glyco-Thymoline  (Kress),  ao  nnti- 
eeptic  of  claret  color,  pleasant  taste,  alkaline   reai^ttt  '  -.   ■' 

enrfacea.  I  have  found  it  &  pleasant  mouth  wash,  a 
ideal  preparation  lor  the  cure  of  acute  und  chroni 
Thymoliae  (Kress)  will  be  found  to  produce  the  desired  result.  It  seldom  fails  to  cure  acute 
pbarynsitia  in  two  days  when  gargled  in  full  strenglh  or  diluted  not  weaker  than  25  per 
cent,  fu  acute  rbiniiia  it  has  produced  best  results  wheu  in  solution  not  stronger  than  liO 
per  cent.  In  chronic  rhinitis  I  have  used  as  strong  as  SO  per  cent,  solution,  gradually  in- 
creasing the  strength  from  25  per  cent. ^^ — American  Journal  of  Surgery  and  Gynecology 
for  January,  1697. 

cor  1^1  A I      ArrrD     ^  fuH-swc  bottle  of  Glyeo-ThymoUnc  (Kress)  will  be  sent 
or  Lt-tl  AL     vF  ■  Cn     to  any  physician  who  will  pay  express  charges. 

K  AO  OoBCba  toPtar*ldaiu,  ISOnts;  tl.SOperPonn.    ReUll  19  Cmto.   Realt  SMnp*. 

KRES5  &  OWEN  COMPANY,  Chemists.  221  Pulton  Street,  New  York 


MORNINGSIDE  RETREAT 

KASHTILLK,  TEMH. 

i  Chartand  InttHuiion  for  Traatmant  of  Montai  ana  Karnoui  Diaonfart, 
Alcoholitm  and  Korphinitm. 

LocatlOD  mbnrbOD.  and  accrnlbls  Iit  plpuant  drlie,  tvo  miles  fail  from  Ifae  rlty.  Build' 
Ingi  Cndoaeil  In  bnoiilull;  wooded  Iftwn  '  f  fnurieeTi  tarn,  tnil  heated  bji  attain  and  llgbud 
Wlthni.  Tblrtrmlnatealrom  Union  SUtloD  In  city.  Elecirlc  car  Una  In  abort  diatanoeol 
Vtevatn,  Cirrlagei  tent  to  Station  wben  notifled.  App]tani:et  loi  laie  and  treatment  «om- 
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INFANTS'  FOOB— 
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Hornlngdde  Retreat 

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