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'^tbrary 


nf   the 


Toronto 

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is^q 


m 


Vol.  XXII 


,  OCTOBER,  1893. 


1^ 


4 


No.  1 


OKIGIKAL    COMMUNICATIONS. 

A  Contribution  to  the  Study  of  Club- 
Hand 1 

SOCIETY  PROCEEDINGS. 

The  Cana.lian  ^ledical  Association..      3 

President's  Address 3 

Case  of  F.elanipsia  4 

Sanitary    Science  —  Some     of     its 

Elfects 5 

The  GeneraJ  Practitioner  and  the 

Insane o 

Is  Alcohol  in  all  Doses  and  in  all 
Cases  a  Sedative  and  Depressant. .      6 

Case  of  Lateral  Curvature 7 

Address  on  Surgery. 7 

Movable  Kidney  with  Two  Cases  of 

Nephrorrhaphy  8 

Case  of  Sub-cordal  Spindle-celled 
Sarcoma  and  its  successful  Remo- 
val by  Thyrotomy 8 

Two  Cases  of  Lapar.  'tomy : . . .      9 

Some  Unusual  Conditions  met  with 
in  Hernia  Operations 0 


OOUSTTEISTTS. 

Prophylaxis  in  Tuberculosis 10 

Report  of  !!sominatiug  Committee  . .     11 
The  more  recent  ^lethods  of  Diagno- 
sis and  Treatment  of  Diseases  of 

the  Stomach 11 

A  Large  Sarcomatous  Growth  in  the 
Neck,  with  Secondary  Deposit  in 

the  Lung 12 

Case  of  Cholecystotomy     12 

Some    of  the    Uses    of  Sulphurous 

Acid 13 

Three  Cases  of  Frieilrieck"s  Ataxia,.     13 

Puerperal  Eclampsia 14 

Report  of  Committee  on  Interpro- 

vincial  Registration 14 

Peculiar  Forms  of  Sleep  or  Allied 

Conditions   15 

Multiple  Xeuritus 15 

Ophthalmic  Memoranda 16 

PROGRESS  OF  SURGERY- 

The  Role  of  the  Posterior  Urethra 

in  Chronic  Urethritis 16 

Anal  Dilatation 17 

Bread  and  Dyspepsia 18 

Ichthyol  in  Gonorrha;a 18 


PROGRESS  OF  GYNSICOLOGY. 

A  Sensible  and  Timely  Caution 18 

Danger  of  Ovarian   Cysts   in   Preg- 
nancy      18 

PROGRESS  OF  OBSTETRICS. 

Ante  and  Post-Partum  r)oui'b<'s 10 

PROGRESS  OF  THERAPEUTICS 

Class-Room  Xotes  19 

Therapeutic  Briefs 20 

The  Clinical  Application  of  Ingluvin  22 
Aperient  Pill  of  Sumbul :   an  Etli- 

cient  Combination 22 

Snutf  for  Recent  Coryza 23 

Personal 23 

Pamphlets  Received 24 

World's  Columbian  Fair 24 


[riginal    ^Communications. 


A  CONTRIBUTION  TO  THE  STUDY 
OF  CLUB-HAND. 

Abstract  of  paper  read  by  Reginald  H. 
Sayre,  M.D.,  before  the  Pan- American 
Medical  Congress,  Washington,  Septem- 
ber, 1893.* 

Club-hand  is  very  much  less  frequent 
than  club-foot.  It  may  be  acquired  as 
the  result  of  paralysis  of  certain  muscles,  or 
contraction  of  others  from  central  nervous 
irritation,  by  cicatrices  resulting  from 
burns,  or  be  due  to  injuries  to  the  bones 
of  the  hand  or  forearm,  or  it  may  be  con- 
genital. 

Of  the  first  variety,  J.  K,  Young  reportsa 
case  where  an  infant  had  the  leftside  of  the 
head  injured  at  birth.  A  large  hematoma 
formed    here,  and   subsequently  the    right 

•  Made  specially  for  The  C.\n.\d.\  Medical  Record. 


hand  was  markedly  adducted  and  the 
fingers  and  thumb  flexed  and  the  hand 
flexed  at  the  wrist  almost  at  a  right  angle 
with  the  forearm  in  the  radio-palmar  posi- 
tion. The  hematoma  was  incised,  profuse 
bleeding  followed,  and  subsequently  the 
deformity  gradually  subsided,  having  been 
caused  by  the  irritation  produced  by  the 
hematoma. 

Biehaut  reports  a  case  of  club-hand  due 
to  fracture  of  the  ulnar  at  birth,  with 
subsequent  loss  of  bone  from  suppuration, 
giving  rise  to  inequality  in  the  length  of 
the  bones  of  the  forearm,  causing  a  sharp 
deflection  of  the  hand  towards  the  ulnar 
side. 

The  congenital  club-hands  differ  widely 
from  the  above  described  cases,  and  may 
be  divided  into  three  varieties  :  1st,  Those 
where  the  skeleton  is  complete  and  well 
formed  ;  2nd,  where  the  skeleton  is  com- 
plete but  ill  formed  ;  and  3rd,  where  the 
skeleton  is  incomplete  and  distorted. 
Various  writers    say  that  the    majority  of 


THE   CANADA   MEDICAL   RECORD. 


cases  come  under  the  3rd  head,  but  the 
author's  personal  experience  does  not  agree 
with  this. 

In  many  cases,  club-hand  is  associated 
with  club-foot,  or  some  other  abnormality 
of  development.  The  direction  of  the 
deformity  may  be  either  in  flection,  exten- 
sion, abduction  and  adduction,  or  a  combi- 
nation of  the  two,  the  most  frequent  being 
the  radio-palmar  variety. 

In  those  cases  where  all  the  bones  of 
the  hand  and  forearm  are  present,  the 
prospects  of  a  good  result  are  more  favor- 
able than  where  there  is  absence  of  one 
or  more  bones,  and  in  these  milder  cases, 
when  seen  early,  it  is  sometimes  possible 
to  restore  the  hand  to  proper  shape  and 
function  by  constant  manipulation  and 
rotation  of  the  parts,  which  are  to  be  held 
in  their  improved  position  by  some  fixed 
dressing,  as  the  plaster-of- Paris  bandage, 
the  dressing  being  changed  from  time  to 
time  as  the  deformity  is  reduced. 

Section  of  the  tendons,  ligaments  or 
fascia  may  be  necessary  if  the  case  is  not 
seen  in  the  early  stages.  Many  of  these 
structures  are  so  situated  as  to  make  open 
section  preferable  to  the  subcutaneous 
method  ;  and  if  the  flexor  tendons  have  to 
be  divided,  it  would  seem  better  to  oper- 
ate in  the  forearm  instead  of  the  hand, 
and  to  split  the  tendons  longitudinally, 
and  after  having  gained  such  additional 
length  as  was  needed  by  sliding  the  ends 
past  each  other,  to  suture  them  together 
once  more. 

In  an  aggravated  case  of  congenital 
club-hand  and  club-foot  of  the  right  side, 
associated  with  lateral  curvature  of  the 
spine,  the  author  had  operated  in  the 
following  manner :  The  club-hand  was 
very  marked.  The  radius  and  thumb 
were  absent,  as  well  as  the  first  metacarpal 
bone  and  a  certain  number  of  the  carpal 
bones.  1  he  ulnar  was  curved  in  its  middle 
at  an  angle  of  about  30°  towards  the  side 
where  the  radius  should  have  been.     The 


hand  was    almost  at  right  angles  with  the 
forearm,  bent  towards  the  radial  side,  and 
flexed  on  the  forearm.     The   carpus    did 
not  articulate    with    the    ulnar,   but   was 
attached  to  it  by  means  of  firm  ligamentous 
bands.     An  osteotomy  was  first   done  on 
the  ulnar  to  correct    the  curve,   and  after 
the    bone   had    united    in  a    straight   line, 
endeavors  were  made  to   stretch  the    con- 
tracted soft  parts  on  the    side  of  the  arm 
where     the    radius   should    have    existed. 
After  several  weeks  of  traction  the    hand 
could  not   be  drawn    far  enough    down  to 
permit  the  ulnar  to  slide  above  the  carpus. 
Through  an   open    incision  the    ligaments 
between    the  ulnar  and  the    carpus    were 
divided,   the  intention    being  to  form  an 
artificial  joint    between   the    lower  end  of 
the    ulnar    and     carpus.        It   was    found 
impossible,  however,  to   draw  the    carpus 
clear  of  the  ulnar,  and  therefore  the  styloid 
process    of  the   ulnar   was  cut  off,  the  os 
magnum    and  unciform  removed,  and  the 
end  of  the  ulnar  put  into   the  gap  in    the 
carpus  thus  formed.      The  bones  were  not 
wired  in    this  position,  with  the  idea  that 
the  hand  might  be  more  useful  if  this  were 
not    done,  and  it    being  of  course  feasible 
to  wire  the  bones  later  on,  if   it  should  be 
deemed  necessary.     The  shortening  of  the 
extremity,  caused  by  the  removal    of  this 
amount  of  bone,  seemed  preferable  to  the 
author,  to  the  very  extensive    division  of 
tendons    and  muscles  which    would  have 
been  necessary  to  permit  the  carpus  to  be 
pulled  down.     The    hand  is  now  approx- 
imately in   line  with  the  forearm.     There 
is  free  motion  at  the  wrist,  and  the  abihty 
to  grasp    objects  is    greater  than  it  was 
before  the   operation,   although  extension 
of  the  hand  on  the    wrist  is  poor,  absence 
of  the   radius    making  a  very    imperfect 
joint. 

In  cases  like  that  described  by  Bouvier 
which  is  in  the  Dupuytren  Museum,  where 
such  carpus  as  is  present  articulates  with 
the    ulnar  on    the  side  where    the    radius 


THE   CANADA   MEDICAL   RECORD. 


should  have  been,  the  radius  being  absent, 
the  proper  operation  would  seem  to  be 
the  division  of  the  ulnar  just  above  the 
articulation  with  the  carpus,  and  then  to 
turn  it  at  right  angles,  letting  the  outer 
surface  reunite  with  the  end  of  the  ulnar, 
and  thus  bring  the  hand  into  a  straight 
line  with  the  arm,  at  the  same  time  preserv- 
ing the  wrist-joint. 


•ocictg    ficocectJings. 


THE  CANADIAN    MEDICAL    ASSOCIA- 
TION. 

Reported  specially  for  The  Caxada  Medical 
Record. 

The  twenty-sixth  annual  meeting  of  the  Can- 
adian Medical  Association  met  in  Victoria  Hall, 
London,  Out.,  Wednesday,  Sept.  20th,  at  11 
a.m.  ;  Dr.  Chas.  Sheard,  of  Toronto,  as  Presi- 
dent. 

The  first  session  was  devoted  to  business, 
there  being  no  papers  read. 

Dr.  Bray  of  Chatham,  after  thanking  the 
members  for  their  kindness  and  consideration 
to  him  as  President  for  the  last  year,  introduced 
Dr.  Sheard  as  his  successor. 

Dr.  BiRKETT,  of  Montreal,  Secretary,  read 
the  minutes  of  last  session,  which  were  adopted, 

A  motion  was  then  introduced,  asking  that 
fees  be  required  only  of  members  in  actual  atten- 
dance at  the  Association.  Another,  that  after 
this  those  members  who  were  to  read  papers 
and  were  unable  to  come  should  telegraph  such 
inability  to  the  Secretary,  so  that  the  pro- 
gramme might  be  more  easily  carried  out. 

The  Secretary  then  read  a  communication 
from  the  National  Bureau  of  Bibliography, 
Washington,  D.C.,  informing  the  members  of 
its  value  as  a  storehouse  of  Medical  literature, 
from  which  they  might  procure  information  on 
any  medical  subject  in  which  they  were  inter- 
ested as  students  or  lecturers. 

Drs.  McGregor,  Campbell,  Butlc,  Hobbs 
and  Weld,  of  London;  Drs.  Starr,  B.  E.  Mc- 
Kenzie  and  J.  N.  E.  Brown  of  Toronto  ;  and 
Dr.  Smith  of  Quebec,  weie  elected  as  members 
of  the  Association. 

The  President  proposed  that  some  pro- 
vision be  made  for  reporting  the  proceedings 
of  the  Association,  and  named  a  committee  to 
arrange  for  such  reporting.  Dr.  Brown  of  Tor- 
onto was  chosen  to  do  the  work. 

The  Nominating  Committee  was  then  ballot- 
ed   for,    Drs.    McPhederan    and   Bray   being 


appointed  scrutineers.  The  result  of  the  ballot 
showed  the  following  to  have  been  elected  : 
Roddick  and  Stewart,  of  Montreal ;  Fulton 
of  St.  Thomas ;  Graham,  McPhederan  and 
Macallum,  of  Toronto  ;  Olmstead,  of  Hamilton  ; 
Harrison,  of  Selkirk  ;  Holmes,  of  Chatham  ; 
and  Bucke,  of  London. 

Drs.  R.  A.  Reeve,  J.  F.  W.  Ross,  H.  A. 
Macallum,  T.  S.  Harrison  and  Holmes,  of  Chat- 
ham, were  ch  jsen  as  the  Committee  on  Ethics. 

The  subject  of  a  uniform  Canadian  Pharmi- 
copceia  was  then  discussed,  and  a  committee, 
consisting  of  Dr.  Blackader,  of  Montreal,  H. 
A.  Macallum,  of  London,  and  Jas.  Macallum, 
of  Toronto,  teachers  of  therapeutics,  were 
appointed  a  Committee  to  memorialize  the 
Government  in  this  regard. 

afternoon  session. 

After  the  opening  business,  the  President 
proceeded  with  his  address,  whose  elegant 
periods  held  the  Association  in  rapt  attention 
and  eHcited  the  most  hearty  applause. 

The  effort  was  a  most  masterly  one  ;  the  sub- 
stance of  his  address  was  solid,  and  the  effect  of 
its  brilliant  delivery  can  be  appreciated  only 
by  those  who  have  listened  to  tlie  magnificent 
oratory  of  the  Doctor  when  he  is  speaking  on 
some  congenial  theme. 

He  expressed  gratitude  to  the  Association  for 
his  election,  saying  that  he  felt  honored  to  fill 
such  a  position,  which  had  formerly  been  filled 
by  men  who  had  made  the  profession  of  medi- 
cine in  Ca'^ada  illustrious.  He  combated  the 
statement  made  by  some  tliat  the  intiuence  of 
the  Association  was  on  the  wane  and  its  work 
usurped  in  part  by  Provincial  institutions.  It 
had  for  twenty-six  years  stood  out  against  char- 
latanism, it  had  developed  a  feeling  of  friend- 
ship and  unity  among  the  profession,  it  had 
stimulated  and  helped  men  to  professional 
excellence,  and  had  given  medical  men  an 
increased  love  and  zeal  for  their  calling.  It 
had  not  outlived  its  usefulness.  Such  men  as 
Howard,  Ross,  Osier,  Hadder,  Workman  and 
Wright,  not  to  speak  of  men  whose  advancing 
years  prevented  them  from  attending  this  Asso- 
ciation, were  examples  of  all  that  was  good  and 
noble  and  inspiring  to  the  younger  members  of 
the  profession.  If  a  man  would  do  good  work 
he  needed  to  devote  his  whole  attention  to  his 
profession.  It  was  unfortunate  that  some  of 
the  younger  men  presumed,  that  because  they 
thought  they  had  the  latest  and  most  improved 
methods  they  should  parade  them  in  such  a  way 
as  to  reflect  on  their  older  colleagues.  Thack- 
eray had  asked  how  it  was  that  the  evil  which 
men  did  spread  so  widely,  whilst  each  good, 
kind  word  seemed  never  to  take  root  and 
blossom. 

The  President  went  on  to  say  : — "  It  appears 
to  me  scarcely  conducive  to  professional  unity 
that  we  should  have  in  the  various  provinces  of 


THE   CANADA   MEDICAL   RECORD. 


the  Dominion  separate  licensing  bodies,  which 
confer  the"privilege  of  practising  only  for  the 
province,  and  that  those  of  us  who  lo-day  may 
reside  in  Ontario,  in  travelling  to  Manitoba  or 
British  Columbia,  require  there  to  pass  a  period 
of  naturalization  before  we  can  even  be  exam- 
ined, and  then  to  again  pass  an  examination 
which  proves  our  qualification  to  practice, — 
and  this  in  our  own  country.  Surely,  we  are  all 
Canadians,  and  if  the  spirit  of  the  time  means 
anything,  we  are  united  in  patriotic  feelings  and 
national  progress.  Why  should  it  be  different 
in  medicine  ?  I  may  express  the  earnest  hope 
that  the  time  is  not  far  distant  when  there  will 
be  some  central  examining  board,  or  boards, 
for  the  whole  Dominion,  when  a  license  from 
such  a  body  will  be  a  qualification  to  practice 
from  one  end  of  the  country  to  the  other." 
(Applause).  The  Doctor  then  spoke  of  the 
great  strides  medicine  had  made  as  a  result  of 
bacteriology  investigations.  Curative  methods 
followed  correct  diagnosis.  Bacteriology  was 
a  practical  scientific  means  to  aid  in  this  direc- 
tion. He  saw  within  the  next  decade  a  solution 
to  the  difficulty  which  besets  the  cure  of  phthisis 
and  such  diseases  whose  causation  had  during 
the  past  decade  been  established.  The  science 
of  medicine  like  others  must  depend  upon  the 
co-relation  of  facts, — upon  the  comparison  of 
cases  alike  in  many  respects  but  differing  some- 
what in  their  phenomena.  Much  difficulty 
there  was  in  ascertaining  what  cases  were  suffi- 
ciently similar  to  become  comparable, — due  to 
insufficient  and  erroneous  records  of  the  pheno- 
mena observed.  Few  men  could  for  and  by 
themselves  see  and  describe  the  things  before 
them.  It  took  a  long  time  before  men  could 
see  the  difference  between  measles  and  scarla- 
tina, between  typhus  fever  and  typhoid.  Plato 
said  :  *'  He  shall  be  a  god  to  men  who  can  rightly 
divide  and  define."  Men,  the  speaker  said, 
who  have  this  faculty  we  cannot  produce  by  any 
system  of  education  ;  they  come,  we  not  know 
when  or  why.  It  was  science,  he  said,  that  laid 
the  basis  upon  which  were  wrought  the  revela- 
tions in  practical  medicine. 

"  Science  seams  and  scars  the  detested  face  of 
hyprocrisy  and  lies,  adds  beauty  to  beauty, 
grace  to  grace,  truth  to  truth.  It  decks  the 
flower  of  the  field  with  loveliness  till  all  the 
universe  beats  with  one  heart,  pants  with  one 
breath.  It  goes  hand  in  hand  with  heart. 
When  the  tale  of  great  deeds  ceases  to  thrill, 
when  the  awe  has  vanished  from  the  snow- 
capped peak  and  deep  ravine,  when  the  lily  of 
the  field  becomes  no  longer  beautiful,  when 
the  tale  of  suffering  causes  no  pity,  then,  indeed, 
and  not  till  then,  may  science  be  said  to  have 
devoured  art." 

Science  and  practice,  he  said,  should  go 
together.  It  should  be  the  work  of  the  patho- 
logist to  study  the  etiology,  diagnosis  and  pro- 
gress of  the    case.     Paget  was  a  pathologist 


and  surgeon  ;  so  was  Bilroth.  Koch  was  a 
general  practitioner;  Cheyne,  a  consulting 
physician.  In  the  lines  of  scientific  attainment, 
Canada  was  fully  abreast  of  the  time.  There 
were  too  many  men  in  our  country,  however, 
who  were  possessed  with  the  sordid  ambition 
of  the  utilitarian,  who  thought  they  could 
not  leave  their  practice  a  day  to  gather  such 
knowledge  and  enthusiasm,  have  their  powers 
of  observation  quickened,  receive  such  mutual 
benefit  as  would  come  to  them  from  attending 
medical  associations.  The  President  eulogized 
the  good  work  of  our  colleges  and.  the  Medical 
Council  of  Ontario.  In  concluding,  the  Presi- 
dent said  the  Government  of  the  province  was 
liberal,  leaving  to  the  profession  the  ordinance 
of  its  own  laws,  and  did  it  show  worthy  in- 
telligence on  the  part  of  those  claiming  to  be 
ornaments  of  the  profession  to  urge  upon  the 
proper  material  body  the  wisdom  of  withdraw- 
ing from  them  what  was  justly  and  legitimately 
their  own?  The  masses  sent  their  representa- 
tives to  represent  them  in  certain  issues,  and  if 
they  did  not  do  so  they  changed  their  represen- 
tatives. "This  is  one  law  of  political  economy 
throughout  the  world.  Have  the  physicians  of 
our  Province  not  enough  intelligence  to  be 
entrusted  with  some  privilege  ?  " 

Dr.  Hingston  was  voted  to  the  chair.  Dr. 
Bray  moved,  Dr.  Reeve  seconded,  a  vote  of 
thanks  to  Dr.  Sheard  for  his  address.  This 
was  carried  with  applause.  The  President 
made  a  suitable  reply. 

Dr.  J.  E.  White  of  Toronto,  seconded  by 
Dr.  Bray  of  Chatliam,  made  a  motion,  to  the 
effect  that  a  committee  be  formed  to  repoit 
some  scheme  whereby  the  barriers  that  exist 
to  inter-piovincial  registration  might  be  over- 
come, so  that  practitioners  in  one  province 
might  be  enabled  to  practise  anywhere  in  the 
whole  Dominion  without  re-examination,  and 
that  such  committee  be  composed  of  Drs. 
Praeger,  British  Columbia ;  Hingston  and 
Mills,  of  Montreal ;  Waugh,  of  London  ;  Sheard, 
of  Toronto ;  Harrison,  of  Selkirk  ;  Taylor, 
of  Goderich  ;  Worthington,  of  Sherbrooke  ; 
and  Ross  of  Toronto, — Carried. 

The  next  feature  was  the  report  of  a  case  of 
eclampsia  by  Dr.  J.Campbell,  of  Seaforth,  Ont. 

Patient  aged  32  complained  of  headache  ex- 
tending down  neck  to  shoulder.  Without  physi- 
cal examination  he  administered  something  for 
what  he  supposed  was  neuralgia,  He  had  not 
noticed  that  she  was  pregnant.  In  three  hours 
patient  had  convulsions.  Was  called  again,  and 
found  patient  suffering  severe  head  pain,  and 
also  in  the  epigastrium.  Temp,  normal ;  pulse 
full  and  bounding.  Found  patient  to  be  about 
7  months  pregnant.  Administered  an  enema  of 
ji  of  chloral.  This  induced  sleep.  Had  ad- 
ministered elaterium,  which  was  soon  effectual. 
Was  unable  to  get  urine.  In  few  hours  called, 
and  while  about  to  give  another  injection  patient 


THE  CANADA  MEDICAL  RECORD. 


took  another  convulsion;  before  CHCLg 
could  be  given.  Found  urine  full  of  albumen 
on  examination.  Very  soon  patient  had 
another  convulsion.  Repeated  enema.  Found 
OS  dilated  to  size  of  quarter.  Ruptured  mem- 
branes. Labor  pains  came  on,  and  after  a 
sleep  till  3  p.m.  (case  having  commenced  at 
II  p.m.  day  before)  was  delivered  of  living 
child.  Gave  51  ergot  half  an  hour  before  de- 
livery. Placenta  delivery  normal.  No  haemorr- 
hage. Administered  a  diuretic  mixture  of 
pot.  acei.  and  digitalis.  Headache  disap- 
peared and  all  symptoms  abated. 

The  Doctor  concluded  his  paper  by  saying 
that  the  subject  was  one  that  required  further 
investigation,  but  thou^iht  that  the  following 
statements  were  justifiable  in  the  light  of  mod- 
ern pathology  : — 

ist.  Cell  activity  both  of  mother  and  foetus 
produced  substances  pernicious  to  mother,  if 
not  excreted.  2nd.  The  excretory  function 
was  inadequate  in  the  pregnant.  3rd.  The 
unknown  accumulated  poison  caused  the 
eclamptic  seizure.  4th.  The  convulsions  are 
believed  to  be  the  result  of  anasmia  of  the 
brain  caused  by  the  contractions  of  the  arteri- 
oles,— probably  by  direct  action  of  some  poison 
on  the  brain  substance  itself. 

On  account  of  the  intense  muscular  action,  the 
blood  was  driven  into  internal  organs, — brain, 
kidneys,  etc.,  causing  apoplexy  and  abroga- 
tion of  the  renal  function,  etc.  Treatment, 
he  said,  should  be  directed  to  elimination, 
diminishing  of  the  nervous  sensibility ;  if  con- 
vulsions ensue,  to  save  child  without  adding 
risk  to  the  life  of  the  mother  ;  and  lastly,  to 
guard  the  mother  from  injury  during  the 
attack. 

Dr.  Lapthorn  Smith  expressed  entire 
approval  of  what  Dr.  Campbell  had  said  in  his 
paper.  He  thought  the  cause  was  due  to  pres- 
•sure  on  the  venous  circulation  of  the  kidneys, 
causing  nephritis.  He  did  not  agree  that. the 
anaemia  of  the  brain  was  the  begmning  of  it. 
The  nephritis  caused  the  albuminuria ;  the 
albuminuria  caused  the  anjemia.  The  indica- 
tion for  treatment  was  to  remove  the  pressure 
by  lessening  the  size  of  the  uterus.  He  fav- 
ored the  use  of  chloral  to  assist  in  the  dilatation 
of  the  OS  and  to  lessen  reflex  action.  He 
thought  hastening  labor  did  not  tend  to  cause 
convulsions. 

I)r.  Harrison  outlined  the  history  of  a 
recent  case  of  his,  where  he  employed  bleeding, 
a  remedy  he  had  spoken  at  some  length  about 
in  the  treatment  of  this  affeciion  at  the  meeting 
of  the  Ontario  Medical  Association.  He  bled 
freely  with  immediate  and  permanent  effects. 
He  employed  as  well  enema  of  chloral  and 
brandy. 

Dr.  Bethune,  of  Seaforth,  corroborated  wliat 
Dr.  Campbell  had  said  regarding  his  case.  He 
was    in    favor    of  bleeding   in  sthenic    cases, 


not  in  anaemic,  but  he  regretted  that  the  young 
practitioner  of  to-day  did  not  know  how  to 
perform  this  simple  and  often  effective  opera- 
tion. 

Dr.  Irving,  of  St.  Mary's,  asked  if  it  were 
proper  to  give  ergot  in  eclampsia.  Did  it  not 
cause  contraction  of  the  arterioles, — a  thing 
to  be  avoided?  Dr.  Smith  had  said  that  the 
pressure  of  the  foetus  in  iitero  was  the  cause  of 
the  convulsion.  How  was  it  that  they  often 
did  not  occur  until  after  delivery  ? 

Dr.  Holmes,  of  Chatham,  said  he  was  re- 
minded of  one  thing  in  what  Dr.  Campbell  had 
said, — the  danger  of  making  too  cursory  an  ex- 
amination of  the  patient.  Dr.  Holmes  pointed 
out  the  benefit  derived  in  causing  profuse 
sweating.  He  leaned  to  the  theory  that  the 
convulsions  were  due  to  the  circulation  of  some 
toxic  element  in  the  blood,  independent  of  the 
nephritis. 

Dr.  Campbell  closed  the  discussion. 

Dr.  Canniff,  of  Toronto,  then  gave  an  ad- 
dress on  "Sanitary  Science, — some  of  its 
Effects." 

Sanitary  science,  he  said,  was  not  a  distinct 
and  separate  science,  but  rather  a  development 
of  medical  science,  and  that  the  medical  man 
should  be  employed  not  only  to  cure  but  to 
prevent  disease.  He  advocated  that  we  should 
have  special  lists  on  the  subject.  He  also 
advocated  the  same  observation  by  individuals 
and  famihes  in  regard  to  sanitation  as  is  done 
in  the  case  of  the  State  and  the  municipalities  ; 
and,  as  it  was  desirable  to  legislate  in  regard 
to  preventible  diseases,  so  the  principle  was 
equally  applicable  in  relation  to  individuals  and 
families,  li  was  nobler  to  prevent  than  to 
cure.  The  principles  of  hygiene  should  be 
taught  by  the  parent  and  continued  in  the 
school.  He  advocated  the  principle  of  families 
employing  a  medical  man  by  the  year,  who 
should  make  regular  visits  and  advise  as  to 
sanitation  ;  by  so  doing  sickness  would  be  pre- 
vented. 

Dr.  Arnoit  thought  the  idea  of  families 
employing  medical  men  by  the  year  good  in 
theory  but  bad  in  practice.  His  experience 
was  such.  He  also  thought  it  would  be  a  bad 
education  to  the  family  itself.  He  thought  the 
importance  of  a  knowledge  of  sanitary  science 
by  medical  men  in  the  cure  of  disease  should 
be  emphasized  as  well  as  the  prevention  of  it. 

Dr.  Bethune  liked  the  idea  of  employment 
by  the  year,  if  possible.  His  experience  had 
been  that,  having  agreed  to  a  certain  amount  of 
his  services,  he  was  called  so  frequently  as  to 
make  it  non-paying.  If  families  could  be  edu- 
cated up  to  it,  it  would  be  well  for  the  country, 
and  much  disease  prevented. 

Dr.  Wesley  Mills  thought  that  it  would  be 
practicable  for  the  physician  to  look  generally 
to  sanitation,  -and  to  be  paid  extra  when  spe- 
cially sent  for,— family  tendencies  would  then 


THE   CANADA   MEDICAL    RECORD. 


be  understood.     Until    physicians    were  em- 
ployed in  the  way  mentioned,  the  best    results 
would  not  be  obtainable.     He   thought  the  ap 
pointment  of  specialists  a  good  thing,  and  stated 
that  in  some  places  this  was  being  agitated. 

Dr.  Canniff  thought  he  had  been  misunder- 
stood,— he  only  intended  saying  if  regulations 
to  hygiene  worked  well  in  municipalities  so  it 
ought  to  in  families.  Statistics  show  that  the 
practice  of  hygiene  is  a  saving  operation, — sav- 
ing the  man  and  saving  the  labor. 

Dr.  Anglin,  of  Verdun,  followed  in  a  paper 
on,  "  The  General  Practitioner  and  the  Insane," 
— a  very  practical  paper.     The  subject  of  in- 
sanity was    one  which  had  been  left  alone  too 
much  by  the  general  practitioner.     It  was  im- 
portant that  he  should  know  more  about  it,  for 
on  him  rested  the  diagnosis  of  insanity,  possibly 
the    administration   of  treatment,    the    recom- 
mendation to  hospitals,  and  the  certification  of 
the    patient's     mental    condition.      Generally 
speaking,  it  was  better  to  advise  hospital  treat- 
ment, but  in  some  cases   this  would  be  impos- 
sible.     It  was  much  less   expensive,  and    the 
change  of  environment  was  generally  beneficial. 
He  was  glad  that  the  old  prejudice  against  insane 
hospitals  was  becoming  lessened.     It  should  be 
taught  to  the  general  public    that  insanity  was 
a  disease,  not  a  crime.     The   Doctor   then  de- 
scribed the  hospital  of  to-day,  showing  that  it 
was  not  a  place  to  be  shunned  as  was  the  one  of 
days  gone    by.     If  a   man    were  called    on   to 
treat  a  case  of  insanity,  he  should  recommend  a 
change  of  scene,  the  employment  of  one  or  two 
trained  nurses.     Relatives  generally  made  poor 
attendants,  as  did   also  ordinary  sick   nurses. 
Sleeplessness  should  be  immediately    combated 
by  giving   moderate  exercise,  a  drive,  a    meal 
or   a    hot   bath.     Of  remedies,    alcohol,    hyo- 
scine,   paraldehyde,  sulfonal,  chloral    hydrate 
(and  opium  in  cases  due  to  pain)  were  useful. 
Constitutional  treatment  should  be  attended  lo 
strictly.      The     Doctor    outHned    the    points 
necessary  to  observe  in  making  out  certificates, 
laying  special  emphasis  on  the  recording  of  phe- 
nomena actually  seen  by  the  examiner.     He  cri 
ticized  the  stupid  methods  of  admission  in  cer 
tain  States,  but  commended  the  prog; ess  of 
Canada  in  this  matter.     A  certain  amount  of 
formality   was    absolutely  necessary,  and   the 
Doctor  should  be  exceedingly  exact  in  replying 
to  the  questions  on  the  blanks    used.     It  was 
wise  to  find  out  all  one  could  about  the  patient 
before  interviewing  him  ;  deception  should  never 
be  used  with  the  patient,  for  this  often  rendered 
him  less  amenable  to  treatment.     It  was  some- 
times exceedingly  difiicult  to  detect  symptoms, 
so  careful    to    coi.ceal   them  was    the    patient 
often.      Ihree  things  should    be  noted, — acis, 
appearances  and  conversation.     The   patient 
should   be  told   frankly    that  he  was  sick   and 
needed  hospital  treatment. 

This  paper  was  discussed  by  Drs.  Matheson, 


Arnott  and  Mills.     Dr.   Anglin  closed   the  dis- 
cussion. 

Dr.  Harrison  of  Selkirk  then  followed  with 
a  paper  on,  "  Is  Alcohol  in  all  Doses  and  in 
all  Cases  a  Sedative  and  Depressant?  " 

He  had  formerly  thought  alcohol  the  great 
stimulant,  and  the  physician  who  failed  to 
administer  it  was  culpable.  Temperance  phy- 
sicians had  refused  to  administer  it,  for  fear 
their  patients  would  acquire  the  drir.king  habit. 
The  subject  was  a  scientific  one,  and  should  be 
discussed  as  such.  If  alcohol  was  a  powerful 
sedative  and  depressant,  as  some  claim,  the  use 
of  it  for  so  many  generations  would  have  caused 
untold  injury,  and  the  number  of  deaths  caused 
by  using  a  sedative  instead  of  a  stimulant 
unaccountable.  He  spoke  of  a  case  in  his  prac- 
tice of  post  partum  haemorrhage  which  pro- 
mised to  end  fatally,  and  while  preparation  was 
being  made  to  inject  blood,  brandy  had  been 
administered  freely  per  os  and  per  rectum,  and 
under  it  the  patient  rallied  and  recovered.  In 
a  case  of  typhoid  fever  lasting  seven  weeks, 
where  the  patient  seemed  dying  of  exhaustion 
and  heart  failure,  after  two  weeks  of  a  diet  of 
port  wine  only,  the  patient  recovered  af  by  a 
miracle.  Another  case  of  puerperal  fever, — an 
extreme  one, — with  pulse  140  to  150, — all 
medication  was  abandoned,  and  brandy  and 
port  wine  in  a  little  milk  and  beef  essence  were 
given,  and  effected  a  permanent  cure.  The 
family  said  a  teaspoonful  had  inCi eased  the 
fever.  He  at  once  administered  two  table- 
spoonfuls. 

When  a  patient  was  nearly  moribund, — when 
a  feather's  weight  in  the  wrong  scale  must  be 
fatal, — and  brandy  was  administered,  if  the 
brandy  acted  as  a  sedative  the  result  must  be 
fatal;  but  the  fact  that  the  patient  rallies  shows 
it  cannot  be  a  depressant. 

Dr.  Arnott  said  he  had  some  diffidence  in 
discussing  the  subject,  as  he  seemed  a"lone^ 
bird  in  the  tree."  His  views  were  and  had 
been"  for  years  that  alcohol  was  not  a  stimulant 
in  Its  direct  action.  The  question  under  discus- 
sion in  other  words  is,  "  Does  alcohol  or  could 
anything  under  varying  conditions  give  the 
same  results  ?  "  Suppose  the  principle  were 
applied  to  water,  although  under  some  circum- 
stances it  causes  death,  yet  no  one  would  say  it 
was  a  poison  ;  the  direct  and  primary  action  of 
water  is  nourishing.  The  profession  are  not 
divided  at  present  as  to  the  sedative  action, 
because  all  use  sedatives  to  bring  about  a  stimul- 
ating result.  There  was,  he  said,  not  so  much 
difference  between  Dr.  Harrison  and  himself  as 
appeared  on  the  surface.  Although  opium  was 
a  sedative,  we  get  stimulating  results  from  it. 
He  mentioned  a  case  of  his  in  practice,  the 
setting  of  an  old  lady's  arm,  a  Colles'  fracture. 
He  had  given  her  a  great  deal  of  pain,  and 
suddenly  she  became  white,  ai  d  pulse  impercei> 
tible.     He  was  afraid  the  patient   was   dying. 


THE   CANADA   MEDICAL   RECORD. 


He  thought  it  clearly  the  result  of  shock,  and 
called  for  whiskey,  not  as  a  stimulant  (being 
opposed  to  that),  but  to  relieve  the  shock;  none 
being  in  the  house,  he  gave  the  patient  chloro- 
form, after  which  the  pulse  became  strong,  and 
the  operation  was  completed.  He  had  an- 
other case  of  typhoid  fever,  in  which  the  depres- 
sion was  very  great,  and  in  which  he  adminis- 
tered whiskey  in  large  doses, — an  ounce  every 
hour.  Being  alarmed,  he  called  in  another  doc- 
tor, and  they  administered//^  grain  of  morphia 
hypodermically,  and  that  did  much  more  good. 

Dr.  Bethune  said  alcohol  was  in  one  case 
a  stimulant,  in  another  a  narcotic,  and  in  an- 
other a  sedative,  according  to  the  condition  of 
the  system.  If  taken  in  big  doses  it  was  a 
narcotic.  Perhaps  some  of  them  had  felt  the 
effect.  (Laughter.)  In  neuralgia  it  was  a  seda- 
tive. When  people  took  a  tumblerful  at  night 
to  put  them  to  sleep  it  was  a  narcotic. 

Dr.  Gardiner,  London,  said  that  by  the  use 
of  alcohol  the  pulse  got  stronger,  the  eye  brighter, 
the  skin  warmer  and  the  body  invigorated. 
Whether  it  was  called  a  stimulant  or  a  narcotic, 
it  should  not  be  used  carelessly,  but  only  when 
there  was  reason  for  it. 

Dr.  Mills,  of  Montreal,  thought  it  was  a 
subject  demanding  careful  scientific  study, 
especially  as  its  elementary  principles  were 
taught  in  the  public  schools.  The  doctor  said 
the  necessity  for  experiment  was  absolute,  and 
they  were  not  prepared  yet  for  dogmatism.  He 
condemned  the  present  school  books  as  extreme. 
The  children  were  taught  that  alcohol  under 
all  conditions  was  a  posion.  The  medical 
profession  should  do  something  to  counteract 
this. 

Dr.  Arxott  said  that  alcohol  was  termed  a 
stimulant,  an  anodyne,  and  a  narcotic.  This 
was  perplexing.  The  fact  that  the  hospital 
having  ihe  lowest  death  rate  in  London,  England, 
did  not  use  alcohol  he  made  his  excuse  for 
speaking  on  the  subject. 

Dr.  Lapthorn  Smith  spoke  of  the  experi- 
ments shewing  the  effect  of  alcohol  on  the 
muscular  power;  how  that,  soon  after  adminis- 
tration of  the  alcohol,  the  individual  tested 
could  lift  much  more,  but  when  the  reaction 
had  set  in,  considerably  less  than  at  first.  It 
was  certainly  a  temporary  stimulant.  It  affect- 
ed the  great  sympathetic,  which  contracted  the 
arterioles,  more  blood  being  forced  into  the 
coronary  arteries,  thus  strengthening  the  heart. 

Dr.  H.  A.  Macallum  said  there  seemed  to  be 
physiologcal  evidence  to  show  that  all  narcotics 
and  poisons  were  stimulants.  The  respiratory 
stimulus  was  a  poison.  It  could  not  be  that 
CO,,  the  respiratory  stimulant,  and  ultimately 
poisonous  to  that  centre,  could  be  a  stimulant 
as  secondary  to  narcotic  action.  All  stimulants 
for  secretion,  respiration  and  circulation 
ultimately  were  narcotic  and  poisonous.  Anaes- 
thetics were    stimulants    in    small   doses.      It 


could  not  be  argued  that  CO,  is  a  natural 
stimulant  and  acts  as  a  narcotic. 

Dr.  Harrison  closed  the  discussion. 

Dr.  B.  E.  McKenzie  presented  a  bad  case  of 
lateral  curvature,  in  which  he  had  used  a  raw 
hide  spinal  support.  The  patient  could  be 
stretched  four  inches,  so  much  was  the 
curvature.  He  knew  of  no  other  treat- 
ment in  such  a  case.  It  was  fitted  to  a  plaster 
Paris  model,  and  had  no  seams.  It  fitted 
smoothly,  and  seemed  to  afford  much  relief. 
This  was  the  first  time  Dr.  McKenzie  had 
tried  it. 


EVENING    SESSION. 

Dr.  HiNGSTON,  Montreal,  then  gave  an  ad- 
dress on  Surgery.  It  consisted  of  an  historical 
review  of  the  subject.  He  held  that  in  Egypt, 
before  the  time  of  Moses,  many  so-called  modern 
operations  were  practised.  The  Greeks  con- 
sidered surgery  a  divine  art.  Pythagores  about 
600  B.  C.  elevated  surgery  to  a  science.  The 
Egyptians  and  Greeks  practised  nephrotomy, 
used  tents,  issues  and  moxas,  and  trephined 
the  skull ;  they  also  practised  percussion  as  an 
aid  to  diagnosis,  and  drew  fluid  from  the  chest. 
Hippocrates  made  use  of  immediate  ausculta- 
tion as  a  means  of  recognizing  disease.  But 
the  fall  of  the  Macedonian  Empire  seriously 
interfered  with  the  progress  of  surgery  The 
Alexandrian  school  were  skillful  in  abdominal 
surgery.  They  first  used  the  catheter.  2200 
years  ago  Ammonious  crushed  stone  in  the 
bladder.  There  was  another  retrogression  in 
the  science  at  the  time  of  the  Caesars.  Celsus 
found  that  there  might  be  rupture  of  brain 
substances  without  fracture  of  skull.  He  was 
first  to  ascribe  the  contre-coicp.  Heledenius 
opened  into  the  bronchial  tubes.  The  Arabians 
were  credited  with  greater  proficiency  in  surgery 
than  history  will  justify;  but  to  them  we  owe 
the  preservation  of  Egyptian  surgery.  The 
suturing  of  wounds  was  practised  by  Albucasis, 
also  the  incising  of  the  kidney  for  abscess. 
The  Council  of  Tours  forbade  the  clergy  to^ 
spill  blood.  By  this  prohibition,  surgery  was 
divorced  from  medicine,  and  got  a  serious  set- 
back. When  Columbus  discovered  America, 
the  physicians  of  Europe  were  not  superior  to 
the  medicine  men  of  the  Aborigines  of  xVmerica. 
Vesaliuslaid  the  foundation  of  modern  surgery. 
Pare  advocated  cupping  for  displacements  of 
the  uterus.  Wiseman,  in  Britain,  was  original 
but  crude.  His  reports  of  successful  treatment 
of  cancer  are  so  remarkable  as  to  arouse 
suspicion  as  to  the  accuracy  of  his  diagnosis. 
Wiseman  believed  in  the  magic  royal  touch  for 
the  King's  evil. 

Surgery,  the  speaker  went  on  to  say,  preceded 
medicine  in  this  country.  The  governor  of 
Nouvelle  France  was  always  asking  for  surgeons 
to   be   sent   out.     The  people   did    not  need 


8 


THE   CANADA   MEDICAL   RECORD. 


physicians.  Dr.  Hingston  then  described  the 
marvellous  advances  of  surgery  during  the 
past  forty  years  in  the  treatment  of  many  surgi- 
cal cases,  but  was  sorry  that  in  some  cases 
this  divine  art  had  degenerated  to  a  commercial 
question,  owing  to  the  greed  for  gold  spirit 
which  has  extended  to  some  of  the  members  of 
the  profession.  He  especially  cauterized  the 
practice  of  those  one-idead  gynaecologists,  who 
referred  all  female  disorders  to  the  uterus  and 
instituted  a  daily  tinkering  process  as  a  means 
of  obtaining  money. 

Dr.  EccLEs'  paper,  "  Movable  Kidney  with 
two  cases  of  Nephrorrhaphy,"  came  next.  This 
condition,  he  believed,  was  often  overlooked, 
and  something  else  treated  (often  hysteria) 
for  it.  This  resulted  from  neglecting  to  examine 
the  kidneys — a  matter  always  to  be  attended  to 
in  obscure  cases,  with  symptoms  of  hysteria, 
melancholy  and  general  nervousness  and  dyspep- 
sia. This  organ  having  no  special  support  was  in 
danger  of  displacement.  The  thirty  cases  Dr. 
Eccles  reported  were  all  females.  Patients  had 
a  dragging  down  feeling,  or  aching  in  the  back 
or  along  the  urethral  lines.  In  most  there  was 
dyspepsia,  accompanied  by  constipation,  diar- 
rhoea occurring  in  only  four.  In  six  there  was 
an  exacerbation  of  symptoms  during  menstrua- 
tion. In  some  seven  there  was  inability  to  lie 
on  the  side  opposite  the  displacement.  Inter- 
mittent hydro-nephrosis  was  observed  in  seven. 
Dr.  Eccles  then  outlined  two  cases  ful'y.  The 
first  had  most  of  the  typical  symptoms  for  a 
number  of  years,  the  most  prominent  being  the 
frequent  attacks  of  severe  pain,  which  at  first 
lasted  about  an  hour  and  latterly  forty-eight. 
These  were  accompanied  by  swelling  inside, 
followed  by  its  disappearance  and  great  liow  of 
pale  urine.  The  Doctor  could  feel  the  kidney. 
Had  support  and  pad  applied  with  complete 
relief.  Movement  no  doubt  of  the  organ  had 
kinked  the  ureter.  The  speedy  relief  of  this 
condition  was  conservative  to  the  kidnc  y. 

In  another  case  reported  the  abdominal 
support  failed  to  give  relief.  Operation  was 
advised.  After  the  usual  incision  the  capsule 
was  opened  along  the  convex  border  one  inch 
in  width.  Two  silk-worm  gut  sutures  ^  of  an 
inch  deep  were  passed  into  the  parenchyma, 
two  catgut  through  capsule  and  fatty  capsule 
above  and  below,  continued  through  the 
muscle  and  fasciae.  The  fasciae  were  united  by 
separate  catgut  sutures  before  those  through 
the  kidney  and  its  capsule  were  tied.  Good 
recovery. 

In  a  second  case  of  operation  Dr.  Eccles  did 
similarly,  but  did  not  dissect  up  capsule,  as  it 
was  thickened,  and  a  cystic  condition  appeared 
underneath.     A  good  recovery  followed. 

Dr.  Hingston  pointed  out  that  a  misplaced 
kidney  was  more  easily  felt  if  the  patient 
leaned  forward  during  the  examination.  He 
howed  how  one  might  be  mistaken,  bytelling 


of  a  patient  who  came  to  him  suffering  in  this 
way,  upon  whom  double  ovariotomy  had  been 
done  for  its  relief.  This  mistake  would  not  be 
made  if  one,  by  grasping  the  kidney  and  making 
gentle  traction  downwards,  found  that  pain  was 
experienced,  while  pushing  it  upward  gave 
relief.  The  reverse  would  take  place  in  the 
case  of  the  enlarged  ovary.  In  many  cases  he 
thought  operation  unnecessary. 

Dr.  Bethune  had  had  a  few  cases.  They  were 
all  in  women  on  the  right  side.  The  trouble 
proved  most  annoying  during  pregnancy.  One 
case  he  had,  the  kidney  on  removal  was  found 
to  be  cancerous.  He  thought  cases  of  displaced 
liver  were  more  common  than  was  generally 
supposed.  He  did  not  see  how  operation 
could  help  the  patient  much,  as  there  would  be 
difficulty  in  retaining  it  in  position,  even  after 
operation,  so  little  was  there  to  which  it  could 
be  solidly  attached. 

Dr.  Bell,  of  Montreal,  agreed  that  many  of 
these  cases  needed  no  treatment.  The  condi- 
tion was  often  accidentally  discovered.  But 
in  cases  where  hydro-nephrosis  developed,  some 
operation  seemed  to  be  necessary.  He  had  no 
personal  experience  in  the  use  of  the  pad  and 
hand,  and  did  not  think  it  likely  they  would  do 
much  good.  He  had  operated  on  patients  where 
this  treatment  had  been  tried,  and  found  to  be 
a  failure.  He  thought  the  operation  of  nephror- 
rhapliy  in  many  cases  effectual  in  making  a 
permanent  cure.  At  first  he  was  sceptical 
regarding  the  operation,  but  he  got  over  that. 
He  knew  of  no  other  means  of  relief. 

Dr.  Lapthorn  Smith  agreed  with  Dr.  Bell. 
The  frequency  of  cases  he  believed  to  be  due 
to  improved  methods  in  diagnosis.  Formerly 
they  were  called  hysteria.  Dr.  Smith  wished 
Dr.  Eccles  would  show  his  ingenious  method  of 
retaining  displaced  kidney  in  such  cases  as  are 
not  bad  enough  for  operation.  He  was  reminded 
of  the  principal  causation  of  the  trouble,  when  he 
heard  a  young  man  remark  to  his  friend,  after  a 
tight-laced  young  lady  passed  by  them  :  "  I  won- 
der where  she  puts  her  thirty  yards  of  intes- 
tines." He  (the  speaker)  had  not  seen  any  cases 
of  men  with  this  affection.  He  considered  the 
ounce  of  prevention  to  be  a  modification  of  the 
corset. 

Dr.  Eccles  closed  the  discussion. 

Dr.  H.  S.  Birkett,  of  Montreal,  read  a 
paper  describing  a  "  Case  of  Sub-cordal  Spindle- 
celled  Sarcoma  and  its  Successful  Removal  by 
Thyrotomy."  The  Doctor  outlined  a  history  of 
the  case.  The  principal  symptoms  were  marked 
by  dyspncea,  hoarseness  until  almost  complete 
aphonia  occurred  ;  in  the  later  stage,  almost 
complete  suffocation  when  in  the  prone  posi- 
tion. Patient  was  thin  and  anaemic,  was 
pregnant,  was  compelled  to  sit  upright  with 
mouth  open.  On  examination,  the  laryngo- 
scope showed  a  large  sub-glottic  tumor  nearly 
filling  the  lumen  of  the   larynx,  dusky  red   in 


THE   CANADA   MEDICAL   RECORD. 


color  ;  vocal  cords  free.  Tracheotomy  was 
performed,  low  down  ;  a  tube  made  breathing 
easy.  Labor  was  induced  ;  tumor,  s'range  to 
say,  decreased  in  size.  In  three  weeks  timior 
was  removed  by  thyrotomy.  Incision  was 
made  between  the  alae  down  to  upper  border 
of  cricord.  On  separating,  tumor  was  well 
exposed  ;  was  attached  to  right  ala  of  thyroid 
just  below  vocal  cord.  After  removal,  site 
was  cauterized  with  chromic  acid.  Three 
deep  silk-worm  gut  sutures  closed  deeper 
structures,  and  superficial  ones  the  wound 
externally.  Microscopical  examination  re- 
vealed it  to  be  a  spindle-celled  sarcoma.  The 
condition  was  unique.  The  operation  of 
thyrotomy  was  i)ractically  devoid  of  danger 
in  itself;  its  result  depended  much  upon  what 
it  was  done  for.  As  to  its  employment  in 
tuberculosis,  opinion  was  divided.  The  Doctor 
closed  by  detailing  at  length  why  he  adopted 
the  method  he  did  rather  than  removing  the 
growth/^/  vias  fuiiurales. 

Dr.  Osborne,  of  Hamilton,  commented  on 
the  decrease  in  the  size  of  the  tumor  after 
delivery.  He  supposed  it  was  on  account  of 
some  reflex  condition  between  the  uterus  and 
the  tumor. 

Dr.  EiRKETT  explained  that  the  whole 
arterial  system  was  in  a  state  of  great  tension 
during  pregnancy  ;  after  delivery  this  wculd 
lessen  much,  and  hence  there  might  be  a 
lessening  in  the  size  of  the  tumor  due  to  the 
fact. 

A  splendid  banquet  was  given  to  the  visitors 
by  the  local  members  of  the  profession  at  the 
Tecumseh  House,  beginning  after  nine  o'clock. 
About  200  sat  down.  Dr.  Hodge  presided,  and 
introduced  the  toast  list.  "  The  Queen  "  was 
honored  with  the  National  Anthem.  Dr. 
Hingston  of  Montreal,  and  Dr.  Praeger  of 
British  Columbia,  responded  for  "  The  Dom- 
mion "  in  witty  speeches.  Dr.  Harrison  of 
Selkirk  spoke  on  behalf  of  the  Ontario  Medi- 
cal Association.  The  Chairman  in  toasting 
"  Our  Guests  "  v.-armly  welcomed  the  visitors. 
He  regretted  that  the  meeting  was  at  the  same 
time  as  the  Western  Fair,  as  it  had  interfered  ( 
with  arrangements.  Dr.  Sheard,  the  Presi-  | 
dent,  replied  warmly.  Drs.  Caniff,  of  Toronto, 
and  Birkett,  of  Montreal,  also  spoke  to  the 
toast.  Mr.  C.  W.  Davis  sang,  and  the 
"  Ladies  "  were  proposed  by  Dr.  J.  S.  iXiven, 
vice-chairman,  and  champioued  by  Drs. 
Thcrnburn  and  Anghn. 

THURSDAY    MORXIXG. 

Dr.  Holmes,  of  Chatham,  read  a  paper,  which 
consisted  of  a  report  of  two  cases  of  laparo- 
tomy for  unusual  conditions.  The  first  gave 
a  history  of  miscarriage  preceded  by  hemorr- 
hage, and  this  was  followed  by  pain  in  the 
left  iliac  region,  where  a  swelling  was  dis- 
covered like  an  orange  in  size  and  shape,  two 


Inches  to  the  left  of  the  uterus,  and  fluctuat- 
ing. Laparatomy  was  performed,  and  an 
ovary  containing  three  ounces  of  pus  removed. 
The  abdominal  cavity  was  flushed,  and  usual 
dressings  applied  ;  no  drainage  tube.  Tiie 
important  point  in  the  case  was  that  there  was 
no  disease  of  the  tubes.  This  was  unique  as 
far  as  he  was  able  to  make  out  from  the  records. 

The  second  case  Dr.  Holmes  had  seen 
after  the  patient  had  been  ill  ten  days.  Pain 
was  present  in  right  iliac  region,  where  the 
attending  physicians  detected  some  hardness. 
Chills  and  fever,  constipation,  vomiting  and 
great  prostration  were  succeeding  symptoms  ; 
also  great  tympanites.  No  tumor  could  be 
made  out  at  this  time.  Exploratory  incision 
was  deemed  necessary.  Appendix  was  sound. 
There  was  no  obstruction,  but  peristalsis  was 
absent.  The  gut  was  stitched  to  the  wound, 
with  the  idea  of  incising  if  bowels  did  not 
move  soon.  This  had  to  be  done,  the  patient 
being  then  almost  /;/  extremis.  A  copious 
evacuation  of  faecal  matter  from  the  fistula 
took  place.  Stimulants  could  then  be  re- 
tained, and  the  patient  improved.  But  the 
fistula  was  a  great  annoyance.  Dr.  Holmes 
made  several  unsuccessful  attacks  to  close  it, 
but  failed.  Patient  was  then  transferred  to 
Harper's  hospital,  Detroit.  Resection  of  the 
affected  portion  of  bowel  was  made,  and  the 
ends  joined  by  Murphy's  buttons.  Patient 
made  a  good  recovery.  The  Doctor  shewed  the 
kind  of  button  used,  and  gave  a  report  of 
operations  in  which  it  had  been  successfully 
employed. 

Dr.  Athk'ton  agreed  with  Dr.  Holmes  that 
abscess  of  the  ovary  without  affection  of  the 
tube  was  rare.  In  regard  to  peritonitis  with 
paralysis,  he  found  puncturing,  to  allow  the  gas 
to  escape,  a  good  measure, — two  or  three  tirnes 
if  necessary.  He  had  seen  m  trouble  arise 
from  such  proceeding.  This  might  be  tried  and 
laparotomy  avoided. 

Dr.  Holmes  replied  to  this  by  saying  that 
he  had  employed  this  measure,  but  it  was  in 
cases  where  the  abdominal  walls  were  thin. 
Where  the  walls  were  thick^  as  in  the  case  re- 
ported, he  considered  it  unwise.  In  fact,  when 
the  abdominal  wall  was  opened,  one  of  the  assis- 
tants introduced  a  small  trochar,  but  without 
relief  of  the  symptoms. 

Dr.  Bell,  of  Montreal,  then  presented  a 
paper  on  "  Some  unusual  conditions  met  with 
in  Hernia  operations."  The  Doctor  reported  five 
cases,  all  of  marked  interest.  The  first  was  a 
case  of  hernia  in  a  woman,  set.  55.  There 
were  not  the  symptoms  of  strangulation,  but 
shesuffered  great  pain.  Temp.  102,  pulse  100, 
bowels  open.  The  tumor  was  situated  in  Scar- 
pa's space  in  right  groin,  looked  livid  red,  was 
indurated  at  the  base,  and  fluctuating, — a  point- 
ing abscess,  in  fact.  It  was  opened  :  a  pint 
of  foetid,    sanious  pus   escaped.      A  mass   of 


10 


THE   CANADA   MEDICAL   RECORD. 


omentum  protruding  was  cut  off.  Then  the 
interesting  point  in  the  case  was  noticed, — in 
the  centre  of  the  mass  was  a  tubular  cavity,  re- 
sembHng  the  large  intestine.  It  was  stitched 
into  the  skin  wound.  To  the  outer  side  of  the 
mass  the  appendix  was  found  strangulated  and 
sloughy.  This  was  removed  and  bowel  returned. 
Patient  made  a  good  recovery. 

The  second  case  was  one  of  congenital 
inguinal  hernia  attached  to  the  bottom  of  the 
tunica  vaginalis.  The  hernia  was  easily  redu- 
cible, but  would  not  stay  so.  It  was  so  trouble- 
some, operation  was  decided  upon ;  was 
omental,  and  the  peculiarity  was,  which  accounts 
for  the  inability  to  retain  it,  a  hydatidiform  cyst 
growing  from  the  omentum  and  adherent  to  the 
bottom  of  the  sac  of  the  tunica  vaginalis  testis, 
just  long  enough  to  allow  the  hernial  contents 
to  escape  within  the  internal  ring,  and  yet  short 
enough  to'  maintain  constant  traction  upon 
this  portion  of  omentum,  and  bring  it  down  in 
spite  of  any  truss.  The  protruding  omentum 
was  tied  and  the  cysts  were  removed.  Patient 
made  a  good  recovery.  This  was  a  unique  case, 
Dr.  Bell  thought. 

The  third  was  a  case  of  congenital  caecal 
hernia  in  a  child  three  years  of  age.  Hernia 
had  existed  from  birth,  and  was  irreducible.  Rad- 
ical operation  done.  Through  the  peritoneum, 
the  cgecum  and  ilium  could  be  made  out,  and 
were  found  adherent  to  the  cord.  Even  after 
spUtting  canal  it  was  impossible  to  reduce. 
When  peritoneum  was  opened  and  traction 
made  on  ilium,  it  readily  slipped  back.  The 
superfluous  neck  of  the  sac  was  dissected  away 
and  the  remamder  sutu'ed  down  around  the 
cord,  the  conjoined  tendon  brought  over  and 
sutured  to  Pouparts  ligament,  and  canal  closed 
by  a  suture. 

The  next  was  a  most  interesting  case  where 
there  vras  hernia  of  a  tubercular  ovary  and  tube 
through  the  inguinal  ca'ialofa  female  infant. 
It  was  diagnosed  omenal  hernia, — was  soHd 
to  feel,  freely  movable,  i>ediculated,  and  gave 
an  impulse  when  child  cried.  Was  exposed 
but  seen  not  to  be  omentum.  Resembled 
undescended  testicle,  but  patient  was  female. 
Was  removed, — diagnosis  still  uncertain. 
Operation  finished  successfully.  Subsequent 
microscopical  examination  revealed  tubercular 
cystic  ovary. 

The  final  case  cited  was  a  most  interesting 
one, — suppurative  inflammation  of  hernial  sac 
simulating  strangulation  ;  onset  sudden(from  a 
fall)  and  constitutional  symptoms  rapid,  calling 
for  immediate  action.  Cutting  down,  sac  was 
found  very  thick  and  oedematous,  from  which, 
upon  incision,  half  an  ounce  of  sero  pus  escaped. 
It  was  occluded  above.  Another  incision 
was  made  mto  the  sac  above  the  occlusion,  and 
a  loop  of  small  intestine  scarcely  constructed 
slipped  back  into  abdomen.  Patient  got  en- 
tirely  well.      The    Doctor    inclined    to    think 


patient  had  suffered  from  hernia  before,  that 
sac  had  become  shut  off,  and  that  the  reputed 
recent  cause  merely  pressed  it  further  down, 
and  the  manipulation  for  reduction  had  set  up 
an  inflammation,  possibly  through  the  agency 
of  the  arnseba  coli,  which  went  on  to  suppu- 
ration. 

Dr.  Canniff  asked  how  Dr.  Bell  diagnosed 
the  omental  tube  which  was  cut  off  from  intes- 
tine. 

Dr.  Bethune  detailed  at  length  a  case  of 
strangulated  hernia  which  was  not  operated  on 
on  account  of  stubbornness  of  patient.  Sup- 
puration occurred,  and  a  faecal  fistula  estab- 
lished, which  finally  closed,  and  patient  made  a 
good  recovery. 

Dr.  McFarlane,  president  of  the  Ontario 
Association,  and  Dr.  Temple,  delegate  from 
that  body,  were  invited  to  seats  on  the  platform. 

Dr.  Bryce  was  not  present  to  read  his  paper 
on  Prophylaxis  in  Tuberculosis,  but  his  paper 
was  handed  in  as  read.  It  was,  the  writer  said, 
pleasurable  to  see  so  much  attention  directed 
to  a  disease  causing  a  greater  economical  loss 
than  any  other  agent  except  alcohol.  He  gave 
some  condensed  results  of  a  study  of  the  sub- 
ject taken  from  the  mortality  returns  of  the 
Registrar  General's  Department  of  Ontario, 
and  arranged  the  table  so  as  to  show  the 
number  of  deaths  occurring  in  persons  of  the 
same  family.  He  also  gave  a  tabular  statement 
of  the  total  mortality  returns  of  Ontario  Insti- 
tutions for  the  Insane  for  1892,  showing  the 
proportion  of  deaths  from  consumption  among 
patients.  He  also  presented  a  tabulated  list  of 
the  various  diseases,  showing  from  the  x\nnual 
Report  of  the  Inspector  of  Public  Health  for 
1892  a  large  proportion  suff"ering  from  this 
disease.  Five  per  cent,  of  the  total  inmates  of 
our  hospitals  suffered  from  this  disease.  The 
elements  in  prophylaxis  partook  of  three  quali- 
ties,— individual,  municipal  and  governmental. 
Individual  prophylaxis  depended  almost  wholly 
upon  the  intelligence  of  the  infected  person, 
his  habits  of  life,  and  the  extent  to  which  he  is 
impressed  with  the  duty  of  protecting  others. 
As  to  municipal,  the  first  measures  are 
largely  those  of  improved  local  sanitation.  As 
to  governmental,  it  consists  mainly  in  giving 
direction,  financial  support  and  legislative  sanc- 
tion to  municipal  efforts. 

He  said  had  he  not  been  an  interested  and 
active  spectator  for  two  years  of  the  manner 
in  which  legislation  has  kept  in  touch  with 
public  and  professional  oi)inion,  he  would  think 
this  visionary.  He  cited  the  numerous  Acts 
providing  for  treatment  of  the  blind,  dumb,  etc., 
and  thought  from  the  fact  that  there  were  but 
two  limits  to  the  class  of  municipal  and  gov- 
ernmental work,  viz.,  the  degree  to  which  the 
public  are  informed  regarding  the  need  for 
work  in  this  direction  and  the  extent  of  muni- 
cipal and  governmental  financial  ability.   This 


THE   CANADA   MEDICAL   RECORD. 


II 


work  was  not  to  be  considered  relegated  to  the 
police  but  to  ihe  action  of  intelligent,  Christian 
men  and  women.  The  two  objects  to  be  held 
in  view  were  :  (i)  the  alleviation  or  cure  of  the 
tubcrcul.irized  patient,  and  (2)  to  lessen  the 
danger  to  the  healthy  public.  In  the  higher 
altitudes  of  our  Province  we  had  suitable 
climatic  conditions.  In  such  places  homes 
might  be  i  stablished  for  patients, — places  where 
they  may  go  and  live,  i'hese  places  might  be 
made  self-sustaining,  as  many  of  the  patients 
would  be  able  to  work.  That  such  homes 
would  be  popular  may  be  concluded  from  the 
success  of  such  semi-piivate  institutions  in 
Germany. 

'Ihe  Nominating  CojMmittee presented  their 
report  as  follows  : — It  first  recommended  that 
the  next  place  of  meeting  be  St.  John,  N.B. 

Dr.  Canniff  did  not  favor  going  so  far. 
Few,  if  any,  physicians  came  from  that  section 
to  Uie  annual  meetings  in  Ontario. 

It  was  explained  that  St.  John  was  tacitly 
promised  the  meeting  next  year,  in  view  of 
London  getting  it  this  year,  on  account  of  the 
movement  westward  to  the  World's  Fair. 

Dr.  Fraeger  urged  the  claims  for  British 
Columbia  for  1895.  The  St.  John  recom- 
mendation v/as  adopted. 

The  report  after  a  few  amendments  resulted 
in  the  election  of  the  following  officers  for  the 
ensuing  year  : — 

President — Dr.  Harrison,  Selkirk 
General     Secretary — Dr.   F.     N. 
Toronto. 

Treasurer — Dr.  Small,  Ottawa. 
Vice-President  for  Ontario — Dr.  F.  R.  Eccles, 
London. 

Vice-President  for  Quebec — Dr.  Stewart, 
Montreal. 

New  Brunswick — Dr.  Chiistie,  St.  John. 
Vice-President  for  Nova  Scotia — Dr.  Muir, 
Truro,  N.S. 

Vice-Pre.-ident  for  Manitoba — Dr.  Spence, 
Br  mdon. 

Vice  President  for  North- West  Territories 
— Dr.  Newburn,  Leth bridge. 

Vice-President  for  ^rince  Edward  Island — 
Dr.  Tyler,  Charlotte  town. 

Vice-President  for  British  Columbia  —  Dr. 
McKechnie,  Nanaimo. 

Provincial  Secretaries  elected  were  : — 
Ontario,  Dr.  I.  Olmstead,  Hamilton;  Qaebec, 
Dr.  Anglin,  Montreal  ;  Nova  Scotia,  Dr.  Keen, 
Cowe  Bay  ;  New  Brunswick,  Dr.  McLaren,  St. 
John  ;  Prince  Edward  Island,  Dr.  Johnston, 
Charlottetown  ;  British  Columbia,  Dr.  Walker, 
New  Westminster ;  Manitoba,  V>x.  McDiarmid, 
Winnipeg  ;  North- West  Territories,  D".  Calder, 
Medicine  Hat. 

It  was  movel  and  seconded  that  all  the 
papers  be  read  in  the  order  received  by  the 
Secretary,  and  if  the  writer  be  not  present  at 
the  time    it  should  be  read,  that  the   paper  be 


Ont. 

G.    Starr, 


placed  at  the  bottom  of  the  list ;  and,  further, 
that  it  was  desirable  that  an  abstract  ""of  the 
paper  be  made  and  forwarded  to  the  Secretary 
at  least  three  weeks  before  the  date  of  the 
Association.  After  a  good  deal  of  discussion 
this  was  carried. 

THE  association  VISITS  THE  ASYLUM. 

On  invitation  of  Dr.  Bucke,  of  London 
Insane  Asylum,  the  membersof  the  Association 
went  out  to  that  institution  for  luncheon,  being 
conveyed  out  on  a  special  C.P.R.  train.  They 
were  taken  first  to  inspect  the  sewage  system. 
I'he  sewage  is  used  as  a  fertilizer  on  the  farming 
land  of  the  institution.  The  luncheon  was 
thoroughly  enjoyable.  Numerous  toasts  were 
drunk  heartily,  while  the  asylum  orchestra, 
under  Prof.  Sippi,  discoursed  sweet  music. 

THURSDAY    AFTERNOON. 

The  Association  assembled  in  Victoria  Hall 
at  3.30. 

Dr.  McPhederan  addressed  the  Association 
on  the  subject,  "The  more  recent  methods  of 
diagnosis  and  treatment  of  diseases  of  the 
stomach."  He  said  that  formerly  it  was  thought 
that  the  stomach  was  the  principal  and  only 
organ  of  digestion,  but  now  it  was  known  that 
the  whole  alimentary  tract  takes  part  in  the 
digesting  process.  He  said  the  function  of  the 
stomach  was  threefold,  viz. :  i — To  receive 
food,  and  to  partly  change  starchy  matter  and 
albuminous  food  into  absorbable  bodies.  2 — 
To  prevent  the  fermentation  of  the  food.  3 — 
To  discharge  its  contents  partly  into  the  blood 
but  chiefly  into  the  duodenum. 

For  the  first  three  quarters  of  an  hour  no  free 
hydrochloric  acid  was,  he  said,  present  in  the 
stomach,  as  it  combined  with  the  albuminates. 
If  present,  there  was  hypersecretion  of  it,  which 
arrested  (he  digestion  of  the  starches.  It 
reached  its  maximum  in  amount  in  four  or  five 
hours.  The  gastric  juice  retarded  the  action 
of  or  destroyed  more  germs,  specific  and  non- 
specific, than  any  of  the  other  digestive  ferments 
The  duration  of  normal  digestion,  he  said, 
depended  on  the  character  and  amount  of  the 
food,  also  on  the  age  of  the  patient.  The  symp- 
toms of  stomach  disorders  were  multiple  and 
various.  Until  the  last  decade  our  knowledge 
of  gastric  disorders  depended  on  experiments 
and  symptoms,  accidents,  etc. 

Now  we  owe  much  of  our  knowledge  to  the 
stomach  tube.  This,  he  said,  should  be  soft. 
The  patient  not  only  readily  became  accus- 
tomed to  It,  but  even  often  would  request  it? 
use  An  approximate  knowledge  of  the  stom- 
ach's contents  would  in  most  cases  be  all  that 
was  requisite  for  the  physician  in  active  practice. 
A  test  breakfast  should  be  given,  consisting  of 
a  round  of  toast  or  a  dry  roll,  with  a  cup  of 
water  or  of  weak  tea  or  coffee,  without  sugar 
or  milk.     This  should  be  withdrawn  from  the 


12 


THE   CANADA   MEDICAL   RECORD. 


Stomach  after  one  hour's  digestion.     The  acidity 
of  a  normal  stomach,  he  said,  should  be  due  to 
lactic  acid  for  the  first  thirty  or  forty  minuti'^s, 
after  this  time  to  free  hydrochloric  acids.    These 
acids    were    discovered    by    Ufiflemann's    and 
Cunzberg's  tests  respectively,  wiiich  the  Doctor 
described.     Ii  had  been  taught  that  absence  of 
hydrochloric  acid  indicated  carcinoma.     This 
was  not  so.     Ii  might  be  absent  in  either  con- 
ditions, and  present  even   excessively  in   this. 
However,  it  could  be    said  that  its   persistent 
presence  formed    strong  evidence   in  favor  of 
cancer.     The  tube  was  useful  in  discriminating 
between  gastric  catarrh  and  carcinoma.     The 
washing  out  would  be  followed  by  improvement 
in  cases  of  tiie  first,  but  not  much  in  the  second. 
Its   principal   use,   however,  was  in  dyspepsia, 
in  determining  the  acidity  of  the  contents.     On 
this  our  treatment  could  be  based.     The  lavage 
stimulated    the    gastric   gland    secretion    and 
stimulated  the  muscular  walls  to  renewed  activ- 
ity.    Proper  diet  and  general  treatment  would 
suffice  to   cure    many   cases.     This    treatment 
was    particularly    useful   in   alcoliolics,  also    in 
infantile  digestive  disturbances.     Const  paiion 
was  relieved  by  its  use,  also  the  gastric  neurosis, 
reflex  vomiting  of  pregnancy,  the  patient  being 
fed  through  the  tube.     This  subject  was  one  of 
immense  importance  on  account  of  the  immense 
frequency  of  disease  of  the  stomach,  4  to  6    of 
all  the  ailments  medical  men  were  called  on  to 
treat   being   caused    by  derangements    of  this 
organ. 

Drs.  Ferguson,  Wesley  Mills,  Gardner  and 
Praeger  discussed  the  paper. 

The  meeting  then  divided  into  sections.  Dr. 
I.  H.  Cameron  presiding  ever  the  surgical  side 
while  Dr.  Moorhouse  presided  over  the  medical. 

SURGICAL  SECTION. 

Dr.  Primrose  presented  a  paper, — subject 
*'  A  Large  Sarcomatous  Growth  in  the  Neck, 
with  Secondary  Deposit  in  the  Lung."  It 
was  found  in  a  boy  four  years  of  age,  a  patient 
in  Victoria  Hospital,  Toronto,  under  Dr.  Came- 
ron. It  extended  on  the  right  side  of  the  neck 
from  the  median  line  in  front  to  a  point  near  the 
vertebral  spine,  and  from  the  lobule  of  the  ear 
to  the  clavicle.  Was  'noticed  two  years  and  three 
months  before,  corresponding  to  the  region  of 
the  right  lobe  of  the  thyroid  gland.  Caused  little 
pain.  Was  somewhat  lobulated,  wiLh  prominent 
veins  coursing  over  its  surface .  Fluctuation  dis- 
tinct. Measurement  on  tumor  side  of  neck  hori- 
zontally 1314  in.  Left  side  6  in.  From  lobule 
of  ear  on  right  side  (over  tumor)  to  outer  extre- 
mity of  tlie  clavicle  7  in.,  on  left  side  2)4  in. 
Left  pupil  twice  size  of  right.  Some  dysphagia. 
Child  died  in  July.  The  tumor  was  found  in  the 
postmortem  to  possess  several  processes,  but  it 
had  not  infiltrated  or  eroded  the  surrounding 
tissues, — a  point  to  be  considered  in  the  diagno- 
sis.    There    were   secondary    deposits   in    the 


lungs.  The  anatomical  relations  of  the  various 
structure  adjacent  were  much  altered.  The 
large  vessels  on  the  tumor  side  were  entirely 
obliterated.  Those  on  the  left  side  were  en- 
larged. The  processes  spoken  of  were  in  the 
direction  of  least  resistance.  The  muscular 
structures  in  the  neighborhood  were  atrophied. 

In  the  upper  part  of  the  tumor  there  was  a 
predominance  of  fibrous  tissue,  and  septa  of  this 
tissue  divided  it  off  into  lobules  of  spongy  tis- 
sue. A  peculiar  condition  was  found  in  the 
spinal  canal,  the  chord  being  surrounded  below 
the  dura  mater  by  a  mass  of  tissue  resembling 
in  gross  appearance  the  tumor  growth,  but  was 
not  the  same.  It  contained  connective  tissue 
corpuscles  and  nerve  cells  and  fibres.  Its 
nature  Dr.  Primrose  had  not  made  out.  The 
tumor  itself  was  examined  microscopically,  and 
proved  to  be  sarcomatous.  The  beauty  of  Dr. 
Primrose's  paper  was  that  he  had  frozen  trans- 
verse sections  through  the  child,  which  exem- 
plified in  a  most  si)lendid  way  his  paper.  The 
sections  were  much  admired  by  the  Association. 
Photographs  of  the  same  were  also  presented 
for  inspection. 

Dr.  Praeger  spoke  in  high  terms  of  the  paper 
and  the  sections. 

Dr.  R.  Ferguson  of  London  then  gave  a 
report,  and  presented  a  recent  successful  case 
ofcholecystotomy.  The  symptoms  of  gall-stones 
in  this  case  were  for  a  long  time  obscure,  the 
pain  being  referred  to  the  epigastrium,  no  pru- 
ritus, faeces  lacking  the  characteristic  color, 
and  the  absence  of  jaundice.  Pulse  and  tem- 
perature remained  normal.  She  had  many 
attacks  of  pain,  which  were  relieved  by  hot  ap- 
pliances and  morphia.  These  paroxysms  did 
not  appear  or  disappear  suddenly.  Gastric  ulcer, 
gastritis  and  intestinil  colic  were  excluded. 
Gastralgia  was  probable.  Stomachic  treatment 
gave  no  relief.  The  ordinary  treatment  for  gall- 
stones afforded  no  relief.  But  finally  some  of 
the  typical  symptoms  of  gall-stones  began  to 
show  themselves.  Patient  was  transferred  to 
the  hospital  with  a  view  to  operation.  But 
after  lying  quietly  for  two  or  three  weeks,  she 
improved  so  much  that  she  went  home,  opera- 
tion being  postponed,  but  she  soon  became 
worse.  On  one  occasion  she  had  felt  after  a 
severe  paroxysm  of  pain  a  dropping  of  something 
in  the  region  where  the  pain  existed.  Opera- 
tion was  gone  on  with.  Eighty  gall-stones 
removed,  the  edges  of  incision  of  the  gall- 
bladder being  sutured  to  the  edges  of  the 
wound.  A  cough  retarded  the  process  of  heal- 
ing. Repair  did  not  take  place  well.  Suppur- 
ation set  in.  Parotitis  in  left  gland  set  in,  also 
localized  peritonitis.  Attacks  of  pain  returned. 
Dr.  Ferguson  then  tried  to  insert  a  catheter 
through  into  the  bile  duct,  which  he  thought 
he  accomplished.  The  side  of  the  catheter 
ap,jeared  to  grate  on  some  hard  substance,  but 
improvement  took  place,  and  patient  returned 


THE   CANADA   MEDICAL   RECORD. 


13 


home  in  ten  and  one-half  weeks  after  the 
operation.  But  in  four  weeks  the  symptoms  re- 
appeared— pain  very  severe.  Chloroform  had  to 
be  administered  constantly,  as  morphia  seemed 
insufficient.  She  inhaled  thirty-six  ounces. 
Another  operation  was  decided  on.  The 
incision  was  extended  downwards  i  )^  inches 
lower,  allowing  exploration  wirh  the  finger  in 
the  region  of  the  bladder.  A  body  2^^  inches 
long,  }8  in.  thick,  was  scooped  out  of  the  gall 
bladder.  Its  structure  had  not  been  deter- 
mined. The  opening  in  gall-bladder  was  secured 
by  a  purse-string  suture,  and  a  drainage  tube 
inserted  into  bladder.  Patient  made,  although 
very  nearly  collapsed  at  the  close  of  this 
operation,  a  good  recovery.  The  pain  in  the 
second  instance  the  Doctor  thought  might  have 
been  due  to  the  presence  of  the  mucous  cast  (if 
such  it  was),  which  might  have  been  forced  out 
of  the  bile  ducts  into  the  Wadder.  The  Doctor's 
paper  was  valued  highly.  The  patient  was 
present,  and  the  seat  of  operation  exposed  for 
inspection.  A  small  biliary  fistu'a  was  still  to  be 
seen,  but  in  other  ways  the  patient  seemed  per- 
fectly well. 

Dr.  Cameron,  Chairman  of  the  section,  asked 
why  cholecystectomy  might  not  be  done  in  such 
cases  rather  than  cholecystotomy. 

Dr.  Praeger  had  had  a  case  where  the  pain 
was  referred  to  the  epigastric  region.  The 
Doctor  then  outlined  the  case.  It  proved  to  be 
much  like  Dr.  Ferguson's,  only  that  the  stones 
were  in  the  duct  instead  of  in  the  bladder,  and 
adherent  to  each  other.  In  closing,  the  edges  of 
the  bladder  were  stitched  to  the  sides  of  the 
wound.  He  was  of  the  opinion  that  cholecy.s- 
tectomy  should  be  preferred  to  cholecystotomy. 

Dr  Meek  had  seen  and  helped  with  Dr. 
Ferguson's  case,  and  agreed  with  him  as  to  tlie 
causation  of  the  recurrence  of  pain  after  the 
first  operation.  Dr.  iNIeek  cited  another  case 
in  which  the  peculiarity  was  the  immense  dila- 
tation of  the  bladder,  one  they  had  recently 
operated  successfully  upon.  He  was  surprised 
to  hear  that  Dr.  Tait  had  adopted  choL-cystec- 
tomy  instead  of  cholecystotomy. 

Dr.  Praeger  told  of  a  similar  case  he  had  to 
that  of  Dr.  Meek:  the  bladder  contained  one 
and  a  half  pints  of  bile  and  some  forty  stones. 

Dr.  Smith,  of  Fingal,  then  reported  on  Dr. 
Meek's  last  case,  which  was  under  his  care. 
Patient  was  doing  well.  A  point  he  dwelt  on 
was  that  the  temperature  at  the  time  of  operat- 
ing was  105'^.  In  three  hours  it  was  norinal, 
and  had  remained  so. 

Dr.  Cameron  then  spoke  of  the  propriety  of 
removing  the  gall  bladder.  In  cases  especially 
where  there  was  great  distension  and  the  pres- 
ence of  a  number  of  stones,  that  operation  was 
preferable.  There  would  thus  be  less  danger 
to  the  peritoneum  after  the  operation  :  the  per- 
sistence of  a  biliary  fistula  is  done  away  with. 
The  bile,  instead  of  escaping  externally,  should 


take  its  natural  course,  and  thus  carry  out  its 
digestive  function  in  the  intestines.  Dr. 
Cameron  sp  jke  of  the  administration  of  very 
large  doses  of  glycerine,  2  or  3  ounces  each 
hour  of  the  paroxysm,  for  the  relief  of  cases  of 
gall  stones.  He  supposed  it  acted  by  its 
hydrogogue  effects, — dehydrating,  and  thus 
relieving  the  swollen  mucous  niMnbrane.  He 
had  seen  satisfactory  results  from  its   use. 

Dr.  Ferguson  said  he  had  tried  equal  parts 
of  glycerine  and  succinate  of  iron  (about  half 
an  ounce  of  glycerine)  four  times  a  day. 

MEDICAL  SECTION. 

"  Some  o\  the  Uses  of  Sulphurous  Acid " 
was  the  subject  of  a  paper  rexd  by  Dr. 
Arnott,  of  London.  He  began  by  saying  that 
he  had  in  his  experience  profited  most  by  learn 
ing  new  applications  of  old  remedies.  Sulphur- 
ous acid  was  an  old  remedy.  Homer  spoke  of 
its  use  in  fumigation.  The  Doctor  spoke  of  its 
application  in  typhoid  fever.  It  was  particu- 
larly useful  in  that  class  (for  he  held  typhoid  had 
different  causes)  of  typhoid  due  to  "  rapid 
multiplication  of  bacteria  in  the  blood."  The 
remedy  should  be  freshly  prepared,  and  ad- 
ministered early  in  the  disease.  He  would 
give  from  j4  dram  to  a  dram  every  two  hours, 
or  even  more,  if  the  patient  could  stand  it. 
With  it  he  had  not  lost  i  p.c.  of  his  cases,  and 
his  patients,  he  said,  were  never  given  alcohol. 
To  his  mind  it  was  the  remedy  in  typhoid.  In 
early  phthisis  it  was  useful.  It  did  not  hurt 
the  stomach.  He  had  almost  discarded  the 
use  of  cod  liver  oil.  It  had  been  noted  t  at 
consumptives  who  labo.ed  in -sulphuric  acid 
works  improved  in  health. 

Dr.  H^)DGe  uresented  three  cases  of  Fried- 
riech's  ataxia  in  one  family,  two  sisters  and  a 
brother.  Father  had  eczema  of  legs  so  badly 
that  he  was  obliged  to  use  crutches,  also  had 
leucoderma  of  hands.  A  paternal  uncle  suffered 
from  hemeralopia.  These  were  the  only  neu- 
rotic points  in  the  family  history.  The  first, 
M.W.,  set.  41,  had  a  history  of  falling  down 
stairs,  having  since  then  a  weakness  in  the  legs. 
Got  worse  since  she  was  ten  years  of  age. 
Now  patient  could  not  walk  without  support. 
Staggers  while  standing  even  with  eyes  open. 
Left  alone,  falls  forward.  Gait  like  one  drunk. 
Leg  muscles  suffer  only  atrophy  of  disuse.  Legs 
sensible  to  pain,  touch  and  temperaturj  varia- 
tion. Has  pain  now  and  then  in  right  hip.  Plan- 
tar reflexes  normal ;  patellar  increased.  Feet  in 
condition  of  talipes  varus.  Marked  curvature 
of  spine.  Upper  extremity  normal.  Pupils 
act  normal.  When  she  fixes  to  either  side, 
there  is  marked  horizontal  nystagmus.  Face 
not  symmetrical, — mouth  drawn  to  left  side. 
Tongue  on  protrusion  turned  to  right,  and  ex- 
hibits fibrillar  twitching.  All  senses  normal. 
The  second,  Sarah,  set,  37,  has  suffered  since  she 
was    13,   but  nothing  wrong  with  the  gait  till 


14 


THE   CANADA   MEDICAL   RECORD. 


six  years  ago,  at  which  time  she  received  a  hurt 
in  the  knee.  Now  she  cannot  walk  without  a 
cane.  She  would  fall  forward  if  unsupported.  In 
most  respects  she  resembles  her  sister.  Her 
spec'-h  is  slow  and  not  very  plain. 

The  brother,  aged  36.  Feet  began  to  deform 
at  15.  When  eyes  were  closed  he  would 
fall  backwards.  Gait  wide  legged,  zig-zag 
and  somewhat  st-^mping.  Lying  down  he  can 
do  all  the  ordinary  movements  of  the  legs.  In 
prominent  symptoms,  much  like  sisters.  Right 
hand  is  claw-shaped.  Atrophy  of  muscles  of 
hands.  Left  hand  somewhat  affected  too. 
Curvature  of  spine.  Suffers  with  excessive 
sweating. 

Drs.  Meyers,  Macallum,  Mills,  Arnolt  and 
Moorhouse  took  part  in  the  discussion,  Dr. 
Hodge  replying. 

Dr.  McKeough  then  followed  by  reading  a 
paper  on  puerperal  eclampsia.  In  all  cases 
the  urine  should  be  examined,— more  espe- 
cially in  primapara,  who  make  up  ^  of  the 
cases.  Albumin  Ilia,  however,  is  not  always 
followed  by  eclampsia.  The  prophylactic 
treatment  should  be  directed  to  diet  and 
the  use  of  eliminatives.  Mild  diet — milk 
being  best — should  be  recommended.  Salines 
should  be  given  to  keep  the  bowels  free  ;  while 
for  the  skin,  nothing  was  so  good  as  the  daily 
hot  bath  for  20  minutes,  the  temperature  on 
immersion  99,  and  gradually  raised  to  112.  Ice 
might  be  applied  to  head,  and  large  quantities 
of  water  sh.uld  be  freely  given  the  patient.  If 
after  this  treatment  ihe  albuminuria  is  still 
present,  labor  should  be  induced.  The  pro- 
cess the  reader  of  the  paper  then  described. 
If  any  nervous  symptoms  showed  themselves, 
chloroform  should  be  administered.  One 
shou'd  always  keep  in  mind  in  treating  such 
cases  three  points  in  the  etiology, — heightened 
vascular  and  nervous  tension,  the  presence  of 
some  poison  probably  from  the  kidneys  in  the 
system,  and  the  presence  of  the  fcetus  in  utero. 
If  eclampsia  comes  on  in  spite  of  all  previous 
treatment,  the  steps  should  be  :  ist,  seda- 
tive; 2nd,  eliminative;  and  3rd,  induction  of 
labor.  The  Doctor  referred  to  venesection. 
In  certain  plethoric  cases  it  might  prove  useful. 
But  in  trying  it  as  a  last  resoi  t  m  two  of  his 
own  cases  it  did  not  save  them.  In  50  cases  in 
Guy's  in  which  it  was  performed,  30  p.c.  died. 
Immediately  after  in  34  cases  where  it  was  not 
used,  2oi^  p.c.  died. 

THURSDAY   EVENING. 

The  report  of  the  Committee,  re  Interpro- 
vincial  Registration,  was  presented  by  Dr. 
Praeger,  in  the  absence  of  Dr.  J.  E.  White, 
Chairman  of  the  Committee.  It  proposed 
that  a  Dominion  Medical  Council  be  formed, 
"  to  take  general  surveillance  of  the  medical 
curriculum,  and  of  all  matters  affecting  the 
general    pubHc    and   profession  of  the   whole 


Dominion,"  formed  either  by  representatives 
(one  each)  from  the  members  of  the  various 
provincial  Medical  Councils,  or  elected  by  the 
Medical  population  of  Canada,  irrespective 
of  provincial  lines;  or  on  the  "line  of  the 
British  Medical  Council."  Its  duties  should 
be  the  equalization  of  the  Medical  curriculum 
to  a  just  and  high  standard  ;  to  secure  inter- 
provincial  reciprocity  ;  to  have  the  power  to 
withhold  or  take  away  a  Dominion  license 
from  a  provincial  graduate  for  just  cause;  to 
approve  all  jirovincial  examination  papers 
before  they  are  presented  to  candidates. 
There  should  only  be  one  examination  for  the 
Provincial  and  Dominion  licenses,  and  an  extra 
fee  for  the  latter.  If  it  followed  the  British 
Medical  Council  in  its  formation,  the  B.  M.  C. 
regulations  should  be  operative  as  applicable 
to  the  Dominion.  All  men  now  on  Provincial 
registers  to  be  entitled  to  Dommion  registra- 
tion within  one  year  t)f  the  formation  of  the 
first  Dominion  Medical  Council,  on  payment  of 
$10.  All  practitioners  outside  of  Canada  and 
Great  Britain  would  be  allowed  a  Dominion 
license  upon  passing  the  prescribed  examina- 
tion. All  those  on  the  British  register  would 
be  entitled  to  registration  upon  payment  of 
$25,  as  soon  as  Great  Britain  extended  the 
same  privilege  to  Canada.  The  Committee 
further  recommended  that  the  Association 
through  a  Committee  should  present  these 
views  to  the  Provincial  councils,  and  by  con- 
certed action  with  them  to  a])ply  at  the  next 
session  of  legislature  for  such  permissive  legis- 
lation as  would  be  required  to  establish  the 
powers  and  duties  of  the  Dominion  Medical 
Council.  If  any  provincial  Council  refused  to 
accede  to  the  demands  of  the  general  profession 
for  these  objects,  that  this  Association  should 
instruct  their  delegates  to  go  to  the  Legislature 
of  such  Province  and  secure  the  required  con- 
cession. 

Dr.  Praeger  moved  its  reception. 

Dr.  A.  B.  Macallum  thought  there  were  many 
difficulties  in  the  way  of  bringing  about  the 
result  desired  for  in  the  report.  The  forma- 
tion of  a  Dominion  Council  as  was  recommend- 
ed in  the  report  would  have  to  conflict  with 
the  various  Provincial  Legislatures  which  had 
under  their  control  the  subject  of  medical 
education.  Such  a  Council  would  be  inert. 
One  of  the  difficulties  was,  that  the  graduates 
of  Universities  in  Quebec  were  granted  licenses 
to  practice,  while  this  was  not  the  case  in 
Ontario.  If  such  outside  Universities  were 
granted  such  extended  privileges,  the  Ontario, 
Manitoba,  and  institutions  of  the  other  Pro- 
vinces would  be  clamoring  for  their  rights. 
Then,  too,  the  courses  of  study  in  medicine  in 
the  various  universities  were  much  dfferent. 
In  Quebec,  for  instance,  subjects  were  taken 
up  which  were  regarded  as  foreign  to  medical 
education.  Some  of  their  universities  demand- 


THE  CANADA  MEDICAL  RECORD. 


i5 


ed  of  ilie  students  a  knowledge  ot"  Catliolic 
history,  metapliysics,  etc.,  mucli  to  the  dissatis- 
faction of  the  English  minority.  Dr.  Macalhim 
would  strongly  support  a  Dominion  Council, 
but  one  with  powers  considerably  different 
from  those  outlined  in  the  presented  report. 
A  British  Medical  Council  would  answer  our 
conditions  far  better  than  such  a  Dominion 
Council  as  proposed.  He  suggested  that 
representatives  of  all  the  various  councils 
and  Universities  of  the  Dom.inion  and  Britain 
form  a  Council,  and  that  they,  after  debate, 
recommend,  after  proper  legislation,  that  the 
standard  shall  be  raised  in  this  or  that  subject 
of  every  Province,  Then  it  would  be  easy  to 
have  the  desired  reciprocity.  The  report 
presented  was  a  most  ill-digested  one. 

It  was  moved  by  Dr.  Cameron  and  seconded 
by  Dr.  Macai.lum,  that  the  report  be  tabled. 
This    was  carried. 

Dr.  Wesley  Mills,  of  ^Montreal,  then  took 
up  the  subject, — '*  Peculiar  Forms  of  Sleep  or 
Allied  Conditions  "  He  gave  a  report  of  his 
observations  of  the  arclomysmonas  (wood- 
chuck)  during  a  period  of  five  years,  and 
more  particularly  during  its  season  of  hiberna- 
tion. With  the  phenomena  presented,  he  com- 
pared strikingly  similar  phenomena  in  two  or 
three  cases  in  human  individuals.  Some  of 
the  points  were  the  periodicity  of  the  attacks  of 
stupor,  abstinence  of  food  and  consequent 
emaciation,  great  slowing  of  respiration  and 
circulation,  the  partial  cessation  of  stupor  to 
attend  to  urination  and  defecation,  the  ten- 
dency to  increase  reflex  action.  The  Pro- 
fessor's account  of  the  lethargic  condition  in 
man  was  listened  to  with  exceeding  interest, 
the  cases,  some  of  them  being  authentic,  hav- 
ing come  under  his  own  observation.  The 
Professor,  as  an  evolutionist,  contended  that 
these  tendencies  were  analogous  to  those  in  the 
lower  animals,  and  inherited,  so  to  speak,  from 
them.  Although  Dr.  Mills  takes  this  advanced 
view,  he  says  he  is  inclined  less  than  ever  to 
pooh-pooh  what  is  said  regarding  trances 
and  other  similar  popular  notions. 

Dr.  A.  B.  M^VCALLUM,  of  Toronto,  while  ad- 
miring Dr.  Mills'  able  paper  very  greatly,  took 
some  exception  to  his  views.  He  contended 
that  pathological  conditions  in  the  subjects 
whose  cases  were  cited  caused  the  lethargy  ; 
no  such  change  in  the  brains  of  the  lower 
animal,  so  far  as  he  knew,  took  place.  The 
subject,  however,  was  one  of  extreme  interest 
in  connection  with  medical  psychology^ — 
question  of  the  relationship  of  periods  of 
lengthened  sleep  to  mental  disease.  Dr. 
Mills  would  be  prepared,  he  said,  to  believe 
in  the  Rip  Van  Winkle  legend. 

Dr.  Cameron  regretted  that  Dr.  Mills  had 
been  obliged  to  omit  the  latter  part  of  his 
paper,  which  dealt  with  the  real  nature    of  the 


hibernating  and  allied  conditions.  It  would 
have  been  interesting  to  have  heard  a  coru- 
parison  between  such  various  conditions  as 
sleep,  ordinary  coma,  the  somnolent  form  of 
status  epilepticus,  etc.  Regarding  the  pig- 
mentary and  fatty  changes,  Dr.  Mills  spoke  of 
all  which  were  familiar.  Dr.  Cameron  incHned 
to  thinkit  was  a  question  of  pathological  chemis- 
try rather  than  a  gross  pathological  change. 

Dr.  H.  A.  Macallum  gave  Dr.  Bucko's 
tide-theory  that  sleep  was  influenced  by  or  in 
the  same  manner  as  the  tides.  The  child's 
sleep  corresponded  to  the  two  periods  of  rest 
between  tides.  In  reply,  Dr.  Mills  said  that 
changes  had  been  found  in  the  brain  cells  of 
hibernating  animals.  He  believed  the  object 
of  the  condition  was  for  preservation  of  life. 
In  winter,  when  it  was  difficult  to  get  food,  the 
woodchuck  did  with  little  or  none;  On 
account  of  his  peculiar  condition,  inherited,  no 
doubt,  from  his  sluggish  ancestors  of  ages  ago, 
"  sleepy  Jo  "  (one  of  the  cases  reported)  found  it 
agreeable  to  his  constitution  and  economical  to 
spend  that  portion  of  time,  when  sustenance 
was  difficult  to  obtain  and  weather  inclement, 
in  the  lethargic  state.  Regarding  the  Rip 
Van  Winkle  story,  he  (Dr.  Mills)  thought  it 
was  like  Shakespeare,  a  case  in  which  the 
genius  anticipated  the  science. 

Dr.  J.  C.  Meyers,  of  Toronto,  then  read  a 
paper  on  Multiple  Neuritis.  He  gave  a  brief 
history.  Family  history  negative.  Had  for 
eleven  years  a  suppurating  knee  :  began  from 
an  injury.  Always  used  to  work.  Two  years 
ago  had  an  attack  of  paralysis  from  exposure 
to  cold ;  recovery  in  ten  weeks.  Present  ill- 
ness began  in  July  last.  Noticed  first,  stiffness 
in  right  foot,  which  soon  attacked  the  left,  then 
went  to  the  hand.  The  stiffness  changed  to 
paralysis,  legs  and  forearms  becoming  involved. 
Took  to  bed.  No  pain  or  abnormal  sensations. 
Complete  paralysis  of  the  flexors  of  the  ankles 
and  extensors  of  the  toes.  Posterior  tibial 
muscles  weak.  All  forearm  muscles  affected, 
extensors  most.  Slight  wasting  of  the  affected 
muscles,  particularly  those  of  the  thenar  emi- 
nences of  the  hand.  Marked  hyperalgesia  over 
the  body.  Tactile  and  temperature  sense  were 
exaggerated.  Knee  and  elbow  jerks  lost,  also 
skin  reflexes.  No  paralysis  of  the  ocular  mus- 
cles. Discs  normal.  Health  in  other  parti- 
culars good.  Galvanic  current  shov/s  A.C.C. 
is  equal  to  K.C.C.  From  August  15th  patient 
began  to  improve,  and  is  continuing  to  do  so. 
Power  gradually  returned,  muscular  nutrition 
increasing,  and  ability  to  walk  returning,  the 
walk  being  that  of  a  "stepper."  Myelitis  was 
suggested  as  the  diagnosis  ;  this  Dr.  Meyers 
negatived  by  the  distribution  of  the  paralysis, 
integrity  of  the  muscles,  and  absence  of  bladder 
and  rectum  symptoms.  He  diagnosed  it  mul- 
tiple   neuritis,    with    a    favorable    prognosis. 


i6 


THE  CANADA  MEDICAL  RECORD. 


Treatment :  salicylate  of  soda  and  warm  baths  ; 
after  a  few  days,  strychnine  and  other  tonics, 
with  massage  and  electricity,  vvere  given.  The 
reader  of  the  paper  then  gave  a  minute  de- 
scription of  the  pathological  changes  which  take 
place  in  this  disease,— the  parenchyma  being 
almost  alone  affected.  The  nerves  most  often 
affected  were  the  anterior  tibial  and  musculo- 
spiral.  It  was  caused,  it  seemed,  from  a  mor- 
bid state  of  the  blood :  this  poison  had  a  spe- 
cial affinity  for  nerve  tissue.  Modern  patho- 
logy had  enabled  us  to  see  that  this  was  a 
separate  disease  from  those  with  which  it  used 
often  to  be  confounded,  in  which  the  lesions 
occurred  in  the  central  nervous  system.  Dr. 
Meyers  pointed  out  the  various  differences  be- 
tween such  diseases  and  multiple  neuritis,  both 
as  regards  pathology  and  symptomatology. 

"  Ophthalmic  Memoranda  "  was  the  subject 
of  Dr.  A.  Reeve's  paper.  He  referred  to  the 
progress  that  had  been  mide  in  ophthalmology 
since  the  introduction  of  such  instruments  as 
the  ophthalmoscope  ;  also  in  the  treatment  of 
such  affections  as  trachoma,  lymphonata,  astig- 
matism, stricture  of  the  lachrymal  duct,  etc. 
The  speaker  outlined  the  present  treatment  for 
such  affections,  and  methods  of  employing  sur- 
gical therapeutics  where  necessary.  He  dis- 
cussed at  some  length  the  subject  of  sympa- 
thetic ophthalmia. 

Dr.  Osborne,  in  discussing  the  paper,  spoke 
of  the  necessity  of  treating  the  nasal  catarrh 
which  was  found  in  many  cases  of  lachrymal 
duct  affections.  He  also  spoke  of  the  great 
value  of  the  ophthalmometer  in  astigmatism. 

Dr.  Reeve  replied. 

Dr.  Harrison,  the  president-elect,  was  then 
voted  into  the  Chair.  Votes  of  thanks  were 
heartily  given  to  the  retiring  president,  the 
medical  profession  of  London,  and  the  rail- 
roads. 

Dr.  Anglin  moved  that  the  usual  honorarium 
be  given  to  the  Secretary, — Carried. 

Mr.  J.  H.  Chapman,  of  Montreal,  had  an 
extensive  and  beautiful  array  of  all  kinds  of 
surgical  instruments  on  the  platform,  which 
were  much  admired  between  sessions  by  the 
members  of  the  Association. 


irojgtess   0f  Bnv^ttji 


THE  ROLE  OF  THE  POSTERIOR  URE- 
THRA IN  CHRONIC  URETHRITIS. 

In  a  paper  read  by  Dr.  Bransford  Lewis,  of 
St.  Louis,  before  the  June  meeting  of  the  Amer- 
ican Association  of  Genito-Urinary  Surgeons 
{^Medical  Record,  June  29,  1893),  the  author 
presents  some    very   radical   and   uiiortliodox 


views  on  the  frequency  of  posterior  urethritis 
and  its  influence  in  the  production  of  chronic 
gonorrhoeas. 

The  various  causes  commonly  accepted  as 
sufficing  to  explain  persistence  in  gonorrhoea 
were  reviewed,  and  their  potency  as  such  was 
denied,  seriatim.  Two  cases  were  reported 
showing  that  the  presence  or  absence  of  the 
gonococcus,  alone,  could  not  form  a  reliable 
criterion  as  to  prognosis  :  Case  I.  (primary) 
with  abundant  gonococci — containing  dis- 
charge, lasted  six  weeks ;  while  Case  II. 
(secondary),  also  giving  abundant  gonococci — 
containing  discharge,  lasted  only  one  week. 
The  influence  of  anatomical  abnormalities  was 
restricted  to  only  a  small  minority  of  the  ex- 
ceedingly numerous  cises  of  chronic  gonorrhoea, 
and  did  not  explain  tiie  great  number  that 
occurred.  The  several  varieties  of  urethritis, 
sucii  as  "granular  urethritis,"  "catarrhal 
urethritis,"  "hypertrophic  urethritis,"  etc.,  were 
only  pathological  incidents,  not  causes,  of 
chronic  gonorrhoea  ;  and  even  on  discriminat- 
ing between  these  several  varieties,  the  question 
still  obtruded  itself:  What  was  it  that  had  pro- 
duced that  particular  variety? 

Again,  urethral  therapists,  with  ardently- 
advocated  new  remedies,  supposably  specifics, 
had  all  in  turn  failed  in  their  endeavors  to 
abolish  prolonged  claps.  So  that  it  must  be 
acknowledged  that  the  various  factors  to  which 
chronic  urethritis  was  usually  attributed,  while 
relatively  important  in  a  contributory  way,  did 
not  cover  the  ground  in  actual  clinical  experi- 
ence ;  and  something  else  must  be  found  to  bear 
the  onus  of  being  a  prolific  source  of  chronic 
gonorrhoea. 

While  aware  that  infection  of  the  posterior 
urethra  was  almost  universally  recognized,  by 
advanced  practitioners  of  the  present  day,  as  a 
complication  of  gonorrhoea  that  was  difficult  to 
cure  when  it  did  occur,  that  interfered  with 
the  usual  course  of  treatment  employed,  and 
required  special  measures  for  its  relief,  etc.,  he 
did  not  believe  that  the  full  importance  of  pos- 
terior inflammation  was  generally  conceived; 
that  its  frequency  was  even  approximately  es- 
timated in  general,  or  that  its  bearing  on  almost 
every  case  of  gonorrhoea  was  understood, 
recognized  or  acknowledged. 

In  Dr.  Lewis'  opinion,  the  posterior  infection 
should  not  be  looked  upon  as  a  complication, 
but  as  a  natural  feature,  occurring  with  such  un- 
failing regularity,  that  an  observer,  watching 
carefully  and  critically  gonorrhoeal  cases,  must 
see  a  great  many  of  them  before  he  would  meet 
with  a  single  one  that  remained  free  from  the 
so-called  complication  throughout  the  disease. 
This  conclusion,  to  which  clinical  investigation 
had  led  him,  was  supported,  in  recent  writings, 
by  the  following  statistics  of  authors  who  had 
been  pursuing  a   similar   study  of  late  years  : 


THE  CANADA  MEDICAL  RECORD. 


Lesser  asserted  that  of  fifty-three  cases  of  pri- 
mary gonorrhcea  under  his  care,  the  posterior 
urethra  escaped  infection  in  only  four  cases, 
making  the  frequency  of  posterior  urethritis 
93.5  per  cent.  Jadassohn  found  posterior 
urethritis  in  143  of  163  cases,  making  87.7  per 
cent.;  Rona  found  it  in  79.7  per  cent  of  his 
cases ;  and  Eraud  found  it  in  80  per  cent,  of  all 
his  cases. 

In  endeavoring  to  harmonize  this  undoubted 
fact  of  frequency  of  posterior  urethritis  with  the 
reason  for  its  frequency,  the  author  disregarded, 
as  inapplicable,  explanations  usually  given. 
Sexual  intercourse,  the  "forced"  injection,  the 
passage  of  instruments,  etc.,  during  an  active 
gonorrhcea,  were  chiefly  complained  of  by  wri- 
ters on  the  subject — extremely  seldom  by  the 
patients  themselves.  Bearing  on  this  point, 
the  time  and  mode  of  onset  of  the  posterior 
inflammation  was  of  importance.  Instead  of 
the  inflammation  progressing  slowly  and  gra- 
dually backwards  over  the  urethral  mucous 
membrane  and  reaching  the  posterior  urethra 
in  the  second  or  third  week,  as  was  commonly 
taught,  it  reached  the  posterior  urethra,  in  most 
cases,  in  the  first  (active)  week  of  the  disease. 
This  rather  favored  tlie  supposition  of  Horte- 
loup  that  the  mode  of  infection  was  through 
the  lymphatics  rather  than  by  continuity  over 
the  mucous  surface. 

The  author,  therefore,  felt  justified  in  sub- 
mitting the  following  conclusions  : 

1.  The  causes  usually  gi.en  for  the  prolon- 
gation of  cases  of  clap  (presence  or  absence  of 
gonococci,  stricture  of  large  calibre,  the  use  of 
particular  drugs  in  treatment,  etc.)  do  not 
satisfactorily  explain  them,  nor  do  they  furnish 
reliable  means  for  prognosticating  the  outcome 
of  a  case. 

2.  A  single  widely  prevalent  cause  for  such 
prolongation  of  gonorrhcea  has,  as  yet,  not 
proved  its  right  to  recognition  as  such. 

3.  Posterior  urethritis,  by  reason  of  its  ana- 
tomical seclusion  and  inaccessibility  to  ordi- 
narily-prescribed treatment,  if  frequent,  offers 
the  best  explanation  for  such  prolongation  or 
repeated  recurrence, 

4.  Scrutinizing  clinical  investigation  shows 
posterior  urethritis  to  be  present  in  the  great 
majority  of  cases  of  prolonged  or  severe 
gonorrhoea. 

5.  Direct,  topical  treatment  to  the  posterior 
urethra  is,  therefore,  necessary  in  the  great 
majority  of  cases. 

6.  The  causes  usually  given  for  producing 
posterior  urethritis  are  not  commonly  found  to 
be  real  factors  in  the  clinic. 

7.  The  mode  of  onset  usually  described  does 
not  coincide  with  that  discerned  in  clinical 
observations, 

8.  These  two  latter  observations  confirm  the 
probability  that  the  posterior  urethral  infection 


is  accomplished  through   the  lymphatics,  and 
explain  the  frequency  of  such  infection. 

9.  Posterior  urethritis  is  not  a  complication, 
but  a  natural  phenomenon  of  gonorrhoea. 


ANAL  DILATATION. 

The  editor  of  the  Eclectic  Medical  Joiinial 
is  a  gentleman  of  pronounced  opinions,  as  the 
following  editorial  from  his  journal  will  attest : 
We  have  noticed  for  some  time  that  "anal 
stretching"  was  becoming  a  feature  of  the  new 
surgery,  and  that  "anal  dilators"  were  becom- 
ing instruments  to  which  men  were  attaching 
their  names  as  inventors,  and  attributing  won- 
derful results  as  "  stimulators  of  the  capillary 
circulation  "  and  the  sympathetic. 

But  this  thing  goes  by  leaps  and  bounds  ;  it 
does  not  walk  and  feel  its  way  as  do°s  ordinary 
medicine.  A  recent  case  of  anal  dilatation  in 
Cook  County  Hospital  will  illustrate : 

"An  operation  was  to  be  performed  on  a 
woman,  and  a  number  of  physicians  were  in- 
vited to  witness  the  surgical  skill.  The  patient 
was  being  put  under  the  anesthetic, — indeed, 
was  put  under  it  too  far,  and  '  let  go.'  At  once 
all  was  excitement,  and  efforts  were  made  in 
sundry  directions  toward  resuscitation.  They 
seemed  of  no  avail,  and  the  woman  was  dying 
or  dead.  One  of  the  visitors  who  had  just 
attended  his  course  on  '  orificial  surgery  '  with 
Dr.  Pratt  was  very  much  interested,  and  asked  : 
'  Have  you  heard  of  "  anal  dilatation  "  in  such 
cases  ?  '  They  had  not.  '  May  I  be  permitted 
to  take  charge  ?  '  He  was  permitted,  and  rushed 
forward,  inserted  both  thumbs  in  her  anus,  and 
with  herculean  strength  divulsed  the  sphincter. 
She  gasped,  she  brea'^hed,  a  rosy  hue  flushed  her 
cheeks  and  lips  ;  she  was  saved.  " 

I  may  not  have  given  the  story  in  the  flowery 
language  of  our  homoeopathic  exchange,  but  I 
have  given  the  facts  as  leported.  If  Cook 
County  denies  it,  then  I  shall  believe  that  Cook 
County  wants  to  cover  up  their  want  of  skill  in 
the  use  of  anaesthetics,  or  their  lapse  from  virtue 
in  allowing  a  believer  in  "  orificial  "  to  save  a 
human  life. 

You  can  see  how  it  is  yourself  If  one  had 
a  straight  ticket  for  the  other  world,  and  suddenly 
someone  should  thrust  both  thumbs  in  his  anus, 
and  rend  it,  he  would  come  back  to  see  what 
was  the  matter.  It  stands  to  reason,  and  does 
not  require  an  argument,  especially  if  the  person 
should  be  a  woman. 

Divulsion  of  the  sphincter  is  a  good  thing  in 
some  cases,  as  removal  of  causes  of  irritation 
of  the  orifices  of  the  body  is  a  good  thing. 
But  it  does  not  want  to  be  vaunted  too  much. 
As  I  read  it,  a  line  from  Shakespeare  is  brought 
forcibly  to  mind  :  "  Methinks  this  woman  doth 
protest  too  much." 


THE  CANADA  MEDICAL  RECORD. 


BREAD  AND  DYSPEPSIA. 

The  conclusion  that  wheat  bread  is  unfit  for 
dyspeptics,  sometimes  jumped  at  because  ill  ef- 
fects are  noticed  to  follow  its  use,  is  erroneous. 
On  the  contrary  it  has  been  pointed  out  by  Bou- 
chard and  others,  that  farinaceous  food  is  pecu- 
liarly adapted  to  some  dyspeptic  patients.  It 
is  the  microbes  in  the  starch,  which  are  capable 
of  producing  irritating  acid  that  cause  the  trou- 
ble. To  avoid  this,  Bouchard  recommends  that 
only  the  crust  or  toasted  crumb  of  the  bread  be 
used  by  dyspeptics,  particularly  those  whose 
stomachs  are  dilated.  The  reason  of  this  is  ex- 
plained by  the  fact  that  baking  temporarily, 
though  not  permanently,  arrests  the  fermenta- 
tion of  dough.  When  it  is  again  heated  by  the 
warmth  of  the  stomach  the  fermentation  is  re- 
newed. In  cases  where  the  bread  is  toasted 
brown  through,  the  fermentation  is  stopped  per- 
manently.— I'ood. 


ICHTHYOL  IN  GONORRHCEA. 

Jadasson  speaks  highly  of  ichthyol  for  gonor- 
rhoea in  women  as  well  as  in  men.  In  37  cases 
occurring  in  females  the  resulcs  of  treatment 
were  excellent.  He  found  that  in  the  male, 
uncomplicated  specific  urethritis  was  the  form 
of  gonorrhoea  most  favorably  influenced  by 
this  treatment,  so  he  employed  ichthyol  for 
gonorrhoeal  urethritis  in  women,  and  as  the  re- 
sults were  good,  he  then  applied  the  same 
substance  to  the  cervix  for  gonorrhoeal  cervical 
catarrh.  It  seems  quite  safe,  when  used  in  the 
early  acute  stage.  Ichthyol  can  readily  be  ap- 
plied to  the  cervix,  and  also  later  on  in  these 
cases  to  the  endometrium  with  an  ordinary 
Playlair's  probe,  covered  with  wool,  a  10  per 
cent  ointment  is  sufficient.  The  probe  may  also 
be  used  for  the  urethra,  a  weaker  preparation 
of  one  to  ten  per  cent  is  needed.  It  may  be 
injected,  and  in  some  cases  the  urethra  should 
be  packed  with  gauze  dipped  in  ichthyol  and 
introduced  through  the  urethral  speculum. 


Ita^rcss   of   ^iinutcoIo^D 


A  SENSIBLE  AND  TIMELY  CAUTION. 

We  have,  on  several  occasions,  given  edito- 
rial expression  to  our  own  decided  views  as  to 
the  impropriety  of  intra-uterine  invasion  by 
inexperienced  and  unskilled  specialists,  and 
have  called  attention  to  the  irreparable  mischief 
that  must  inevitably  ensue.  We  know  that  in 
such  comments  we  have  been  supported  by  the 
best  men  in  the  profession,  among  whom  are 
many  able  and  careful  gynecologists.  We  quote, 
therefore,   with   pleasure,    the    sensible   views 


expressed  in  a  recent  article  bearing  upon  this 
subject,  from  the  pen  of  one  whose  practical 
views  are  well  worthy  of  general  diffusion. 
He  writes  as  follows  : — 

After  a  three  years'  service  in  the  Gynaecolo- 
gical Department  of  the  Jefferson  Hospital,  and 
after  witnessing  what  we  have  at  the  operating- 
table,  in  connection  with  the  sad  experience 
that  attended  our  work  in  several  instances 
with  the  electrode,  we  consider  that  the  difiicul- 
ties  and  uncertainties  besetting  gynaecological 
diagnosis  are  a  bar,  to  a  very  large  extent,  to 
all  forms  of  intra-uterine  treatment.  If,  as  point- 
ed out,  pathological  conditions  of  such  gross 
character  are  so  difficult  of  proper  recognition, 
how  much  more  difficult  is  it,  in  the  vast  majo- 
rity of  cases,  to  diagnosticate  a  catarrhal,  or 
even  a  suppurative,  salpingitis,  where  the 
presence  of  fluid  material  in  the  tube  is  limited 
to  a  few  drops  of  pus  or  muco-pus,  giving  rise, 
in  many  insiances,  to  but  little,  if  any,  distress, 
yet  possessing  all  the  latent  properties  of  in- 
tense energy  if  its  smouldering  embers  are  but 
stirred  into  activity,  as  they  often  have  been, 
by  an  irritant  intra  uterine  application  !  Of  all 
the  specialties  in  medicine,  none  is  entitled  to  a 
better  trained  hand  and  the  exercise  of  a  ma- 
turer  judgment  than  that  of  gynaecology.  In 
the  present  state  of  our  knowledge  of  pelvic 
disease,  and  with  the  facilities  at  hand  to  acquire 
legitimate  diagnostic  and  operative  skill,  no 
man  has  a- right  to  do  anything  above  the  va- 
ginal vault,  gynecologically,  especially  in  our 
large  cities,  save  when  the  exigencies  of  a  given 
case  or  the  circumstances  surrounding  the  same 
demand  it,  unless  he  has  first  served  a  well- 
appointed  apprenticeship  with  some  experi- 
enced operator.  Scores  of  women  are  unneces- 
sarily mutilated,  and  many  lives  sacrificed, 
by  men  of  insufficient  experience,  who  have 
nothing  more  to  guide  them  in  their  eagerness 
to  do  an  abdominal  section,  or  make  an  intra- 
uterine application  of  electricity,  than  a  "  pain 
in  the  side"  or  a  discharge  from  the  cavity  of 
the  uterus. —  ColL  and  Clin.  Record. 


DANGER  OF  OVARIAN  CYSTS  IN 
PREGNANCY. 

Potherat  {France  Med.,  March  25th,  1892) 
attended  in  October,  1891,  a  patient,  aged  34, 
who  had  been  delivered  twenty  days  previously. 
Two  years  befoie,  a  surgeon  had  discovered  an 
ovarian  cyst,  and  advised  her  not  to  submit  to 
any  operation.  Labor  was  natural ;  but,  a 
few  days  after  delivery,  fever,  rigors  and  vomit- 
ing set  in.  A  cystic  tumor  was  discovered, 
and  Potherat  operated.  The  cyst  was  adherent 
to  intestine,  omentum,  the  parietes,  and  the 
pelvic  peritoneum.  The  breaking  down  of 
adhesions  was  very  difficult.  The  ovarian  fluid 
was  full  of  blood.     The  pedicle  was    twisted. 


THE  CANADA   MEDICAL  RECORD. 


19 


The  peritoneal  cavity  was  washed  out  and 
drained.  On  the  third  day  the  temperature 
rose  ;  this  was  due  to  the  development  of  an 
abscess  in  the  posterior  part  of  the  right  thigh. 
The  abscess  was  freely  laid  open  and  the  pa- 
tient at  once  began  to  recover.  She  was  soon 
restored  to  excellent  health.  For  a  long  time 
she  had  been  sickly,  with  a  sallow  complexion 
and  a  rough  tongue.  This  case  shows  tiie  im- 
portance of  early  ovaiiotomy,  and  also  indi- 
cates that  pregnancy  and  labor  exercise  a  bad 
influence  on  an  ovarian  cyst.  In  this  case 
there  was  acute  torsion,  and  in  other  instances, 
where  torsion  had  not  occurred,  acute  inflam- 
mation of  the  cyst  had  been  set  up  in  childbed. 
— Brit.  Med.  Journal. 


\tti%xt%%   of  B^sttitics. 


ANTE  AND  POST  PARTUM  DOUCHES- 

In  a  discussion  of  this  subject  before  the 
Philadelphia  County  Medical  Society,  Times 
and  Register,  Dr.  Joseph  Price  said  : 

During  the  last  six  years  I  have  kept  a  record 
of  the  number  of  puerperal  deaths  occurring  in 
my  consulting  practice.  I  have  seen  over  one 
hundred  such  cases.  I  cannot  sufficiently  em- 
phasize my  position  in  this  matter,  for  I  see  too 
many  women  dying  to  hesitate  to  express  my- 
self freely.  I  have  been  interested  in  some 
eight  thousand  cases  of  labor,  and  I  have  had 
nearly  thirteen  hundred  lying-in  patients  at  the 
Preston  Retreat,  without  a  death  from  any  cause. 
The  practice  at  the  Retreat  has  been  that  of  the 
greatest  cleanliness  possible  to  obtain,  from  the 
admission  to  the  discharge  of  the  patient,  I 
always  regard  a  woman  after  labor  as  a  wounded 
patient,  and  treat  her  as  such.  Sometimes  the 
wounds  are  deep  and  severe,  and  without  proper 
antiseptic  precautions  many  of  these  women 
would  die  after  childbirth  When  I  find  a 
woman  after  labor  dying  with  high  temperature, 
I  generally  find  a  severe  lesion  of  the  perineum, 
vagina  or  cervix. 

I  agree  with  what  has  been  said  in  regard  to 
the  importance  of  theante-partiim  and  the  post- 
partum douche.  I  look  upon  creoiin  as  abso- 
lutely worthless,  and  carbolic  acid  as  quite  as 
useless,  I  value  the  ante-partum  douche  quite 
as  much  for  the  saving  of  the  infant's  eyes  as 
for  saving  the  life  of  the  mother.  I  firmly  believe 
that  if  every  woman  delivered  in  this  State  in 
the  next  ten  years  had  an  ante-partum  mercurial 
douche  carefully  administered,  the  number  of 
blind  asylums  would  be  reduced  from  five  to 
one.  In  the  thirteen  hundred  women  admitted 
to  the  Retreat  there  were  three  ophthalmias. 
une  was  delivered  in  the  gutter,  another  in  the 
hallway  and  the  third  in  the  bath-room^  all  before 


a  bath  or  a  douche.  These  were  the  only  three 
ophthalmias  born  within  the  institution.  There 
have  not  been  any  other  cases  in  the  Retreat  for 
two  years.  I  employ  as  the  solution  corrosive 
sublimate  i  :  2000. 


Sro0tess    of  S^erapetttics. 


CLASS-ROOM  NOTES. 

Prof.  Hare  recommends  the  following  pre- 
scription in  cases  of  Infantile  Colic  : — 

R.  Sodi  bromidi,         gr.  xlviij-xcvj 
Chloral,  gr.  xxiv-gr.  xlviij 

Syrup,  lactucarii,  q,  s.  ad  f  3  iij. 

SiG. — Teaspoonfulto  be  given  on  retiring. 

M. 

A  very  common  condition  in  the  later  stages 
o{ phthisis,  Prof.  Wilson  says,  is  ulceration  of 
the  larynx,  which  condition  has  often  been 
mistaken  for  syphilitic  patches.  They  can  be 
readily  diagnosed  correctly  by  remembering 
the  fact  that  syphilitic  ulcers  are  almost  painless 
and  resp  )nd  very  readily  to  syphilitic  treatment, 
while  the  others  are  very  painful  and  do  not 
respond  to  treatment. 

Prof.  Graham  is  of  the  opinion  that  the 
Prognosis  of  Hereditary  Syphilis  in  children 
will  depend  to  a  great  extent  on  the  length  of 
time  that  elapses  between  the  birth  and  the 
appearance  of  the  eruption.  The  sooner  the 
eruption  appears  after  birth,  the  better  will  the 
prognosis  be. 

Prof.  Keen  gives  the  following  formula  for 
Morton's  Fluid :  useful  where  absorption  is 
required  : — 

R.  lodinii,  gr,  x 

Potassi  iodidi,  gr.  xxx 

Glycerini,  fgj  M. 

SiG. — Use  locally. 

If  a  Saline  is  administered  on  account  of  its 
purging  properties.  Prof.  Hare  recommends 
that  it  be  administered  in  as  concentrated  a  form 
as  possible  ;  for  it  is  due  to  its  being  alkaline  to 
a  greater  degree  than  the  juices  in  the  tissues 
of  the  intestines  that  a  saline  possesses  the 
power  to  withdraw  the  fluid  from  these  tissues. 

Prof.  Hare  advised  the  following  treatment 
in  a  case  oi Aortic  Obstruction:  Ten  drops  of 
the  tincture  of  digitalis  every  eight  hours,  and 
ten  drops  of  the  tincture  of  the  chloride  of  iron, 
and  if  no  good  results  be  obtained  from  this 
treatment,  then  supplement  the  digitalis  by  five 
drops  of  the  tincture  of  strophanthus  every  six 
hours. 

Prof.  Graham  ordered  the  following  as  a  Dust- 
ing  Powder  for  Syphilitic  Eruptions  on  a 
child:— 

R.  Acid  boracic,  Z}\ 

Hydrarg.  chlorid.  mitis.,    gij 
Lycopodii,  Svj  M. 


20 


THE   CANADA  MEDICAL  RECORD. 


SiG. — Dust  on    the  parts    affected  night  and 
morning. 

Prof.  Hare  gives  the  following  prescription  as 
useful  in  the  Sub-acute  Stages  of  Bronchitis  : — 
B.  Vini  ipecac  fgj 

Tinct.  scillse  f  ^ij 

Syrup  tolutan.,  f  g  v 

Aquae  destillal.,  f^j  M. 

SiG. — Teaspoonful  every  three  houis. 


THERAPEUTIC  BRIEFS. 

— Local  Anesthesia  may  be  readily  pro- 
duced in  about  a  minute  by  a  spray  of  menthol, 
p.  j. ;  chloroform,  p.  x. ;  ether,  p.  xv. ;  and  will 
last  from  two  to  six  minutes. 

— Bromidism  may  be  prevented  by  com- 
bining an  intestinal  antiseptic  with  each  dose 
of  the  bromide  salt  as  follows  : — 

R.     Potassii  bromidi,  ,  gr.  xxx 

Sodii  salicylat,  gr.  x,        M. 

— For  Pain  in  the  Ear  from  inflammation, 
Dr.  John  Dunn  (quoted  in  La  Semaine  Med- 
icale')  recommends  the  following  : — 
B.     Menthol,  pulv., 

Camphor,  pulv.,         aa         gr.  xx 
VaseHne  liquid,  f3J.  M. 

SiG. — Instil  a  few  drops  into  the  ears  several 
times  a  day. 

— For  Urticaria  of  Children  {L"  Union 
Med.)  :— 

B.     Chloral  hydrat., 
Camphors  pulv., 
Acaciae  pulv.,         aa  sj. 

Triturate  until  liquified,  and  add 

Cerat.  simpl.,  5j.  M. 

SiG. — Apply  topically. 

— Bromide  of  strontium  is  recommended  for 
the  relief  of  Vomiting  {^Repert.  de  Fhartn.), 
15  grains,  before  meals,  relieves  nausea,  and 
this  dose — 30  to  45  grains  a  day — is  said  to  be 
efficacious  even  in  the  obstinate  vomiting  of 
pregnancy. 

— For  Irritable  Cough,  a  writer  in  the 
Practitioner  suggests  : — 

B.     Acidi  hydrocyanici  diluti,     fgiss 
Morphinae  acetatis,  gr.  iss 

]\Iucilaginis  acaciae,  5J 

Syrupi  pruni  virginianas,       fs  iv 
Aquam  ad  §  vj. 

Misce  et  fiat  mistura. 
A  teaspoonful  to  be  sipped  every  four  or  six 
hours. 

— Rossolo    {Annales   dOrthopedie^   in  The 
Therap.   Gazette)  warmly  recommends  chrys- 
arobin  in  the  form  of  suppository  in  the  treat- 
ment of  Hemorrhoids,  made  as  follows  ; — 
B.     Chrysarobin,  gr.  j 

01.  theobromae,  gr.  xxx 

Iodoform,  gr.  ^^ 


Extract,  belladonnse, 


gr-  i\ 


M. 


— For  Membranous  Enteritis,  Dujardin- 
Beaumetz     {Jour    de  Med.,    in   Med.  News, 
April  29)  suggests  : — 
B.     Salol, 

Benzo-naphthol, 

Sodii  bicarb.,  aa         jij.  M. 

Fiant  cachets  xxiv. 
Sig. — One  after  each  meal. 
A  quart  of  a  ten  or  twenty  per  cent,  solution 
of  naphthol  in    warm  water   is  also   injected 
daily. 

For    the    Night-sweats    of    Pulmonary 
Tuberculosis,  Dr.  Ewart  {La  Semaijie  Med. 
in  Med.  Neius)  suggests  :  — 
B.     Quininae  sulphat., 

Zinci  sulphat,,  aa  gr.  ij 

Ext,  hyoscyami,  gr.  j 

Ext.  nucis  vomicae,  gr.  Yi,         M. 

Ft.  pil.  j.     S. — Take  at  bedtime. 
For  an   Emulsion  of  Cod-Liver   Oil  {The 
Practitioner)  : — 

B.     01.  morrhuae,  -njjxxx 

Glycerini,  -njjx 

Liquor,  calcis,  vel 

Mucilag.  acaciae,      f^j.  M. 

— For  the  Insomnia  of  Children,  Simon 
{L' Union  Med.,  in  Therap.  Gazette)  employs 
the  following  injection  : — 

B.     Chloral,  gr.  ij 

Tinct.  moschi,  gtt  xx 

Tinct.  valerian,  gtt.  xx 

Aquae  destillat..  f|j,  M. 

Inject  the  entire  quantity  into  the  rectum, 
and,  if  necessity  requires  it,  the  dose  may  be 
repeated  if  sleep  does  not  come  on  in  the 
course  of  two  or  three  hours. 

— Dr.  S.  Solis-Cohen  {2he Phila,  Polyclinic, 
April  15,  1893)  states  that  in  several  cases  of 
malarial  intoxication  of  long  duration,  in  which 
Anemia  has  been  marked,  and  in  which,  after 
cessation  of  acute  symptoms,  a  course  of  arsen- 
ic has  failed  to  bring  about  marked  improve- 
ment, rapid  return  of  corpuscle  and  hemo- 
globin to  an  approximately  normal  standard 
has  followed  the  administration  of  a  solution 
prepared  as  follows  : — 

B .     Tincture  of  ferric  chloride,     fjij 
Diluted  phosphoric  acid,         f^  iij 
Glycerin,  fg  vj 

Solution  of  hydrogen  diox- 
ide, enough  to  make  f3  iij. 
SiG. — Two   teaspoonfuls  in  three  ounces  of 
water  before  meals  thrice  daily. 

This  is  slightly  modified  from  a  formula  of 
B.  W.  Richardson's.  It  will  be  practically 
stable  for  the  few  days  during  which  the  three- 
ounce  mixture  lasts.  It  is  useful  in  chlorosis 
and  anaemias  generally. 

— Dr.  Edward  J.  Bermingham  (iV.  Y.  M. 
Journal,  Feb.  4th),  Surgeon  to  the  New  York 
Throat  and  Nose  Infirmary,  describes  a  very 
ingenious  apparatus  which  he  has  devised  for 
controlling  the  Edison  current,  so   that  it  can 


THE   CANADA   MEDICAL   RECORD. 


21 


be  used  direct  for  Galvano-cautery  Opera- 
tions. The  apparatus  con^istsofa  rheostat, 
made  of  coils  of  iron  wire  and  a  handle.  The 
peculiarity  of  the  handle  consists  of  its  having 
solid  conductors,  and  the  circuit  is  therefore 
always  closed.  It  is  under  the  control  of  the 
operator's  thumb  at  all  tinics  during  the  opera- 
tion, and  the  current  can  be  cut  off  from  or 
allowed  to  pass  to  the  knife  instantaneously 
and  without  producing  an  arc.  The  apparatus 
is  simple  and  inexpensive,  and,  from  the  de- 
tailed description  given,  any  electrician  can 
construct  it.  Dr.  Bermingliam  has  been  using 
it  for  two  years  and  a  half  for  all  his  cautery 
operations. 

— Treatment  of  Follicular  Tonsillitis 
— Dr.  J.  C.  Hoag  {Chicago  Med.  Recorder, 
April)  recommends  removing  the  exudate  of 
the  tonsils  in  cases  of  acute  follicular  tonsilUtis. 
This  he  does  with  a  small  spoon,  a  probe  wrap- 
ped in  cotton,  dipped  in  peroxide  of  hydrogen, 
and  a  small  pair  of  forceps.  He  finds  that  the 
removal  of  the  cheesy  plugs  from  the  lacunas 
and  follicles  is  uniformly  followed  by  a  very 
marked  amelioration  of  all  the  symptoms  of 
the  disease,  and  believes  that  in  this  way  the 
source  of  the  constitutional  disturbance  is  at- 
tacked. He  uses  a  gargle  of  peroxide  of  hy- 
drogen. 

— A  one  to  five  per  cent,  solution  of  styrone 
(which  is  a  compound  of  styrax  and  balsam  of 
Peru)  in  alcohol  is  recommended  in  Chronic 
Inflammation  of  the  Middle  Ear  {Archives 
of  Otology).  Dr.  Spalding  recommends  it  as 
specially  useful  in  perforations  of  Shrapnell's 
membrane.  He  appHes  it  on  a  small  cotton 
swab  after  having  had  the  ear  thoroughly 
cleansed  by  syringing,  and  from  results  ob- 
tained he  thinks  that  it  merits  a  trial. 

— Dr.  W.  E.  Putnam,  of  Whiting,  Ind., 
writes  to  Med.  Record,  April  15,  as  follows  : 
"  I  wish  to  make  known  a  plan  of  treatment 
in  Diphtheria  which  I  have  just  carried  out 
successfully  in  the  case  of  my  own  children, 
aged  two,  four  and  five  years  respectively. 
I  used  a  spray  of  peroxide  of  hydrogen,  full 
strength,  to  which  I  added  one  part  per  thou- 
sand of  corrosive  sublimate.  I  reasoned  that 
if  others  can  give  one-half  grain  of  sublimate  a 
day  internally,  I  can  use  a  grain  a  day  in  my 
atomizer,  knowing  that  the  child  will  spit  out 
nine-tenths  of  it.  I  also  used  a  little  oil  stove, 
a  tin  tea-kettle,  and  a  piece  of  hose  three  feet 
long.  In  the  kettle  I  put  turpentine  and  lime 
water,  in  the  proportion  of  a  tablespoonful  to 
a  pint,  and  then  steamed  the  child,  placing  the 
end  of  the  hose  six  or  eight  inches  from  his 
mouth." 

— Prof.  W.  W.  Keen  corrects  a  statement 
in  the  Medical  News,  of  April  22,  in  which  Dr. 
Allen  Starr  mentioned  that  "  craniotomy  had 
apparently  been  undertaken  without  regard  to 
age.     Keen  operated  on   a  patient  aged  nine- 


teen years,"  etc.  He  writes  that  the  oldest 
patient  he  had  ever  operated  on  was  six  and 
one-half  years  of  age,  and  that  he  had  uni- 
formly declined  to  operate  on  any  child  over 
seven  years  old.  It  had  always  seemed  to  him 
unwise  to  perform  such  operations  on  any  pa- 
tient except  in  early  childhood. 

— In  recent  treatment  of  tinea  tonsurans, 
LosoPHAN,  a  new  and  very  active  mycotic,  has 
been  giving  remarkably  good  results.  Loso- 
phan  is  a  triiodocresol,  very  rich  in  iodine 
(about  80  per  cent.)  with  which,  on  application 
to  dermatic  lesions,  it  slowly  parts,  thus  avoid- 
ing toxic  effects,  while  making  the  pathological 
field  untenable  for  living  organisms.  For  these 
reasons,  losophan  is  indicated  in  all  cutaneous 
conditions  due  to  the  development  of  the  try- 
cophyton  fungus,  in  mycosis,  pityriasis,  sycosis 
prurigo,  pediculosis,  and  in  all  of  the  large 
groups  of  skin  diseases  due  to  the  presence  of 
filamentous  fungi  or  microspores.  The  clini- 
cal reports  advise  the  use  of  losophan  in  one  to 
two  per  cent,  ointments  with  lanolin  or  vaselin. 
Where  awash  is  needed,  a  solution  should  be 
made  of  one  or  two  parts  of  losophan  in  a  mix- 
ture of  25  parts  of  water  with  75  parts  of  alco- 
hol. The  mixture  keeps  well.  Losophan  has 
already  been  tested  in  the  treatment  of  phim- 
osis and  chancre.  The  best  results  were  gained 
from  a  one  per  cent,  powder,  dusted  over  the 
lesions. 

— Shoemaker  {Materia  Medica  and  Thera- 
peutics) recommends  Papain  in  Dyspepsia  as 
follows  : — 

R.     Papaini,  jss 

Liquor,  ammonii  acetatis,   f5ij 
Creasoti,  n^  v 

Glycerini,  f.5ij- 

M.  SiG. — Two  teaspoonfuls  an  hour  or  two 
after  taking  food. 

In  fissures  and  ulcers  of  the  tongue,  papain 
has  been  employed  thus  : — 

B.     Papaini,  3J 

Pulv.  sodii  bicarbonatis,      3  iij 
Aquae  menth.  pip.,  f  5  iv. 

M.     SiG. — Paint  frequently  over  the  face. 

Papain  has  also  been  used  externally  in  the 
treatment  of  the  chronic  scaly  form  of  eczema 
with  advantage,  as  follows  : — 

R.     Papaini,  3j 

Pulv.  sodii  biboratis,  ^ss 

Aquae  hamamelidis  dest.,     fg  j. 

M.     Apply  well  over  the  scaly  surface. 


HEALTH    COMMANDMENTS. 

1.  Thou  shalt  have  no  other  food  than  at 
meal  time. 

2.  Thou  shalt  not  make  unto  thee  any  pies 
or  put  into  the  pastry  the  likeness  of  anything 
that  is  in  the  heavens  above  or  in  the  earth  below. 
Thou  shalt  not  fail  to  chew  it  or  digest  it,  for 
the  dyspepsia  shall  be  visited  upon  the  children 


22 


THE  CANADA  MEDICAL  RECORD. 


to  the  third  generation  of  them  that  eat  pie,  and 
long  Hfe  and  vigor  upon  those  that  live  prudently 
and  keep  the  laws  of  health. 

3.  Remember  thy  bread  to  bake  well;  for 
he  will  not  be  kept  sound  that  eateth  his  bread 
as  dough. 

4.  Thou  shalt  not  indulge  sorrow  or  bor- 
row anxiety  in  vain. 

5.  Six  days  shalt  thou  wash  and  keep  thyself 
clean;  and  the  seventh  day  thou  shalt  take  a 
great  bath,  thou  and  thy  son,  thy  daughter  and 
thy  maid  servant,  and  the  stranger  that  is  with- 
in thy  gates.  For  in  six  days  man  sweats  and 
gathers  filth  and  bacteria  enough  for  disease; 
whereupon  the  Lord  has  blessed  the  bath-tub 
and  hallowed  it. 

6.  Remember  thy  sitting-room  and  bed 
chamber,  to  keep  them  well  ventilated,  and  thy 
days  may  be  long  in  the  land. 

7.  Thou  shalt  not  eat  hot  biscuit. 

8.  Thou  shalt  nut  eat  thy  meat  fried. 

9.  Thou  sha  t  not  swallow  thy  food  un- 
chewed,  or  highly  spiced,  or  just  before  hard 
work  or  just  after  it. 

10.  Thou  shalt  not  keep  late  hours  in  ihy 
neighbor's  house  nor  with  thy  neighbor's  wife, 
nor  man  servant,  nor  his  maid  servant,  nor  his 
cards,  nor  his  glass,  nor  with  anything  that  is 
thy  neighbor's. —  Med.  Brief, 


THE  CLINICAL  APPLICATION  OF 
INGLUVIN. 

Ingluvin  is  the  name  given  to  a  preparation 
made  from  the  gizzard  of  the  domestic  fowl. 
It  is  a  yellowish,  gray  powder  of  a  faint  odor, 
and  almost  devoid  of  taste.  It  is  insoluble 
ill  water.  Ingluvin  is  put  up  by  its  manufac- 
turers (Messrs.  William  R.  Warner  &  Co.,  of 
Philadelphia)  in  5  grain  tablets.  Ingluvin  is 
compatible  with  alkalies.  Its  virtues  reside  in 
a  peculiar  bitter  principle  which  enters  into  its 
composition.  It  is  prescribed  in  the  saine 
doses  and  combinations  as  pepsin.  Ingluvin 
was  introduced  to  the  notice  of  the  medical  pro- 
fession about  18  years  ago.  It  is  of  special 
benefit  in  IJie  relief  of  sick  stomach.  This  sub- 
stance may  be  given  with  success  when  vomit- 
ing depends  upon  organic  affection  of  the 
stomach,  as  in  acute  and  chronic  gastric  catarrh 
and  in  gastric  ulcer.  Nausea,  due  to  disease 
of  other  abdominal  or  pelvic  viscera,  as  the 
liver,  kidneys,  uterus  and  ovaries,  is  likewise 
relieved  by  the  administration  of  this  remedy. 
It  allays  the  gastric  irritability  which  accom- 
panies tabes-mesenterica  and  marasmus. 
Vomiting  produced  by  over-indulgence  in 
liquor  has  been  subdued  by  its  powers.  It  has 
been  found  of  advantage  in  cases  of  sea-sickness 
and  in  the  relief  of  the  gastric  irritability  of 
bottle-fed  babes.  Its  peculiar  province,  how- 
ever, is  alleviation  of  the  vomiting  of  pregnancy, 


in  which  it  approaches  the  character  of  a  speci- 
fic. A?  everyone  knows,  the  difiiculty  is 
frequently  very  intractable,  and  one  approved 
remedy  after  another  may  be  used  without  avail. 
To  those  who  have  witnessed  repeated  failures 
of  medication,  Ingluvin  can  be  recommended 
as  one  of  the  most  efficient  remedies  which  we 
possess  for  the  relief  of  this  distressing  symptom. 
Ingluvin  is  likewise  beneficial  in  dyspepsia, 
when  produced  by  functional  inactivity.  It  is 
able  to  promptly  check  the  diarrhoea  which  is 
caused  by  indigestion.  By  reason  of  its  influ- 
ence upon  the  stomach  and  bowels,  Ingluvin 
is  capable  of  marked  service  in  cases  of  cholera 
infantum  and  cholera  morbus.  From  the  pre- 
ceding account  it  will  be  seen  that  Ingluvin 
possesses  an  exceedingly  important  sphere  of 
usefulness. 

Ten  grains  I  found  generally  a  sufficient 
dose.  In  some  instances  20  grains  were  re- 
quired, while  in  the  milder  forms  of  indigestion 
a  5  grain  tablet,  after  each  meal,  accomplished 
the  desired  purpose.  To  infants  I  gave  the 
remedy  in  doses  of  i  or  2  grains. 

A  series  of  cases  occurring  during  the  past 
few  years  in  which  Ingluvin  was  administered 
with  benefit  has  been  selected  as  affording  a 
typical  example  of  the  efficacy  of  Ingluvin. 
The  total  number  amounted  to  49,  and  a  brief 
history  is  given  of  each  case.  They  were 
classified  as  follows  : — 4  cases  of  cholera  morbus; 
8  of  infantile  diarrhoea;  9  of  diarrhoea  in  the 
adult  ;  2  of  dysenteric  diarrhoea  ;  i  of  acute 
indigestion;  3  of  dyspepsia;  2  of  dyspepsia 
with  reflex  symptoms ;  i  of  dyspepsia  from 
uterine  disease  ;  2  of  flatulent  dyspepsia  ;  i  of 
nervous  dyspepsia;  2  of  gastralgia  ;  2  of  colic; 
4  of  gastric  and  gastro-intestinal  catarrh  ;  i  of 
gastric  ulcer  ;  i  of  vomiting  caused  by  alcohol- 
ism ;  6  of  vomiting  of  pregnancy. — Abstract 
of  a  paper  by  J oJm  V.  Shoemaker^  A.M.,  Af.D., 
in  the  Medical  Bulletin  for  fune,  1893. 


APERIENT    PILL    OF     SUMBUL : 
EFFICIENT  COMBINATION. 


AN 


SuMBUL,  or  musk-root,  is  an  excellent  anti- 
spasmodic and  nervous  tonic.  Its  action  re- 
sembles that  of  musk  and  valerian.  In  small 
doses  it  stimulates  appetite  and  improves  di- 
gestion. It  allays  irregular  nervous  action,  and 
is  beneficial  in  dejjressed  or  excitable  condition 
of  the  nervous  system.  Sumbul  may  be  very 
advantageously  employed  in  the  treatment  of 
hysteria,  neurasthenia,  neuralgia,  functional 
irregularity  of  the  heart,  restlessness,  the 
insomnia  of  chronic  alcoholism,  and  nervous 
dyspepsia.  The  extract  is  given  in  the  dose  of 
j54^  to  I  grain.  It  is  essential  that  it  be  made 
from  a  pure  specimen.  As  most  of  these  dis- 
orders occur  in  neurotic  individuals — especially 
women — with  impaired  nutrition,  a  morbidly 


THE  CANADA  MEDICAL  RECORD. 


23 


sensitive  organization,  dyspeptic  difficulties, 
and  sluggish  movement  of  the  bowels,  I  have 
advantageously,  in  many  instances,  associated 
it  with  nervine  and  laxative  remedies.  The 
following  combin  tion  which  I  have  devised  is 
now  put  up  on  a  large  scale  by  the  well-known 
manufacturing  pharmaceutists,  Messrs.  William 
R.  Warner  &  (To.       Each  pill  contains  : 

R     Ext.  Sumbul gr.  i. 

Asafoetida  gr.  i. 

Kxt.  Cascar.  Sagrad.  g.  ss. 

Aloin gr.    i-io 

Ext.  Nucis  Vom gr.  ^. 

Gingerine gr.   }(. 

Tijj     The  dose  is  i  or  2  i)ills. 

From  a  long  list  of  cases  in  which  the  above 
pill  proved  of  value,  a  few  examples  a^e  select- 
ed : 

A  light  complexioned,  florid  young  woman 
became  subject  to  spasms  of  hysterical  chorea. 
There  \vere  twitching  and  jerking  of  the  mus- 
cles of  the  forearm  and  face.  Two  pills  were 
administered  ihrice  daily  with  excellent  results. 
The  paroxysms  gradually  became  less  freq.;ent, 
and  at  length  ceased. 

A  woman  was  subject  to  aching  pains  in  the 
loins,  radiating  to  the  pelvis  and  groin. 
Attacks  of  intercostal  neuralgia  also  occurred  ; 
she  was  weak,  and  often  had  palpitation  of  the 
heart.     The  patient  made  a  complete  recovery. 

The  same  treatment  was  of  marked  benefit 
in  the  case  of  a  woman  who,  consecutive  to 
her  first  confinement,  had  suffered  for  nearly 
a  year  from  palpitation,  dyspepsia,  constipa- 
tion, mastodynia,  headache  and  giddiness. 
The  action  of  the  heart  was  rapid  and  irritable, 
but  there  was  no  organic  disease. 

A  lady,  about  five  week  pregnant,  suffered 
from  an  almost  constant  headache,  and  could 
not  sleep  well ;  was  nervous,  depressed,  weak, 
dyspept  c  and  constipated.  The  pills  correct- 
ed the  state  of  the  digestive  apparatus,  ban- 
ished the  pains  and  nervousness,  and  the  pa- 
tient progressed,  without  special  difficulty,  to 
the  end  of  her  term. — Abstract  of  a  paper  by 
John  V.  Shoemaker,  A.M.,  M,D. ,  in  the  Medi- 
cal Bulletin  for  May,  1S93. 


PERSONAL. 


A  DISTINGUISHED  CANADIAN. 

Dr.  Jean  Lukin  Le])rohon,  A.M.,  M.D., 
C.M.,  of  Montreal,  celebrated  his  semi-centen- 
nial May  26lh  last,  as  a  graduate  in  medicine 
and  surgery  of  the  Medical  Faculty  of  McGill 
College,  Montreal. 

The  subject  of  this  sketch  was  born  April 
7lh,  1822,  at  Chamblv,  Province  of  Quebec.  He 
received  a  thorough  education,  finisliing  his 
classical  study  at  Nicolet   College,  P.  Q.     He 


then  entered  on  the  study  of  medicine  at 
McGill  College,  graduating  May  26,  1843. 
He  then  visited  Europe,  for  further  study  and 
travel,  returning  to  Canada  in  1845,  when  he 
commenced  practice. 

Of  the  graduating  class  of  that  year  but  two 
are  living— both  distinguished  French  Cana- 
dians— Dr.  Leprohon  and  the  Hon.  Charles 
Boucher  de  Boucherville  ;  the  latter  never 
practised,  but  entered  politics,  and  has  attained 
distinction. 

Dr.  Leprohon's  trend  was  essentially  scienti- 
fic and  literary.  He  founded*  La  Lancette 
Canadienne.  In  1870,  he  was  appointed 
Professor  of  Hygiene  in  the  Medical  Faculty 
of  Bishop's  College,  Montreal.  Has  been  a 
justice  of  the  Peace  ;  Surgeon  of  Militia.  Is 
one  of  the  founders  of  the  Women's  Hospital, 
Montreal,  and  a  Consulting  Physician  to  thi 
Montreal  Dispensary.  In  September,  1890, 
the  Lieutenant  Governor  of  the  Province  of 
Quebec  appointed  him  a  member  of  the  Roman 
Catholic  Council  of  Public  Instruction  for  the 
Province  of  Quebec, 

Dr.  Leprohon,  for  twenty-two  years  past, 
has  been  a  vice-consul  of  Spain,  when  the 
vice-consulate  in  Montreal  was  raised  to  the 
dignity  of  a  consulate  general,  the  then  Consul 
General  there  (now  of  this  city),  Senor  Don 
Arturo  Baldesano  Topete,  paid  Dr.  Leprohon 
the  compliment  of  confirming  his  rank — an 
exception  to  the  rule,  as  in  Spain's  diplomatic 
service,  vice-consuls  are  not  attached  to  con- 
sulates general.  For  his  care  and  protection 
of  Spanish  interest  he  was  made  a  chevalier, 
and  received  the  Decoration  of  the  Order  of 
Charles  the  Third  of  Spain. 

In  185 1,  Dr.  Leprohon  was  married  to  Mi^s 
R.  E.  Mullins,  a  native  of  Montreal.  At  the 
early  age  of  fourteen  she  evinced  a  marked 
inclination  for  writing  and  literary  pursuits. 
Her  early  promise  was  confirmed.  She  became 
an  accomplished  and  talented  authoress,  whose 
graceful  writings  over  the  initials  R.  E.  M.  are 
historic  in  Canada. 

Dr.  Leprohon  is  in  full  health  and  active 
practice.  To  have  known  him  is  a  lasting 
pleasure,  as  he  is  characterized  by  that  gentle- 
ness and  urbanity  that  invariably  attracts  and 
makes  many  lasting  friendships. — N.  Y.  Med, 
Record. 


SNUFF  FOR  RECENT  CORVZA. 

The  Practitioner  gives  the  following  : 
R     Morphinse  hydrochloratis  grs.   ij. 
Pulveris  acaciae,  ^ij. 

Bismuth  subnitratis,  3vj. 

Misce  et  fiat  pulvis. 

Not  more  than  a  quarter  of  this  quantity  to 
be  used  in  the  twenty-four  hours. 


24 


THE   CANADA- MEDICAL   RECORD. 


PAMPHLETS  RECEIVED. 

Report  For  The  Year  1892-93,  presented 
by  the  Board  of  Managers  of  the  Obser- 
vatory of  Yale  University  to  the  President 
and  Fellows.  Observatory  of  Yale  Uni- 
versity, Board  of  Managers: — Rev. 
Timothy  Dwight,  D.D.,  LL.D.,  President  ; 
Professor  Hubert  A.  Newton,  LL.D..  Secre- 
tary ;  William  W.  Farnam,  M.A.,  Thomas  G. 
Bennett,  Ph.B.,  Professor  Charles  S.  Has- 
tings, Ph.  D.  Officers  — Robert  Brown, 
M.A.,  Secretary;  WilHam  L.  Elkin,Ph.D., 
Astronomer  in  charge  of  the  Helio- 
meter;  Frederick'L.  Chase,  Ph.D.,  Assistant 
Astronomer. 

Annual  Announcement  of  Trinity  Medical 
College,  Toronto.  Established  1850, 
Incorporated  by  special  act  of  Parliament 
Tn  affiliation  with  Trinity  University,  the 
University  of  Toronto,  Queen's  University, 
and  the  University  of  Manitoba;  and  spe- 
cially recognized  by  the  Royal  College  of 
Surgeons  of  England;  the  Royal  College 
of  Physicians  of  London  ;  the  Royal  Col- 
leges of  Physicians  and  Surgeons  of  Edin- 
burgh ;  the  Faculty  Physicians  and  Sur- 
geons of  Glasgow;  the  King's  and  Queen's 
College  of  Physicians  of  Ireland;  and  by 
the  Conjoint  Examining  Boards  of  London 
and  Edinburgh.     Session  1893-4. 

The  Alienist  and  Neurologist  for  July, 
1893,  contains:  "Morbid  Jealousy," 
by  Dimitry  Stefanowski,  Jaroslawl,  Russia  ; 
"The  Sensory  Symptoms  in  Three  Cases 
of  Syphilitic  Spinal  Cord  Disease,"  by 
Frank  R.  Fry,  A.I^L,  M.D.,  St.  Louis; 
"  Contribution  to  the  Study  of  Transitory 
Mania, "  by  Salemi  Pace  and  Miraglia^ 
Italy  ;  "  Insanity  in  Children,  "  by  Har- 
riet C.  B.  Alexander,  A.B.,  M.D.,  Chi- 
cago ;  "Recent  Discoveries  in  the  Nervous 
System,  "  by  Frank  Baker,  M.D.,  Ph.D., 
Washington ;  "  Psychology  of  Queen 
Christina  of  Sweden,  "  by  Dr.  F.  DeSarlo  ; 
"Medico-Legal  and  Psychological  Asj^ect 
of  the  Trial  of  Josephine  Mallison  Smith,  " 
by  Edward  C.  Mann,  M.D.,  New  York. 
Besides  the  usual  Selections,  F"-ditorials, 
Hospital  Notes,  Reviews,  etc.  C.  H. 
Hughes,  M.  D.,  Editor,  421-22-23  Com 
mercial  Bldg,  St.  Louis.  Subscription, 
$5.00   per  Annum  ;  Single  Copies,  $1.50. 

Extraction  of  Steel  from  the  Interior  of 
THE  Eye  with  the  Electro-Magnet. 
By  Alvin  A.  Hubbell,  M.D.,  Buffalo,  N.Y., 
Professor  of  Diseases  of  the  Eye  and  Ear 
in  the  Medical  Department  of  Niagara  Uni- 
versity;  Surgeon  to  the  Charity  Eye,  Ear 
and  Throat  Hospital ;  Eye  and  Ear  Sur- 
geon to  the  Buffalo  Hosjital  of  the  Sisters 
of  Charity,  etc.  Rejjrinted  from  Trans- 
actions of  the  New  York  State  Medical 
Association.     1892. 


Annuaire  de  l'Ecole  de  Medecine  et  de 
Chirurgie  de  Montreal.  Faculte  de 
Medecine  del'Universite  Laval  a  Montreal. 
5ieme  annee,  1893-94.  Montreal,  Typ. 
Gebhardt-Berthiaume,  30  Rue  St-Gabriel, 
1893. 

Annual  Announcement  of  the  Halifax 
Medical  College.  Established  1867. 
Halifax,  Nova  Scotia.  Twenty-fifth  session, 
1893-94.  Halifax,  N.S.  Nova  Scotia 
Printing  Company,   1893. 

University  of  Bishop's  College.  23rd 
Annual  Announcement  of  the  Faculty  of 
Medicine,  Montreal.  Session  1 893-1 894. 
The  Geo.  Bishop  Engraving  &  Printing 
Company,  Montreal. 

Six  Months'  Medical  Evidence  in  the 
Coroner's  Court  of  Montreal.  By 
Wyatt  Johnston,  M.D.,  Montreal,  and 
George  Villeneuve,  M.D.,  Montreal 
(reprinted  from  the  Montreal  Medical 
Journal,  August,   1893). 

Day  Nursery,  174  Mountain  Street.  Annual 
Report,  March,  1893. 

An  Educational  Need.  (Reprinted  from  the 
Medical  and  burgical  Reporter,  October 
29,  1892.)  By' Joseph  Price,  M.D.,  Phila- 
delphia. 


WARNER    &  CO.'S    EXHIBIT    AT    THE 
WORLD'S  COLUMBIAN  FAIR. 

In  the  Manufacturers  and  Liberal  Arts 
Building  is  a  department  devoted  to  Phar- 
maceutical products,  in  the  north-west  corner 
of  the  gallery.  This  is  a  prominent  position, 
because  the  spectator  can  look  upon  the  ex- 
hibits below  in  a  comprehensive  way  that  clearly 
illustrates  the  magnitude  of  this  great  building 
of  44  acres  of  floor  space.  The  exhibit  of  Wm. 
R.  Warner  &  Co.  is  located  in  this  department, 
Section  D  loi,  at  the  junction  of  two  avenues. 
It  comprises  400  square  feet,  and  consists  of  a 
pyramid  18  feet  high  with  steps  forming  shelves, 
trimmed  with  gilt  mouldingand  surmounted  by 
a  staiue  of  Mercury.  There  is  a  4  foot  space 
on  either  side  with  seats  for  visitors,  and  a  door 
leading  to  the  interior.  The  stand  is  simple 
and  conspicuous,  without  any  attempt  at  a 
cabinetmaker's  display  or  of  beautifully  cut 
bottles.  This  collection  comprises  sugar-coated 
and  gelatin-coated  pills,  flat,  oval,  pink,  white, 
blue  and  yellow.  Compressed  Tablets,  Fluid 
Extracts,  Effervescing  Salts,  including  Bromo 
Soda  highly  extalled  in  sea-sickness,  insomnii 
and  migraine. 

The  firm  of  Wm.  R.  Warner  &  Co.  (founded 
in  1856)  occupies  a  most  prominent  position  in 
their  particular  line.  F.  Newbery  &  Sons,  i 
and  3  King  Edward  Street,  are  their  agents  in 
London.  Wm.  R.  Warner  .^  Co.  have  branch 
stores  at  197  Randolph  Street,  Chicago,  and 
18  Liberty  Street,  New  York. 


bcort 


<^ 


Vol.  XXII 


MONTRE.\L,  NOVEMBER,  1893. 


No.  2 


ORIGINAL   COMMUNICATIONS. 

Improved  Apiiaratus  for  Potfs  Dis- 
ease of  tbe  Spine. .. . 25 

Some  Points  in  the  Surgical  Treat- 
ment of  Appendicitis 28 


SOJIETY  PROCEEDINGS 

Montreal  Medioo-Cbinirjpcal  Society    32 
Enchondroma     of     the     Mamniarv 

Gland  in  a  Bitch  ".    32 

Papillomatous    Outgrowth    of    the 

Lower  End  of  the  Ileum 33 

Nephrectomy     through    Abdominal 

Incision  33 

Discussion  on  Tuberculosis. 34 

Abstract  of  the  Proceedings  of  the 
Third  Annual  .Meeting  of  the 
American  Electro-Therapeutic  As- 
sociation     37 

The  Influences  Governing  the  Pro- 
gress of  Electro-Therapeutics 37 

On  Standard  Coils 37 

On  Standard  Meters 38 

On  Static  Machines 38 

On  Constant  Current  Generators  and 

Controllers     38 

On  Electroiles 38 

On    Investigation  of    Dr.  Xewnian'.s 

Statistics  in  Urethral  Stricture 39 

Electrolysis  in  Tumors  of  the  Blad- 
der     3 


EDITORIAL. 

The  Stamping  out  of  Tulierculosis  in 
Cattle  and  in  Man         

A  University  of  Canada   

The  Closure  of  the  Kingston  Wo- 
men's College 

Announcement 


BOOK  NOTICES. 

.4.  JIanual  of  :Medi  al  Trealnu-nt  or 
Clinical  Therapeutics 

A  Treatise  of  the  Science  and  Prac- 
tice of  Midwifery 

The  Throat  and  Xose  and  their  Dis- 
eases         

A  Manual  for  Boards  of  Health  and 
Health  Officers 

A  Dictionary  of  :Medical  Science 

Chemistry  and  Phvsics 

New  Illustrated  Dictionary  of  .Medi- 
cine. Biology  and  Collateral 
Sciences  

The  Theorv  and  Practice  of  Medicine 
prepareitfor  Students  and  Practi- 
tioners   

Minor  Surgery  and  Bandaging 

Outlines  of  Practical  Hygiene 

A  Sew  Medical  Dictionary 

American  Text-Book  of  Gynecology 

Essentials  of  :\linoi  Surgery,  Band- 
aging and  Venereal  Diseases 

Hernia :  Palliative  and  Radical 
Treatment  in  Adults, Children  and 
Infants  


PAMPHLETS  RECEIVED 

Diet  in  its  Kelations  t>  the  Treat- 
ment and  Prevention  of  Disease.    .     47 

Post-Part um  Hemorrhage  :  Its  Etio- 
logy and  Management  47 

Origin  and  Development  of  Modern 
Gyn:vcolo"y 47 

Adciress  on  liygieue 47 

Report  of  a  Case  of  Appendicitis... .     47 

A  Consideration  of  Some  of  the  Oper- 
ative Measures  Employed  in  Gyna?- 
cologj- 48 

Hygiene  de  I'Enfance  et  de  I' Adoles- 
cence     4? 

Xourrices   sur     Lieu   Conseils    aux 

1      Jeunes  Meres 48 

'  Etude    sur  le  Derinographisme    on 
Dermoneurose  Toxivasoniotrice.        48 

Guide  Pratique  pour  la  Preparation 
et  1' Injection  des  Liquides  Organ- 
iques 48 

The  Influence  of  Dress  in  Producing 
the  Physical  Decadence  of  Amer- 
ican Women 48 

The  Advantages  of  Version  in  a 
Certain  Class  of  Obstetric  Cases. . .     48 

Des  Jleilleurs  Moyens  d'Anesthcsie 
a  em  plover  en  Art  Dentalre 48 

The  Nature  of  Shock  48 

Observations  on  a  Case  of  Recurrent 
Anxvbic  Dysentery  with  Succes- 
sive Large  "Hepatic  Abscesses 48 


Put'lishers'  Department 4S 


Idgtnal    tommunicittions. 


IMPROVED    APPARATUS    FOR 

POTT'S  DISEASE  OF  THE 

SPINE.* 

By  Hexrv  Ling  Taylor.  M.D., 
New  York. 

The  indications  for  treatment  in  Pott's 
disease  are  to  relieve  the  carious  vertebrae 
from  pressure  and  shor':  with  a  minimum 
of  confinement  and  a  r  aximum  of  comfort. 
There  are  no  more  powerful  stimuli  to  gene- 
ral and  local  nutrition  in  these  cases  than 
the  relief  from  mechanical  and  ntrrvous 
strain,  and  the  access  to  fresh  air  made 
possible  by  the  use  of  an  efficient  spinal 
splint.  This  should  be  in  effect  an  artifi- 
cial and  temporary  backbone,  giving  firm 
support  and  protection  at  the  point  of  dis- 


*  Exhibited  to  the  Surgical  Section  of  the  Pan  American 
Medical  Congress   W.ashington,  September  6,   1893. 


ease,  and  receiving,  partially  at  least,  the 
strains  that  would  otherwise  fall  upon  the 
diseased  vertebral  bodies,  and  assist  in  their 
disintegration. 

Recumbency  for  short  periods  and  ab- 
stention from  standing  and  walking  for 
longer  periods  are  necessary  during  the 
acuter  stages,  but  the  prime  indication  from 
the  start  is  for  definite  spnal  suppoit,  for 
which  no  period  of  recumbency  alone,  how- 
ever long  or  strict,  can  be  successfully 
substituted. 

It  is  now  over  thirty  years  since  Dr.  C. 
Fayette  Ta\-lor  described*  the  early  diag- 
nostic signs  of  Pott's  disease,  and  showed 
the  indication  for  treatment  by  antero- 
posterior support  and  protection,  that 
is,  by  leverage  fixation.  His  later  im- 
provements in  the  apparatus  designed  to 
meet  this  indication  are  shown  in  this 
paper. 

*  The  mechanical  treatment  of  angular  curvature,  or 
Polt'sdisease  of  the  spine,  New  York  Stale  Medic.1l  Soci- 
ety, February,  1863. 


26 


THE  CANADA   MEDICAL   RECORD. 


:\Iuch  ingenuity  has  been  wasted  in  the 
endeavor  to  apply  a  continuous  extending 
force  to  the  spine,  in  an  apparatus  to  be 
worn  on  the  person.  As  this  appears  to  be  a 
practically  insoluble  problem,  it  is  fortunate 
that  a  vertically  extending  force  is  not 
needed.  Antero-posterior  leverage  alone 
is  used,  because  by  that  means  pressure 
can  be  most  directly  and  perfectly  trans- 
ferred from  the  diseased  vertebral  bodies  in 
front  to  the  sound  arches  behind. 

How  then  about  the  plaster  of  Paris 
jacket .?  Bradford  and  Lovett  in  their  ex- 
cellent work  on  Orthopedic  Surgery  give 
the  following  answer,  pp.  60,  61  and  71  : 

"The     undoubted     beneficial    effect    of 
plaster  jackets  is  due,  not  to  the  separation 
of  the  affected  vertebrae,  but  to  a  fixation 
support  in  an  improved  position.     In  short 
the    plaster   jackets    afford     an    excellent 
antero-posterior  support."  "  Unfortunately, 
however,    the    plaster   jacket   does  not  of 
itself,  by  its  hold  upon  the  thorax,  main- 
tain a  continued  extension,  but  the  jacket 
and   thorax  so  adapt  themselves  to  each 
other  that  active   suspension  ceases.     The 
jacket,   however,  does    act    as  an  antero- 
posterior support,  until  it  becomes  loose  and 
inefficient."  We  prefer,  as  do  the  authors  of 
the  foregoing  sentences   in  most  cases,  if 
I    understand    their    practice,  a    properly 
adapted  steel  leverage  apparatus  to  jackets 
of  any  make  or  material,  on  account  of  its 
greater  precision,  adjustability  and  cleanli- 
ness ;  but  it  should  not  be  overlooked  that 
as  regards  results  the  workman  is  more  im- 
portant than  his  tool,  and  that  better  results 
will  be  obtained  with  a  jacket   in  skillful 
hands  than  with  the  most  perfect  apparatus 
carele.ssly  or  unintelligently  used. 

The  improved  spinal  apparatus  is  shown 
in  the  figures. 

It  differs  from  the  apparatus  shown  to 
the  New  York  State  Medical  Society  in 
1863  in  the  following  points: 

I.  The  vertical  parallel  bars  have  been 
lencrthened,    and    end    in    hooked    pieces. 


passing  well  over  the  shoulders 
neck. 


near  the 


2.  The   hinges  differ  somewhat  in    con- 
struction 


THE    CANADA    MKDICAI,    KFXORD, 


and  are  screwed  to  the  bars,  being  retained 
for  purposes  of  adaptation  and  adjustment 
only. 

3.  The  horizontal  hip  band  is  dis'.'ardcd, 
and  is  replaced  by  a  rigid  steel  bar  or 
vertical  hip-band  having  the  shape  of  an 
inverted  U  ;  to  the  upper  horizontal  part 
of  this  band  the  lower  ends  of  the  vertical 
bars  are  firmly  attached.  The  ends  of  the 
f[-shaped  band  are  protected  by  hard-rub- 
ber plates,  and  rest  in  the  post  trochanteric 
sulcus  on  either  side,  and  together  with 
the  hooked  pieces  at  the  base  of  the  neck, 
fix  the  apparatus  laterally,  and  assist  in 
vertical  and  antero-posterior  fixation. 

4.  Hard  rubber  pads  are  used  instead  of 
the  soft  pads  formerly  employed,  to  trans- 
mit the  leverage  of  the  apparatus  to  the 
region  of  the  spine  which  it  is  desired  to 
protect. 

5.  For  counter  pressure  at  the  upper 
part  of  the  chest,  instead  of  the  straps 
encircling  the  arms  formerly  used,  a  "  chest 
piece  " 


is  employed,  consisting  of  two  triangular 
hard-rubber  pads,  fitted  below  the  clav- 
icles and  resting  upon  the  pectoral  muscles 
at  the  sides  of  the  chest ;  these  pads  are 
joined  by  a  steel  bar  curved  forward  to 
escape  the  chest,  and  so  contrived  that  the 
distance  between  the  plates  may  be  in- 
creased or  diminished  at  will.  The  chest- 
piece  is  buckled  to  straps  coming  from  the 
hooked  shoulder-pieces  above,  and  below 
it  is  strapped  to  buckles  at  the  angles  of 
the  ['i  hip  band  on  either  side,  leaving 
the  arms  and  axillae  free. 


6.  The  apron  which  holds  the  whole 
apparatus  forward  reaches  to  the  posterior 
border  of  the  axilla  on  either  side,  and 
from  the  trochanter  to  the  arm  laterally, 
and  is  secured  by  straps  and  buckles  to 
the  apparatus. 

7.  Perineal  straps  may  pass  from  the 
lower  border  of  the  apron  in  front,  under 
the  thighs,  to  the  ends  of  the  vertical  hip- 
band  to  aid  in  fixing  the  apparatus. 

It  is  to  be  understood  that  appropriate 
modifications  of  the  form  of  the  apparatus 
are  made  to  correspond  with  the  indica- 
tions presented  by  disease  in  the  different 
regions  of  the  spine,  and  by  the  character 
and  amount  of  the  deformity.  Most  cases 
above  the  ninth  dorsal  will  require,  in  addi- 
tion, Dr.  Taylor's  circular  pivoted  head- 
support  or  chin  rest, 
which  is  easily  fitted 
to  this  apparatus. 

The    treatment    of 
this    affection,      while 
remarkably      satisfac- 
tory    in      the     main, 
would  be  less  tedious,  if  the  nature  and  seri- 
ous character  of  the  disease  were  earlier  re- 
cognized, and   proper  management  inaugu- 
rated without  delay.    The  first  months  of 
the  affection  often  pass  entirely  unnoticed, 
owing  to  the  absence  of  pain,  and  if,  later, 
symmetrical   pains  at  the  sides,    over  the 
abdomen  or    down  the  legs   appear,   they 
are  frequently   attributed   to  digestive  or 
other  troubles.   The  short,  rapid  breathing 
caused    by    disease  in    the    upper   dorsal 
region  may  lead  to  the  suspicion  of  pulmon- 
ary   trouble,   as    in    a   case    which    came 
after  having    been    treated   two   years   for 
asthma.      The  breathing    became  natural 
after    proper    support    was    applied,  and 
the  disease  was  entirely  cured    with  but 
slight    deformity.       In     another    case    of 
disease  in  the    lower  dorsal  region,   poor 
nutrition  and  pains  were   attributed  to  in- 
digestion, and  valuable  time  was  lost  in  the 
endeavor  to  correct   the  digestive  disturb- 


28 


THE   CANADA   MEDICAL   RECORD. 


ance,  which  together  with  severe  pains  in 
the  legs  permanently  disappeared  soon 
after  the  spine  was  properly  supported, 
with  speedy  and  marked  improvement  in 
the  patient's  health.  An  early  diagnosis 
can  often  be  made  before  the  appearance  of 
pain  or  deformity,  from  spinal  stiffness, 
shown  in  the  attitude  and  movements,  the 
tendency  to  lean  on  chairs  and  tables  or  up- 
on the  mother's  lap  for  support,  the  careful 
shuffling  gait,  failing  health  and  nocturnal 
restlessness.  At  this  stage  the  happiest 
results  follow  thorough  treatment,  for  half- 
way measures  taken  with  the  idea  that  the 
trouble  will  disappear  in  a  few  weeks  are 
of  no  avail,  even  in  the  earliest  stages.  The 
symptoms  will  temporarily  subside,  as  in- 
deed they  frequently  do  for  a  time  without 
treatment,  only  to  reappear  later  with  in- 
creased intensity,  unless  the  spine  is  effi- 
ciently and  persistently  supported. 

It  should  never  be  forgotten  in  the 
treatment  of  these  cases  that  an  apparatus 
Is  intended  to  be  an  aid  in  the  general  and 
local  hygiene  of  the  patient,  who  should  be 
under  constant  supervision  and  regulation, 
and  such  changes  made  in  the  mechanical 
appliance  and  other  elements  of  manage- 
ment as  the  progress  of  the  case  may 
demand. 


SOME  POINTS  IN  THE  SURGICAL 
TREATMENT  OF  APPENDICITIS. 

A  paper  read  in  the  Section  on  General 
Surgery  of  the  Pan-American  Medical 
Congress  held  at  Washington,  D.  C,  Sep- 
tember, 1893,  by  Augustus  P.  Clarke, 
A.M.,  M.D.,  of  Cambridge,  Mass.,  U.S.A. 

Recent  experiences  of  surgeons  as  well 
as  of  the  general  practitioner  have  most 
materially  changed  the  teachings  of  the 
earlier  views  respecting  the  treatment  of 
appendicitis.  In  those  cases  in  which  the 
inflammation  of  the  appendix  is  of  a  minor 
degree,  it  may  be  overcome  by  an  expec- 


tant method.  Undoubtedly  the  larger 
proportion  of  the  cases  involving  the  addi- 
tamentum  coli  is  of  this  lesser  grade.  Such 
cases  often  arise  from  the  presence  of  bac- 
teria or  bacilli,  which  have  gained  admis- 
sion into  the  tissues  in  immediate  connec- 
tion with  the  intestinal  tract.  The  symp- 
toms occurring  may  be  characterized  by 
pain  or  tenderness,  by  moderate  distension, 
marked  constipation,  and  by  disturbance 
of  the  constitution  generally.  Under  fa- 
vorable circumstances,  or  by  rest  and  by 
the  application  of  heat  and  by  the  admin- 
istration of  gentle  laxatives  the  symptoms 
may  subside,  without  exciting  any  grave 
apprehensions  on  the  part  of  the  patient  or 
on  thepart  of  those  who  are  in  attendance. 
After  intervals  more  or  less  remote  there 
is  liable  to  occur,  from  various  causes,  a 
recrudescence  of  the  inflammation.  Not 
unfrequently  after  the  lapse  of  some  few 
days  the  disease  may  take  on  retrograde 
processes  ;  in  other  instances,  it  may  become 
so  intensified  as  to  demand  prompt  surgical 
interference  for  the  patient's  recovery. 
From  a  careful  study  of  the  histoiies  of 
cases  coming  under  my  observation  during 
a  number  of  years  past,  and  also  from 
learning  in  many  instances  the  final  results, 
I  feel  that  it  is  not  unsafe  to  say  that  in 
every  case  in  which  there  is  reason  to 
believe  that  the  vermiform  appendix  is 
involved,  however  mild  or  transient  the 
symptoms  may  at  first  appear,  the  surgeon 
or  medical  attendant  should  be  on  careful 
watch  for  sudden  surprises  or  for  untoward 
results.  There  is  great  probability  in 
almost  any  event  that  the  appendix  during 
an  attack  of  inflammation  will  become  ad- 
herent to  other  parts  in  the  immediate 
vicinity.  In  a  case  of  laparotomy  to  which 
I  was  called  for  the  removal  of  diseased 
uterine  appendages,  I  found  that  the 
vermiform  appendix  had  become  adherent 
to  the  tube  and  to  the  ovary  of  the  right 
side.  The  appendix  caeci  was  thickened 
and  also  indurated  as  the  result  of  inflam- 


THE   CANADA    MEDICAL   RECORD. 


29 


matory  processes  of  considerable  duration. 
In  some  instances  the  first  intimation  the 
surgeon  may  have  of  the  case  will  be  the 
formation  of  a  localized  abscess  ;  this  may 
occur  in  or  near  the  McBdrney  point,  be- 
tween the  umbilicus  and  the  anterior  supe- 
rior spinous  process  of  the  ilium,  or  about 
five  centimetres  from  that  point  on  the 
ilium.  The  temperature  in  such  a  case  is 
not  usually  very  high  ;  it  is  often  not  more 
than  loo'^  to  102}4'\  The  pulse  may 
become  soft  and  compressible,  and  occa- 
sionally much  more  frequent  than  the  tem- 
perature would  indicate.  The  vomitus  is 
of  a  dark  or  grumous  substance,  at  times 
it  is  of  a  light  greenish  color.  When  the 
symptoms  become  urgent,  surgical  meas- 
ures should  immediately  be  instituted  for 
relief.  In  many  cases,  if  not  in  the  most, 
the  incision  should  be  made  over  the  point 
of  greatest  tenderness.  This  point,  as  before 
intimated,  is  midway  between  the  umbilicus 
and  the  superior  spinous  process  of  the 
ilium,  and  is  usually  in  the  right  linea  semi- 
lunaris. Such  an  incision  will  afford  an 
opportunity  for  free  drainage  and  for  flush- 
ing the  parts  with  warm  carbolized  water, 
or  with  water  of  the  temperature  of  115° 
to  120'^,  containing  boracic  acid  or  other 
agents  that  can  safely  be  introduced  into 
the  abscess  cavity.  A  liberal  incision  when 
timely  made  over  the  tender  part  has  always 
yielded  in  the  cases  occurring  in  my  prac- 
tice an  immediate  and  permanent  result. 
In  all  cases  after  the  incision  has  been  made 
the  parts  should  be  thoroughly  explored.  If 
the  appendix  is  within  easy  reach,  it  should 
be  brought  forward  and  then  sewed  off  by 
means  ofsutures  of  aseptic  kangaroo  tendon. 
If,  however,  the  appendix  is  bound  down  by 
firm  adhesions,  or,  if  it  cannot  be  found 
without  much  difficulty,  or  without  doing 
excessive  violence  to  the  caecum  or  to 
other  structures,  it  is  far  better  to  let  it 
remain,  for  its  presence  when  left  will  not 
seriously  interfere  with  the  patient's  reco- 
very.    In    a   case    to  which   I  was   called 


some  months  since,  the  patient,  who  was 
aged  twenty  years,  had  been  suffering  nine 
days.  I  made  a  free  incision  over  the 
tenderest  point  ;  the  operation  was  followed 
with  a  profuse  discharge  of  purulent  exu- 
dation. Careful  search  at  the  time  was 
made,  but  the  appendix  could  not  be  found. 
The  patient,  however,  died  next  day. 
Extensive  dissection  at  the  autopsy  re- 
vealed the  fact  that  the  appendix  was  drawn 
upward  behind  the  caicum,  and  was  firmly 
adherent  to  the  intestine.  It  required 
much  patience  to  isolate  and  to  identify  it 
as  the  part  for  which  we  were  in  search. 
No  portion  of  the  intestine  nor  other  part 
was  found  gangrenous.  It  is  highly  pro- 
bable that,  had  the  patient  consented  in 
the  early  stage  of  the  attack  to  the  opera- 
tive measures,  he  could  have  been  saved. 

In  another  case  to  which  I  was  called, 
the  patient,  a  girl  aged  fourteen  years,  had 
been  ill  from  the  local  symptoms  for  four 
days  ;  there  had  been  much  distension  of 
the  abdomen.  The  point  of  greatest  ten- 
derness was  lower  down  than  usual,  but 
the  symptoms  so  strongly  pointed  to  the 
existence  of  appendicitis  that  a  resort  to 
operative  measures  was  advised.  An 
incision  was  made  eight  centimetres  in 
length  over  the  point  of  greatest  tenderness, 
there  was  considerable  discharge  of  puru- 
lent and  bloody  exudation.  The  appendix 
was  unusually  long  and  was  bifurcated,  and 
at  its  junction  with  the  caecum  it  was 
larger  than  normal.  The  excision  of  the 
appendix  was  effected  without  much  trou- 
ble ;  it  was  sewed  off  as  in  the  other  cases 
by  means  of  the  cordwainer's  stitch,  in 
which  kangaroo  tendon  was  employed. 
The  patient  maJe  a  speedy  and  uninter- 
rupted recovery. 

In  another  case  to  which  I  was  called, 
that  of  Miss  G.,  aged  thirteen  years,  the 
symptoms  had  been  in  progress  upward  of 
four  weeks.  The  attending  physician  had 
early  diagnosticated  the  case  as  one  of 
appendicitis,   and    after  consultation  with 


30 


THE  CANADA  MEDICAL  RECORD. 


another  practitioner  had  advised  a  resort 
to  surgical  measures.  The  symptoms, 
however,  soon  became  so  much  easier,  that 
the  operation  was  deferred.  After  the  lapse 
of  some  days  there  was  a  sudden  return  of 
the  graver  symptoms.  At  this  time  I  was 
called  to  see  the  case.  The  parents  now 
dech'ned  the  proposition  for  any  operative 
interference  unless  they  could  be  positively 
assured  of  ultimate  success.  Nothing  then 
remained  to  be  done  but  the  adoption  of 
an  expectant  method.  For  some  days  the 
patient  was  nourished  solely  by  enemas  of 
beef  juice,  brandy  and  beef  peptonoids. 
After  that  the  patient  was  able  to  take  by 
the  mouth  small  quantities  of  malted  milk 
and  beef  essence.  Morphia  and  other  seda- 
tives in  small  quantities  frequently  repeated 
were  employed.  Under  this  regime  the 
pain  was  kept  under  control,  the  vomiting 
almost  entirely  ceased,  the  abdominal  dis- 
tension markedly  lessened,  though  there 
was  probably  suppuration  going  on  at  the 
McBurney  point.  The  father  still  refused 
a  resort  to  operative  interference.  Though 
the  patient  was  so  much  relieved,  the  tem- 
perature was  at  times  somewhat  above 
the  normal.  On  the  thirteenth  day  from 
the  adoption  of  the  expectant  method  the 
patient  experienced  an  unfavorable  return 
of  the  symptoms.  She  died  from  sudden 
collapse  on  the  following  day,  which  was 
the  forty-second  from  the  apparent  onset 
of  the  disease.  In  the  treatment  of  this 
case  the  patient  had  the  opportunity  to 
try  the  benefit  of  the  expectant  method 
carried  out  from  the  first  in  the  most 
approved  manner.  Hail  an  operation  been 
undertaken  in  the  early  stage  of  the  inflam- 
mation the  patient  would  undoubtedly 
have  recovered. 

At  no  time  after  I  was  called  did  it  seem 
that  an  operation  could  have  offered  much 
chance  for  relief,  owing  to  the  excessive 
emaciation  and  to  the  other  unfavorable 
phases  which  the  disease  had  assumed. 

If  consent  had  been  obtained,  I   should 


nevertheless   have  given  the    patient  the 
benefit  of  an  exploratory  incision.     When 
an    operation    in  the    early  stage    of  the 
inflammation  is  undertaken,  there  will  be 
but    little     difficulty    experienced    in    the 
removal  of  the  appendix ;  of  course,  after 
adhesions    are   formed   the   danger  is    in- 
creased.    In  all  cases  the  wound  should  be 
kept  in  an  aseptic  condition.     If  an  abscess 
has  formed,  the  cavity  should  be  irrigated 
or  flushed  with  a  warm  medicated  solution. 
When  the  appendix  is  not  easily  reached, 
or   is  bound  down  behind  the  caecum,  the 
safer  method,  as  before  stated,  will  be  to 
let  it  remain,  and  not  to  make  any  extend- 
ed  search,   or   dissection,    especially  after 
suppuration   has   taken  place.      When  the 
mesentery  or  other  structures   have  been 
sufficiently  detached,  the  appendix  should 
not  be  tied   but  should  be  clamped,  and 
then    should   be  sewed    off   by  means   of 
carbolized  animal  sutures.     As  soon  as  all 
bleeding  points  have  been  controlled,  the 
appendix   should    be    incised    about    two 
centimetres    from    the    caecal     tissue.     In 
order  to  prevent   adhesions   of  the  stump 
or  base  of  the  pedicle  to  other  parts,  the 
peritoneal   tissue  in  immediate  vicinity  of 
the    marging    of  the    incision   should    be 
closely  approximated    by  a  subperitoneal 
or   by  a    Lembert   suture.      The  smaller 
sized  kangaroo  tendon    rendered    aseptic 
should  preferably  be  the  material  for  such 
use.     A  thorough  closure  of  the  peritoneal 
surface  of  the  wound  thus  effected  will  not 
only  obviate    the  occurrence  of  agglutina- 
tion   of   the    parts,   but  will  also    help  to 
prevent  the  escape  into  the  peritoneum  of 
septic   matter  that   may  gravitate  toward 
tliis  point,  and  thus  to  preclude  the  occur- 
rence    of    a    fistulous   tract.     The   entire 
wound  should  as   far  as  possible  be  kept 
in     an    aseptic     condition.      Aristol    and 
iodoform  will    be    found    to    be  excellent 
adju/ants    in   accomplishing    this     result. 
The  danger  of   the  subsequent  occurrence 
of  hernia    may  be    overcome    by   paying 


THE  CANADA  MEDICAL  RECORD. 


careful  attention  to  the  closure  of  the 
severed  parts  that  have  been  divided 
in  the  operation  ;  the  peritoneum,  the  mus- 
cular tissue,  the  fascia  and  the  external 
integument  should  each  be  brought  toge- 
ther separateh'. 

Carbolized  animal  sutures  should  be 
used  for  this  purpose.  Entire  closure  of 
the  wound  by  the  first  intension  can  be 
effected  only  in  those  cases  in  which  the 
operation  has  been  undertaken  in  the  early 
stage  of  the  attack.  After  the  formation 
of  an  abscess,  complete  union  at  first  can- 
not be  expected  to  result,  because  some 
method  for  maintaining  drainage  for  a 
while  will  have  to  be  emplo}-ed.  Some 
operators  recommend  that,  after  the  appen- 
dix has  been  incised,  the  stump  should  be 
disinfected  with  a  small  pointed  cautery. 
In  cases  in  which  the  appendix  has  become 
gangrenous,  or  in  which  there  has  been 
sloughing  or  marked  septic  processes  going 
on,  such  a  method  of  procedure  may  do 
no  harm  ;  but  in  those  cases  in  which  it  is 
desirable  to  achieve  immediate  union  of 
the  tissues,  cauterization  may  cause  further 
sloughing  and  exudation  that  will  delay 
cicatrization.  In  most  cases,  disinfection 
w'ith  I  to  lOOO  or  to  2000  mercuric  bi- 
chloride solution  and  the  liberal  use  of 
aristol  and  iodoform  will  be  more  con- 
ducive to  this  end,  and  be  a  far  safer 
practice  to  adopt.  The  different  steps  of 
the  operation  are  much  complicated  when 
there  is  present  an  unusual  abdominal 
distension  ;  so  also  it  will  be  in  cases  in 
which  there  is  excessive  or  marked  obesity. 
In  one  case  to  which  I  was  called, though  the 
distension  was  not  uncommon,  expulsion  of 
the  intestines  began  as  soon  as  a  moderate 
incision  was  made  ;  the  employment  of  the 
Trendelenburg  posture,  however,  overcame 
the  complication,  and  enabled  me  to  com- 
plete the  operation  without  further  incon- 
venience. The  advantage  of  Trendelen- 
burg's position  in  all  cases  of  abdominal  sec- 
tion for  intestinal  affections  cannot  be  over- 


estimated. In  those  cases  in  which  some 
means  for  drainage  becomes  necessary,e\er}- 
detail  in  the  treatment  should  receive  the 
utmost  attention,  for  if  there  should  occur 
any  hindrance  to  a  free  discharge  of  the 
exudation,  a  risk  of  a  dangerous  sepsis  to  the 
or  anism  will  be  incurred.  In  c\ery  such 
case  of  abdominal  section  when  a  drainage 
tube  has  been  employed,  the  possibility  of 
the  occurrence  of  hernia  should  not  be 
overlooked.  In  all  cases,  whether  the 
drainage  tube  has  been  required  or  not,  a 
firm  binder  or  a  thorough  bandaging 
should  be  employed  ;  the  patient  for  some 
weeks  should  be  kept  for  the  most  part  in 
the  horizontal  position.  As  already  intim- 
ated, an  abdominal  section  with  the 
removal  of  the  appendix,  in  the  early  stages 
of  the  inflammation,  is  most  likely  to  be 
followed  with  favorable  results.  In  the 
initial  stage  of  many  of  the  milder  cases 
the  medical  attendant  often  hesitates,  or 
shrinks  from  assuming  the  responsibility 
of  undertaking  operative  measures  ;  he 
rather  indulges  in  the  hope  that  the  case 
will  ultimately  take  on  a  more  favorable 
aspect.  It  is  true  that  in  some  cases  there 
will  be  for  a  while  considerable  improve- 
ment, which  will  lead  to  the  thought  that 
the  patient  may  finally  recover.  In  other 
cases  there  is  an  evident  fear  on  the  part 
of  medical  attendants  that  the  diagnosis 
may  be  incorrect,  or  that  the  symptoms 
are  dependent  on  the  presence  of  uncer- 
tain factors.  Such  a  conclusion,  however, 
at  the  present  day  should  not  obtain  when 
it  is  conside  ed  that  our  increasing  expe- 
rience will  enable  us  to  decide  most  accu- 
rately in  reference  to  the  elimination  of 
the  existence  of  other  possible  causes. 
Assuming  that  our  diagnosis  is  occasionally 
incorrect,  the  dangers  of  an  exploratory 
incision  are  infinitely  less  than  would 
result  from  allowing  the  symptoms  to 
progress  without  availing  ourselves  of  the 
advantages  of  an  abdominal  section,  which 
in  most  cases  is  in  any  event,  when  pro- 


32 


THE  CANADA   MEDICAL   RECORD. 


perly  carried  out,  a  comparatively  harmless 
procedure.  The  question  often  arises : 
should  the  surgeon,  when  called  upon  in 
the  later  stages  of  a  case,  advise  operative 
interference  ?  In  answer  to  this  it  may  be 
remarked  that  our  experience  is  favorable 
to  the  adoption  of  an  exploratory  incision. 
When  an  operation  is  undertaken  in  the 
later  stages,  the  patient  must  of  course  as- 
sume more  risks,  for  the  chances  of  recovery 
are  much  less  than  when  an  operation  is 
attempted  much  earlier,  though  surgical 
measures  at  such  late  date  may  prevent 
the  rupturing  of  an  abscess  into  the  peri- 
toneal cavity.  When  there  has  been  such  a 
rupture,  removal  of  the  pus  and  cleansing 
of  the  parts  may  afford  an  opportunity  for  a 
retrograde  process  of  the  disease  to  take 
place.  Nothing,  therefore,  but  the  occur- 
rence of  extreme  collapse  should  weigh 
against  the  employment  of  operative  mea- 
sures. Some  surgeons  have  advised  that 
when  the  existence  of  peritonitis  has 
become  somewhat  diffused,  it  should  be 
regarded  as  a  bar  to  the  adoption  of  sur- 
gical treatment.  It  should,  however,  be 
remembered  that  the  implication  of  the 
peritoneum  may  be  dependent  in  any  case 
on  the  presence  of  lesions  that  may  have 
their  origin  at  a  distant  point,  and  that  the 
removal  of  the  cause  of  such  morbid  pro- 
cesses may  effect  a  speedy  subsidence  of 
the  peritoneal  inflammation.  A  peritoneal 
inflammation  should  always,  according  to 
the  light  afforded  by  recent  pathological 
investigations,  be  considered  only  as  a 
secondary  affection  to  other  processes  that 
have  had  a  more  or  less  continuance. 

Before  closing  this  paper,  I  deem  it  im- 
portant to  say  that  in  those  cases  of  appen- 
dicitis which  have  gone  on  to  suppuration 
before  operative  measures  have  been  under- 
taken, there  may  occur  secondary  abscesses 
in  other  parts  of  the  abdominal  cavity.  An 
operation  to  insure  relief  must  therefore  em- 
brace a  course  of  procedure  that  will  afford 
a  free  discharge  to  all  accumulations  of  puru- 


lent exudation.  It  will  sometimes  be  neces- 
sary to  make  an  extensive  dissection  at 
different  parts,  and  also  to  overcome  adhe- 
sions of  an  unusual  extent.  Great  care  will 
also  have  to  be  exercised,  lest  an  opening 
be  made  into  an  adherent  intestinal  mass. 
In  some  instances,  portions  of  the  epiploon 
may  become  gangrenous  ;  there  may  occur 
in  the  veins  of  the  abdomen  an  inflamma- 
tion that  may  extend  outward  to  the 
femoral  and  to  other  veins.  In  carrying 
out  for  these  complications  the  necessary 
surgical  treatment,  much  judgment  will 
have  to  be  exercised  and  much  precaution 
taken  that  the  dissection  or  search  be  not 
prolonged  beyond  what  may  afterward 
prove  to  be  a  beneficial  or  safe  proceeding. 

tea 
octctg    proceedings. 


THE    MONTREAL    MEDICO- CHI- 
RURGICAL  SOCIETY. 

Stated  Meeting,  March  ;^ist,  1893. 

James  Stewart,  M.D.,  President,  in  the 
Chair. 

Enchondroma  of  the  Mammary  Gland  in  a 
Bitch. — Dr.  Adami  brought  before  the  Society 
a  case  of  this  condition  on  account  of  its  rarity. 
Enchondroma  has  been  very  occasionally  re- 
ported as  occurring  in  the  female,  perhaps  more 
frequently  in  the  domestic  animals.  The  pre- 
sent specimen,  a  buUet-hke  growth  234  inches 
in  diameter,  was  obtained  from  a  setter  bitch, 
having  been  removed  by  Mr.  Hart,  one  of  our 
students,  in  conjunction  with  Mr.  Tracey, 
veterinary  student.  The  growth  would  seem 
to  be  of  less  than  a  year's  duration,  and  to  have 
originated  after  a  rather  severe  mammitis.  The 
bitch  had  a  litter  of  puppies  in  February,  1892. 
There  was  some  difficulty  about  tlie  weaning, 
and  one  of  the  teats  became  injured  and  in- 
flamed. The  bitch  recovered,  but  in  the  autumn 
a  small  lump  was  observed  in  the  previously 
injured  teat.  It  was  removed  at  l^ie  beginning 
of  last  month. 

The  structure  of  this  tumor  is  typical,  it  is 
slightly  lobulated,  and  the  centre  is  of  bony 
hardness.  Sections  showed  the  lobules  towards 
the  periphery  to  be  of  hyaline  cartilage,  with 
some  regions  presenting  stellate  cells  and  less 
dense  matrix;  they  were  separated  by  bands  of 
fibrous  tissue.    Deeper  down,  the  matrix  became 


THE   CANADA    MEDICAL   RECORD. 


OJ 


impregnated  with  calcareous  salts,  but  even 
at  the  centre  there  was  not  true  bone.  There 
were  large  channels  in  which  ran  the  blood 
vessels  surrounded  by  loose  cellular  structure, 
but  the  surrounding  osteoid  framework  pos- 
sessed neither  proper  Haversian  canals  nor  true 
lamellx.  Langlois,  in  the  Dictionnaire  des 
Sciences  Medicales.  gives  a  good  account  of 
these  mammary  enchondromata. 

Papillomatous  Outgrowth  of  the  Lower  End 
of  the  Ileum. — Dr.  Adami    exhibited  for   Dr. 
Wyatt  Johnston  the  lowest  three   inches  of  the 
ileum  presenting  the  above  condition.     Several 
tubercular  ulcers  had  been  found  hi-her  up  in 
the    ileum,  but  this  last  portion  was  quite  free, 
and    exhibited    numerous     delicate   papillary 
prolongations,  the  longest  from  Yz  to  f^  of  an 
inch  in  length.  There  was  no  sign  of  surrounding 
inflammation,  and  they  differed  both  in  appear- 
ance  and    structure  from  the    larger   coarser 
papillomata  which  not  infrequently  are   found 
in  the    neighborhood   of   ulcers       These   are 
beset    by  villi,   and  in    structure    most  nearly 
recemble  the  hypertrophied  projecting,  solitary 
glands  which  are  occasionally  met  with  ;  but  if 
this  be  their  nature,  their  length  and    delicate 
finger-like  appearance  distinguishes  them  from 
the  specimens  usually  encountered  in  museums. 
Dr.    WvATT  Johnston  said  that   this  very 
unusual   specimen  was  obtained  from  a  patient 
who  had  died  from  taking  Paris  green.     At  the 
autopsy  there  was  found  severe  tuberculosis  of 
the  intestines,  with  but  little  elsewhere.     In  the 
lungs    there  were    two  tuberculous  foci,   each 
about  the  size  of  an  almond,  and  were  composed 
entirely  of  little,  grey  miliary  tubercles ;  there 
were  also  signs  of  old  cicatrices  in  the  apex  of 
one   lung.     The  case   appeared  to  present  the 
unusual  conditions  of  primary  intestinal  tuber- 
culosis, there  being  extensive  ulceration  of  the 
caecum  and  ascending  colon. 

The  case  is  of  interest  from  a  medico-legal 
point  of  view,  as  to  the  possible  interpretation 
that  might  be  put  on  these  ulcerations  in  view 
of  the  history  of  poisoning  by  arsenic.  In  re- 
garding them  from  the  side  of  the  mucous 
membrane  it  would  be  difficult  to  say  positively 
that  they  were  tubercular;  but  in  viewing 
them  from  the  serous  coat  inward;,  their 
tubercular  nature  becomes  quite  evident.  The 
polypoid  nature  of  the  growths  is  very  interest- 
ing. They  usually  grow  in  the  large  bowel, 
and  when  they  occur  in  the  small  intestine  they 
are  usually  in  connection  with  leuksemia.  The 
little  projections  contain  lymphoid  follicles  aris- 
ing from  the  lymphatic  tissue  of  the  submu- 
cosa. 

Dr.  Lapthorn  Smith  said  that  for  the  pur- 
pose of  comparison  with  Dr.  Johnston's  speci- 
men he  had  brought  one  cihown  by  himself 
some  meetings  back.  They  are  papillae  obtained 
from  a  papillomatous  disease  of  the  large  intestine 
about  the  region  of  the    sigmoid   flexure.     Dr. 


Adami,  at  the  time,  made  a  microscopical 
examination  of  these  shreds,  and  pronounced 
the  growth  benign,  to  the  great  relief  of  the 
patient.  They  resemble  Dr.  Johnston's  speci- 
men to  the  naked  eye. 

Dr.  Wesley  Mills,  referring  to  the  specimen 
taken  from  the  bitch,  said  that  enchondromata 
are  rather  unusual,  although  tumors  of  the 
mammary  glands  are  quite  common  and  tend 
to  become  malignant.  By  far  the  most  remark- 
able tumor  that  he  had  ever  seen  in  connec- 
tion with  the  mammary  gland  was  a  cyst  contain- 
ing a  large  worm,  some  five  or  six  inches  long. 
Tnis  position  for  such  a  parasite  was  one  of  the 
most  remarkable  cases  he  had  ever  heard  of. 
The  bitch  belonged  to  him,  and  he  had  removed 
the  tumor. 

Dr.  Adami  hoped  that  Dr.  Smith  would  not 
express  too  sanguine  opinions  with  reference 
to  the  non-malignity  of  the  intestinal  grov/th 
submitted  to  him  for  examination  some  time 
ago.  While  from  the  appearance  of  the  tissue 
examined  it  was  undoubtedly  benign,  it  is  well 
known  that  these  tumors,  although  at  one  time 
quite  benign,  may  later  take  on  mahgnant 
growth.  Such  growths  were  of  a  much  coarser 
nature  than  Dr.  Johnston's  specimen. 

Nephrectomy  through  Abdominal  Incision. — 
Dr.  Lapthorn  Smith  exhibited  an  enormous 
kidney,  and  gave  the  following  history  of  the 
case  :  The  patient  was  sent  to  me  with  what 
was  supposed  to  be  a  large  multilocular  ovarian 
cyst.  The  tumor  so  completely  filled  the 
abdomen  as  to  be  immovable.  The  uterus 
was  pushed  downwards,  backwards  and  to 
the  left  by  the  growth.  The  tumor  seemed 
to  rest  on  the  brim  of  the  pelvis.  On  the 
bowels  being  well  emptied  I  felt  pretty  sure 
that  this  was  a  tumor,  not  of  the  uterus, 
but  of  the  kidney.  I  suspected  pyelo-nephritis. 
When  I  opened  the  abdomen  the  tumor  at  once 
presented,  but  with  a  layer  of  peritoneum  over 
it.  After  selecting  a  spot  in  the  peritoneum 
where  there  were  no  vessels,  we  (Dr.  Lockhart 
assisted  me)  made  an  opening,  and  proceeded  to 
dissect  the  peritoneum  off  the  tumor.  On 
reaching  the  back  we  found  a  large  pedicle, 
which  was  regularly  ligated.  We  then  found 
the  incision  too  small  to  deliver  the  tumor 
through  ;  the  latter  was  then  tapped,  when  it 
immediately  collapsed,  and  delivery  was  easily 
effected.  The  renal  artery  was  tied,  and  the 
kidney  removed  without  any  great  difficulty. 
We  then  washed  out  the  abdominal  cavity  with 
boiled  water,  and  inserted  a  drainage  tube  at  the 
lowest  part.  The  pedicle  was  dropped  into 
the  cavity.  During  the  operation  there  was  little 
or  no  bleeding,  and  afterwards  there  escaped 
from  the  tube  in  the  first  24  hours  about  two 
ounces  of  blood,  when  the  discharges  rapidly 
became  serous  in  character.  Since  the  operation 
the  patient  has  had  almost  no  pain, 
and     temperature     has    been     normal.       On 


34 


THE   CANADA   MEDICAL   RECORD. 


opening  the  kidney  it  was  seen  to  be  saculated, 
and  in  one  of  the  sacs  a  calculus  was  found. 
In  regard  to  the  condition  of  the  urine,  before 
the  operation  it  was  free  from  albumen,  but 
very  scanty  in  quantity.  The  first  24  hours 
after  the  operation  she  only  passed  8  ounces, 
the  next  24  hours  the  quantity  had  gone  up  to 
20  ounces.  No  water  was  allowed  to  be  taken 
by  the  mouth  after  the  first  24  hours  from 
operating. 

Discussion  ox  Tuberculosis — Co/it i/iued. 

Dr.  Lapthorn  Smith,  in  opening  the  discus- 
sion, said  that  Dr.  McEachran's  paper  was  the 
very  thing  necessary  to  rouse  the  profession  to 
a  true  way  of  looking  at  the  matter.  The  infec- 
tious nature  of  tuberculosis  has  been  more  read- 
ily accepted  by  the  public  than  by  the  profes- 
sion, and  in  this  respect  the  profession  is  not 
altogether  free  from  blame.  The  public  should 
have  been  long  ago  fully  informed  of  the  nature 
of  this  disease,  for  as  a  result  of  their  ignorance 
thousands  have  died  from  exposure  to  infection 
— ansemic  girls  put  into  the  hospital  wards 
with  tuberculous  patients  ;  young  men  in  lodg- 
ing houses  occupying  the  same  bed  or  same 
room  with  chronic  consumpuves  ;  young  girls 
in  boarding  schools  or  convents. 

We  have  so  far  laid  too  much  stress  on  the 
idea  that  consumption  is  hereditary,  and  this  is 
largely  due  to  the  habit  of  insurance  companies 
inquiring  into  all  the  branches  of  the  family 
tree,  but  it  never  seems  to  occur  to  them  that 
a  person  may  contract  consumption  by  sleeping 
in  the  same  room  with  another  in  the  last  stage. 
He  had  met  cases  again  and  again  where  a 
perfectly  healthy  girl  contracted  consumption 
in  a  few  months  from  a  tuberculous  husband,  and 
cited  a  case  here  in  Montreal  of  a  young  girl 
who  moved  in  o  a  house  in  May,  in  which  a 
consumptive  had  died  in  April,  and  before  six 
months  had  elapsed  she  had  contracted  the 
disease  herself. 

The  children  of  consumptives  are  not  more 
likely  to  die  of  consumption  than  anyone  else, 
if  they  are  timely  removed  fiom  infection. 
The  death  ra^e  from  tuberculosis  among 
children  in  the  hospitals  in  Paris,  the  greatest 
number  of  which  are  taken  from  tuberculosis 
parents,  is  not  greater  than  that  prevail- 
ing amongst  children  elsewhere.  This  Society 
has  great  influence,  and  if  it  sends  out  advice 
to  the  public,  the  advice  will  be  well  received. 
\\q  can  stamp  out  consumption  as  well  as  we 
can  stamp  out  small-pox. 

Dr.  F.  W.  Campbell  thought  that  perhaps 
he  was  one  of  those  men  who  have  been  edu- 
cated by  insurance  companies  to  look  upon  the 
transmissibiliiy  of  this  disease  from  one  genera- 
tion to  another  as  the  all-important  factor. 
There  are  sometimes  facts  which  present  them- 
selves to  a  man's  observation  and  which  he  fails 
to  realize.     The  facts  as  regards  the  contagious- 


ness of  tuberculosis,  which  now  seem  so  plain 
to  our  eyes,  were  no  less  plain  ten  years  ago  ; 
but  not  having  the  theoretical  knowledge  of  to- 
day to  work  upon,  they  either  remained  as 
stumbling-blocks  in  our  path,  or  were  explained 
on  other  lines.  In  connection  with  tubercu- 
losis, not  only  as  a  disease  which  we  may 
communicate  to  one  another,  but  also  as  one 
which  may  be  contracted  from  the  lower  animals, 
we  must  remember  that  our  patients  should  be 
guarded,  not  only  against  exposing  themselves 
with  friends  who  have  tuberculosis,  but  also 
that  the  importance  of  enquiring  into  the  nature 
of  their  food  supply,  especially  that  of  milk 
and  meat,  should  be  duly  impressed  upon  then\ 
We  will  never  reach  the  bottom  of  the  difficulty 
until  we  get  a  thoroughly  honest  and  scientific 
investigation  of  the  city  milk  and  food  supply. 
So  long  as  the  milk  is  allowed  to  be  delivered 
without  bacteriological  investigation,  so  long 
will  our  efforts  be  futile ;  we  may  isolate,  we 
may  carry  out  antiseptic  processes  in  the  treat- 
ment of  our  patients  ;  but  so  long  as  the  milk 
and  flesh  of  tuberculous  animals  is  allowed  to 
be  used  by  the  public,  just  so  long  will  we  have 
tuberculosis  existing  to  an  enormous  extent 
among  the  population. 

Now,  although  inheritance  is  no  longer  re- 
garded as  the  sole  factor  in  the  etiology  of  phthi- 
sis, it  is  of  unquestionable  importance  in  this  re- 
spect. There  seems  to  be  a  great  susceptibility 
of  persons,  under  certain  conditions,  for  the 
absorption  of  the  tubercular  poison.  But  there 
is  no  question  as  to  the  advisability  of  treating 
the  affection  as  a  contagious  disease.  The 
absolute  necessity  of  at  least  partial  isolation 
must  be  borne  m  mind.  So  far  as  occupying 
the  same  bed  or  the  same  room  is  concerned, 
so  far  as  having  every  particle  of  expectoration 
disinfected  or  destroyed,  the  principles  of  anti- 
sepsis must  be  rigidly  applied.  The  patient 
should  be  required  to  spit  into  cloths  or  a  paper 
spit-box,  which  may  be  destroyed.  So  long  as 
these  precautions  are  neglected,  just  so  long  will 
we  have  tubercular  patients.  We  may  never  get 
rid  of  the  disease  altogether,  but  there  is  a  great 
future  before  us  in  modifying  its  existence.  The 
first  thing  to  do  is  to  absolutely  impress  upon 
the  people  the  idea  that  it  is  absolutely  a  con- 
tagious and  infectious  disease. 

The  treatment  of  tuberculosis  is  a  question 
of  great  difficulty  to  the  medical  practitioner. 
When  a  tuberculous  patient  comes  to  him,  he  is 
in  a  difficulty  to  know  what  is  the  proper  advice 
to  give.  There  is  not  a  physician  who,  the 
moment  he  gets  such  a  case,  does  not  feel  that 
he  has  a  very  complicated  matter  to  deal  with  ; 
it  is  often  a  matter  in  which  finances  play  a  great 
part.  Many  of  us  have  of  late  been  sending 
patients  to  Florida,  to  California,  or  to  the  heights 
of  Colorado;  but  the  amount  of  money  required 
to  enjoy  such  resorts  will,  in  a  great  many  in- 
stances, be  beyond  the  means  of  the  individual. 


THE   CANADA   MEDICAL   RECORD, 


35 


Now,  we  liave  within  reasonable  reach  a  phice 
which  is  before  long  to  stand  pre-eminently  the 
home  for  consinni)tives,  and  which  is  only  a  few 
hours  ride  from  Montreal.  There  is  to-day  in 
the  Adirondacks  a  sanitarium,  under  the  care  of 
Dr.  'Prudeau,  which  is  indeed  a  very  excellent^ 
place.  This  geitleman  has  done  a  great  deal 
to  make  a  good  home  for  consumptives,  his 
charges  are  only  five  dollars  a  week,  which 
includes  the  medical  attendance ;  he  treats 
cases,  and  treats  tiiem  very  successfully,  almost 
entirely  by  keeping  them  in  the  open  air, 
amongst  the  pines.  Thus,  while  we  have  so 
desirable  a  locality  close  at  hand,  we  should 
hesitate  before  recommending  long  journeys 
and  great  expense  where  fatigue  and  money  are 
subjects  of  consideration. 

Dr.  Armstrong  thought  that  it  would  be  a 
wise  proceeding  if  the  facts  brought  out  in  the 
discussion  were  put  in  pamphlet  form  and  sent 
to  each  member  for  consideration,  and  that 
some  means  should  be  adopted  to  spread  this 
knowledge  among  the  laity,  for  by  so  doing  it 
would  lighten  the  burden  of  the  family  practi- 
tioner. P^very  medical  man  knows  how  difficult 
it  is  to  get  families  to  carry  out  proper  precau- 
tions when  the  disease  is  in  their  homes,  because 
they  do  not  realize  the  danger. 

Dr.  Wesley  Mills  had  noticed,  in  watching 
the  progress  of  thought  in  the  profession,  a  very 
dangerous  tendency  to  swing  round  from  one 
extreme  to  another.  This  is  very  well  seen  in 
the  relation  of  heredity  to  tuberculosis — from 
considering  it  the  sole  factor,  we  are  coming  to 
regard  it  as  of  no  importance  whatever.  If  we 
were  to  assume  that  heredity  has  nothing  to  do 
with  the  subject,  we  would  be  making  a  mis- 
take, and  a  little  consideration  will  show  that 
all  modern  physiology  and  pathology  attach  as 
much  importance  to  the  invaded  cells  as  to  the 
invading  ones.  Heredity  means  the  same 
tendencies  in  the  offspring  as  in  the  parents ;  it 
may  be  associated  with  similarity  of  form,  or  it 
may  not;  it  may  be  visible  or  invisible,  but  it 
is  there.  Now,  we  all  know  from  the  experi- 
ence of  breeders  that  an  hereditary  tendency 
can  in  the  course  of  generations  be  annihilated, 
ai:d  this  fact  should  be  borne  in  mind  in  the 
forming  of  human  alliances.  By  an  injudicious 
alliance  an  inherited  tendency  to  a  disease  can 
be  intensified,  just  as  it  can  be  lessened  by  a 
judicious  one.  So  that  in  spite  of  bacilli  and 
antisepsis  it  is  not  less  but  more  important  than 
ever  that  people  should  be  warned  in  niaking 
their  alliances  for  life.  It  is  true  that  an  indi- 
vidual who  has  no  special  predisposition,  when 
s-leeping  with  a  phthisical  patient,  may  contract 
the  disease,  but  that  is  an  extreme  case,  and 
under  such  circumstances  the  infection  must  be 
due  to  the  enormous  quantity  of  the  germs.  As 
a  rule,  a  person  who  has  no  predisposition  will 
not  contract  the  disease,  and  an  alliance  of  a 
predisposed   person  with   such  might  help    to 


eradicate  the  tendency.  There  are  many  in- 
stances in  pathology  when  the  contraction  of 
the  disease  depjids  upon  the  quantity  of  the 
germs,  and  it  is  to  such  circumstonces  we  must 
attribute-infection  where  no  predispositionexists. 
As  to  the  question  of  whether  the  bacilli 
themselves  can  be  inherited,  it  has  been  shown 
that  ihe  placenta  has  contained  not  only  actual 
bacilli,  but  actual  tubercles.  What  we  have  yet 
to  determine  is  whether  there  is  actual  intra- 
uterine infection  or  not. 

During  the  past  few  years  he  had  bred 
miny  hundred  pigeons  of  high  breed,  that  is  to 
say,  pigeons  which  have  deviated  much  from 
the  normal  by  man's  selection.  Such  organisms 
are  easily  disturbed,  and  disease  works  great 
ravages  amongst  them.  It  is  his  custom  to 
make  post-mortems  on  all  deaths ;  some  of 
them  were  submitted  to  Dr.  Johnston,  and  by 
this  means  many  facts  about  tuberculosis  have 
been  acquired ;  one  is,  that  the  organism  is 
quite  as  important  as  the  bacillus.  For  a  time 
there  was  but  a  little  of  the  disease,  at  other 
limes  considerable.  How  is  that  to  be  ex- 
plained ?  The  strains  he  was  dealing  with  were 
known,  as  well  as  that-  environment  which  is 
best  suited  for  resisting  all  sorts  of  disease. 
It  is  also  known  that  in  birds  there  is  one  par- 
ticular period  of  the  year  at  which  their  vitality 
is  at  the  lowest,  namely,  when  they  are  chang- 
ing their  feathers,  which  they  do  completely 
once  a  year.  When  the  amount  of  feathers  on 
a  bird  is  considered,  the  amount  of  metabolism 
that  is  required  to  restore  these  feathers,  and 
also  when  many  of  these  feathers  have  blood  at 
their  base,  it  can  easily  be  understood  how  the 
bird's  vitality  must  at  this  time  be  at  its  lowest 
ebb  ;  and  it  is  at  this  period  that  tuberculosis, 
entritis,  etc.,  is  most  prevalent  amongst  them. 
Then  again,  during  the  cold  weather  we  have 
many  instances  of  tuberculosis  amongst  our 
birds.  These  are  splendid  instances  of  how 
condition  and  environment  may  detergiine 
disease.  Tuberculosis  runs  in  birds  a  very 
rapid  course.  Symptoms  of  a  serious  nature 
may  be  absent  to  within  a  few  days  of  death; 
even  death  may  result  without  profound 
emaciation. 

Dr.  G.  P.  GIRDWOOD  could  not  disregard  a 
hereditary  tendency  to  the  disease.  Whether 
tuberculosis  passes  direct  from  the  parent  to  the 
offspring,  or  whether  it  is  some  weak  constitu- 
tion brought  about  by  the  union  of  two  people 
with  a  mal-affinity,  may  be  a  disputed  point; 
but  every  old  practitioner  knows  it  as  a  matter 
of  observation,  that  in  certain  families  all  the 
individuals,  one  after  another,  die  off  as  soon 
as  they  arrive  at  a  certain  age.  In  other 
families  you  find  the  greater  part  die  off  in 
consumption,  all  but  one  or  two,  and  these 
usually  the  scapegraces,  who  have  probably 
lived  a  less  sedentary  life — have  lived  more  in 
the  open  air. 


36 


THE   CANADA  MEDICAL  RECORD. 


There  is  another  point  in  connection  with 
heredity,  and  that  is,  that  a  pecuHarity  of 
constitution  may  be  developed  which  has  no 
congenital  antecedent  in  the  nature  of  either 
parent,  but  that  some  transient  condition  of 
either  or  both  parents,  some  depressed  vitality, 
may  at  the  moment  of  conception  beget  a 
constitution  for  the  offspring  which  renders  it 
liable  to  attacks  of  the  bacillus  in  after-life. 

He  had  also  seen  associated  with  tuberculous 
disease,  madness  and  cancer.  There  were 
families  of  which  several  members  die  of 
tuberculosis,  some  of  madness,  others,  especi- 
ally the  girls,  of  cancer.  Now,  it  may  be  all 
the  one  tendency  which  takes  a  particular  turn 
in  certain  constitutions,  now  developing  into 
tuberculosis,  now  into  cancer,  and  again  into 
madness.  Again,  there  are  cases  of  acute 
mania  in  young  men  and  women  who  recover 
and  afterwards  die  of  tuberculosis,  which  shows 
another  association  between  madness  and 
tuberculosis.  Where  this  tendency  lies  is  a 
disputed  point. 

With  regard  to  the  treatment  of  tuberculosis, 
he  was  strongly  of  the  impression  that  the 
proper  place  for  a  sick  man  is  his  own  home. 
All  the  advantages  of  distant  places  can  pro- 
bably be  obtained  at  home,  such  as  open  air 
and  exercise  which  keeps  a  man  employed  out 
of  doors,  and  surroundings  which  conduce  to 
health.  The.'-e  will  place  the  patient  in  the  best 
possible  position  to  fight  the  bacilli.  Tliere  is 
also  a  moral  aspect  of  the  question  :  What 
right  has  one  member  of  a  family  to  spend  the 
money  required  for  a  change  of  climate,  when 
by  doing  so  it  often  means  hirassing,  if  not 
impoverishing,  the  rest  of  the  family? 

Dr.  Roddick,  speaking  of  the  treatment, 
said  that  sending  patients  away  is  a  subject  of 
considerable  importance,  not  only  to  the  patient, 
but  to  those  with  whom  the  patient  has  to 
travel.  In  a  trip  to  the  South  recently,  he  was 
obliged  to  live  for  a  day  and  a  half  in  a  sleep- 
ing car  with  three  persons  very  far  advanced  in 
phthisis.  It  not  only  impressed  him  very  much, 
but  many  others  in  the  same  car  ;  one  lady 
absolutely  refused  to  travel  with  them  ;  she  can- 
not be  blamed,  as  she  was  in  delicate  health. 
Three  years  ago  he  had  crossed  the  Atlantic 
with  a  man  who  was  going  to  the  south  of 
France ;  he  was  locked  up  in  the  same  berth 
with  this  man,  who  was  constantly  complaining 
of  draft  and  would  insist  on  having  the  door 
closed.  Such  people  are  unquestionably  dan- 
gerous, and  should  not  be  allowed  to  travel  in 
sleeping  cars  or  steamboats,  except  under 
special  circumstances.  In  fact,  in  the  South, 
where  they  have  much  experience  of  the  results 
of  such  practices,  so  thoroughly  alive  is  popular 
sentiment  to  the  danger  of  contagion,  that  many 
people  will  not  occupy  a  room  in  a  hotel  unless 
it  has  been  first  as  completely  disinfected  as 
if  there  had  been  a  rase  of  scarlet  fever  occupy- 


ing it  previously.  This  is  causing  so  much 
extra  expense  that  they  are  now  refusing  to 
receive  consumptives  in  the  hotels,  and  prob- 
ably it  will  soon  come  to  pass  that  in  Southern 
resorts  these  unfortunates  will  have  recognized 
quarters  which  they  must  occupy,  and  no  others. 

Dr.  McEachran,  in  answer,  said  that  he 
felt  sure  the  remarks  made,  if  published,  would 
have  a  very  valuable  influence  relative  to  the 
treatment  of  the  disease  in  the  lower  animals, 
and  causing  some  steps  to  be  taken  with  a  view 
to  even  controllirj  it  among  human  beings. 

When  statistics  in  the  human  subject  are 
looked  for,  they  are  not  as  easily  furnished  as  in 
the  case  of  cattle;  but  if  the  similarity  of  the 
disease  in  animals  and  man  can  be  shown,  the 
facts  furnished  from  the  '"ormer  should  serve  as 
data  for  our  manner  of  dealing  with  the  latter. 
With  regard  to  copulation  as  a  means  of  pro- 
pagating the  disease,  he  quoted  several  instances 
of  unquestionable  transmission  in  this  way,  and 
in  this  respect  it  can  pass  as  readily  from  the 
male  to  the  female  as  from  the  female  to  the 
male.  He  had  met  with  many  instances  which 
show  beyond  doubt  the  communicability  by 
contact,  sometimes  produced  by  the  males, 
sometimes  by  the  females,  of  this  dread  disease. 

He  thought  that  if  the  Society  goes  before 
the  public,  and  makes  strong  statements  as  to 
the  nature  and  manner  of  dealing  with  the 
disease,  it  will  be  doing  a  work  which  shall 
prove  a  lasting  benefit  to  the  country  ;  while  so 
far  as  Government  interference  with  the  disease 
in  animals  is  concerned,  something  will  be  done 
in  the  near  future.  The  Government  is  going 
to  get  up  ])amphlets,  distribute  them  broadcast, 
and  have  the  public  informed  of  the  true  nature 
of  the  disease.  Now,  if  the  medical  part  was 
equally  made  known,  the  C')mbined  effect  would 
be  a  work  of  very  great  good. 

Dr.  Adami,  in  answer,  said  he  was  very  glad 
that  this  subject  of  heredity  had  been  brought 
forward,  'i'he  right  view,  that  is,  the  one  which 
has  been  fairly  well  accepted,  is  that  heredity 
does  not  imply  an  inheritance  of  the  bacilli, 
but  rather  an  inherited  weakness  towards  resist- 
ing ihis  particular  germ.  With  regard  to 
whether  the  foetus  is  ever  affected,  there  are 
two,  if  not  more,  undoubted  instances  recorded 
in  which  the  foetus  has  been  affected  by  tuber- 
culosis. There  is  no  question  but  it  can  occur, 
but  it  is  of  very  rare  occurrence. 

In  conclusion,  he  agreed  wiih  what  Dr. 
McEachran  and  every  speaker  had  said,  that 
information  upon  this  subject  should  be  wide- 
spread, and  that  the  public  should  be  made 
acquainted  with  the  extreme  infectiousness  of 
this  disease,  and  that  we  should  do  our  best 
in  every  way  to  stamp  out  this  terrible  scourge. 
The  PRbSiDENT  named  the  following  com- 
mittee to  draw  up  rules  in  accordance  with  the 
discussion  :  Drs.  A.  D.  Blackader,  McEachran, 
Laberge,  Adami  and  Wyatt  Johnston. 


THE    CANADA   MEDICAL   RECORD. 


Il 


ABSTRACT  OF  THE  PROCEEDINGS  OF 
THE  THIRD  ANNUAL  MEETING  OF 
THE  AMERICAN  ELECTRO-THE- 
RAPEUTIC ASSOCIATION. 

HELD  IN  CHICAGO,    SEPIEMBER     12,    13AXDI4, 
1893. 

AuGUSTiN  H.  GoELET,  ^l.T>.,  Freside/if. 
FIRST  DAY— Septembfr  12th. 

MORNING    SESSION. 

The  Association  was  called  to  order  by  the 
President,  Dr.  Goelet,  and  after  the  transac- 
tion of  .some  routine  business,  the  President 
delivered  the  annual  address,  taking  for  his 
subject,  "  The  Influences  Governing  the  Pro- 
gress of  Electro-Therapeutics." 

He  said  that  last  ye?  r  in  a  spirit  of  humor  the 
Association  had  been  referred  to  as  a  vigorous 
infant,  but  its  vigor  was  readily  explained  when 
it  was  remembered  that  it  boasts  of  three 
parents.  In  the  beginning  it  was  predicted  that 
it  would  never  prosper,  but  would  die  young — 
even  before  the  completion  of  its  first  dentition. 
He  thought,  however,  that  its  present  state  of 
health  and  prosperity  was  sufficient  evidence 
that  it  was  destined  to  a  long  life  of  great  use- 
fulness and  a  ripe  old  age.  He  thought  the 
inauguration  of  this  Association  marked  an 
event  in  medicine  quite  as  important  as  any  that 
had  occurred  within  the  present  century, 
because  it  established  a  recognized  position  for 
an  important  and  long  neglected  branch  of 
therapeutics.  The  need  of  such  an  Association 
was  quite  evident  to  anyone  who  had  attempt- 
ed to  present  technical  papers  upon  electrical 
subjects  at  other  medical  societies  where  there 
is  usually  so  much  unreasonable  opposition  to 
electrotherapeutics  that  profitable  discussion  is 
impossible. 

The  work  thus  far  accomplished  he  consider- 
ed very  creditable  for  so  young  an  organization, 
particularly  as  the  field  is  entirely  new,  and  in 
the  beginning  involved  much  uncertainty.  He 
emphasized  the  fact  that  the  methods  adopted 
must  bear  investigation  and  the  stamp  of 
scientific  reasoning.  Results,  he  said,  may  be 
doubted,  but  methods  based  upon  scientific 
laws  could  not  be  questioned. 

Electro-therapeutics  must  contend  with  the 
natural  opposition  by  the  profession  to  every 
new  inroad  upon  old  and  established  methods. 
The  fact  that  it  is  not  more  universally  em- 
ployed is  due  to  a  want  of  appreciation,  and  was 
attributed  to  restricted  medical  education  and 
unfamiliarity  with  electro-physics  and  electro- 
physiology.  Some  of  the  more  progressive  of 
medical  schools,  he  was  pleased  to  observe, 
were  beginning  to  realize  the  necessity  cf 
teaching  this  branch  of  therapeutics.  The  imper- 
fections of  past  methods,  which  were  certainly 


unscientific,  likewise  operated  greatly  against  a 
proper  appreciation  of  modern  electro-thera- 
peutics. This  could  be  overcome  by  diffusing 
a  more  general  know'edge  of  the  true  position 
occupied  by  electro-therppeutics,  and  its  suc- 
cessful accomplishment  depended  greatly  upon 
the  character  of  ihe  work  done  by  the  Associa- 
tion  and  upon  tiie  personality  of  its  members. 

The  progressive  spirit  of  the  Association  was 
well  shown  by  the  fact  that  there  were  no  less 
than  six  committees  charged  with  investigating 
scientific  questions  having  an  important  bear- 
ing upon  the  different  branches  of  the  subject. 
He  regarded  the  admission  of  other  scientists 
from  the  electrical  world  to  membership  in  the 
Association  a  step  iii  the  riglit  direction,  and 
further  evidence  of  its  progressive  nature. 

He  recalled  the  fact  that  within  the  past  five 
years  scarcely  a  year  had  clasped  without  the 
development  of  some  new  and  important  feature 
involving  the  application  of  electricity  in  some 
one  of  its  forms.  As  an  instance  of  this,  he 
cited  the  development  of  metallic  electrolysis 
and  its  extensive  application,  also  the  alternat- 
ating  sinusoidal  current  of  D'Arsonval  and  the 
capabilities  of  the  interrupted  induced  current 
obtainable  from  modern  apparatus. 

The  important  improvements  that  have  been 
made  within  the  past  few  years  in  induction 
a^^paratus,  whereby  an  increased  frequency  of 
interruption  and  an  increased  electro-motive 
force  of  the  current  was  obtained,  he  thouglit 
deserved  special  mention.  The  possibilities  of 
this  current,  from  a  therapeutic  standpoint,  are 
quite  beyond  the  conception  of  anyone  who 
has  not  had  a  practical  clinical  experience 
with  it. 

The  programme  of  the  present  meeting  gave 
abundant  evidence  of  the  advanced  thought  and 
work  which  have  characterized  the  Association 
ever  since  its  inception,  and  it  was  evident  that 
electro-therapeutics  is  steadily  progressing 
towards  an  exact  science. 

Attention  was  directed  to  the  fact  that,  though 
concerted  effort  for  electro-therapeutics  is  still 
young,  its  influence  upon  the  views  prevailing 
in  medicine  is  already  distinctly  manifest. 

In  conclusion,  the  President  declared  that 
by  conjoint  efforts  electro- therapeutics  would 
be  brought  to  that  scientific  plane  which  would 
make  its  most  strenuous  opponents  their  most 
cordial  supporters. 

The  next  order  of  business  was  the  reading 
of  "  Reports  of  Committees  0.1  Scientific 
Questions." 

0)1  Standard  Coils. — The  Chairman  of  this 
Committee,  Dr.  William  James  Morton  of  New 
York,  said  that  the  subject  was  so  large,  and 
each  month  was  bringing  so  many  new  facts, 
that  it  seemed  premature  to  make  a  report  as 
to  what  should  constitute  a  standard  coil.  On 
motion,  the  committee  was  continued. 


38/ 


THE  CANADA   MEBICAL   RECORD. 


On  Standard  Meters. — Ur.  Margaret  A. 
Cleaves  of  New  York  read  a  report  of  tliis  Com- 
mittee. The  report  stated, that  a  good  meter 
should,  possess  a  clear,  legible  scale  of  long 
range, -^aii^  should  be  so  cohsti acted  that  it 
could  be  easily  read  by  the  operator  while  at 
workj  that  although  in  itself  a  shunt  is  not  dis- 
advantageous, it  is  undesirable^  because  of  the 
possibility  of  its  heating  and  thereby  changing 
its  resistance;  that  the  instrument  should  indi- 
cate inall  positions,  and  is  preferable  when  con- 
structed to  indicate  with  the  current  passing  in 
either  direction;  that  it  should  be  very  portable; 
and  lastly,  that  it  sh.ould  not  easily  get  out  of 
order.  Instruments  of  the  galvanometer  type 
were  considered  to  be  inaccurate  on  account  of 
the  magnetic  influence  exerted  by  surrounding 
objects 

Then  followed  a  detailed  description  of  the 
nine  meters  which  had  been  submitted  to  the 
Committee  for  examination,  and  the  tests  to 
which  these  instruments  had  been  subjected. 
The  report  concluded  with  the  statement  that 
in  the  opinion  of  the  (,"ommittee  the  two  meters 
which  most,  nearly  fulfilled  the  requirements 
were  tive  Weston  and  the  Kennelly  meters,  and 
the  Association  was  urged  to  adopt  at  once  a 
standard  meter. 

The  report  called  forth  a  long  and  earnest 
discussion  as  to  the  advisabi  ity  of  adopting 
at  present  a  standard  meter.  Some  of  the 
members  were  of  the  opinion  that  one  of  the 
meters  especially  recommended  by  the  Com- 
mittee had  not  been  sufficiently  long  before 
the-  profession  to  enable  many  of  those 
present  to  pass  intelligently  upon  its  advan- 
tages or  disadvantages,  and  they  therefore 
deprecated  hasty  action.  Others  thought 
it  w^s  impossible, to  combine  in  any  one  meter 
all  the  points  a  meter  should  possess  in  order 
to  render  it  a  thoroughly  reliable  instrument  for 
all  kinds  of  clinical  works;  and  they  conse- 
quently favored  the  adoption  of  two  types  of 
standard  meters.  It  was  also  suggested  that  to 
avoid  unnecessary  discrimination  the  Associa- 
tion-should adopt  a  type  of  meter  as  a  standard 
rather  than  any  one  particular  instrument.  The 
report  of  the  Committee  was  finally  accepted, 
and  the  Chairman  of  the  Committee  continued. 

On  static  ^fachines. — Dr.  Morton  reported 
that  in  order  to  pursue  their  investigations 
systematically,  a  number  of  questions  had  been 
sent  out  in  a  circular  letter,  but  no  responses 
had. been,  received.  The  Committee  made  the 
following  recommendation  :  That  electro-static 
machines  adapted  to  medical  practice  should 
not  have  less  than  four  revolving  plates,  and 
that  the  diameter  of  these  plates  should  not  be 
less  than  twenty-six  inches.  The  report  of  the 
Committee  was  accepted  and  the  Committee 
continued. 

On  Constant  Current  Generators  and  Con- 
trollers.— -Dr.  W.  J.  Herdman,  of  Ann  Arbor, 


read  a  carefully  prepared  report  on  this  subject, 
in  which  he  considered  in  detail  the  work  ac- 
complished by  the  various  batteries  which  had 
been  subaiitted  to  him  for  examination.  No 
s?condary  batteries  h.ad  been  submitted,  and 
mention  of  one  or  two  batteries  which  had  only 
been  very  recently  sent  in  was  omitted  for  lack 
of  time  to  make  the  necessary  tests.  On  motion, 
the  report  was  accepted,  and  the  Chairman  of 
the  Committee  continued. 

On  Electrodes. — Dr.  A.  Lapthorn  Smith,  of 
Montreal,  read  a  report  of  the  committee.  I  he 
committee  expressed  the  opinion  that  the  best 
ground-work  of  all  electrodes  is  copper  wire 
gai'ze.  and  that  the  connection  is  b^st  made  by 
copper  wire  soldered  the  whole  length  of  the 
gauze  and  terminating  in  a  binding  post — that 
known  as  No.  6-32  (?) — which  is  largely  used 
by  telephone  comixmies  throughout  the  world. 
Clay  was  considered  the  best  covering,  as  it 
was  the  only  substance  which  could  be  rendered 
moist  enough  to  conduct  properly  without  at 
the  same  time  soiling  the  patient's  clothing.  It 
should  be  half  an  inch  thick  and  of  the  consis- 
tency of  putty.  Before  each  application  it  can 
be  readily  cleaned  by  washing  its  surface  with 
soap-suds.  The  back  of  the  electrode  is  insul- 
ated with  common  table  oilcloth. 

The  committee  recommended  three  sizes  of 
dispersing  electrodes,  viz.:  each  having  a  uni- 
form length  of  one  foot,  and  the  width  three, 
six  and  nine  inches  respectively.  It  was  desir- 
ab'e  that  these  sizes  should  be  given  in  the 
metric  system.  For  active  electrodes  to  be 
used  with  the  positive  pole,  the  committee 
npturally  sehcted  p'atinum  as  the  best,  its  one 
objection  being  its  fii St  cost.  Where  the  appli- 
cations are  to  be  made  to  the  surface  of  the 
body  or  to  the  interior  of  a  cavity  like  the 
uterus,  carbon  is  equally  good,  and  for  such 
purposes  carbon  beads  can  be  threaded  on 
platinum  wire.  Zinc  is  also  a  useful  material 
for  intra-uterine  galvano-cauierizatio;i.  It 
should  be  connected  with  the  reophore  by 
means  of  the  standard  binding  post  already 
mentioned.  It  was  recommended  that  the  con- 
ducting cords  employed  in  electro-therapeutical 
work  should  be  of  the  standard  sizes  and  lengths 
used  by  the  Bell  Telephone  Company. 

For  negaiive  intra-uterine  application,  a  Simp- 
son sound  made  a  useful  clc  trode,  and  its  size 
should  be  staled  according  to  the  French  scale. 
Where  the  surface  of  the  electrode  is  necessarily 
very  irregular,  its  area  should  be  determined 
by  ascertaining  how  much  water  it  will  displace. 
It  will  "be  well  for  manufacturers  to  stamp  all 
electrodes  with  two  numbers — one  giving  the 
French  scale,  and  the  other  the  dispLicement  of 
water  on  the  surface  of  the  electrode. 

The  committee  recommended  that  a  stan- 
dard insulating  material  be  adopted,  and  that 
the  standard  screw  should  be  No.  2-40  of  the 
American  gauge. 


THE   CANADA   MEDICAL   RECORP. 


'39 


All  electrodes  should  be  washed  with  soap- 
suds after  each  application,  and  boiled  for  five 
minutes  before  being  used  again. 

Dr.  Morton  supplemented  this  report  by  pre- 
senting certain  electrodes  which  he  had  devised, 
and  which  had  proven  useful  in  his  practice. 
The  fist  was  a  rubber  covering  for  dispersing 
electrodes.  It  was  an  elastic  rubber  cap  which 
would  slip  over  the  various  sized  electrodes, 
and  which  formed  a  pocket  around  the  elec- 
trode, thus  catching  the  water  which  would 
otherwise  leak  out  on  the  patient's  clothing. 
The  second  instrument  was  a  new  cataphoric 
ekxirode.  With  the  usual  form  of  this  electrode 
it  had  been  found  impossible  to  apply  the 
desired  quantity  of  the  medicated  solution  to 
the  el  clrode  without  increasing  the  thickness 
of  the  blotting-paper,  to  such  an  extent  that  it 
interfered  with  and  sometimes  wholly  prevents 
cataphoresis ;  for  it  is  essential  that  the  dis- 
tance between  metallic  conduction  and  electro- 
lytic conduction  should  be  reduced  to  a  mini- 
mum. To  obviate  this  defect,  Dr.  Morton  had 
an  electrode  made  in  the  form  of  a  hollow  box 
of  hard  rubber,  the  bottom  of  the  box  being 
formed  by  a  piece  of  block  tin  perforated  with 
numerous  small  holes.  The  box  is  filled  with 
the  desired  quantity  of  the  medicated  solution, 
which  passes  through  the  small  openings  in  the 
tin  bottom  and  is  fed  to  a  thin  piece  of  blotting- 
paper  on  its  lower  surface.  In  this  way  any 
quantity  ol  the  solution  may  be  employed  with- 
out interfering  in  the  slightest  degree  with  the 
cataphoric  action. 

The  third  instrument  exhibited  was  an  Apos- 
toli  intra-uterine  electrode  insulated  at  the  tip 
and  at  the  cervical  portion.  In  conclusion,  the 
speaker  referred  to  the  advantages  of  punk  as  a 
covering  for  electrodes,  and  said  his  patients 
invariably  found  it  the  most  agreeable  cover- 
ing of  any  employed.  It  had  the  great  advan- 
tage of  remaining  moist  for  a  long  time. 

Dr.  G.  Betton  Massey,  of  Philadelphia,  said 
that  two  years  ago  he  devised  an  electrode 
made  of  a  spiral  of  platinum  wire  enclosing  a 
second  spiral,  the  object  of  this  construction 
being  to  facilitate  rendering  the  instrument 
aseptic.  A  flat  coil  of  No.  20  wire  was  in  his 
opinion  a  much  better  basis  for  an  electrode 
than  gauze.  If  the  French  scale  were  employed, 
he  thought  it  should  indicate  the  diameter  and 
not  the  circumference  of  the  instrument. 

Dr.  Franklin    H.   Martin,  of  Chicago,  called 

attention  to  the  fact  that  he  was  the  first  one 

to  invent  and  exhibit  a  spiral  electrode.     His 

.  instrument  was  first  brought  to  the  notice  of  the 

profession  in  1887. 

Dr.  J.  B.  Greene,  of  Indiana,  preferred  the 
English  to  the  French  scale.  The  best  mate- 
rial he  had  ever  used  for  an  electrode  was  moist- 
ened wood-pulp  ;  it  was  an  excellent  conduc- 
tor, and    so  cheap   that  it  can  be  thrown   away 


after  use.  In  his  opinion,  it  would  be  imprac- 
tical)le  to  fix  upon  standard  sizes  for  elec- 
trodes. 

A  communicaiion  was  read  from  Dr.  Lucy 
Hall  Brown,  of  Brooklyn,  in  which  she  recom- 
mended a  special  electrode  made  of  perforated 
brass  plate  covered  with  punk,  and  connected 
to  the  reophore  by  a  peculiar  spring  clamp 
which  she  had  devised.  • 

On  Invest  ii.  ation  of  Dr.  Neicman'  s  Statistics 
ill  Urethral  Stricture. —  I  he  coTnmiitee,  con- 
sisting of  Drs.  A.  H.  ,  Goelet,  Wni.  J.  Morton 
and  W.  J.  HerJman,  reported  that  they  had 
made  a  very  careful  and  conscientious  examin- 
ation of  Dr.  Newman's  records  and  statistics, 
and  had  asked,  but  unsuccessfully,  for  the  co- 
operation of  certain  general  surgeons.  .  The 
committee  unanimously  ag'eed  that  Dr.  New- 
man's statistics  fully  substantiat-.d  the  claims 
he  had  made. 

AFTERNOON  SESSION. 

Dr.  Newman,  of  New  York,  read  a  paper  on 
"  Electrolysis  in  Tumors  of  the  Bladder." 

The  author  considered  only  cases  of  non- 
malignant  tumors  in  the  female  bladder.  If 
the  bladder  be  very  irritable,  the  preparatory 
treatment  should  consist  in  the  careful  use  of 
medicated  injections,  by  which  means  a  bladder 
which  can  hardly  retain  four  ounces  may  be 
made  to  tolerate  as  much  as  twelve  ounces  of 
fluid.  For  the  proper  use  of  the  cystoscope  it 
is  necessary  to  have  from  four  to  six  ounces  of 
fluid  in  the  bladder.  The  cystoscope  is  first 
used  to  locate  the  tumor,  and  the  author  ad- 
vised that  its  use  should  be  immediately  fol- 
lowed by  an  examination  with  the  endoscope. 
By  means  of  the  rubber  ring  slid  on  to  the 
instrument  it  is  easy  to  locate  the  distance  of 
the  tumor  from  the  meatus. .  Indeed;  he  had 
found  comparatively  little  difficulty  in  subse- 
quently cauterizing  the  exact  spot  d-^sired. 
'i'he  constant  current  of  a  galvanic  battery  was 
invariably  employed,  and  except  where  it  is 
necessary  to  control  haemorrhage,  the  negative 
pole  was  the  one  selected.  The  average  cur- 
rent strength  was  10  m.a.  ;  each  sitting  lasted 
from  five  to  fifteen  minutes,  and  the  intervals 
depended  upon  the  result  of  each  sitting  ^nd 
the  condition  of  the  patient.  .■■     ■- 

There  are  two  methods  of  electrolysis,  gen- 
eral and  local.  General  electrolysis  has  a 
specific  absorbing  and  healing  eifect  upon  a 
tumor,  and  may  be  employed  when  the  patient 
cannot  tolerate  other  measures.  Local  electro- 
lysis may  be  performed  :  ist,  by  means  of  a  little 
bulb  placed  in  contact  with  the  tumor;  2ndly, 
by  the  introduction  of  a  platinum  needle;  and 
3rdly,  by  fixation  of  the  tumor  and  the  introduc- 
tion of  a  platinum  needle  into  the  tumor. 

-  To  be  continued. 


40 


THE   CANADA   MEDICAL   RECORD. 


THE  CANADA  MEDICAL  RECORD. 

Published  Moxthlt. 


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EDITORS : 

k.  L&PIHOilN  SMITH,  B.A.,M.D.,  M.R.C.S.,  Eng.,  F.O-S. 

London- 
F.  WAYLAND  CAMPBELL,  M.A-,  M.D,  L.RC.P  ,  London 

ASSIST  AN  r  EDITOR 
ROLLO  CAMPBELL,  C-M.,    M.D- 

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MONTEEAL,  iNOVEMBER,  1893. 

THE    STAMPING  OUT  OF    TUBERCU- 
LOSIS IN  CATTLE  AND  IN  MAN. 

As  a  result  of  the  discussion  of  this  subject  at 
the  Medical  Society  of  Montreal  last  session,  the 
Goveriment  of  Canada  has  with  commendable 
energy'set  about  eradicating  this  d  isease  from 

the  herds  of  Canada,  beginning  by  the  slaughter 
of  all  the  animals  found  to  be  infected  on  the 
experimental  farms.  The  diagnosis  is  made  with 
Koch's  lymph,  and  appears  to  have  been  verified 

in  every  case  by  the  subsequent  autopsy. 

So  far,  however,  little  has  been  done  towards 
banishing  the  fell  disease  from  the  midst  of  the 
six  millions  of  human  beings  among  whom  its 
presence  is  annually  causing  financial  loss  and 
general  misery,  in  comparsion  with  which  the 
few  million  dollars  involved  in  the  cattle  interest 
are  a  mere  bagatelle.  It  is  unnecessary  for  us  to 
go  into  elaborate  calculation,  estimating  the  an- 
nual cost  of  consumption  to  a  country  like  ours  ; 
everyone  who  reads  this  is  only  too  well 
aware  of  the  expense  and  loss  of  earning  power 
which  it  inflicts.  The  most  important  question 
is  :  Can  anything  be  don.-^  to  prevent  or  at  least 
to  diminish  it?  The  answer  is,  we  think,  de- 
cidedly. Yes. 

To  begin  with,  a  great  deal  can  be  done  with- 
out at  all  interfering  with  the  liberty  of  the  un- 
fortunate people.  In  our  experience  of  con- 
sumptives, at  least  75  per  cent,  of  them  were 
so  poor  that  they  would  gladly  have  acceiDted 
an  invitation  to  become  the  guests  of  the  State: 


in  fact,  a  great  many  of  them  applied  in  vain  for 
admission  to  our  overcrowded  hospitals.  We 
feel  sure  that  if  the  information  which  we  now 
possess  concerning  the  contagiousness  of  the 
disease  were  scattered  broadcast,  and  at  the 
same  time  the  Federal  Government  would 
establish  a  free  sanitarium  for  consumptives,  at 
least  75  per  cent,  of  all  the  consumptives  in  the 
country  would  voluntarily  apply  for  admission. 
They  might  be  accepted  on  condition  that  they 
would  promise  to  remain  until  they  died  or 
were  cured.  We  say  cured,  for  there  is  not  the 
slightest  doubt  that  many  cases  would  be 
cured  under  special  treatment.  Microscopical 
examination  of  the  sputa  would  easily  decide 
when  the  latter  were  free  from  bacilla  and  when 
the  patient  might  return  to  his  family.  It  is 
difficult  to  realize  the  magnificent  results  from 
the  removal  of  even  75  per  cent,  of  this  foe:  of 
infection.  But  even  the  remaining  25  per  cent, 
among  the  well-to-do  classes  would  soon  be 
educated  up  to  the  point  of  making  a  little  self- 
sacrifice  for  the  sake  of  those  they  loved,  and 
before  long  private  sanitariums  for  pay  patients 
would  be  opened  for  the  reception  of  those  who 
were  able  and  willing  to  pay  their  own  ex- 
penses. 

Neither  does  it  follow  that  the  inmates 
of  the  vast  free  national  sanitarium  would  be 
condemned  to  enforced  idleness;  on  the  contrary, 
farming  and  many  other  outdoor  occupations 
are  eminently  conducive  to  the  ventilation  of 
tie  lungs,  which  is  one  of  the  first  steps  in  the 
process  of  killing  the  parasitic  fungi  of  the 
disease.  The  establishment  would  probably 
in  a  short  time  become  self-supporting.  The 
great  objection  to  this  very  rational  scheme  is 
of  course  the  expense.  But  are  human  lives  not 
worth  fully  as  much  as  those  of  cattle  ?  If  so, 
then  no  matter  what  the  cost,  the  Federal 
Government  is  justified  in  incurring  the  expense 
of  stamping  out  this  plague  from  the  homes  as 
well  as  from  the  stables  of  Canada. 


A  UNIVERSITY  OF  CANADA. 

More  than  once  the  establishment  of  such  an 
institution  has  been  advocated  in  these  columns, 
but,  until  lately,  without  much  prospect  of  suc- 
cess. The  idea,  however,  has  been  steadily 
growing  in  favor  with  the  profession,  and  before 
many  years  we  hope  to  see  it  ini  fait  accotnpii. 


THE  CANADA.   MEDICAL   RECORD. 


41 


At  present  a  physician  of  the  highest  standing, 
the  Dean  of  McGill  College,  for  instance,  might 
be  prosecuted  for  practising  without  a  licence  on 
one  side  of  the  Ottawa  river  in  Ontario,  although 
he  would  be  eniitled  to    practise  in  the  village 
of  Hull,  a  quarter  of  a  mile  distant,  in  the  prov- 
ince of  Quebec.     This  arrangement  or  lack  of 
interprovincial  reciprocity  is  felt  to  be  such  an 
anomaly  that  various  schemes  have  been  pro- 
posed   for    its    remedy.     All   are   agreed  that 
there  should  be  some  kind  of  a  Federal  or  Do- 
minion licensing    board   whose  diploma  would 
carry  with  it  the  right  to  practise  in  any  part 
of  the  Dominion.     It  seems  to  us,  however,  that 
if  such  a  piece  of  machinery  is  to  be  organized, 
it  would   be  better  to  make  it   the   best  of  its 
kind,  and  call  it  a  University,  modelling  it  after 
the  most  illustrious  University  at  present  in  the 
world, — the  University  of  London.    This  would 
in  no  way  interfere  with  the  rights  of  the  various 
Medical  colleges,  which  could  continue  to  exer- 
cise their  teaching  and  even  degree  and  diploma- 
giving  functions,  for  the  University  of  Canada 
would  not   be  a   teaching   body.     The    duties 
would  simply  be  to  meet  at  Ottawa  once  a  year, 
for   a  week  or  longer,  for  examining   purposes 
only,  and   anyone  from  any  land    presenting 
proper  guarantees  of   previous  general  educa- 
tion, and  paying   a  fee  of,  say,  one  hundred 
dollars,  could  present  himself  for  examination. 
This  would  provide  a  long-felt  want  for   some 
standard  portal  through  which  the  graduates  of 
all   the  schools  might  pass    if  they  were    able, 
and  go  forth  on  a  perfect  equality.    There  is  no 
doubt  that  on  the  establishment  of  such  a  Uni- 
versity, and  adducing  proof  of  its  high  stand- 
ards, its  decree  would  be  accepted  by  England 
and  France  on  reciprocal   terms.     A  talented 
Canadian,  who  has  the  glory  of  our  country 
deeply  at  heart,  and  who  is  now  a  leading  Lon- 
don surgeon,  has  urged  us  to  advocate  persist- 
ently the  great   step    towards    convincing  the 
world   that   medical   education    in   Canada   is 
second  to    none.     The    examiners    should    be 
chosen  for  merit  only  from  the  teachers  in  all 
parts  of  the  Dominion,  the  fees  for  examina- 
tion offering  ample  remuneration  for  their  time 
and  travelling  expenses.     We  would  strongly 
urge  those  who  have  the  question  of  a  Dominion 
license  in  hand  to  make  it  take  the  form  of  a 
University    degree,   and    forthwith    bring    the 
matter  before   Parliament  at  its  next  session. 


THE    CLOSURE    OF    THE    KINGSTON 
WOMEN'S  COLLEGE. 

After  several  years  of    brave  struggling  to 
keep  open  in  the  face  of  many  discouragements, 
the  above  College  has  been  compelled  to  close 
its   doors,   and   the  female  students  have  been 
transferred  to  the  excellent  Women's  Medical 
College  of  Toronto,    Manj^  of  them  would  have 
come  to    Montreal   had   any  of   the   medical 
schools  been   able   to  receive  them.     But  the 
McGill    Medical  P'aculty  is  oppsed  to  female 
medical    students,  and  the  Faculty  of  Bishop's 
College,  which  is  favorable  to  them,  has  unfor- 
tunately no  hospital   facilities  for   clinical  in- 
struction, the   authorities    of    both  the  Hotel 
Dieu  and  General  Hospital  having  declined  to 
admit  them  to  the   practices  of  the  hospitals. 
So  that  Bishop's  College,  which  made  consider- 
able  preparations  for  the  reception  of  female 
medical  students,    sees    them    drawn  away  to 
Toronto,  owing  to  the  action  of  the  governors  of 
the  General    Hospital.     With    so    many  diffi- 
culties to  contend  with,  we  fear  that  Bishop's 
College  will  never  attain  a  satisfactory  position 
until  it  has  at  its  disposal   hospital  facilities  of 
its  own,  and  to   this  end  we  think    she  should 
devote  all  her  energies.     The  acquirement    of 
hospital   facilities   is    all   the   more   important 
now  that  the  whole  tendency  of  modern  medical 
teaching  is   inclining   towards   clinical  instead 
of  didactic  lectures.     The  loss  of  these  female 
students  is  the   more    to    be   deplored  at  the 
present  time,  when  the  number  of  male  students 
has    been    considerably     diminished    by   the 
financial  depression  in  the  United  States.    We 
hope  that  some  wealthy  friend   of  the  College 
may   come  forward  with   a  liberal  endowment 
for  a  general  hospital,  so    that  the  students  of 
Bishop's  may  be  able  to  obtain   there  clinical 
instruction,  without  having,  as    at  present,  to 
depend  for  it   upon   the  good   nature  of  the 
professors  of  rival  schools.      As, it  is,  the  vast 
endowment  of  McGill  and   Laval   with  a  large 
corps  of  paid  teachers  renders  it  very  difficult 
for  a  small    and  une  ndowed  college  to  attract 
pupils ;   for  no  matter  how  willing  the  unpaid 
teachers   may    be,   they    must    attend    first  to 
their  private  practice,  on  which  their  livelihood 
depends. 


42 


THE   CANADA   MEDICAL   RECORD. 


ANNOUNCEMENT. 


i^For  Etig/ish-speaking  Co/ididates.) 

COLLEGE  OF  PHYSICIANS  AND  SUR- 
GEONS OF   THE  PROVINCE 
OF  QUEBEC. 

PROGRAMME    OF   THE    PRELIMINARY 
EXAMINATION  FOR  I  894. 


Latin. — The  Commentaries  of  Cresar,  Bks.  I, 
II,  III,  IV,  v.— The  .F.neid  of  Virgil,  Bks. 
I  and  II.— The  Odes  of  Horace,  Bk.  III. 
A  sound  kno.vledge  of  the  Grammar  will 
be  required. 

English. — A  critical  knowledge  of  Shakesj^eare's 
play  of  HENRY  VIII.  Questions  of  gram- 
mar, Etymology  and  Analysis. 

French. — Translation  into  English  of  passages 
from  "  Telemachus'''  with  questions  of 
grammar  and  parsing.  Also  translation 
into  French  of  easy  English  sentences. 

Belks-Lettres. — Principles  of  the  subject  and  of 
Rhetoric  ;  also  History  of  the  Literature  of 
the  age  of  Pericles  in  Greece,  of  Augustus 
in  Rome  and  of  English  and  French  Liter- 
ature of  the  17th,  i8th  and  19th  centuries. 

History. — A  general  knowledge  of  the  History 
of  Greece  and  of  Rome,  and  a  more  parti- 
cular knowledge  of  British,  French  and 
Canadian  History. 

Geograj)hy. — A  general  knowledge  of  the  sub- 
ject, and  more  especially  of  England. 
France  and  North  America. 

Arithmetic — Must  include  vulgar  and  decimal 
fractions,  simple  and  compound  propor- 
tion, interest,  percentages  and  square  loot. 

Algebra. — Must  include  fractions  and  simple 
equations  of  two  unknown  quantities. 

Geometry. — The  first  three  books  of  Euclid 
and  principal  propositions  of  the  Sixth. 
Also  the  measurement  of  the  lines,  surfaces 
and  volumes  of  the  regular  geometrical 
figures. 

OPTIONAL  SUBJECTS. 

The  Candidates  must  select  one  oj  the  following. 

Greek. — The  j^nabasis  of  Xenophon,  Bks.  I, 
II,  III,  and  the  Iliad  of  Homer,  Bks.  I 
and  IV,  with  questions  of  grammar. 

Physici. — General  principles  as  ''n  Peck's  trans- 
lation of  Ganot. 

Philosophy. — Logic  with  Mental  and  Moral 
Philosophy. 

N.B. — Candidates  must  produce  certificates  of 
good  moral  character.  Any  candidate 
detected  in  copying  or  in  aiding  another 
to  copy,  or  in  using  books  or  notes,  will 
be  immediately  dismissed  from  the  room. 
At  the  conclusion  of  the  examination,  each 
candidate  will  be  required  to  make  before 
a  magistrate,  then  present,  a  solemn  declar- 


ation that  he  has  not  had  recourse  to  any 
fraudulent  means  to  aid  him  in  the  examin- 
ation. He  must  also  furnish  proof  of 
his  identity. 

ORDER  OF  SUBJECTS  AND  NUMBER  OF  MARKS 
FOR  EACH. 

First  Day. 

Latin from    9  to  11 200  marks. 

<^    History "    11    "   12 100  " 

G,  Geography...     "    12    "      i 100  '* 

§    French '•   2>^   "     4 150  "■ 

O    English "     4     "  5)^.... 150  " 

Be^'esT.ettres     "  5)^  •'  6>4....ioo  " 

Second  Day. 

pq    Geometry from  8^  to  10 100  marks. 

;:!.  Arithmetic...     "    10    "    iii^...ioo       " 

%    Algebra "ii>^"      t 100       " 

O    Optional  Sub- 
ject        "    2i^  "     4 200      " 


Note. — A  Candidate  must  obtain  half  the  total 
marks   allowed  for  Group  A.  in  order  to 
pass  in  that  group.    So  also  for  Group  B.  ; 
but  his  failing  to  pass  in  one  of  the  groups 
will  not  nullify  success  in  the  other. 
Further,  in  order  to  pass  in  the  several  subjects, 
a  candidate  must  obtain  marks  for  them 
as  follows  : — 
For  English,  being  the  mother  tongue,  three- 
fourths  of  the  marks. 
For    Latin,  Arithmetic  and    Optional  subject, 

one-half  of  the  marks  for  each. 
For  all  other  subjects,  one-fourth  each. 
Lastly,  if  a  candidate  fail  in  any  one  subject  of 
a  group,  he  will  be  required  to  repeat  exam- 
ination in  all  the  subjects  of  that  group, 
though  he  may  have  been  successful  in  the 
other  group. 

H.  Aspinwall  Howe,  LL.D., 
J.  C.  K.  Laflamme,  LL.D., 
Henry  Watters,  B.A., 
Prof.  Charles  Albert  Pfister, 
Examiners. 


BOOK    NOTICES. 


A  Manual  of  Medical  Treatment  or 
Clinical  Therapeutics.  By  I.  Burney 
Yeo,  M.D.,  F.R  C.P.,  Professor  of  Thera- 
peutics in  King's  College,  London.  In 
two  i2mo.  volumes  containing  1275  pages, 
with  illustrations.  Complete  work,  cloth, 
$5.50.  Philadelphia,  Lea  Brothers  &  Co., 
1893. 

This  work  is  devoted  entirely  to  the  treat- 
ment of  disease,  being  the  first  we  have  ever  seen 
of  the  kind.  There  are  many  excellent  works  on 
therapeutics,  but  this  is  the  first  work  devoted 
to  clinical  therapeutics.     For  this  reason,  and 


THE  CANADA  MEDICAL  RECORD. 


also  because  it  is    wriiten    in    such    clianning 
language,  this  book  is  really  interesting.     More 
than  once  we  have  taken  it  up  to  glance  over 
it,  which,  we  are  sorry  to  say,  is  all  the  time  we 
can   spare  for  the  work  of  reviewing,  but  after 
an  hour's  reading  we  were  unable  to  lay  the  vol- 
ume down,  and,  instead  of  writing  a  notice  of 
it,  we  have  just  read  on  and  on.      As  the  author 
says,  he  has  approached   the  subject  from  the 
side  of  the  disease  and  not  from  the  side  of  the 
drug  or  remedy.     Only  enough  of  the  pathology 
and  etiology  of  disease  is  introduced  as  is  ne- 
cessary to  arrive   at    the  rational  indications, 
without    which    the    administration  of  a   drug 
can  hardly  be  called  scientific.      Haifa  dozen 
choice  formulae  by  leading  London  physicians 
are  appended   to   each   chapter.      The  author 
deprecates  the  modern  tendency   to  prescribe 
new  remedies,  some  of  them  patent  chemical 
agents  merely  on  the  recommendation  of  the 
manufacturers.     There   is  no  doubt  that  many 
medical  men  are  the  poor  tools  of  the  wealthy 
drug  exporter,  and  many  a  physician  of  good 
ability  has  prescribed    himself  out  of  practice, 
when,  if  he  had  stuck  to  the  well-known  stand- 
ard drugs  which  have  stood  the  test  of  years, 
he  would  have  reaped  a  splendid  success.      It 
is  impossible,  of  course,   to  specially  notice  all 
the  good  qualities  of  this  work,  we  can  only  take 
up  a  few  in  which  we  are  more  especially  inter- 
ested—  for  instance,  the  article  on  habitual  con- 
stipation   is   a    remarkably    clear    one.       The 
author  points  out  that  in  many  of  such  cases, 
the  patient  does  not  take  in  a  sufficient  quan- 
tity of  water,  so  that  after  the  other  organs  have 
been  supplied,  none  remains  over  with  which 
to  keep  the  contents  of  the  bowels  soft;  others 
again,  he  says,  owing  to  defective  appetite   or 
painful  digestion. do  not  take  a  sufficient  qjantity 
of  food  to  yield  the  necessary  stimulus  to  per- 
istaltic contraction  in  the  intestinal  canal.      He 
lays  great   stress    on   the   necessity  for  bodily 
exercise,  and  where  this  cannot  be  obtained  in 
sufficient    amount,    he     recommends     abdom- 
inal massage  along  the    whole    course   of  the 
colon.     He   does  not  neglect  either  to  urge, 
especially  in  the  case  of  young  girls,  the  impor- 
tance of  having  a  regular  hour  every  day    for 
attending  to  the  bowels.      His  article  on   the 
treatment  of  peritonitis  is  thoroughly  up  to  date, 
and  he  brings  forward  a  good  deal  of  evidence 
to  show  that  the  operative  treatment  is  on  the 
whole  most  likely  to  be   of  benefit.     The  piece 
de  resistafice,  his  article  on   pulmonary  tuber- 
culosis, having  been  for  many  years  physician 
to  Brompton  Hospital,  we  are  not  surprised  to 
find  that  he  has  devoted  one  hundred  and  thirty- 
one  pages  to  the  treatment  of  this  disease. 

In  his  chapter  on  the  prevention  of  the 
disease,  he  sets  forth  very  clearly  the  necessity 
for  the  disinfection  or  the  destruction  of  the 
sputum  of  phthisical  patients.  He  considers 
that  the  exposure  of  tubercle  bacilli  to  boiling 


water  for  cleanliness  is  the  most  effective  method 
of  destroying  them.      The  risk  of  infection  by 
the    dust    of  dried    sputum  may  be  provided 
against  to  some  extent  by  warning  the  patients 
not  to  spit  on  the  floor  either  in  the  house  or 
in  street  cars,  etc.       He  recommends  Japanese 
paper  handkerchiefs,   which  afterwards   can  be 
burned.       He  is  also  greatly  in  favor  of   the 
sanitary    cuspidor,    which    we     have     already 
noticed    in  this  Journal.     There  are  also  five 
chapters  on   the  general  medical  treatment  of 
phthisis,  on  the  symptomatic  treatment,  on  the 
treatm  nt    of  complications,    and  the  surgical 
treatment  of  phthisis   cavities.     Chapter  Five 
treats  of  the  regimenal  treatment,  and  Chapter 
Six,  climatic   treatment.     In    his  article  on  the 
medical    treatment    of  acute    rheumatism   and 
speaking  of  rheumatic  endocarditis,  he  is  very 
severe  on   the  dry  diet   recommended  by   our 
esteemed  confrere,  Professor  James  Stewart  of 
Montreal.   He  says,  "  to  attempt  to  feed  a  patient 
suffering  from  acute  rheumatism,  who  is   sweat- 
ing profusely  and    passing  dense  high-colored 
uiine,  with  a  dry  diet  in  order  to  obtain  some 
very  problematic  lowering  of  blood  pressure,  is 
surely  to  misapprehend  the  situation  entirely." 
The   index  is  so  arranged  that  one  can    find 
either  a  disease  or    the  various  remed-'es  at  a 
glance.     Without  exaggeration,  we  can  say  in 
cone  usion,  that  one  could  hardly  read  anything 
affording  at  the   same  time   so  much  pleasure 
and  profit  as  this  elegantly  written  and  beauti- 
ully  printed  book  by  Doctor  Burney  Yeo. 


A  Treatise  on  -rHE  Science  and  Practice  of 
Midwifery.  By  W.  S.  Playfair,  M.D., 
F.R.C.P.,  Professor  of  Obstetric  Medi- 
cine in  King's  College,  London;  E.x- 
aminer  in  Midwifery  to  the  Universities  of 
Cambridge  and  London,  and  to  the  Royal 
Colleje  of  Physicians.  Sixth  American 
from  the  eighth  English  edition.  Edited, 
with  additions,  by  Robert  P.  Harris,  M.D. 
In  one  octavo  volume  of  697  pages,  with 
217  engravings  and  5  plates.  Cloth,  $4.00; 
leather,  $5.00,  Philadelphia,  Lea  Brothers 
&  Co.,  1893. 

The  demand  for  eight  English  and  six  Ameri- 
can editions  of  this  standard  work  in  seventeen 
years  testifies  to  the  success  with  which  the 
author  has  executed  his  original  purpose.  His 
object  "  has  been  to  place  in  the  hands  of  his 
readers  an  epitome  of  the  science  and  practice  of 
midwifery  which  embodies  all  recent  advances." 
He  has  "  endeavored  to  dwell  especially  on  the 
practical  part  of  the  subject,  so  as  to  make  the 
work  a  useful  guide  in  this  most  anxious  and 
responsible  branch  of  the  profession."  The 
present  issue  is  the  result  ofa  thorough  revision 
of  its  predecessor  at  the  hands  of  the  author. 
It  has  likewise  received  the  benefit  of  careful 
revision   by   Dr.  Robert   P.  Harris,    of  Phila- 


44 


THE   CANADA    MEDICAL   RECORD. 


delphia,  whose  annotations  in  this  and  in  pre- 
vious editions  have  covered  the  points  wherein 
American  practice  differs  from  that  of  English 
obstetricians.  The  work  will  continue  to  be  a 
favorite  text-book  for  students  and  a  trust- 
worthy guide  for  the  practitioner. 

Ever  since  its  first  appearance  it  has  enjoyed 
the  reputation  of  being  the  leading  text-book  in 
England  on  this  subject.     We  had  the  pleasure 
seventeen   years  ago   of  being   intimately   ac- 
quainted with  a  young   Canadian  in    London, 
who  had  won    the    gold  medal    for    Obstetrics 
offered  by  the  University  of  London.     He  told 
us  then  that  he  had  made  "  Playfair  "  his  vade 
mecum.    We  were  rather  disappointed  in  former 
editions  at  the  small  attention  devoted  to  puer- 
peral fever.    1  his  defect  has  been  fully  remedied 
in  the  present  edition,  the  chapter  on  puerperal 
sepiicsemia  and  also  the  one  on  symphyseotomy 
being  very  complete,   witli   the   one  exception 
that  the  total    removal   of  the  septic  uterus  is 
not  mentioned  among  the  methods  of  treaiment. 
The  great  claim  which  maybe  made  for  Playfair 
is  its  thoroughness.     There  is  hardly  anything 
connected  wi  h  midwifery  that  one  cannot  find 
an  amjjle  but  concise  notice  of,  under  its  appro- 
priate heading;  and  the  wood-cuts  are  all  useful    : 
ones.  In  fact,  there  is  a  total  absence  of  padding 
either  in  the  cuts  or  in  the  text.     The  veteran 
American   editor.  Dr.    Harris  of  Philadelphia,    j 
who   is    recognized    all  over  the  world    as    an    j 
authority  on  symphyseotomy  in  partii  ular,and  as    , 
a  vigorous  writer  on  obstetrical  topics  generally,    i 
has  fully  made  use  of  his  privilege  to  make  anno-    I 
tations,  and  to  the  American  reader  his   notes 
are  a  valuable  addition  to  the  book.     Both  the 
author    and    American    editor    show     a   vast 
amount   of  erudition  and    wonderful  familiarity 
with   journal  literature,  as  evidenced  by    their 
quoting  nearly  every  important  case  that  has    | 
been  reported  on  this   topic,  while  their  own    j 
opinions  are  expressed  so  modestly  and  yet  so    '< 
decidedly  as  to  deserve  our  admiration.     We  do    i 
not  say  that  this  is  the  best  work  extant,  but  we 
can  truly  say  that  il  is  one  of  the  most  valuable    j 
text-books  on  midwifery  that  has  ever  appeared.    I 


The  Throat  and  Nose  and  their  Diseases. 
With  one  hundred  and  twenty  illustrations 
in  color  and  two  hundred  and  thirty-five 
engravings  designed  and  executed  by  the 
Author.  Lennox  Brown,  F.R.C.S.  Eng., 
Senior  Surgeon  to  the  Central  London 
Throat  and  Ear  Hospital,  late  President 
British  Laryngological  Association.  Fourth 
edition.     Philadelphia:    Lea  Bros.  &  Co. 

Li  this  edition  the  author  has  introduced  all 
recent  information  of  value,  much  that  was 
doubtful  has  been  expunged,  and  the  space 
thus  gained  has  been  devoted  to  further  details 
of  the  influence  of  micro-organisms  in  pro- 
ducing throat  diseases.    The  main  feature  of  this 


I   new  edition,  however,  has  been  the  expansion  of 
j  that  portion  of  the  work  which  deals  with   dis- 
I   eases  of  the  nose,  for  in  the  condition  of  the 
I  nasal  fossae  which  constitute  the  first  avenues 
I   of  the  natural  breath  way  is,  to  be  found  the  key 
I    to  the  right  understanding  and  successful  treat- 
ment of  the  majority  of  faucial,  pharyngeal  and 
laryngological  diseases.     One  of  the  things  that 
strikes    us  more  forcibly  is  the    valuable    help 
afforded  by  the  very  numerous  and  exquisitely 
beautiful  lithographic  plates  drawn  from  nature 
and  on  stone  by  the  author. 

The  wood-cuts  which  appear  on  every  page 
are  not  less  explicit  in  their  teaching.  With 
commendable  courtesy  the  author  says  in  his  in- 
troductory chapter,  that  he  has  quoted  largely 
from  the  writings  of  his  American  confreres  in 
this  specially.  No  excuse  is  made  for  this  pro- 
cedure, bec-Uise  from  no  quarter  have  we  de- 
rived in  these  later  days  so  many  original  observ- 
ations and  suggestions  of  real  practical  value  as 
from  the  members  of  the  American  Laryngolo- 
gical Association. 

In  addition  to  the  unusual  thorough  subject- 
matter  of  the  work,  the  mechanical  part,  as  is 
usual  with  Messrs.  Lea's  publications,  is  of  the 
highest  order,  it  being  evident  that  no  expense 
has  been  spared  to,make  it  one  of  the  best  works 
cf  its  kind,  the  article  on  tubercle,  syphilis 
and  di]jhtheria  being  especially  worthy  of  men- 
tion. Although  quite  complete  enough  for  the 
use  of  specialists,  it  is  at  the  same  time  so  clear 
as  to  be  of  daily  value  to  the  general  practi- 
tioner, who  will  find  at  the  end  of  the  volume  a 
number  of  well  tried  formulas  most  in  vogue  at 
the  London  hospitals  for  diseases  of  the  throat. 
The  book  may  be  obtained  through  Mr.  Renouf, 
book-seller,  Montreal,  or  directly  from  the  pub- 
lishers. 


A  Manual  for  Boards  of  Health  and 
Health  Officers. — By  Lewis  Balch, 
M.D.,   Ph.D.,  Secretary    State   Board   of 

^  Health  of  New  York  ;  Health  Officer  of 
Albany  ;  Emeritus  Professor  of  Anatomy  ; 
and  Professor  of  Medical  Jurisprudence, 
Alb.rny  Medical  College. 

The  Secretary  of  the  State  Board  of  Health, 
Dr.  Lewis  Balch,  has  prepared  a  Manual  for 
the  use  of  members  of  local  BOc^rds  of  Health, 
Health  Officers  and  all  others  interested  in 
health  matters.  The  book  is  exactly  what  it 
purports  to  be,  a  practical  working  manual. 
It  defines  the  powers  of  the  State  and  Local 
Boards,  it  contains  direction  to  the  Local 
Health  Officer,  it  gives  examples  of  problems 
which  may  arise  and  their  solution,  it  offers 
suggestions  for  the  prevention  of  disease,  and  it 
includes  directions  to  be  followed  in  times  of 
danger  from  epi  emics  of  contagious  diseases. 
Price  $1.50,  delivered  upon  receipt  of  price. 
Banks  &  Brothers,  Albany,  N.Y. 


THE   CANADA    MEDICAL   RECORD. 


45 


A  Dictionary  of  Medical  Science.  Contain- 
ing a  full  exi)Ianation  of  the  various  subjects 
and  terms  of  Anatomy,  Physiology,  Medi- 
cal Chemistry,  Pharmacy,  Pharmacology, 
Therapeutics,  Medicine,  Hygiene,  Diet 
etics,  Pathology,  Surgery,  Bacteriology, 
Ophthalmology,  Otology,  Laryngology, 
Dermatology,  Gynaecology,  Obstetrics, 
Pediatrics,  Medical  Jurisprudence  and 
Dentistry,  etc.,  etc.  By  Robley  Dungli- 
son,  M.D.,  LL.D.,  late  Professor  of  Insti- 
tutes of  Medicine  in  the  Jefferson  Medi- 
cal College  of  Philadelphia.  Edited  by 
Richard  J.  Dunghson,  A.M.,  M.D.  New 
(21st)  edition,  thoroughly  revised,  greatly 
enlarged  and  improved,  with  the  Pro- 
nunciation, Accentuation  and  Deriva- 
tion of  the  Terms.  In  one  magnificent 
imperial  octavo  volume  of  1181  pages. 
Cloth,  $7.00;  leather,  $8.00.  Philadel- 
phia:   Lea  Brothers  &  Co.,  1893. 

This  has  been  for  the  past  sixty  years  the 
favorite  Medical  dictionary  on  this  continent, 
the  fact  that  it  has  gone  through  twenty-one 
editions  during  that  period  being  sufficient 
proof  of  its  popularity.  As  the  science  of  ^ledi- 
cine  has  progressed,  hundreds  and  thousands 
of  changes  have  been  made,  but  in  this  edition 
these  changes  have  reached  the  great  number  of 
forty-four  thousand  new  words  and  phrases. 
Although  the  page  has  been  enlarged,  this 
volume  contains  one  hundred  more  pages  than 
its  predecessor. 

Dr.  Richard  J.  Dunglison  enjoys  a  wide 
reputation  as  a  medical  writer,  and  no  one  more 
fitted  could  have  been  found  to  revise  the  work 
of  his  talented  father.  Some  minor  faults  have 
been  found  in  the  work,  such  as  the  printing  of 
the  Greek  roots  in  English  letters  ;  this,  how- 
ever, has  probably  been  intentional,  in  order  to 
adapt  the  work  to  the  use  of  the  unfortunately 
very  large  class  of  practitioners  who  are  imac- 
quaintcd  with  tiie  Greek  language.  There  are 
also  a  few  mistakes  in  pronunciation,  but  these 
are  so  few  in  comparison  with  the  many  thou- 
sands of  correct  ones  that  they  may  be  easily 
ignored.  The  derivations  and  explanatory  defi- 
nitions for  which  this  work  has  long  been 
celebrated  are  thoroughly  given. 

Under  diseases  we  find  their  symptoms  and 
treatment  ;  under  drugs,  their  properties  and 
doses;  under  poisoning,  their  symptoms,  anti- 
dotes and  treatment. 

Very  complete  tables  furnish  a  vast  amount 
of  information  which  cannot  be  otherwise  ob- 
tained. One  cannot  even  glance  over  the  work 
without  uttering  an  expression  of  admiration 
for  the  indomitable  energy  of  the  author  and 
reviser.  We  have  tested  several  words,  and 
have  been  very  much  struck  with  the  complete- 
ness with  wliich  the  subjects  are  hand'ed.  For 
instance,  taking  the  word  liver,  in  the  space  of 
three-quarters  of  a  pa  ge  we  have  the  anatomy. 


physiology  and  pathology  of  the  organ,  includ- 
ing a  table  of  dimensions  and  weights  of  the 
liver  and  its  component  parts.  A  dictionary  is 
of  necessity  a  difficult  work  to  review,  but  we 
can  only  say  that  it  has  long  been  recognized 
as  the  standard  work  of  its  kind  on  this  contin- 
ent, and  that  no  medical  library  can  be  said  to 
be  complete  without  it. 


Chemistry  and  Physics.  By  Joseph 
Struthers,  Ph.  B.,  Columbia  College  School 
of  Mines,  N.Y.;  D.  W.  Ward.  Ph.  B.,  Colum- 
bia College  School  of  Mi  es,  N.Y.;  and 
Charles  H.  Willmarth,  M.  S.,  N.  Y.  $r.oo. 
(The  Students'  Quiz  Series.)  Philadelphia, 
Lea  Brothers  &  Co.,  1893. 

This  new  series  of  manuals  for  students  of 
medicine  is  rapidly  approaching  completion. 
The  volume  on  Chemistry  and  Physics  is  the 
twelfth  to  appear,  and  the  thirteenth  and  final 
volume,  that  on  Surgery,  will  shortly  follow. 
This  series  is  written  by  well-known  New  York 
teachers  and  specialists,  and  it  enjoys  the  ad- 
vantages of  issue  under  competent  editorship. 
I'he  volume  on  Chemistry  and  Physics,  like  its 
companions,  deals  with  those  facts  of  its  sciences 
which  are  requisite  to  a  thorough  medical  educa- 
tion. The  various  matters  are  presented  tersely 
an.l  pointedly  in  the  form  of  questions,  which 
are  answeied  with  equal  clearness.  The  book 
is  well  illustrated.  Teachers  as  well  as  students 
will  gain  much  advantage  from  the  use  of  these 
manuals — in  fact,  their  value  far  exceeds  their 
modest  price,  which  is  rendered  possible  only 
by  a  large  sale. 

When  one  looks  through  this  small  work,  it  is 
astonishing  to  see  how  much  information  on 
Chemistry  and  Physics  have  been  compressed 
into  it.  For  students  preparing  for  examina- 
tions, and  even  for  teachers,  rev'ewing  this  small 
work  saves  a  large  amount  of  time. 


New  Illustrated  Dictionary  of  Medicine, 
Biology,  and  Collateral  Sciences. 

Dr.  George  M.  Gould,  alreudy  well  known 
as  the  editor  of  two  small  medical  dictionaries, 
has  now  about  ready  an  unabridged,  exhaus- 
tive work  of  the  same  class,  upon  which  he  and 
a  corps  of  able  assistants  have  been  uninterrapt 
edly  engaged  for  several  years. 

The  feature  that  will  attract  immediate  atten- 
tion is  the  large  number  of  fine  illustrations  that 
have  been  included,  many  of  which — as,  for 
instance,  the  series  of  over  tiftyof  the  bacteria — 
have  been  drawn  and  engraved  especially  for  the 
work.  Every  scientific-minded  physician  will 
also  be  glad  to  have  defined  several  thousand 
commonly  used  terms  in  biology,  chemistry, 
etc. 

The  chief  point,  however,  upon  which  the 
editor  relies  forjhe  success  of  his  book  is  the 
unique    epitomization  of  old  and   new    know 


46 


THE  CANADA  MEDICAL  RECORD. 


ledge.  It  contains  a  far  larger  number  of  words 
than  any  other  one-volume  medical  lexicon.  It 
is  a  new  book,  not  a  revision  of  the  older 
volume  ;  pronunciation,  etymology,  definition, 
illustration,  and  logical  groupings  of  each  word 
are  given.  There  has  never  been  such  a 
gathering  of  new  words  from  the  living  litera- 
ture of  ♦^he  day.  It  is  especially  rich  in  tabular 
matter,  a  method  of  presentation  that  focuses, 
as  it  were,  a  whole  subject  so  as  to  be  under- 
stood at  a  glance. 

The  latest  method  of  spelling  certain  terms, 
as  adop:ed  by  various  scientific  bodies  and 
authorities,  have  all  been  included,  as  well  as 
those  words  c'assed  as  obsolete  by  some  editors, 
but  still  used  largely  in  the  literature  of  to-day, 
and  the  omission  of  which  in  any  work  aiming 
to  be  complete  would  make  it  unreliable  as  an 
exhaustive  work  of  reference. 

The  publishers  announce  that,  notwith- 
standing the  large  outlay  necessary  to  its  pro- 
duction on  such  an  elaborate  plan,  the  price 
will  be  no  higher  than  that  of  the  usual  medical 
text-book. — P.  Blakiston,  Son  «S:  Co. 


author's  descriptions,  render  it  an  excellent  text- 
book for  the  use  of  both  students  and  practi- 
tioners. 


The  Theory    and    Practice    of    Medicine 

PrF  PARED  FOR  STUDENTS  AND  PRACTI- 
TIONERS- By  James  T,  Whittaker,  M.D., 
LL.D.,  Professor  of  the  Theory  and  Prac- 
tice of  Medicine  in  the  Medical  College  of 
Ohio ;  Lecturer  on  Clinical  Medicine  at 
the  Good  Samaritan  Hospital ;  Fellow  of 
the  College  of  Physicians  of  Philadelphia; 
Member  of  the  Association  of  American 
Physicians,  of  the  American  Academy  of 
Medicine,  and  of  the  American  Medical 
Association.  With  a  chromo  lithogra- 
phic plate  and  three  hundred  engravings. 
Octavo,  840  pages.  Extra  muslin,  price, 
$5.75;  leather,  price,  $6.50.  New  York  : 
AVilliam  Wood  &  Company. 

The  author  of  this  book  is  of  wide  reputation 
and  recognized  abiHty,  and  possesses  an  exper- 
ience admirably  suited  to  the  production  of 
such  a  work  as  this.  All  the  more  recent  ad- 
vances in  diagnoses  and  in  therapeutics  will  here 
be  found.  The  practitioner  who  looks  up  from 
the  signs  and  lesions  to  the  cause  will  entertain 
more  hopes  of  treatment. 

Part  I.  is  devoted  to  general  diseases,  such 
as  infections  and  parasites. 

Part  II.  to  diseases  of  organs,  including 
digestion,  respiration,  circulation,  genito- 
urinary system,  and  nervous  system.  It  is  un- 
usual to  find  in  such  works  so  many  as  three 
hundred  illustrations  which  this  book  contains, 
and  which  adds  so  much  to  the  interest  of 
the  reader.  Its  general  excellence  is  beyond 
our  power  to  criticize.  Its  size,  clear  type, 
good  paper  and  above  all  the  conciseness  of  the 


Minor  Si'rgery  and  Bandaging. — Including 
the  Treatment  of  Fractures  and  Disloca- 
tions, Tracheotomy,  Intubation  of  the 
Larynx,  Ligations  of  Arteries  and  Amputa  ■ 
tions.  By  Henry  R.  Wharton,  M.D., 
Demonstrator  of  Surgery,  and  Lecturer  on 
Surgical  Diseases  of  Children  in  the  Uni- 
versity of  Pennsylvania.  Second  edition 
thoroughly  revised  and  enlarged.  With 
four  hundred  and  sixteen  illustrations. 
Philadelphia,  Lea  Brothers  &  Co.,   1893. 

Although  the  author  only  claims  this  to  be  a 
book  on  minor  surgery,  it  is  really  much  more 
than  that,  as  it  includes  nearly  100  pages  on  frac- 
tures, 30  pages  on  dislocations,  40  pages  on  the 
ligation  of  arteries,  and  50  pages  on  amputa- 
tions. The  illustrations  are  nearly  all  photo- 
engravings while  the  woodcuts  are  of  the  highest 
order.  There  is  nothing  for  us  to  criticize, 
the  descriptions  of  the  preparations  of  ligatures, 
sutures,  etc.,  being  according  to  the  most  recent 
methods.  We  cannot  speak  too  highly  of  the 
e:  cellence  of  the  mechanical  part  of  the  work, 
which  comprises  in  all  a  little  over  500  pages. 
Although  probably  intended  for  the  student, 
it  contains  so  much  recent  information  on 
aseptic  operating  and  dressing  which  is  not 
yet  otherwise  accessible  in  book  form,  that 
this  little  volume  would  be  especially  useful  to 
the  country  practitioner  who  has  a  taste  for 
surgery. 


Outlines  of  Practical  Hygiene  — The  Art  of 
Preserving  Health  by  Preventing  Disease. 
Adapted  to  American  conditions.  By  C. 
Oilman  Currier,  M.D.,  Visiting  Physician 
to  the  New  York  City  Hospitals  ;  Fellow 
of  the  New  York  Academy  of  Medicine; 
Member  of  the  New  York  Pathological 
Society;  Member  of  the  American  Medi 
cal  Association,  eic,  etc. 

Contents  from  Chaptek  Headings. — 
Soil — Chmate — Protection  of  Body — Clothing 
— Bathing — Personal  Hyg  ene — Physical  Exer- 
cises— Schools — Occupations — Their  Influence 
on  Health — Heating — Lighting — Buildings — 
Ventilation — Diet — Foods — Their  Preparation 
and  Adaptation — Water  and  Water  Supplies 
— Fluid  Waste — Sewers  — Drainage —  Plumb- 
ing— Garbage  and  Other  Refuse — Disposal  of 
the  Dead — Human  Excreta,  Disposal  of — 
Bacteria  and  Diseases — Infectious  Diseases — 
Disinfection  —  Restriction  —  Communicable 
Diseases.  One  large  octavo  volume,  468 
pages,  illustrated,  $2.75. 


THE   CANADA   MEDICAL   RPXORD. 


47 


A  New  Medical  Dictionary. — A  completely 
new  Medical  Dictionary  is  annor  iced  for 
early  publication  by  Lea  Brothers  &  Co 
The  author,  Dr.  Alexander  Duane,  of  New 
York,  is  already  widely  known  as  the 
medical  expert  for  Webster's  International 
Dictionary.  His  new  work  lias  been 
drafied  to  supply  medical  students  with 
all  desired  information  concerning  the 
words  they  will  meet  in  their  course  of 
reading;  and  as  the  vocabulary  has  been 
selected  most  liberally,  the  work  will  be  of 
value  to  practitioners  also.  The  pro- 
nunciation of  each  word  is  given  by  a 
simple  and  obvious  phonetic  spelling; 
then  follows  the  derivation,  an  unexcelled 
aid  to  memory,  and  finally  a  full  defini- 
tion. Descriptive  matter  has  been  ap- 
pended to  such  words  as  cannot  be  ade- 
quately explained  by  simple  definition. 
Thus,  diseases  are  described,  and  their 
symptoms  and  treatment  are  given  ;  drugs 
are  followed  by  their  properties,  eftects, 
doses,  etc.  Extensive  tables  of  bacteria, 
doses,  etc.,  are  placed  in  the  alphrbet 
most  conveniently  for  reference.  A  work 
of  real  value  is  promised,  and  we  '.shall 
take  an  early  opportunity  of  reviewing  it 
in  these  columns. 


American  Text-Book  of  Gyn.ecology. — Mr. 
W,  B.  Saunders,  Publisher,  of  Philadelphia, 
Pa.,  am. ounces  this  work  as  ready  for 
early  issue.  It  is  the  joint  work  of  Drs. 
Howard,  Kelley,  Pryor,  Byford,  Baldy, 
'luttle,  and  others  who  stand  before  the 
profession  for  all  that  is  progressive  in 
gyrsecology.  The  work  will  contain  oper- 
ations not  before  described  in  any  other 
book,  notably  ablation  of  fibroid  uterus. 
It  is  designed  as  a  profusely  illustrated 
reference  book  for  the  practitioner,  and 
every  practical  detail  of  treatment  is  pre- 
cisely stated. 


Essentials  of  Minor  Surgery,  Bandaging 
AND   Venereal    Diseases.    Arranged   in 
the  form  of  Questions  and  Answers.     Pre- 
pared especially  for  Students  of  Medicine. 
By  Edward  Martin,  A.M.,  M.D.,  Clinical 
Professor    of    Genito  -  Urinary    Diseases, 
Instructor  in  Opera  ive  Surgery,  and  Lec- 
turer  on    Minor    Surgery,    University   of 
Pennsylvania.      Second    edition^    revised 
and     enlarged.     78    illustrations.     Phila 
dclphia :     W.    B,    Saunders,    925    Walnut 
S  -eet,   1893. 
This  is  a   useful  little  volume  of  163   pages 
arra.iged     in    the     form     of     questions     and 
answers,    and    while   in  no    sense    taking    the 
placj  of  larger  works,  will  be  fuund   handy  for 
students  reviewing  their  work. 


Hernia:  Palliative    and  Radical  'I'rkat- 
MENT  IN  Adults,  Children  and  Infants 
—By  Thomas    H.    Mar'ey,    A.M.,  M.D  , 
Visiting   Surgeon     to    Harlem     Hospi  al^ 
Consuliing Surgeon  to  Fordham  Hospital  '• 
Philadelphia,  Pa.    The  Medical  Press  Co.,' 
Limited,  1725  Arch  street,   1893. 
Although   this    little  wo:k   of  2^7   pages    is 
hardly   up  to    the  usual  standard   as    regards 
paper,  printing  and  engravings,  yet  it  co.i  tains  a 
vast  amount  of  information  concerning  Hernia 
in    a     comparatively    condensed    form.      His 
chapter  on    the   Argen    p:  ogress  and   present 
position  of  the  radical  cure  is  very  good,  as   is 
also  his  description  of  Bassini's  method.'    The 
three    woodcuts    illustrating   it   are    also    very 
good.     We  are    surprised  to    find    the  author 
taking  a  decided   position   against    the   opera- 
tion,     'i'he  author  is   well  up  in  the   literature 
of  the  subject,  the  book   being  jilentifuUy  sup- 
plied with  references  to  the  book  and  journal 
literature. 


PAMPHLETS  RECEIVED. 


Diet  in  its  Rel.a.tion  to  the  Treatment 
AND  Prevention  of  Disease.  Read  be- 
fore the  Section  of  Physiology  and  Diete- 
tics at  the  Forty-third  Annual  Meeting  of 
the  American  Medical  Association,  held 
at  Detroit,  Mich.,  June,  1892,  by  Aug- 
ustus P.  Clarke,  A.M.,  M.D.,  of  Cam- 
bridge, Mass.,  U.S.A.,  President  of  the 
Gynaecological  Society  of  Boston  ;  Vice- 
President  of  the  Pan-American  Medical 
Congress,  Washington,  1893. 


PoST-PaRTUM     HE.MORRH.A.GE  :     ItS     EtIOLOGY 

AND  Management,  by  .\ugustus  P. 
Clarke.  A.M.,  M.D.,  of  Cambridge,  Mass., 
U.  S.  A. 


Origin  AND  Developme.vtof  Modern  GvN.t- 
COLOGV,  by  Augustus  P.  Clarke,  A.M., 
M.D.,  of  Cambridge,  Mass.,  U.  S.  A, 


Address  on  Hygiene. — Delivered  by  Prof. 
Samuel  G.  Dixon,  M.D.,  at  the  meeting  of 
the  State  Medical  Society,  WiUiamsport, 
Pa. 


Report   of   a   Case   of    Appendicitis.      By 
Dr.  Mordecai  Price,  Philadelphia. 


48 


THE    CANADA    MKDICAL    RECORD. 


A  Consideration  of  some  of  the  Operative 
Measures  Employed  in  Gynaecology, 
by  Augustus  P.  Clarke,  A.M.,  M.D.,  of 
Cambridge,  Mass.,  U.S.A. 

Hygiene  de  l'Enfance  et  de  l'Adoles- 
CENCE.  Ouvrage  lionore  d'une  Medaille 
d'argent  de  1' Academic  de  INIedecine 
(Comm.  d' Hygiene  de  l'Enfance)  :  Le 
Premier  Age  et  La  Seconde  Enfance,  par 
le  Dr.  E.  Verrier,  ancien  preparateur 
a  la  Faculte  de  Medecine,  Laureat  de 
I'Academie  de  Medecine  (prix  Capuron), 
Officier  de  I'lnstruction  Publique.  Troi- 
sieme  Edition,  Paris,  Societe  d'Editions 
^cientifiques,  Place  de  I'Ecole  de  Mede- 
cine, 4,  Rue  Antoine-Dubois,    1893. 


NOURRICES  SUR  LlEU,  CONSEILS  AUX  JeUNES 

Meres.  Par  le  Dr.  Henry  Drouet,  An- 
cien Interne  des  Hopitaux  de  Paris  et 
de  la  Maternite  de  I'Hopital  Beaujon, 
\  aureat  de  la  Faculte  de  Medecine,  Lau- 
reat de  I'Academie  de  Medecine  (Prix 
de  I'Hygiene  de  l'Enfance),  Ancien 
Medecin  Inspecteur  des  Enfaiits  du  pre- 
mier age,  etc.  Paris,  Societe  d'Editions 
Scientitiques.  Place  de  I'Ecole  de  Mede- 
cine, 4,  Rue  AHcOine-Dubois,  1893.  Tons 
droits  reserves. 


Etude  sur  le  Dermographisme  ou  Der- 
moneuroseToxivasomotrice.  Par  Tous- 
saint  Barthelemy,  Medecin  nomme  au 
Concours  de  Saint  Lazare.  Ancien  Chef 
de  Cliniquede  la  Faculte  de  Paris  a  I'Hop- 
ital Saiiit  Louis,  etc.  Avec  17  planches. 
Paris,  Societe  d'Editions  Scientifiques. 
Place  de  I'Ecole  de  Medecine,  4,  Rue 
Antoine-Dubois,       1893. 


Guide  Pratique  pour  la  Preparation 
et  L'Injection  des  Liquides  Organiques 
(Methode  Brown-Sequard),  par  le  Dr.  H. 
Melville.  Paris,  Societe  D'Editions 
Scientifiques.  Place  de  I'Ecole  de  Mede- 
cine,    4,  Rue  Antoine-Dubois,     1893. 


The  Influence  of  Dress  in  Producing  the 
Physical  Decadence  of  American 
Women.  [Annual  Address  upon  Ob- 
stetrics -and  Gynecology.]  By  J  H. 
Kellogg,  M.D.,  Fellow  British  Gynaeco- 
logical Society,  and  the  American  Asso- 
ciation of  Obstetricians  and  Gyngeco- 
logists,  Member  Societe  d' Hygiene  of 
France,  American  Medical  Association, 
British  and  American  Associations  for  the 
Advancement  of  Science,  American  Cli- 
matological  Society,  etc.  Battle  Creek, 
Michigan.  Reprinted  from  Transactions 
of  Michigan  State    Medical  Society,  1891. 


The  Advantages  of  Version  in  a  Certain 
Class  op  Obstetric  Cases,  by  Augustus 
P.  Clarke,  A.M.,  M.D.,  Fellow  of  the 
American  Association  of  Obstetricians  and 
Gynaecologists,  Cambridge,  Mass.  Re- 
printed from  The, American  Journal  of 
Obstetrics.  Vol.  XXVI,  No.  5,  1892. 
New  York,  William  Wood  &  Company, 
Publishers,  1892. 


Des  Meilleurs  Moyens  d'Anesthesie  X 
employer  en  Art  Dentaire,  par  le  Doc- 
teur  E.  Sauvez,  de  la  Faculte  de  Paris, 
Ancien  Externe  des  Hopitaux,  Professeur 
Suppleant  a  I'Ecole  Dentaire  de  Paris, 
Membre  de  la  Societe  de  Stomatologic. 
Paris  :  Societe  d'Editions  Scientifiques, 
Place  de  I'Ecole  de  Medecine,  4  rue 
Antoine-Dubois,  4 ;    1893. 


The  Nature  of  Shock,  by  Eugene  Boise,  M.D. 
Gynaecologist  to  St.  Maik's  Hospital, 
Fellow  of  the  American  Association  of 
Obstetricians  and  Gynaecologists,  Grand 
Rapids,  Mich.  New  York,  Stuyvesant 
Press,  154  and  156  West  Twenty-Seventh 
Street,  1893. 

Observations  on  a  Case  of  Recurrent  Amce- 
Bic  Dysentery  with  Successive  Large 
Hepatic  Abscesses. —  by  John  Winters 
Brannan,  M.D.,  Assistant  Pathologist  to 
St.  Francis  Hospital,  New-York.  Re- 
printed from  the  New  York  Medical  Jour- 
nal for  March  25,  1893.  New  York,  D. 
Appleton  &  Company,  1893. 


PUBLISHERS'  DEPARTMENT. 


William  R.  Warner  &  Co.  Given  the  High- 
est Columbian  Award. — W.  R.  Warner 
&  Co.,  of  Philadelphia,  have  obtained  the 
highest  prize  for  the  purity  and  perfection 
of  iheir  medicinal  and  officinal  standard 
pharmaceutical  and  chemical  products. 
This  extensive  firm  have  obtained  hitherto 
twelve  grand  World's  Fair  prizes,  and  they 
must  feel  deservedly  proud  of  the  Colum- 
bian award,  which  is  the  highest  of  its 
class. 


Wilson  Saffin,  M.  D.,  of  Carthage,  Ohio, 
writes  :  — "  I  often  use  Antikamnia  and  Dover's 
Powder  combined,  and  the  combination  acts  so  nicely  I 
have  often  thought  of  the  advisabiUty  of  a  tablet  con- 
taining 2^  gr.  each  of  Antikamnia  and  Dover's 
Powder  combined.  The  Dover's  Powder  seems  to  act 
harmoniously,  and  favors  the  action  of  Antikamnia.  I 
have  used  your  Antikamnia  for  more  than  2  years, 
both  in  my  hospital  and  private  practice,  and  have 
always  found  same  eminently  satisfactory." 


w. 


WM 


f 


^4> 


Vol.  XXII, 


MONTREAL,  DECEMBER,  1893. 


No.  3 


ORIGINAL   COMMUNICATIONS. 

rmiiiitoil  Kraoluro  4ii 

'J'Ir-  I'ropliylaxis  aiul   Treatment  of 
Puerperal  Eelniiipsia 53 


SOCIETY  PROCEEDINGS. 

Alistractof  tli.'  Pnxee.liiijjs  (.f  the 
'J'liiril  Annual  Meeliug  of  the 
Auieriean  KU'etro-Therapeulie   As- 

soeiation — (t'ontiiiuej). 57 

Tlie  Nutritional  Ktr.-cts  of  Statical 
Eleetrieity  Coiisiilered  in  Kelatiou 
to  High  Frefir.encv  anil  High  Po- 
tential Currents,  and  the  Transpa- 
rency of  the  Dielectric 57 

Electro-Medical  Eccentricities 5S 

The  Action  of  the  Continuous  Cur- 
rent within  Living  Tissue.-;  as  Dis- 
tinguished from  the    local  Polar 

Actii>n 59 

Observations  on  the  Treatment  of 

Ciiitre 59 

Case  of  Ascites  Cured  bv  Galvanism.    6o 

Metallic  Electrolysis..." CO 

.Some  Observations  on  the  Fine  Wire 

Coil  or  Current  of  Tension 62 

The  Inlluence  of  Frequency  of  Inter- 


O  O  HSr  T  E  USTTS . 

ruptions  anil  Character ot  Induced 
Current  Waves  upon  the  Physiolo- 
gical Klfcct f.O 

Induction  Coils ....".'.     (!2 

Kemarks  upon  Apparatus  to  produce 
Induction  Currents  and  the  Ch.i- 
racterof  the  Waves  of  Individual 
Apparatus,  with  especial  leference 
to  those  applicable  to  .Medical 
li'.ses e3 

T  h  e  GraphicStudy  of  Electrical  ciir- 
rentsin  Relation  to  Therapeutics.     C3 

In  Meilical  Induction'  Coils,  how 
does  the  Current  of  the  Primary 
ditler  from  that  of  the  Secondarv'; 
and  what  Influence  has  this  ditfer- 
ence  npou  the  respective  I'hvsiolo- 
^ical  Effects  ....   ." g3 

A  Study  of  Electrieal-Ana-sthesia 
and  Frequency  of  Induction  Vibra- 
tion      C4 

On  the  Influence  of  Frequency  ami 
the  Graphic  Cnrve  on  the  Results 
of  Gynsecological  FJlectro-Tliera- 
peutics.  particularly  with  the  Sinu- 
soidal Current g  I 

The  Alternating  Current  in  Electro- 
Therapeutics  G4 

The  Treatment  of  Dysmenorriuva  by 
the  Galvanic  Current 65 


TJie  Treatment  of  Subinvolution  by 
F:iectricity (m; 

A  Xew  Intra-Uterine  Electrode GG 

A  Contribution  to  Elect roTherapeu- 
tics  in  Salpingitis G7 

What  are  the  Pussiiblities  of  Electri- 
city in  the  Ireatment  of  Fibroid 
G  ro  wths G7 

Improvements  in  Electro-Stati<^al  or 
Influence  JIachines (W 

F"arailization  as  it  was  ami  as  it  i.^ 
with  the  Controllable  an<l  Record- 
able Current,  as  jirovided  bv  a 
New  Apparat  us i;9 

EDITORIAL. 

The  Causes  of  Rhcuniatisiu   70 

Imperial  Honors  for  the  Canadian 

.Medical  Profession 71 

Thyri)id  (ilands  as  Medicine 72 

BOOK  NOTICES. 

Le  Mcdecin  de  la  Famille   12 


friqinnl    lEomtnuntCtittons. 

UNUNITED  FRACTURE. 

By  Llewkllvx  Eliot,  A.M.,  M.D.,  Pre- 
sidentof  the  JSlcdical  Association  of  the  Dis- 
trict of  Columbia,  Surgeon  to  the  Eastern 
Dispensary ,  Consultant  to  St.  Ann's  Infant 
Asylum,  etc.,  iVashington,  D.  C* 

It  is  with  much  hesitation  I  appear 
before  such  an  august  and  critical  assem- 
blage of  surgeons  as  are  gathered  here, 
for  I  feel  nothing  1  may  say  will  appear 
new  to  the  majority  of  you. 

The  subject — Ununited  Fracture,  De- 
layed Union,  Pseudarthrosis — has  re- 
ceived attention  at  the  hands  of  w  riters 
on  Surgery  from  the  earliest  time,  and 
engaged  the  attention  of  the  best  and 
ablest  surgeons.  To  follow  its  literature 
would    be  an   almost  endless  task,  and   to 

*Read  at  the  Section  of  Surgery,  First  Paii- American 
Medical  Congress,  Washington,  DC,  September,  1893. 


review,  in  detail,  the  various  methods  of 
treatment  would  occupy  much  more  time 
than  I  desire  to  consume.  According  to 
writers  on  Surgery,  firm  union  between  the 
fractured  ends  of  a  bone  may  sometimes 
be  delayed  beyond  five  or  six  weeks,  the 
period  of  time  usually  required  for  their 
repair.  This  condition  constitutes  what 
is  termed  non-union,  ununited  fracture  or 
pseudarthrosis.  This  delayed  firm  union 
may  be  temporary  or  permanent,  it  may 
correct  itself  or  it  ma}-  require  the  inter- 
vention of  the  surgeon.  The  character  of 
the  union  in  these  cases  is  of  a  fibrous  or 
ligamentous  nature,  or  is  a  proliferation 
of  brittle  callus. 

The  causes  of  this  non-union  are  divided 
into  two  classes, — those  of  a  constitutional 
character  and  those  of  a  local  character. 
Among  the  constitutional  are  h.tmorrhage, 
scorbutus,  diarrhccal  diseases,  excessive 
lactation,  pregnancy,  shock,  any  state  of 
the  system  attended  by  a  diminution  of 
the  vitality  of  the  patient.     The  reparative 


50 


THE  CANADA  MEDICAL  RECORD. 


process  itself  may  be  at  fault,  since  the 
callus  thrown  out  about  the  fractured  ends 
may  be  so  proliferative  that  it  softens  and 
dissolves  before  it  lias  performed  its  part 
in  the  repair,  or  it  may  become  so  brittle 
as  to  be  useless.  Old  a|j^e,  cancer,  para- 
lysis, rheumatism  and  syphilis  are  passive 
and  Jiot  active  constitutional  causes,  al- 
though the  contrary  is  strongly  asserted. 
As  local  causes  we  enumerate:  the  inter- 
position of  a  foreign  bod\'  between  the 
ends,  such  as  a  piece  of  muscle,  tendon  or 
clothing,  the  destruction  of  the  blood 
supply  of  the  bone,  improper  adjustment 
of  fragments,  defectively  applied  fixation 
apparatus,  where  the  fragments  are  not 
held  in  a  proper  position,  but  are  movable. 
More  cases  occur  in  hospital  practice  than 
f6rmerly,  as  the  hospital  internes  are 
allo\\;ed  greater  liberty  in  the  treatment 
6f  fractures  to-day  than  they  were  accorded 
some  years  ago. 

There  should  be  no  difficulty  in  the  diag- 
i^osis  of  cases  of  non-union  after  fractures. 
The  condition,  as  a  rule,  is  apparent. 

The  treatment  of  cases  of  ununited 
fracture  must  be  in  accord  with  the  cause 
of  the  delay.  Iron  for  the  anicmic,  iodide 
of  potash  and  the  salicylates  for  the  rheu- 
inatic,  mercury  for  the  syphilitic  constitute 
our  remedies  for  those  cases  which  depend 
upon  some  fault  of  the  system.  But  even 
with  this  course,  many  patients  become 
tired  and  discouraged  at  the  delay,  and 
demand  that  more  active  measures  be 
adopted.  It  is  then  that  rubbing  the  ends 
together,  injections  of  irritants,  introduc- 
tion of  setons,  caustics  and  pins,  resection 
of  the  ends  of  the  bone,  bone  grafting,  wir- 
ing, and  finally  amputation  of  the  member 
must  be  considered.  One  or  more  of  these 
methods  may  be  adopted  ;  of  course  it  is 
to  be  understood,  any  faulty  position  must 
be  corrected.  The  history  of  these  various 
procedures  is  entirely  out  of  place  in  a 
practical  paper,  and  then,  again,  you  are  all 
familiar  with  them.     The  best  method,  so 


far  as  my  limited  experience  goes  to  show, 
is  that  of  resection,  resection  witli  wiring 
of  the  freshened  ends  of  the  bone.  After 
the  operation  I  encourage  free  suppuration, 
believing  the  bone  which  results  will  be 
firmer  and  more  permanent,  since,  as  VVyeth 
has  written  :  "If  the  broken  ends  do  not 
come  in  contact  with  the  air — that  is,  if  the 
fracture  is  not  compound — the  process  of 
repair  in  bone  after  an  injury  is  similar  to 
the  ph)'siological  process  of  development 
of  this  tissue — name'y,  the  embryonic  tis- 
sue is  developed  into  cartilage-cells,  and 
these,  undergoing  proliferation,  develop 
into  a  secondary  embryonic  tissue,  which 
is  formed  directly  into  bone.  If,  however 
air  is  admitted  to  a  wound  in  bone,  the  pro- 
cess of  ossification  in  the  embryonic  tissue 
is  more  rapid  and  direct,  since  the  inter- 
mediate stage  of  cartilage-cell  formation 
does  not  occur." 

Repair  begins  in  adult  subjects  gener- 
ally about  the  tenth  day,  the  callus  is  solid 
from  tlie  fifteenth  to  the  thirtieth  days,  and 
is  absorbed  by  the  sixtieth  day. 

I  have  seen  four  cases  of  ununited  frac- 
ture during  the  last  twenty  years;  in  two 
success  followed  resecting  the  ends  and  wir- 
ing, one  died  from  shock  following  ampu- 
tation of  the  thigh,  and  the  fourth  would 
not  consent  to  any  operative  treatment, 
and  has  a  perfect  pseudarthrosis  of  the 
lower  third  of  the  thigh,  without  disability, 
but  a   shortening  of  about    two  inches. 

Case  i.  B.  S.  P.— White,  adult.  Was 
first  seen  and  treated  for  secondary  syphilis, 
Further  examination  revealed  the  presence 
of  a  pseudarthrosis  of  the  right  humerus 
at  the  upper  third,  of  several  years  duration. 
The  arm  was  perfectly  useless  to  him, 
hanging  flail-like  by  his  side,  so  when  an 
operation,  looking  to  its  improvement,  was 
proposed  to  him,  it  was  gladly  accepted. 
Under  a  mixed  anaesthesia  of  chloroform 
and  ether,  an  incision  three  inches  long 
was  made  along  the  outer  aspect  of  the  arm^ 
the  bone  exposed,  and    the  ends  found  to 


Tine   CANADA   MfeDICAL   RECORD. 


$1 


be    bound    tofrether    with    strong    fibrous 
bands.     The    fracture   had    been    oblique, 
the   lower  end  was  resting  high  up  on  the 
latter  and    on   the    inner  side.      Dividing 
the     h'ganientous    bands,    the    periosteum 
was  pushed  out  of  the  way  and  the  ends  of 
the    bone    freshened,    about    half-an-inch 
being  taken  from  each  end.     The  freshened 
ends  were    pierced  with  strong  silver  wire, 
and  tied  tightly,  the  ends   of  the  bone  hav- 
ing been   brought    into   exact    apposition 
and    the    periosteum   drawn    down.      The 
wound  was  allowed  to  heal  by  granulation. 
In  four  weeks  the  bone  was  united,  and  in 
six    months  he  was   dismissed  from  treat- 
ment.    At  the  expiration  of  two  years,  the 
wires  had   worked  their  way  to  the  surface 
and  were  removed,  the  arm  at  that  time  be- 
ing  strong  and  of  equal  size  as  the   other. 
Case    2.    W.     H.      R.— White,     adult. 
Sustained  a  double  fracture  (simple)  of  the 
right  femur.     After    months    of  treatment, 
he  came  under  the  care  of  one  of  the  most 
distinguished   surgeons   of  the  District  of 
Columbia,  in  a  frightfully  debilitated  condi- 
tion.    A  fracture   just  about    the  junction 
of  the  middle    and  lower    thirds,  and    an- 
other nearly  midway  of  the  lower  third,  al- 
lowed the   intervening  fragment  to  remain 
loose.      After    consultation,    wiring     was 
considered,  but  the   lower  end  of  the  bone 
was  so  unhealthy  that  amputation  was  done 
at  the  upper  third. 

Case  3.  P.  M. — White,  aged  25  years, 
blacksmith,  of  good  muscular  develop- 
ment. History  of  syphilis  contracted 
about  two  years  previously,  at  which  time 
he  was  circumcised  under  cocaine  an.nes- 
thesia.  V\'as  treated  at  irregular  intervals 
with  the  protiodide  of  mercury,  stopping 
treatment  when  the  eruption  had  become 
dried.  Has  been  a  very  hard  drinker  of 
whiskey  for  the  past  twelve  years.  On 
May  28th,  1892,  while  under  the  influence 
of  alcohol,  he  boarded  the  engine  of  an 
express  train  ;  after  riding  a  few  blocks, 
about  a  quarter  of  a  mile,  he  jumped  off. 


thereby  sustaining  a   comminuted  fracture 
of   the    right    tibia   and    fibula.      He    was 
carried    to    hospital    in    the   police    patrol. 
After    being    made     comfortable    for    the 
night,  the    next     morning    an     extension 
apparatus  with  weights    was  applied  and 
retained  on  the  leg  for  twelve  days,  when 
a  plaster  of  Paris  bandage  was  substituted, 
the     weight    extension    being    continued. 
This    bandage  was   allowed  to    remain  on 
the  limb  for  one    month,  when   it  was  re- 
moved  and  another  applied.     At  the  end 
of  six  weeks  he  was  allowed  to  get  out  of 
bed  and  walk  about  the  ward  on  crutches. 
On  July    26th    the   plaster   bandage  was 
removed,  and  he  was  discharged  as  cured. 
During  his  stay  in  hospital  he  was  treated 
for  syphilis  with  iodide  of  potassium.      He 
now  came  under  my  care  ;  was  impatient, 
and     wanted    something  done    for    him. 
After  attempting  to  set  up  an  inflammation 
by  rubbing  the  fragments  together,  I  deter- 
mined upon  resection  and  wiring.     Having 
been    given    a     soap    bath    and    his    leg 
shaved,  this  was  done  on  Augujt  5th,   at 
half-past- six  in  the  morning,  Drs.  T.  M. 
Vincent,  J.  V.  Carraher  and  R.  A.  Neale 
assisting.     The  anaesthesia  was  begun  with 
chloroform,  but  as  he  took  it  so  badly,  ether 
was    substituted.     An  incision    extending 
downwards  from   the    promontory  of  the 
tibia   to  very    near    the    end  of   the   bone 
was  made  ;    this    was  supplemented    by   a 
T  incision  over  the  seat  of  non-union,  the 
bones  separated  from  their  muscular  attach- 
ments, and  the  following  condition  found  ; 
a    fracture    at    the    middle    of    the    tibia, 
united  ;   a  fracture  half  an  inch   below  this, 
united  ;  a   long  fracture  starting  from  the 
internal  angle  of  this  last  fracture  and  ex- 
tending down  at  an    angle  of   about   75, 
united  by  fibre  ;  in  the  low^er  fragment  the 
bone   had    been    split   for  an    inch.     The 
fibula  had  been  shattered,   but  had  united 
in  all  its  fragments  with  much  shortening. 
Each  fragment  of  the  ununited  portions  of 
the  tibia  was  resected  obliquely,  an  inch- 


S2 


THE   CANADA   MEDICAL    RECORD. 


and-a-half  of  bone  being  removed  ;  with  a 
jeweller's  drill  each  freshened  end  was 
perforated  in  two  places  and  wire  passed 
through  the  perforations,  drawing  the  ends 
together,  the  wires  were  twisted,  the  ends 
pressed  well  down  upon  the  bone  and  the 
periosteum  drawn  over  them.  Eleven 
sutures  were  required  to  close  the  wound, 
a  drainage  tube  introduced  at  the  angle 
of  the  wound  and  an  iodoform  dressing 
applied.  The  leg  was  then  placed  in  a 
fracture  box  with  bran  supports.  Given 
morphia  sulphate  gr.  14.  Reaction  from 
the  anaesthesia  good.  7  p.m.,  temp.  lOi''^ ; 
pulse  120.  Has  vomited  several  times; 
has  not  eaten  anything  ;  given  whiskey  at 
intervals;  pain  along  tibial  nerve  severe; 
morphia  sulphate  gr.  '4  ever)-  two  hours 
if  necessary. 

August  6th,  10.15  a.m.,  temp.  looi''; 
pulse  96  ;  slept  very  little  during  the  night, 
as  muscular  contractions  were  very  painful 
and  annoying  ;  morphia  sulphate  gr.  y^  as 
necessary. 

August  7th,  II  a.m.,  temp.  loo^^  ; 
pulse  96  ;  slept  during  the  night ;  feels  com- 
fortabe;  wound  is  discharging  at  angle 
over  the  wires,  other  parts  look  well  ; 
washed  with  a  solution  of  carbolic  acid 
and  dressed  with  iodoform. 

August  8th,  7.30  p.  m.,  temp.  102!"'; 
pulse  120  ;  wound  at  angle  is  discharging 
very  freely  around  and  through  drainage 
tube;  tube  taken  out,  wound  washed  with 
carbolized  water  and  dressed  with  iodo- 
form ]  given  bromide  of  potassium  and 
chloral  hydrate  ;  muscular  contractions  not 
so  severe ;  has  eaten  nothing  since  the 
operation  ;  milk  punch  continued. 

August  9th,  12  m.,  temp.  100' "^  • 
pulse  112;  feels  comfortable  ;  has  eaten 
chicken  broth  and  toasted  bread  ;  wound 
discharging  freely. 

August  loth,  1 1  a.  m,,  temp.  loo*^  ;  pulse 
100;  suppuration  free;  has  pain  and  jerk- 
ing in  leg;  dressed  with  carbolized  water 
and  iodoform. 


August  iith,  12  m.,  temp.  99  2-5^' 
pulse  96;  suture  at  a::gle  taken  out  to 
allow  freer  drainage  ;  iodoform  dressing  ; 
batting  changed  ;  morphia  sulphate  and 
chloral  hydrate  as  necessary. 

August  I2th,  II  a.  m.,  temp.  100  i-S''; 
pulse  112  ;  delirious  during  the  night,  at- 
tempted to  get  out  of  bed  ;  suppuration 
free ;  took  out  sutures,  wound  at  upper 
portion  healing,  leaving  the  T  incision 
open,  felt  bones  of  leg  jump;  su'phate  of 
magnesia. 

August  I3lh,  12  m.,  temp.  100  i-S*^  ; 
pulse  112;  slight  pains  in  leg. 

August  14th,  1 1. 1 5  a.m.,  temp.  99  3-5'^ ; 
pulse  96;  feels  comfortable;  felt  bones 
jump  during  the  night,  pads  changed,  sup- 
puration free. 

August  i6th,  10  a.  m.,  temp.  99  4-5^; 
pulse  90 ;  feels  well,  except  little  sickness 
at  stomach  ;  bones  give  him  the  sensation 
he  had  when  they  were  uniting,  dressed 
with  carbolized  water  and  iodoform  ;  lax- 
ative. 

August  18th,  a.  m.,  temp.  98  4-5*^  ;  pulse 
88 ;  has  malarial  symptoms.  R.  quinine 
sulphate  gr.  ii  every  three  hours. 

August  22nd,  temp.  98  3-5"^  ;  pulse  88  ; 
bones  uniting. 

August,  24th  temp.  99  3-5"  ;  pulse  90  ; 
doing  well,  bedding  changed. 

September  12th,  abscess  at  upper  ex- 
tremity of  incision  incised,  and  a  large 
amount  of  clean,  healthy  pus    evacuated. 

September  i8th  ;  doing  well,  no  dis- 
charge, wound  healed,  wires  cannot  be  felt. 

September  26th  ;  put  on  posterior  tin 
splint  with  foot  piece,  allowed  to  get  out. 
of  bed  and  go  about  his   room  on  crutches 

October  9th  ;  dressing  removed,  tin 
splint  re-applied  with  silicate  of  potash 
bandage  ;.  allowed  to  go  about  at  will  on 
crutches. 

October  20th  ;  new  silicate  of  potash 
bandage  applied,  can  lift  leg  without  pain 
or  strain   when   no    bandage    is  on    it.      In 


THE  CANADA  MEDICAL  RECORD. 


53 


January  went  to  work  at  Iior.se-shoein<^, 
wound  up  with  a  heavy  sjirce  and  hard 
fijht,  was  thrown  down  and  drasj^ged 
about  the  rootn,  felt  no  bad  effects  in  the 
eg,  union  perfect. 
Februar}-  i6th  ;  leg  still  doing  well 
wears  the  last  banJage.  Has  sect)ndary 
syphilitic  symi)toms  ;  given  hydrarg.  pro- 
tiodide  gr.   '^'  every  four  hours. 

February  26th  ;  bubo  incised  ;  continue 
pills. 

July  4th;  bandage  taken  ofif,  wires  still 
in  the  bones,  leg  perfectly  strong,  can  do 
as  good  a  day's  work  at  horse-slioeing  as 
before  injury.  Me  wears  a  shoe  that  pre. 
vents  any  limping. 

Cases  I  and  3  prove  to  me  syphilis 
is  not  a  cause  of  non-union,  and  that  the 
bony  union  following  free  suppuration  is 
stronger  and  more  permanent  than  that 
following  the  closed  method  of  treating 
these  cases. 


i 


THE  PROrHYLAXIS  AND  TREAT- 
MENT OF  PUERPERAL  ECLAMPSIA. 

By  George  T.  McKeough,  M.D., 
M.R.C.S.  Eng.,  L.R.C.P.  Edin.,  F.O.S. 
Lond.,  Chatham,  Ont.* 

In  selecting  the  subject  of  Puerperal  Al- 
buminuria and  Eclampsia  for  a  short  paper 
before  this  Society,  I  scarcely  think  any, 
apology  necessary,  as  no  subject  can  have 
greater  interest  or  be  of  more  supreme 
importance  to  the  obstetric  physician. 

The  suddenness,  frequently  of  its  onset, 
its  grave  character,  the  conflicting  opinions 
still  held  both  as  regards  the  pathology 
and  the  treatment  of  the  complication, 
render  it  a  subject  peculiarly  fit  for  a 
profitable  and  instructive  interchange  of 
opinions. 

First,  regarding  the  prophylactic  treat- 
ment of  eclampsia.  In  many  cases,  unfor- 
tunately, we  have  not  an  opportunity  to 
advise    or  adopt  any  preventive   measures, 

*  Read    before  I  he    Canadian   Medical  Association, 
J.ordon,  Om.,  Sept.  21st,  1893. 


as  we  may  find  our  patient  in  convulsions 
at  our  first  visit,  the  attack  occurring  un- 
expectedly and  without  warning.  This, 
however,  is  not  always  the  case,  and  we 
are  either  conudtetl  by  a  pregnant  wo;n m 
in  reference  to  symptoms  which  suggest  an 
examination  of  her  urine,  or  we  are  simply 
informed  our  patient  is  enceinte,  and  the 
management  of  her  case  left  in  our  hands. 
Frequent  examinations  of  her  urine  should 
thus  become  imperative,  especially  should 
this  be  attended  to  in  priniipara,  as  seven- 
eighths  of  the  cases  of  eclampsia  occur  in 
first  pregnancy.  (Goldberg,  British  Med. 
Journal,  July,  1892.) 

Observers  differ  as  to  the  percentage 
of  albuminous  urine  in  pregnant  women. 
Galabin,  at  Guy's  Hospital  Charity,  found 
only  2  p.  c.  with  the  ordinary  tests  of 
heat  and  nitric  acid  ;  on  the  other  hand, 
some  French  observers  have  found  from 
14  to  20  p.  c.  In  these  last  observations 
the  amount  discovered  in  most  cases  was 
very  small,  and  only  with  very  delicate 
tests,  and  was  possibly  due  in  some  in- 
stances to  cystitis  or  gonorrhoea.  P^rom 
my  own  observations,  however,  among 
French  Canadian  women.  I  believe  they 
are  more  susceptible  to  this  complication 
than  women  of  other  races. 

The  conditions,  however,  that  produce 
albuminuria  during  pregnancy  may  not  in 
every  instance  induce  eclampsia,  and  some 
pregnant  and  pai  turient  women  may  have 
albumen  in  their  urine  without  having 
convulsions.  Still,  if  albumen  be  found 
in  any  quantity,  and  persists,  the  patient 
cannot  be  too  carefully  watched  and  in- 
structed. 

The  diet  should  be  strictly  regulated  : 
if  the  patient  can  be  persuaded  to  limit  it 
to  milk  or  buttermilk,  it  will  be  advisable 
to  do  so  ;  otherwise,  barley  water,  o.itmcal 
gruel,  arrowroot,  chicken  broth,  etc.,  may 
be  allowed.  The  patient  should  be 
warmly  clothed,  and  especially  warned  to 
avoid  chills  and   draughts.     In    my  own 


54 


THE  CANADA  MEDICAL  RECORD. 


practice  convulsions  occurred  in  one  case, 
and  grave  nervous  prodromata  in  another, 
after  taking  a  cold  bath — in  neither  case 
were  there  any  symptoms  previous  to  the 
bath  sufficiently  alarming  to  cause  the 
patient  to  consult  a  physician.  The 
cmunctories,  especially  the  bowels  and 
skin,  should  be  fully  acted  upon.  For  the 
bowels,  Rochelle  or  Epsom  salts,  Pulv. 
Jalapae  Co.,  Bicarb  of  Potash  or  Elaterium, 
are  deservedly  favorite  laxatives.  The 
kidneys  can  be  flushed  as  well  with  pure 
water,  or  some  of  the  innumerable  mineral 
waters,  as  with  other  more  powerful 
diuretics.  For  the  skin  there  is  no  other 
remedy  probably  as  good  as  the  warm 
bath  so  highly  recommended  by  the 
German  obstetricians.  When  possible 
and  convenient,  the  following  method, 
described  by  Dr.  Earle  of  Chicago  {Amer. 
Jour.  Obst.,  Vol.  22,  1889,  page  853),  and 
known  as  the  Vienna  method,  is  excellent : 

"  The  patient  is  placed  in  a  bath  tub 
filled  with  water  slightly  above  99" F. 
The  tub  is  covered  with  a  heavy  blanket, 
leaving  the  face  free,  and  the  temperature 
of  the  water  gradually  elevated  to  i  lo*^ 
F.  or  112'^F.  The  patient  remains  in  the 
bath  tub  from  20  to  30  minutes.  A  towel 
wrung  out  of  ice  water  and  placed  upon 
the  head  relieves  any  distressing  cephalic 
sensation.  While  in  the  bath,  the  patient 
drinks  large  quantities  of  water.  Upon 
emerging  from  the  bath  she  is  covered 
with  a  warm  sheet  and  enveloped  in  an 
upper  and  lower  layer  of  thick  blankets, 
so  that  only  the  face  is  exposed.  Within 
a  very  few  minutes  free  perspiration  is 
observed.  The  sweating  is  continued  for 
two  or  three  hours,  according  to  the  gravity 
of  the  case  ;  the  bath  may  be  repeated  once 
daily  for  an  indefinite  period." 

When  it  is  not  possible  to  carry  out  this 
plan  of  inducing    sweating,    the  ordinary 
hot  vapor  bath  can  always  be  extempor- 
ized, and  answers  very  well. 
If,  notwithstanding  these  efforts  carefully 


and  assiduously  carried  out,  the  quantity 
of  albumen  remains  large,  persists  or 
increases  in  quantity,  the  proportion  of 
urea  diminishes  with  or  without  cedema, 
with  or  without  nervous  symptoms,  the 
induction  of  premature  labor  should  un- 
hesitatingly be  resorted  to,  especially  if 
the  pregnancy  has  advanced  to  or  beyond 
the  seventh  month.  The  cause  of  the  albu- 
minuria is  undoubtedly  the  pregnancy, 
— by  ending  the  cause,  the  effect  is  soon 
relieved. 

In  the  practice  of  my  partner,  Dr. 
Holmes,  and  myself,  we  have  induced  labor 
in  nine  (9)  cases  of  albuminuria  of  preg- 
nancy, after  first  adopting  the  means  related 
without  amelioration  of  threatening  symp- 
toms ;  in  all  cases  the  child  was  born  alive 
and  the  mothers  mide  good   recoveries. 

Labor  was  induced  by  means  of  an 
aseptic  gum  elastic  catheter  usually  prosta- 
tic on  account  of  its  length,  gently  inserted 
between  the  membranes  and  uterine  walls 
posteriorly,  well  up  to  the  fundus  ;  uterine 
contractions  will  be  accelerated  and  labor 
terminated  much  more  speedily  by  the 
injection  of  glycerine. 

When  pains  become  established,  labor 
may  be  hastened  by  rupturing  the  mem- 
branes. If  convulsions  seem  imminent, 
dilatation  of  the  cervix  may  be  assisted 
by  the  fingers  or  Barne's  bags. 

About  an  hour  previous  to  the  intro- 
duction of  the  catheter  a  full  dose  of  chloral 
is  usually  administered  for  the  joint  pur- 
pose of  relaxing  the  os  uteri  and  allaying 
nervous  irritation.  The  patient  is  after- 
wards carefully  watched,  and  if  headache 
is  complained  of,  or  other  nervous  symp- 
toms observed,  chloral  or  chloroform  is 
administered. 

But  despite  preventive  measures,  eclamp- 
sia may  occur,  or,  what  more  frequently 
happens,  the  first  introduction  to  the  pa- 
tient finds  her  in  convulsions. 

In  treating  eclampsia,  three  important 
factors    in  its   etiology   should  be  remem- 


THE   CANADA    MEDH  .\L   "RECORD. 


33 


bered.  The  first  is  the  exalted  nervous 
and  vascular  tension  peculiar  to  preg- 
nane}' ,  the  second  is  that  some  noxious 
material,  whether  the  result  of  a  kidney- 
lesion  or  the  toxini?  proJuct  of  sonu 
pathogenic  microbe,  or  some  other  cause, 
as  yet  to  be  demonstrated,  is  retained 
and  circulates  in  the  blood.  Dr.  Anvard  ex- 
presses it  aptly  when  he  says  that  eclamp- 
sia is  the  result  of  a  strike  on  the  part  of 
the  organs  of  elimination ;  the  third  is 
the  ultimate  cause  of  the  complication, — the 
presence  of  the  child  in  utero.  The  thera- 
peutics of  eclampsia  are  therefore  reduce^l 
to  the  following  indications  :  sedation,  elim- 
ination, and  the  evacuation  of  the  uteru-;. 
The  patient  should  be  quieted  as  soon  as 
possible.  Have  the  light  in  the  room  sub- 
dued, the  surroundings  calm,  take  the  pre- 
caution to  protect  the  woman's  tongue  by 
inserting  a  soft  gag,  or  have  one  ready  for 
immediate  use.  Then  put  her  immediately 
under  the  influence  of  chloroform.  This 
should  be  done  before  any  attempt  is  made 
to  draw  off  the  urine,  to  introduce  the 
finger  into  the  vagina,  or  to  administer  any 
medicine,  as  the  slightest  irritation  in  the 
highly  sensitive  condition  of  the  nervous 
system  may  precipitate  another  convul- 
sion. 

Besides  quieting  the  patient  and  allaying 
the  fears  of  excited  and  anxious  friends, 
you  have,  while  administering  the  anaes- 
thetic, a  few  moments  for  quiet  reflection, 
which  in  the  face  of  probably  an  unex- 
pected exigency  may  be  desirous.  Small 
quantities  of  chloroform  usually  suffice  to 
produce  the  desired  effect  and  ward  off 
the  threatening  fit. 

As  soon  as  the  patient  is  resting  com- 
fortably, the  sedative  action  of  the  chloro- 
form should  be  assisted  and  maintained  by 
chloral  or  morphine  ;  the  latter  drug  is 
more  easily  administered  and  acts  more 
promptly,  and  obstetric  literature  during 
the  past  few  years  is  replete  with  favor- 
able reports.      Dr.    Fry   {Amer.  Jour,    of 


Obst.,  Vol.  2  1.  (.SSS,  p-ige  536)siys:  "In 
the  treatment  of  puerperal  eclampsia  we 
ha\eas  palliatives,  chloroform,  chloral,  po- 
tassium bromide  and  morphine.  Of  these, 
morphine  administered  hypodermically  is 
by  far  the  best  and  most  reliable.  Dr. 
Washburn  (J/r/.  Xcivs,  \o\.  59.  pa^c  29) 
highly  extols  the  virtues  of  morphine  in  all 
forms  of  anaemic  poisoning.  It  is  unne- 
cessary to  mention  other  favorable  ex- 
periences with  morphine,  as  most  physi- 
:  cians  have  had  more  or  less  experience 
.  with  it.  From  my  own  personal  use  of  the 
two  drugs,  morphine  in  eight  cases,  chloral 
;  in  six  cases,  and  morphine  and  chloral 
together  in  six  cases,  I  prefer  chloral  in 
j  most  instances.  The  action  of  morphine 
I  upon  the  kidneys  is  disputed,  some  au- 
:  thorities  asserting  that  it  increases  the  flow 
of  urine.  Stephen  McKenzie's  Z^rwrA  vol. 
■  2,  1 89 1,  page  209,  reports  a  case  of  chronic 
ura.'mia,  in  which  morphine  not  only  re- 
lieved the  distressing  symptoms  but  largely 
increased  the  flow  of  urine.  Others  again 
believe  that  it  usually  diminishes  the  flow. 
But  whatever  its  action  on  the  kidneys, 
morphine  certainly  constipates  the  bowels 
and  interferes  with  the  rapid  action  of  the 
hydrogoguecathartic,  which  is  highly  essen- 
tial in  the  successful  treatment  of  most  cases 
of  eclampsia.  If  morphine  is  preferred  for 
any  reason,  do  not  make  the  mistake  that  I 
unfortunately  did  once  some  years  ago,  of 
injecting  a  dissolved  triturate  of  morphine 
and  atropine.  The  atropine,  by  reason  of 
its  action  on  the  skin,  is  contra-indicated 
If  the  patient  is  comatose  or  unable  to  swal- 
low, the  chloral  may  be  given  by  enema,  or 
by  inserting  a  long  soft  rubber  catheter  or 
tube  through  the  nose  or  mouth  into  the 
oesophagus,  and  injecting  it  through  the 
catheter  into  the  stomach,  using  due  care 
to  see  that  the  tube  is  some  distance  into 
the  oesophagus,  and  have  the  patient 
slightly  elevated. 

The  sedatives  having  been  administered, 
our  attention  should   now  be  directed   to 


56 


THE   CANADA   MEDICAL   RECORD. 


elimination.  This  is  equally  important  as 
the  first  indication  of  treatment.  The 
bowels  should  be  freely, very  freely,  moved  ; 
this  is  not  only  the  best  portal  for  carrying 
off  excrementatious  material  in  the  blood, 
but  by  bleeding  the  patient  moderately  as 
it  were  into  her  cAvn  intestines,  vascular 
tension  is  lowered  as  well  as  the  excessive 
action  of  the  heart.  Rochelle  salts  or  saly- 
cilate  of  magnesia,  on  account  of  their  rapid 
hydragogue  action,  are  most  useful.  It  can 
be  introduced  into  the  stomach,  if  neces- 
sary, in  a  way  similar  to  the  chloral.  Be- 
sides the  bowels,  the  skin  should  be  made 
to  secrete  freely.  This  can  readily  be  ac- 
complished by  abundant  covering  and  arti- 
ficial heat  placed  about  the  body  of  the 
patient. 

These  means  can  be  assisted  by  the  ac- 
tion of  pilocarpine,  in  cases  when  the  coma 
is  not  profound,  in  doses  of  ^^  to  ^  hy- 
podermically  every  two,  four  or  six  hours, 
according  to  its  action  on  the  skin. 

The  patient  quieted,  and  under  the  in- 
fluence of  the  anaesthetics,  the  purgative 
administered,  the  skin  secreting  freely, 
proceed  to  terminate  labor  as  speedily  as 
possible  consistent  with  safety  to  mother 
and  child. 

Early  in  the  stage  of  pregnancy,  before 
the  cervix  is  effaced  and  the  os  undilatable, 
a  catheter  is  introduced  (as  previously  re- 
ferred to).  Puncturing  the  membranes  if 
possible  will  accelerate  labor,  and  the  escape 
of  the  liquor  amnii  is  not  uncommonly 
followed  by  cessation  of  the  convulsions. 
Dilatation  of  the  os  may  be  expedited  by 
the  fingers  or  Barne's  bags,  and  delivery 
hastened  and  completed  by  the  forceps  or 
turning  and  extraction. 

Special  care  should  be  taken  that  all 
interferences  should  be  done  upon  strictly 
aseptic  principles. 

Efforts  must  not  cease  as  soon  as  deliv- 
ery is  accomplished,  the  patient  should 
still  be  carefully  watched,  and  all  nervous 
symptoms    allayed    with.  Qhloroform   and 


chloral.  The  bowels  should  still  be  kept 
open,  and  the  skin  secreting  until  the 
kidneys  act  freely  and  the  albumen  mark- 
edly diminishes  in  quantity. 

If  the  procedures  thus  indicated  are 
persisted  in,  the  physician  will  be  rewarded 
in  most  cases  by  the  recovery  of  his  patient. 
But  if,  in  spite  of  chloroform,  chloral,  mor- 
phine and  elimination  the  convulsions  con- 
tinue, the  question  of  venesection  may  arise, 
and  its  value  is  probably  one  of  the  most 
unsettled  questions  in  the  treatment  of 
eclampsia.  It  is  one  of  the  oldest  remedies, 
and  is  still  relied  upon  by  many  as  one  of 
the  most  etificacious  means  to  control  con- 
vulsions. 

Dr.  Swa)-ne  of  Bristol  [British  Med. 
Jour.,  Sept.,  '91)  gives  a  record  of  36  cases 
of  puerperal  eclampsia,  in  24  of  which  bleed- 
ing was  used,  and  in  18  it  was  decidedly 
beneficial.  Barnes  says:  "  It  is  not  wise  to 
make  venesection  a  rule  in  practice,  but  the 
empirical  evidence  in  its  favor  in  appro- 
priate cases  is  incontestable  ;  nothing  so^ 
quickly  lowers  the  excessive  action  of  the 
heart." 

Many  others  publish  good  results,  but 
the  weight  of  authority,  I  think,  is  opposed 
to  venesection. 

At  Guy's  Hospital,  in  the  last  50  cases 
in  which  venesection  was  used  the  mortality 
was  30  per  cent.  In  34  cases  since,  it  has 
been  20^  per  cent.  Kucher,  of  the 
Vienna  School,  where  the  results  have  been 
very  good,  says  that  blood-letting  has  been 
completely  discarded.  In  Schroeder's 
clinic,  bleeding  is  not  now  practised, 
Winckel  is  also  opposed  to  blood-let- 
ting. In  my  own  cases  I  have  resorted  ta 
bleeding  in  three  instances  in  large 
amounts,  30  to  40  oz.,  when  other  means, 
were  apparently  failing  to  control  the  con- 
vulsions, with  the  result  of  stopping  the 
convulsions,  but  losing  my  patient  in  each 
instance.  From  what  I  can  gather  from 
my  reading,  from  statistics  and  my  own  ex- 
perience, I  believe  better   results  would  be 


THE   CANADA    MEDICAL    RECORD. 


57 


obtained  in  these  cases  by  pcrsistingly 
carr}ing  out  the  indications  I  have  en- 
deavored to  la)' down  in  this  paper. 

But  there  is  a  class  of  cases  one  meets 
with  usually  in  strong  and  plctiioric  sub- 
jects ;  the  patient  has  liad  one  or  more 
convulsions,  is  probably  comatose,  there  is 
great  vencnis  congestion,  the  veins  of  the 
neck  are  turgid,  the  lips  purplish,  the  face 
bloated  and  suffused  ;  there  is  much  em- 
barrassment of  respiration,  when  it  always 
seems  to  me  reasonable  and  good  practice 
to  extract  a  moderate  amount  of  blood  ; 
and  wlien  1  ha\e  resorted  to  it,  the  symp- 
toms have  improved,  the  color  of  the  face 
becomes  more  natural,  the  respirations 
easier,  and  the  general  condition  of  the 
patient  more  favorable;  perhaps  rdso  a 
brain  lesion  is  prexented,  absorption 
favored,  and  the  action  of  other  remedies 
assisted. 


Socictj)    JSrocccbings. 


ABSTRACT  OF  THE  PROCEEDINGS  OF 
THE  THIRD   ANNUAL  MEETING  OF 
THE  AMERICAN  ELECTRO-THER- 
APEUTIC   ASSOCIATION. 

HELD  IN  CHICAGO,    SEPIEMBER   12,     13    AND     I  4, 
1893. 

AuGLSTiN  H.  GoELET,  M.D.,  President. 
FIRST  DAY— SEPrEiJBER  i2TH. 
AFTERNOON  SESSION — Continued. 

Trie  fixation  of  tlie  tumor  may  be  accomplished 
with  the  help  of  an  instrument  called  the  vesical 
tenaculum  cache,  and  this  instrument  can  be 
used  as  a  guide  to  the  introduction  of  the  elec- 
trode. With  this  method  a  cannulated  platinum 
needle  is  employed,  which  not  only  allows  of 
the  easy  introduction  of  the  needle,  but  is  so 
arranged  that  the  needle  is  projected  only  a 
certain  distance  beyond  the  end  of  the  cannula 
into  the  tumor — a  distance  which  can  be  deter- 
mined beforehand  by  the  proper  adjustment 
of  the  instrument. 

All  the  operations  were  done  through  the 
urethra,  without  the  employment  of  anaesthesia, 


the  production  of  pain,  or  interference  with 
the  jiatient's  occupation.  The  author  did  not 
wish  to  he  understood  as  asseriin'^  that  elec- 
trolysis would  cure  all  benign  tumors  of  the 
bladder,  yet  he  claimed  very  sali->faclory  results 
in  the  cases  which  he  had  thought  proper  to 
subject  lo  this  treatment. 

''Tile  Nutrition  d  Effects  of  Statical  Elec- 
tricity Considered  in  Relation  to  High  Fre- 
quency and  High  Potential  Currents,  and  the 
Transparency  of  the  Dielectric." 

Dr.  William  J.  Morton,  of  New  Yoik,  read 
a  paper  with  this  title.  Through  the  recent 
labors  chiefly  of  D'Arsonval,  Tesla  and  Elihu 
Thompson,  statical  electricity  has  assumed 
new  and  important  relations  to  electro-thera- 
peutics. In  conlra-distinclion  to  the  low  fre- 
quency of  the  current  obtained  from  the 
ordinary  faradic  coil,  the  high  frequency  high 
potential  current  is  simply  a  periodical  current, 
or  one  in  which  the  electrical  energy  is  cut  up 
into  many  waves  or  periods — ten  thousand  lo 
ten  million  j  er  second.  With  this  high  fre- 
quency there  is  a  correspondingly  high  electro- 
motive force,  and  it  is  mainly  these  factors  and 
not  electrolytic  conduction  which  is  the  impor- 
tant point  to  be  considered  when  studying  the 
electio-iherapeutic  effects  of  this  current. 

When  a  Leyden  jar  is  suspended  in  connec- 
tion with  any  electrostatic  machine  and  the 
spark  caused  to  pass,  every  time  the  spark 
passes  there  is  a  corresponding  discharge  in 
the  Leyden  jar,  and  with  each  discharge  oscil- 
lations take  place  many  thousands  of  times 
a  second.  This  is  the  periodiral  current  with 
which  we  are  dealing  in  electi-ostaties.  The 
oscillatioiis  are  reduced  in  frequency  in  pro- 
portion to  the  resistance  in  the  circuit. 

The  high  frequency  current  seems  to  p'ossess 
an  unlimited  power  of  penetrating  tissues  of 
the  body.  As  the  static  machine  is  set  in 
motion  and  a  spaik  passes,  every  particle  of 
ether  in  the  room  is  also  set  in  motion,  and  the 
same  vibration  is  set  up  in  our  own  bodies. 

According  to  the  modern  view  of  electricity, 
the  electrical  energy  which  produces  what  wc 
call  the  current  is  around  the  wire  and  not  in 
the  wire,  and  the  electrical  influence  is  tVlt  in 
the  medium  around  the  wire.  If  this  is  not  a 
conductor,  then  these  same  ether  vibrations 
impinging  on  the  dielectric  put  it  in  a  conduion 
of  Strain.  The  dielectric  is  a  non-conductor, 
having  a  charge,  and  being  in  relation  t(^anoiher 
body  also  having  a  charge.  It  is  found  that 
these  periodical  currents  are  cmveyed  bo;h  by 
our  conductors  and  our  non-conductors,  and 
in  the  technical  language  of  the  present  lime  it 
is  said  that  a  dielectric  is  "transparent"  to 
periodic  currents. 

The  jnincipal  object  of  the  paper  was  to 
present  the  results  of  a  series  of  observations 
which  the  author  had  made  at  his  clinic  in 
the  New  York  Post-Graduate  Medical  School. 


58 


THE  CANADA  MEDICAL  RECORD. 


The  secretions  weie  affected.  That  the  circu- 
lation is  visibly  affected  is  shown  by  the  dilata- 
tion of  the  cutaneous  vessels  following  imme- 
diately ujjon  the  application  of  sparks  locally 
or  generally.  A  series  of  tabulated  cases  were 
shown,  showing  that  in  a  great  number  of  cases 
under  observation  the  pulse  was  lowered  by 
statical  electrization  from  fifteen  to  twenty 
beats,  and  that  the  body  temperature  was 
usually  increased  from  half  to  one  degree. 
Slating  broadly,  he  thought  he  might  deduce 
the  law  that  the  disposition  of  statical  electri- 
zation is  to  produce  an  equalization  by  acting 
upon  the  centres — reducing  a  freqtient  pulse 
and  elevating  a  subnormal  temperature,  or  v\c^ 
versa. 

Observations  were  also  presented,  which 
showed  that  in  ca^es  of  chronic  articular  rheu- 
matism this  treatmem  resulted  in  greatly  dim- 
inishing the  quantity  of  uric  acid  and  corres- 
pondingly increasing  the  quantity  of  urea.  It 
was  also  noted  that  many  patients  while  under 
ihis  treatment  gained  in  weight  very  perceptibly 
— one  patient  gaining  forty-two  pounds  in  five 
weeks. 

'J'he  author  concluded  by  expressing  the 
conviction  that  statical  electrizalior  was  onlj- 
the  beginning  of  a  new  and  extremely  important 
era  in  which  the  periodical  current  would  play 
a  prominent  part,  and  lead  to  much  belter 
practical  results.  The  very  mechanism  which 
the  author  was  the  first  to  describe,  and  which 
was  published  in  1881,  is  to-day  found  to  be 
essential  for  producing  these  wonderful  electro- 
static effects  of  alternating  currents. 

DISCUSSION. 

Dr.  H.  E.  Hayd,  of  Buffalo,  said  he  could 
vouch  for  the  statement  that  statical  electricity 
profoundly  affects  the  secretions,  for  he  had 
frequently  observed  that  it  increased  the  specific 
gravity  of  the  urine.  He  also  knew  from  per- 
sonal observation  that  it  stimulated  the  circu- 
lation, and  was  especially  useful  in  muscular 
rheumatism  owing  to  its  power  of  increasing 
the  activity  of  the  hepatic  function.  He  could 
also  confirm  what  had  been  said  about  the 
increase  in  body  weight  and  in  the  quantity  of 
urea  excreted. 

Dr.  Massey  referred  to  a  recent  case  in  which 
the  improved  nutrition  could  only  be  attributed 
to  the  effect  of  the  static  charge. 

Dr.  Herdman  said  that  the  effect  of  statical 
electrization  on  the  circulation  was  sufficient 
to  explain  many  of  the  beneficial  results  men- 
tioned. He  believed  that  in  spinal  irritation, 
and  in  neurasthenia,  the  good  effects  of  this 
treatment  were  directly  attributable  to  its  action 
in  relieving  the  passive  congestion  which  he 
considered  to  be  the  fundamental  cause  of  these 
affections. 

A  few  days  ago,  Tesla  admitted  in  his  pres- 
ence that  his  experiments    with  the  high  fre- 


quency current  were  the  result  of  his  attention 
being  directed  to  the  subject  by  Morton's 
description  of  his  method  of  i)rodiRing  the 
sialic  induced  current. 

Dr.  Hollord  ^Valker,  of  Toront'-<,  said  that 
although  his  experience  with  statical  electricity 
extended  only  over  the  past  year,  he  had  ob- 
served beneficial  effects  from  its  use,  which  r ould 
only  be  explained  by  its  action  in  increasing 
the  circu  ation. 

Dr.  J.  B.  Greene,  of  Indiana,  said  tint  the 
author  had  not  shown  any  marked  change  in 
the  temperature  as  a  result  of  statical  electriz- 
ation, although  claiming  a  marked  effect  on 
the  pulse  ;  nor  had  he  exhibited  any  sphygmo- 
giaphic  tracing  from  these  patients.  This  he 
considered  a  very  serious  omission.  His  own 
observations  had  led  him  to  believe  that  the 
good  effects  observed  after  statical  electrization 
were  largely  due  to  "  suggestion." 

Dr.  W.  B.  S])ragiie,  of  Detroit,  said  that 
although  using  one  of  the  small  static  machines 
which  had  been  characterized  as  a  '"  toy,"  he 
had  obtained  gratifying  results  with  it  in  cases 
of  neurasthenia. 

Dr.  P,  S.  H  lyes,  of  Chicago,  said  that  his 
experience  with  statical  electrization  during 
the  past  ten  years  justified  him  in  endorsing 
what  had  been  said  in  its  favor.  Taking  into 
account  the  high  tension  of  statical  electrolysis, 
he  believed  that  the  current  acted  directly  on 
the  contents  of  the  cells  in  the  tissues,  and  not 
merely  on  the  fluids  suriounding  the  cells. 

Dr.  Margaret  A.  Cleaves,  of  New  York,  said 
that  she  had  also  observed  a  remarkable  in- 
crease of  body  weight  in  many  cases.  She 
also  called  attention  to  one  very  practical  point 
— viz  :  that  constipation  of  many  years'  standing 
is  very  commonly  relieved  by  statical  electricity 
applied  over  to  the  lumbar  and  sacral  plexes 
of  nerves  and  to  the  abdominal  parietes. 

Dr.  Morton,  in  closing  the  discussion,  said 
that  if  "  suggestion  "  were  capable  of  uniformly 
affecting  the  pulse  and  temperature  in  the  man- 
ner exhibited  in  his  tables,  it  might  well  be 
adopted  instead  of  electrical  treatment.  A 
rather  intimate  acquaintance  with  the  subject 
of  hypnotism  had  failed  to  convince  him  that 
it  possessed  any  such  remarkable  power.  A 
change  of  one  degree  uniformly  in  given  cases 
he  considered  a  "marked  change." 

A  paper  on  '•  Electro-Medical  Eccentricities," 
by  H.  Newman  Lawrence,  Esq.,  of  London, 
Eng.,  in  the  absence  of  the  author  was  read  by 
the  Secretary. 

He  first  discussed  a  very  common  defect  of 
many  text-books  on  electro-therapeutics,  viz. : 
the  apparent  lack  of  connection  between  the 
part  which  treats  of  electro-physics  and  that 
which  treats  of  the  therapeutical  applications 
of  electricity. 

He  next  suggested  that  there  should  be  a 
proper  standard  of  qualifications  for    medical 


THE   CANADA   MEDICAL   RECORI>. 


59 


electricians,  and  that  those  so  qualified  might 
with  advantage  carry  out  the  electrical  treat- 
ment of  cases  referred  to  them  by  general  ])rac- 
litioners.  The  third  topic  which  received 
attention  was  the  existence  of  so  rnucii  quackery 
under  the  name  of  electricity  or  magnetism. 
The  author  thought  the  medical  ])rofession 
sliould  no  longer  remain  silent  in  regard  to  so- 
called  magnetic  apparatus  and  apj^liances  de- 
pendent for  their  action  upon  the  well-known 
])rocess  of  electro-physic^,  and  he  suggested 
that  the  Association  appoint  a  committee  to 
consider  the  best  way  of  overcoming  these 
abuses. 

The  paper  was  discussed  by  Dr.  Morton  and 
Dr.  Herdman,  both  of  whom  expressed  the 
opinion  that  any  attemi)t  to  overcome  such 
outrages  by  legislation  would  produce  the  very 
opposite  result  to  that  which  all  desired.  It 
was  only  by  individual  effort  in  the  dissemina- 
tion of  correct  popular  information  on  medical 
electricity  that  we  could  hope  to  defeat  these 
quacks. 

"The  Action  of  the  Continuous  Current 
within  Living  Tissues  as  Distinguished  from 
the  Local  Polar  Action."' 

Dr.  W.  J.  Herdman,  of  Ann  Arbor,  read  a 
paper  on  this  subject.  Whenever  a  tissue  is 
subjected  to  the  action  of  a  continuous  current, 
owing  to  the  fact  that  the  tissue  is  made  up  of 
cells  containing  fluids  and  surrounded  by  cell 
walls  having  a  greater  resistance,  these  fluids 
must  be  absorbed.  This  is  by  a  process  of 
convection  and  not  of  conduction.  This 
theoretical  view  that  electricity  must  exert  a 
systematic  eff'ect  is  confirmed  by  experiments 
made  by  the  author  and  by  others  on  healthy 
animal  and  vegetable  tissues.  It  was  found 
that  when  these  tissues  were  exposed  to  a  feeble 
current  of  electricity  for  a  short  time  daily, 
their  growth  was  decidedly  increased,  but  it 
was  retarded  by  a  more  prolonged  action  of 
the  current. 

DISCUSSION. 

Dr.  Massty  said  that  the  abdominal  walls  of 
many  patients  undergoing  the  Apostoli  treat- 
ment for  uterine  fibroids  became  the  seat  of  an 
increased  deposit  of  fat  owing  to  the  improve- 
ment of  the  general  health  consequent  upon  the 
treatment. 

Dr.  Morton  said  that  the  experiments  of  G. 
Weiss,  the  physiologist  in  Paris,  bore  out  the 
point  made  in  the  paper  regarding  electrolytic 
action  and  its  effect  on  functional  activity  of 
the  cells.  This  investigator  passed  a  strong 
continuous  current  through  one  leg  of  a  healthy 
frog.  After  a  week  it  was  found  that  the  ex- 
citability of  this  leg  was  about  ten  times  less 
than  that  of  the  other  leg.  The  speaker  said 
he  believed  in  the  polar  effect,  and  believed  it 
reached  deeply.  Acting  on  this  purely  physical 
view  of  the  action  of  the  electrical  current  in 


the  human  body,  he  had  been  in  the  habit  of 
applying  the  j^ositive  pole  to  the  spine  for  all 
spinal  Lord  degener itions,  and  the  negative 
pole  for  all  inflammations.  This  was  exactiv 
the  reverse  of  the  usual  treatment,  but  his  ex- 
perience with  this  method  of  treatment  had 
only  served  to  convince  him  that  it  was  founded 
on  a  correct  theory. 

Dr.  Herdman,  in  closing  the  discussion,  said 
that  although  many  electro-therapeutists  did 
not  believe  at  all  in  the  intra-])olar  action  of 
the  current,  he  not  only  believed  in  it,  but  con- 
sidered it  very  important.  By  the  term  "con- 
vection "  he  had  meant  to  convey  the  same 
idea  as  we  represent  in  the  expression  "  pro- 
gression of  the  atoms." 

"  Observations  on  the  Treatment  of  Goitre." 

Dr.  Charles  R.Dickson,  of  Toronto,  read  a 
paper  with  this  title.  He  now  uses  Goelet's 
modification  of  Aposioli's  clay  pad,  and  begins 
with  a  current  of  lo  to  15  m.a.  for  ten  minutes. 
The  treatment  is  continued  on  alternate  days, 
and  the  strength  of  the  current  gradually  in- 
creased up  to  100  or  120  m.a.,  although  in 
exceptional  cases  over  200  m.  a.  niay  be  used. 
He  considers  a  strong  current  applied  for  a 
short  time  preferable  to  using  a  weak  one  for  a 
long  time.  After  the  treatment,  the  paits  are 
sponged  off  with  a  cold  solution  of  boracic  acid. 
If  alter  several  weeks  of  this  external  treatment 
there  is  no  result,  it  is  proper  to  resort  to 
puncture.  Strict  antiseptic  precautions  are 
observed,  and  the  puncture  is  made  with  a 
surgeon's  needle  insulated  with  several  coats  of 
collodion.  The  puncture  should  be  made,  if 
possible,  low  down  through  the  isthmus,  and 
during  the  introduction  of  the  needle  the  patient 
should  be  directed  to  swallow,  so  that  puncture 
of  the  larynx  may  be  avoided.  The  subsequent 
punctures  are  all  made  at  the  same  spot. 

In  the  cystic  form  the  external  treatment  is  of 
little  use.  Here  the  author  advises  inserting 
an  aspirating  needle,  drawing  off  the  contents 
and  filling  the  sac  with  a  solution  of  salt  in 
boiled  water.  The  object  of  this  is  to  make 
use  of  an  electrode  which  will  fill  the  deepest 
recesses  of  the  sac.  The  aspirating  needle  is 
used  as  an  electrode,  and  after  the  application 
the  fluid  is  withdrawn. 

In  conclusion,  the  author  said  tliat  he  still 
maintains  that  in  electricity  we  have  one  of  the 
most  valuable  agents  in  the  treatment  of  all 
forms  of  goitre,  and  that  it  is  the  safest  treai- 
inent.  He  had  known  even  external  applica- 
tions of  iodine  to  produce  so  much  oedema 
that  death  from  asphyxia  seemed  imminent. 
Electrical  treatment  in  exceptional  cases  may 
hive  to  be  extended  over  a  period  of  two  years. 

DISCUSSION, 

Dr.  Massey  said  that  some  years  ago  he  had 
succeeded  in  absolutely  curing  a  cystic  goitre 
which  had  resisted  other  means.     Four  out  of 


6o 


THE  CANADA  MEDICAL  RECORD. 


six  cases  of  exophthalmic  goitre  he  had  com- 
pletely cured  by  the  exlernil  application  of  a 
current  of  lo  m,  a. 

Dr.  Morton  cited  one  oise  in  wliich  he  had 
succeeded  in  reducing  a  very  large  goitre  to 
one-lhird  its  original  size  by  means  of  the  faradic 
and  galvanic  currents  used  simultaneously  by 
a  combining  switch. 

Dr.  Walker  spoke  of  a  case  in  which  a  lady 
received  such  prompt  relief  from  electrical 
treatment  that  she  would  not  continue  it  long 
enough  for  a  cure  to  be  effected,  but  preferred 
to  return  once  each  year  and  receive  treatment 
for  about  three  weeks. 

Dr.  Dickson  said,  that  in  one  case  where  the 
goitre  was  large  and  distinctly  fibrous,  there 
was  a  i)rotrusion  of  the  right  eye-ball,  which 
diminished  in  proportion  as  the  goitre  was 
reduced. 

SECOND  DAY— SEPieMBKR  13TH. 

MORNING    SESSION. 

■Dr.  Holford  Walker,  of  Toronto,  repotted  a 
"  Case  of  Ascites  Cured  by  Galvanism."  The 
patient,  a  liitle  boy,  was  treated  by  galvanism, 
thirty- nine  applications  being  given.  The 
positive  pole  was  a  large  clay  abdominal  elec- 
trode, and  the  negaiive  a  large  metal  disk, 
which  was  applied  alternately  to  the  shoulders 
and  back  every  other  day  for  fifteen  minutes. 
The  patient  was  unable  to  tolerate  a  current  of 
more  than  50  to  75  m.a.  At  the  end  of  three 
weeks  it  was  evident  that  the  fluid  was  being 
absorbed,  and  in  a  month  or  two  itentirely  dis- 
appeared, and  since  then  the  patient  has  con- 
tinued well  except  for  a  mild  attack  of  rheu- 
matism. Previous  to  resorting  to  electricity, 
all  the  usual  remedial  measures  had  been  tried, 
and  had  failed. 

DISCUSSION. 

Dr.  Newman  cited  from  memory  the  case  of 
a  man  with  extensive  anasarca  and  ascites  who 
was  brought  to  him  after  a  number  of  consult- 
ing physicians  had  expressed  the  opinion  that  in 
spite  of  treatment  he  could  not  live  more  than 
two  days.  Not  more  than  this  time  elapsed  be- 
fore he  measured  three  inches  less  than 
before  the  electrical  treatment  was  begun, 
and  he  ultimately  recovered  entirely.  The 
speaker  could  not  recall  the  original  diag- 
nosis recorded  in  his  case-book.  He  thought 
that  the  treatment  caused  the  withdrawal  of 
some  of  the  fluid,  and  that  it  stimulated  the 
secretions. 

Dr.  Engkman  cited  a  case  of  ascites,  seem- 
ingly just  as  severe,  where  two  very  able 
physicians  gave  a  similar  prognosis.  At  this 
juncture,  some  of  the  patient's  family  insisted 
upon  calling  in  a  quack,  whose  treatment  con- 
sisted in  making  certain  ''  passes  "  about  the 
patient.     One  of  the  regular  physicians  con- 


tinued to  call,  in  order  to  watch  the  treatment. 
I'he  patient  immediately  began  to  improve,  and 
during,  the  ten  years  which  had  elapsed  since 
then,  slie  had  lemained  entirely  well;  In  tha"; 
case,  microscoi)ical  and  chemical  examinations 
of  the  urine  confirmed  the  diagnosis  of  renal 
disease  which  had  been  made  by  the  physicims 
originally  in  charge  of  the  case. 

Dr.  Eugene  C.  Gehrung,  of  St.  Louis, 
thought  that  an  ascites  associated  with  kidney 
disease  was  due  largely  to  spasmodic  irritation, 
and  that  a  cure  was  brought  about  by  the  relax- 
ing effect  of  electricity  on  the  nervous  system. 

Dr.  J.  B.  Greene,  of  Indiana,  said  that  he 
had  been  called  in  consultation  a  few  months 
ago,  to  a  similar  case,  where  the  diagnosis  of 
renal  disease  was  substantiated  by  the  results 
of  the  microscopical  and  cliemical  examination 
of  the  urine;  yet,  to  his  surprise,  the  attending 
physician  afterwards  informed  him  that  from 
the  time  galvanism  was  begun  the  patient 
began  to  improve,  and  eventually  recovered. 

Dr.  Walker,  in  closing  the  discussion,  said 
that  the  diagnosis  in  his  case  had  never  been 
clear.  As  the  boy  had  been  standing  daily 
immersed  in  water  up  to  his  waist,  it  was  possi- 
ble that  the  ascites  was  the  result  of  an  ordinary 
subacute  peritonitis,  or  of  tubercular  peritonitis, 
as  there  was  a  history  of  tuberculosis  on  the 
maternal  side.  The  kidneys  were  perfectly 
healthy. 

"  Metallic  Electrolysis." 

Dr.  Margaret  A.  Cleaves,  of  New  York,  read 
a  paper  on  this  subject.  By  this  term  was 
meant  treatment  by  inserting  in  the  natural 
cavities  and  in  the  tissues  soluble  metallic 
electrodes,  such  as  those  made  of  copper,  zinc 
and  iron.  Experiments  were  cited,  which 
proved  not  only  that  an  oxychloride  of  copper 
was  deposited  in  the 'tissues,  but  that  subcu- 
taneous injections  of  comparatively  large 
quantities  of  this  deposited  salt  failed  to  produce 
in  rabbits  any  toxic  symptoms.  Other  experi- 
ments indicated  that  this  copper  salt  had  a  more 
powerful  bactericidal  action  than  the  ordinary 
galvano-caustic  applications,  and  that  by  the 
cataphoric  action  of  the  current,  the  deposited 
metallic  salt  is  made  to  penetrate  deeply  into 
the  tissues.  This  is  a  convenient  method  of 
applying  a  metallic  salt  in  the  very  depths  of 
the  most  tortuous  sinuses,  and  it  should  not  be 
forgotten  that  the  salt  so  deposited,  being  in  the 
nascent  state,  is  peculiarly  active. 

The  author  stated  that  for  intra-uterine  work 
'  a  current  of  25  to  50  m.  a.  is  sufficient  when 
given  for  fifteen  minutes,  and  that  then  a 
fyverseti  current  o(  10  or  15  m.a.  should  be 
given  for  six  or  eight  minutes  in  order  to  loosen 
the  electrode.  However,  it  should  be  noted  that 
this  adherence  of  the  electrode  to  the  tissues 
may  be  avoided  by  gentle  and  continued 
manipulation  in  suitable  localities  during  the 
application    of    the    current,     Too    frequent 


TlTR   CAXAn\   MEDiCAT.   RKCOkD. 


6  I 


a])|  lic.uionsaic  lial)lc  to  rclaid  the  pioL^rcss  ol 
llie  ca<e.  I  lie  wnik  of  elimination  a lul  repair 
wliich  takes  |)lace  in  the  neighboring  tissues 
without  pain  and  without  inflamniatory  reaction 
extended  over  a  period  of  eight  days.  Metallic 
electrolysis  has  provcci  extremely  efficient  in 
controlling  uterine  hemorrhage.  'I  he  elec- 
trodes .'•hould  be  carefully  rubbed  with  emery 
paper  after  eacli  application. 

Cases  were  also  cited  in  which  the  author 
used  metallic  electrolysis  successfully  in  uterine 
fibroma,  endometritis,  urethritis,  granular  de- 
generation of  the  cervix,  hypertrophic  ihinitis, 
trachoma  and  hemorrhoids.  Improvement  was 
observed  in  most  of  these  cases  after  one  or 
two  sittings,  and  the  cure  was  bo  h  speedy  and 
permanent. 

An  especial  set  of  electrodes  for  applications 
to  the  conjunctival  membrane  weie  j^resented 
by  the  reader  of  the  i)aper,  as  well  as  needles 
for  puncture. 

DISCUSSION. 

Dr.  Morton  said  he  had  proposed  the 
name  '■  metallic-electrolysis  "  instead  of  "  inter- 
stitial elecirolyhis,  "  as  used  by  Gautier, 
because  interstitial  electrolysis  may  occur  any- 
where where  there  is  a  powerful  continuous 
current,  even  though  the  electrodes  aie  not 
metallic.  He  had  been  surprised  to  find  in  a 
book  written  by  Butler,  in  1876,  a  very  good 
description  of  a  similar  method  of  treaimeni, 
but  without  any  reference  to  its  application 
in  gynrecology. 

Dr.  Morton  then  exhibited  special  fo:ms  of 
electrodes  which  had  been  found  useful  in 
applying  this  treatment  to  the  nose,  uterus, 
urethra  and  rectum.  The  adhesion  of  the 
electrode  to  the  tissues  is  particularly  notice- 
able in  the  treatment  of  urethritis,  and  it  is  pro- 
bably due  to  the  formation  of  a  soluble  albumi- 
nate of  the  nieial  constituting  the  electrode. 
The  speaker  then  cited  a  case  in  which  he  had 
promptly  cured  a  gonorrhoea  of  three  months' 
standing,  and  also  the  treatment  of  a  cyst  on 
the  side  of  the  neck.  He  also  described  the 
action  of  metallic  electrolysis  in  curing  hemorr- 
hoids and  atrophic  rhinitis,  the  cure  in  the 
latter  condition,  he  thought,  being  probably 
due  to  a  restoration  of  the  activity  of  the  few 
glands  which  have  .  escaped  tiie  destructive 
process. 

Dr.  Hayd  objected  to  the  treatment  from 
theoretical  consideration.  He  thought  it  was 
unduly  magnifying  the  local  action  of  the 
current,  and  at  the  same  time  encouraging  the 
■  already  too  prevalent  practice  of  employing 
intra-uterine  treatment. 

Dr.  Massey  said  that  the  objections  made 
by  the  last  speaker  did  not  apply  to  the  expert 
use  of  intra-uterine  applications  We  have 
metallic  electrolysis  every  time  we  use  the 
galvanic  current,  unless  the  patient  be  protect- 
ed by  a  very  large  clay  pad  to  catch  the  particles 


of  mcial  wiiich  juiss  off  from  the  meiallic  con- 
ductor. As  regards  this  mode  o.'  treatment  in 
connection  with  hemorrhoids,  he  wished  to 
state  that  he  had  applied  a  current  of  40  or  50 
m.a.  with  a  carbon  electrode  to  hemorrhoids, 
and  had  seen  them  reduced  by  this  means,  so 
that  it  could  not  be  said  that  metallic  electro- 
lysis is  essential  for  such  reduction. 

Dr.  Green  also  objected  to  this  indiscriminate 
probing  of  the  uterus  as  unwise  and  unsafe. 
He  had  quickly  cured  one  case  of  hydrocele  by 
galvano-punclure  of  the  sac  with  a  zinc  needle, 
without  withdrawal  of  the  fluid.  There  had 
been  no  relapse. 

Dr.  P.  S.  Hayes  said  that  while  admitting  the 
dangers  likely  to  follow  upon  the  employment 
of  iiUra-uterine  galvanic  treatment  in  impro- 
perly selected  cases,  befell  that  in  suitable  ones 
the  expert  operator  could  have  accomplished  his 
purpose  much  more  safely  than  by  the  usual 
topical  applications  of  medicines,  [t  was  im- 
portant to  remember  that  without  due  regard 
to  the  proper  technique  of  metallic  electrolysis, 
ii  was  an  easy  matter  to  produce  a  trauma  as  a 
result  of  the  agglutination  of  the  electrode  to 
the  tissues.  The  speaker  also  emphasized  the 
peculiar  powers  possessed  by  metallic  electro- 
lysis by  virtue  of  the  metallic  salts  being  in  the 
nascent  state,  and  the  current  cariying  them 
deeply  into  the  tissues.  It  is  probably  because 
of  this  penetiating  action  that  it  has  been  found 
so  useful  in  the  treatment  of  goiiorrha-a. 

Dr.  Gehrung  remarked  that  this  cataphoric 
action  of  the  current  carried  along  one  portion 
of  the  medicament  before  another  particle  was 
piesented  to  the  tissues,  thus  preventing  a 
clogging  up  of  the  spaces  with  the  medicine. 

The  President  said  that  he  was  the  first  to 
call  attention  to  the  uterine  colic  excited  by 
cupric  electrolysis.  Further  investigation  con- 
vinced him  that  the  astringent  action  of  the 
application  tended  to  constrict  the  canal  and 
obstruct  drainage,  and  some  of  the  gas  which 
was  evolved  during  the  electrolysis  did  not 
combine  with  the  metal  of  the  electrode^  but 
remained  free  in  the  cavity.  By  securing  better 
drainage  from  the  cavity  by  means  of  ])revious 
dilatation,  cases  which  had  before  suffered  from 
colic  were  able  to  receive  the  treatment  with 
entire  freedom  from  this  unpleasant  complica- 
tion. He  knew  of  nothing  superior  to  cupric 
electrolysis  for  controlling  the  most  severe 
forms  of  uterine  hemorrhage,  but  for  endome- 
tritis and  granular  degeneration  of  the  cervix, 
he  preferred  zinc  elecirolysi-.  Zinc  electrolysis 
was  also  useful  in  ])romoting  the  healing  and 
obliteration  of  the  sac  of  suppurating  vulvo- 
vaginal glands  aft*,  r  incision  and  evacuation  of 
the  contents.  He  had  also  treated  successfully 
by  zinc  electrolysjs  a  large  keloid  involving  the 
anterior  surface  of  the  thigh,  using  5  m.  a.  for 
each  zinc  needle,  for  10  minutes,  about  10  or  12 
applications  being  required.  He  had  employed 
zinc  electrolysis  also  in  one  case  of  fibroid  by 


62 


THE   CANADA   MEDICAL   RECORD. 


means  of  vaginal  puncture,  and  had  noted  that 
it  produced  decided  softening  and  marked  dimi- 
nution in  the  size  of  the  growth. 

Dr.  Cleaves,  in  closing  the  discussion,  said 
that  while  she  believed  a  great  deal  of  intra- 
uterine treatment  is  unnecessary,  she  was  satis- 
fied that  in  certain  cases  the  results  from  such 
treatment  were  quicker  and  more  lasting  than 
from  any  other.  In  her  own  practice,  she  did 
not  exceed  a  current  of  30  m.  a.,  and  oftener 
used  a  less  current  strength. 

"  Some  Observations  on  the  Fine  Wire  Coil 
or  Current  of  Tension." 

Dr.  H.  E.  Hayd,  of  Buffalo,  read  a  i)aper  on 
this  subject.  He  said  that  his  own  induction 
coil  consists  of  3500  feet  of  No.  32  wire,  tapped 
at  three  points,  so  as  to  permit  of  using  lengths 
of  1500,  2500  and  3500  feet  respectively.  He 
had  been  inform  d  that  the  vibrator  made  from 
250  to  350  vibrations  per  second.  In  securing 
asedati-e  action  from  such  a  coil,  it  is  very 
important  that  the  action  of  the  vibrator  should 
be  both  rapid  and  smooth.  The  current  from 
the  fine  coil  may  be  considered  a  specific  in  the 
relief  of  that  form  of  neuralgic  dysmenorrhcea 
characterized  by  tenderness  over  the  ovaries, 
marked  epigastric  tenderness,  nausea  and  vomit- 
ing. The  treatment  is  snfe  and  painless,  and 
the  current  is  best  administered  by  means  of  a 
simple  bi-polar  vaginal  electrode.  These  con- 
clusions were  supported  by  a  number  of  illus- 
trative cases. 

DISCUSSION. 

Dr.  A.  Lapthorn  Smith,  of  Montreal,  said  that 
at  least  half  a  dozen  cases  which  had  not  been 
relieved  by  laparotomy  and  the  removal  of  the 
appendages  had  come  to  him  subsequently,  and 
had  been  completely  relieved  of  all  symptoms 
by  the  use  of  the  fine  wire  current. 

Dr.  Engleman  said  that  very  vague  notions 
prevail  regarding  the  speed  of  the  ordinary 
interrupters  on  induction  coils.  If  the  author 
had  used  a  speed  of  350  vibrations  per  second, 
the  patient  would  not  have  felt  the  current. 
The  average  vibrator  he  had  found  by  actual 
experiment  made  from  2000  to  2400  vibrations 
per  minute,  and  the  best  of  the  old  kind  of 
vjbrators  which  he  had  been  able  to  find  in  the 
market — that  of  (]aiffe — only  vibrated  3000 
times  per  minute,  or  50  per  second. 

(At  this  point  the  discussion  was  interrupted 
in  order  that  it  might  form  a  part  of  the  formal 
discussion  on  this  subject  which  had  been 
arranged  to  take  place  in  the  afternoon.) 

AFTERNOON     SESSION. 
DISCUSSION. 

"The  Influence  of  Frequency  of  Interrup- 
tions and  Character  of  Induced  Current  Waves 
upon  the  Physiological  Effect." 

Dr.  William  James  Morton,  of  New   York, 


opened  the  discussion.  He  said  we  possessed 
three  mechanisms  for  exciting  induced  currents, 
viz. :  (i)  the  induction  coil  ;  (2)  dynamo-electric 
machines  ;  and  (3)  condensers — Leyden  jars, 
etc.  It  has  b/en  found  that  the  current  with 
long  periods  will  kill  instantaneously  while  one 
with  short  periods  is  harmless.  The  speaker 
said  that  in  April,  1881,  the  Neiu  York  Medi- 
cal Record  published  an  article,  in  which  he 
described  a  new  induced  current  obtained  from 
the  static  machine.  His  conclusions  were  :  (i) 
'I  hat  the  current  possessed  great  diffuseness  ; 

(2)  that  it  produced  an  analgesic  effect;  (3)  that 
it  produced  a  vaso-motor  effect,  manifested  by 
dilatation  of  the  superficial  blood  vessels  and 
the  occurrence  of  perspiration  ;  and  (4)  that  it 
caused  an  elevation  of  the  body  temperature. 
His  mechanism,  then  published,  is  the  funda- 
mental electrical  mechanism  necessary  to  pro- 
duce the  high  frequency  high  potential  currents 
now  so  thoroughly  familiarized  by  the  labors 
of  Tesia,  P^lihu  Thompson  and  D'Arsonval. 

In  February,  1891,  Tesla  published  his  first 
article  on  high  frequency  currents.  In  this 
article  he  made  the  statement  that  the  writer's 
experiences  tend  to  show  that  the  higher  the 
frequency  the  greater  the  amount  of  electrical 
energy  which  may  be  passed  through  the  body 
without  serious  discomfort. 

About  the  same  time,  Elihu  Thompson  was 
investigating  the  same  subject.  He  found:  (i) 
that  the  higher  the  frequency  the  less  the  effect 
on  an  animal  ;  (2)  that  the  cause  of  pain  lies 
chiefly  in  the  muscular  contractions  produced  ; 

(3)  that  the  cutaneous  nerves  were  less  painfully 
affected  at  a  higher  rate  ;  (4)  that  the  visual 
mechanism  was  not  excited  at  a  higher  rate, 
even  with  a  pressure  of  fifteen  volts. 

D'Arsonval's  conclusions  were  :  (i)  That  the 
high  frequency  current  had  no  effect  on  the 
organs  of  feeling;  (2)  that  it  produced  no  mus- 
cular contractions;  (3)  that  there  was  a  dim- 
inution of  the  sensation  of  pain  ;  (4)  that  there 
was  a  dilatation  of  the  blood  vessels;  (5)  that 
it  caused  an  increased  perspiration  ;  (6)  that 
it  caused  increased  tissue  change,  manifested 
by  inci  eased  absorption  of  oxygen  and  in- 
creased elimination  of  carbonic  acid;  and  (7) 
that  it  caused  no  increase  of  body  temperature. 

Dr.  Morton  then  exhibited  a  medical  induc- 
tion alternator  affording  sinusoidal  current, 
which  Mr.  A.  E.  Kennelly  had  constructed  at 
his  suggestion.  It  gave  a  current  jiaving  1200 
periods  per  second. 

The  discussion  was  continued  by  a  commu- 
nication from  A.  E.  Kennelly,  Esq.,  of  the  Edi- 
son Laboratory,  entitled  "  Induction  Coils." 

In  his  absence,  the  paper  was  read  by  Mr. 
E.  M.  Smiles.  The  author  began  by  giving  a 
strictly  technical  description  of  the  magnetic 
laws  involved  in  the  working  of  induction  coils. 
Observation  shows  that  the  primary  current 
does  not  instantly  reach  its  full  value,  but  there 


THE  CANADA.    MEDICAL   RECORD. 


is  develo])ed  in  the  primary  coil  an  electro- 
motive force  which  is  always  in  opposition  to 
that  of  the  battery.  This  is  called  self-induc- 
tion. As  soon  as  the  vibrator  spring  leaves 
the  contact  point,  the  metallic  circuit  is  broken, 
but  not  instantly,  for  there  is  induced  a  secc)nd- 
ary  flu.x  in  both  ihe  ])rimary  and  secondary 
coil,  and  in  such  a  direction  as  to  sustain 
the  battery  current.  The  duly  of  the  faradic 
coil  is  to  supply  a  certain  strength  of  alternat- 
ing current  at  a  given  frequency.  Probably  no 
two  '  oils  give  precisely  the  same  wave  char- 
acters; long  coils  and  many  windings  produce 
smoother  flowing  and  less  abrupt  waves.  The 
ordinary  form  of  spring  vibrator  rarely  supplies 
more  than  250  vibrations  per  second,  while 
the  ribbon  spring  easily  makes  1000  vibrations 
per  second  ;  but  both  are  very  irregular.  If  a 
current  of  5  m.  a.  be  supplied  by  an  ordinary 
fiiradic  coil  at  250  alternations,  there  will  be 
much  uncertainty  as  to  the  wave  characteis, 
but  if  the  primary  be  excited  by  a  sinusoidal 
current  of  the  same  frequency,  the  character  of 
the  waves  can  be  accurately  determined. 

A  communication  from  Professor  Edwin 
Houston,  of  Philadelphia,  entitled  "  Remarks 
upon  Apparatus  to  produce  Induction  Currents 
and  the  Character  of  ihe  Waves  of  Individual 
Apparatus,  with  especial  reference  to  those  ap- 
plicable to  Medical  Uses,"  was  read  by  Dr. 
Morton  in  the  ab:^ence  of  the  author. 

Reference  was  made  to  the  remarkable 
change  in  the  physiological  effect  which  resulted 
from  a  change  in  the  frequency  of  the  interrup- 
tions of  the  current.  The  harmlessness  of  the 
high  frequency  current  is  probably  due  to  the 
fact  that  it  is  unable  to  reach  the  deeper  organs, 
for.  if  the  effect  of  the  discharge  on  a  bar  of 
solid  copper  is  very  superficial,  the  effect  on  the 
human  body  must  be  still  more  superficial. 

Dr.  J-  H.  Kellogg,  of  Battle  Creek,  continued 
the  discussion  in  an  article  entitled  "  The 
Graphic  Study  of  Electrical  Currents  in  Rela- 
tion to  Therapeutics." 

Dr.  Kellogg  said  that  he  thought  thus  far  in 
the  discussion  two  or  three  different  forms  of 
current  had  been  confounded,  for  the  rapidly 
interrupted  current  is  not  a  sinusoidal  current. 
He  first  described  this  current  in  a  paper  read 
before  the  American  Medical  Association  in 
1888.  The  effects  obtained  from  it  varied  with 
the  speed  on  the  machine.  When  only  fifteen 
or  twenty  alternations  were  made  per  second, 
it  produced  vigorous  muscular  contractions 
with  complete  relaxation  at  each  alternation. 
.']  he  sensory  effects  are  best  obtained  by  giving 
the  machine  a  high  velocity  ;  under  such  cir- 
cumstances, it  will  be  found  that  if  the  electrode 
be  placed  in  the  region  of  the  eye,  the  subject 
will  perceive  a  luminous  field  which  varies  its 
position  with  that  of  the  electrode. 

He  had  made  more  than  twenty  thousand 
applications    of  the     sinusoidal    current,    the 


greater  number  being  in  gynaecological  cases, 
and  with  it  he  had  been  enabled  to  cure  hun- 
dreds of  women  who  had  previously  suffered 
many  things  at  the  hands  of  gynaecologists. 
The  current  is  chiefly  useful  :  (i)  In  exercising 
muscles  which  are  not  easily  brought  into  ac- 
tion by  voluntary  effort  ;  (2)  for  producing 
muscular  contraction  in  cases  wiiere  degenera- 
tive chmges  have  advanced  so  far  that  the 
muscles  fail  to  respond  to  the  faradic  current; 
(3)  in  connection  with  '•  the  rest  cure  "  for  giv- 
ing exercise  to  feeble  patients.  Here  it  is  su- 
perior to  the  faradic  current  on  accoimt  of  the 
painlessness  of  the  contractions  and  their 
greater  vigor.  The  application  is  also  more 
easily  made  as  it  is  not  necessary  in  most  cases 
to  locate  accurately  the  motor  points.  (4)  It 
is  very  valuable  when  used  alternately  with 
massage.  (5)  It  is  of  the  greatest  advantage  in 
strengthening  relaxed  abdominal  muscles, 
which  are  often  responsible  for  displacements 
of  various  abdominal  viscera,  and  the  occur- 
rence of  various  reflex  symptoms.  (6)  For  the 
treatment  of  hyper^esthetic  conditions  of  the 
nervous  system.  Here  it  is  necessary  to  em- 
])loy  an  extremely  delicate  rheostat,  and  to  use 
the  current  obtained  from  the  machine  while 
at  a  high  speed.  In  marked  contrast  with  the 
faradic  current,  he  had  found  no  idiosyncrasy 
to  the  sinusoidal  current. 

He  believed  the  rheotome  was  a  fatal  ele- 
ment of  weakness  in  the  induction" coil,  and  that 
this  well  known  instrument  is  inherently  faulty 
as  an  agent  in  electro  therapeutics.  Nothing 
but  the  graphic  method  would  enable  the  med- 
ical practitioner  to  regulate  a  faradic  apparatus 
so  as  to  obtain  exactly  the  same  current  at  all 
times,  and  he  predicted  that  the  faradic  appa- 
ratus would  have  to  give  place  to  a  more  reli- 
able instrument. 

(Discussion  postponed  until  next  morning.) 


THIRD  DAY.— September  14TH. 

MORNING   SESSION. 

{Disiussio/i  of  yesterday  concluded.) 

H.  Newman  Lawrence,  Esq.,  M.I.E.E.,  of 
London,  England,  sent  a  contribution  to  the 
discussion,  entitled,  "  In  Medical  Induction 
Coils,  how  does  the  Current  of  the  Primary 
differ  from  that  ot  the  Secondary  ;  and  what 
Influence  has  this  Difference  upon  the  Re- 
spective Physiological  Effects  ?  " 

The  charging  cunent  can  be  measured  both 
as  to  voltage  and  amperage  ;  the  secondary 
current  is  tlie  source  of  alternating  impulses, 
and  dependent  for  voltage  and  amperage  upon 
the  number  of  turns  around  the  primary,  the 
strength  of  the  charging  current,  and  the  rate 
of  interruption  of  the  vibrator.  Muscular  con- 
traction may  be  produced  by  an  infinitesimal 
amperage,  provided  it    be   sufficiently  concen- 


64 


TM£   CANADA   MEDICAL  RECORD. 


trated.  In  general,  therefore,  when  muscular 
contraction  is  required,  the  piimary  current  is 
the  more  painful  to  use  ;  but  owing  to  its  other 
properties  it  may  be  found  in  certain  rases  less 
]iainful  when  applied  to  the  nerves. 

The  discussion  was  continued  by  the  reading 
of  a  communication  from  Dr.  William  F.  Hut 
chinson,  of  Providence,  R.  I.,  entitled,  "A 
Study  of  Electrical-Anesthesia  and  Frequency 
of  Induction  Vibration."  This  paper  was  sup. 
plementary  to  one  on  the  same  subject  lead  at 
the  last  meeting  of  the  Association,  By  means 
of  Cook's  reed-pipe,  the  author  iiad  been  able 
to  more  accurately  determine  the  number  of 
vibrations.  He  now  believed  that  the  cause  of 
electrical-anesthesia  must  be  looked  for  in  that 
principle  of  mechanics  known  as  the  superpo- 
sition of  small  motions.  In  a  vibrating  wire  it 
is  found  that  there  is  a  "dead  point  "or  spot 
at  which  the  wire  is  at  rest.  Replacing  the 
reflected  wave  on  the  wi:e  by  an  efferent  im- 
pulse along  the  nerve,  we  can  imagine  that 
electrical-amesthesia  is  due  to  the  formation  of 
a  similar  '•  dead  poi;U  "  along  the  nerve.  Just 
as  many  vibrations  must  be  imparted  to  a  sen- 
sory nerve  inwardly  as  are  proceeding  out- 
wardly upon  it,  in  o;dcr  that  a  dead  point  or 
zone  of  anesthesia  be  created.  The  rate  of 
the  electric  wave  and  that  of  the  nerve  impulse 
seem  to  be  identic.;d,  and  hence,  pain  is  the 
mechanical  expression  of  disturbed  energy,  and 
it  is  to  be  destroyed  temporarily  by  such  vibra- 
tory action' "as  will  restore  rest  to  the  nerve. 
'Hie  writer  admits,  however,  his  inability  to  ex 
plain  why  it  is  that  the  anesthesia  should  be 
confined  to  an  area  not  much  greater  than  the 
electrode,  although  it  is  easy  to  demonstrate 
that  the  current  traverses  the  whole  length  of 
a  nerve. 

The  President  here  took  part  in  the  discus- 
sion, making  some  remarks  ''  On  the  Influence 
of  Frequency  and  the  Graphic  Curve  on  the 
Results  of  Gynecological  Electro-Therapeuiics, 
particulaily  with  the  Sinusoidal  Current." 

His  conclusions  were  based  upon  observa- 
tions made  with  the  faradic  current  and  an 
apparatus  constructed  for  him  by  the  Kidder 
Manufacturing  Co.,  consisting  of  an  alternator 
run  by  a  motor,  by  which  an  alternating  curient 
having  800  aliern-^tions  per  second  could  be 
sent  thioiigh  the  primary  coil  of  his  induction 
apparatus.  With  five  Leclanche  cells  in  the 
piimary,  the  current  obtained  in  this  manner 
and  with  this,  this  number  cf  alternations  was 
almost  imperceptible  to  the  hand,  but  he 
noted  that  it  was  appreciable  in  the  vagina. 
It  had  a  marked  soothing  effect  on  the 
patients  upon  whom  he  had  tested  it.  He 
claimed  to  be  able  to  cure  endometritis 
with  the  alternating  current  or  the  interrupt- 
ed induced  current  as  obtained  from  the 
improved  faradic  apparatus  he  had  devised. 
The  way  in  which  it  accomplished  this  was,  in 


his  opinion,  by  its  influence  upon  the  vaso- 
motor supply  in  relieving  pelvic  congestion 
which  is  often  the  primary  cause  of  the  trouble. 
When  the  canal  is  not  patulous,  free  drainage 
was  secured  by  occasional  negative  galvanic 
applications  of  very  moderate  strength. 

He  believed  with  Mr.  Bland  Sutton,  that  in 
the  great  mnjoiily  of  cases  of  salpingitis  the 
obstruction  in  the  tube  is  due  to  tumefaction  of 
the  mucous  membrane;  and  if  this  can  be  re- 
moved, as  is  often  possible,  by  means  of  a  pio- 
per  application  of  the  current,  it  is  an  easy 
matter  to  secure  natural  drainage  of  the  lubes 
through  the  uterine  cavity. 

One  very  noticeable  effect  of  this  current 
was  a  very  decided  improvement  in  the  systemic 
condition  even  when  it  waS  applied  to  the 
pelvic  organs. 

(The  discussion  was  here  interrupted  to 
allow  Dr.  Kellogg  and  Dr.  Morton  to  demon- 
strate the  properties  of  the  alternating  current 
as  obtained  from  their  machines.) 

Dr.  A.  Lapthorn  Smith  then  resumed  the 
discussion.  He  said  that  the  same  increase  in 
weight  which  is  observed  after  the  application 
of  the  sinusoidal  current  results  from  ordinary 
exercise.  Referring  to  the  fineness  ofthein- 
terru])tions,  he  said  that  an  excellent  vibrator 
for  this  purpose  could  be  made  out  of  a  piece 
of  ferrotype  metal.  He  had  been  able  to  obtain 
with  the  fine  wire  faradic  current  all  that 
Apostoli  claimed  for  the  sinusoidal  current. 
The  improvement  in  the  circulation  was  princi- 
l)ally  due  to  the  muscular  contractions  pro- 
duced by  the  current. 

"  The  Alternating  ('urrent  in  Electro-Thera- 
peutics." 

Drs.  Georges  Gautier  and  A.  Larat,  of  Pan's, 
France,  sent  a  paper  with  this  title.  It  was 
translated  and  read  in  abstract  by  Dr.  A.  Lap- 
thorn  Smith. 

The  paper  stated  that  the  faradic  current 
attained  its  maximum  quite  suddenly,  whereas 
the  sinusoidal  current  reaches  its  maximum 
much  more  gradually,  and  consequently  a 
larger  dose  can  be  borne.  They  claimed  that 
any  current  having  oscillations  not  over  20,000 
per  minute  is  a  sinusoidal  current,  and  that  the 
action  of  the  sinusoidal  current,  even  when 
muscular  movements  are  absent,  is  to  increase 
the  absorption  of  oxygen  and  the  elimination  of 
carbonic  acid  and  urea.  One  curious  point 
noted  was,  that  if  after  a  j)erson  has  eaten 
asparagus  he  be  subjected  to  the  action  of  the 
sinusoidal  current,  the  asparagus  will  not  im- 
part its  pec'uliar  odor  to  that  j^erson's  urine. 
They  claim  that  the  current  is  useful  in  re- 
ducing obesity  and  in  treating  certain  forms 
of  eczema  and  vitiligo,  and  that  it  is  peculiarlj' 
efficient  in  the  treatment  of  infantile  and 
pseudohypertrophic  paralysis.  They  recom- 
mend that  the  current  be  applied  through 
electrodes  hanging  over  the  edge  of  a  porcelain 


THE   CANADA    MEDICAL   RECORD. 


65 


bath,  and  they  add  that  for  the  sake  ul"  pro- 
priety it  is  desirable  that  the  water  of  the  bath 
should  be  rendered  opaque  by  the  addition  of 
starch. 

Dr.  Herdman  said  he  had  had  very  little 
personal  experience  with  the  high  frequency 
currents,  but  he  had  been  using  for  the  past 
three  years  the  Thompson-Houston  dynamo 
current,  giving  ten  thousand  alternations  per 
minute.  It  was  an  agreeable  current,  but  exert- 
ed a  peculiar  tonic  effect  on  the  vaso-motor 
syteni.  We  must  admit  that  vibrations  pro- 
ducing musical  tones  have  some  special  physio- 
logical effects,  but  remarkable  results  are  ob- 
tained with  vibrations  extending  even  beyond 
the  limits  of  such  tones. 

Dr.  George  J.  Engleman,  of  St.  Louis, 
thought  in  this  discussion  the  faradic  current 
had  been  treated  in  a  pitiable  way.  The  objec- 
tions which  had  been  made  against  it  were 
those  which  applied  to  the  old-time  instruments 
and  which  he  had  overcome  by  his  separate 
vibrator  and  interruptor.  Determining  the 
number  of  the  vibrations  by  musical  notes  is 
not  only  time-consuming,  but  is  necessarily  in- 
accurate on  account  of  the  large  personal 
equation  which  it  involves.  He  had  gone  still 
further  with  his  investigations,  and  had  shown 
that  in  addition  to  the  improvements  already 
mentioned,  special  coils  must  be  constructed 
for  certain  definite  effects.  He  had  no  experi- 
ence with  the  sinusoidal  current,  but  from  what 
he  had  seen  and  heard  from  those  who  had  in- 
troduced it,  he  had  not  been  tempted  to  experi- 
ment with  it. 

Dr.  Morton,  in  closing  the  discussion,  said 
that  he  thought  the  criticisms  of  the  preced- 
ing speaker  admitted  the  objections  which  had 
been  made  upon  the  unreliability  and  limited 
efficiency  of  the  faradic  coil  as  ordinarily  con- 
structed. 

He  had  been  much  puzzled  by  Dr.  Hutch- 
inson's paper,  for  if  he  understood  it  correctly 
we  were  asked  to  assume  that  the  vibrations  of 
an  electric  current,  which  are  given  at  540  per 
second,  interfere  with  the  vibration  of  nerve  im- 
pulse, which  are  about  11  to  19  per  second. 
Although  he  admitted  the  power  of  the  current 
to  produce  certain  analgesic  and  subjective 
effect,  he  did  not  believe  it  could  produce  true 
anaesthesia,  and  he  could  not  but  deprecate 
the  fact  that  at  neither  the  last  meeting  nor  the 
present  one  had  Dr.  Hutchinson  demonstrated 
his  method  of  producing  electrical-ansesthesia. 

"  The  Treatment  of  Dysmenorrhea  by  the 
Galvanic  Current." 

Dr.  A.  Lapthorn  Smith,  of  Montreal,  read  a 
paper  on  this  subject,  in  which  he  took  the 
ground  that  dysmenorrhoea  is  very  commonly 
due  to  endometritis  rather  than  to  stenosis  cf 
the  canal.  Thus,  many  cases  are  not  at  all 
relieved  by  rapid  dilatation  of  the  canal  un- 
less this  procedure  is  followed  by  curetting  or 


the  appiicauon  of  iodine.  From  theoretical 
considerations  he  had  been  inclined  to  believe 
at  first  that  the  method  of  intra-uterine  galvan- 
ization which  he  advocated  for  the  relief  of 
dysmenorrhoea,  would  result  in  sterility,  but 
further  experience  has  shown  this  not  to  be  true. 
Apostoli  quotes  thiriy  cases  in  which  preg- 
nancy followed  such  applications.  This  im- 
port int  theoretical  objection  being  disposed  of, 
he  felt  free  to  urge  the  adoption  of  this  treat- 
ment, as  the  mild  currents  employed  rendered 
it  both  safe  and  painless.  If  the  uterus  be  large 
and  the  menstrual  flow  profuse,  he  would  use  the 
positive  pole  in  the  uterus  :  but  if  the  uterns 
were  poorly  developed,  and  the  flow  scanty, 
then  he  would  prefer  negative  pole. 

After  a  careful  bi-manual  examination  has 
excluded  pregnancy,  and  has  enabled  the  oper- 
ator to  form  a  correct  idea  of  the  condition  of 
the  pelvic  organs,  the  vagina  should  be  disin- 
fected with  a  douche,  and  a  large  Simpson 
sound,  curved  to  correspond  with  that  of  the 
uterine  canal,  is  passed  through  the  flame  of  an 
alcohol  lamp,  cooled,  and  insulated  with  rubber 
tubing  to  within  about  2^^  inches  of  its  tip. 
Under  the  guidance  of  the  finger  it  is  then 
gently  passed  into  the  canal  until  an  obstruction 
is  met  with,  when  a  current  of  about  10  m.  a. 
is  turned  on.  The  instrument  soon  passes  on, 
and  after  a  current  of  from  20  1050  m.a.  has 
been  allowed  to  flow  for  about  five  minutes,  it 
is  gradually  reduced  and  turned  off.  The 
sound  will  then  usually  almost  drop  out  of  itself. 
A  boroglyceride  tampon  is  then  inserted  in  the 
vagina,  and  the  patient  allowed  to  go  home. 
No  precautions,  such  as  resting  in  bed,  are 
considered  necessary,  and,  as  a  rule,  the  patient 
only  received  the  treatment  twice  a  week  for 
from  three  to  six  v\'eeks,  when  the  second 
period  will  usually  come  on  without  pain. 
When  the  intra-uterine  electrode  is  connected 
with  the  negative  pole,  the  positive  pole  consists 
I  of  a  clay  abdominal  electrode.  Where  the 
j  positive  pole  is  made  the  active  one,  this  pole 
must  be  of  platinum,  carbon  or  zinc. 

i  DISCUSSION. 

Dr.  Massey  said  he  could  endorse  all  that 
the  author  had  said  about  the  simplicity  and 
safety  of  this  treatment.  He  rarely  saw  atresia 
except  after  the  use  of  very  strong  currents,  or 
where  the  operator  had  neglected  to  insulate 
the  cervical  portion  of  the  electrode.  For  this 
purpose,  he  preferred  shellac  to  a  rubber  tube. 

Dr.  W.  B.  Sprague,  of  Detroit,  said  he  had 
very  rarely  failed  to  relieve  dysmenorrhoea  by 
intra-uterine  application  of  electricity.  He 
preferred  to  use  the  negative  pole  with  a  current 
of  moderate  strength,  and  so  far  from  producing 
atresia,  he  had  relieved  such  as  already  existed. 
In  this  class  of  cases  he  never  used  currents 
stronger  than  15  m.a.,  and  he  was  inclined  to 
believe  that  the  menstrual  pain  is  due  to  hyper- 


66 


THE   CANADA   MEDICAL    RECORD. 


sensitiveness  of  the  nerves  rather  than  to  endo- 
metritis ;  for  he  had  relieved  the  condition  by 
currents  so  mild  that  they  could  hardly  be  ex- 
pected to  cure  an  endometritis. 

Dr.  P.  S.  Hayes,  of  Chicago,  said  he  wished 
to  be  placed  on  record  as  fully  endorsing  the 
claims  made  in  the  paper. 

Dr.  Margaret  A.  Cleaves,  of  New  York,  said 
that  after  an  experience  of  six  or  seven  years, 
she  could  corroborate  what  had  been  said  in 
the  paper.  She  thought  the  dysmenorrhoea 
was  quite  as  often  due  to  pelvic  congestion  as 
to  endometritis,  and  that  this  explained  why  it 
was  relieved  by  such  mild  currents.  A  number 
of  her  patients  had  become  pregnant  within  a 
few  months,  and  she  did  not  believe  that  intra- 
uterine galvanization  caused  sterility  after  the 
treatment.  She  greatly  preferred  leaving  an 
interval  of  from  five  to  seven  days  between  the 
treatments. 

Dr.  Kellogg  had  found  that  although  there 
was  no  stenosis  of  the  canal,  many  cases  of 
dysmenorrhoea  are  associated  with  vegetations, 
which  he  believes  swell  up  at  tlie  menstrual 
period,  and  so  produce  a  temporary  obstruction. 
At  any  rate,  such  cases  readily  yield  to  applica- 
tions of  10  to  20  m.a.,  usually  with  the  positive 
pole  in  the  uterus.  Where  the  trouble  seems 
to  be  due  to  simple  hyperesthesia,  he  had 
foimd  the  positive  pole  especially  effective. 
His  experience  was  entirely  opposed  to  the 
idea  that  the  treatment  prevented  pregnancy. 

Dr.  C.  R.  Dickson  believed  with  Dr.  Cleaves 
that  dysmenorrhoea  is  very  frequently  due  to 
simple  pelvic  congestion.  He  was  glad  to  see 
that  operating  surgeons  were  showing  a  greater 
disposition  than  formerly  to  refer  these  cases 
to  those  who  make  a  specialty  of  electro-thera- 
peutics. 

Dr.  Franklin  H.  Martin  sounded  a  note  of 
warning  against  recommending  such  intra- 
uterine treatment  too  freely  to  the  general 
profession.  The  initial  step  should  be  the 
making  of  an  accurate  diagnosis.  If  the  dys- 
menorrhoea were  due  to  non-development  of 
the  uterus,  the  faradic  current  of  slow  vibration 
would  be  much  more  appropriate  than  the 
galvanic ;  if,  on  the  other  hand,  it  were  due  to 
tubal  or  ovarian  disease,  the  galvanic  treatment 
would  result  disastrously.  Where  dysmenor- 
rhoea is  due  to  endometritis  or  stenosis  of  the 
canal,  positive  galvanisms  to  the  interior  of 
the  body  of  the  uterus  only  was  indicated. 

Dr.  Walker  said  that  when  the  pain  was  most 
marked  two  or  three  days  previous  to  the 
appearance  of  the  flow,  he  was  always  very 
suspicious  of  the  existence  of  disease  of  the 
appendages,  and  therefore  would  not.resort  to 
galvanic  treatment  until  a  careful  examination 
under  chloroform  had  excluded  such  a  condi- 
tion . 

Dr.  Smith,  in  closing  the  discussion,  said 
that  he  had  taken  it  for  granted  that  an  accuratq 


diagnosis  was  a  pre-requisite  to  safe  and  suc- 
cessful treatment.  Believing,  as  he  did,  that  in 
the  majority  of  cases  dysmenorrhoea  is  due  to 
reflex  spasm  of  the  fibres  of  the  internal  os, 
brought  about  by  an  endometritis,  he  preferred 
to  apply  a  mild  current  dij-ectly  to  the  internal 

OS. 


AFTERNOON    SESSION. 

"  The  Treatment  of  Subinvolution  by  Elec- 
tricity. " 

Dr.  Charles  G.  Cannaday,  of  Roanoke,  Va., 
read  a  paper  with  this  title.  The  author 
believed  that  the  greatest  benefit  is  to  be  ob- 
tained in  the  shortest  time  from  the  use  of 
electricity.  He  recommended  for  restoring  the 
tone  of  the  uterus  that  a  current  of  30  m.a.  be 
applied  to  the  interior  of  the  uterus  for  ten 
minutes  at  a  time,  and  that  this  be  followed 
by  the  application  of  the  faradic  current  from 
an  Engleman  coil  of  600  meters,  using  a  bipolar 
vaginal  electrode.  He  thought  that  free  use 
of  ergot  durmg  labor  predisposed  to  subinvo- 
lution, and,  therefore,  when  this  drug  had  been 
used  in  this  way,  he  favored  as  a  routine 
measure  the  daily  application  to  the  uterus  of 
the  faradic  current. 

DISCUSSION. 

Dr.  Hayes  thought  no  agent  superior  to 
electricity  for  reawakening  the  retrograde 
physiological  process  necessary  to  complete 
involution,  but  he  preferred  the  galvanic  to  the 
faradic  current.  He  more  commonly  employed 
the  positive  pole,  as  there  is  ordinarily  a  con- 
dition of  undue  moisture  present. 

Dr.  Sprague  did  not  think  it  made  much 
difference  whether  the  galvanic  or  the  faradic 
current  vv^as  employed^  but  to  obtain  the  best 
results  the  applications  should  be  made  on 
alternate  days. 

Dr.  Massey  used  the  faradic  current  chiefly 
in  cases  which  had  not  existed  for  more  than 
six  months  ;  for  the  more  chronic  forms,  he 
preferred  galvanism.  He  believed  subinvolu- 
tion to  be  due  to  microbic  infection  of  the 
uterus  at  the  puerperal  period,  and  if  the  in- 
fection be  due  to  the  gonorrhceal  germ,  the 
case  will  prove  most  obstinate  to  treatment. 

Dr.  Smith  also  thought  that  septic  infection 
was  chiefly  responsible  for  subinvolution.  He 
corroborated  what  had  been  said  about  the 
value  of  the  continuous  current. 

Dr.  Cannaday,  in  closing  the  discussion, 
said  that  where  sub-involution  had  lasted  for  a 
year  or  more,  the  congestion  had  in  large 
measure  subsided,  and,  therefore,  greater 
benefit  was  likely  to  follow  negative  galvaniza- 
tion. 

"  A  New  Intra-Uterine  Electrode." 

Dr.  Plym.  S.  Hayes,  of  Chicago,  exhibited 
an  intra-uterine  electrode  made  of  a  platinum 
spiral  with  a  stilette  in  its   centre.     The  object 


THE   CANADA   MEDICAL   RECORD. 


67 


of  tliis  special  construction  was  to  furnish  an 
instrument  which  would  allowof  the  free  escape 
from  the  uterus  of  the  gas  evolved  during  the 
Apostoli  treatment.  He  had  found  that  by  at- 
tention to  this  detail  in  the  treatment,  much  of 
the  after-pain  could  be  avoided. 

DISCUSSION. 

Dr.  Eug.  C.  Gehrung,  of  St.  Louis,  said  that 
when  he  first  employed  the  Apostoli  treatment 
by  galvano-punclure,  he  found  that  the  gas 
accumulated  in  the  tumors,  and  formed  the 
basis  of  future  abscesses;  so  he  had  construct- 
ed an  electrolytic  trocar  and  canula,  which  was 
described  and  illustrated  in  Dr.  Massey's  book. 
It  was  found  that  the  gas  and  fluids  sometimes 
escaped  from  the  tube  for  days  after  the  treat- 
ment. 

Dr.  Massey  said  he  had  observed  enormous 
quantities  of  gas  escaped  from  the  canula,  but 
he  thought  most  of  the  irritation  observed  after 
the  treatment  was  due  to  the  use  of  inflexible 
instruments. 

Dr.  Dickson  thought  that  the  tip  of  the  in- 
strument should  be  protected,and  that  any  such 
spiral  instrument  was  objectionable  on  account 
of  the  trauma  likely  to  be  produced  during  its 
introduction  and  withdrawal. 

Dr.  Hayes  replied  that  there  was  not  in 
reality  so  much  difficulty  in  introducing  and 
withdrawing  the  instrument  as  one  would  sup- 
pose who  had  not  tried  it.  The  evolution  of 
gas  is  so  great  when  strong  currents  are  em- 
ployed, that  it  prevents  in  a  measure  the 
adherence  of  the  tissues  to  the  electrode. 

"  A  Contribution  to  Electro-Therapeutics  in 
Salpingitis." 

Dr.  W.  B.  Sprague,  of  Detroit,  read  a  paper 
on    this    subject.     The   paper    contained    the 
histories  of  several  cases  of  salpingitis,  in  which 
the  author  had  been  able  to  introduce  an  elec- 
trode through  the  uterus  and  into  the  Fallopian 
tubes  at  a  time  when  these  tubes  were  distend- 
ed with  pus.   In  each  case,  there  was  a  free  dis- 
charge of  pus,    and  prompt  relief  to  the  symp- 
toms.    Of  course,    in  many   cases  he  found  it 
impracticable  to  carry  out  intra-tubal  galvaniza- 
tion, but  he  had  succeeded  in  other  cases  be- 
sides those  reported  in   the  paper,   and  in    no    | 
instance    had   serious  symptoms  followed   the 
treatment.     His  experience  with  this    method 
extended  over  a  period  of   three  years.     The 
treatment  is  necessarily  of  limited  application, 
but  is  still  extremely  useful  in  appropriate  cases.    , 
He  used  a  sound  with  a  curve  slightly  sharper    • 
than  the  normal  one,  and  was  of  course  careful    , 
not  to  use  any  force.     If  after  the  instrument 
has  reached  the  cornu  of  the   uterus    a    mild 
current  be  turned  on,  it   will  be  found  usually    i 
that   in  proper  cases  the  instrument  will  soon    j 
pass  on  into  the  tube.  I 


DISCUSSION. 

Dr.  Smith  said  that  many  would  not  believe 
it  was  possible  to  caiheterize  the  tubes,  but 
when  in  Liverpool,  Dr.  Wallace  had  shown  hfm 
no  less  than  six  cases  in  his  hospital  at  one 
time,  in  which  the  uterine  sound  had  been 
passed  into  the  Fallopian  tubes. 

Dr.  M.  S.  Weber,  of  Detroit,  referred  to  the 
sneering,  doubting  manner  in  which  the  first 
communication  of  the  author  on  this  subject 
liad  been  received  by  the  Michigan  State 
Society,  but  he  felt  sure  from  what  he  had  seen 
of  Dr  Sprague's  work,  that  he  was  to  be  con- 
gratulated upon  what  he  had  accomplished. 

Dr.  Massey  said  that  in  1880  he  brought  up 
this  subject  before  the  Philadelphia  Obste- 
trical Society.  At  that  time,  he  had  succeeded 
in  emptying  a  number  of  tubes  through  the 
uterus.  It  should  be  remembered,  however, 
that  this  was  work  suitable  only  for  experts. 

Dr.  Sarah  H.  Stevenson,  of  Chicago,  said 
that  she  had  long  been  convinced  that  such 
treatment  was  feasible,  but  had  hitherto  lacked 
the  courage  to  try  it. 


Discussion. — "  What  are  the  Possibilities  of 
Electricity  in  the  Treatment  of  Fibroid  Grov.'ths?** 
Those  participating  in  the  discussion  were 
asked  to  do  so  under  certain  specific  heads. 

Dr.  Kellogg  opened  the  discussion.  He 
said  that  the  improvement  in  the  general 
health  observed  was  due  to  the  influence  of  the 
electric  current  on  the  abdominal  sympathetic. 
The  growth  could  be  arrested,  and  in  certain 
cases  near  the  menopause,  retrograde  change 
could  be  expected.  He  had  on  a  former  occasion 
reported  a  series  of  fifty  cases,  in  seven  of 
which  the  tumor  disappeared.  Since  then,  he 
had  not  been  quite  so  fortunate.  No  one  would 
think  of  employing  anything  but  the  constant 
current  except  for  the  relief  of  pain.  He  usually 
employed  a  coulombmeter  in  conjunction  with 
the  milliampermeter,  thus  avoiding  troublesome 
calculations.  His  personal  experience  had  led 
him  to  think  that  the  phlebitis  sometimes  excit- 
ed where  very  powerful  currents  are  employed 
is  a  decided  help  in  bringing  about  retrograde 
changes  in  the  tumor.  He  would  not  employ 
this  treatment  in  rapidly  growing  tumors  unac- 
companied by  hemorrhage,  in  rapidly  growing 
tumors  appearing  after  the  menopause,  where 
ovarian  cysts  accompany  the  fibroid  tumor, 
where  the  apphcation  is  followed  by  inflamma- 
tion, and  in  cases  which  do  not  show  improve- 
ment after  a  reasonable  trial.  Recently  he  had 
been  employing  milder  currents  because  they 
caused  less  inconvenience,  and  admitted  of  more 
frequent  applications.  Seventy-five  per  cent,  of 
his  cases  had  been  symptomatically  cured  ;  in 
55  per  cent,  the  tumor  had  been  very  much 
reduced,  and  in  14  per  cent,  it  had  entirely 
disappeared. 


68 


THE   CANADA   MEDICAL   RECORD. 


Dr.  Felice  La  Torre,  of  Rome,  Italy,  sent  a 
contribution  to  the  discussion.  The  galvanic 
current,  in  his  opinion,  certainly  arrests  hem- 
orrhage, but  the  diminution  in  size  of  the  tumor 
was  rare.  He  discussed  a  number  of  theories 
as  to  the  action  of  the  current,  and  concluded 
that  it  acts  chiefly  in  two  ways,  viz.  :  (i)  by 
causing  energetic  contraction  of  the  uterus,  and 
in  this  wav  causing  compression  of  its  vessels 
and  arrest  of  hemorrhage  ;  (2)  by  producing  a 
disturbance  in  the  molecular  interchange  of  the 
elements  of  the  tumor,  by  which  the  nutritive 
iuices  are  transformed  into  peptones  or  other 
substances  which  are  absorbed  or  eliminated  by 
the  kidneys,  thus  giving  rise  to  absorption  of 
the  fibroma. 

Dr.  A.  Lapthorn  Smith  had  found  that  this 
treatment  arrests  hemorrhage,  even  in  every 
desperate  cases,  and  the  general  health  is  at  the 
same  time  improved.  In  about  half  of  his  cases 
there  was  arrest  of  growth,  and  in  about  half  of 
these,  the  tumor  had  diminished  in  size.  In 
only  one  case  was  he  sure  that  the  tumor  had 
entirely  disappeared.  The  treatment  is  contra 
indicated  when  there  is  reason  to  believe  there 
is  pus  in  the  tubes.  He  favored  the  use  of 
mild  currents,  and  the  sittings  not  oftener  than 
■  twice  a  week.  He  had  never  given  in  any  one 
case  of  this  kind  more  than  one  hundred  ap- 
plications, and  he  usually  observed  marked 
improvement  after  about  fifteen  applications. 

Dr.  Cleaves  said  that  she  had  found  the 
treatment  of  especial  value  in  intra-mural 
growths,  and  that  in  this  class  of  tumors  the 
pressure  symptoms  were  invariably  relieved, 
the  general  health  improved,  and  in  hemorr- 
hagic cases  there  was  arrest  of  the  hemorrhage. 
In  a  limited  number  of  cases  there  was  anatom- 
ical retrogression,  but  in  no  instance  had  she 
observed  a  complete  disappearance  of  the 
tumor.  She  believed  that  the  arrest  of  the  hem- 
orrhage was  as  largely  due  to  the  cataphoric 
action  of  the  current  as  to  the  chemical  cauter- 
ization. She  called  attention  to  the  experi- 
ments made  by  Mr.  Stewart,  of  Owen's  College 
Laboratory,  by  which  he  had  demonstrated  the 
increase  of  Hquids  at  the  negative  pole  and  also 
an  accumulation  of  salts  at  the  negative  pole. 
In  order  that  there  should  be  such  an  accumula- 
tion, it  was  necessary  that  first  there  should  be 
a  decomposition  and  redistribution  of  the  salts. 
Fibroid  tumors  and  inflammatory  products  are 
rich  in  salts,  especially  in  chloride  of  sodium,  and 
are  very  largely  dependent  upon  the  presence 
of  these  for  the  maintenance  of  their  nutrition 
and  growth.  The  experiments  to  which  she 
referred  go  to  show  that  the  remov-al  of  a  consi- 
derable proportion  of  the  salts,  even  if  that 
removal  were  temporary,  would  result  in  the 
destruction  of  the  tissue,  while  the  removal  of  a 
small  proportion  would  affect  its  nutritive  ac- 
tivity. She  had  also  found  the  induced  and  static- 
induced  currents  of  very  great  value  as  an  ad- 


juvant to  the  treatment  of  fibroid  growths  by 
means  of  the  constant  current.  Cases  in  which 
the  static-induced  had  been  used  noted  a  marked 
sense  of  well-being,  buoyancy  and  lightness,  not 
only  in  the  pelvis,  but  in  tlie  entire  abdominal 
region. 

Dr.  Massey  said  that  in  a  series  of  eighty 
cases,  in  all  of  the  thirty-four  hemorrhagic  ones, 
the  hemorrhage  was  controlled ;  in  ten,  the 
growth  was  simply  arrested  ;  in  forty-nine,  there 
was  distinct  retrogression  ;  and  in  seven,  the 
tumordisappeared.  The  average  current  strength 
was  50  to  150  m.a.,  and  the  duration  of  active 
treatment  varied  from  six  weeks  to  three 
months. 

Dr.  Engleman  had  had  much  the  same  expe- 
rience as  the  other  speakers.  He  did  not  doubt 
that  the  tumors  could  be  reduced  in  size  provid- 
ed they  were  placed  under  treatment  at  the  pro- 
per time  ;  but  he  was  also  compelled  to  admit 
that  he  had  seen  some  very  large  tumors  disap- 
pear without  any  treatment,  and  this  had  been 
the  experience  of  other  surgeons.  We  should  be 
very  careful  not  to  employ  electrical  treatment 
if  there  is  reason  to  suspect  that  the  tumor  had 
already  begun  to  undergo  malignant  metamor- 
phosis, for  under  such  circumstances  electricity 
will  certainly  aggravate  the  condition. 

The  President  said  that  one  of  the  principal 
uses  of  electricity  in  some  cases  of  large  tumors 
is  to  so  improve  the  general  health  of  the  patient 
when  it  is  so  much  deteriorated  as  to  admit  of 
operative  procedures  when  they  are  demanded. 
He  had  observed  considerable  retrogression  in 
favorable  cases,  but  had  never  seen  a  complete 
disappearance  of  the  tumor.  It  was  almost 
always  possible  to  effect  a  symptomatic  cure. 
He  preferred  strong  currents  and  short  sittings, 
and  did  not  think  much  could  be  accomplished 
in  less  than  six  months.  In  recent  growths,  and 
in  myomata,  he  would  expect  retrogression.  He 
advocated  the  use  of  the  positive  pole  in  myomas 
and  where  hemorrhage  was  a  symptom,  and  the 
negative  pole  in  fibromas.  He  called  special 
attention  to  the  danger  of  producing  stenosis, 
even  with  negative  applications  of  only  50  m.a., 
when  the  cervical  canal  is  included  in  the  action 
exerted  by  the  current. 

Dr.  Hayes  thought  a  useful  adjuvant  to  the 
ordinary  Apostoli  treatment  consisted  in  apply- 
ing the  static-induced  current  by  means  of  ab- 
dominal and  vaginal  electrodes. 

"  Improvements  in  Electro-Statical  or  Influ- 
ence Machines." 

Paper  by  Dr.  Wm.  James  Morton.  The  im- 
provements related  to  important  points  in  me- 
chanical construction  and  to  utilizing  Dr.  Mor- 
ton's discoveriesfor  converting  statical  dischar- 
ges into  currents.  There  are  two  directions  in 
which  influence  machines  are  of  use  to  physi- 
cians, one,  the  spark  and  its  modifications,  the 
other,  the  Morton  currents.  The  former  are 
familiar  to  all.  the  latter  exhibit  the  phenomena 


THE   CANADA    MEDICAL   RECORD. 


69 


of  high  frequency,  high  poteniial  currents  now 
familiarized  by  the  labors  of  Tesla,  Elihu 
Thomson  and  D'Arsonval. 

As  a  result  of  continued  medical  work  for  13 
years  with  statical  machines,  the  writer  had 
iiad  constructed,  by  theGalvano  Faradic  Com- 
pany' of  New  York  City,  a  machine  which  em- 
bodied, in  his  opinion,  every  modern  advance. 
It  was  fundamentally  of  the  Wimshurst-Holtz 
type  ;  it  had  8  revolving  plates,  each  one  30 
inches  in  diameter ;  it  was  provided  with  a 
simple  device,  by  aid  of  which  the  physician 
could  employ  at  will  the  spark,  spray,  static- 
induced  and  the  transformer  current.  In  its 
present  shape  the  new  machine  answered  every 
purpose  in  medicine  to  which  influence  ma- 
chines could  be  put.  It  was  known  as  the  Mor- 
ton-Wimshurst-Holtz  machine. 

EVENING  SESSION. 

Dr.  William  J.  Morton  exhibited  a  new  trans 
former  for  use  with  influence  machines.  The 
transformer  consists  of  two  flat  spirals  placed  in 
an  ebonite  box  containing  oil.  The  static  in- 
duced current  is  led  into  one  coil,  and  from  the 
secondary  coil  the  current  passes  to  the  patient. 

This  current  produces  a  peculiarly  vigorous 
but  painless  muscular  contraction. 

Dr.  Morton  also  exhibited  a  helmet  such  as 
was  employed  by  Charcot  in  the  treatment  of 
disease  by  means  of  rapid  percussion.  The  vi- 
brations are  produced  by  a  small  electric  motor. 
The  application  of  this  helmet  uniformly  and 
almost  immediately  relieves  the  sensation  of  fa- 
tigue, and  in  some  cases  it  will  relieve,  at  least 
temporarily,  most  excruciating  neuralgic  head- 
aches. 

Dr.    E.    H.   Woolsey,    of  California,    called 
attention  to  the  fact  that  the  relief  was  probably 
obtained  through  the  agency  of  the  spine,   and   | 
was  similar  to  the    relief  experienced  by  some 
when  riding  on  horseback  or  on  a  railroad. 

"  Faradization  as  it  was  and  as  it  is  with  the 
Controllable  and  Recordable  Current,  as  pro-   i 
v'ided  by  a  new  Apparatus."  1 

Dr.  George  J.    Engleman,  of  St.  Louis,  read   i 
a  paper  with  this   title.     The  author  described   ' 
his  method  of  separating  the  interrupter   from    ; 
the  faradic  coil,  so  that  the  current  of  the  latter   ; 
may  be  independent  of  the  slow  or  rapid  action    ^ 
of  the  vibrator.  The  apparatus  is  provided  with 
a  comparatively  slowly  revolving  wheel,  by  which 
one  can  easily  compute  the  number  of  interrup- 
tions.    In  view  of  the  fact  that  the  full  current 
from  the  fine  wire  coil  is  scarcely  bearable  when 
the  interruptions  are  2000  to  3000,  and  yet  when 
they  are  15,000  the  current  is  scarcely  percep- 
tible, the  importance  of  determining  the  rate  of 
vibration  is  evident.     Personally  he  thought  the 
useful  limit  was  50,000    interruptions.     Again, 
where  external  irritation    is  desirable,   a  short 
coil  of  fine  wire  is  required,  whereas  an  entirely 
different  construction  is  needed  for  producing 


a   sedative  effect.     In  addition  to  noting  the 

number  of  vibrations  of  the  interruptor,  it  has 
been  found  that  the  essential  points  to  be  re- 
corded are  the  resistance,  the  number  of  wind- 
ings, and  ihe  fineness  of  the  wire. 

DISCUSSION. 

Dr.  Massey  remarked  that  a  very  objection- 
able feature  of  the  ordinary  faradic  apparatus  is 
the  rapid  o.xydation  of  the  contact  surfaces  of 
the  vibrator. 

Dr.  Herdman  said  that  this  objection  had 
been  done  away  with  in  the  new  apparatus, 
because  the  rubbing  of  the  contacts  on  the  brake 
wheel  sufficed  to  kee[)  these  surfaces  bright.  He 
did  not  think  the  physiological  limit  of  such  an 
apparatus  had  yet  been  determined. 

Dr.  Engleman  replied  that  he  thought  the  phy- 
siological limit  had  been  reached,  for  experi- 
ment had  shown  that  the  best  physiological 
effects  were  obtained  when  the  number  of  wind- 
ings did  not  exceed  thirteen  thousand. 

The  following  papers  in  the  absence  of  the 
writers  were  read  by  tide  : 

"  Notes  upon  some  uses  of  Galvanism  in 
Surgery."  By  D.  B.  D.  Beaver,  M.D.,  of 
Reading,  Pa. 

"  An  Unconsideied  and  Important  Factor  in 
the  Explanation  of  the  Action  of  Electricity  in 
Uterine  Disease."  By  Henry  McClune,  M.D., 
of  Cromer.  England. 

"The  Present  Position  of  Electricity  iu  the 
Treatment  of  Eclopic  Gestation."  Bv  A.  Bro- 
thers, M.D.,  of  New  York  City. 

"Uterine  Displacements  and  their  treatment 
by  Electricity."  By  G.  Betton  Massey,  of  Phil- 
adelphia. 

"Synovitis  treated  by  Cnlaphoresis."  By  F. 
H.  Wallace,  M.D.,  of  Boston,  Mass. 

"  The  Primary  Action  of  the  Galvanic  Cur- 
rent on  the  Blood.  It  increases  the  Amount 
of  Ozone  it  Contains,  as  shown  by  Chemical 
Tests  of  the  Blood  in  the  Arteries."  By  J. 
Mount  Bleyer,  M.D.,  and  M.  M.  Weil,  M.O.. 
of  New  York. 

"  The  Use  of  Static  Electricity  in  Incipient 
Insanitv."  By  W^  E.  Robinson,  M.D..  of 
Albany,  N.Y. 

' '  The  Conservation  of  Energy  as  a  Successful 
Factor  in  Electro-Therapy."  By  Horatio  R. 
Bigelow,  M.D.,  of  Philadelphia,  Pa. 


Dr.  W.  J.  Herdman,  of  Ann  Arbor,  was  elect- 
ed President,  and  Dr.  Margaret  Cleaves  of  New 
York,  Secretary  ;  Dr.  Franklin  H.  Martin,  of 
Chicago,  and  Dr.  A.  Lapthorn  Smith,  of  Mont- 
real, Vice-Presidents ;  Dr.  R.  J.  Nunn,  of 
Savannah,  Ga.,  Treasurer,  for  the  ensuing  year. 
It  was  decided  to  hold  the  next  meeting  in  New 
York  City,  on  the  last  Tuesdav  in  September, 
1S94. 


70 


THE    CANADA   MEDICAL   RECORD. 


THE  CANADA  MEDICAL  RECORD. 

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ASSISTANT  EDITOK 
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MONTEEAL,  DECEMBER,  1893. 


THE   CAUSES    OF  RHEUMATISM. 

It  seems  strange  that  after  so  many  years  of 
study  of  this  disease,  with  an  abundance  of 
cHnical  material,  it  should  still  be  so  little  un- 
derstood. We  have  more  than  once  in  these 
columns  endeavored  to  show  that  the  disease 
s  entirely  due  to  thesupersaturation  of  the  blood 
with  uric  acid,  which  is  the  last  stage  of  oxyd- 
ation  of  nitrogeno.is  food  before  the  final  one  of 
urea.  We  have  shown  that  the  malady  is  en- 
tirely preventable  in  one  or  all  of  three  ways  : 
First,  and  most  important,  by  abstaining  from 
such  articles  of  diet  as  are  known  to  consist 
very  largely  or  almost  entirely  of  nitrogen,  such 
as  lean  meat,  cheese  and  milk  ;  second,  by 
taking  in  as  much  oxygen  by  means  of  active 
exercise  as  may  be  necessary  to  oxydize  all  the 
nitrogen  in  the  blood  ;  and  third,  if  one  is  un- 
willing or  unable  to  eat  less  meat  and  take 
more  exercise,  then  the  next  best  thing  to  do 
is  to  drink  enough  pure  water  to  dissolve  as 
much  of  the  unoxydized  nitrogen  as  possible, 
and  thus  to  eliminate  it  by  means  of  the  kid- 
neys from  the  blood. 

This  subject  has  been  brought  prominently 
to  mind  by  the  appearance  in  the  Journal  of 
the  American  Medical  Association,  4ih  Nov- 
ember, 1893,  of  an  interesting  and  exceedingly 
instructive  paper  by  Sir  JamesGrant  of  Ottawa, 
on  "Some  rare  forms  of  gout  and  rheumatism.'' 
After  relating  several  rare  and  interesting  cases 
of  pulmonary  gout,  perityphlitic  gout  and  rheu- 
matic perityphlitis,  he  goes  on  to  say  :     ■'  Errors 


in  diet,  as  an  etiological  factor,  have  much  to 
do  with  the  production  of  both  gout  and  rheu- 
matism, and  such  strengthens  the  metabolic 
theory  that  rheumatism  depends  on  a  morbific 
material,  produced  within  the  system,  the  result 
of  defective  processes  of  assimilation.  True, 
Prout,  Latham,  RichardsOii,  Mitchell  and  Dr- 
William  H.  Porter  of  New  York  have  thrown 
much  light  on  the  subject  of  rheumatism,  and 
certainly  the  present  case  points  to  rheumatic 
complications  as  the  outcome  of  defective  assi- 
milation,— an  important  factor  in  its  production. 
Thus  the  chemical  laboratory  of  the  human 
system  becomes  disturbed,  resulting  in  false 
products,  enabling  us  to  establish  a  connecting 
link  between  even  perityphlitis  and  rheuma- 
tism. In  the  structure  of  the  intestinal  walls 
there  is  undoubtedly  a  large  amount  of  fibrous 
tissue,  just  as  in  the  fascia  and  the  tendons  of 
the  joints,  and  it  is  reasonable  to  suppose  that 
these  structures  should  be  influenced  in  the 
same  manner.  Assuming  that  the  case  under 
consideration  was  even  quasi-rheuniatic  in  its 
character,  it  affords  one  more  illustration  as 
to  the  importance  of  giving  due  consideration 
to  the  line  of  action  embraced  in  medical  or 
surgical  treatment  under  like  ciicumstances." 
One  of  his  most  striking  observations  is  the 
following  one,  which  Sir  James  Grant  is  espe- 
cially qualified  to  make,  for  Ottawa  is  not  only 
the  official  residence  of  the  Governor  General, 
to  whose  family  he  is  the  attending  physician, 
but  it  is  also  the  greatest  lumbering  centre  in 
Canada,  and  Sir  James  has  pracii-ed  there  for 
at  least  40  years.  "  After  noting,"  he  says  "  the 
life  history  of  many  thousands  of  our  lumbermen 
I  have  been  amazed  at  the  few  attacked  by 
rheumatism.  Bread,  pork  and  strong  tea  con- 
stitute their  chief  articles  of  diet,  and  the 
general  inference  is  that  the  tea  enables  them 
to  digest  the  pork  with  remarkable  comfort,  and 
certainly  after  a  hard  winter's  work  they  return 
home  wellnouiishcd  and  healthy  in  every  parti- 
cular." How  can  we  explain  this  apparent 
anomaly?  These  men  pass  six  or  eight  months 
of  winter  in  the  forests  about  the  head  waters, 
of  the  Ottawa  river,  very  near  the  latitude  of 
Hudson  Bay  ;  and  although  the  cold  is  intense, 
and  they  are  out  in  it  from  daylight  to  dark, 
still,  rheumatism  is  almost  unknown  among 
them.  If  cold  would  cause  rheumatism,  then 
every  lumberman  ought  to  have  it. 


THE   CANADA   MEDICAL   RECORD. 


71 


I 


For  us  the  explanation  is  quite   clear :  they 
have  nothing  in  their  blood  to  make  the  little 
sharp  pointed  crystals  of  uric  acid  out  of,  for  to 
these  latter  is  due  the  severe  pain  of  articular  and 
the  dull  pain  of  muscular  rheumatism.     Uric 
acid  crystals    cannot  be  made  wiilioui  an  im- 
mense surplus   of  nitrogen  in  the  blood,  for  if 
there  is  just  enoi;gh  nitrcgen  for   the  quaniily 
of  work  done  and  oxygen  inspired,  all  the  nitro- 
gen will  be  converted  into  urea.     These  lumber- 
men perform  tiie  hardest  kind  of  muscular  work, 
and  yet  they  consume  less  nitrogen  than  a  city 
clerk  who  is  carried  10  his  office  in  the  morning, 
breathes  the  smallest  quantity  of  bad  air  neces- 
sary to  sustain  life  all  day,  and  is  carried  home 
again  at  night.  The  lumberman  on  the  one  liand 
consumes  large  quantities  of  hydrocarbons  in 
the   shape   of  slarch    and   fat,  but  very    iitile 
nitrogen,  for  the  fat  pork  contains  ahiiost  none, 
the  main  supply  being  found  in  the  gluten  of 
the  bread.     He  has  no  milk  for  his  tea  and  he 
never  tastes  cheese.     His    luxuries   are   dried 
apples  and  molasses,  and  in  some  cases  baked 
beans  which  mostly  consist  of  starch.     As    Sir 
James  Grant  says,  these  facts  point  to  the  im 
portance  of  simplicity  of  diet.     Our  progenitors 
frequently   attained  the  age  of  three-score  and 
ten,  nourished   by  grain  ground  between    two 
stones."     To  us  rheumatism  is  a  disease  of  diet, 
not  of  climate,  and   we     are    therefore  neither 
surprised  at  the  immunity  from  it  of  the  lumber 
man,  as   observed   by    Sir  James    Grant,     nor 
do    we  expect  anything   else  but   rheumatism 
to  result  for  the  man  of  sedentary  occupation 
deprived  of  sufficient  oxygen  who  gorges  him- 
self with  meat  and  milk  and  cheese  three  times 
a  day.     If  would  be  interesting   to  hear  from 
some  of  our    confreres  practising  in  other   and 
distant  sections  of  the  country,  down  South  for 
instance,  where  the  negro  lives  lai-gely  on  hog 
and  hominy, whether  he  enjoys  the  same  freedom 
from  rheumatism  as  does  the  wood  chopper  in 
the  ice-bound    forests  of  the  far   North.     ^Ve 
have    always    been    astonished    at   the    treat- 
ment  of  rheumatism  practised  by  our  leading 
hospital  physicians  in  this  city,  who,   with  the 
absolute    control  of  the  patient's  diet  in  their 
own    hands,    dehberately    place  the    suffering 
rheumatic  on  an  almost  exclusively   nitrogen 
diet,  as  found  in    the  cheese  of  two  quarts  of 
milk  a  day.     No  wonder  the  urine  continues  to 
be  high  colored  and  loaded  with   uric  acid  and 


urates,  and  that  he  takes  an  average  of  six  weeks 
to  be  cured.  To  add  insult  to  injury,  as  it  were, 
he  is  by  some  deprived  of  water.  We  trust,  for 
the  sake  of  the  sufferers,  that  these  lines  may 
lead  the  physicians  to  put  them  on  an  exclusive 
hydrocarbon  diet,  with  an  abundance  of  water. 
When  a  few  days  with  or  without  the'aid  of  sali- 
cylate of  soda  or  bicarbonate  of  potash  the 
sharp  little  uric  acid  crystals  will  soon  be  dis 
solved  out  of  the  blood,  and  the  patient  will 
be  cured. 

Lest  any  may  say  that  cold  certainly  lias 
something  to  do  with  the  disease,  we  must  of 
course  admit  that  given  a  blood  liquid  at  a 
temperature  of  100  degrees  F,  super-saturated 
with  a  given  solid,  this  solid  will  be  precipitated 
in  a  shoulder  or  hand  or  knee  joint,  if  the  tem- 
perature of  the  latter  should  fall  to  ninety 
degrees.  But  when  the  blood  is  free  from  uric 
acid  there  is  nothing  to  be  precipitated  in  the 
joints,  no  matter  how  cold  they  become. 


IMPERIAL  HONORS  FOR  THE  CAN- 
ADLVN  MEDICAL  PROFESSION. 
Wlien  we  glance  over  the  list  of  Car.adians 
who  have  received  imperial  honors,  we  cannot 
fail  to  be  struck  with  the  small  number  of  phy- 
sicians in  comparison  with  the  lawyers  and 
politicians,  a  condition  of  things  very  dif- 
ferent from  that  which  exists  in  Great  Britain 
and  Ireland.  There  are  at  present  more  than 
five  thousand  physicians  practising  in  Canada, 
nearly  every  one  of  whom  has  more  than  once 
performed  an  act  of  heroism,  although  it  may 
have  been  unnoticed  and  unrecorded  in  the 
book  of  fame,  but  none  the  less  the  equal  of 
any  deed  of  valor  on  the  field  of  battle.  Of 
these  many  have  reached  a  high  degree  of  emi- 
nence, and  some  have  become  celebrated  not 
only  throughout  our  own  land  but  even  through- 
out Europe.  Apart  from  that,  the  profession 
as  a  whole  stands  high  throughout  the  world. 
And  yet  so  far  but  one  Canadian  physician  as 
such  has  ever  received  an  imperial  honor.  Dr. 
Tache  and  Dr.  Tupper,  it  is  true,  were  knighted, 
but  that  was  for  political  services  and  not  as 
medical  men.  Many  people  attach  but  slight 
importance  to  these  distinctions,  but  so  long 
as  they  are  conferred  somewhat  lavishly  upon 
judges  and  lawyers,  we  must  protest  against 
this  continued  slight  to  a  profession  which,  it 
cannot  be  denied,  renders  services  which  are  in- 


72 


THE   CANADA    MEDICAL   RECORD. 


finitely  greater.  These  distinctions,  moreover, 
are  the  means  of  drawing  more  closely  the 
bonds  of  affection  which  bind  the  various  parts 
of  the  empire  together.  Neither  does  the  giving 
of  them  when  done  with  discretion  impoverish 
the  royal  source  whence  they  flow.  We  attri- 
bute this  apparent  neglect  to  the  well-known 
self-negation  of  the  members  of  our  profes- 
sion whenever  its  interests  are  concerned  ; 
this  is  evidenced  by  the  unbounded  charity  and 
unselfish  devotion  of  the  medical  man  often  in 
the  face  of  the  basest  ingratitude.  Lawyers 
seldom  give  their  services  day  after  day  without 
the  hope  of  pecuniary  reward,  and  yet  when  a 
lawyer  reaches  a  certain  position  in  his  profes- 
sion on  the  bench  he  receives  the  honor  of 
knighthood  as  a  matter  of  course.  The  med- 
ical ])rofession  of  Canada  has  long  considered 
this  lack  of  appreciation  as  a  slight  as  well  as 
an  injustice,  and  we  think  it  is  now  time  for  it  to 
ask  whether  it  should  not  at  least  receive  the 
recognition  which  it  deserves  and  which  it  re- 
ceives elsewhere. 


more  good  air,  they  would  be  more  likely  to  be 
cured  than  if  they  ate  an  unlimited  quantiiy  of 
thyroid  glands. 


THYROID  GLANDS  AS  MEDICINE. 

We  see  in  a  recent  number  of  the  Medical 
Press  and  Circular  that  thyroid  glands  are 
supposed  to  be  of  such  value  in  several  diseases, 
notably  myxoedema  and  psoriasis,  that  the 
butchers  have  put  up  the  price.  Even  a  phy- 
sician, who  is  suffering  from  psoriasis,  writes  to 
the  above  journal  to  know  whether  the  thyroid 
of  any  animal  would  do  as  well  as  that  of  the 
sheep. 

It  sounds  more  like  witchcraft  than  nine- 
teenth century  science  to  see  such  evidences  of 
credulity  as  are  witnessed  every  day  by  the 
vaunting  of  different  parts  of  animals  for  the 
cure  of  special  diseases.  We  smile  when  we  read 
the  fashionable  prescriptions  of  five  thousand 
years  ago,  which  include  such  articles  as  parts 
of  a  dog's  foot,  legs  of  a  black  spider,  skin  of  a 
frog,  etc.;  but  are  we  really  very  much  in  advance 
of  our  ancestors  when  we  gravely  eat  "  a  ragged 
bit  of  flesh  like  liver,  about  half  the  size  of  a 
rabbit's  ear,"  as  the  writer  above  referred  to  de- 
scribes it,  with  the  firm  belief  that  it  is  going 
to  cure  a  case  of  inveterate  psoriasis  ?  If  people 
with  psoriasis  would  pay  more  attention  to  their 
diet,  eat  less  meat,  drink  more  water  and  breathe 


BOOK    NOTICES. 


Le  Medecix  de  la  Famille,  World  Publish- 
ingCompany,  Guelph,  Canada,  1893. 

Is  the  title  of  a  new  work  just  issued,  which 
is  the  French  edition  of  that  excellent  and  re- 
liable family  medical  book.  The  Practical 
Home  Physician.  The  newly  revised  edition 
of  the  latter  stands  at  the  head  of  all  similar 
words.  "  Le  Medecin  de  la  Famille  "  in  typo- 
graphy, paper  and  binding  presents  a  superior 
appearance  to  its  English  prototype.  The 
text  in  both  the  English  and  French  editions 
is  correct  in  style  and  intelligible  to  every 
reader.  New  contributions  appear  from  the 
pens  of  Dr.  Severin  Lachapelle  and  Dr.  L.  E. 
Fortier  of  our  City,  members  of  the  Medical 
Faculty  of  Laval  University. 

The  work  is  well  called  not  only  the  Home 
Physician,  but  an  Encyclopaedia  of  Medicine 
and  of  Hygiene,  public  and  private.  It  is  a 
large  volume  of  over  1300  pages,  profusely 
illustrated  with  about  230  engravings  and 
colored  plates.  The  manikins  of  the  head  and 
of  the  body,  and  the  other  colored  anatomical 
plates  are  exceedingly  good,  and  interesting  to 
the  medical  practitioner  as  well  as  to  the 
general  reader.  The  various  subjects  treated 
of  are  very  numerous,  but  the  exhaustive  and 
complete  Indexes  enable  you  quickly  to  find 
any  particular  matter  desired. 

Everyone  should  have  a  general  knowledge 
of  Anatomy  and  Physiology,  of  the  laws  of 
health,  of  the  diseases  and  accidents  commonly 
met  with,  and  the  remedies  usually  applied. 
The  intelligent  patient  could  tliereby  better 
appreciate  the  importance  of  the  science  of 
medicine,  and  could  better  assist  the  physician 
in  his  practice. 

In  the  work  before  us  a  vast  amount  of 
useful  information  about  Hygiene  in  its  applica- 
tion to  our  daily  life  is  set  forth  in  about  100 
pages,  which  should  be  read  and  studied  by 
every  household.  To  be  forewarned  is  to  be 
forearmed.  The  knowledge  herein  given  as  to 
the  various  diseases,  their  causes,  symptoms 
and  treatment,  including  most  excellent  pre- 
scriptions, is  such  that  the  intelligent  reader 
may  better  guard  against  disease,  and  when 
present  can  more  successfully  manage  and 
control  it. 

The  book  is  of  great  value  to  every  house- 
hold ;  the  subscription  price  of  $4.75  or  $5-75. 
according  to  binding,  brings  it  within  the 
reach  of  all. 


e^jfeil   BtiTifl 


4> 


Vol.  XXII. 


MONTRE.VL,  JANUARY,  1894. 


No.  4. 


OBIGINAL   COMUUNICATIONS. 


Fell  Method — Forced  Respiration. 


SOCIETY  PROCEEDINGS 

The    Montreal     Medico-Chirurgical 

Society  88 

Paralysis  of  the  Arm  followiiig  the 
Application  of  an  Esmarchs  Ban- 
dage      88 

Myeloid    Sarcoma    of    the    Second 

Metatarsal  Hone     .... 88 

Upon  Morse-Pox  attPcting  the  Cow..  89 
Epithelioma  of  the  Soft  Palate,  etc.  9lt 
Xeurasthenia  of  the  Stomach 92 

The  late  Dr.  William  F.  Hutchin- 
son         93 


EDITORIAL. 

Lodge  Doctors 91 


NEWS  ITEM. 
International  Medical  Congr3SS 95 


PAMPHLETS  RECEIVED. 


Exercise  for  Pulmonary  Invalids.. . .     95 

Outlines  of  Obstetrics 9J 

Connecticut  State  Medical  Directo 


ry. 


95 


De  la  Meningite  Tuberculeuse  chez 
I'Enfant 95 


BOOK  NOTICES. 


The  Medical  News  Visiting  List  for 
1894  96 

The  Physician's  Visiting  List  for 
1894 dii 


PUBLISHERS  DEPARTMENT. 


A  too  Common  Affront  to  the  Pro- 
fession     96 


Iri^tnal    jfommumcations. 


FELL  METHOD— FORCED  RESPIR- 
ATION. 
*  Report  of  cases  resulting  in  the  saving  of 

ttocnty-eight  Jinman  lives.     History  and  a 

Plea  for  its  general  use  in  Hospital  and 

Naval  Practice. 
By      Geo.    E.     Fell,     M.D.,     F.R.M.S. 

Ex-President    American     Microscopical 
Society,  etc.,  Buffalo,  N.Y. 

It  may  be  well  to  premise  what  I  have 
to  say  by  calling  attention  to  the  meaning 
of  the  term  Forced  Respiration.  We 
understand  by  artificial  respiration  an 
artificial  method  of  breathing  for  an  indi- 
vidual ;  but  since  forced  respiration  has 
been     used,    with    the    remarkable    results 

*Read  before  Section  General  Medicine  Pan-American 
Medical   Congress,   VVashingion,    D.C.,    September  7th, 

>893- 

As  this  is  the  first  report  giving  results  of  value  on 
this  subject  presented  outside  of  the  members  of  home 
societies,  and  the  knowledge  of  the  subject  being  new 
to  most  of  the  members  of  the  Congress,  it  is  given  in 
detail. 


here  recorded,  it  appears  terms  should  be 
employed  which  would  be  distinctive,  and 
some  time  ago  I  made  a  suggestion  to  the 
profession,  which  seems  to  have  been  quite 
universally  adopted,  to  the  following  effect : 

Auto-respiration :  respiration  by  the  in- 
dividual for  himself. 

Deep  respiration :  forcible  respiration  by 
the    individual     himself. 

Artificial  respiration :  This  we  under- 
stand to  be  that  produced  by  the  methods 
which  have  been  suggested  by  Sylvester, 
Howard,  Marshall  Hall  and  others,  in 
which  movements  of  the  limbs  of  the 
patients  and  pressure  are  made  with  the 
view  of  inflating  the  lungs.  In  many 
instances  artificial  respiration  cannot  be 
depended  on  to  furnish  a  sufficient  supply 
of  air  to  the  lungs,  hence  the  need  for  the 
following. 

Forced  respiration :  those  measures  by 
which  air  is  forcibly  passed  into  the  lungs, 
according  to  the  method  first  systematically 
u'^ed  successfully  in  the  saving  of  human 
life  by  the  author. 

The  following  cases  are  reported  in  detail 
simply  to  silence  all  doubters  as  to  the 
serious  aspect  of  each  case,  as  in  the  intro- 


74 


THE   CANADA   MEDICAL   RECORD. 


duction  of  a  new  method  into  medical  or 
surgical  practice  it  is  important  to  state 
cases  fully.  \\'hile  some  of  these  cases 
liave  been  heretofore  reported,  the  object 
of  the  paper  would  be  rendered  ;///  by  mere 
reference  to  them,  as  the  majority  of  the 
members  of  the  Congress  appear  to  know- 
very  little  regarding  the  work  accomplished 
by  the  methods  described. 

REPORT   OF   CASES. 

CASE  I. — Dr.    FEEL. 

At  12.30  a.m.,  Saturday,  July  23,  1887, 
I  was  called  to  attend  Mr.  Patrick  Burns 
book-keeper,  residing  at  No.  49  Mor- 
gan Street.  I  found  the  patient  in  a 
semi-conscious  condition.  His  wife  r-e- 
ported  that  he  had  been  drinking  heavily 
for  a  week  past,  and  had  been  in  the  habit 
of  using  alcoholic  liquors  to  excess  for  ten 
or  twelve  years.  His  pr-esent  excesses 
induced  him  to  try  chloral  to  produce 
sleep,  but  finding  this  unsuccessful,  he 
added  twenty  grains  of  morphine,*  with 
the  following  r-esult.  According  to  his  state- 
ment, he  had  taken  the  drug  late  on  Friday 
afternoon,  so  that  sufficient  time  had  elapsed 
to  permit  complete  absorption.  When  first 
discovered  by  his  wife,  he  was  breathing 
stertorously,  and  was  with  difficulty 
aroused.  A  draught  of  black  coffee  was 
given,  which  produced  vomiting.  On  my 
arrival,  I  supplemented  this  with  one  of  mus- 
tard, sodium  chloride,  and  water,  which 
effectually  emptied  the  stomach.  This  pro- 
cluced  no  further  effect,  as  the  patient,  left  to 
himself,  immediately  passed  into  the  deep, 
narcotic  condition  of  opium  poisoning. 
The  pupils  were  markedly  contracted,  and 
it  was  evident  a  serious  case  was  on  hand, 
At  this  time  I  administered  two  cathartic 
pills  which  I  had  with  me,  and,  at  differ-ent 
times,  minim  doses  of  fluid  extr-act 
of  belladonna,  sent  for  some  atropia, 
and  frequently  administered  the  one- 
sixtieth  of  a  grain  hypodermically.  To 
keep  the  patient  awake,  he  was  di'essed, 
and  two  attendants  walked  him  around  the 
block  in  the  cool,  pure  atmosphere  of  the 
early  morning.  At  each  round  I  examined 
him,  and  administered  more  atropia.  The 
fourth  or  fifth  round,  when  within  one-half 

*  Mr.  Burns  stated  on  ques-tioning  iliat  lie  had  a 
powder  two  inches  long,  three-fourths  of  an  inch  wide, 
and  about  one-fourth  of  an  inch  thick,  and  that  he  took 
one-halfof  it ;  on  measurement,  found  equal  to  grains  x,n. 


block  of  the  house,  his  limbs  gave  out,  and 
while  being  tugged  and  jerked  along,  ster- 
torotis  breathing  began  again  ;  he  was 
carried  into  the  house,  and  laid  on  the 
fiooi",  as  I  believed,  to  die.  This  was  about 
3.30  a.m.  As  the  respiration  failed,  and 
the  inter\als  between  them  lengthened, 
S)'lvester's  method  of  artificial  respiration 
was  employed,  and  kept  up  at  intervals 
long  after  I  had  given  up  an}'  hopes  of  the 
man's  i-ecoveiy  and  until  I  was  thoroughly 
exhausted,  and,  further,  without  apparent 
benefit  to  the  patient.  In  the  meantime, 
I  notified  the  family  that  the  patient  could 
not  live. 

At  this  juncture.  Father  Grant,  of  the 
Cathedral,  appeared,  and  performed  the 
last  rites  of  the  Catholic  Church.  At  my 
suggestion,  a  bed  was  prepared  in  the 
front  parlor  of  the  house,  and  the  patient 
laid  upon  it.  From  Mrs.  Burns  I  obtained 
the  data  for  the  death  certificate,  which  I 
confidently  expected  to  file  in  the  morning. 
I  then  took  a  last  look  at  the  patient,  only 
to  confirm  my  opinion  that  death  was 
imminent,  and  then  thought  nothing  more 
could  be  done.  I  was  too  thoroughly  fa- 
tigued  to  think  of  forced  respiration. 

The  pulse,  before  Father  Grant  camCf 
had  registered  as  high  as  180,  and  before  I 
left  the  house  it  could  have  been  counted 
with  difficulty  :  1  considered  it  200  or  more. 
The  respirations  at  4  o'clock  in  the  morn- 
ing v.'ere  five  per  minute,  and,  when  I  left 
the  house  for  home,  were  intermittent,  or 
with  a  long  intermission  followed  by  a  few 
spasmodic  respiratory  efforts,  and  then 
apparent  inanition  for  a  time.  I  left  for 
home  a  little  after  5  o'clock  in  the  morning, 
went  to  bed,  and,  after  a  sound  sleep,  was 
awakened  by  a  call  about  8  o'clock. 

Dr.  F.  R.  Campbell,  who,  through  ill- 
ness, had  been  unable  to  respond  to  an 
early  summons  from  Mrs.  Burns,  called 
about  8  a.m.,  and  finding  Mr.  Burns  still 
alive,  sent  for  me.  I  promptly  repaired 
to  the  house,  and  indeed  the  patien.t  was 
alive,  with  respirations,  however,  not  more 
than  one  per  minute,  and  the  pulse  with 
difficulty  to  be  detected  at  the  wrist.  The 
extremities  were  quite  cold  ;  the  face  had 
assumed  a  cyanotic  appearance ;  pupils 
still  contracted.  The  doctor  suggested 
that  more  atropia  be  given  hypodermically, 
to  which  I  assented.     Together  we  rcpairecl 


THE  CANADA  MEDICAL  RECORD. 


75 


to  the  drug  store  near  by,  had  some 
powders  prepared,  and  on  our  return  were 
surprised  to  find  i\\Q^\X[n\sividely  dilated  ; 
it  is  needless  to  say  no  more  atropia  was 
administered.  Tiie  sudden  dilatation  of  the 
pupils  was  undoubtedly  caused  b}'  the  par- 
ah'sis  of  the  nerve  centres  controlling  the 
iris,  and  is  one  of  the  frequent  conditions 
in  the  last  stages  of  opium-poisoning  and 
indicative  of  general  muscular  paralysis  ; 
it  is  also  known  as  the  "  dilatation  of  as- 
phyxia." 

Dr.  Campbell  made  the  remark  :  "  We 
can  do  nothing  more  nov»'."  I  agreed  with 
him  ;  but  recalling  a  case  of  opium  poison- 
ing in  a  Mr,  Dyke,  which  I  had  lost  about  a 
year  previous,  and  my  views  then  enter- 
tained, I  mentioned  to  Dr.  Campbell  my 
conviction  that  Mr.  Burns'  life  might  be 
saved  by  opening  the  trachea  placing  a 
tube  in  it,  and  with  suitable  apparatus 
keeping  up  the  respirations  until  the  poison 
could  be  eliminated.  I  informed  him  that 
I  had  the  apparatus  used  on  dogs  in  the 
laboratory  of  the  col'ege  at  my  residence 
near  by.  He  oiTered  to  assist  if  I  would 
make  the  experiment.  With  the  aid  of  a 
gentleman  stopping  at  the  house,  I  ob- 
tained the  apparatus.  On  my  way  I  asked 
Mr.  G.  H.  McMichael,  a  medical  student, 
to  assist  in  the  operation. 

Details  of  Operation. — The  tracheal 
tube  wasquickl)  cleaned  \\\\.\\  a  bi-chloride 
solution,  and  the  operation  of  tracheo- 
tomy begun  at  9  a.m.  The  h?emorrhage 
was  overcome  before  incising  the  trachea. 
The  greatest  difficulty  was  experience.!  in 
passing  a  ligature*  about  the  trachea,  to 
prevent  the  air  from  passing  up  the  throat. 
After  this  was  accomplished  we  were  ready 
to  begin   the  respirations. 

The  blood  passing  from  the  incision  was 
of  a  dark  coffee  color,  indicating  an  exii  enie 
venous  condition.  Having  been  deeply 
occupied  with  the  operation,  I  had  nut 
noticed  the  condition  of  the  patient  farther 
than  to  be  able  to  state  that  no  respiratory 
effort  had  been  made  for  some  time,  and 
that  the  dark  blue  tinge  of  the  face  had 
materially  increased. 

We  began  the  forced  respirations.  The 
lungs  were  inflated  ;    no":  the  slightest  ex- 

*  Tliis  is  now  obviated  by  placing  a  ring  on  the 
tracheotomy  tuba.  The  face  mask  will,  howe.'er,  take 
the  place  of  tracheotomy  or  intubation  in  tlie  great  ma- 
jority of  cases, 


piratory  effort  was  made,  indicating  not 
J  onl}-  paralysis  of  the  muscles  of  respira- 
;  tion,  but  loss  of  elasticity  in  the  lung 
tissue.  No  mention  has  been  made  of  the 
difficulty  encountered  after  the  patient  re- 
vived and  began  to  move  uneasily  about. 
These  movements  loosened  the  tube  in  the 
trachea,  and  started  haemorrhage,  and  as  at 
this  time  the  patient  was  depending  upon 
the  forced  respiration  for  his  life,  the  result 
was  made  uncertain.  This  was  the  most 
serious  time  in  the  operation.  In  the  house 
were  boarding  three  soldiers  of  the  U.S. 
recruiting  service,  who  were  quickly  sum- 
moned, and  performed  efficient  service  in 
restraining  the  patient.  At  this  time,  and 
before  the  tracheal  tube  was  inserted, 
considerable  blood  passed  into  the  lungs  ; 
it  was  subsequently  coughed  out  at  the 
opening  of  the  valve  of  the  apparatus. 
At  12  o'clock  mid-day,  after  the  forced 
respirations  had  been  under  way  two  and 
one-half  hours,  the  ordinary  tracheotomy 
tube  was  substituted  for  the  tubs  of  the 
apparatus,  and  the  patient  allowed  to 
breathe  for  himself 

This  case  (No.  i)  was  reported  in  a  paper 
read  at  the  Washington  International 
Medical  Congress  in  1887,  and  some  two 
months  afterwards  Case  No.  2  occurred  in 
Vienna.  It  will  be  noted  that  my  first  case 
had  been  fully  published  previously,  com- 
municated with  Professor  Boehm  of  the 
Vienna  Hospital,  August  14,  1888,  request- 
ing an  account  of  the  second  case  of  forced 
respiration.  November  1 1,  1888,  I  received 
from  him  the  following  account  of  the  case, 
which  coincided  with  my  views  previously 
expressed  regarding  the  value  of  forced 
respiration. 

CASE    II. 
Professor  Doctor  BoEHM,  Vienna,  Austria. 
Allegemeines  Krankenhaus, 

ViEXXA,  Oct.  2  1,   1888. 

Honored  Confrere, 

Having  just  returned  to  Vienna,  I  take 
great  pleasure  in  answering  your  fa\"or  of 
August  14th,  1888. 

There  has  as  yet  been  no  authentic  re- 
port published  of  the  methods  which  were 
employed  in  rescuing  Dr.  Langer  from 
deaJi  by  morphia  poisoning,  I  therefore 
givj  briefly  the  important  points  of  the 
case. 

Dr.  Langer  tojk,  between  the  loth  and 


76 


THE   CANADA   MEDICAL   RECORD. 


20th  of  September  1887  (nearly  two 
months  after  Dr.  Fell's  first  operation),  six 
decigrammes  (8.24  grains)  of  morphia  dis- 
solved in  water.  As  his  servant's  attempt 
to  awaken  him  in  the  morning  was  fruit- 
less, a  physician  from  the  hospital  was 
immediately  called  in,  and  he  diagnosed 
morphia  narcotism. 

The  pulse  was  very  small  and  inter- 
mittent, respiration  had  nearly  ceased,  the 
number  about  five  per  minute.  The  pu- 
pils were  contracted  to  the  size  of  a  pin's 
head  and  insensible  to  light  ;  corneal  reflex 
absent  ;  deep  coma  ;  briefly,  a  typical  case 
of  narcotism  by  morphia. 

The  attempts  to  save  the  patient's  life 
were  now  made. 

The  stomach  was  emptied  of  its  con- 
tents and  rinsed  out  with  black  cofi"ee. 
This  was  followed  by  injections  of  ether, 
both  of  which  were  followed  by  apparent 
good  results.  After  the  respirations  had 
increased  to  seven  per  minute,  the 
patient  was  removed  to  the  Royal  Hospital, 
at  which  place  artificial  respiration  was 
kept  up  from  8  a.m.  until  12.  30  p.  m.  As 
it  was  now  apparent  that  artificial  respira- 
tion was  not  sufficient  to  restore  normal 
breathing,  tracheotomy  was  performed.  A 
canula  connected  with  a  bellows  was  in- 
troduced, and  "  forced  respiration  "  (kunst- 
lich  Luft  eingeblason)  kept  up  for  three  or 
four  hours.  At  5  p.m.  the  use  of  the 
bellows  could  be  dispensed  with,  and  our 
attention  entirely  devoted  to  watching  the 
natural  respiration. 

The  attempts  which  the  patient  made  to 
breathe  for  himself  continued  to  increase 
in  number,  and  the  next  morning  he  be- 
came conscious.  Our  subsequent  treatment 
consisted  in  simply  caring  for  the  wound 
and  in  elevating  and  enlivening  the  much 
depressed  spirits  ot  the  patient. 
CASE  III. — Dr.  Fell. 
Mr.  J.  A.  v.,  aged  43,  took  two  ounces 
of  laudanum  and  some  chloral  about  9  or  10 
p.m.,  Saturday,  December  10,  1887.  About 
midnight  his  wife  heard  him  breathing 
heavily,  and  tried  unsuccessful!)'  to  arouse 
him,  and  sent  for  aph}'sician.  Dr.  Lawrence 
G.  Hanley,  of  the  Emergency  Hospital,  was 
the  first  to  respond  to  the  call,  and  was 
shortly  thereafter  followed  by  Dr.  Jacob 
Goldberg.*   The  condition    of  the  patient 

*Dr.  Samuel   Goldberg  was  present  later  in  the  case  ; 
also  a  number  of  medical  students. 


at  this  time,  1.15  a.m.,  indicated  that  a 
large  dose  of  some  powerful  narcotic  had 
been  taken.  Breathing  was  stertorous  ; 
pulse,  128  ;  respirations,  6  per  min. ;  and 
pupils  contracted.  At  1.40  a.m.,  Saturday 
morning,  I  was  called,  and  found  that  the 
physicians  were  employing  Sylvester's 
method  of  artificial  respiration.  Assuming, 
at  their  request,  entire  charge  of  the  case, 
I  had  the  patient  placed  upon  a  mattress 
on  the  dining-room  table. 

2.20  a.m. — The  natural  respirations 
ceased,  or  would  last  but  a  short  time  with- 
out the  aid  of  the  artificial  respirations. 
Pulse,  72  to  84,  indicating  satisfactory 
oxygenation  of  the  blood  ;  however,  the 
notes  taken  at  the  time  show  that  the  natu- 
ral respiratory  efi'orts  were  so  irregular  and 
deficient  that  it  was  difficult  to  count 
them.-j- 

The  ineflicient  character  of  the  natural 
respirations,  even  when  supplemented  with 
the  artificial  method  of  Sylvester,  Mas 
evidenced  by  the  gradually  marked  in- 
crease of  cyanosis.  Previous  to  this,  when 
noticing  the  first  good  results  of  the  arti- 
ficial respiration  in  this  case,  I  informed 
the  physicians  that  this  wo.  Id  be  a  good 
time  to  efi'ectually  answer  ;  se  who  be- 
lieve that  artificial  respiration  would 
accomplish  as  much  as  forced  respiration 
in  cases  of  deep  narcosis  from  poisons 
which  act  upon  the  respiratory 
centres.  1  informed  them  that  if  the  life 
cf  the  patient  could  be  saved  by  artificial 
respiration,  or  by  any  other  known  means, 
my  apparatus  adapted  to  man  should  not 
be  used.  It  was  evident  that  the  artificial 
respirations  were  doing  little  good,  grow- 
ing less  and  less  efficient. 

2.30  a.m. -Natural  respirations,  seven  per 
minute.  2.40  a.m. —  Natural  respirations, 
stertorous,  twelve  per  minute,  but  so 
"shallow"  that  little  good  was  effected  by 
them.  3.25  a.m. — Respirations  failed. 
Owing  to  evident  signs  of  heart  failure,  it 
was  considered  by  all  thephysicians  present 
that  the  life  of  the  patient  demanded  the 
application  of  forced  respiration.  Time  was 
given  to  demonstrate  bc)'ond  question  the 


t'lhis  case  is  reported  fioni  full  notes  taken  during  its 
progress  by  the  different  physicians  present. 

This  was  ihe  first  ca^e  in  which  Dr.  FelTs  apparatus 
for  use  on  man  was  used.  ResjMration  was  kept  up  for 
I4,'2  hours,  which  cojld  not  have  been  done  under  con- 
ditions existing  with  apparatus  used  in  first  case, 


THE   CANADA   MEDICAL    RECOUD. 


11 


uselessness  of  the  artificial  respiration,  until 
it  was  feared  that  the  patient  might 
succumb  before  the  forced  respirations 
could  be  applied.  3.40  a.m.  — Operation 
of  tracheotomy  begun.  Blood  venous.  Dr. 
Hanley  remarked  at  the  time  that  it  was 
"ebon}-  colored."  4.05  a.m. —  Forced 
respirations  begun.  In  a  short  time  the 
pulse  became  stronger  and  was  reduced  to 
78  per  minute.  5.30  a.m. — Pulse  102. 
5.45  a.m. — Pulse  64.  6.25  a.m. — The 
patient,  itf^  to  this  time  insensible,  opened 
his  eyes,  stared  in  a  half  dazed  manner,  and 
raised  his  head  above  the  pillow.  He  recog- 
ed  Dr.  Goldberg  (by  voice  only,  as  after- 
wards stated),  and,  in  answer  to  inquiries, 
stated  that  he  had  taken  twenty  grains  of 
chloral  with  some  stimulant.  This  was 
found  to  be  untrue.  6.45  a.m. — First  noted 
that  when  forced  respiration  is  discon- 
tinued, not  the  slightest  attempt  at  breath- 
ing is  made  b\-  the  patient,  even  when 
the  cyanotic  condition  is  extreme. 

During  the  progress  of  the  case  water 
was  frequently  swallowed  by  the  patient. 
In  one  or  two  instances  the  forced  respira- 
tions were  unintentionally  kept  up  when 
the  patient  was  swallowing.  The  glottis 
being  opened  at  this  time,  water  entered 
the  lungs,  and  was  subsequently  coughed 
up  and  passed  out  of  the  valve  of  the  ap- 
paratus.* 

7.00  a.m. — Pulse  96.  8.15  a.m. — Pulse 
108.  It  was  found  that  the  patient  could 
breathe  for  himself,  but  only  for  a  short 
time,  and  forced  respirations  had  to  be 
continually  kept  up.  9.00  a.m. — The  tra- 
chea tube  not  being  secured  tightly  in 
the  trachea,  permitted  quite  an  amount  of 
blood  to  pass  into  the  lungs  and  the  air 
to  pass  upward  into  the  mouth,  so  that  the 
lungs  were  not  thoroughly  inflated  at  each 
inspiration.  This  blood  gurgled  ominously 
at  each  respiration.  With  a  curved  needle 
encircling  the  trachea,  another  ligature  was 
passed  and  tightened  about  the  trachea 
and  tube,  as  the  rings  to  the  tracheotomy 
tube  had  not  been  devised  or  value  of  face 
mask  known  at  this  time.  The  forced 
inspirations  following  markedly  improved 
the  action  of  the  heart. 

*l'his  indicates,  in  part,  the  value  of  the  application 
of  the  apparatus  in  cases  of  drowning  ;  also  that  it  would 
be  objectionable  to  pass  a  tube  into  the  larynx  by  way 
of  the  buccal  cavity  when  the  elimination  of  poison  is 
important,  as  liquid,  in  swallowing,  would  be  apt  to 
enter  the  lungs.  It  indicates  the  value  of  the  face 
mask  in  drowning.     See  later  pages. 


As  the  poison  became  more  completely 
incorporated  with  the  blood,  the  effect  of 
even  a  short  stoppage  of  the  forced  res- 
piiations  was  indicated  in  a  weaker  action 
of  the  heart.  At  one  time  the  rubber  tube 
connecting  the  respiratory  or  air  valve  with 
the  trachea  tube  became  almost  completely 
clogged  with  clotted  blood.  It  was  re- 
moved and  thoroughly  cleaned,  as  was  also 
the  inner  tube  of  the  tracheotomy  tube  a 
number  of  times.  Digitalis  fluid  extract, 
in  half  minim  doses,  was  given  a  number 
of  times  ,  also  atropia,  one-eighth  grain  at 
one  time  and  smaller  doses  also.  Xo  dila- 
tation of  the  pupil  took  place  at  this  time. 

The  question  of  keeping  up  the  forced 
respiration  when  there  seemed  to  be  no 
prospect  of  the  ultimate  recovery  of  the 
patient  was  seriously  discussed.  I  was 
urged  to  discontinue  the  respirations  on 
account  of  the  case  being  considered 
hopeless.  At  one  time  I  stopped  the  res- 
pirations for  a  longer  period  than  usual, 
thoroughly  discouraged  and  tired.  The 
man  was  not  dead,  and  we  had  to  keep  it 
up. 

11.30  a.m. — Drank  some  brandy  and 
water ;  vomited.  As  the  patient  had  at 
this  time  been  given  up  to  die,  his 
family  were  permitted  to  see  him  and  '•  bid 
him  good-bye." 

12.00 — Pulse  117.  Grain  1-73  of  atropia 
administered  hypodermically.  12.10  p.m 
Face  cyanosed  ;  efforts  to  breathe  made  ; 
twitching  of  toes  ;  respirations  not  supply- 
ing air  enough.  12.40  p.m. — Owing  to  a 
solution  of  atropia  being  placed  on  or  in 
the  eyes,  the  pupils  gradually  dilated.* 
Pulse  126.  12.55  P-tii- — The  patient,  who 
had  become  unconscious  for  a  short  time, 
regained  consciousness  and  drank  some 
water.  Pulse,  after  drinking,  168,  weak  and 
flickering.  After  this,  more  air  was  admin- 
istered by  giving  three  movements  of  the 
bellows  for  the  inspiration  instead  of  two, 
as  formerly. 

3.20  p.m. — Temperature  100.3'''  Fahr. 
6.00  p.m. — Pulse  120. 

After  nearly  fifteen  hours  of  forced  res- 
piration, at  6.15  p.m.  the  patient  began 
breathing  for  himself  Respiration,  fourteen 
per  minute.  This  lasted  fift}'-five  minutes, 
when  the  respirations  lowering  to  eight  per 

*  This  may  not  have  been  judicious,  but  it  was  done 
under  the  belief  of  all  the  physicians  present  that  the 
patient  coal  1  not  recover. 


;3 


THE  CANADA  MEDICAL  RECORO. 


minute,  at  the  request  of  the  patient  the 
forced  respirations  were  again  proceeded 
with. 

9.15  p.m. — Pulse  120;  respirations,  four- 
teen, natural  ;  becoming  shallozu,  they  zvere 
supplemented  with  the  forced  respirations. 
11.30  p.m. — Pulse  100. 
December  11,  1887,  12  midnight.  It  is 
now  twenty  hours  since  the  forced  respira- 
tions were  begun. 

1.05  a.m. — Pulse  128,  strong.  The  pa- 
tient has  been  breathing  for  himself  for 
the  last  four  Jiours,  but  lias  now  requested 
that  the  forced  respirations  be  used  for  a 
time.  Since  then  he  has  breathed  sponta- 
neously. For  over  fourteen  hours  he  could 
not  be  left  to  breathe  voluntarily,  even  for 
half  a  minute,  without  evident  discomfort 
and  danger,  viz.,  between  4.00  a.m.  and 
6.30  p.m.  of  the  loth  inst.,  and  for  nearly 
seven  hours  thereafter  the  natural  had  to  be 
supplemented  by  the  forced  respirations, 

4.00  a. m — Pulse  117.  Although  oleum 
tiglii  to  gtt.  v.  has  been  administered,  no 
movement  of  the  bowels  has  taken  place. 
Essence  of  peps'n,  beef  peptonoids,  milk 
and  spiritus  fruaienti  given  a  number  of 
times.  Enemata  of  water,  soap  and  water, 
wiih  oil  and  stimulants,  given  also. 

Every  six  or  eight  hours  the  catheter 
was  used.  Up  to  12.30  a.m.,  nth  inst., 
and  some  twenty-seven  hours  after  two 
ounces  of  laudanum  had  been  taken,  not 
more  than  six  ounces  of  urine  had  been 
drawn  from  the  patient.  This  large  amount 
of  poison  (two  ounces)  had  been  going  the 
round  of  the  circulation,  producing  its 
maximum  effect  on  the  whole  system.  The 
left  arm  was  partially  paralyzed  and  the 
brain  congested. 

Between  3.00  and  4.00  a.m.,  nth  inst, 
bowels  moved  for  the  first  time.  At  7.00 
a.m.  the  patient  left  the  table  without  assis- 
tance, to  use  stool.  At  9.00  a.m.  the 
tracheotomy  tube  was  removed,  wound 
plugged  antiseptically,  and  patient  put 
to  bed.  Although  very  seriously  ill  for 
three  or  four  days  following,  no  serious  lung 
difficulty  set  in,  and  the  patient  has  fully 
recovered. 

CASE  IV. — Dr.  Fell. 
The  following  case  I  do    not  hesitate  to 
pronounce  one  of  the  most   remarkable  in 
the  annals  of  Medicine: 

Julius  Baere,  a  resident  of  Lockport, 
N.Y.,  aged    forty-five   years,  of  a    nervous 


temperament,  a  naturally  lively  disposition 
was  subject,  through  ill  health  and  mental 
suffering,  to  spells  of  melancholy,  which 
were  aggravated  by  several  serious  reverses 
in  business  and  other  matters  which  need 
not  be  stated.  He  was  of  medium  height, 
weighed  about  one  hundred  and  thirty-five 
pounds,  and  was  in  poor  condition  to  with- 
stand the  terrible  physical  ordeal  to  which 
he  was  to  be  subjected.  January  24,  1888, 
he  left  home  for  Buffalo,  having  previously 
obtained  a  two-ounce  vial  of  laudanum.  On 
his  arrival  at  Buffalo  he  put  up  at  the  Con- 
tinental Hotel,  complained  of  not  feeling 
well,  ate  very  little  supper,  and  retired  to 
his  room.  This  was  the  last  time  he  was 
seen  until  he  was  found  next  day  at  three 
o'clock  p.m.,  to  all  appearances,  dead  (so 
reported). 

The  first  physician  to  arrive  at  the  hotel 
was  Dr.Luther  Phillips,  who,  on  examina- 
tion, gave  up  the  patient.  The  physicians 
from  the  Fitch  Emergency  Hospital,  Dr. 
George  E.  Penrose  in  charge,  next  appear- 
ed, and  administered  brandy  and  ether 
subcutaneously.  Drs.  William  A.  Hoddick, 
Carlton  R.  Jewett,  Hermon  Mickle,  John 
D.  Flagg.  and  several  others  subsequently 
were  present  during  the  progress  of  the 
case,  and  without  exception  gave  it  up  as 
hopeless.  Coroner  Kenny  was  summoned, 
and,  before  leaving  his  office,  telephoned  to 
Undertaker  Rodney  to  go  to  the  hotel  with 
a  coffin,  which  he  did. 

The  two  ounce  vial  of  laudanum  was 
empty  ;  the  throat  of  the  patient  was  cut, 
severing  the  trachea  and  anterior  jugular 
vein  ;  it  was  found  also  that  the  left  arm 
had  been  incised  with  the  razor  so  as  to 
clearly  expose,  without  opening,  the 
basilic  vein.  At  this  time  the  patient  was 
making  a  faint  gasp  once  in  about  ten 
seconds,  and  breathing  through  the  hole 
he  had  made  in  the  trachea. 

On  arrival  at  5  p.m.,  Jan.  25,  I  found 
the  corridor  and  bed-room  filled  with 
physicians  and  laymen,  the  patient  lying 
on  the  right  side  of  the  bed.  Haemorrhage 
extensive  ; — as  an  indication,  it  may  be 
mentioned  that  the  right  side  of  the  over- 
and  undershirt,  the  shirt-sleeves  to  the 
wrists,  right  end  of  pillow,  and  side  of 
mattress  were  literally  soaked  with  coagu- 
lated blood.  A  tall  slop-jar  at  head  of 
bed  was  one-half  full  of  blood  and  water. 
The  pupils  contracted,  pallor  of  face   and 


THE  CANADA  MEDICAL  RECORD. 


79 


an  occasional  gasp,  only  indicated  that  life 
existed.  Xo  pulse  at  wrist,  and  fluttering 
movements  of  heart  on  auscultation  ;  skin 
cold  ;  patient  had  a  cadaverous  appear- 
ance, and,  of  course,  Avas  unconscious. 
The  physicians  had  ceased  their  efforts  at 
resuscitation.  Dr.  William  A.  Hoddick 
reported  the  condition  of  the  patient  at 
timeof  my  arrival  as  follows  : — "  Skin  cold, 
cadaverous  appearance,  lips  colorless,  the 
pallor  of  death  apparent,  extremities  cold, 
pulse  almost  imperceptible,  only  a  slight 
fluttering  of  the  heart  could  be  discovered, 
eyes  insensible  to  light,  pupils  completely 
contracted,  but  little  blood  in  the  body." 

My  first  marked  interest  was  in  noting 
that  the  incision  in  the  trachea  was  just 
suited  -to  my  tracheotomy  tube,  which  I 
immediately  inserted,  causing  a  reflex 
inspiratory  spasm.  Within  one  minute 
from  the  time  I  entered  the  room  I  was 
practising  forced  respiration  upon  the 
patient. 

Within  a  few  minutes  the  cyanotic 
condition  slowly  passed  from  the  face. 
Forced  respiration  being  kept  up  steadily, 
in  about  three  hours,  at  8  o'clock  p.m.,  the 
pulse  could  be  detected  at  the  wrist  and 
the  patient  showed  signs  of  consciousness. 
The  bowels  moved  freely,  great  quantities 
of  stercoraceous  matter  passing  from  the 
patient.  At  9  p.m.  the  patient  became 
fully  conscious  of  his  surroundings  and 
condition.  Contraction  of  the  pupils  con- 
tinued, showing  continued  effect  of  the 
narcotic.  When  forced  respiration  was  dis- 
continued, an  occasional  attempt  at  respir- 
ation was  made  ;  at  no  time,  how^ever,  dur- 
ing the  first  ten  hours  while  the  instrument 
was  in  steady  use,  would  he  make  more 
than  two  or  three  attempts  at  respiration 
without  it. 

As  he  gradually  became  weaker  from 
continued  movements  of  the  bowels  and 
frequent  attacks  of  vomiting,  attem.pts  w^ere 
made  to  nourish  him.  The  most  easily 
assimilable  substances  were  rejected.  Milk 
and  lime  water,  peptonized  liquids,  liquid 
and  powdered  peptonoids,  iced  champagne, 
brandy,  etc.,  were  used,  but  the  stomach 
would  not  retain  them  ;  vomiting  conti- 
nued ;  the  patient  approached  the  stage  of 
collapse  ;  brandy  hypodermically  was  fre- 
quently given  without  marked  benefit. 
The  action  of  the  heart  was  of  abounding, 
uncertain  character    undoubtedly  produced 


by  a  deficiency  of  blood  upon  which  to 
work.  At  one  time  stercoraceous  vomiting 
set  in. — in  fact,  a  most  deplorable  condition 
existed.  It  was  decided  to  attempt  the 
introduction  into  the  circulation  of  a  saline 
fluid  by  the  transfusion  method  I  re- 
paired to  the  Fitch  Accident  Hospital,  se* 
cured  the  apparatus  and  the  assistance  of 
Dr.  Penrose,  who  with  Dr.  Mickle  opened 
the  conveniently  exposed  basilic  vein  of 
the  left  arm,  introduced  the  transfusion 
canula,  and  allowed  about  six  ounces  of  the 
fluid  to  slowly  mingle  w'ith  the  circulation.* 
Xo  apparent  change  in  the  condition  of 
the  patient  was  noticed  from  this  injection  ; 
the  forced  respiration  was  continualh-  kept 
up,  and  the  life  of  the  patient  depended 
upon  it;  as  all  other  means  taken  would 
have  proved  futile  without  it.  At  this 
time  no  pulse  at  the  wrist  could  be  detect- 
ed for  fifteen  minutes  at  a  time  :  the  caro- 
tid pulse  could  be  made  out  at  all  times. 
Continuing  the  work  through  the  night 
with  the  aid  of  my  class  of  students  from 
the  college  and  a  number  of  physicians, 
toward  early  morning  the  opinion  still  pre- 
vailed that  the  case  was  hopeless.  The 
wife  and  daughter  of  Mr.  Baere  were  called 
in  to  see  him.  Their  presence,  with  that 
of  Mrs.  A.,  the  wife  of  the  hotel  proprietor, 
seemed  to  cheer  him  up.  Mrs.  A.  urged  me 
to  discontinue  the  work  of  resuscitation,  on 
the  plea,  shared  by  all,  that  it  was  only  pro- 
longing the  misery  of  the  patient,  and  the 
case  was  hopeless.  I  urged,  as  in  my  sec- 
ond case,  that  a  physician  was  not  justified 
in  giving  up  until  life  became  extinct,  and 
kept  the  forced  respirations  under  way. 
The  unsuccessful  attempts  at  feeding  by 
the  stomach  had  been  discontinued  for  a 
time  after  the  stercoraceous  vomiting. 
The  nourishment  of  the  patient,  how- 
ever, had  become  a  matter  for  serious  con- 
sideration, and,  at  the  suggestion  of  Dr. 
C.  R.  Jewett,  half  teaspoonful  doses  of  Ci- 
bil's  Fluid  Extract  of  Beef.diluted  with  a 
little  carbonic  acid  water  were  adminis- 
tered. This  was  the  first  substance  to  be 
retained  ;  the  dose  was  repeated,  increased, 
and  at  last  the  patient  showed  signs  of  im- 
provement. 

Some  twelve  hours  after  we  had  been  at 
work,  the  satisfactory  result  of  forced  res- 


*The  formula  for  this  fluid  was  as  follows  :  R  .—  Sod. 
carb.,  grs.  iij  ;  Sod.  chloride,  grs.  xviij  ;  Aquae  ^  vij. 
Misce.     Inject  one  to  six  ounces. 


THE  CANADA  MEDICAL  RECORD. 


piration,  as  a  means  of  breathing  for  a  hu- 
man being,  was  demonstrated  in  the  pas- 
sive condition  of  the  patient.  During  the 
forenoon  the  effect  of  the  narcotic  grad- 
ually passed  away,  the  pupils  dilating  more 
and  more.  The  condition  of  the  patient 
was  such,  however,  that  he  could  not 
breathe  for  himself  for  any  time  without 
evident  discomfort  and  risk.  The  forced 
respiration  had  to  be  kept  up.  During  the 
day,  many  physicians  and  laymen  visited 
the  room  and  witnessed  the  steady  action 
of  the  apparatus.  Noon  passed,  and  yet 
the  patient  could  not  be  left  to  breathe  for 
himself.  At  1.30  p.m.,  however,  nearly 
one  full  day  (twenty  and  one  half  hours) 
after  the  forced  respiration  was  begun,  Mr. 
Baere  began  to  breathe  for  himself.  In  a 
few  hours  he  became  so  fatigued  that  he 
begged  to  have  the  forced  respirations  re- 
sumed, and  the  little  instrument  was  again 
called  into  action,  quieting  and  easing  the 
patient.  Several  times  this  was  done  be- 
fore he  continuously  breathed  for  himself, 
thus  making  the  use  of  the  instrument  to 
cover  more  than  a  day  before  it  was  laid 
aside  for  good.  Towards  evening  the 
temperature  of  the  room  in  which  the  pa- 
tient lay  became  so  cold  that  he  was  trans- 
ferred to  a  warmer  and  better  location. 
Under  careful  treatment  he  rapidly  im- 
proved, but  complained  of  constant  pain  in 
his  chest.  It  was  feared  that  pneumonia 
would  set  in,  as  the  respirations  were  some- 
what rapid.  It  did  not,  and  there  was 
nothing  to  indicate  that  the  lungs  were  un- 
favorably affected  by  the  long  continued 
forced  respiration.  Within  five  days  after 
the  operation,  the  patient  was  transferred 
to  the  Hospital  of  the  Sisters  of  Charity, 
and  his  temperature  was  normal  and  pulse 
96.  The  pain  in  the  chest  was  found  to 
have  been  caused  by  the  hypodermic  injec- 
tions, given  at  a  time  when  the  circulation 
was  so  inactive  in  the  surface  capillaries 
that  gangrene  was  produced  by  them. 
The  poor  fellow  suffered  for  months  after 
the  operation  from  this  cause.  The  greater 
portion  of  the  left  breast  sloughed  down  to 
the  ribs,  and  in  the  right  thigh  an  abscess, 
produced  from  the  same  cause,  appeared, 
which,  when  first  opened,  on  the  20th  of 
February,  gave  out  a  pint  of  pus.  There 
is,  then,  a  possibility  of  overdoing  the  hypo- 
dermic treatment  where  a  large  quantity 
of  blood  has  been  lost.     I  do  not  hesitate 


to  state  my  belief  that  Mr.  Baere  would 
have  been  in  condition  to  leave  the 
hospital  within  two  weeks  of  the  date  of 
the  operation,  had  it  not  been  for  the  re- 
sult produced  by  hypodermic  medication. 
At  this  time  following  it,  his  throat  was 
closed  up  and  in  good  condition.  He  was 
able  to  walk  about  and  do  light  work  long 
before  he  left  the  hospital,  and  when  he 
did  so  was  in  better  physical  condition 
than  he  had  been  for  years. 

Regarding  my  first  three  cases,  there  is 
no  question  as  to  the  outcome,  had  any 
other  means  been  tried  to  save  them. 
Forced  respiration  alone  is  to  be  credited 
with  the  saving  of  these  lives  to  future 
usefulness.  To  demonstrate  beyond  ques- 
tion the  thoroughness  of  the  work  accom- 
plished, at  my  request  Messrs.  Burns,  Van 
Orden  and  Baere,  all  in  good  health, 
appeared  before  the  Fourth  District 
Branch  of  the  New  York  State  Medical 
Association,  at  its  meeting  in  Buffalo,  May 
8th,  1888,  where  I  gave  a  preliminary  re- 
port upon  the  subject  of  this  paper.  To 
the  insurance  companies  this  work  was  a 
boon,  as  it  saved  to  them  some  $23,000 
life  insurance.  But  how  trivial  is  this 
compared  to  the  saving  of  human  life  and 
the  future  possibilities  of  this  operation  ! 

CASE   V. — Dr.  FELL. 

This  case  is  taken  from  the  records  of 
the  Emergency  Hospital,  where  it  occurred, 
and  is  reported  by  the  house  physician, 
Dr.  J.  F.  Mulherin. 

Hospital  Case  No.  1,000. — Peter 
Church,  aged  80,  U.S.,  admitted  May  18, 
1888,  8.30  p.m.  This  man  was  brought  in 
ambulance  from  126  JMohawk  street,  where 
he  was  found  in  a  dazed  condition. 
Patient  had  stated  to  friends  at  this  place 
that  he  had  taken  laudanum  ;  empty 
bottle  shown  to  ambulance  attendant.  On 
admission,  patient  unconscious,  pulse  full 
and  strong,  84  per  minute ;  respirations 
about  10  per  minute;  pupils  contracted 
down  to  pin  points. 

Emetics  administered  ;  atropia,  gr.  1- 
100,  hypodermically  and  catheterization  at 
8.35  p.m.;  repetition  of  atropia,  gr.  i-ioo, 
in  ten  minutes.  Artificial  respiration  by 
Sylvester's  method  at  9  p.m.  ;  heart  failed, 
and  respirations  about  three  or  four  per 
minute;  respirations  gradually"  became 
imperceptible;    atropia,    gr.    i-ioo;    also 


THE  CANADA  MEDICAL  RECORD. 


81 


brandy    and     digitalis    given    h\i)odermi- 
cally. 

At  1  I  p.m.  Dr.  Fell  was  called,  and 
tracheotomy  with  forced  respiration  deter- 
mined upon.  Present,  Drs.  Fell,  Ileath, 
Mickle  and  Mulherin.  Trachea  opened 
and  tubes  inserted  by  Dr.  Heath  at  10.25 
p.m.  ;  forced  respiration  commenced  ; 
patient  seemed  to  revive ;  pulse  became 
fuller,  was  irregular  ;  color  in  face  returned, 
and  at  12.15  a.m.  patient  first  opened  his 
eyes.  Stomach  tube  introduced  to  wash 
out  contents,  at  12.30.  Injection  of  soap- 
suds per  rectum,  i  a.m.  This  found  ineffi- 
cient, and  gtt.  ii.  olei  tiglii  administered  at 
I.I 5;  urine  again  drawn  at  1.45.  Signs 
of  returning  consciousness  at  2.30  ;  patient 
opened  eyes  and  lifted  hand.  Between  2 
and  3  a.m.,  condition  good,  pulse  full  and 
regular ;  vigorous  slapping  of  face  and 
yelling  in  ears  elicited  no  response  ;  3  a.m., 
pulse  90;  3.45  a.m.,  patient  suddenly 
raised  his  arms  and  attempted  to  speak. 
At  this  time  the  forced  respiration  was 
discontinued,  but  patient  refused  to 
breathe.  At  no  time  since  the  operation 
was  begun  has  the  patient  been  cyanotic. 
At  4.15,  patient  again  threw  his  arms 
about,  and,  in  answer  to  a  question,  said  he 
was  "  awake."  Haemostatic  forceps  re- 
moved from  neck  after  vessels  were  ligated, 
slight  hsemorrhage.  Respiration  con- 
tinued ;  5  a.m.,  patient  opened  eyes,  be- 
came somewhat  convulsed,  and  again 
relapsed  into  a  state  of  unconsciousness  ; 
two  ounces  of  nitre  given  by  mouth,  and 
stimulants  through  the  air-heating  section 
of  the  apparatus.  At  5.15  a.m.,  bellows 
working  at  the  rate  of  108  movements  per 
minute,  patient  b)'  this  means  receiving  21 
respirations  to  the  minute  ;  pulse  good  and 
color  of  face  normal  ;  5.20,  air-heating  ap- 
paratus again  used  ;  5.40,  heated  air  discon- 
tinued ;  5.  50,  urine  drawn  ;  7.00  a.m.,  face 
and  hands  more  cyanotic,  pulse  90,  tem- 
perature 99.5  ^  Fahr.  ;  7.30,  pulse  growing 
weaker,  patient  somewhat  cyanosed  ;  8.20, 
failing  ;  9.00  a.m..  pulse  88,  heart  very 
weak  ;  9.30,  pulse  varies,  becoming  alter- 
nately strong  and  weak.  At  no  time 
during  the  operation  has  the  patient  been 
able  to  breathe  of  his  own  accord.  At 
10.00  a.m.,  pulse  90,  temperature  98°  ; 
peptonized  beef  extract  given  per  rectum. 
12.45  P'lTi.)  patient  made  a  few  convulsive 
efforts  to  breathe,  again  relapsed  into  un- 


consciousness, pulse  becoming  very  weak 
and  feeble ;  patient  grows  pale ;  skin 
cold.  Complete  cessation  of  pulse  at  i.io 
p.m.  May  19  ;  patient  dead  ;  forced  re- 
spiration discontinued,  and  instrument 
removed  at  1.13  p.m. 

In  this  case  the  patient  was  kept  alive 
by  the  forced  respiration  for  fourteen 
hours  and  ten  minutes  ;  and  it  is  reason- 
able to  infer  that  his  life  was  prolonged  at 
least  twelve  hours  longer  than  it  could 
have  been  done  b\'  any  other  methods 
known. 

CASE  VI. — Dr.  Fell. 

May  26,  1888,  I  was  called  to  the  resi- 
dence of  H.C.F.,  Delaware  avenue,  Buffalo, 
and  found  his  eighteen-day-old  infant 
held  by  a  nurse  in  a  tub  of  warm  water  ; 
body  deeply  cyanosed  ;  an  occasional  gasp 
indicated  that  life  still  existed  ;  pupils  con- 
tracted ;  reflexes  absent.  Inquiry  elicited 
the  following  history:  a  homoeopathic  prac- 
titioner of  Buffalo  had  been  called  to  pre- 
scribe for  the  child.  He  took  out  of  his 
case  a  powder  containing  morphiae  sul- 
phat,  gr.  j.  By  some  psychological  freak, 
he  directed  the  nurse  to  give  it  to  the 
babe,  thinking  he  had  replaced  it  in  his 
case  and  handed  her  a  harmless  powder  in 
its  stead.  Sor.ie  time  after  the  ph}'sician 
had  left  the  house,  the  nurse  called  the 
child's  mother's  attention  to  the  super- 
scription on  the  powder, — morph.  sulph. 
gr.  j — and  with  the  probable  belief  that 
all  homoeopathic  (?)  medicine  was  harmless, 
the  fatal  drug  was  placed  in  the  mouth 
of  the  little  one  at  12.45  p.m.,  and  all  ab- 
sorbed. At  2.30  p.m.  the  child  was  dis- 
covered in  convulsions,  a  physician  Dr. 
A.  M.  Curtis,  summoned,  and  the  usual 
steps  taken  to  resuscitate.  When  it  is 
considered  that  the  quantity  of  morphine 
taken  was  equivalent  to  about  seventy 
doses  for  an  infant  of  this  age,  it  appears 
a  hopeless  task.  From  2.30  until  about 
4.30  p.m.  artificial  respiration  was  used 
with  little  benefit.  It  was  nearly  5.00 
p.m.  before  I  arrived  at  the  house,  and 
with  difficulty  in  one  so  young,  only  to  be 
appreciated  by  experience,  I  made  tra- 
cheotomy. Previous  to  the  trachea  being 
reached,  respirations  would  cease  ;  but  by 
placing  my  mouth  over  the  nose  and 
mouth  of  the  babe,  and  forcibly  blowing, 
the  lungs  were  inflated,  resulting  in  keep- 
ing up  the  action   of  the  heart  until  tae 


S2 


THE   CANADA   MEDICAL   RECORD. 


trachea  could  be  irritated.  Irritation  of 
the  trachea,  followed  by  incision,  seemed 
to  stimulate  the  respiratory  centres  for 
some  time,  but  as  the  case  was  approach- 
ing a  crisis,  at  last  a  small-sized  catheter, 
^  inch  external  diameter,  was  used  to 
make  connection  with  the  trachea,  and  by 
an  increasing  series  of  larger  tubes,  this 
Avas  connected  with  the  tube  from  the  air- 
valve  of  the  forced  respiration  apparatus. 
About  6  p.m.  the  forced  respiration  was 
begun,  Dr.  A.  M.  Curtis  giving  valued  as- 
sistance in  holding  the  small  tube  in  the 
trachea.  In  fifteen  to  twenty  minutes  the 
cyanotic  condition  passed  away,  the  child 
steadily  improved  for  an  hour,  when  the 
cyanosis  returned.  Examination  revealed 
that  the  tube  had  slipped  out  of  the  trachea. 
After  replacing,  forced  respirations  were 
continued,  and  natural  hue  of  health  re- 
turned. The  pulse  improved,  ranging  for 
a  time  at  134  per  minute.  Drs.  W.  H. 
Heath  and  Geo.  W.  T.  Lewis  were  called 
in  to  assist.  Natural  movements  of  the 
limbs  returned,  reflexes  again  established, 
the  limbs  moved,  bowels  acted  freely,  and 
eight  or  ten  natural  respirations  were 
taken.  Hopes  for  recovery  were  almo.st 
entertained  from  the  remarkable  changes 
produced  by  the  forced  respirations,  but 
at  9.30  p.m.  the  little  heart  ceased  beat- 
ing. 

In  this  case,  no  less  than  in  those  pre- 
ceding, the  result  of  forced  respirations 
was  remarkable.  The  infant,  only  eight- 
een days  old,  had  for  five  and  one  quarter 
hours  been  subjected  to  the  influence  of 
one  grain  of  morphine,  in  an  asphyxiated 
condition  for  at  least  four  and  one-quarter 
hours,  thus  weakening  the  muscular  tissue 
of  the  body.  Under  forced  respiration 
life  was  retained,  with  the  results  men- 
tioned, for  three  and  one-half  hours.  I 
hazard  the  opinion  that  if  forced  respiration 
had  been  instituted  within  the  first  two 
hours,  the  results  might  have  proved  differ- 
ent. 

June  18,  1888,  I  was  called  to  attempt 
the  resuscitation  of  a  still-born  babe.  No 
heart  action  could  he  detected.  A  cath- 
ether  was  placed  in  the  trachea  by  intuba- 
tion method,  connected  with  the  f9rced 
respirator,  lungs  were  inflated  and  expira- 
tion produced  by  pressure ;  no  results. 
The  child  was  undoubtedly  dead  before 
the   forced  respiration   was    begun.     The 


feasibility   of  the    operation    was  demon- 
strated. 

CASEvn.-~Dr.  Fell. 

Frederick  Ryers  was  found  in  front  of 
an  "opium  joint,"  and  taken  to  the  "  Emer- 
gency "'  hospital.  His  condition  was  so 
serious  that  the  house  f/hysician  sent  for 
me.  Cyanosis  was  marked,  absence  of 
reflexes,  contraction  of  pupils,  spasmodic 
respiration,  doing  little  good.  Tracheo- 
tomy made.  Blood  venous.  Forced  res- 
piration was  kept  up,  calling  the  heart 
!  into  positive  action,  and  causing  the  return 
I  of  the  pulse  at  both  wrists,  and  a  change 
I  from  the  venous  to  the  arterial  state  of  the 
I  blood  at  the  wound  in  the  neck.  Reflex 
action  could  not  be  induced  ;  the  brain 
tissue  did  not  respond  to  the  revivified 
circulation,  and  the  pupils  continued  dil- 
ated. The  action  of  the  heart  kept  up 
for  about  an  hour  before  final  stoppage. 
A  few  days  previously  I  had  had  at  the 
same  hospital  a  case  in  which  the  patient 
was  saved  without  resort  to  forced  res- 
piration, although  the  indications  were 
such  as  almost  to  warrant  the  operation. 
I  was  preparing  to  operate,  when,  a  slight 
improvement  being  noticed,  I  desisted,  and 
the  patient  recovered  without  requiring 
tracheotomy.  Influenced  by  this  case  I 
waited  too  long  with  Mr.  Ryers,  until,  in 
fact,  the  pulse  was  lost  at  both  wrists,  and, 
on  auscultation,  no  action  of  the  heart 
could  be  detected. 

CASE  viiL — Dr.  Fell. 

I  was  called  to  attend  a  case  of  "  still- 
birth "  by  Dr.  Geo.  R.  Stearns.  Face 
presentation.  Application  of  forceps  in 
delivery  had  ruptured  brain  tissue,  pro- 
ducing, as  was  subsequently  ascertained, 
sufficient  haemorrhage  to  prevent  resusci- 
tation. Previous  to  my  arrival,  the  nurse 
had  kept  up  the  action  of  the  heart  by 
mouth  to  mouth  insufflation.  Cyanosis 
was  extreme.  As  I  did  not  wish  to  at- 
tempt tracheotomy,  for  a  time  I  resorted 
to  the  same  means. 

This  not  giving  satisfactory  result,  the 
tube  connecting  with  the  air  control  valve 
of  the  apparatus  was  placed  in  the  mouth 
of  the  infant,  the  nostrils  closed,  and  the 
lips  compressed  about  the  tube,  and  forced 
respiration  instituted.  The  change  was 
immediate.  Cyanosis  passed  away,  the  heart 
action  became  good  and  full,  reflexes  of  the 


THE  CAxN'ADA  MEDICAL  RECORD. 


83 


lower  limbs  were  induced,  but  no  change  in 
brain  could  be  produced.  After  four  or  five 
hours  work  it  was  evident  that  the  brain 
was  so  injured  that  it  was  useless  to  pro- 
ceed further,  and  forced  respiration  was 
discontinued. 

The  vahie  of  this  case  is,  that  it  demon- 
strates that  forced  respiration  may  be  car- 
ried on  without  tracheotomy,  showing  that 
in  many  cases  it  could  be  applied  through 
the  medium  of  a  suitable  mouth-piece,  and 
again  illustrating  its  marked  value  over 
artificial  respiration  which  would  have 
proved  entirely  useless.  It  was  the  ex- 
perience obtained  in  this  case  that  enabled 
me  to  hold  the  life  of  my  next  patient  un- 
til forced  respiration  could  be  systemati- 
call}'  applied,  and  by  which  the  patient 
was  saved. 

CASE  IX.— Dr.  Fell. 

June  21,  1889,  I  was  called  by  Dr.  J.  S. 
Armstrong,  about  midnight,  to  attend  Mr. 
S.  F.,  a  giocer,  troubled  with  melancholia. 
Dr.  C.  C.  Fredericks  was  called  in  to  assist. 
The  previous  evening  the  patient  had 
taken  Tr.  Opii  5ii  Evidences  of  approach- 
ing death  from  the  poison  were  noticeable. 
Patient  placed  on  a  table,  and  an  incision 
for  tracheotomy  made.  Blood  in  incision 
purple.  Dr.  Fredericks  informed  me  the 
patient  was  dying,  the  pupils  dilating  (dila- 
tation of  asphyxia).  The  tube  of  the 
apparatus  was  placed  in  the  mou.h  of  the 
patient  as  in  previous  case,  the  lips  tightly 
compressed  about  the  tube,  the  nostrils 
closed,  and  forced  respiration  kept  up  for 
a  short  time.  The  lungs  were  inflated,  the 
blood  in  the  wound  changed  to  arterial, 
and  the  pulse  improved  slightly.  The 
tracheotomy  was  then  proceeded  with,  but 
before  its  completion  it  became  again 
necessary  to  inflate  the  lungs  through  the 
mouth.  On  the  institution  of  forced  res- 
piration per  tracheotomy  tube,  the  cyanosis 
rapidly  passed  away,  the  pulse  became 
stronger,  and  in  about  thirty  nfiinutes  the 
patient  became  conscious.  After  about 
eleven  hours  of  forced  respiration,  auto-res- 
piration was  established,  and  the  patient 
made  a  good  recovery. 

CASE  X. — Dr.  Fell. 

October  nth,    1889,   this  same  patient 

took    another   two    ounces    of  Tr.    Opii, 

together  with  five  to  ten  grains  of  morphia. 

With  Dr.  Armstrong  I  performed  trache- 


otomy over  the  wound  of  first  operation, 
and  after  fourteen  hours  of  forced  respira- 
tion, the  patient  was  again  rescued  and 
made  a  good  recovery,  the  wound  in  the 
neck  closing  completely  in  eight  days. 

These  two  cases  resulted  in  the  prepara- 
tion of  the  face  mask,  which  marks  an  im- 
portant era  in  the  evolution  of  forced 
respiration,  and  brings  the  operation  to  that 
degree  of  simplicity  that  it  may  be  readily 
utilized  by  physicians  unwilling  to  make 
tracheotomy,  and  the  crews  of  life-saving 
stations  who  can  readily  be  instructed  to 
use  the  method  per  face  cup  when  it  would 
be  entirely  impracticable  without.  The 
late  Capt.  D.  P.  Dobbins,  inspector  of  life 
saving  stations  on  the  great  lakes,  was 
much  impressed  by  the  results  of  my 
method  per  tracheotomy,  but  admitted 
that  it  could  not  be  put  into  operation  by 
the  crews  at  life-saving  stations.  Now,  how- 
ever, the  method  per  face  mask  makes  it 
par  excellence  the  only  method  which 
should  be  in  use  at  these  stations. 
CASE  XI.— Dr.  Fell. 

A  young  woman  had  taken  one  or  two 
ounces  Tr.  Opii.  Artificial  respiration 
failed.  Forced  respiration  for  four  hours, 
with  face  mask,  saved  patient. 

CASES   XIL,    XIII.,    XIV. 
Dr.    C.    R.    Vanderburgh,     Columbus 
Ohio,  reported  three  cases  saved  by  fa  ce 
mask. 

CASE  XV. — Dr.  Fell. 

A  woman  had  taken  an  uncertain 
amount  of  morphia, — a  large  amount,  how- 
ever, as  was  evident  from  the  efi"ect  pro- 
duced upon  her.  About  midnight  a  phy- 
sician was  called,  but  refused  to  attend, 
so  that  she  was  under  the  influence  of  the 
narcotic  all  through  the  night,  until  about 
10  o'clock  the  next  morning.  I  was  called 
at  9  a.m.,  and  arrived  at  9.30.  I  ascer- 
tained there  was  no  pulse  at  either  wrist, 
but  on  auscultation  found  the  heart  faintly 
acting,  cyanosis  deep.  I  then  had  her 
placed  on  a  mattress  in  an  adjoining  room, 
and  with  the  face-mask,  air-control  valve 
and  the  bellows,  went  to  work.  It  was 
fully  an  hour  and  a  half  before  the  pulse 
at  the  wrist  could  be  detected.  The 
woman  became  conscious,  sat  up,  and  asked 
for  a  drink.  In  the  middle  of  the  afternoon 
Dr.  Porter  came  in  to  witness  the  opera- 
tion, and  offered  his  assistance?  which  was 


S4 


THE  CANADA  MEDICAL  RECORD. 


accepted.  It  may  be  stated,  that  when  a 
person  is  very  deeply  narcotized  with 
forced  respiration, we  may  occasionally  pro- 
duce a  conscious  condition,  but  the  patient 
will  again  pass  under  the  influence  of  the 
narcotic,  and  become  utterly  unconscious. 
You  may  breathe  for  him  for  half  an  hour 
at  a  time,  yet  there  will  be  no  evidence  of 
life  except  the  action  of  the  heart  and  the 
fact  that  the  blood  is  supplied  with  oxgyen. 
So  this  patient  would  occasionally  become 
conscious.  During  one  of  these  conscious 
periods.  Dr.  Porter,  who  had  been  standing 
in  one  corner  of  the  room,  came  forward, 
and  began  to  perform  Sylvester's  method 
of  artificial  respiration,  with  the  object,  I 
presume,  of  demonstrating  that  it  would 
accomplish  as  much  as  what  I  was  doing. 
He  understood  how  to  apply  that  method 
from  previous  experience.  All  watched 
the  result  with  interest.  In  a  little  while 
the  cyanotic  condition  began  to  appear 
along  the  face,  gradually  becoming  deeper 
and  deeper.  I  said  :  "  Doctor,  you  see  now 
just  what  the  result  is." 

"  Yes,"  he  said,  "  there  is  no  question 
about  it." 

We  then  renewed  the  forced  respiration 
with  the  face-mask.  In  a  short  time  the 
cyanotic  condition  disappeared,  and  the 
woman  again  became  conscious.  I  kept 
up  forced  respiration  with  this  woman  until 
she  revived  again  and  began  to  be  in  quite 
a  jovial  condition,  and,  as  I  thought,  was 
perfectly  safe.  Then  Dr.  Porter  desired 
to  try  the  Faradic  battery,  which  I  con- 
sented to,  regarding  the  woman's  condition 
as  such  that,  were  it  again  necessary,  we 
could  at  any  time  rely  upon  the  forced 
respiration  again.  I  was  anxious,  of 
course,  to  report  this  as  another  case  of  life 
saved  by  forced  respiration.  After  breath- 
ing some  eight  hours,  and  carrying  the  case 
through  the  most  critical  period,  we  called 
the  Faradic  battery  into  play.  But  what 
is  the  result  of  faradization  in  a  case  of 
that  kind  .-*  Merely  the  stimulation  of  the 
heart  at  the  expense  of  its  energy.  How- 
ever weak  the  current  may  be,  if  you 
obtain  any  heart  action  it  is  of  a  tonic 
nature,  and  is  secured  at  the  expense  of 
the  energy  of  the  heart  muscle.  What  we 
need  to  look  out  for  in  such  a  case  is  to 
conserve  the  energy  and  the  vitality  of  the 
heart  muscle.  In  this  case  the  result  was, 
that    in  about  three  quarters  of    an  hour 


after    the    faradization    began,    the    heart 
stopped  beating,  spasmodically.     This  case 
was  lost  through  faradization. 
CASE  XVI. 
Hospital  case  reported  as  saved  by  the 
P'ell  method.      Particulars  not  obtained. 

CASE  XVII. — DR.  FELL. 
Sunday  morning,  March  ist,  1 891,  at  3.20 
a.m.,  I  was  called  to  the  residence  of  Dr. 
Harrington,  on  Franklin  street,  and  there 
found  a  young  lady  who  had  taken  a  large 
dose — about  i  5  grains — of  morphine.  At 
3  a.m.,  Mr.  Harrington,  sr.,  had  noticed 
stertorous  breathing.  He  arose,  looked  at 
the  patient,  but  concluded  it  was  nothing 
more  than  a  very  deep  slumber.  The  con- 
dition continuing,  however,  he  called  Dr. 
Harrington,  who  examined  the  patient, 
finding  her  in  a  comatose  condition,  cyan- 
otic, pupils  markedly  contracted,  and  a 
bottle  of  morphine  on  the  table.  She  had 
written  two  or  three  letters  which  clearly 
indicated  the  cause  of  the  trouble. 

I  immediately  proceeded  to  forced  res- 
piration with  the  face-mask,  which  result- 
ed in  overcoming  the  cyanosis  and  pro- 
ducing an  improvement  in  the  heart  action. 
We  continued  forced  respiration  with  the 
face-mask  until  6.30  a.m.,  when  it  was 
observed  that  the  cyanosis  was  again  in- 
creasing, and  the  condition  of  the  patient 
growing  more  and  more  desperate.  No 
evidences  of  consciousness  were  present.  By 
shouting  into  the  ear,  ocular  reflexes  were 
noticed  in  a  contracting  of  the  orbicular 
muscles.  There  appeared  to  be  no  hope 
of  recovery  at  this  time. 

With  Dr.  Harrington's  assistance  we 
made  tracheotomy,  and  inserted  the  tra- 
cheotomy tube,  as  arranged  for  forced  res- 
piration, into  the  trachea.  Connection  was 
then  made  with  the  apparatus,  and  forced 
respiration  kept  up.  The  improvement 
on  the  employment  of  forced  respira- 
tion by  tracheotomy  over  that  produced 
by  the  face-mask  was  evident.  The  chest 
movements  were  greater,  and  the  results 
were  more  satisfactory  in  many  respects. 
However,  of  so  serious  a  nature  was  the 
condition  of  the  patient  at  this  time,  that 
not  one  present  expected  other  than  a 
fatal  termination.  No  pulse  existed  at 
either  wrist ;  auscultation  could  detect  no 
heart  movement,  either  by  Dr.  Harring- 
ton, myself,  or  the  students  present.     Two 


THE   CANADA    MEDICAL    RECORD. 


85 


conditions,  however,  appeared  to  indicate 
that  Hfe  was  not  extinct :  the  pupils  con- 
tinued contracted,  and  cyanosis  did  not 
supervene.  The  glassy  stare  of  the  eyes 
was  present,  and  outside  of  the  two  favor- 
able conditions  mentioned,  it  appeared 
that  death  could  not  be  far  oft". 

At  this  point  Dr.  Harrington's  father 
made  the  remark,  that  if  this  young  lady 
was  made  to  live  it  would  indeed  be  "  a 
miracle."  However,  I  kept  up  the  forced 
respiration,  saying  that  I  would  do  so  for 
a  little  while  longer,  "just  for  the  fun  ofit." 
In  a  short  time  auscultation  on  the  part  of 
Dr.  Harrington  gave  us  the  satisfactory 
information  that  the  heart  was  beating. 
In  the  course  of  a  few  hours  these  reflexes 
were  more  and  more  marked,  and  con- 
sciousness supervened.  Forced  respiration 
was  continued  through  the  forenoon  and 
until  late  in  the  afternoon,  making  some 
twelve  to  fourteen  hours  of  continual 
forced  respiration  before  the  patient  could 
be  allowed  to  breathe  for  herself.  She  has 
made  a  good  recovery.  In  this  case 
artificial  respiration  would  at  no  time 
have  been  of  any  avail  to  the  patient. 

CASE  XVIII. — Dr.  FELL. 

Sunday,  March  15th,  1891,  at  11.30 
a.m.,  I  was  called  to  attend  Joseph  Altiere. 
A  prescription  containing  phenacetin, 
morphine,  and  cocaine  in  small  quantity, 
had  been  prescribed  by  the  attendant 
physician  for  neuralgia  of  the  stomach. 
The  patient  had  taken  repeated  doses, 
without  regard  to  instructions  upon  the 
prescription,  until  a  large  poisonous  dose 
of  these  very  dangerous  drugs  had  been 
taken.  At  11.30  a.m.,  forced  respiration 
with  the  face-mask  was  commenced,  and 
quickly  overcame  the  marked  cyanosis, 
which  was  intensified  undoubtedly  b}-  the 
phenacetin.  With  the  face-mask,  forced 
respiration  was  kept  up  all  the  afternoon, 
the  patient  at  times  becoming  conscious. 
The  cyanotic  condition  seemed,  however, 
to  increase,  owing  to  the  base  of  the  tongue 
falling  back  and  occluding  the  larynx.  A 
ligature  was  placed  through  the  tongue 
and  the  organ  pulled  well  up,  with  the 
result  that  the  lungs  were  more  readily 
inflated. 

In  this  case  ox)'gen  gas  was  acl minister- 
ed in  connection  with  the  forcetl  respira- 
ation  apparatus,  it  being  supplied  in  greater 


or  less  quantities,  as  seemed  to  be  desirable. 
At  times  the  amount  of  air  passing  to  the 
stomach  and  bowels  was  so  great  as  to 
markedly  distend  them,  thus  interfering  to 
a  certain  extent  with  the  inflation  of  the 
lungs  by  the  forced  respiration,  and  in- 
dicating one  of  the  difficulties  lo  be  met 
with  in  forced  respiration  with  the  face- 
mask.  In  the  afternoon  the  patient  became 
comatose,  and  responded  very  little  to  the 
respiratory  work.  During  the  evening  it  was 
evident  that  the  patient  was  not  progressing 
satisfactorily,  the  influences  of  the  poisons 
being  peculiar  in  their  action,  there  not 
appearing  to  be  any  elimination  of 
the  drugs,  although  the  catheter  was 
used  as  often  as  was  necessary,  and  the 
antidotes  which  seemed  to  be  indicated, 
and  stimulants,  such  as  digitalis  and  alcohol, 
injected  hypodermically.  At  10  p.m., 
Sunday  night,  I  made  tracheotomy,  and 
forced  respiration  was  then  kept  up  by  the 
direct  method.  The  result,  as  in  the  former 
case,  indicated  the  very  great  readiness 
with  which  the  method  could  be  used  in 
the  inflation  of  the  lungs;  and  the  patient 
was  apparently  holding  his  own.  I  left 
for  home  at  1 1  p.m.,  trusting  that  the 
patient  would  be  in  good  condition  in  the 
morning. 

An  army  of  students  was  present  to 
assist  in  the  work  of  respiration,  and  with 
Dr.  Harrington  they  kept  faithfully  at  work 
through  the  night,  until  5.30  in  the  morn- 
ing. At  this  time  the  patient  was  breath- 
ing with  comparative  ease,  and  the  pros- 
pects looked  encouraging.  However,  a 
spasmodic  contraction  of  the  stomach 
occurred  ;  its  contents  were  ejected  with 
force.  Every  efTort  was  made  to  prevent 
any  of  the  vomited  matter  from  passing 
into  the  lungs,  but  the  spasm  resulted, 
however,  in  the  ceasing  of  the  action  of  the 
heart,  and  the  labor  of  eighteen  hours  was 
lost. 

']  he  necessit)'  cf  something  other  than 
manual  labor  in  the  forcing  of  a  column  of 
air  ii'to  the  lungs  was  strongly  demonstra- 
ted in  this  case.  Althoui;h  there  were 
plent)-  of  persons  pnsent — the  studen  .^, 
and  the  relatives  of  the  patient  — who  per- 
f  rmed  all  the  labor  r,  quired,  no  one  who 
has  I  ot  witnesse  i  a  case  of  forced  respira- 
tion can  really  appreciate  tlie  amount  of 
energy  expended  in  respiring  for  a  human 
being,  be  it-exen  so  eas)*  comparatively  a^j 


86 


THE   CANADA    MEDICAL   RECORD. 


by  the  method  used  in  forced  respiration. 

This  is  the  first  extended  case  in  which 
oxygen  gas  was  administered  in  conjunc- 
tion with  the  forced  respiration.  The 
results  were  satisfactory,  but  the  odds 
against  which  we  were  fighting — the  com- 
bination of  deadly  drugs  which  had  been 
taken— were  too  much  for  even  an  expecta- 
tion that  success  would  crown  our  efforts. 
With  morphia  alone  in  large  quantity,  I 
believe  the  patient  would  have  been  saved. 
CASE  XIX.— Dr.  FELL. 

The  value  of  forced  respiration  as  a 
tidino'-over  measure  in  various  conditions 
was  exemplified  in  the  following  case  :  An 
old  lady,  seventy-three  years  of  age,  had 
taken,through  the  carelessness  of  a  druggist, 
a  dose  of  aqueous  solution  of  corrosive 
sublimate.  Its  influence  on  the  nerve 
centres  produced  shock  ;  cyanosis  was  pre- 
sent, and  death,  which  seemed  inevitable, 
would  soon  have  ensued.  Forced  respira- 
tion with  the  face-mask,  easily  applied, 
toned  up  the  system,  respiration  was  much 
improved,  and  the  patient  lived  about  two 
days  longer  for  the  treatment. 
CASE   XX. 

In  the  surgical  clinic  of  Dr.  Hal.  C.  Wy- 
xjian,  Detroit  Emergency  Hospital  Reports, 
reported  by  Dr.  Robert  S.  Linn  under 
Fell's  operation  for  morphine  poisoning, 
etc.,  as  follows : 

'•Miss  C,  a;t.  21,  had  taken  20  grs. 
morphiae  sulph.  about  one  hour  before 
the  ambulance  was  called.  Her  condition 
when  brought  to  Emergency  Hospital  was 
critical.  Pupils  were  much  contracted,  and 
did  not  respond  to  light.  Respirations 
were  only  five  a  minute  and  pulse  quite 
weak.  The  stomach  was  evacuated  of  its 
contents  with  stomach  pump,  and  about 
one  pint:  of  strong  coffee  injected  into  it. 
About  i6  oz.  of  urine  were  drawn  from  the 
bladder.  A  hypodermic  injection  of 
atropine  sulph.,  grs.  i-6o,  was  given,  and 
artificial  respiration  performed  without 
benefit.  An  incision  2^  inches  long  was 
made  in  medi  .n  line  over  the  trachea, 
tracheotomy  performed,  forced  respiration 
kept  up  for  about  three  hours,  and  the 
life  of  the  patient  was  saved." 

CASE  XX[.  — Dr    FELL. 

I  was  called  by  Dr.  Eli  H.  Long  to  attend 
a  case  of  opium  narcosis  in  a  lady  seventy- 
ei'dit    vcars    of  age.     -She    had    taken     a 


large  quantity  of  gum  opium.  Respirations 
shallow,  fourteen  per  minute,  pupils  con- 
tracted, coma  existing.  Face-mask  applied, 
and  used  about  eleven  hours,  when  tracheo- 
tomy was  made,  but  too  late  to  save  the 
patient.  Convulsions  set  in,  and  continued 
uninterruptedly  until  death  ensued.  A 
mistake  was  made  in  this  case  in  not  per- 
forming tracheotomy  sooner.  With  the 
face-rnask  the  cyanosis  was  not  satisfac- 
torily overcome.  Extension  of  the  head, 
which  was  used  with  success  for  some  time, 
had  finally  no  influence  in  raising  the 
epiglottis.  A  ligature  through  the  tongue, 
by  which  the  base  of  the  tongue  was  raised, 
worked  better.  The  cerebral  hemispheres 
were  greatly  congested.  Free  venesec- 
tion would  have  been  beneficial  if  per- 
formed in  season.  The  indications  for  tra- 
cheotomy existed  for  some  time  before  it 
was  made. 

CASE  XXII. — Dr.  FELL. 

I  am  under  obligations  to  Dr.  Allen  A. 
Jones,  instructor  in  practice.  Medical 
Department  University  of  Buffalo,  by 
whom  I  was  called,  for  the  following  report 
of  this  case,  in  which  the  face-mask  demon- 
strated again  its  great  value  in  a  typically 
appropriate  case. 

"  About  4  o'clock  on  the  afternoon  of 
Thursday,  October  8;  1891,  I  was  hurried, 
ly  summoned  to  the  house  of  a  former 
patient,  and  found  her  lying  on  a  sofa- 
unconscious,  extremely  cyanosed,  her  lips 
and  ears  being  blue  ;  her  pupils  were  con- 
tracted almost  to  pin  points,  and  her 
respiration  \\as  of  the  Cheyne-Stokes 
character,  ceasing  entirely  for  two  or  three 
full  minutes,  then  coming  with  peculiar 
groanings  and  whistlin^i^s.  which  died 
away  until  respiration  ceased. 

"  I  had  been  told  over  the  telephone 
that  she  had  taken  morphine,  but  I  did 
not  know  how  much. 

"  Her  pulse  was  frequent  and  small,  but 
yet  of  good  strength  when  I  first  arrived. 
I  sent  for  Dr.  George  E.  Fell  without 
delay,  with  instructions  that  he  should 
bring  his  apparatus  for  performing  forced 
artificial  respiration, 

"  While  awaiting  his  arrival,  with  the 
b.elp  of  those  about  me,  I  succeeded  in 
r  storing  some  color  to  the  lips  by  arti- 
ficial respiration  (Sylvester's  method). 
Tlie  pulse  grew   weaker  and    weaker,  and 


THE   CANADA   MEDICAL    RECORD. 


87 


the  heart  almost  ceased  beating  before  Dr. 
Fell  arrived. 

"It  was  impossible  to  give  emetics  per 
orom,  so  we  gave  one-fifth  of  a  grain  of 
apomorphine  hypodermicalh',  as  soon  as 
Dr.  Fell  arrived.  Then  with  the  patient 
on  the  table  we  instituted  forced  respira- 
tion (b\-  face  mask). 

"  The  patient's  lungs  filled  easil)'  and 
well  without  tracheotomy. 

"  We  breathed  for  her  steadily  for  about 
one  hour,  and  then  she  moved  her  hands 
to  her  face  and  opened  her  e}'e3.  Her 
cyanosis  had  entirel}'  disappeared,  and 
good  oxygenation  was  manifest.  The 
face-mask  was  taken  off,  and  the  patient 
breathed  for  herself  in  a  long,  slow,  sigh- 
ing fashion  several  times,  but  ceased  en- 
tirely after  a  few  minutes.  The  lips  turned 
blue  once  more,  and  she  would  inevitably 
have  died  had  we  not  recommenced  forced 
respiration  again.  \"ery  soon  she  was 
again  able  to  breathe  alone,  and  temporar- 
ily stopping  the  forced  respiration,  we  gave 
her  mustard  water,  and  she  vomited  pro- 
fusely. We  repeated  the  mustard  water, 
but  she  did  not  vomit  ;  her  head  fell  back, 
respiration  cenSed,  and  again  she  was 
turning  blue  when  we  applied  the  face- 
mask  and  used  forced  respiration  for  the 
third  time. 

•'  After  a  short  time  we  induced  her  to 
swallow  another  large  cupful  of  warm 
water  and  mustard  with  a  teaspoonful  of 
salt  in  it,  with  the  result  that  she  emptied 
her  stomach  completely. 

"As  is  common  in  conditions  where  the 
respiratory  centre  is  benumbed,  emesis 
seems  to  stimulate  that  centre,  and  res- 
pirations were  more  willingly  taken. 
Even  at  this  junction,  however — being 
about  two  and  one-half  hours  from  the  time 
that  forced  respiration  was  commenced 
— she  would  certainl)-  have  died  had 
it  not  been  continued,  as  it  was,  altogether 
for  four  hours.  At  the  expiration  of  that 
time,  she  breathed  herself  seven  times  in 
the  minute,  and  in  the  morning  her  res- 
pirations were  20,  her  pulse  80,  tempera- 
ture 101°. 

"  Dr.  Herbert  U.  Williams,  who  kindly 
remained  all  night  w  ith  the  patient,  stated 
that  the  pulse  graduall)'  fell,  and  the  respir- 
ations gradually  increased  from  hour  to 
hour  ;  that  he  g;ive  her  a  h\i)odermic  of 
atropine     (the  onc-hundrcd-fifticth    of    a 


grain),  of  strychnine  (one-sixtieth  of  a 
grain),  and  of  tincture  of  digitalis  (fifteen 
drops),  about  11.30  p.m.  At  1.30  a.m.  she 
had  a  cup  of  strong  coffee,  and  a  glass  of 
warm  milk  at  2  a.m.  At  2.30  a.m.  she 
urinated  freely. 

"  This  patient  said  she  took  eleven  grains 
of  morphine  dissolved  in  a  glass  of  water 
at  I  o'clock  on  the  8th.  I  saw  her  at  4. 
Dr.  Fell  arrived  about 4.30  ;  we  performed 
forced  respiration  until  9  o'clock,  with  the 
result  that  the  woman's  life  was  saved. 

"  I  am  convinced  that  ordinary  artificial 
respiration  would  not  have  saved  her  life, 
and  I  cannot  speak  in  too  high  praise  of 
Dr.  Fell's  effectual  and  simple  apparatus 
for  forcing  such  a  patient  to  breathe,  if 
necessary,  for  many  hours  in  succession. 
I  think  more  physicians  ought  to  possess 
and  have  in  readiness  Dr.  Fell's  apparatus, 
and  many  lives  would  be  easily  saved, 
where  now  the}'  are  lost  because  no  such 
facility  is  at  hand. 

"  It  is  interesting  to  note  in  this  case  that 
diplopia  existed  from  the  return  of  con- 
sciousness on  Thursday  evening  until  some 
time  Saturday  morning  ;  and  for  four  days 
the  patient  thought  a  cup  of  food,  or  what- 
ever it  might  be  in  her  hand,  was  held  at 
the  lips,  when  in  reality  it  was  four  inches 
from  them,  and  at  first  she  poured  out  milk 
and  tea  upon  her  dress." 

CASE  XXIII. — Dr.  Fell. 

December  i,  1891.  Called  to  Erie  County 
Penitentiary  by  Keeper  Albert  H.  Neal. 
Geo.  C.  W.,  a  prisoner,  had  taken  tincture 
of  opium,  3  oz.,  and  a  quantity  of  sweet 
spirits  of  nitre,  with  suicidal  intent,  at  i  p.m. 

Grains  i-ioapomorphia  hypodermically 
administered  by  Drs.  Fohl  and  Hays,  re- 
sident physicians,  produced  vomiting.  I 
reached  the  case  at  3.10  p.m.  The  condi- 
tions usually  produced  by  the  poison  were 
present.  After  about  one  half  hour's  forced 
respiration  work  per  the  face-mask,  the 
cyanosis  prevailing  passed  away,  heart  ac- 
tion became  stronger,  and  patient  became 
conscious  at  short  intervals  of  time.  This 
condition  prevailed  underforced  respiraion 
for  some  four  hours,  then  auto-respiration 
ensued.  The  stupor  was  unusual,  and  I  as- 
cribed it  to  the  intense  congestion  of  the 
enccphalonic  vessels.  Death.  I  belie\e,  has 
been  caused  in  se\  eral  of  my  cases  b}'  this 
condition.      At  my  request  Drs.    F'ohl  and 


88 


THE   CANADA   TMEDICAL   RECORD. 


Hays  removed  4  oz.  of  blood  from  the  left 
arm  with  quite  satisfactory  results,  relieving 
the  congested  state,  and  aiding.  I  believe, 
very  much  in  the  saving  of  the  life  of  the 
patient.  This  patient  was  put  to  bed  before 
I  left  the  case,  and  was  apparently  on  the  fair 
road  to  recovery.  Some  few  days  later,  to 
my  great  surprise,  I  noticed  that  he  died  of 
heart  failure.  I  had  not  seen  him  since  my 
operation,  although  informed  that  he  had 
progressed  favorably  until  the  time  of  his 
death,  which  occurred  suddenly.  The  next 
case  indicates,  as  this  does  also,  the  im- 
portance of  sustaining  treatment  and  care- 
ful watching  of  the  patient  for  a  few  days 
at  least  following  the  operation. 

(  To  be  contifiued.) 


Socictg    firocccbings. 

THE  iMONTREAL  MEDICO-CHIRUR- 
GICAL  SOCIETY. 

Stated  Meeting,  April  14M,  1893. 

James  Stewart,  M.D.,  President,  in  the 
Chair. 

Paralysis  of  the  Arm  folloiving  the  Appli- 
cation of  an  Es7narch's  Bandage. — Dr.  James 
Bell  related  the  history  of  the  case,  the  circum- 
stances being,  in  his  experience,  nnique.  A 
young  woman,  20  years  old,  admitted  to  the 
hospital  Jan.  i6lh,  with  ankylosed  elbow  joint. 
The  position  was  not  a  very  bad  one,  being  a 
little  gi eater  than  a  right  angle.  The  history 
of  the  injury  was  as  follows  :  On  the  6th  of 
last  July  slie  fell  in  a  car,  and,  knocking  against 
the  wall,  hurt  her  elbow.  At  the  time  she  did 
not  pay  much  attention  to  it ;  but  after  a  while, 
the  j.  int  having  become  stiff,  it  was  thought 
necessary  to  call  on  a  doctor.  'I'he  latter 
attempted  passive  motion,  which  was  partially 
successful,  but  the  ultimate  result  was  anky- 
losis in  the  above  position.  Excision  of  the 
joint  was  advised,  to  which  she  after  a  wliile 
consented,  and  the  operation  was  carried  out 
in  the  ordinary  way.  It  was  noticed,  after 
removal  from  the  operating  room,  th  u  siie  had 
no  power  in  any  of  the  fingers,  and  that  even 
sensation  was  nc  t  normal.  Owing  to  the  hand 
being  encased  in  dressing,  no  very  accurat3 
observations  could  be  made  for  some  days,  but 
it  was  remarked  that  the  fingers  [)er.spired 
profusely.  At  the  end  of  the  third  day  after 
operation,  being  anxious  and  unab'e  to  ex[)lain 
the  paralysis  (the  operation  was  done  sub- 
periosteal,  and  he  was  sure  no  injury  had  b^cn 


done  the  ulnar  nerve,  besides,  injury  to  the 
latter  wouTd  not  account  for  paralysis  of  all 
the  fingers  and  muscles  of  the  forearm),  the 
dressing  was  removed,,  and  the  explanation  was 
at  once  patent.  The  Esmarch  had  been  ap- 
plied in  the  upper  portion  of  the  arm,  just  above 
the  belly  of  the  biceps,  and  below  the  promi- 
nence of  the  deltoid,  and  it  had  been  tied  so 
tightly  that  the  skin  was  blistered.  There  was 
consequently  no  longer  any  doubt  as  to  the 
Esmarch  being  the  cause.  The  whole  opera- 
tion only  occupied  40  minutes,  so  that  the 
band  altogether  could  not  have  been  applied 
more  than  half  an  hoir.  Upon  the  discovery 
of  the  neuritis,  she  was  at  once  put  under  the 
care  of  D.^  Stewart.  Motor  paralysis  remain- 
ed absolute  for  three  weeks.  On  the  21st 
day  the  first  sign  of  movement  returned,  being 
a  slight  motion  of  the  thumb,  and  after  about 
six  weeks'  treatment  she  returned  to  her  home 
with  almost  complete  power  of  the  arm.  Once 
movement  began  to  appear,  it  progressed  very 
rapidly.  She  was  able  to  flex  and  extend  the 
arm  and  fingers  completely,  though  not  with 
the  full  amount  of  power.  There,  however, 
was  no  motion   deficient. 

This  case  is  very  instructive  and  very  impor- 
tant, in  view  of  the  frequency  of  the  application 
of  the  Esmarch.  It  is  interesting  on  account 
of  its  larity.  It  was  the  first  time  he  had  met 
with  the  accident,  and,  considering  the  number 
of  operations  he  had  seen  in  the  last  twenty 
years,  and  the  recklessness  with  which  the 
Esmarch  had  been  applied  in  all  sorts  and 
conditions  of  patients,  it  seemed  to  him  that 
this  must  indeed  be  a  rare  complication.  It 
could  hardly  have  occurred  had  the  Esmarch 
been  applied  in  any  other  part  of  the  body  : 
but  it  is  a  lesson  well  worth  bearing  in  mind. 

The  President  drew  attention  to  the  value 
of  electricity  in  prognosis.  This  case,  even 
up  to  the  second  week,  pies.nted  no  signs  of 
the  action  c,f  degeneration,  so  that  although 
the  paralysis  nt  the  time  was  absolute,  he  could 
give  a  favorable  prognosis,  and  the  uhima'e 
result  justified  it. 

Myeloid  Sarcoma  of  the  Second  Mi  (afarsal 
Bone. — Dr.  Adami  exhibited  t!ie  tumor  because 
its  position,  namely,  the  sect-nd  mctataisal 
bone,  is  distinctly  uncommo.i,  and  therefore 
worthy  of  record.  It  was  removed  in  the  hos- 
pital recently  by  Dr.  Shepherd,  during  which 
some  difficulty  was  experienced,  owing  to  tlie 
deep  arch  passing  close  beneath  the  second 
metatarsal  bone.  'J'he  arch  was  tut  acro-.s, 
and  considerable  haemorrhage  was  experienced. 
At  first  it  looked  as  if  the  tumor  had  giowii 
from  the  tendons,  owing  to  the  latter  being 
closely  apphed  to  its  upper  surface.  Further 
examination,  however,  showi  d  this  was  not 
the  case  ;  the  tendons  were  with  mode:  ate  ease 
dissected  off,  and  the  tumor  seen  to  be 
attached  to  the  bone.     On  examining  the  tumor 


THE   CANADA    MEDICAL   RECORD. 


8( 


9 


Stretching  across  the  tumor,  originating  from 
the  periosteal  surface  of  the  bone.  We  are 
then  really  dealing  with  a  periosteal  tumor. 
Further  examination  shows  it  to  be  a  very 
pretty  and  very  good  example  of  a  myeloid  sar- 
coma. The  main  features  are  large  s])indle  cells 
of  various  sizes  ;  and  amongst  these  some  very 
large  giant  cells  multi-nucleated.  In  addition  to 
these,  and  accounting  for  this  being  rather  a  slow 
growth,  there  is  a  considerable  amount  of 
fibrous  tissue  in  the  tumor,  and  which  in  places 
has  undergone  hyaline  degeneration.  The 
correct  name,  therefore,  for  the  growth  would 
be  hyaline  myeloid  sarcoma.  'I  he  patient  was 
a  young  man. 

Upon  Horse-Fox  Affecting  the  Cow. — Dr. 
Adami  brought  this  subject  before  the  Society, 
not  because  his  observations  could  be  con- 
sidered as  oilier  \ha.n  at  their  commencement, 
but  because  at  the  present  mom3nl  great  in 
terest  is  being  manifested  in  the  subject  of 
vaccinia  and  the  various  diseases  allied  to  or 
liable  to  be  mistaken  for  it. 

[n  Montreal,  horses  are  very  subject  to 
horse-ppx,  and  especially  during  this  winter 
has  the  disease  assumed  the  character  almost 
of  an  epizootic.  Dr.  Adami  himself  had  seen 
as  many  as  twenty  cases.  It  would  seem  to 
come  on  just  about  the  time  of  a  thaw,  when 
the  horses  in  their  work  about  the  streets  are 
very  much  exposed  to  partly-frozen  water 
about  the  lower  portions  of  their  legs.  Many 
of  these  cases  this  winter  have  been  associated 
with  the  production  in  the  groom,  or  those 
attending  the  horses,  of  definite  eruptions,  very 
similar  to  the  true  vaccinial  pox.  Dr.  Bell 
and  others  present  could  give  records  of 
grooms  and  others  going  to  the  hospital  with 
pocks  on  the  hard,  lips  and  face  obtained  in 
this  way. 

The  case  in  question  was  one  which  oc- 
curred in  the  stable  of  Mr.  Strathy,  a  gentle- 
man who  has  well-kept  stables.  Unfortunately, 
less  than  a  montli  ago  both  his  horses  were 
attacked  with  horse-pox.  Now,  it  is  the  cus- 
tom in  Montreal  with  many  peoi)le  to  keep  a 
cow  in  the  stables  with  the  horses,  for  greater 
waimth  as  well  as  for  domestic  convenience. 
Such  was  the  case  in  Mr.  Strathy's  stable,  and 
the  cow  was  milked  and  tended  to  by  the 
groom  who  looked  after  the  horses.  One 
horse  had  the  pox  about  ten  days,  the  other, 
the  greater  part  of  two  weeks,  when  it  was 
noticed  one  Monday  that  there  were  upon  the 
two  posterior  teats  of  the  cow  a  small  papular 
eruption.  On  Wednesday,  Mr.  Baker  very 
kindly  showed  him  (Dr.  Adami)  the  cow;  the 
])apules  had  then  become  distinct  vesicles, 
and  on  the  Friday  following  they  showed  well- 
marked  scabs.  There  was  a  certain  amount 
of  inflammation  in  the  vicinity;  but  this  had 
been  reduced  to  a  minimum  by  the  cessation 


ul  ail  uKuupuialion  of  the  uduers  ana  by  cm 
ploying  a  milk  tube  to  draw  off  the  milk.  The 
scabs  were  very  characteristic,  and  accorded 
wholly  with  the  classical  pictures  given  of  the 
true  cow-pox  affecting  the  udders  and  teats  of 
the  cow.  The  history  seemed  to  be  most 
clear.  The  stable  was  outside  Montreal ;  the 
horses  and  cow  were  kept  apart  from  all  other 
animals,  and  they  were  attended  to  by  the 
same  man  ;  the  cow  showed  the  characteristic 
eruption.  It  would  seem  most  probable  that 
here  we  were  dealing  with  a  ca<e  of  horse-pox 
communicated  to  the  cow  by  the  milker,  who 
was  at  the  same  time  groom.  A  week  previous 
to  the  meeting.  Dr.  Adami  had  inoculated  a 
calf  with  the  scabs  rubbed  up  in  glycerine,  and 
again  with  the  knife  that  he  had  employed  in 
removing  these  scabs,  with  the  result  that  on 
that  day  there  were  to  be  seen  on  the  l-itter 
well-marked  typical  vesicles,  some  beginning 
to  dry  up,  some  becoming  slightly  pustular, 
such  as  one  gets  in  vaccinating  the  cow  for  the 
purpose  of  obtaining  vaccine  lymph.  This  is 
a  subject  of  extreme  interest.  One  hundred 
years  ago  Jenner  declared  that  cow-pox  was 
produced  from  horse-pox.  On  further  investi- 
gation it  was  seen  that  he  had  made  a  mistake, 
that  he  had  inoculated  "grease"  instead  of 
horse-pox,  and  ever  since  the  anti-vaccina- 
tionists  have  availed  themselves  of  this  circum- 
stance as  a  fruitl'ul  source  of  derision  in  their 
attacks.  Since  then  there  have  been  many 
workers  in  this  line,  but  the  conclusions  drawn 
have  been  very  vague  ones.  He  thought  that 
the  present  case  afforded  an  opportunity  of 
doing  some  good  work  in  clearing  up  the  diffi- 
culty and  establishing  the  identity  or  separate 
status  of  horse  and  cow-pox.  Having  once 
obtained  a  cow-pox  from  a  horse,  as  we  almost 
surely  have  done,  and  then  by  inoculation  from 
the  cow,  obtained  typical  vaccinia  in  the  calf, 
if  some  human  being  will  allow  himself  to  be 
vaccinated  by  this  lymph  from  the  calt",  and 
typical  vaccine  vesicles  or  pustules  are  ob- 
tained. Dr.  Adami  held  that  he  would  go  near 
to  prove  that  these  two  conditions  are  ideiiical. 
It  is  an  experiment  well  worth  carrying  out, 
especially  as  there  is  a  commission  now  work- 
ing on  this  subject  in  London,  and  so  far  they 
have  been  able  to  arrive  at  no  ver}'  definite 
results.  Dr  Adami  expresses  his  indebted 
ness  to  Dr.  Baker  .''or  much  assistance  in  t 
case. 

Dr.  James  Bell  saw  two  cases  during  h, 
winter  of  horse-pox  in  grooms.  The  first  ma  i 
came  with  a  sore  on  his  lip  ;  it  was  large,  hard 
and  indurated,  with  depressed,  umbilicafed, 
vesicular  surface;  enlargement  of  the  lymphatic 
glands  beneath  the  jaws.  It  was  at  first  re- 
garded as  a  hard  chancre,  though  the  man 
persistently  d.-nied  any  confirmatory  hi-tory. 
Finally,  on  learning  his  occupation  and  w  lo  .1 
he  worked  for,  his  case  was  better  understood. 


90 


THE   CANADA   MEDICAL   RECORD. 


No  doubt  it  was  a  case  of  horse- pox.  He  was 
a  groom  to  a  gentleman  whose  horses  had  been 
afflicted  with  the  disease  this  winter.  More- 
over, the  subsequent  history  and  development 
of  the  case  confirmed  the  diagnosis  of  horse- 
pox. 

The  other  case  was  seen  some  time  after  the 
foregoing,  and,  with  the  benefit  of  this  expe- 
rience as  a  guide,  a  diagnosis  was  more  readily 
made.  His  was  a  sore  thumb,  and,  although 
the  history  is  not  so  reliable  as  in  the  first  case, 
still  he  (Dr.  Bell)  was  practically  sure  it  was  a 
case  of  horse-pox. 

Now,  if  it  can  be  inoculated  on  the  groom 
it  can  be  inoculated  on  the  cow,  and  this  is 
another  link  in  the  evidence  going  to  prove  the 
identity  of  small-pox  in  the  different  species  of 
animals,  only  modified  by  the  special  organism 
in  each  case.  He  asked  for  some  information 
as  to  a  differential  diagnosis  between  "  grease  " 
and  "horse-pox'*  in  horses.  It  seems  rather 
suspicious  that  horse-pox  should  be  so  preva- 
lent in  horses  at  a  time  of  the  year  when  they 
are  exposed  to  wet  and  damp  weather,  which 
is  known  to  be  the  cause  of  "  grease  "  in  these 
animals ;  or,  in  other  words,  that  a  good  many 
cases  of  "  grease  "   are  diagnosed  as  horse-pox. 

Dr.  D.  J.  EvAXS  said  that  a  case  of  this  kind 
came  under  his  observation  some  three  weeks 
ago.  A  groom  who  was  attending  to  three 
horses,  all  of  whom  were  afiiicted  with  the  pox, 
happened  to  get  a  slight  scratch  on  his  hand. 
At  the  seat  of  the  scratch  a  little  inflammation 
was  noted,  with  some  slight  constitutional 
febrile  disturbances ;  a  vesicle  formed,  which 
in  a  few  days  becarne  juistular,  when  it  broke, 
and  a  marked  little  ulcer  remained.  The  ulcer 
finally  healed  up.  and  left  a  distinct  cicatrix 
behind. 

Dr.  KiRKPATRiCK  asked  if  horse-pox  pro- 
tects against  small-pox  in  the  same  way  as 
when  the  vaccine  has  passed  through  the  calf. 

Dr.  GuRD  referred  to  a  case  he  had  seen 
about  eight  years  ago.  A  groom,  while  attend- 
ing to  some  horses  suffering  from  this  disease, 
was  accidentally  inoculated  in  the  cheek.  An 
inflammation  followed  and  a  typical  vesicle  was 
developed.  The  cheek  began  to  swell  con- 
siderably, and,  being  so  close  to  the  eye,  he 
began  to  fear  an  injury  to  his  sight,  and  went  to 
Dr.  Buller,  who,  no  doubt,  can  corroboraie 
these  statements. 

Dr.  Smith,  referring  to  the  differential  diag- 
nosis between  horse-pox  and  "  grease,"  thought 
that  the  course  and  termination  was  sufficient 
to  distinguish  them.  Horse-pox  does  not  last 
two  or  three  months,  as  '■  grease  "  often  does. 
Like  all  the  acute  fevers,  it  is  a  self-limited 
disease.  "  Grease"  is  looked  upon  as  a  neglect 
on  the  part  of  the  groom  to  properly  dry  the 
horse's  feet. 

Dr.  Elder  thought  that  there  were  still  one 
or  two  links  wanting  to   complete  a   valuable 


piece  of  evidence.  He  understood  that  the 
groom  did  not  have  the  pox  at  all,  and  it 
seemed  that  the  connection  between  the  sick- 
ness of  the  cow  and  that  of  the  horses  is  not 
clearly  established.  There  is  nothing  more 
common  than  for  cows  to  have  cow-pox,  and 
that  this  cow  should  have  it  at  the  time  that  the 
horses  had  horse-pox  may  at  the  most  be  only 
a  coincidence.  If  the  pox  had  been  taken 
from  the  horse  and  put  into  the  calf,  then  it 
would  have  been  a  direct  piece  of  evidence. 
As  it  is,  the  calf  was  inoculated  from  the  cow, 
and  the  resemblance  of  the  calf's  disease  to  cow- 
pox  may,  after  all,  be  due  to  that,  and  not 
horse-pox,  being  the  true  malady  of  the  cow. 

Dr.  Adami  stated  that  this  was  purely  a 
preliminary  communication,  and  the  experi- 
ments reported  are  only  the  beginning  of  a 
series  of  experiments.  He  had  already  taken 
material  from  the  horses,  also  a  scab  from  one 
of  the  grooms  that  has  had  horse-pox,  and 
intended  inoculating  them  in  cows.  With  re- 
gard to  the  matter  of  "grease,"  one  important 
point  is  the  duration  of  the  disease.  ' '  Grease  " 
is  a  long  disease  ;  it  does  not  have  the  stages 
of  horse-pox.  Horse-pox  is  a  papular  eruption, 
followed  by  the  coalescence  of  the  papules, 
the  formation  of  vesicles  and  the  development 
of  the  vesicles  into  pustules.  Finally,  you  have 
the  rupture  of  these  pustules,  the  formation  of 
little  ulcers  and  the  healing  of  those  ulcers, 
leaving  behind  a  permanent  cicatrix,  "  Grease," 
on  the  other  hand,  is  not  characterized  by 
pustules,  but  rather  by  pus.  It  is  simply  a 
superficial  inflammation  of  the  skin,  which  goes 
on  to  suppuration.  This  refers  to  typical 
cases.  Of  course,  there  are  atypical  cases 
where  it  is  not  so  easy  to  separate  them.  He 
had  seen  a  case  of  horse-pox  in  ]\Iontreal 
where  regular  suppuration  took  place,  with 
great  swelling  and  tenderness,  but  this  is  ex- 
ceptional. He  was  not  properly  acquainted 
with  all  the  manifestations  which  "grease" 
may  undergo,  nor  could  he  give  what  he  felt 
to  be  an  adequate  history  of  its  course  and 
termination,  although  he  can  detect  it  readily 
enough  when  he  sees  it.  "  Grease  "  is  a  sub- 
cutaneous as  well  as  a  cutaneous  affection,  and 
he  doubted  whether  it  has  any  counterpart  in 
the  human  being.  With  regard  to  horse-pox 
granting  protection  against  small-pox,  this  is 
as  yet  an  unsettled  point.  In  the  last  few 
years  a  good  many  experiments  have  been 
made  in  this  direction,  and  many  of  them 
seemed  to  declare  that  it  did  protect;  others 
have  doubted  it.  Among  grooms,  twenty  or 
thirty  years  ago,  when  horse-pox  was  more 
prevalent  in  the  Old  Country,  it  was  believed 
that  it  did  protect,  but  this  is  also  a  matter 
which  requires  to  be  thoroughly  investigated, 
and  a  complete  series  of  experiments  is  urgently 
required. 

Epithelioma  of  the  Soft  Palate,  etc — Dr. 


THE   CANADA.   MEDICAL   RECORD. 


91 


H.  U.  Hamilton',  after  stating  that  he  had  to 
thank  Dr.  George  W.  Mijor  for  the  permission 
to  utiHze  material  from  his  clinic,  read  the  re- 
port of  the  case,  as  follows  : — 

R.  H.,  female  aged  45  ;  unmarried;  a  do- 
mestic servant  ;  lived  in  Montreal. 

First  applied  for  relief  at  Nose  and  Throat 
Department  of  the  Montreal  General  Hospital 
in  November,  1891,  complaining  of  soreness 
of  the  throat  and  painful  swelling  of  the  glands 
of  the  neck,  both  on  the  right  side. 

Present  Ilbiess — Began  in  the  summer  of 
1 89 1  as  a  small  sore  on  the  soft  palate  to  the 
right  of  the  middle  line.  This  was  described 
as  a  "  pimple,  about  the  size  of  a  split-pea, 
painful  and  red  like  a  burn."  When  this  had 
been  noticed  one  month,  a  doctor  was  con- 
sulted, who  used  a  paint,  which,  the  patient 
says,  cured  the  spot. 

A  few  weeks  later  a  similar  sore  appeared 
nearer  the  right,  on  the  soft  palate.  This  was 
treated  as  before,  with  no  effect ;  the  spot  in- 
creased in  size  and  the  glands  of  the  right  side 
of  the  neck  became  swollen  and  painful,  and 
when  this  had  been  going  on  for  three  months 
the  patient  applied  at  the  hospital  in  Novem- 
ber, 1891. 

Through  the  winter  of  '91-92,  patient  ap- 
plied at  irregular  intervals  at  the  hospital,  and 
her  condition  seems  to  have  remained  about 
the  same,  with  the  exception  of  marked  increase 
of  pain  in  throat  and  neck  when  she  was  ex- 
posed to  a  cold.  (She  was  able  to  keep  on 
with  her  work.)  When  I  first  had  the  oppor- 
tunity of  seeing  patient,  June,  1892,  she  com- 
plained of  difficulty  in  swallowing  solids. 
The  ulceration  had  then  attacked  the  right 
posterior  pilkr  of  the  fauces  and  the  pharyn- 
geal wall  immediately  behind. 

Her  case  was  followed  up  through  the  sum- 
mer and  winter  of '92,  during  which  time  this 
discomfort  varied  in  degree,  but  flesh  was  lost 
steadily,  and  the  ulceration  gradually  spread 
towards  the  left,  both  by  way  of  the  post- 
pharyngeal wall  and  the  soft  palate,  so  that  at 
the  New  Year,  the  left  cervical  glands  had  also 
become  involved,  and  the  patient  was  obliged 
to  give  up  work  and  come  to  live  with  a  mar- 
ried sister  in  the  city. 

The  tongue  was  attacked  first  in  January, 
1893.  The  patient  was  suffering  from  "la 
grippe,"  when  an  acute  glossitis  occurred. 
The  swelling  subsided  in  a  few  days,  leaving 
a  deep  ulceration  in  the  right  side  of  the  tongue 
opposite  a  decayed  lower  tooth.  The  tooth 
was  drawn,  and  soon  the  tongue  returned  to  its 
normal  size,  leaving  a  painful  ulcerated  spot 
marking  the  position  of  the  tooth. 

At  this  time  the  patient  had  been  six  months 
without  solid  food  ;  pains  shooting  from  the 
angles  of  the  jaw  towards  the  ears  and  vertex 
were  almost  constant.  (Hearing  was  not  im- 
paired.)    Nutrient  enemata    had  to    be  com- 


menced on  the  19th  of  February  last.  The 
throat  became  so  painful  during  an  acute  in- 
flammation that  the  patient  could  swallow 
nothing.  Feeding  by  soft  rubber  catheter  was 
tried,  but  produced  too  much  pain  and  retch- 
ing. After  a  few  days,  liquid  food  could  again 
be  taken  in  small  quantities,  but  enemata  were 
constantly  used  from  that  time.  The  ulcera- 
tion of  the  tongue  had  now  been  present  one 
month,  and  had  become  surrounded  by  a  hard 
mass  the  size  of  a  marble.  The  voice  was  now 
noticed  hoarse  for  the  first  time. 

One  week  later,  February  26, 1893,  the  floor 
of  the  mouth  became  rapidly  swollen  and  very 
painful,  the  discharge  from  the  mouth  became 
blood-stained  and  foetid,  and  the  patient 
c  jughed  frequently.  Lungs  on  examination 
found  clear. 

Patient  was  admitted  into  the  General  Hos- 
j)ital  on  9th  of  March,  where  she  remained  for 
one  week,  having  the  artificial  feeding  regularly 
attended  to,  both  by  stomach  tube  and  ene- 
mata. On  returning  home  she  kept  her  bed  ; 
took  nothing  by  the  mouth  ;  her  mind  wandered 
frequently ;  the  blood-stained  fcetid  discharge 
from  the  mouth  was  very  offensive. 

]\Iarch  27th  the  patient  died  suddenly  after 
a  large  quantity  of  blood  escaped  by  the  mouth 
and  nose.  When  seen  earlier  in  the  day,  the 
wasting  and  weakness  were  very  marked. 
The  mind  was  weak.  Pulse  124,  small  and 
thready  ;  respirations  20 ;  temperature  (under 
the  tongue)  97  25^  F.  No  pain  complained 
of. 

Personal  History — Negative,  patient's  habits 
being  regular  and  her  health  always  good  be- 
fore this  disease  began. 

Family  History — Father  died  of  cancer  at 
age  of  55  years.  (His  tongue  had  been  re- 
moved for  this  disease  by  Dr.  Shepherd.) 

General  condition  has  been  sufficiently  de- 
scribed, except  that  the  heart  gave  a  faint 
systolic  "  bruit  "  over  the  mitral  area  early  in 
the  course  of  the  illness. 

Post-mortem  examination  could  only  be 
partial  (by  the  wishes  of  the  family),  so  I  en- 
deavored to  get  as  much  of  the  diseased 
pharynx  and  larynx  away  as  possible.  The 
stomach  and  liver  were  roughly  examined,  but 
only  a  small  infarction  on  the  surface  of  the 
liver  was  found. 

When  the  floor  of  the  mouth,  tongue,  larynx 
and  commencement  of  oesophagus  were  re- 
moved, the  naso-pharynx  could  be  felt  a  crumb- 
ling mass  of  superficial  ulceration.  The  whole 
of  the  soft  palate  was  absent ;  no  bare  bone 
could  be  felt.  The  parts  removed  showed  bone 
attacked,  viz.,  the  greater  ala  of  the  hyoid  bone 
on  the  right  side.  To  enumerate  the  parts 
affected,  we  have  the  walls  of  the  pharynx  and 
naso-pharynx,  the  soft  palate,  fauces  and  ton- 
sils, the  larynx  externally  and  internally  on 
the  right   side.     Externally  the  superior  ala  of 


THE  CANADA  MEDICAL  RECORD. 


the  thyroid  cartilage  was  absent,  and  internally 
the  disease  had  reached  the  true  vocal  cord. 
The  right  half  of  the  epiglottis  was  removed  by 
-ulcerauor,,  and  the  tongue  immediately  in  front 
was  infiltrated  throughout  its  whole  width, 
while  the  right  side  towards  the  tip  was  deeply 
ulcerated.  The  glands  affected  were  beneath 
the  jaws  and  the  anterior  cervical  chains  on 
both  sides. 

The  course  taken  by  the  disease,  as  fir  as 
can  be  made  out  by  the  clinical  observations, 
was  as  follows  :  First,  the  right  side  of  the  soft 
palate  and  the  cervical  glands  on  the  right  ; 
the  pillars  of  the  fauces,  the  tonsil  and  the  side 
of  the  pharynx  on  the  right.  Then  the  back  of 
the  pharynx,  the  remainder  of  the  soft  palate, 
the  left  tonsil,  fauces  and  anterior  chain  of 
glands.  Towards  the  end  the  right  side  of 
tongue  and  glands  below  the  jaw,  and  llie  in- 
terior of  the  larynx. 

Sections  from  the  tongue  and  left  anterior 
pillar  of  the  fauces  were  removed  for  microsco- 
pical examination.  Dr.  Adami  kindly  made 
the  examination,  and  with  his  consent  I  will 
quote  what  was  written  at  the  time  concerning 
the  two  sections  : 

"Sections  from  tne  tongue  and  palate  are 
aty]>ical  euithelioma,  that  is,  the  masses  of  cells 
passing  down  from  the  epithelium  into  the 
deeper  tissues  are  small  and  devoid  of  cell  nests, 
so  that  at  a  very  little  distance  from  the  sur- 
face the  growth  might  easily  be  mistaken  for  a 
true  carcinoma." 

If  I  may  impose  on  the  time  of  the  Society 
for  a  few  minutes  more,  I  should  like  to  draw 
attention  to  a  few  characteristics  of  this  disease 
accurately  borne  out  in  this  case. 
..  Epithelioma  of  the  tongue  runs  n  rapid 
course;  the  lymphatic  glands  are  soon  infected, 
and  death  follows  in  a  short  tirr.e. 

Again,  in  malignant  growths  of  rapid  couise, 
there  is  more  than  the  usual  tendency  to  be 
atypical. 

Epithelioma  of  the  tongue  is  seen  to  be  in- 
fluenced by  irritation  as  a  cause  almost  more 
than  any  other  growth.  In  this  case  the  tongue 
was  affected  within  'hree  months  of  the  end. 
The  microscopical  examination  has  proved  the 
growth  to  be  atypical.  The  onset  of  the 
disease  with  the  irritation  of  a  root  of  a  tooth 
against  an  acutely  swollen  tongue  is  significant. 

I  have  gone  thus  fully  into  the  case,  for  the 
following  reasons  : — 

Firstly,  this  is  a  case  where  the  cancer  clearly 
began  in  the  soft  palate  and  fauces — not  at  all 
a  common  occurrence. 

And,  ::econdly,  since  the  variety  of  the  growth 
is  the  same  in  both,  the  interesting  question 
arises,  viz.  :  May  the  recent  involvement  of  the 
tongue  not  be  due  to  direct  infection,  the  tongue 
being  constantly  in  contact  with  the  diseased 
palate  and  fauces?  An  avenue  for  infection 
was  widely  opened  by  the  irritation  of  the  tooth 
described. 


Lastly,  it  is  worth  noticing  the  effect  of 
"  Influenza  "  in  this  case.  Several  times  during 
the  earlier  part  of  the  winter  the  patient  came 
complaining  of  rapid  onset  of  pain  and  swelling 
of  the  throat  and  neck,  making  it  next  to  im- 
possible to  swallow  or  even  open  the  mouth. 
The  skin  over  the  glands  would  then  be  rei 
and  tender.  The  attack  of  glossitis  accom- 
panied one  of  these  attacks,  and  most  likely 
depended  chiefly  upon  the  epidemic. 

Dr.  Ahami: — Dr.  Hamil  on's  cases  inter- 
ested me  a  great  deal.  It  is  so  rare  to  have 
two  forms  )f  carcinoma  occurring  in  the  same 
patient  at  the  same  time,  tiiat  although  this 
conclusion  that  the  two  forms  were  present  was 
forced  upon  me  as  the  result  of  first  sections, 
I  was  unwilling  to  believe  it,  and  have  spent 
two  days  cutting  and  preparing  more  than  half 
a  dozen  portions  of  the  tissues,  with  the  result 
that  I  am  glad  to  retract  my  previous  report. 
First  of  all,  taking  the  facts  as  they  come,  in 
examining  the  tongue  one  is  no  doubt  dealing 
with  an  epithelioma,  though  unfortunately  this 
inflammatory  condition,  coupled  with  a  foul 
sanious  discharge,  and  the  time  that  elapsed 
before  the  post-moitem  was  made  rendering  the 
whole  surface  more  or  less  disintegrated,  made 
it  difficult  to  be  certain.  I  find  a  proliferation 
of  the  epithelium;  that  proliferation  is  not  the 
same  as  in  the  typical  epitheliomatous  prolif- 
eration. In  some  regions  one  sees  it  a  prolif- 
eration affecting  the  ducts  oftheg'ands  passing 
down  the  lower  portion  of  the  tongue,  and 
again  one  sees  these  glands  undergoing  malig- 
nant change.  In  all  sections  examined  there 
is  this  curious  absence  of  well  marked  "cell 
nests  ;  "  there  are  cell  nests,  but  they  are  poorly 
developed.  In  the  lower  portion  of  the  tongue 
the  appearance  is  very  similar  to  what  one  gets 
in  scirrhus  cancer,  long  thin  lines  of  cancerous 
cells  separated  from  each  other  by  marked 
fibrous  stroma.  Then  one  sees  the  ir.filtration 
between  the  masses  of  the  cells. 

Going,  then,  to  the  fauces,  there  is  here 
complete  absence  of  anything  like  true  epithe- 
lioma ;  in  its  place  there  is  a  carcinomatous 
appearance.  However,  in  sections  made  to- 
day, in  some  regions  nearer  the  tongue  than 
those  first  made  for  Dr.  Hamilton,  one  sees 
similar  appearances  to  that  found  in  the  tongue, 
so  now  I  say  that  throughout  we  are  dealing 
with  an  atypical  epithelioma.  The  epithelioma 
seems  to  spring  from  the  lower  portion  of  the 
epithelium,  loses  its  appearance  very  rapidly, 
and  soon  grows  to  resemble  ordinary  gland 
cancer.  When  I  came  to  examine  the  right 
vocal  cord,  there  I  found  purely  inflammation 
and  no  carcinomatous  appearance  whatever. 

Neurasthenia  of  the  Stomach. — Dr.  Gunn 
read   his   paper  on  this   subject. 

The  President  took  exception  to  one  of  Dr. 
Gunn's  statements,  viz.,  that "  anorexia  nerv- 
osa" never  occurs  in  the  male  sex.     Most  of  the 


THE   CANADA    MEDICAL    RECORD. 


senior  medical  men  in  this  city  remember  a 
case  of  the  medical  student  named  Brou'n  who 
was  suffering  from  this  disease.  He  was  looked 
upon  as  the  most  perfect  type  of  the  living 
skeleton  that  liad  ever  been  known.  One  of 
♦he  most  important  of  Dr.  Gunn's  remarks  is 
that  every  case  requires  to  be  treated  on  its 
own  merits.  A  great  many  of  these  cases  are 
certainly  very  difficult  to  cure,  and  in  the  vast 
majority  of  ihem  it  requires  a  man  like  Weir 
Mitchell  to  be  successful.  There  is  something 
about  the  mental  type  of  the  man  that  is  essen- 
tial to  success  in  such  states.  There  is  one 
form  of  treatment  that  Dr.  Gunn  forgot  to 
mention,  namely,  hydro-therapeutics  Winter- 
nitz,  in  Europe,  treats  with  cold  water,  but  he 
is  no  more  successful  than  Weir  Mitchell. 

Dr.  Lafleur  said  that  about  three  years 
ago  he  had  seen  a  case  of  ''  anorexia  nervosa  " 
in  the  male.  The  man  had  at  the  same  time 
another  neurosis,  that  increased  very  consider- 
ably the  difficulty  of  the  forced  feeding  treat- 
ment, viz.,  persistent  eructations.  However, 
when  last  heard  of  he  was  very  much  improved. 
In  Johns  Hopkins  Hospital,  Baltimore,  they 
have  had  some  experience  with  the  Weir  Mit- 
chell treatment,  having  as  a  rule  quite  a  num- 
ber of  patients  in  the  private  wards  suffering 
from  general  neurasthenia,  and  many  of  them 
suffering  from  gastric  disorders.  He  corrobo- 
rated the  statement  that  the  treatment  is  very 
successful  when  properly  carried  out;  but  it 
requires  a  special  type  of  man,  one  with  unusual 
tact  and  persuasiveness,  to  carry  it  out  and 
unless  thoroughly  enforced  it  is  worse  than 
useless,  it  is  really  harmful. 

Dr.  Wyatt  Johnston  remembered  a  case 
which  would  probably  come  under  the  category 
of  neurasthenia  of  the  stomach,  although  not 
anorexia  nervosa.  The  patient,  a  man  slightly 
over  40  years  of  age,  fairly  healthy  as  a  rule, 
fairly  strong,  from  time  to  time  suffers  from  the 
most  severe  attacks  of  what  it  would  be  im- 
possible to  describe  as  being  anything  but  ner- 
vous dyspepsia.  The  attacks  come  on  gradu- 
ally ;  food  begins  to  disagree  with  him.  He 
has  a  great  inclination  to  take  food,  but  its  in- 
ception causes  him  pain,  and  again  pain  is  felt 
more  when  food  is  not  taken.  There  were 
never  any  definite  signs  pointing  to  an  organic 
disease,  such  as  ulcer  ;  there  were  never  any 
haemorrhages  or  any  definitely  localized  pain. 
These  attacks  used  to  reduce  him  to  a  perfect 
skeleton.  I  hey  lasted  several  weeks,  and 
during  that  time  it  was  impossible  to  do  any- 
thing for  him.  At  the  end  of  that  time  he  got 
perfectly  well,  and  remained  so  for  a  year  or 
more.  One  peculiarity  he  had  about  him  was 
that  when  he  began  to  get  well  he  would  diet 
himself,  and,  in  spite  of  the  extremely  small 
quantity  of  food  ingested,  managed  to  perform 
a  very  unusual  amount  of  active  exercise.  One 
slice  of  bread  and  three  glasses  of  milk  was  his 


average  daily  allowance,  while  at  the  same  time 
he  walked  from  10  to  15  miles  daily,  besides 
other  active  employment.  Notwithstanding 
this  discrepancy  between  the  quantity  of  food 
taken  and  the  amount  of  work  done,  he  gained 
flesh,  and  picks  up  rapidl}'.  Between  the  times 
he  enjoys  good  health,  but  is  any  day  liable  to 
one  of  these  severe  attacks  of  gastric  pain. 

Dr.  Gunn,  in  reply,  said  he  was  very  glad 
to  hear  of  cases  of  anorexia  nervosa  appearing 
in  the  male,  as  it  corrects  a  wrong  impression 
hitherto  existing  in  his  mind.  This  impression 
he  received  from  the  author  quoted  in  his 
paper,  who  states  positively  it  never  appears  in 
the  male ;  and  the  cases  mentioned  here  to- 
iiight  he  had  not  seen  reported  anywhere. 


THE  LATE   DR.  WILLIAM  F.  HUTCH- 
INSON. 

I       At  a  meeting  of  the   Executive  Council    of 
the  .\merican  Electro-Therapeutic  As  iociation, 
the  following  resolutions  on   the  death  of  Dr. 
William  F.  Hutchinson   of  Providence.     R.I., 
were  unanimously  adopted  : 

Whereas,  it  becomes  our  painful  duty  to 
announce  the  death  of  Dr. William  F.  Hutchin- 
son, one  of  the  foundation  fellows  of  the 
American  Electro-Therapeutical  Association, 
as  well  as  the  first  vice-president  of  the  same  ; 
and 

Whereas,  in  his  death  we  lose  a  warm  and 
faithful  friend,  a  valued  associate  and  an 
accomplished  member  of  the  profession,  there- 
fore be  it  : 

Resolved :  That  this  Association  desires  to 
place  on  record  its  appreciation  of  his  genial 
spirit,  his  active  cooperation  in  the  work  of 
the  Association  and  of  his  deep  interest  in 
the  scientific  question  to  his  chosen  profession. 

Resolved:  That  we  express  our  sincere  re- 
gret and  heartfelt  sorrow  at  his  death. 

Resolved:  That  we  tender  to  liis  sorrowiug 
family  an  expression  of  our  profound  sympathy 
in  their  great  loss. 

Resolved:  That  a  copy  of  these  resolutions 
be  sent  to  the  bereaved  family,  to  the  Medical 
journals,  and  that  they  be  entered  upon  the 
minutes  of  the  Association. 

AuGUSTiN  H.  Goelet,  M.D.    ^ 

W.  J.  Morton,  M.D.  |  „ 

G.  Betton  Massey,  M.D.         ;.  Executive 

Robert  Newma:,',  M.D.  |     '-o^'^'^'Cil. 

Charles  R.  Dickson,  M.D.  j 

W.\i.  J.  Herd.max,  M.D.,  President. 

Margaret  A.  Cleaves,  M.D.,  Secretary. 

New  York.  N-.Y.,    December  13,  1893. 


94 


THE    CANADA    MEDTCAI.    RECORD. 


THE3  CANADA  MEDICAL  RECORD. 


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EDITORS : 
A.  LAPTHORN  SMITH,  B.A„M.D.,  M.R.C.S.,  Eng.,F.OS. 

London 
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ASSIST  AN  r  EDITOR 
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MONTREAL,  JANUARY,  1894. 


LODGE  DOCTORS. 

The  question,  whether  physicians,  in  justice 
to  themselves  as  well  as  in  justice  to  their  pro- 
fessional brethren,  should  accept  the  position 
of  doctor  to  a  lodge  has  lately  raised  a  good 
deal  of  discussion,  more  especially  during  the 
last  few  years,  during  which  the  practice  has 
become  more  and  more  abused.  While  it  is 
quite  true  that  the  majority  of  workingmen  are 
unable  to  pay  the  ordinary  tariff  of  fees,  yet  in 
most  cases  they  could  pay  more  than  the 
amount  which  the  lodge  doctor  at  present 
receives,  namely,  one  dollar  per  annum,  includ- 
ing medicine.  It  is  true  also  that  the  principle 
on  which  benefit  societies  are  founded  is  that 
only  a  small  proportion  of  the  total  number  of 
members  may  be  expected  to  be  sick  and  re- 
quiring medical  attendance  or  the  financial 
assistance  of  the  lodge  at  a  time,  and  that  the 
well  ones  will  contribute  towards  the  expenses 
of  the  sick  and  disabled  member.  So  far,  the 
principle  is  a  good  one,  encouraging  providence 
or  the  providing  during  health  for  a  time  ot 
sickness  ;  on  the  other  hand,  the  tendency  is  to 
depreciate  the  value  of  the  services  of  physi- 
cians in  general,  for  when  a  man  belonging  to 
a  lodge  who  only  pays  one-  dollar  a  year  is 
stricken  down  with  typhoid  fever,  and  receives 
fifty  visits  fioiP-  the  lodge  doctor,  he  will  be 
strongly  under  the  impression  that  the  dollar 
which  he  has  paid  is  an  ample  recompense 
for  those  services  which  are  really  worth  from 
fifty  to  one  hundred  dollars. 


Another  objection  to  lodge  work  is  the 
tyranny  which  the  managers  of  lodges  often 
exercise  over  the  lodge  doctor.  As  it  costs 
no  more  for  a  night  visit  than  a  day  one,  the 
lodge  doctor  is  often  summoned  at  times  which 
are  most  inconvenient  for  him  to  attend;  and 
while  he  would  probably  suit  his  own  con- 
venience in  the  case  of  an  ordinary  paying 
patient,  he  might  not  dare  to  do  so  in  the  case 
of  a  lodge  patient,  lest  the  latter  should  com- 
plain to  the  lodge  and  thus  have  him  dismissed. 
These  remarks  have  been  suggested  to  us  by 
the  appearance  of  a  well  written  letter  by  Dr. 
R.  Ovens  of  Forest,  Ont.,  which  appears  in  the 
Ontario  Medical  Journal  for  November.  In 
this  the  doctor  states  that  he  felt  that  his  re- 
maining the  court  physician  for  the  two  lodges 
in  his  town  was  an  injustice  to  himself  and  to 
the  other  physicians  of  the  place  ;  and  feeling 
that  it  was  unfair  for  him  to  thus  obtain  an 
undue  advantage  over  the  other  physicians, 
he  generously  acted  on  his  convictions,  and 
asked  each  court  to  relieve  him  from  being  a 
court  physician,  with  the  result  that  they  de- 
cided to  abolish  that  part  of  their  constitution 
which  required  them  to  have  a  lodge  doctor. 
The  same  patients  still  employ  him,  but  instead 
of  paying  him  only  one  dollar  for  fifty  visits, 
they  are  paying  him  fifty  dollars  at  least  for 
the  same  work ;  and  as  people  value  what  they 
get  very  mach  in  proportion  to  what  they  pay 
for  it,  it  is  likely  that  his  action  in  obtaining 
the  abolition  of  court  physicians  of  lodges  has 
raised  the  status  generally  of  the  medical  men 
in  that  town.  It  is  true  thit  the  physicians  to 
great  railway  and  other  corporations  are  in 
much  the  same  position  as  the  lodge  doctor, 
only  on  a  larger  scale,  and  eventually  something 
should  be  done  to  put  a  stop  to  that;  but  in 
the  meantime  we  believe  it  would  be  for  the 
welfare  of  the  profession  generally  to  refuse  to 
hire  themselves  out  to  lodges  for  less  than  a 
quarter  of  their  proper  remuneration. 

This,  however,  brings  up  another  point  which 
we  have  discussed  already  several  times  in 
these  columns,  and  that  is  :  what  are  the  poorer 
classes  of  laboring  men  to  do  for  medical 
advice?  It  is  utterly  impossible  for  them  to 
pay  a  dollar  a  visit  for  every  time  any  member 
of  their  family  is  ill,  and  yet  they  must  be 
attended  by  someone.  The  view  we  have 
always  taken  on  this  point  is  that  the  young 


THE  CANADA  MEDICAL  RECORD. 


95 


doctor  who  has  iime  expenses  lo  meet,  plenty 
of  time  on  his  hands  and  a  great  deal  of  expe- 
rience to  learn,  should  be  ready  to  attend  these 
patients  for  a  sum  quite  within  their  means  to 
pay.  We  have  often  been  struck  by  the  hard- 
ship and  even  cruelty  which  is  inflicted  upon 
an  honest  laboring  man  by  charging  him  the 
full  fees  for  medical  attendance.  In  addition 
to  the  enormous  cost  of  medicines,  a  laboring 
man  receiving  one  dollar  a  day — and  there  are 
thousands  of  them  who  do  not  average  more 
than  that,  taking  into  account  the  time  lost  by 
bad  weather,  short  time,  lack  of  employment, 
etc.,  and  having  to  pay  rent,  fuel,  taxes,  and 
to  provide  food  and  clothing  for  himself  and 
wife,  and  perhaps  a  half  a  dozen  or  a  dozen 
children — cannot  afford  to  pay  a  dollar  a  visit. 

The  proper  course,  we  believe,  would  be  for 
the  young  doctor  to  attend  the  case  faithfully, 
making  as  many  visits  as  are  necessary  and 
providing  medicine  himself,  and  to  charge  him 
for  only  every  third  or  fourth  visit;  if  pos- 
sible, obtaining  his  fee  in  cash.  We  know 
of  many  instances  where  a  poor  man's  life  has 
been  made  miserable  by  the  running  up  of 
large  bills  on  the  same  scale  of  prices  as  are 
charged  to  wealthy  men — bills  which  the  poor 
man  can  never  hope  to  pay.  We  have  even 
known  these  bills  to  be  placed  in  the  hands  of 
a  lawyer  for  collection,  thereby  adding  costs 
to  swell  the  amount. 

Rather  than  that  anyone  in  our  noble  and 
liberal  profession  should  be  the  cause  of  such 
a  hardship,  it  will  be  better  to  attend  these 
case  at  the  dispensaries  or  hospitals  for  noth- 
ing. 

This,  however,  the  poor  but  respectable 
citizen  does  not  ask  or  wish  ;  he  would  much 
prefer  to  pay  in  proportion  to  his  means,  as 
well  as  his  millionaire  fellow-citizen.  We  shall 
never  cease  to  cry  out  against  the  great  disparity 
in  the  charges  made  to  the  millionaire  and  to 
the  struggling  laboring  man  for  the  same  service. 
Much  of  the  abuse  of  hospitals,  dispensaries 
and  lodges  is  due  to  the  comparatively  exorbi- 
tant charges  made  by  some  of  the  younger  prac- 
titioners. All  these  evils  could,  we  believe,  be 
abolished  it  the  young  practitioner  would 
charge  and  collect  as  much  as,  and  no  more 
than,  the  poor  but  honest  workingman  can 
afford  to  pay. 


NEWS  ITEM. 


The  undersigned  chairman  of  the  American 
National  Committee  of  the  Internaiior.al 
Medical  Congress,  which  was  postponed  from 
September  24th  on  account  of  Cholera  prevail- 
ing in  Italy,  has  been  notified  by  the  Secretary- 
General  that  the  Congress  will  be  held  at 
Rome  from  March  29th  to  April  5ih,  1894. 
Instructions  and  documents  relating  to  the 
journey,  etc.,  are  promised  for  the  near  future. 
Yours  very  respectfully, 

A.  JACOBI,  M.D. 
no  W.  34th  Street,  New  York, 
November  \']th,  1893. 


PAMPHLETS. 


Exercise     for     Pulmonary    Invalids,     by 
Charles  Denison,    A.M.,    M.I).,     Denver, 
Colorado. 
Outlines    of    Obstetrics.      A    syllabus    of 
lectures    delivered   at    the     Long    Island 
College  hospital.  By  Charles  Jewett,  A.M.;, 
M.D.,  Professor  of  Obstetrics  and    Pedia- 
trics  in   the   college,  and   Obstetrician  to 
the  hospital.      Edited  by  Harold  F.  Jewett, 
M.D.    Philadelphia  :  W.  B.  Saunders,  925 
Walnut  Street,  1894.     Price  $2.00. 
Connecticut    State    Medical    Directory. 
Dedicated    to    the  Medical    profession   (jf 
Connecticut.     Containing  a  <  arefully  pre- 
pared list  of  physicians,  dentists  and  drug- 
gists,   together   with    colleges,    hospitals, 
medical       associations,      and      societies 
throughout   the    State.    1893.      The  Dun- 
bury    Medical    Printing    Co.,     Danbury, 
Conn. 
De  la  Menixgite  Tuberculeuse  CHEZ  l'En- 
fant,   par  le  Dr.   E.  Schoull,  de    Troyes. 
Vient    de   paraitre.      Societe     d'Editions 
Scientifiques     4,     rue  Antoine-Dubois,    el 
Place  de  I'Ecole-de-Medecine,  Paris.  Prix  : 
3  francs  ;  envoi  franco  contre  un  mandat. 
L'auteur,  dont  la  competence  dans  I'etude  de 
la  tuberculose  s'est   aflftrmee  deja  par  plusieurs 
travaux  importants  sur  ce  sujet,  est  convaincu, 
a  I'encontre  de  la  plupart  des  contemporains,  de 
la  guerison  possible  de  la  meningite  tuberculeuse. 
Ayant  en  vue  surtout  un    but  pratique,  il  s'est 
ab^^tenu  de  details  trop  etendus  sur  I'hisiorique 
e^  I'anatomie  pathologique  de  cette    affection, 
mais  a    developpe  avec    soin  les    chapitres  si 
importants  du  diagnostic  et  du  traitement.  Ce 
petit  livre  sera  lu  avec  fruit    par  tous  les  prati- 
ciens;  il  sera  de  meme  utile  aux  meres,  a  qui  sont 
indiques    les    moyens    de    preserver,    dans   la 
mesure    du    possible,    leurs    enfants    plus    ou 
moins    predisposes,  et   d'appeler   a   temps    le 
medecin  quand    apparaitront    les  signes    pr6- 
curseurs    de  cette  terrible  maladie. 


96 


THE   CANADA   MEDICAL    RECORD. 


BOOK    NOTICES. 


The  Medical  News  Visiting  List  for  1894. 
Weekly  (dated,  for  30 patients);  Monthly 
Cundated,  for  120  patients  per  month); 
Perpetual  (undated,  for  30  patients  weekly 
per  year) ;  and  Perpetual  (undated,  for 
60  patients  weekly  per  year).  The  first 
three  styles  contain  32  pages  of  data  and 
176  pages  of  blanks.  The  60  Patient 
Perpetual  consists  of  256  pages  of  blanks. 
Each  style  in  one  wallet-shaped  book, 
pocket-pencil,  rubber,  and  catheter-scale, 
etc.  Seal  Grain  Leather,  $1.25.  Philadel- 
phia: Lea  Brothers  &  Co.,  1893. 

The  Medical  News  Visiting  List  for  1894  has 
been  thoroughly  revised  and  brought  up  to 
date  in  every  respect.  The  text  portion  (32 
pages)  contains  the  most  useful  data  for  the 
physician  and  surgeon,  including  an  alphabeti- 
cal Table  of  Diseases,  with  the  most  approved 
Remedies,  and  a  Table  of  Doses.  It  also 
contains  sections  on  Examination  of  Urine, 
Artificial  Respiration,  Incompatiblcs,  Poisons 
and  Antidotes,  Diagnostic  Table  of  Eruptive 
Fevers  and  the  Ligation  of  Arteries.  The 
classified  blanks  (176  pages)  are  arranged  to 
hold  records  of  all  kmds  of  professional  work, 
with  memoranda  and  accounts.  Four  styles 
are  now  published :  Weekly  (dated,  for  30 
patients);  Monthly  (undated,  for  120  patients 
per  month,  and  good  for  any  year)  ;  Perpetual 
(undated,  for  30  patients  weekly  per  year) ; 
and  Perpetual  (undated,  for  60  patients  weekly 
per  year).  This  last  style  consists  of  256  pages 
of  assorted  record  blanks,  without  text.  The 
Medical  News  Visiting  List  adapts  itself  to  any 
system  of  keeping  professional  accounts.  Each 
style  is  in  one  volume,  bound  in  handsome  red 
leather,  with  pocket-pencil,  rubber,  and  cathe- 
ter-scale ;  price,  $[.25.  When  desired,  a  Ready 
Reference  Thumb-letter  Lidex  is  furnished, 
which  is  peculiar  to  this  Visiting  List,  and 
will  save  many-fold  its  small  cost  (25  cents) 
in  the  economy  of  lime  effected  during  a  year. 
In  short,  every  need  of  the  physician  seems  to 
have  been  anticipated  in  The  Medical  News 
Visiting  List. 


for  a  poioUxi  lhj.L  may  iiavc  bci^u  a\v'allj,\^J,  or 
the  proper  method  of  resuscitating  a  half 
drowned  jK'rson.  True,  he  should  know  these 
things,  but  who  does  not  occasionally  forget 
when  he  most  wishes  to  remember  ?  There  are 
also  dose-tables,  tables  of  tb.e  metric  system,  a 
list  of  new  remedies,  rules  for  examining  urine, 
a  table  for  calculating  the  period  of  pregnancy, 
and  other  equally  useful  information.  Tne 
arrangement  fur  entering  patients,visits,  consu't- 
ation?,  etc.,  is  exceeuingly  simple,  and  the  whole 
makes  a  thin,  compact,  and  easily  carried 
volume. 


The  Physician'.s  Visiting  List  For 
1894,  published  annually  for  43  years 
Lindsay  ^  Blakiston,  Philade  phia. 
Price,  $1. 

The  fact  that  this  Visiting  List  has  been 
pnbhshed  annually  for  forty  years  is  sufficient 
guarantee  of  its  excellence  and  popularity. 
In  addition  to  the  visiting  list  proper,  it  contains 
easily-accessible  suggestions  upon  many  of 
the  emergencies  that  may  arise  in  a  physician's 
practice,  as  when  he  is  too  far  from  home 
to    learn    fror     his    text-books    the    :.ntidote 


PUBLISHERS'  DEPARTME3NT. 


A  TOO  COMMON  AFFRONT  TO  THE  PROFES- 
SION. 

About  a  year  since,  the  Journal  of  the  American 
Medical  As$ociation,\xi  an  editorial  article,  referred  in 
unqualified  language  to  the  strained  relations  which  it 
asserted  were  existing  between  physician  and  druggist  : 
the  salient  cause  being  ths  habit  of  counter -prescribing, 
coupled  with  the  more  viciou-;  habit  of  substituting. 
Since  then,  if  we  may  judge  fiOTi  the  tone  of  the  bulk  of 
new  literature  being  sent  o.it,  the  substitution  habit  is 
shown  to  be  the  one  great  enemy  ''ertopping  all  others 
lo  successful  medical  practice. 

We  do  not  mean  to  assert  that  n  ])harmacists  are 
gi%'en  to  the  habit.  On  the  contrary,  we  believe  a  large 
majority  of  them  to  be  entirely  free  and  al)ove  suspicion. 
Still,  the  fact  remains  that  substitution  is  practised  to 
such  an  extent  as  to  engender  anxiety  and  timidity  on 
the  part  of   prescribing  physicians. 

Persistent  effort  ai  substitution  is  but  a  commendation 
of  the  genuine  product  sought  to  be  imitated,  and  the 
practising  physician  is  quick  to  recognize  the  fact.  And, 
once  recognizing  it,  his  confidence  in  the  genuine  is 
strengthened,  while  at  the  same  time  he  is  forced  inlo 
the  upleasant  attitude  of  maintaining  a  constant  wari- 
ness over  his  prescriptions. 

As  fairly  typifying  this  condition,  we  give  below  an 
extract  from  a  letter  from  1  'r.  Bostick,  of  (ialena, 
written  Oct.  24lh,  1893,  to  the  Antikamnia  Chemical 
Co  This  letter  is,  by  the  way,  a  fair  prototype.  He 
says  : 

"  I  became  dissatisfied  some  lime  since  with  the 
action,  or  rather  non-action,  of  what  I  supposed  to  be 
Antikamnia.  I  began  to  look  into  the  matter,  and 
discovered  the  druggist  had  been  substituting  in  my 
prescriptions.  I  then  had  him  get  me  tablets  which  I 
felt  quite  sure  he,  with  any  appliances  he  had,  could  not 
imitate,  since  which  time  I  have  been  entirely  satisfied 
with  it.=  action.  1  am  satisfied  that  much  stuff  is  sold 
and  palmed  off  as  Antikamnia,  much  to  the  detriment 
of  your  article,  which  has  proven  so  very  satisfactory  to 
me.  In  many  cases  where  quinine  is  indicated,  I  cannot 
prescribe  it  on  account  of  its  action  on  the  brain,  unless 
with  Antikamnia,  which  seems  to  remove  the  objection- 
able feature." 

The  foregoing  will  suiely  justify  all  practitioners, 
where  they  may  have  cause  to  suspect  they  are  being 
subjected  to  any  such  practices,  in  insisting  upon  the 
perfect  integrity  o{  everything  they  specify  in  their  pre- 
scriptions. 'J he  ddctor  has  the  highest  and  best  right 
to  insist  that  no  worthless  substitute  he  imposed  upon  his 
defenceless  fatient. —  Courier  of  Medicine,   Nov.,  1893. 


t 


HAfal 


Vol.  XXII, 


MONTRE.\L,  FEBRUARY,  1894. 


No. 


D. 


ORIGINAL   COMMUNICATIONS. 


Foil  MethfHl — Forced  Itespiration. . .     97 


SOCIETY  PROCEEDINGS- 


Provincial  Board  of  Medicine 105 

The    Montreal    .Medico-Cliirurglcal 


Poisoning  by  Paris  Green  IVy 

Report  of  the  C'^muiittee  appointed 
to  draw  up  R  lies  for  the  Preven- 
tion of  the  Spread  of  Tuberculosis  llG 
District    of    St.    Francis     Medical 
Association lis 


BOOK  NOTICES. 

Duane's    Students'    Dictionary     of 
Medicine 12U 


PAMPHLETS  RECEIVED. 


■  The  Prevention  and  Management  of 
Pelvic  Inflammation  iu  Puerperal 

EDITORIAL.  Women 120 

Mechanical  Aids  in  the   Treatment 

Society T..   .  110  ,  The  Cold  Bath  Treatinenr  of  Febrile         ',      of  Chronic  Forms  of  Disease  12) 

Rupture  of  the    Pulmonai'y  Artery. .   110        Di.'^orders   119    Report  on  Xasal  Surgery,  with  iUus- 

A  Case  of  Addison's  Disease '..  110'  trate  I  Cases " 120 

Sclerosis  of  the  brain 112^  Erotopathia  (Morbid  Erotism)  120 

Cirrhosis  of  the  Liver  with  Jaundice  113  I                                   - —                                    Counter-Drainage  after  Celiotomy..  120 
Appendicitis  Occurring  in  a  Patient         I                                                                           I  The  Treatment  of  Nasal    Duct    Oh- 
with  Sacro-'liac   Disease 114;  struetion 120 


Original    (|ommunic;itions. 

FELL  METHOD— FORCED  RESPIR- 
ATION. 
By     Geo.     E.    Fell,     M.D.,     F.R.M.S. 
Ex-President    American    Microscopical 
Society,  etc.,  Buffalo,  N.Y. 
(Continued.) 
CASE    XXIV. — Dr.    FELL. 

December  25,  1891,  Mr.  C,  a  resident 
of  Niagara  street,  Buiifalo,  a  man  not  habi- 
tually accustomed  to  drink,  came  under  the 
influence  of  liquor  under  peculiar  circum- 
stances, and  is  said  to  have  taken  2  oz.  of 
laudanum.  He  was  taken  by  the  ambulance 
to  the  Fitch  Hospital,  and  treated  in  the 
ordinary  manner  by  the  surgeons  in  atten- 
dance at  the  hospital,  but  with  unsatis- 
factory results.  The  wife  and  brother- 
in-law  were  called  about  1 1  p.m.,  and  they 
were  informed  by  the  physicians  in  charge 
that  there  was  no  hope  for  the  patient  ; 
that  everything  had  been  done  that  was 
possible  to  be  done.     At  the   urgent  re- 


quest of  the  wife  of  the  patient,  I  was  call- 
ed about  II  p.m.  I  found  the  patient  in 
a  very  precarious  state,  totally  unconscious, 
and  in  danger  of  death  supervening  quick- 

I  applied  the  forced  respiration  appa- 
ratus with  favorable  results.  The  cyanosis 
was  overcome,  and,  after  some  four  hours' 
work,  the  patient  became  conscious,  re- 
spired for  himself,  and  at  6.30  in  the  morn- 
ing was  taken  to  his  home  in  the  ambu- 
lance. A  condition  of  stupor  continued 
at  his  home  for  a  number  of  days  following 
the  operation  ;  he  did  not  seem  to  improve 
as  rapidly  as  was  the  custom,  until  he  was 
taken  to  a  neighbor's  house,  when  it  was 
noticed  improvement  was  rapid.  He  had 
been  placed  on  stimulating  and  supportive 
treatment,  but  with  apparently  very  little 
success.  It  was  noticed,  however,  that 
there  was  quite  an  escape  of  natural  gas  at 
the  stove  connection  in  the  room  in  which 
he  lived,  and  very  much  of  this  slow  recov- 
ery must  be  attributed  to  this,  as  after  the 
removal  from  the  house  he  recovered  very 
quickly,  and  on  the  leak  in  the  pipe  being 
repaired  he  was  not  further  affected,  and 
made  a  good  recovery.      This  case  t//us- 


98 


THE   CANADA   MEDICAL   RECORD. 


irates  the  importance  of  hospitals  being  pro- 
vided ivith  an  apparatus  suitable  for  perform- 
ing forced  respiration.  Had  it  not  been 
for  the  special  request  of  tiie  wife  of  this 
gentleman,  who  was  very  devoted  indeed, 
there  is  no  question  but  that  he  would  have 
died  under  the  treatment  used  at  the  Fitch 
Hospital.  All  had  been  done  that  artifi- 
cial respiration  or  ordinary  methods  would 
accomplish,  and  yet  wathin  four  hours  from 
the  time  I  was  first  called  to  see  this  patient, 
he  was  placed  out  of  a  dangerous  condi- 
tion. The  question  arises  ivhether,  zvith 
such  facts  presented  to  the  profession,  any 
hospital  in  the  cou7itry  is  justified  in  not 
being  prepared  for  cases  of  this  character, 
which  may  at  any  time  be  presented  to  them. 

CASE  XXV. 

Mrs.  W.,  of  Elliott  street,  Buffalo,  took 
an  overdose  of  morphia.  I  was  sent  for, 
but  was  unable  to  attend  owing  to  illness, 
and  sent  my  apparatus  in  charge  of  niy 
office  student,  a  nephew  17  years  of  age. 
The  case  was  reported  as  hopeless  under 
the  ordinary  treatment,  but  quickly  recov- 
ered under  forced  respiration. 

Having  notified  the  profession  in  Buffalo 
that  I  desired  its  members  to  use  my  appa- 
ratus gratuitously,  if  desired,  in  cases  which 
called  for  it,  several  physicians  have  availed 
themselves  of  the  offer.  I  present  two  cases 
of  interest,  and  number  them  consecutively. 

CASE  XXVI. 

Dr.  L.J.  McAdams,  Buffalo,  N.  Y. 

Mary  M.,  on  July  23,  1893,  became  un- 
conscious from  several  doses  of  morphine 
administered  for  the  relief  of  biliary  colic, 
in  all  about  ^  of  a  grain  were  given 
hypodermically.  About 4  p.m.  was  seen 
to  become  very  quiet  and  cyanotic.  Artifi- 
cial respiration  was  immediately  begun,  as 
there  was  no  voluntary  effort  to  breathe. 
This  was  kept  up  for  53^  hours,  and  all  the 
time  the  stupor  becoming  more  profound, 
and  the  cyanosis  to  such  an  extensive  de- 
gree, that  Dr.  Dignew  and  myself  thought 
that  before  we  could  get  the  forced  respir- 
ation apparatus  and  perform  tracheotomy, 
the  patient  would  die  of  CO.  poisoning. 
As  the  heart  kept  up  fairly  good,  at  9.30 
the  messenger  arrived  with  the  apparatus 


(Fell's  forced  respiration),  and  at  9.45  the 
bellows  were  going,  and  the  patient  began 
to  change  color,  and  at  3  a.m.,  July  24,  the 
patient  could  converse  and  was  out  of  dan- 
ger, and  has  madean  uninterrupted  recovery 
(after  51^  hours  of  forced  respiration  which 
resulted  in  saving  her  life). 

CASE  NO.  XXVII. 

Dr.  J.  C.  Green  and  Dr.  J.  W.  York, 
Buffalo,  N.  Y. 

August  8th,  1893,  Mrs.  P.,  aged  forty- 
six  years,  and  poorly  nourished  owing  to 
the  fact  that  she  had  taken  very  little  food 
for  past  three  or  four  weeks,  was  seen  at 
4.15  in  the  morning.  Dr.  J.  C.  Green  was 
called  at  2  o'clock,  and  found  her  suffering 
from  opium  poisoning.  It  was  learned 
that  one  ounce  had  been  taken  at  9  o'clock 
on  the  previous  evening.  Dr.  Green  states 
that  he  found  her  pulse  1 20,  and  her  respir- 
ations three  per  minute  ;  the  patient  was 
cyanosed.  He  gave  her  i-i6  gr.  ofatropia, 
and  in  one-half  hour  1.30  gr.  more,  hypo- 
dermically. Patient  could  not  be  aroused. 
Sylvester's  method  of  artificial  respiration 
was  produced,  but  with  no  improvement 
in  her  condition.  Began  forced  respiration 
with  face-mask  apparatus  of  Dr.  Fell  at 
4.30  a.m.  This  was  continued  for  seven 
hours  vi'ith  occasional  intermissions,  during 
which  Sylvester's  method  was  used.  Pa- 
tient had  a  feeble  pulse,  which  at  times  was 
not  perceptible  at  the  wrist.  One  one- 
hundredth  (i-ioo)  gr.  of  nitro-glycerine 
was  given  hypodermically  twice,  and  an 
injection  of  strong  coffee  per  rectum  three 
times.  At  11.30  patient  moved  for  the 
first  time,  and  opened  her  eyes,  but  made 
no  attempt  to  breathe.  For  the  next  two 
hours,  forced  respiration  was  practised  at 
intervals,  the  patient  becoming  cyanosed 
very  soon  after  it  was  omitted.  At  1.30 
she  was  considered  out  of  danger,  respira- 
tion having  begun  one-half  hour  before,  at 
first  almost  imperceptibly.  Dr.  J.  C.  Green 
rendered  valuable  assistance  duiing  the 
last  six  or  seven  hours  of  treatment. 

I  was  unable  to  obtain  a  very  clear  his- 
tory as  to  patient's  mental  condition  pre- 
vious, or  family  history. 

This  woman's  life  was  saved  by  Dr. 
Fell's  method  of  forced  respiration.  She 
weighed  about  100  pounds,  and  had  taken 


THE  CANADA  MEDICAL  RECORD. 


99 


very  little  nouiibhaieiit  for  three  or  four 
weeks,  none  in  24  hours.  This  I  think 
made  one  ounce  of  opium  tincture  produce 
as  much  effect  in  her  case  as  two  would 
do  under  ordinary  circumstances.  During 
six  or  seven  hours  of  the  treatment  I  think 
she  would  have  died  in  15  minutes  without 
forced  respir.ition. 

Dr.  Joseph  C.  Green,  one  of  the  oldest 
and  most  respected  practitioners  in  Buffalo, 
said  of  this  case  in  a  letter  received  by  me 
the  day  I  started  for  this  place,  September 
4,  1893:— 

"  I  have  been  acquainted,  theoretically, 
with  your  apparatus  for  producing  artificial 
respiration  in  cases  of  drownitig  and  opiurn 
poisoning,  for  some  time,  but  I  never  had 
an  opportunity  to  test  the  merits  of  it  un- 
til one  day  last  month  (August,  1893).  I 
was  called  to  the  bedside  of  a  lady  belon.^"- 
ingt-)  one  of  my  old  families,  and  found 
that  she  was  suffering  from  the  effects  of 
an  overdose  (one  ounce)  of  laudanum, 
taken  five  hours  previous  to  my  visit.  She 
was  cyanotic  ;  breathing  four  times  a  min- 
ute when  undisturbed  ;  pulse  small  and 
fluttering,  with  all  the  other  symptoms  of 
opium  poisoning.  Emetics  and  stomach 
pump  being  out  of  the  question,  I  gave  a 
hypodermic  injection  of  1-16  of  atropia, 
which  dilated  the  pupils  perfectly,  and  sent 
a  messenger  for  you  to  bring  your  appa- 
ratus, but  you  being  out  of  the  city.  Dr. 
J.W.  York  kindly  consented  to  come  with 
it.  For  ten  mortal  hours  we  used  it  conti- 
nuously. At  the  end  ofthat  time  natural 
respiration  was  established. 

"This  one  case,  dear  Doctor,  is  sufficient 
to  establish  its  superiority  over  all  other 
methods  that  I  have  any  knowledge  of  It 
speaks  volumes  for  your  instrument,  and 
no  doctor  in  active  practice  should  be  out 
of  its  reach.  I  have  been  in  active  practice 
for  over  thirty  years,  and  I  have  lost  pa- 
tients after  all  the  old  methods  known  to 
science  had  been  tried,  and  I  am  confident 
that  some  of  them  might  have  been  saved 
by  your  method  if  it  had  been  known." 

CASE  XXVin. —  Dr.   FELL. 

The  following  case  is  presented  with  the 
belief  that  it  has  some  features  of  novelt}- 
of  an  interesting  character  ;  and 

1st.  To  illustrate  how  forced  respiration 
ma}-  possibly  be  of  great  value   in  surgical 


operations    associated   with  conditions  of 
asphyxia  ; 

2nd.  To  illustrate  its  value  per  face-mask 
in  cases  of  membraneous  diphtheria  and 
croup. 

A  resident  of  Buffalo,  his  family  consist- 
ing of  wife  and   four  children,  the  eldest  a 
daughter  9  years  of  age,  a  son  7  years  and 
3  months,  a  daughter  4  years,   and  an    in- 
fant   son,    2    years    of   age.      The    eldest 
daughter  was  taken  ill  with  throat  troubles 
and   general    disturbance    of   the    system. 
She   was  quite  sick,  and   was   taken  from 
school.      On  the  29th  of  March  the  eldest 
son  was  taken  sick,  and  he,  like  the  sister, 
was  treated  with  home  remedies  until  about 
5  a.m.  on  the  Sunday  following,  when  the 
father  discovered  him  in  a  cyanotic  condi- 
tion, breathing  with    great   difficulty,   and 
evidently  in   great   danger.      I    was  called 
about    8   o'clock    in   the    morning,  and  ar- 
rived at    the  residence  an  hour  later.     On 
examination,  I  found    the  four   children  ill 
with  diphtheria,  the  exudates   being  quite 
clearly  marked  in  the  eldest  daughter  and 
the  son.     The  son  was  respiring  with  j^reat 
difficulty,    and  his    life  was  in    immediate 
danger.      I  informed   the  father  that  there 
w^as  only  one   thing  that  could  be  done  at 
that  time,  and  I  recommended  tracheotomy 
as  a  means  of  holding  the  case,   but  held 
out  no    hope   of    ultimate  recovery  of  the 
child.      They>'unger  children  were  also  ill, 
the  exudates,  however,    not  so    extensive, 
as  the  disease  had  affected   them  later  than 
the    first    two.     The  mother   desired    the 
operation    to    be   made.      I    sent    for    Dr. 
Albert    J.  CoUon,    near  by,  to   assist  me, 
but  befoie    we  were  ready    to    make  the 
operation  the  lad  became  unconscious  from 
the  asphj'^xia,  and  was  in  a  very  desperate 
condition.      He   was  placed   upon  a  table, 
the  initial  incision  made  for  the  operation 
of  tracheotomy.     The  blood   was  purple. 
No  anaesthetic  was  used  as  it  was  not   ne- 
cessary.    A    few  moments    after   the  first 
incision  was  made,  Dr.    Colton  called   my 
attention  to  the  fact  that  the  pupils  of  the 
eyes  were  dilating.      I  had  fortunately  pre- 
pared my  forced  respiration   apparatus    so 
as  to    have    it  for    immediate  use   should 
occasion  warrant,  and  had  it  not  been  ready 
I    undoubtedly  would  have  had  the  expe- 
rience of  death  occurring  during  the  opera- 
tion.     I    iftimediately    placed    the    forced 
respiration  cup  upon  the  face  and  respired 


lOO 


THE   CANADA   MEDICAL   RECORD. 


for  the  little  fellow,  resulting  in  ckangifig 
the  blood  to  a  bright  scarlet  in  the  wound 
in  the  neck,  and  causing  the  return  of  auto - 
respiration.  I  had  proceeded  with  the 
operation,  and  found  it  necessary  before  I 
completed  it  to  repeat  the  respiratory  work 
with  the  forced  respiration  apparatus  some 
six  or  seven  times,  in  some  instances  having 
to  respire  quite  a  little  time  before  auto- 
respiration  was  re-established.  This  is  a 
peculiarly  interesting  fact,  associated  with 
the  question  of  interference  with  respira- 
tion through  exudates  in  the  respiratory 
tract,  that  it  is  possible  (it  may  be  for  a 
short  time  only,  and  at  other  times  save 
life)  to  retain  the  life  of  a  patient,  breathe 
for  him,  and  tone  up  the  system  so  as  to 
enable  auto-respiration  to  be  carried  on. 
I  completed  the  operation  and  placed  the 
tracheotomy  tube  in  the  trachea,  and  found 
it  necessary  before  consciousness  returned 
to  respire  for  the  lad  for  some  time.  He 
became  conscious  and  breathed  easily, 
apparently  with  very  little  trouble,  for  quite 
a  period  of  time.  The  general  treatment 
directed  was  the  application  to  the  throat 
and  nasal  passages  of  the  peroxide  of  hy- 
drogen, about  30  per  cent,  aqueous  solution. 
The  father  was  directed  to  use  this  with  the 
spray  apparatus  occasionally  in  the  wound 
in  the  neck  if  he  found  it  necessary.  The 
afternoon  of  Sunday  revealed  the  con- 
dition the  same  as  that  which  existed  after 
the  operation  in  the  morning.  The  boy 
was  moving  around  the  house,  although  the 
respirations  were  at  all  times  more  or  less 
labored.  In  a  little  while  the  inner  tube  of 
the  tracheotomy  tube  would  close  up  with 
the  exudate,  and  would  frequently  require 
cleansing.  The  father  said  to  me  that  if 
he  would  follow  my  directions,  to  merely 
spray  lightly  the  wound  in  the  neck,  his  boy 
would  probably  have  been  asphyxiated. 
He  said  he  found  it  was  necessary  to  place 
the  tube  of  the  spraying  apparatus  in  the 
neck  or  in  the  tracheotomy  tube,  frequent- 
ly to  prevent  the  cyanotic  condition  from 
ensuing.  He  said :  "  The  spray  seems  to 
liquify  the  membrane  or  the  mattery  sub- 
stance, and  it  comes  away  in  a  sort  of  foamy, 
frothy  state."  During  the  afternoon  the 
condition  became  worse,  the  membranes 
filling  up  the  trachea  apparently,  so  that 
Dr.  Colton,  who  was  present,  applied  the 
forced  respiration  throngh  tJie  tracheotomy 
tiibcj  again  relieving  the  little  patient  from 


the  severe  dyspnoea  which  prevailed  at  the 
time.  Sunday  night  the  case  progressed 
about  the  same,  frequent  resort  having  to 
be  made  to  the  peroxide  of  hydrogen  to 
enable  the  little  fellow  to  get  along  at  all. 
On  Monday  and  Tuesday,  membraneous 
casts  of  the  tubes  and  trachea  were 
coughed  up  and  passed  out  of  the  tracheal 
opening.  The  boy  retained  his  vigor  under 
adverse  conditions  existing  until  Tuesday 
afternoon,  when  the  exudate  seemed  to  be 
increasing  and  interfered  with  the  respira- 
tory efforts,  which  conditions  could  not 
be  overcome  even  by  the  forced  respiration 
apparatus,  and  about  1 1  o'clock  Tuesday 
evening  the  patient  died  from  exhaustion 
and  heart  failure. 

It  was  very  clearly  evidenced  in  the 
case  of  the  boy  that  he  would  have  died 
before  I  could  possibly  have  performed  the 
operation  of  tracheotomy  had  it  not  been 
for  the  forced  respiration  apparatus.  How 
many  cases  of  a  serious  character  might 
be  benefited,  or  have  life  retained,  by  such 
work  and  tided  over  the  most  serious 
results,  cannot  be  foretold.  It  is  unreason- 
able to  assert  that  some  patients  may  not 
recover  who  are  as  seriously  sick  as  was 
this  young  boy. 

FITCH   ACCIDENT   HOSPITAL   CASES. 

The  following  cases  took  place  at  the 
Buffalo  Fitch  Accident  Hospital  which 
had  been  supplied  with  one  of  my  emer- 
gency cases.  I  was  not  present  at  any  of 
them,  and  am  obligated  to  Drs.  John 
Paramenter  and  E.  L.  Ruffner  of  the  hos- 
pital staff  for  the  information  regarding 
them.  Dr.  Ruffner  stated  that  all  the 
cases  saved  would  have  proved  fatal  without 
the  use  of  forced  respiration. 

No  detailed  reports  of  these  cases  were 
kept,  so  that  the  reports  are  wanting  in 
many  interesting  particulars.  The  variety 
of  cases  in  which  the  apparatus  was  used 
with  success  indicates  in  part  its  wide  range 
of  application. 

It  was  used  in  cases  of  carbonic  oxide, 
opium,  cocaine  and  chloroform,  "rough  on 
rats,"  and  cocaine  poisoning ;  in  drown- 
ing,case  of  internal  injury  from  house  falling 
on  a  man,  injury  to  base  of  brain,  ether 
narcosis,  etc. 

CASE  XXIX. 

September  10,  1892.  Opium  narcosis. 
Mr.  B.  The  Fell  Method  failed  to  resusci- 
tate. 


THE   CANADA   MEDICAL   RECORD. 


lOl 


CASE  XXX. 

John  Moxfeldt,  1482  Broadway.  Opium. 
Life  saved  by  the  Fell  Method.  Time 
used  not  given. 

CASE  XXXI. 

February  12,  1893.  Chas.  K.  Storms, 
256  Hoyt  St.  Received  at  7.30  p.m.,  died 
at  3  a.m.  Kept  alive  by  Fell  Method  about 
8  hours.  A  case  of  drowning.  Patient  did 
not  regain  consciousness.  Oxygenation 
of  the  blood  through  forced  respiration 
brought  about  when  other  methods  failed, 
demonstrating  the  remarkable  value  of  the 
method  in  drowning.  It  will  save  life  in 
cases  of  drowning  where  those  usual!}- 
applied  fail. 

CASE     XXXII. 


In  March,  1893,  a  Mr.  Gleason  was  found 
suffering  from  cocaine  poisoning.  The 
Fell  Method  of  forced  respiration  saved 
life  after  four  hours'  use  of  apparatus. 

CASE    XXXIII. 

M.  E.  Peck.  Opium  narcosis.  Two 
hours  of  Fell  ]\Iethod  saved  his  life. 

CASE    XXXIV. 

May  25,  1893.  Mrs.  Smith.  Cocaine 
and  chloraldine  poisoning.  Life  saved  by 
Fell  Method. 

CASE  XXXV. 

June  2,  1893.  Genano  Borneo,  y8 
Lloyd  street.  Fracture  base  of  brain. 
Fell  Method  kept  him  alive  3  hours. 

*  CASE    XXXVI. 

June  I,  1893.  John  Willis,  458  Perry 
street.  Carbonic  oxide  poisoning.  Fell 
Method  used  for  ^6  hours  ;  patient  never 
regained  consciousness.  Died  of  ursemic 
poisoning. 

CASE      XXXVII. 

July  6,  1893.     Mrs.  Gross,  large  dose  of 
morphia.     Ceased  breathing  on  arrival  at 
hospital.      Fully  recovered  after  1 14  hours 
of  Fell  Method.  1 


CASE  XXXVIII. 

Jul}',  1893.  Miss  Fitzmauricc  while 
under  an  operation,  ether  narcosis,  ceased 
breathing.  The  Fell  Method  of  forced 
respiration,  twenty  minutes'  use,  kept  her 
alive  until  she  could  breathe  for  herself; 
recovery. 

Note  the  following  case: — 

Within  the  last  year,  a  lady  died  of  ni- 
trous oxyde  poisoning  while  in  a  dentist's 
chair  in  Buffalo,  N.Y.  Doctor  M.  Hart- 
wig,  who  was  in  attendance,  stated  that  the 
respirations  alone  ceased,  that  the  heart 
kept  up  its  action  until  asphyxia  set  in  and 
the  patient  died.  Dr.  Hartwig  was  confi- 
dent that  the  life  of  this  lady  could  have 
been  saved  by  my  apparatus.  He  did  not 
think  of  it  at  the  time,  although  acquainted 
with  its  work. 

CASE    XXXIX. 

December  26,  1892.  Minnie  St.  Clair. 
Profound  opium  narcosis.  Kept  alive  for 
forty-eight  hours  by  Fell  Method.  Died 
of  heart  failure. 

CASE    XL. 

June  2,  1893.  Tony  Macaroni.  Inter- 
nal injury  from  house  falling  on  him.  Fell 
Method  four  or  five  days  on  and  off,  when 
auto-respiration,  shallow  or  deficient,  would 
revive  him.  He  died  of  pneumonia  pro- 
duced by  inhalation  of  cement  and  debris 
which  covered  him  in  the  fall  of  the  house. 

CASE    XLI. 

Abraham  Hackett,  1 1 2  Main  street. 
Opium  narcosis.  Died  after  about  10 
hours'  use  of  Fell  Method.  He  had  lain 
a  long  time  before   discovery. 

CASE      XLH. 

October  i,  1892.  Took  rough  on  rats. 
Three  or  four  hours  of  Fell  Method  saved 
life  of  patient. 

CASE     XLIII. 

April  2,  1893.  Miss  j\I.  Cocaine 
poisoning.  Hypodermically  injected.  Life 
saved  after  about  one  hour's  use  of  appara- 
tus. 


I02 


THE   CANADA   MEDICAL   RECORD. 


CASE  XLIV. 

Sept.  4,  1893.  Reported  saved.  Parti- 
culars not  obtained. 

I  have  taken  the  unusual  course  of  pre- 
senting my  cases  first,  and  general  facts 
pertaining  to  niy  methods  later,  in  this 
paper.  The  audience  is  made  up  of  many 
who  have  not  become  acquainted  with  the 
subject  of  forced  respiration,  so  that  now 
it  will  be  in  order  to  present  some  facts 
pertaining  to  the  history  of  the  subject. 

Medical  literature  abounds  with  very 
little  of  any  value  upon  the  subject.  There 
is  no  question  that  experimentation  pre- 
vious to  my  own  had  demonstrated  that  it 
was  almost  useless  to  attempt  to  save  life 
by  this  means,  but  that  artifical  respiration 
would  accomplish  all  that  could  be  ob- 
tained by  artificial  means.  The  opinion  also 
prevailed  that  more  forcible  measures 
than  those  used  in  artificial  respiration 
would  endanger  the  delicate  lung  tissue, 
or  that  the  air  vesicles  might  be  ruptured. 
We  may  instance  the  very  generally  ac- 
cepted Marshall  Hall's  "Ready  Method 
in  Asphyxia,"  wherein  we  find  the  use  of 
bellows  or  z.\\y  forcing  instrument  strongly 
condemned.  Even  in  some  of  our  "  Visit- 
ing Lists,"  where  Ave  might  expect  to  find 
only  axiomatic  phrases,  this  rule  was  laid 
down  until  lately,  with  special  stress  upon 
the  inadvisability  of  using  any  "forcing" 
measures  or   ''  instrument." 

While  forced  respiration  has  been  prac- 
tised for  many  years,  both  here  and 
abroad,  upon  animals  in  physiological  labor- 
atories, in  vivisection  experimentation,  A\e 
have  yet  to  ascertain  that  such  application 
has  taught  it  to  be  considered  as  of  value 
in  the  saving  of  human  life,  the  keeping 
up  of  respiration  in  the  human  organism, 
or  as  a  means  of  resuscitation  in  asphyxia. 

Can  this  be  wondered  at  when  high  au- 
thorities inform  us  that  artificial  respir- 
ation will  supply  the  blood  with  oxygen 
fully  as  well  as  forcible  measures,  or  utter 
statements  which  convey  just  such  im- 
pressions .•*  In  "  Heath's  Dictionary  of 
Practical  Surgery."  under  the  head  of 
"  Suspended  Animation,  "  this  statement 
appears  : — "  It  is  important  to  bear  in  mind 
that  artificial  respiration  is  purely  a  me- 
chanical act,  and  that,  if  efficiently  per- 
formed, air  must  enter  the  lungs  even  of  a  1 
corpse  which  is  hopelessly  dead."  , 


In  a  short  discussion  which  ensued  upon 
the  report  of  my  first  case,  presented  to  a 
section  of  the  International  Medical 
Congress  at  Washington,*  several  phy- 
sicians took  the  ground  that  the  o[)era- 
tion  of  forced  respiration  was  not  need- 
ed, that  artificial  respiration  (Sylvester's 
method)  would  have  accomplished  as 
much.  With  such  statements  accepted  and 
supported  by  the  mass  of  surgical  litera- 
ture, it  would  be  ridiculous  to  assert  that 
the  methods  employed  in  the  physio- 
logical laboratory  were  considered  valuable 
in  the  resuscitation  of  human  beings  in 
asphj'xia.  I  will  now  defend  the  position 
based  upon  my  own  experience,  that  arti- 
ficial respiration,  as  practised  by  the 
Sylvester  method,  which  is  conceded  to  be 
one  of  the  best,  will  fail  to  supply  the 
lungs  with  air  in  sufficient  quantity  to 
keep  up  the  action  of  the  heart  in  deeply 
narcotized  subjects,  where  forced  respira- 
tion in  many  cases  would  prove  entirely 
successful.  In  one  of  my  cases,  the  opin- 
ion was  expressed  by  an  experienced  ph.y- 
sician+  who  witnessed  the  operation,  that 
the  simple  institution  of  artificial  respira- 
tion, through  the  bodily  movements  re- 
quired, might  have  proved  disastrous  to 
the  patient,  owing  to  his  weakened  con- 
dition through  loss  of  blood.  The  contras*: 
between  the  two  in  operation  is  very 
noticeable.  In  artificial  respiration  the 
patient  is  tugged,  squeezed  and  rolled 
about,  according  to  the  method  employed  ; 
while  in  forced  respiration,  he  is  entirely 
pas.'-ive,  and  will  lie  for  hours  without 
moving  or  appearing  uncomfortable  as  long 
as  the  latter  procedure  is  properly  kept  up. 
In  the  case  just  referred  to,  the  life  of  the 
patient  depended  upon  the  forced  respira- 
tion for  nearly  a  day  and  a  quarter,  and 
now  the  patient  is  as  well  as  ever.  The 
question  may  yet  arise  in  desperate  cases 
—  it  has  already  in  a  number  of  cases — as 
to  the  propriety  of  the  early  substitution 
of  forced  respiration  for  artificial  respira- 
tion. When  I  had  made  my  third  opera- 
tion and  saved  three  human  lives  after  all 
usual  methods  had  failed,  a  gentleman,  who 
presumably  was  a  physician,  stated  in  an 
article  furnished  to  the  Daily  Press,  that 
"The  resuscitating  bellows  is  as  well 
known  to  every  physiologist  as   is  the  use 


*  September,  18S7. 

t  Dr.  Carlton  R.  Jewett,  of  Buftalo,  N.Y, 


THE   CANADA   MEDICAL   RECORD. 


103 


of  the  stomach  pump,  and  that  Dr.  Fell 
learned  its  use  with  the  other  students  at 
a  medical  college  in  Buffalo,  where  its 
emplo\'nient  was  thorough!}^  taught  by 
Piofcssor  M —  for  twent)'  years."  If  this 
correspondent  had  left  out  the  word 
"  resuscitating  "  he  would  have  been  more 
truthful,  and  if  he  will  recall  the  apparatus 
used  and  the  manner  of  using  it, — which 
will  be  explained  further  on, — he  will  see 
his  mistake.  Many  times  during  my  assis- 
tanceship  of  two  years  in  the  laboratory  of 
the  Medical  Department  of  the  University 
of  Buffalo,  when  operating  upon  canines  for 
the  purpose  of  exhibiting  the  thoracic  vis- 
cera in  action,  the  animal  has  been  over- 
dosed with  the  aneesthetic,  and  the  respir- 
ation would  cease.  Under  these  condi- 
tions artificial  respiration  was  always 
resorted  to  and  kept  up  by  pressure  at 
intervals  upon  the  chest,  after  which  the 
operation  of  opening  the  thorax  would  be 
continued,  and  usually  among  the  last 
procedures  would  be  the  substitution  of 
the  forced  respiration  by  opening  the 
trachea  and  using  the  bellows.  It  was  not 
"  taught  "  that  even  the  life  of  a  dog  could 
be  saved  by  forced  respirations. 

It  is  not  necessary  to  refer  to  the  litera- 
ture on  this  subject  further  than  to  state 
that,  \\\\\\t  spasmodic  efforts  have  been  made 
at  times  to  make  use  of  forced  respiration, 
owing  to  the  improper  methods  used,  the 
results  have  not  proved  sufficiently  satis- 
factory to  prove  it  a  valuable  procedure, 
but,  on  the  contrary,  to  condemn  its  use  as 
stated. 

I  cannot  do  better  to  indicate  the  general 
aspect  of  the  profession  toward  this  opera- 
tion than  to  modify  for  the  present  occasion 
the  utterances  in  my  last  paper,  read  before 
the  American  Medical  Association  at  De- 
troit. 

It  is  now  about  six  years  since  I  saved 
my  first  life  by  systematically  respiring  for 
a  human  being  by  forced  respiration.  Up 
to  the  present  time,  about  thirty  lives  have 
been  saved  by  this  means.  The  method 
has  been  given  as  great  publicity  as  pos- 
sible by  publication  in  well-known  med- 
ical journals  and  proceedings  of  societies. 
The  fulle.-t  detail  as  to  the  arrangement  of 
the  apparatus  has  been  described,  so  that 
the  successful  methods  could  be  utilized 
and  the  apparatus  prepared  by  anyone 
sufficiently  interested.    I  have  always  been 


willing  to  aid  and  assist  anyone  disposed 
to  utilize  the  method.  The  most  simple 
means  by  whicli  the  operation  could  be 
satisfactorily  performed  have  been  detailed, 
with  a  view  of  aiding  the  practitioner  in  ur- 
gent cases  where  the  complete  apparatus 
could  not  be  obtained.  However,  what 
results  have  been  accomplished  as  already 
stated,  the  saving  of  thirty  or  more  human 
lives,  have  with  some  exceptions  taken  place 
through  ni)'  own  individual  endeavors. 
Many  human  beings,  as  the  reports  of  the 
daily  press  have  indicated,  have  been  allow- 
ed to  die  when  preventative  means  existed 
which  the  members  of  the  medical  profes- 
sion could  have  utilized,  had  they  only 
taken  advantage  of  the  statements  and  facts 
freely  presented  to  them.  It  may  not  be 
entirely  truthful  to  state  that  the  medical 
profession  in  America  is  ultra-conservative 
re^ardinCT  the  use  of  "  new  methods,"  in  the 
face  of  the  wild  furore  over  tuberculin  or 
the  Brown- Saquard  Elixir,  The  latter 
quickly  settled  itself,  and  the  former  the 
best  authorities  now  appear  to  discredit  as 
anything  of  a  specific  for  tuberculosis.  How 
has  it  treated  forced  respiration  }  —  in  its 
success  an  entirely  American  idea,  and 
which  from  the  first  intelligent  application 
gave  results  that  could  not  be  questioned 
by  even  those  inclined  to  be  jealous  and 
unfriendly  }  It  has  not  even  been  made  the 
subject  of  special  comment  in  the  medical 
institutions  of  the  day  ;  so  that  the  gradu- 
ates in  Medicine  of  but  few  colleges  in  the 
land  are  intelligently  qualified  to  carry  it 
out,  and  medical  practitioners  are  not  pre- 
pared to  use  it  or  apply  it  when  supplied 
with  the  apparatus.  This  was  quite  inter- 
estingly demonstrated  in  Case  No.  25  at 
a  time  when  I  was  unable  to  attend,  and 
sent  my  young  nephew  with  the  apparatus 
to  assist  two  regular  practitioners  in  the 
saving  of  a  human  life  from  opium  narcosis. 
Although  both  residents  of  my  native  city, 
and  the  methods  of  forced  respiration  being 
very  simple,  these  gentlemen  were  not 
sufficiently  well  acquainted  with  the  simple 
details  of  the  apparatus  to  use  it  intelli- 
gently. My  student,  a  young  man  about 
16  years  of  age,  having  seen  it  frequently 
in  use,  assumed  charge,  and  saved  the  lady 
by  his  efforts.  I  only  speak  of  this  to  show 
that  simple  methods  require  more  or  less 
study  and  consideration  on  the  part  of  any- 
one, even  capable  physicians,  who  desires 


104 


THE  CANADA   MEDICAL   RECORD. 


to  use  them  intelligently ;  and  I  deprecate 
most  fully  the  assertion  of  Prof.  Horatio  C. 
Wood,  that  any  method  upon  which  the 
life  of  a  human  being  may  hinge  may  be 
used  by  "  unskilled  persons." 

Through  the  simplicity  of  the  methods 
which  may  be  utilized  in  forced  respiration 
which  have  been  brought  to  our  present 
knowledge  through  my  own  efforts  consists 
its  greatest  v^alue  to  mankind  —  the  saving 
of  the  life  of  many  human  beings  has,  how- 
ever, been  accomplished  in  my  hands,  only 
by  the  skillful  use  of  an  apparatus  specially 
adapted  for  use  upon  man,  and  through 
practical  knowledge  which  it  has  taken  me 
some  years  to  become  satisfactorily  ac- 
quainted with. 

Another  instance,  which  indicates  that 
medical  press  notices  and  publication  in 
State  Association  Transactions  will  not  suf- 
fice to  impress  upon  the  profession  the  value 
of  forced  respiration  as  a  life-saving  factor, 
was  instanced  in  the  case  of  CarlyleW.  Har- 
ris,* convicted  of  the  murder  of  his  young 
wife, Helen  Potts,  through  the  administering 
of  morphia  in  fairly  large  doses.  In  one 
report  of  the  case,  it  is  claimed  that  young 
Harris  desired  or  suggested  to  the  physician 
who  was  attempting  to  resuscitate  the 
young  woman,  that  he  make  tracheotomy, 
having  a  vague  idea  only  of  its  use.  The 
physician  appeared  to  know  nothing  about 
the  method.  In  this  one  instance,  I  have 
no  hesitancy  in  stating  that  the  life  of  the 
young  woman  could  have  been  saved  by  my 
method  of  forced  respiration,  and  in  the 
event  of  the  execution  of  Harris  (which  did 
take  place),  we  will  have  to  record  two  lives 
lost  through  what  will  be  some  ofthese  days 
almost  criminal  ignorance  of  physicians. 

The  public  press  is  almost  daily  record- 
ing cases  of  death  from  narcotic  poisoning 
or  from  drowning,  in  which  the  old  methods 
have  failed.  Why  not  try  something  better, 
which  has  succeeded  time  and  again  where 
they  have  failed  and  must  frequently  fail  ? 

Regarding  the  question  of  the  originality 
of  my  method.  Prof.  H.  C.  Wood  has  given 
the  impression  through  his  statements  be- 
fore the  Berlin  Congress,  that  the  apparatus 
I  used  was  similar  to  that  used  in  the 
laboratory  upon  lower  animals,  so  that  Dr. 
John  O'Dwyer,  of  New  York,  has  given  pub- 
lic utterance  to  the  statement  which  Dr. 
Wood    first  and,  I  think,    unwarrantably, 

•  Subsequently  electrocuted  at  Sing  Sing,  N.Y. 


urged.  In  an  article  in  answer  to  Dr.  O'Dwyer 
on  the  improved  method  of  performing  arti- 
ficial respiration  (see  Archives  of  Pediatrics, 
May,  1892).  I  show  nine  marked  practical 
features  of  difference  between  the  apparatus 
which  I  have  used  successfully  and  the 
laboratory  apparatus  with  which  I  saved 
my  first  life  by  forced  respiration.  I  quote 
from  my  answer  as  follows  : 

"  That  used  in  my  laboratory,*  before  I 
devised  my  forced  respiration  apparatus 
for  use  upon  man,  consisted  of  a  large  foot 
bellows,  a  rubber  tube  to  connect  it  with  a 
large  brass  tracheotomy  tube  supplied 
Avith  a  valve,  which  had  to  be  turned  by 
hand  to  let  the  air  pass  into  the  lungs,  and 
turned  in  the  opposite  direction  to  let  it 
pass  out. 

''  With  this  arrangement,  each  time  the 
valve  was  turned,  for  the  inspiration  as 
well  as  the  expiration,  the  trachea  was 
given  a  wrench.  I  have  found  that  it 
makes  a  great  difference  whether  you  are 
wrenching  the  trachea  of  a  dog  or  a  living 
human  being.  I  overcorrie  this  feature  of 
the  laboratory  apparatus  by  making  my 
tracheotomy  tube  and  the  valve  which  con- 
trolled the  air-column  in  separate  parts,  con- 
necting them  by  flexible  rubber  tubing. 
This  would  permit  the  patient  to  move 
about  without  endangering  the  trachea. 
This  may  be  noted  as  t\\Q  first  feature  dif- 
fering from  the  laboratory  apparatus. 

'•  In  the  laboratory  apparatus,  the 
trachea  had  to  be  ligated  around  the  tube, 
as  Dr.  O'Dwyer  states,  but  not  so  in  my 
apparatus.  To  prevent  this,  I  screw  to  the 
tracheal  end  of  the  tube  a  larger  or  smaller 
ring,  according  to  the  size  of  the  trachea, 
which  fills  up  the  trachea,  preventing  an 
excess  of  air  from  passing  out  by  the  side 
of  the  ring, 

''This  is  the  second  novel  feature  of  dif- 
ference from  laboratory  methods. 

"  Again,  I  made  the  connection  between 
the  flexible  rubber  tube  and  the  tracheot- 
omy tube,  so  that  it  could  be  easily  and 
quickly  disconnected.  This  is  an  impor- 
tant feature,  and  constitutes  \\i^  third  fea- 
ture of  difference  between  my  own  and  the 
laboratory  methods. 

"  The  valve  \\'hich  controls  the  air  also 
has    some  valuable  features  :       i.  With  it, 


*  Medical   Department     Niagara    University,  Buffalo, 

N.Y. 


THE   CANADA    MEDICAL   RECORD. 


lOS 


the  air  can  pass  into  and  out  of  the  kings 
at  all  tinies,  except  during  the  forcible  in- 
spiration. Fourth  and  fifth  differences  from 
that  of  the  laboratory  apparatus.  2.  The 
air  from  the  bellows  is  constantly  passing 
through  the  valve  during  expiration,  thus 
allowing  the  air  to  immediately  enter  the 
lungs  from  the  air-valve  when  the  piston 
is  pressed  down,  without  traversing  the 
whole  length  of  tube  from  bellows-  With 
this  arrangement,  auto-respirations  can  be 
assisted  instead  of  interfered  w^ith, — a  factor 
of  importance  in  many  cases  I  have  met 
with. 

"This  marked  the  sixth  and  seventh 
differences  between  my  apparatus  and 
that  used  in  the  laboratory. 

"  In  the  construction  of  the  bellows  I 
used  a  diaphragm  of  rubber  dam  (now  a 
double  bellows  without  perishable  rubber), 
which  equalized  and  produced  a  steady 
instead  of  an  interrupted  or  jerky  column 
of  air,  such  as  Prof.  H.  C  Wood  provides 
in  his  so-called  "  cheaper  apparatus,"  al- 
though I  used  even  a  more  simple  appara- 
tus previously  with  common  bellows. 
Here  we  have  the  ^/V/////  difference  between 
my  own  and  the  laborator}-  apparatus. 

"  If  I  wish  to  present  still  more  features 
of  difference,  I  might  include  the  air-heater, 
which  I  also  have  used  upon  cases  of  resus- 
citation of  human  beings.  The  eight 
features  of  difference  mentioned  above  will, 
I  trust,  put  a  quietus  upon  the  question  of 
similarity  between  my  own  and  the  labor- 
atory apparatus.  What  I  have  accom- 
plished has  resulted  from  careful  attention 
to  the  details  o{ practical  import  associated 
with  an  operation  which  holds  human  life 
in  the  balance,  not  by  slipshod  methods 
which  have  in  the  past  relegated  this  opera- 
tion to  oblivion.  If  the  saving  of  over  thirty 
human  lives — the  record  of  results  with 
which  my  work  must  so  far  be  credited — 
is  not  an  argument  in  support  of  my  state- 
ments, what  '•  under  the  stars"  does  or 
will  give  credence  to  human  utterance  ? 
However,  I  have  overlooked  another  dis- 
similarity between  the  laboratory  appa- 
ratus and  my  own, — the  face-mask — which 
brings  the  operation  within  the  reach  of 
the  instructed  unprofessional.  Of  course, 
the  face  mask,  everyone  will  admit  who 
knows  nothing  about  it,  w^as  used  in  the 
laboratories  in  the  days  of  Galen.  With- 
out joking,    however,  this    constitutes  the 


ninth  marked  difference  between  the  labora- 
tory apparatus  and  my  own.  and  yet  Dr. 
O'Dwyer  does  what  appears  to  me  an  in- 
justice, in  speaking  of  the  ti^'o  as  being 
identical.  1  desire  to  state  that,  notwith. 
standing  an  experience  in  laboratory  vivi- 
section work  for  eight  years  prior  to  my 
first  operation  of  forced  respiration  upon 
man;  it  was  not  until  \.\i\s  first  operation 
that  I  was  enabled  to  conceive  its  great 
value.  All  my  experiments,  the  gradual 
unfolding  through  operations  upon  living 
Jiuman  beings  of  the  value  of  the  face-mask, 
should  give  weight  to  my  words  above 
those  resulting  from  experimentation  upon 
dogs ;  the  conditions  are  very  different. 
All  that  experimentation  upon  dogs  has 
revealed  as  to  the  value  of  forced  respira- 
tion in  saving  life  /  had  previously  demon- 
strated upon  living  human  beings  ;  when  I 
began  my  work,  as  stated,  it  was  not  even 
known  that  it  would  save  a  dog's  life. 
Now  a  few  words  with  reference  to  the 
evolution  of  the  face-mask.  I  had  begun 
the  operation  of  tracheotomy  upon  one  of 
my  patients,  when  my  attention  was  called 
to  the  fact  that  he  was  dying,  the  dilata. 
tion  of  asphyxia  taking  place.  I  imme- 
diately placed  the  tube  of  the  apparatus  in 
his  mouth,  closed  the  lips  about  it,  and 
compressed  the  nostrils  ;  inspiration  then 
being  produced,  I  was  pleased  to  find  the 
purple  deoxygenized  blood  in  the  tra- 
cheotomy incision  change  to  a  bright  scarlet 
I  had  many  demonstrations  of  this  charac- 
ter following,  which  gave  me  the  idea  of 
the  face-mask.  Having  a  rubber  cup  used 
for  cupping  purposes,  I  fitted  it  to  the  face 
and  saved  several  lives  with  it  without 
tracheotomy,  before  preparing  the  one  I 
now  use." 

(To  be  ContinuLd.) 

gocictg    j|roceebin0S. 


PROVINCIAL  BOARD  OF  MEDICINE. 

The  half-yearly  meeting  of  the  College  of 
Physicians  and  Surgeons  of  the  Province  of 
Quebec  was  held  on  Wednesday,  the  27th 
September,  1893,  in  the  rooms  of  the  Medical 
Faculty  of  the  University  of  Laval,  Quebec. 

In  the  absence  of  the  President,  the  Hon.  [. 
J.  Ross,  M.D.,  who  was  unwell,  Dr.  L.  J.  A. 
Simard,  Vice-President  for  Quebec,  took  the 
chair,  at  10 -o'clock  precisely. 


io6 


THE   CANADA   MEDICAL   RECORD. 


The  Governors  present  were  Drs.  F.  W. 
Campbell,  Vice-President  for  Montreal  ;  A.  G. 
Belleau  and  A.  T.  Biosseau,  Secretaries  ;  A. 
Dagenais,  Treasurer ;  and  J.  M.  Beausoleil, 
Registrar  ,:  A.  Vallee,  W.  A.  Verge,  C.  S.  Parke, 
A.  A.  ^Vatters,  Leonidas  Larue.  C.  E.  Lemieux, 
Come  Rinfret,  L.  T.  E.  Rousseau,  P.  M.  Guay, 
Alfred  Morisette,  J.  M.  McKay,  R.  Craik,  J.  B. 
McConnell,  the  Hon.  D.  Marcil,  J.  B.  Gibson, 
P.  Cartier,  R.  Latraverse,  H.  Cholette,  P.  J.  L. 
Bissonnette,  F.  Pare,  Thos.  Larue,  F.  J.  Austin, 
E.  C.  P.  Chevrefils  and  L.  A.  Plante. 

The  minutes  of  the  last  meeting  were  read  I 
and  adopted,  excepting  that  it  was  resolved  to 
add  the  words  "  not  sworn  "  (jxis  asscrmcnte) 
opposite  the  name  of  Mr.  Lucien  Miller,  gra-  \ 
duaie,  who  is  there  inscribed  as  having  his 
license;  Dr.  Beausoleil,  the  Registrar,  having  it 
still  in  his  possession. 

Letters  from  the  Hon.  J.  J.  Ross,  M.D-,  and 
Dr.  J.  H.  L.  St.  Germain  were  read,   regretting    i 
their  inability  to  be  present  at   the  meeting,  on 
account  of  their  being  too  unwell. 

As  some  of  the  members  of  the  Board  had 
suggested  that  the  examiners  for  the  preliminary 
examination  should  meet  together  some  days 
in  advance,,  to  come  to  an  understanding  relative 
to  the  questions  to  be  put  at  the  examina-  : 
tion,  a  letter  from  the  Rev.  Mr.  Laflamme  was 
read,  asking  the  advice  of  this  Board  on  the 
subject.  It  was  decided  that  a  meeting  was 
unnecessary.  I 

Dr.  J.  B.   McConnell  was   named  a  member   ' 
of  the    Board,     representing     the    Faculty    of 
Medicine  ot  Bishop's  College,    in  the  place  of 
Dr.  James  Perrigo,  who  has  resigned.  ! 

The  reports  of  the  Assessors  of  the  Laval 
University  (Quebec  and  Montreal^  were  read 
and  adopted. 

The  reports  of  the  Examiners  for  the  pre- 
liminary exarriination  were  read  and  adopted.  '■ 
Thirty-one  candidates  presented  themselves,  : 
and  ten  were  admitted.  The  following  are 
their  names  : —  Messrs.  J.  H.  L.  Page,  W,  S. 
Picotte,  Ashton  Kerr,  Edgar  Cassegrain, 
Arthur  Lucier,  D.  Romuald  Picard,  Oswald  H. 
LetourneaU;  Fred.  H.  Wainwright,  Wm.  Kerr 
Brown  and  Jos.  E.  A.  Poliquin. 

The  followingBachelors  were  admitted  to  the 
study  of  Medicine,  after  havijiig  been  sworn  on 
their  respective  diplomas  : — Messrs.  Alfred 
Simard,  B.L.,  C  Eugene  Parrot,  B.S.,  Wilfred 
Lamay,  B.S.,  Achille  Comptois,  B.A.,  Henri 
Larue,  B.S.,  F.  H.  Pelletier,  B.  A.,  Achille  Bois- 
vert,  B.A.,  Henri  Lafleur,  B.S.,  Joseph  Pageau, 
B.S.,  Marc  Rudeau,  B.L  ,  Arthur  Poirier,  B.A., 
Elias  Groulx,  B.L.,  George  Cartier,  B.S.,  F.X. 
Massicotte,  B.A.,  Calixte  Ethier,  B.L.,  Ernest 
Primeau,  B.S.,  F.  X.  Duplessis,  B.S.,  Olivier 
Tourigny,  B.S.,  H.  Lennon,  B.A.,  L.  J.  A.  Noi- 
seux,  B.S.,  Elzear  Duguire,  B.S.,  Hormisdas 
Deschambault,  B.L. 


'J'he  report  of  the  Committee  Oji  Credentials 
was  read,  recommending  that  the  license  be 
given  to  the  following  graduates,  who  received 
it,  after  having  been  duly  sworn  on  their  re- 
spective diplomas  : — 

Laval  University^  Quebec. — Michel  Thomas 
Blais.  Louis  Alfred  Frechette,  F.  X.  Jules 
Dorion,  Gustave  Bacon,  Joseph  Eugene 
Mathieu,  Albert  Alphonse  Jobin. 

Laval  University^  Montreal. — Aurele  Na- 
deau,  Francois  Plourde,  Jos.  George  Elzear 
Miviile-Dechene,  E.  R.T.Larue,  L.  O.  Bourni- 
val,  J.  T.  Arthur  Gauthier,  Isidore  Laviolette. 
Henri  Lesage,  L  Z.  Lajoie,  L.  A.  Lacombe, 
O.  C.  Milot,  G.  E.  Landry,  F.  X.  Renaud,  G. 
C.  F.  Schiller,  Jules  Jehin-Prume,  H.  Denis, 
Victor  Geofifrion,  Pierre  Barrette,  J.  E.  Ger- 
vais,  R.  Daze,  Zenophile  Beauchamp,  J.  P. 
Gagnon,  Eugene  Lafontaine. 

McGill  University. — J.  W.  A.  Seguin,  J.  ^\'. 
Lawrence,  T.  P.  Shaw,  J.  A.  Henderson,  W.  J. 
Decks,  P.  H.  Phillemore. 

Edinburgh  University. — Walter  Scott. 

On  the  motion  of  Dr.  Dagenais,  seconded  by 
Dr.  Guay,  it  was  resolved  that  Mr.  F.  X. 
Lemoine  DeMartigny  should  be  allowed  to  take 
the  oath  upon  presentation  of  his  diploma  of 
Doctor  of  Medicine  of  Laval  University  at 
Montreal,  which  is  not  ready  to-day. 

The  Committee  on  Credentials  makes  this 
further  report: — That  Messrs.  F.X.  Plouffe 
and  J.  A.  Lapierre,  who  were  lawfully  admitted 
to  the  study  of  Medicine  in  September,  1889, 
and  who  have  presented  a  diploma  of  Doctor  of 
Medicine  dated  in  April,  1892,  that  is  to  say, 
obtained  before  the  fourth  session,  that  they 
shall  only  obtain  their  licenses  on  proving  that 
they  have  followed  the  course  of  Medicine 
during  their  fourth  year,  and  by  undergoing  a 
further  examination  before  this  Board. 

These  two  gentlemen  having  obtained  from 
Dr.  Kingston  a  certificate  of  attendance  at  the 
indoor  and  outdoor  clinic  cf  Laval  University 
during  their  fourth  year,  it  is  resolved  that  they 
be  allowed  to  undergo  the  professional  ex- 
amination. 

Mr.  A.  G.  Ferguson,  of  Vancouver,  admitted 
to  the  study  of  Medicine  in  1884,  and  graduated 
in  1887  at  Queen's  University,  makes  applica- 
tion for  a  license. 

Proposed  by  Dr.  Dagenais,  seconded  by  Dr. 
Rousseau,  and  resolved  that  this  Board  does 
not  accord  a  license  to  Mr.  Ferguson  without 
an  examination. 

Mr.  Eugene  Ferron,  undergraduate,  is  also 
referred  to  the  Committee  of  Professional  Ex- 
amination named  by  the  President. 

The  meeting  adjourned  at  12.15  '^o  ^-3°  P-i'"''- 

Afternoon    Meeting. 

The  President/;-£»  teni  took  the  chair  at  2  p.m. 
The    Examination    Committee   reports   that, 


THE  CANADA   MEDICAL   RECORD. 


lo: 


Messrs.  Ferguson,  Plouffe  and  Lapierre  have 
successfully  passed  the  professional  examina- 
tion before  the  sj)ecial  committee  appointed  by 
the  Board,  and  that  the  license  be  given  to 
them.     Mr.  Ferron  is  refused. 

In  the  absence  of  Dr.  St.  Germain,  confined 
to  his  house  by  illness,  Dr.  Bissonnette  laid  on 
the  table  a  series  of  amendments  to  the  pro- 
jecteJ  Medical  Bill,  but,  as  a  large  number  of 
propositions  of  very  great  importance  are 
before  the  chair,  he  did  not  press  the  reading 
of  tliese  amendments  at  present,  but  hoped 
that  in  the  month  of  May  next,  Dr.  St.  Germain 
would  be  able  himself  to  explain  the  advantages 
offered  by  these  amendments. 

Di.  Dagenais  gave  notice  that  at  the  nest 
meeting  of  the  Board  he  would  propose  : — 

1.  That  the  members  of  this  Board  shall 
receive  for  each  day's  attendance  the  sum  of 
ten  dollars  and  their  travelling  expenses. 

2.  That  the  President  be  authorized  to 
administer  the  oath  to  those  who  take  their 
license  and  their  degree  the  day  before  the 
meeting,  after  the  session  of  the  Committee  on 
Credentials. 

3.  That  the  two  Secretaries,  the  Registrar 
and  the  Treasurer  receive  annually  a  fee  of 
two  hundred  and  fifty  dollars. 

4.  That  Bachelors  who  have  a  right  to  their 
matriculation  without  examination  have  the 
oath  administered  to  ihem,  either  at  Montreal 
or  Quebec,  at  least  eight  days  before  the  meet- 
ing of  the  Board,  by  one  of  the  Secretaries, 
who  shall  make  a  report  at  each  meeting  of  the 
number  and  the  name  of  these  Bachelors. 

Dr,  Bissonnette  asked  the  following  ques- 
tions :- 

1.  Have  the  Secretaries  forwarded  to  each 
licensed  physician  a  copy  of  the  Statutes  and 
Rules  of  the  College? 

Reply. — No.  There  only  remain  twelve  or 
thirteen  copies. 

2.  Have  the  Secretaries  forwarded  to  each 
licensed  physician  the  reports  of  the  proceed- 
ings of  each  sitting  of  the  Board,  containing 
also  the  names  of  those  newly  admitted  to 
degrees  and  licenses,  andof  midwives  ? 

Reply. — No,  because  no  copies  remain  of 
the  medical  register.  For  the  last  year  and  a 
half  the  reports  of  the  meetings  have  been  pub- 
lisl.ed  in  the  Union  Medicale,  and  Dr.  Guay 
adds  that  all  the  members  of  the  Board  receive 
this  journal. 

3.  Has  the  medical  register,  giving  the 
names  of  all  physicians  licensed  and  not 
licensed  in  the  Province  of  Quebec,  been 
published  and  distributed  among  the  members 
of  the  profession  ? 

Reply. — Dr.  Beausoleil,  the  Registrar,  re- 
plies that  he  is  about  to  prepare  an  alphabetical 
table  of  the  names  of  all  licensed  physicians, 
and  that  then  the  statutes  and  rules,  as  well  as 


the  proceedings  of  the  meetings,  will  be  regular- 
ly distributed. 

It  was  then  unanimously  resolved  that  the 
Board  authorizes  the  Registrar  to  have  printed 
an  extract  of  the  register  giving  the  names  of 
all  licensed  physicians  in  the  Province. 

Dr.  BeausoK  il  read  the  following  report  of 
the  Committee  on  Medic  al  Legislation  : — 

PR0V1NCLA.L  Board  of  Medicine. 

COM.MnTEE  ON  MKDICAL  LEGISLATION. 

Mr .  President  and  Members  of  the  Provincial 
Board  of  Medicine. 

I  have  the  honor  to  present  to  you  the  re- 
port of  the  Commiitee  on  Legislation  appointed 
by  you   at  the  half-yearly  meeting  in  Alay  last. 

Your  Commiitee  sat  on  the  7th  of  June  and 
on  the  5th  of  July  last. 

'{'he  labors  of  your  Committee  have  been 
directed  towards  the  creation  of  a  Provincial 
Board  of  Examination,  with  the  object  of 
obtaining  reciprocity  of  licensing  with  Ontario, 
of  protecting  the  profession,  and  of  gaining  in- 
formation. 

After  considerable  discussion,  Dr.  Rottot, 
delegate  of  the  Medical  Faculty  of  the  Univer- 
sity of  Laval  at  Montreal,  suggested  to  the 
Committee  to  think  over  the  following  proposi- 
tion, seconded  by  Dr.  Chevrefils  :  — 

1.  To  augment  the  powers  of  the  Assessors 
of  the  Medical  Faculties  of  the  Province. 

2.  To  increase  the  number  of  the  Assessors 
pro  rata  to  the  number  of  Committees  of  Ex- 
amination of  the  Medical  Faculties,  up  to  a 
complement  of  six. 

3.  To  permit  the  Assessors  of  the  Medical 
Board  to  interrogate  those  candidates  whose 
examination  has  appeared  to  them  to  have  been 
unsatisfactory. 

This  proposition,  submitted  to  the  Univer- 
sities and  to  the  Faculties  of  Medicine,  has  re- 
sulted in  the  following  replies  : — 

Universite   Laval, 
Quebec,  i6th  June,  1893. 

Dr.  Simard,  Professor  Universite  Laval  : 

Sir, —  In  reply  to  the  enclosed  communica- 
tion of  the  Committee  on  Medical  Legislation, 
Monseigneur  the  Rector  desires  me  to  say  that 
Laval  University  has  no  objection  to  the 
Assessors  interrogating  the  candidates  at  the 
examinations  of  Bachelor  of  Arts  and  of  Doctor 
of  Medicine. 

With  respect,  I  remain,  &c.,  &:c., 

J.  C.  K.  Laflamme, 
Secretary  Laval  University 

Dr.  Rottot  makes  known  the  position  of  the 
Faculty  which  he  represents  as  follows  : — 


loS 


THE  CANADA  MEDICAL  RECORD. 


School   of   Medicine   and  Surgery  of 

Montreal,    Medical    Faculty    of     Laval 

University,  Montreal, 

Montreal,  istjuly,  1893. 
Dr.  Brosseau,   Secretary     to    the    Provincial 
Board  of  Medicine,  Quebec  : 

Mr.  Secretary, — In  the  event  of  Dr.  Rottot, 
representative  of  the  Medical  Faculty  of  Laval 
at  Montreal,  being  unable  to  be  present  at  the 
meeting  of  the  5th  July  of  the  Committee  on 
iSledical  Legislation,  and  lo  make  a  report  in 
the  name  of  the  Faculty,  1  beg  lo  inform  you 
officially  that  the  moticn  Roitot-CluWrefils, 
adopted  by  the  aforesaid  Commiitee,  has  been 
submitted  to  the  Laval  Faculty  of  Montreal  on 
the  15th  and  20th  June,  1893,  and  has  been 
adopted. 

Wiih  r(s])ect,  I  beg  to  remain,  &c.,  &:c., 
H.  F.  DesROSiERs, 

Secretary. 
E.  M.  &  C.  of  Monireal,  Fac.  Med.  Univ.  Laval. 

Dr.  R.  C  raik  reported  verbally  that  McGill 
University  refused  to  give  to  the  Assessors  of 
the  Medical  Board  the  power  to  interrogate  the 
candidates  at  the  examination  in  Medicine. 

Dr.  McConnell,  representative  of  Bishop's 
College,  reported  that  it  had  been  impossible 
to  have  a  meeting  of  the  Faculty,  but  that  he 
was  under  the  impression  that  his  University 
would  oppose  any  increase  in  the  powers  of 
the  Assessors. 

On  the  proposition  of  Dr.  Gibson,  seconded 
by  Dr.  Brosseau,  the  Committee  approved  of 
the  proposition  RottotChevrefils,  and  referred 
it  to  the  Medical  Board  at  its  semi-annual 
meeting  of  September. 

The  votes  in  favor  of  this  resolution  were  ; — 
Hon.  Dr.  Marcil,  Drs.  Rottot,  Brosseau, 
Chevrefils,  Simard,  Gibson  and  Beausoleil. 
Against  this  resolution  : — Drs.  Craik  and  Mc- 
Connell. 

It  was  then  proposed  by  Dr.  Brosseau, 
seconded  by  Dr.  Chevrefils  :  That  in  the  event 
of  the  motion  Rottot-Chevrefils  not  being 
carried.  Dr.  Simard  be  requested  to  forward  to 
the  Committee  of  Legislation  his  proposition 
relative  to  the  facilitating  of  reciprocity  of 
license  between  this  Province  and  that  of 
Ontario. 

This  proposition  reads  as  follows  : 

W/tereas,  it  appears  that  the  Board  of  Medi- 
cine of  Ontario  would  be  disposed  to  accord 
reciprocity  to  the  diploma  of  licentiates  of  the 
College  of  Physicians  and  Surgeons  of  the  Prov- 
ince of  Quebec,  provided  that  this  diploma 
shall  have  been  obtained  by  an  examination 
held  by  the  Board  of  Physicians  and  Suigeons 
of  the  Province  of  Quebec. 

And  whereas,  in  consequence  of  the  uniform 
formula  of  the  diploma  of  the  license  of  the 
Board  of  the  Province  of  Quebec,  those  who 
have  already  passed,  or  who  shall   pass,  an  ex- 


amination before  the  said  Board  would  not  be 
able  to  prove  prima  facie  their  right  to  such 
reciprocity. 

Be  it  resolved,  that  tie  formula  of  the  license 
of  this  Board  shall  for  the  future  indicate  if  it 
has  been  conferred  upon  the  presentation  of  a 
Universi'y  diploma,  or  if  it  has  been  given  after 
an  examination  before  this  Board. 

And  moreover,  be  it  resolved  to  ask  the 
Medical  Board  of  Ontario,  and  of  the  other 
I'lovinces,  reciprocity  for  those  physicians  of 
the  Province  of  Quebec  who  are  of  the  latter 
class — that  is  to  say,  those  who  have  passed 
their  medical  examination  before  this  Board. 

The  whole  respectfully  submitted. 

Dr.  D.  Marcil,   President. 

Dr.  J.  M.  Beausoleil,  Secretary. 

Proposed  by  Dr.  Beausoleil,  seconded  by 
Dr.  A.  Dagenais,  and  unanimously  resolved, 
that  the  report  of  the  Committee  on  Legislation 
be  adopted. 

Proposed  by  Dr.  Beausoleil,  seconded  by  Dr. 
Dagenais,  and  resolved,  that  the  Secretaries  of 
the  Medical  Boaid  be  authorized  to  sign  an 
agreement  with  the  authorities  of  tlie  Univer- 
sities to  put  in  operation  the  Rottot  Chevrefils 
resolution,  adopted  by  this  Board,  which  reads 
a'j  follows  :--- 

"  To  permit  the  Assessors  of  the  Medical 
Board  to  interrogate  those  candidates  whose 
examination  shall  not  appear  to  them  to  have 
been  satisfactory." 

In  case  of  the  motion  Rottot-Chevrefils  not 
being  carried.  Dr.  Beausoleil  proposed,  se- 
conded by  the  Hon.  Dr.  Marcil : — 

1.  That  it  is  in  the  interest  of  the  public  to  as- 
sure to  the  peoj^le  of  this  Province  a  medical 
service  worthy  of  confidence. 

2.  That  it  is  the  duty  of  the  Council  of  the 
profession  (Medical  Board)  to  assure  itself  of 
the  scientific  proficiency  of  the  candidates  for 
the  diploma  of  practice  (license). 

3.  That  every  endeavor  to  obtain  the  ex- 
ercise of  this  power  of  control  has  been  frus- 
trated by  the  opposition  of  the  Medical 
Faculties. 

4.  That  all.  efforts  towards  reconciling  the 
interests  of  the  Universities  and  those  of  the 
public  and  of  the  profession  have  been  fruit- 
less (in  consequence  of  the  refusal  of  certain 
Faculties  to  conform  to  the  motion  Rottot- 
Chevrefils). 

5.  That  this  Beard  considers  that  it  is  he 
duty  of  the  Government  to  take  in  hand  the 
interest  of  the  people  in  general,  and  of  the 
profession  in  particular. 

6.  That  a  new  legislation  be  adopted,  so  as 
to  give  to  the  corporation  of  the  College 
of  Physicians  of  this  Province  the  control  of 
the  entry  of  its  future  members  (admissionto 
practice). 

Dr.  Beausoleil,  Registrar  of  the  College,  read, 


THE  CANADA  MEDICAL  RECORR. 


109 


clause  by  clause,  the  notice  of  motion  given 
by  him  at  the  semi-annual  meeting  of  last  May 
to  the  Board. 

Proposed  by  Dr.  Beausoleil,  seconded  by 
Dr.  Dagenais,  and 

Resolved  (i).  That  the  fee  for  the  certificate 
of  admission  to  study  shall  for  the  future  be 
twenty  dollars  ($20),  in  place  of  ten  dollars 
($10). 

Resolved  (2),  That  the  fee  for  the  Provincial 
license  shall  be  forty  dollars  ($40).  in  place  of 
twenty  dollars  ($20). 

Resolved  (2a),  That  the  regular  fixed  meet- 
ing-) of  the  Board  of  Governors  shall  be  held 
the  first  Wednesday  in  July  and  the  last  Wed- 
nesday in  September  of  each  year ;  the  meet- 
ings in  July  in  the  City  of  Montreal,  and  those 
in  September  in  the  City  of  Quebec. 

Res'lved  (3),  Tiiat  the  following  subjects 
shall  be  part  of  the  programme  of  the  examina- 
tion for  admission  to  the  study  of  Medicine  : — 
Botany,  Chemistry,  Elementary  Physics  and 
Intellectual  Philosophy. 

Resolved  (4),  That  the  medical  studies  be 
modified  i^i  the  followmg  manner: — i.  Nor- 
mal Histology.  2.  Descriptive  Anatomy.  3. 
Practical  Anatomy.  4.  General  and  Special 
Physiology.  5.  Hygiene.  6.  General  Path- 
ology. 7.  Medical  Chemistry,  Theoretical  and 
Practical.  8.  Internal  Pathology.  9.  Exter- 
nal Pathology.  10.  Materia  Medica  and 
Therapeutics,  Practical  Pharmacy.  11.  Ob- 
stetrics and  Pathology  of  Early  Infancy.  12. 
To  have  been  present  at  at  least  twelve  con 
finements  at  a  maternity  hospital,  and  to  have 
followed  a  course  of  clinical  obstetrics  of  forty- 
two  lessons,  or  two  courses  of  twenty-four 
lessons.  13.  Medical  Clinics  and  Surgical 
Clinics,  three  courses  of  eight  months,  or  four 
courses  of  six  months,  in  an  hospital  containing 
at  least  fifty  beds  for  each  of  the  subjects.  T4. 
Medical  Jurisprudence.  15.  Instruction  at  the 
Morgue.  16.  Mental  and  Nervous  Diseases. 
17.  Diseases  of  Children  or  Paediatrics.  18. 
Gynaecology.  19.  Histology,  Pathology  and 
Bacteriology.  20.  Operative  Medicine  and 
Minor  Surgery.  21.  Medical  History  and 
Medical  Ethics.  22.  Ophthalmology  and 
Otology.     21.     Rhinology  and  Laryngology. 

That  the  professional  examination  made  by 
the  Facuhies  and  the  Board  shall  be  conformed 
to  the  above  programme. 

Resolved  {e^'),  That  in  place  of  two  Assessors 
to  the  Faculties  of  Medicine,  the  Board  shall 
name  not  less  than  two  and  not  more  than  six 
Assessors  for  each  Faculty. 

That  in  future  the  Board  shall  only  supply 
Assessors  for  the  annual  examination  of  eacli 
Faculty. 

That  in  case  of  any  Faculty  wishing  to  have 
the  services  of  the  Assessors  for  a  supplemen- 
tary examination,  notice  must  be  given  thirty 
days  beforehand  to  the  Secretary  of  the  section 


to  which    it  belongs,  and  remit    the    amount  of 
the  fees  to  the  said   Assessors. 

The  Assessors  shall  have  the  right  to  be 
reimbursed  for  their  travelling  expenses,  and, 
moreover,  a  fee  of  ten  dollars  ($10)  for  each 
day  that  they  are  detained  by   their  duties. 

Resolved  (6),  That  it  shall  be  part  of  the 
duty  of  the  Assessors  to  be  present  at  the  ex- 
amination of  each  student.  Before  proceeding 
with  an  examination,  the  Assessor  shall  enter 
in  a  book  ad  hoc  the  names  and  surnames  of 
each  candidate,  the  date  of  his  certificate  of 
admission  to  study,  the  title  of  each  subject  for 
which  he  has  a  certificate  of  attendance,  and  he 
will  note  in  writing  his  observations  in  such  a 
manner  as  to  show  cause  for  his  report.  The 
notes  of  the  .Assessors  shall  be  the  property  of 
the  Medical   Board. 

Resolved  (7),  That  the  Assessor  shall  only 
hear  the  examination  of  such  candidates  as  shall 
have  fulfilled  the  following  conditions  :  For  the 
primary  examination,  he  must  have  a  certificate 
of  admission  to  study  for  the  space  of  at  least 
two  University  sessions  in  a  Faculty  of  Medi- 
cine recognized  in  this  Province,  conformably 
to  the  regulations  of  the  College  of  Physicians 
and  Surgeons  of  the  Province  of   Quebec. 

The  primary  examination  shall  include  Nor- 
mal Histology,  Descriptive  and  Practical 
Anatomy,  Bacteriology,  General  a^jd  Special 
Physiology,  Hygiene,  General  Patho  gy.  Medi- 
cal Chemistry,  Theoretical  and  Practical,  and 
Practical  Pharmacy. 

Any  candidate  who  shall  have  failed  in  Ana- 
tomy or  Physiology  shall  have  to  undergo  the 
entire  examination  afresh. 

Resolved  (8),  That  the  final  examination 
shall  include  Internal  and  External  Pathology, 
Materia  Medica  and  Therapeutics,  Obstetrics 
and  Pathology  of  Early  Infancy,  Medical  Juris- 
prudence and  Toxicology. 

No  candidate  shall  be  admitted  to  the  final 
examination  witliout  having  passed  his  primary 
examination  to  the  satisfaction  of  the  Assessors 
of  the  Provincial  Medical  Board. 

Resolved  {()),  That  the  following  subjects  of 
special  instruction  shall  be  part  of  the  examina- 
tion questions  in  the  practical  examination  : — 
Mental  and  Nervous  Diseases,  the  Diseases  of 
Children,  Pathological  Histology,  Gynaecology, 
Operative  Medicine  and  Minor  Surgery,  Oph- 
thalmology. Rhinology,  Otology  and  Laryngol- 
ogy- 
No  candidate  shall  have  the  right  to  pass 
this  final  examination  before  the  Assessors 
without  he  shall  have  studied  in  a  University 
during  at  least  four  sessions,  starting  from  the 
date  of  his  certificate  of  admission  to  study  : 
so  as  to  have  in  all  points  conformed  himself 
to  the  statutes,  rules  and  regulations  of  the 
College  of  P.hysicians  and  Surgeons  of  the 
Province  of  Quebec. 


I  lO 


THE   CANADA   MEDICAL   RECORD. 


Resolved  {id).  That  in  giving  notice  of  die  j   to  the  General  Hospital,  wliere  he  died.    Owing 


date  of  their  annual  examination,  the  Faculties 
shall  also  inform  the  Secretary  of  the  section  ' 
to  which  they  belong,  of  the  names  of  the  candi- 
dates for  examination,  both  primary  and  final. 
Resolved  ill),  That  the  Assessors  shall  only 
be  required  to  go  to  the  Faculties  when  the«e 
latter  shall  be  ready  to  pass  consecutively  ail 
the  students  who  shall  have  entirely  conformed 
to  the  requirements  of  the  statutes  and  regula- 
tions of  the  College  of  Physicians  and  Surgeons 
of  the  Province  of  Quebec. 

Proposed  by  Dr.  Beausoleil,  seconded  by 
Dr.  M.  Guay,  and  resolved,  that  Dr.  J.  A.  Du- 
chesneau,  of  Terrebonne,  be  named  a  member 
of  this  Board,  to  replace  the  late  Dr.  W.  Pre- 
vost. 

Proposed  by  Dr.  Beausoleil,  seconded  by 
Dr.  Dagenais,  that  the  resolution  adopted  by 
this  Board  in  May.  1892,  concerning  admission 
to  the  study  and  to  the  practice  of  medicine, 
enters  this  day  fully  into  force,  without  con- 
sideration for  the  permits  to  study  obtained  be- 
fore 1892,  and  that  the  Secretaries  of  the  Medi- 
cal Board  inform  all  the  medical  corporations 
of  the  Dominion  of  this  rule. 

That  the  present  resolution  shall  only  be 
applicable  to  those  Provincial  Boards  of  Medi- 
cine with  whom  the  Board  of  this  Province  lias 
not  established  reciprocity  of  license. 

Unanimously  adopted. 

Proposed  by  Dr.  Brosseau,  seconded  by  Dr. 
Beausoleil,  and  resolved,  that  the  following 
names  be  added  to  tliose  of  the  former  Assess- 
ors : — Drs.  J.  Gauthier,  H.  Choletie,  A.  R. 
Marsolais,  F.  Pare,  J.  Girouard,  P.  J.  L.  Bis- 
sonneite,  W.  Grignon,  J.  A.  Duchesneau,  J.  M. 
Beausoleil,  E.  P.  Lachapelle,  Come  Rinfret. 
C.  S.  Parke,  W.  A.  Verge,  P.  M.  Guay,  Thos. 
Larue. 

On  the  motion  of  Dr.  Guay,  seconded  by 
Dr.  Brosseau,  a  vote  was  passed  thanking 
Laval  University  for  the  gratuitous  use  of  their 
rooms. 

The  meeting  adjourned  at  4.15  p.m. 

—  Translatio'i  of  the  Official  Report  in 
V  Vnion  Medicale. 


THE  MONTREAL   MEDICO-CHIRUR- 
GICAL  SOCIETY. 
Stated  Meeting,  April  28///,  1893. 

James  Stewart,  M.D.,  President,  in  the 
Chair. 

Rupture  of  the  Pulmonary  Artery  —Dr. 
Wyatt  Johnston  exhibited  the  specimen, 
which,  he  said,  illustrated  a  very  frequent  mode 
of  sudden  death.  The  patient,  an  elderly  man, 
was  overtaken  suddenly  on  the  street  by  a 
haemorrhage,  and  when  seen  by  a  physician  was 
practically  in  a  dying  condition.     He  was  taken 


to  certain  features  of  the  case,  especially  owing 
to  the  body  not  being  identified,  an  autopsy 
was  ordered  by  the  coroner,  to  make  sure  of 
the  cause  of  death. 

A    quantity  of  blood  was  found  about    the 
mouth  and  fauces,  and  a  large  clot  lay  at  the 
back    of  the   pharynx.     Blood  was  found   in 
considerable    quantities    throughout  the  bron- 
chial   tubes,  and  also  in  the  finer  bronchi.     In 
the  right  lung  there  were  spots  of  haemorrhage 
into    the   lung,    small    pulmonary   apoplexies, 
apparently  due  to  the   rupture  of  little  blood 
vessels,   caused    by   extraordinary   respiratory 
efforts.     The  cause  of  death  was  easily  found. 
At  the  apex  of  the  left  lung,  which  was  adhe- 
rent to  the  pleura,  was  found  a  cavity  as  large 
as  a  goose-egg.    Springing  from  the  wall  of  the 
cavity  couid  be  seen  a  small  aneurysmal  sac,  at 
one  point  of  which  was   seen  a  rapture  which 
was  partly  closed   by  a  blood   clot.     An  inter- 
esting feature  was  the  state  of  the  lining  mem- 
brane of  the  cavil) ,  which  was  covered  with  a 
grayish,  ragged  material,  which  upon  removal 
left  a  smooth    membrane    behind,  evidently  a 
distinctly  pyogenic  membrane.     The  fibrinous 
flocculi  on  the  surface  were  evidently  the  results 
of  previous    haemorihages,    for    as    the    blood 
exuded  from  the  smaller  vessels  into  thisravity 
in  considerable  quantities  on  several  occasions, 
the  walls  became  covered  with  fibiin. 

This  form  of  lesion  is  the  commonest  cause 
of  death  from  pulmonary  haemorrhage,  the  other 
principal  causes  of  haemoptysis  being  rupture 
of  the  wall  of  an  artery  without  the  previous 
formation  of  an  aneurism,  or,  less  frequently, 
haemorrhage  from  the  granulating  membrane 
lining  the  cavity.  This  latter,  however,  is 
more  likely  to  give  rise  to  small,  slight  hasmorr- 
hages  than  to  serious  complications. 

This   case    further   shows   tlie  advantage  of 

doing  an  autopsy  on    persons    who  die    under 

mysterious  circumstances.     In  this  case  it  was 

thought   that   there  might  have  been  some  foul 

play,    some   chest    injury,  to  account    for    the 

haemorrhage;  but  when  the  result  of  the  autopsy 

f  was   made    known,  the    coroner  decided    that 

'  there  was  no  necessity  for  an  inquest. 

(       A  Case   of  Addison' s    Disease. — Dr.    A.  I). 

j  Blackader    showed    a  patient  suffering   from 

I  what  he   believed   to  be   Addison's   disease,  a 

disease  characterized  by  two  or  three  very  pro- 

'  minent  features  :  First,  a    discoloration    of  the 

I   skin,  wliich  in  this  patient  is  fairly  well  marked. 

More  than  that,  it  has  the  minute  spots  of  dis- 

\   coloration    which   have    been    pointed  out    by 

I   Greenhow  as  being  tolerably  characteristic.   He 

1   has  also,  on    the  front  of  the  chest,  pretty  well 

I   marked  patches  of  leukoderma.    The  symptoms, 

I  too,  are  fairly  characteristic.     The   [)atient  first 

I  entered  the    hospital    complaining   of  asthenia, 

breathlessness,    palpitation  on    slight  exertion, 

1   inability  to  walk  or  perform  woik  of  any  severe 


THK   CANADA   MEDICAL   RECORD. 


II  I 


kind.  A.I  prcst-.iu  he  is  scarcely  able  to  walk 
across  the  hospital  ward  without  getting  out  of 
breath.  There  is  also  associated  with  these 
symptoms  a  tolerably  moderate  amount  of 
anaemia,  his  blood  now  containing  only  2,500,- 
000  red  capsules  to  the  cubic  millimetre. 

One  other  symptom  which  has  been  put 
down  as  characteristic  this  man  has  not  yet  had, 
viz.,  symptoms  of  gastric  irritation ;  there  has 
been  no  vomiting,  no  diarrhoea.  Still,  consider- 
ing the  short  time  the  patient  has  been  complain- 
ing of  any  symptoms  at  all,  that  is  only  from 
about  the  middle  of  February,  we  are  scarcely 
warranted  in  expecting  the  disease  to  have 
reached  its  full  development. 

With  reference  to  the  treatment, Dr.  Blackader 
proposed  to  treat  the  case  by  feeding  with  finely 
minced  supra-renal  capsules.  He  was  led  to 
do  so  by  the  similarity  which  can  be  traced 
between  this  disease  and  rayxadema,  which 
similiarity  is  especially  touched  on  by  Dr. 
C)sler.  In  both  we  have  distinct  histological 
changes  met  with  in  the  tissues,  being  in  the  one 
an  increase  in  the  mucin,  in  the  other  an  in- 
crease in  the  pigment  of  the  cells;  and  ihey  are 
both  accompanied  by  marked  nervous  pheno- 
mena. In  myxoederaa  we  have  mental  dullness, 
in  Addison's  disease  ])rofound  asthenia.  We  may 
also  trace  the  likeness  still  further,  when  we 
come  to  consider  the  history  of  the  respective 
glands  which  give  rise  to  them.  In  myxoedema, 
before  the  connection  was  made  out  between  it 
and  the  removal  of  the  thyroid,  it  was  stated  that 
that  gland  was  of  no  account  in  the  economy, 
and  that  it  could  be  removed  without  giving  rise 
to  any  serious  symptoms.  Now,  the  same  thing 
has  been  alleged  of  the  supra-renals,  and  the 
question  is  whether  they  have  any  use  in  the 
economy,  and  whether  their  administration  by 
the  mouth  will  prove  of  any  service  in  cases 
where  the  glands  themselves  are  diseased. 

Dr.  MiGNAULT  referred  to  a  case  of  this  kind 
which  had  occurred  many  years  ago  in  the 
General  Hospital  under  the  care  of  Dr.  Osier, 
The  patient,  a  young  man,  was  brou  ht  there 
with  a  discoloration  of  this  kind  ;  everyone 
was  much  surprised  at  the  condition,  and  many 
theories  were  advanced  to  account  for  it.  Dr. 
Osier  finally  diagnosed  the  case  as  Addison's 
disease.  The  young  man  only  lived  three  or 
four  weeks.  Both  supra  renals  were  found 
diseased,  thus  confirming  the  diagnosis. 

Dr,  G.  P.  GiRDwooD  could  just  recollect  hav- 
ing seen  the  case  alluded  to,  and  as  far  as  he 
could  remember  the  color  was  very  much  the 
same  as  in  this  case. 

Dr.  Adami  briefly  noted  a  few  cases  of  the 
disease  which  he  had  the  opportunity  of  observ- 
ing. One  of  these  was  at  the  Addenbrooke's 
Hospital  at  Cambridge;  England,  a  young 
woman,  presenting  all  the  cardinal  symptoms  of 
the  disease,  who,  nevertheless,  to  the  surprise 
of  all,  recovered  under  the  arsenic  treatment. 


He  called  attention  to  an  autopsy  held  by  him 
at  the  General  Hospital  the  previous  week,  in 
which  one  supra-renal  had  become  a  caseous 
tubercular  mass,  the  other  being  unaffected,  and 
neither  the  history  of  the  patient  nor  the  post- 
mortem appearances  yielded  the  slightest  indica- 
tion of  Addison's  disease.  He  referred  to  this 
case  inasmuch  as  recently  there  had  been 
recorded  instances,  contrary  to  the  general  rule, 
of  Addison's  disease  associated  with  cancer,  etc., 
of  one  supra-renal.  He  agreed  with  Dr.  Blacka- 
der that  the  treatment  by  supra-renal  juice  was 
well  worthy  of  being  tried  ;  the  eminent  success 
of  Dr.  Murray's  plan  of  t-eatment  of  myxoedema 
by  thyroid  extract  rendering  it  advisable  that 
other  extracts  should  be  tested  in  other  more 
or  less  parallel  diseases,  though  he  deprecated 
the  excesses  that  were  already  being  recorded 
in  the  employment  of  body  juices. 

Dr.  FiXLEY  knew  of  two  cases  of  Addison's 
disease  which  had  occurred  at  the  General 
Hospital  within  a  few  weeks  of  each  other.  The 
first  case  \^  as  one  in  which  the  pigmentation 
was  very  marked,  as  the  patient  came  in  late 
in  the  disease.  There  was  excessive  nervous 
prostration,  vomiting  and  fever,  the  patient 
dying  in  a  few  days. 

The  other  case  was  one  in  which  pigmenta- 
tion was  absent,  and  therefore  it  was  not  possi- 
ble to  make  a  diagnosis  during  life.  Yet  the 
train  of  symptoms  was  markedly  similar  in  both 
cases — vomiting,  nervous  prostration,  delirium 
and  death. 

He  recollected  a  case  in  which  he  had  per- 
formed an  autopsy  for  the  late  Dr.  Howard. 
There  was  an  injury  involving  the  right  supra- 
renal, but  without  any  of  the  symptoms  of 
Addison's  disease, 

Dr,  Wyatt  Johxston  remembered  the  two 
cases  referred  to  by  Dr.  Finley,  and  which  were 
called  Addison's  disease  in  the  hospital.  One 
of  the  patients  showed  a  considerable  amount 
of  bronzing  of  the  skin ;  they  both  suffered 
from  diarrhoea,  vomiting,  nervous  prostration, 
and  died,  one  of  them  rather  suddenly.  He 
had  had  some  doubts  about  the  correctness  of 
the  diagnosis.  However,  they  have  been 
looked  upon  as  Addison's  disease  for  some^time. 
As  to  the  condition  of  the  supra-renals,  in  the 
one  case  there  was  slight  tuberculosis,  slight 
caseation  ;  in  the  other  there  v/as  none ;  at  all 
events,  they  were  obscure  cases,  certainly  not 
typical  ones.  He  had  examined  the  semi-lunar 
ganglia,  with  negative  results,  as  far  as  finding 
any  special  fibrosis  or  atrophy  of  the  nerves 
was  concerned. 

Dr.  KiRKPATRiCK.  referred  to  a  man  who 
came  to  the  hospital  complaining  of  general 
asthenia,  and  after  some  time,  developing 
illusions,  he  was  sent  to  the  Verdun  Hospital  for 
the  Insane.  The  asthenia  increased  until  the 
man  died,  but  shortly  before  death  he  developed 
marked  bronzing  of  the  face.     At  the   autopsy 


112 


THE  CANADA  MEDICAL   RECORD. 


the  only    lesion    thai  ^could  be   detected   was 
marked  caseation  of  one  supra-renal  capsule. 

Dr.  McCoNNELL  said  that  the  treatment 
which  Dr.  Blackader  is  about  to  try  seems  to 
be  in  keeping  with  the  principle  which  is 
supposed  to  exist,  viz.,  that  the  organs  of  the 
body  seem  to  be  amenable  to  their  own  secre- 
tions when  taken  as  remedies.  The  idea 
originated  in  Browu-Sequard's  elixir  of  life.  A 
great  djal  of  fun  was  made  of  Brown-Sequard 
at  the  time,  but  his  remedy  does  not  appear  to 
be  discarded  even  yet.  Some  short  time  ago 
Dr.  Hammond,  of  New  York,  announced  a  new 
remedy  for  heart  troubles,  which  he  calls 
■'  cardine,"  and  which  he  thinks  will  prove  a 
strong  tonic  for  weak  and  fatty  degenerated 
hearts.  All  have  read  of  the  effects  of  the  juice 
of  the  thyroid  gland  in  myxoedema,  which  is 
simply  carrying  out  the  same  idea  as  that  now 
about  to  be  tried  by  Dr.  Blackader.  We  all 
will  look  forward  anxiously  for  the  results  of 
this  application. 

Dr.  J.  E.  MoLSON  asked  if  slow  pulse   is  not 
a  sign  frequently  found  in  Addison's  disease. 

Dr.  Blackader,  in  answer  to   Dr.  Molson, 
said  that   in    all  the  literature  he  had  read  on 
this  subject    he  had    not    noticed    any    such 
symptoms  dwelt  upon.     Wiih    reference  to  the 
cases  Ur.  Adami   alludes  to   of  onj  gland  only 
being  affected,  he  understood  that  both   glands 
are  invariably    affected    in    Addison's    disease. 
However,  it  is  most  likely  one  gland  becomes 
involved  before  the  other,  so  in  the  post-mortem 
room   one  supra-renal  may    be  found   to  have 
undergone  destruction,    while  its  fellow  is  only 
in  the  early   stage.     Both   Addison  and  Wilkes 
and    others  in  Guy's     Hospital    considered  it 
necessary  for  both  glands  io  be  affected.    Cases 
where  only   one     gland    is    involved    do    not 
seem  to  stand  very  severe  criticism,  but  recent 
investigations  seem  to  show   that  there  may  be 
symptoms  developed    when    only  one  gland  is 
affected.     Of  course  if  one  gland   is   perfect,  it 
should    be  able  to    do  the  work   of   both,  and 
there    should    consequently   be  nj  Addison's 
disease.     If,  however,    this  is  the  case,  if  with 
a  perfect  supra-renal  capsule  in  the    body  we 
have  still  Addison's    disease,   my  remedy  is  not 
likely  to  prove  of  much   account,  as  that  would 
destroy   the  theory  that   it  is   the  want  of  this 
tissue  that  gives  rise  to  these  symptoms. 

Sclerosis  of  the  Brain. — Dr.  Johnston  ex- 
hibited this  specimen,  and  gave  the  following 
report  of  the  autopsy  :  Head  only  examined; 
nothing  unusual  about  the  scalp  or  external 
surface  of  skull  cap  ;  veins  moderately  full  of 
blood  ;  skull  cap  of  ordinary  thickness  ;  tables 
not  denser  than  normal ;  veins  of  diploe 
moderately  full;  in  inner  surface  no  irregulari 
ties  or  abnormal  appearances;  dura  only  slight- 
ly adherent  to  the  calvarium,  which  is  removed 
with  ease;  outer  surface  of  dura  normal;  longi- 
tudinal sinus  contains  soft,  dark,  non-adherent 


clot  in  its  i)osterior  half.  (  n  reflecting  dura,  the 
pia  over  both  hemisphere^-,  is  thickened,  and  has 
an    opaque,  milky    appearance.     Beneath    the 
pia  is  excess  of  clear  fluid,  somewhat  distending 
the  membrane  in  the  regions  corresponding  to 
the  sulci.     Moderate   adhesion  of  dura    to  the 
pia  along    the  convexity.     Pacchionian   bodies 
not  unusually  large  ;    brain  removed  with  ease  ; 
slight  excess    of  cerebro-spinal     fluid    escapes 
during     removal ;    dura  at  the    base  normal  : 
sinuses  normal.     In  the    petrous  bone  on  both 
sides  the  upper  surface  presents  several   small 
areas  o.i    to    0.2  inches    in   diameter,  where   a 
small  cavity    exists,  only    separated   from  the 
cerebral   cavity  by  a  thin,  transparent,   fragile 
membrane,   readily  broken    with  the    point    of 
an  ordinary  dissecting  forceps.     On  exam  ning 
the  brain  the  contour  appears  to  be  normal;  the 
vessels  of  the  base    are    normal    in    size  and 
arrangement,    and   are    free  from   obstruction. 
There  appears  to  be  some  thickening  in  the  pia 
arachnoid  extending  out  into  th.*  sylvian  fissure. 
No  signs  of  hc^morrhage  and  no  appearance  at 
all    suggesting    the    presence    of  old   hcSinatin 
pigment.     Over  the  convexity  the  pia  is  greatly 
thickened  and  detached  from  the  convolutions 
with  much  difficulty;  when  removed,   the  con- 
volutions appear  to  be  normal  in  size  and  out- 
line ;  no  cysts.     There  is   no  trace   of  localized 
disease  in    the    convoluiions;  in  regard  to  this 
point  the  third   left  frontal  and  motor  areas  of 
the  cortex  were  examined  with  special  care  and 
with  perfectly  negative  results. 

On  opening  the  lateral  ventricles  they  are 
found  to  be  of  normal  size.  The  choroid  plexus 
is  somewhat  denser  than  normal,  and  is  slightly 
adherent  to  the  surface  of  the  ventricle  at  the 
head  of  the  right  corpus  striatum.  Adhesions 
between  the  floor  and  the  roof  of  the  ventricle 
also  exist  in  the  region  of  the  corpora  quadri- 
gemina,  and  the  fornix  is  reflected  with  some 
difliculty.  The  ependyma  of  the  lateral  ven- 
tricles is  smooth,  but  on  passing  the  finger  over 
it  the  ganglia  at  the  base  feel  denser  than 
normal.  The  fourth  ventricle  appears  widened, 
the  ependyma  covering  its  surface  is  thickened 
and  covered  with  minute  translucent  grey 
granulations.  The  cerebellum  is  found  to  be 
normal. 

On  dissecting  the  ganglia  at  the  base  of  the 
head  of  the  right  corpus  striatum  in  the  anterior 
one  ip.ch  is  smooth  and  of  a  dull  greyish-yellovv 
color  in  patches.  This  region  cuts  with  great- 
ly increased  resistance,  and  leaves  a  sm  )oih, 
pale,  firmly  resisting  surface.  On  incising 
the  substance  of  the  hemispheres,  the  white 
substance  is  found  to  be  moderately  firm  and  its 
vessels  contain  but  little  blood.  The  grey  mat- 
ter of  the  cortex  throughout  the  whole  of  both 
hemispheres  is  greatly  increased  in  consistency, 
and  cuts  with  great  resistance;  in  cutting  it,  a 
slight  creaking  of  the  knife  is  constantly  noticed. 
On  the    cut    surface    the    grey    matter    forms 


THE  CANADA  MEDICAL  RECORD. 


II 


everywhere  a  raised  ridge,  projecting  above  the 
level  of  the  adjacent  white  matter.  To  the 
touch  tlie  grey  matter  feels  firm  and  dense,  the 
consistency  being  about  ■  three  times  that  of 
normal  grey  matter.  Tlie  color  of  the  grey 
matter  is  somewhat  deeper  and  redder  tiian 
normal  and  tlie  thickness  of  the  cortex  is  every- 
where considerably  reduced,  being  on  the 
average  i  mm.  and  the  maximum  thickness 
being  only  2  mm.  This  condition  appears  to 
be  diffused  uniformly  throughout  all  parts  of 
the  cortex,  and  no  focal  lesions  can  be  detected. 
Microscopical  examination.  —  Throughout 
cortex,  ganglion  cells  reduced  in  size  and  fewer 
in  number  ;  stroma  dense,  and  contains  more 
nuclei  than  normal  ;  no  infiltration  about  smaller 
arteries ;  section  of  cervical  cord  in  upper 
cervical  region  shows  no  sclerosis. 

Remarks. — It  is  difficult  to  say  to  what  ex- 
tent syphilis  is  to  be  held  responsible  for  the 
state  of  the  cerebral  cortex  in  this  case.  A 
diffuse  cerebral  sclerosis  with  atrophy  of  the 
nerve  elements  proper  is  thought  by  some  to  be 
always  due  to  syphilis.  Others  only  recognize 
syphilis  when  marked  endarteritis  is  present.  The 
absence  of  arteritis  in  any  degree  sufficient  to 
explain  the  change  seems  to  lead  to  the  inference 
that  while  the  syphilitic  poison  possibly  was  the 
cause  of  the  lesion  in  the  right  corpus  striatum, 
its  irritative  powers  had  probably  passed  away 
at  the  time  of  death.  Tlie  lesions  in  the  brain 
do  not  appear  to  be  definitely  syphilitic,  though 
the  absence  of  syphilis  can  hardly  be  held 
proved  where  no  examination  of  the  other 
organs  was  made. 

Dr.  Perrigo  gave  the  clinical  history.  In 
November  he  was  called  in  to  see  the  patient 
owing  to  the  result  of  his  falling  down  the  stairs. 
At  that  time  the  appearance  of  his  face  was  so 
peculiar  that  it  was  thought  he  had  been  drink 
ing,  but  afterwards  this  was  found  to  be  a  mis- 
take, he  was  an  abstemious  man,  and  had  been 
so  for  years  ;  but  in  the  course  of  the  enquiries, 
a  history  of  syphilis  occurring  some  50  or  60 
years  ago  was  obtained.  His  condition  then  and 
afterwards  showed  something  as  follows  :  In 
walking,  while  he  could  perfectly  co-ordinate, 
he  would  suddenly  have  to  sit  down,  as  if  struck 
on  the  head,  owing  to  loss  of  power  in  his  legs  ; 
it  was  this  that  caused  him  to  fall  down  stairs. 
He  was  ordered  the  iodides,  and  that  treatment 
was  followed  by  a  gradual  improvement.  Then 
lie  developed  epileptiform  attacks  and  some  loss 
of  memory  and  defects  in  the  power  of  speech.  | 
This  last  was  not  of  an  aphasic  nature,  nor  yet 
one  of  articulation;  he  seemed  to  stop  in  the 
middle  of  a  sentence  or  middle  of  a  word  and 
go  on  to  something  else,  all  the  time  being 
unconscious  of  this  defect. 

On  being  sent  to  the  hospital  he  appeared  to 
improve,  his  speech  became  better,  memory 
better,   epileptic  attacks  ceased,  the  attacks    of 


sudden  sitting  down  became  less  frequent,  and 
he  was  discharged  practically  a  well  man.  In 
regard  to  the  iodide  treatment,  at  one  time  he 
was  taking  as  much  as  320  grains  during  the 
24  hours. 

The  patient  then  went  on  a  trip  to  Baltimore, 
and  while  there  he  grew  worse.  His  defect  of 
speech  returned,  patellar  reflexes  were  gone, 
memory  was  lost,  epileptic  attacks  returned, 
and  he  appeared  to  lose  at  times  control  of  his 
muscles.  In  going  to  bed,  for  instance,  in 
sitting  on  the  edge  of  the  bed,  his  legs  would 
go  through  a  series  of  irregular  motions.  He 
never,  however,  had  any  difficulty  in  feeling  the 
ground.  He  then  became  maniacal,  and  finally 
died. 

Dr.  Lafleur  asked  if  the  epileptic  attacks 
were  those  of  true  epilepsy  or  of  a  Jacksonian 
character.  The  reason  for  asking  was  because 
he  had  seen  a  precisely  similar  case,  in  which 
the  same  di  ignosis  was  made — cerebral  syphilis 
with  meningitis,  right-sided  paraplegia  be- 
ginning in  the  foot  and  gradually  travelling  up 
the  leg.  The  patient  was  put  on  anti-syphilitic 
treatment,  without  much  result.  At  the'autopsy 
there  was  no  evidence  of  syphilis  in  the  brain 
or  viscera,  in  fact,  no  obvious  lesion  of  the 
brain.  But  on  more  careful  examination,  just 
such  a  condition  as  Dr.  Johnston  has  described 
was  found — diffused  sclerosis,  narrowing  of  the 
cortex.  There  was  no  lesion  of  the  basal 
ganglia.  There  is  a  close  similarity  between 
the  cases,  both  from  the  clinical  history  and  the 
autopsy. 

Dr.  Armstrong  related  the  condition  of  the 
patient  while  in  hospital.  His  symptoms  were 
mixed  ones.  He  was  maniacal,  and  required  a 
man  to  keep  him  in  bed.  His  symptoms  were 
largely  irritative  ;  noise  would  irritate  him  ;  lift- 
ing an  arm  would  cause  general  spasms  of  the 
body.  The  right  side  of  the  body  was  distinctly 
weaker  than  the  left  ;  the  grasp  of  his  right 
hand  was  nil,  while  that  of  his  left  was  fair.  In 
addition  to  these  he  was  unconscious  for  two  or 
three  days,  no  questions  could  be  asked  at  all, 
and  when  consciousness  and  speech  returned 
he  was  distinctly  aphasic.  Not  being  able  to 
get  any  information  from  himself,  the  diagnosis 
had  to  be  made  from  the  history  and  remarks  of 
his  friends.  A  diagnosis  of  cerebral  syphilis  had 
been  made  in  London,  and  on  the  strength  of 
this  he  was  put  upon  the  iodides  and  mercurial 
inunctions.  Improvement  took  place,  the 
power  returned  to  his  right  side,  his  memory 
retun  ed,  speech  returned,  and  general  condi- 
tion was  one  of  apparently  very  considerable 
improvement,  supposed  to  be  in  consequence 
of  the  anti-syphilitic  treatment. 

Cirrhosis  of  the  Liver  with  Jaundice. — Dr. 
Wyatt  Johnston  exhibited  the  specimens  from 
a  case  under  the  care  of  Dr.  Perrigo  and  read 
the  history  of  the  autopsy  as  follows  : 


114 


THE   CANADA    MEDICAL   RECORD. 


Autopsy  28  hours  after  Heath. —  Body  of  a 
large  elderly  woman ;  abdomen  distended. 
Body  intensely  jaundiced  over  the  entire  sur- 
face of  deep  bronze  tint ;  conjunctivcc  deep 
yellow.  Moderate  rigor  mortis  and  lividity. 
Subcutaneous  fat  in  fair  amount  of  deep  bronze- 
yellow  color:  in  peritoneum,  about  three  quarts 
of  clear,  bile-stained  fluid  ;  peritoneum  smooth  ; 
omental  fat  abundant ;  colon  and  small  intes- 
tines considerably  distended ;  liver  does  not 
extend  beyond  costal  border.  Spleen  very 
large,  over  300  gras. ;  on  section  dark  and 
'abundant ;  consistency  not  increased.  Kidneys 
"both  appear  to  be  nearly  double  normal  size, 
are  soft  and  deeply  jaundiced.  The  cortex 
appears  swollen  ;  supra  renals  normal,  pelvic 
viscera  appear  normal.  Stomach  contains 
■about  a  tumblerful  of  brownish-black  fluid. 
Mucosa  reddened  and  shows  signs  of  ecchy- 
mosis  ;  mucosa  soft,  not  thickened.  Duodenum 
contains  dark,  slaty,  greyish  fluid.  Bile  papilla 
normal  in  appearance  and  no  signs  of  catarrh 
in  its  neighborhood.  On  slight  pressure  on 
the  bile  duct  a  clear,  almost  colorless  greyish 
mucous  fluid  readily  flows  oui  of  the  papilla. 
Bile  ducts  rather  large,  walls  thin  ;  their  mucosa 
appears  normal ;  no  increase  of  connective 
tissue  about  the  ducts;  glands  in  portal  fissure 
not  increased.  Gall-bladder  contains  a  table- 
spoonful  of  pale  greyish,  thin  fluid,  not  in  the 
least  bile-stained.  Hepatic  artery  normal; 
portal  vein  rather  small  in  calibre,  but  appears 
normal.  Liver  weighs  1.900  gms.,  is  of  a  deep 
yellow-biown  color,  mottled  with  small  pale 
yellow  spots,  evidently  fatty.  The  surface  is 
uneven  and  has  a  fairly  well  marked  hob-nail 
appearance,  the  projecting  portions  of  tissue 
being  separated  by  fibrous  strands  running  in  all 
directions  between  the  lobules.  On  section 
the  organ  cuts  with  but  slightly  increased 
resistance  and  to  the  touch  does  not  feel  very 
dense  ;  the  surface  yields  a  greyish  pulp  on 
scraping  ;  pancreas  normal.  Intestine  contains 
greyish  fffices ;  near  the  ileo  caecal  valve  the 
mucosa  is  normal.  No  etilargement  of  retro 
peritoneal  or  retro-thoracic  glands  ;  lungs 
crepitant.  Heart  not  opened.  Brain  not 
examined. 

'  Microscopic  examination  of  liver  shows 
intense  jaundice  of  the  hepatic  cells  in  places, 
with  marked  fatty  infiltration  irregularly  dis- 
tributed. Increase  of  fibrous  tissue,  which 
penetrates  between  and  into  the  acini.  No 
changes  in  connection  with  the  bile  ducts  ;  no 
proliferation  of  epithelium  or  connective  tissue 
in  connection  with  the  smaller  ducts. 

Remarks. — The  rarity  of  icterus  as  a  com- 
plication of  cirrhosis  of  the  liver  makes  it  worth 
while  to  study  carefully  every  case  of  this  kind 
met  with.  In  the  present  instance  no  changes 
were  discovered  at  the  autopsy  or  by  micro 
scopic  examination  to  show  that  the  jaundice 
was  obstructive  or  had  anything  to  do  with  the 


anatomical  changes  in  the  bile  passages,  and  is 
therefore  not  the  biliary  cirrhosis  of  French 
writers.  According  to  Fagge,  icterus  occurs  in 
about  10  per  cent,  of  all  cases  of  cirrhosis  of  the 
liver,  and  is  almost  always  a  bad  omen. 

Dr.  Perrigo  said  that  the  patient  had  been 
under  his  observation  for  the  last  14  or  15 
years.  Sire  was  a  lady  who  was  a  good  illus- 
tration of  the  difTiculiy  of  obtaining  a  reliable 
history  in  family  practice.  It  was  only  the 
day  after  the  autopsy  that  he  succeeded  in  eli- 
citing a  true  account  of  her  private  habit  of 
dram-drinking.  The  case  shows  well  to  what 
an  extent  tippling  can  be  carried  on  and  )et 
kept  secret  from  both  husband  and  family. 
The  patient  was  of  a  remarkably  despondent 
temperament,  always  looking  at  the  blackest 
side  of  every  question.  She  was  the  subject  of 
chronic  rheumatism  as  well  as  chronic  bronchi- 
tis, the  latter,  however,  imi)roving  during  the 
last  year  or  two.  About  nine  weeks  ago,  shortly 
after  having  a  cataract  removed  from  her  right 
eye,  she  developed  jaundice.  Previous  to  that, 
she  had  morning  vomiting  for  six  or  seven  days. 
The  jaundice  continued  for  six  or  seven  weeks, 
but  finally  it  disappeared  under  treatment, 
and  remained  away  for  three  or  four  weeks. 
During  this  interval,  however,  she  did  not  pick 
up  her  strength  as  well  as  might  have  been 
expected.  Suddenly  the  jaundice  reappeared 
and  became  very  intei  se,  and  just  as  suddenly, 
acoupleof  weeksbefore  death,  ascites  appeared. 
The  latter  rapidly  filled  up  the  peritoneal 
cavity,  and  impeded  respiration  so  much  that  it 
was  thought  advisable  to  tap  her,  which  was 
done  a  few  days  before  death,  and  several 
ounces  of  fluid  drawn  off.  This,  however,  was 
not  followed  by  much  improvement,  as  she 
finally  became  comatose,  and  died. 

From  her  facial  expression  he  had  suspected 
tippling,  but  always  received  such  positive  as- 
surances to  the  contrary  that  he  was  obliged 
to  put  that  possibility  aside.  During  the  last 
five  or  six  months  she  had  a  peculiar  drawn 
expression  that  made  him  suspect  malignant 
disease. 

Dr.  Blackader  endorsed  Dr.  Perrigo's  re- 
mark of  how  frequent  the  habit  of  tippling  ex- 
ists in  ladies  in  whom  one  can  find  no  reason- 
able signs  of  it,  ladies  who  had  been  secret 
tipplers  for  years,  and  yet  in  whom  he  was  un- 
able to  detect  the  slightest  symptoms  of  it ;  the 
tongue  was  clean  ;  no  excitement  in  conversa- 
tion was  ever  evinced,  no  flushing  of  the  face, 
and,  in  fact,  nothing  which  might  point  to  the 
real  cause  of  their  trouble,  namely,  alcoholism. 

The  President  suggested  an  examination 
of  the  urine  for  alcohol  in  such  cases,  as  a 
means  of  arriving  at  the  diagnosis. 

Appendicitis  Occurring  in  a  Patient  with 
Sacro-lliac  Disease. — Dr.  Armstrong  related 
the  following  case  :  A  young  girl,  14  years  of 
age,  came  to   the  hospital  with  a  letter  saying 


THE  CANADA   MEDICAL   RECORD. 


115 


that  nine  monihs  before  slie  fell  downstairs. 
Nothing  was  thought  of  the  injury  at  the  time, 
until  about  three  months  at'terwards  she  devel- 
oped a  tumor  in -the  right  iliac  fossa,  accompa- 
ni-^d  by  a  temjierature  running  al)0Ut  1030. 
This  condition  improved,  the  temperature  be- 
came normal,  she  was  considered  convalescent, 
but  the  riglit  thigh  became  flexed  and  has  re- 
mained so. 

As  she  appeared  in  the  hospital  clinic,  as  to 
diagnosis,  two  very  good  arguments  could  be 
made  out  :  one  man  could  argue  very  s-trongiy 
in  favor  of  sacro-iliac  disease  ;  another  man 
could  produce  just  as  convincing  evidence  in 
favor  of  appendicitis.  In  favor  of  the  first 
we  had  the  history  of  an  -injury,  tubercular 
family  history,''  flexion  of  the  thigh,  lateral 
curvature  of  the  spine,  that  peculiar  hitching 
u|).of  the  right  side  of  the  pelvis,  which  on 
looking  at  it  from  behind  makes  the  perfect 
picture  of  sacro  iliac  disease.  In  favor  of  the 
second  we  had  the  tumor,  the  high  tempera- 
ture, the  pain,  nausea,  vomiting,  etc.  To 
settle  the  matter  he  decided  on  a  exploratory 
incision,  and  on  doing  so  very  readily  came 
down  upon  the  appendix  lyii^g  in  a  little  pocket 
of  pus.  At  this  point  it  ^eeiiied  quite  clear 
that  the  case  was  one  of  appendicitis.  How- 
ever, after  the  appendix  was  removed  and 
everything  made  nice  and  clean,  he  noticed 
that  the  right  iliac  fossa  seemed  to  come  for- 
ward more  than  usual,  and  on  closer  inspection 
decided  there  was  evidence  of  inflammatory 
pioducts  within  the  sheath  of  the  ])soas  muscle. 
On  making  another  incision,  then,  this  muscle 
was  found  th.-oughout  nearly  the  whole  of  its 
exi.ent  infiltrated  with  the  ordinary  cheesy 
material,  commencing  near  the  crus  of  the 
diaphragm  and  extending  down  to  Poupart's 
ligament,  where,  no  doubt,  if  left  long  enough, 
it  would  ultimately  have  pointed.  Over  the 
sVeaih  of  the  psoas,  and  attached  to  it,  the 
appendix  was  lying ;  at  one  spot  there  looked 
as  if  some  necrosis  had  taken  place,  but  there 
was  no  actual  cominunication  between  the 
abscess  in  the  appendix  and  that  in  the  psoas. 

So  that,  as  may  be  seen,  the  evidence  in 
favor  of  both  conditions  was  vvell  founded,  the 
truth  being  that  here  we  had  a  case  of  sacro- 
iliac disease,  in  the  course  of  which  an  appendi- 
citis was  developed.  1  he  patient  made  a  good 
recovery  after  the  operation  ;  her  temperature 
is  normal,  and  she  appears  to  be  doing  nicely 
in  every  respect. 

Dr.  Adami  regretted  that  his  investigation, 
had  not  been  as  thorough  as  he  would  have 
wished.  Examining  some  of  the  cheesy  sub- 
stance, however,  he  succeeded  in  finding  some 
bacilli.  In  the  appendix  he  found  some 
chronic  thickening,  the  outer  wall  being  espe- 
cially thickened  and  congested.  On  making 
the  bacteriological  exammaiion,  he  found,  in 
addition    to    inflammatory  products,  a    large 


number  of  diplococci.  micrococci  and  other 
pyogenic  organisms  ;  so  that  bacteriologically 
he  came  to  exactly  the  same  conclusion  as  did 
Dr.  Armstrong  clinically,  viz.,  that  in  the  ap- 
pendix there  was  a  simple  inflammation,  as 
shown  by  the  presence  of  the  ordinary  pyogenic 
organisms,  while  in  the  cheesy  matter  we  had 
tubercle,  as  shown  by  the  presence  of  the 
bacilli. 

Poisoning  by  Paris  Gree-i. — Dr.  Wvatt 
Johnston,  exhibiting  the  specimens,  said  that 
lately  this  usually  quiet  community  seems  to 
iiave  taken  to  poisoning  itself  with  Paris  green, 
as  within  the  past  month  four  or  five  cases  of 
this  nature  have  come  before  the  public.  On 
Tuesday  last,  two  inquests  were  held  on  casrs 
of  this  nature  by  the  coroner.  In  one  case  a 
large  dose  was  taken  about  one  week  before 
death;  the  duration  of  life  after  the  inception 
of  the  poison  was  due  to  the  treatment  which 
was  inaugurated  very  soon  afterwards,  the 
pump  and  emetics  being  employed  with  a  fair 
degree  of  success.  In  the  second  case  a 
smaller  dose  was  taken,  but  owing  to  the  man 
not  comin-,'  under  treatment  for  some  consider- 
able time  afterwards,  he  died  much  sooner 
than  the  first  one- 

The  first  specimen  is  from  the  case  in  which 
a  relatively  small  amount  of  poison  was  taken, 
and  in  which  little  after-treatment  was  em- 
ployed There  is  intense  engorgement  of  the 
vessels  and  ecchymosis  of  the  stomach  walls. 
As  a  rule,  in  arsenical  poisoning  the  changes 
in  the  stomach  wall  are  not  nearly  so  profound 
as  one  might  expect  to  meet  with  according 
to  the  descriptions  given  in  the  text-books. 
In  this  case,  however,  there  is  an  extreme 
degree  of  ecchymosis  of  the  mucosa,  haemorr- 
hages into  the  deep  mucosa.  The  duodenum 
also  shows  intense  congestion,  which  evidently 
has  gone  as  far  as  complete  stasis.  More  or 
less  haemorrhage  has  also  occurred  in  places 
throughout  the  intestinal  tube,  and  well  down 
in  the  jejunum,  particles  of  Paris  green  were 
found. 

The  other  specimen  is  one  in  which  the  dose 
of  the  poison  was  larger,  but  where  the  con- 
tents of  the  stomach  had  been  speedily 
evacuated,  death  occurring  one  week  afterwards. 
There  is  some  congestion,  although  the  red- 
dening in  the  specimen  is  more  pronounced 
than  at  the  post-mortem,  owing  to  the  action 
of  the  fluid  in  which  the  specimen  was  pre- 
served. There  is  no  ulceration  here,  no  ne- 
crosis, simply  a  congestion  of  the  mucosa. 
Congestion  in  this  case,  however,  is  not  a 
symptom  diagnostic  of  poisoning.  The  man 
just  before  taking  the  poison  had  been  on  a 
rather  prolonged  spree,  and  was  besides  an 
old  drunkard,  and  under  these  circumstances 
some  congestion  of  the  mucosa  might  have 
been  expected,   independent  of  the  poisoning. 

An  interestirrg   feature    in  connection   with 


ii6 


THE   CANADA    MEDICAL   RECORD. 


the  first  case  is  that  in  the  brain  a  region  of 
softening  was  noticed  in  each  hemisphere, 
almost  symmetrical,  and  situated  in  the  region 
of  the  internal  capsule.  It  is  very  unusualio 
find  lesions  of  this  kind  bilateral,  and  t'till 
more  so  to  find  them  situated  in  almost  tlie 
same  region  on  each  side.  In  this  case  they 
go  to  show  the  existence  of  an  old  standing 
brain  disease.  This  is  a  very  important  dis- 
covery from  a  medicolegal  point  of  view.  In 
the  eyes  of  the  law,  willful  suicide  is  a  crime, 
but  suicide  while  insane  does  not  constitute  a 
crime.  This  has  important  bearing  socially, 
and  also  has  certain  religious  relations  which 
makes  it  verj^  important  to  determine,  if  pos- 
sible, whether  suicide  occurs  in  an  insane 
person  or  not.  In  this  case  an  autopsy  was 
ordered  for  the  special  purpose  of  dett:"rmining 
whether  insanity  could  be  established  or  not, 
and  there  was  no  doubt  that  a  man  with  this 
condition  of  brain  would  be  certainly  one  that 
would  be  extremely  liable  to  suffer  from  men- 
tal weakness.  We  know  that  where  there  is  a 
tendency  to  softening  of  the  brain,  it  is  cus- 
tomary for  patients  to  show  more  or  less  an 
unsound  condition  of  mind,  and  in  this  case 
the  history  of  the  man's  life  during  the  last 
few  years  seemed  to  point  to  some  cerebral 
trouble. 

Dr.  W.  F.  Hamilton  related  the  clinical 
history.  The  first  case  which  came  lo  the 
hospital  was  that  in  which  a  small  quantity  of 
the  poison  was  used,  half  an  ounce  being  the 
amount  stated  to  have  been  taken.  The  man 
said  that  he  had  taken  the  poison  at  about 
3  p.m.,  he  walked  home  about  5  p.m.,  and  was 
first  noticed  by  his  wife  and  daughter  to  be  ill. 
To  their  enquiries  as  to  the  cause  of  his  illness 
he  admitted  having  taken  poison,  and  a  doc- 
tor was  at  once  called,  who  administered 
emetics  and  antidotes,  and  succeeded  in  having 
ejected  some  Paris  green  and  a  considerable 
quantity  of  blood.  At  about  7  p.m.  he,  Dr. 
Hamilton,  was  called  in,  when  he  found  the 
patient  in  a  condition  of  collapse,  his  pulse 
being  very  weak,  etc.  Thirty  grains  of  zinc 
sulph.  with  large  quantities  of  warm  water 
were  given,  and  then  washed  out  the  stomacli 
with  the  stomach  tube.  At  about  half-past 
nine  he  was  sufficiently  revived  to  be  conveyed 
to  the  hospital  in  the  ambulance.  On  his 
arrival  there,  another  very  efficacious  emetic 
was  administered,  namely,  a  teaspoonful  of 
mustard  with  a  large  quantity  of  warm  water, 
which  was  followed  by  copious  emesis,  in  which 
more  Paris  green  was  noticed.  At  12  p.m.  he 
appeared  to  be  a  little  easier  ;  at  7  a.m.  he 
complained  of  intense  pain  in  the  abdomen ; 
his  pulse  was  120,  his  respiration  30.  Bismuih 
sublimate  gr.  xxx.  with  ^  gr.  opium,  as  well 
as  hot  applications  to  the  abdomen,  were 
given.  Little  or  no  relief  was  experienced 
from  this,  and  he  died  about  8  a.m.,  judging 


from    the  general    symptoms,    of  cardiac   fail- 
ure. 

The  second  case  was  another  alcoholic.  On 
the  morning  of  the  20th  he  took  three  ounces 
of  Paris  green.  Immediately  upon  taking  it  he 
started  for  the  hospital,  and  rushing  into  the 
office  told  what  he  had  done.  He  was  already 
being  purged  from  its  effects.  About  half  an 
ounce  of  dialyzed  iron  was  given  to  him 
immediately,  as  well  as  some  zinc  sulphate, 
until  he  vomited  freely.  He  was  then  trans- 
ferred to  the  ward,  and  doses  of  zinc  sulph.  30 
grains  were  repeated  until  in  all  about  180 
grains  had  been  taken  ;  no  dose  was  admin- 
istered until  the  previous  one  had  produced 
free  vomiting.  At  the  end  of  each  act  of  emesis 
he  ejected  large  quantities  of  an  intensely  green 
substance.  In  addition  to  the  emetics  we  ad- 
ministered bo'h  dialyzed  and  oxide  of  iron. 
At  3  o'clock  that  afternoon  he  passed  by  the 
bowel  some  green  substance  which  was  con-, 
sidered  to  be  Paris  green.  On  ihe  21st  he 
seemed  considerably  belter.  On  the  22nd  the 
temperature  went  up  to  100"^,  the  heart  became 
weaker,  and  he  became  very  restless.  Through 
the  latter  part  of  his  life  he  was  constantly 
retching.  Later  he  developed  an  intense  con- 
gestion of  the  fauces,  which  interfered  with 
swallowing.  He  died  at  10  am.  on  the  25th, 
or  about  five  days  after  his  admission, 

Report  of  the  Committee  appointed  to  draw 
up  Rules  for  the  Prevention  of  the  Spread  of 
Tuberculosis. — Dr.  Adami  read  the  report. 

Dr.  A.  D.  Blackader  moved  that  the  report 
be  adopted  and  printed  for  circulation. 

Dr.  HiNGSTON  thought  that  the  practical 
suggestions  in  the  middle  of  the  i)aper  were 
admirable,  but  there  is  at  the  very  outset  laid 
down  a  principle  which  may  not  be  universally 
adopted,  and  which,  for  the  public,  is  certainly 
not  necessary.  It  is  that  in  every  case  of 
turberculosis  the  tubercle  must  have  been 
obtained  from  some  pre-existing  case  where 
tubercle  was  present,  and  in  that  way  alone. 
This  question  is  a  very  large  one,  and  as  yet  a 
very  debatable  one,  and  a  great  deal  may  and 
has  been  said  to  modify  that. view.  What,  for 
instance,  becomes  of  those  experiments  of 
Cruveillher,  with  which  you  are  all  no  doubt 
fi\miliai  ?  In  the  healthy  rabbit  taken  from  the 
field  he  induced  tuberculosis,  and  caused  its 
disappearance  at  pleasure.  He  caught  them, 
confined  them  in  a  dark,  damp  place,  and 
tubercles  were  developed.  This  he  proved  by 
killing  several  of  them  one  after  another,  and 
finding  them  in  different  stages  of  phthisis. 
Others,  again,  after  they  had  shown  symptoms 
of  the  disease,  he  liberated,  and  after  they  had 
been  at  liberty  for  some  time  he  recaptured 
them,  and  examination  showed  that  one  after 
another  the  tubercles  were  being  eliminated. 
Now,  if  tubercle  is  alwa\  3  due  to  the  existence 
of  tubercle    bacilli  in    oihers,   where    did  the 


THE   CANADA   MEDICAL   RECORD. 


Il7 


healthy  rabbits  get  the  bacilli  ?  Or  were  the 
bacilli  responsible  for  the  mischief  in  the  im- 
prisoned rabbits  ?  That  is  impossible  to  say, 
as  in  the  days  of  Cruveillher  the  bacillus  was 
not  recognized  as  the  cause  of  tubercle,  and 
even  at  the  present  day  it  is  not  universally 
recognized  as  the  cause,  while  some  think  it  the 
result. 

In  joint  affections,  and  of  these  he  spoke 
with  more  confidence,  we  commonly  find  the 
healthy  child  of  healthy  parents  afflicted.  On 
enquiring  as  to  the  previous  health  of  the 
patient,  we  fiequently  get  the  answer:  "  Ves, 
ihe  healthiest  of  my  children."  Then  there 
is  a  history  of  an  injury  some  time  previously  ; 
the  child,  in  the  act  of  running  or  climbing,  fell 
and  injured  the  knee,  the  hip,  or  the  sacro- 
iliac synchondrosis  perhaps,  as  the  case  may 
be.  An  inflammation  follows  in  the  injured 
joint, and  this  inflammation  is  said  to  be  due  to 
the  bacillus,  rather  than  to  the  clearly  recognized 
fall  or  injury  !  Where  does  this  healthy  child 
get  the  bacilli  from?  It  is  true  that  in  the 
course  of  time  tubercles  may  develop  ;  but 
have  we  the  right  to  say  that  "they  do  so  as  the 
result  of  the  child  being  brought  in  contact  with 
the  tubercular  disease  rather  than  as  a  re.-ult 
of  perverted  nutrition  ?  From  time  imme- 
morial, inflammatory  affections  of  this  kind 
were  treated,  and  generally  without  benefit,  as 
strumous  ;  it  is  only  since  they  came  to  be 
recognized  as  inflammatory  and  the  result  of 
traumatism  that  treatment  has  become  success- 
ful. This  is  one  of  America's  great  contri- 
butions to  surgery. 

Moreover,  is  it  as  yet  quite  settled  whether 
the  bacilli  develop  themselves  in  the  course  of 
the  disease,  or  whether  they  already  exist  in  the 
system,  and  manifest  themselves  only  in  the 
injured  parts  ?  In  joint  affections  it  is  certain 
ly  not  generally  admitted  that  the  bacilli  are  the 
cause.  Cases  sometimes  occur  where  the 
origin  of  the  disease  is  supposed  to  be  due  to 
some  depression  of  the  vital  energies  of  the 
part,  consequent  on  over-work  or  injury,  in- 
ducing a  condition  where  we  should  look  rather 
for  the  spores  of  inflammation  than  for  the 
bacilli  of  tubercle.  Even  now  the  latter  are  by 
some  supposed  to  contain  the  former. 

He  fully  endorsed  all  the  other  points  of  the 
instructions  to  the  public  :  those  relating  to 
ventilation,  cleanliness,  etc.,  but  thought  we 
should  stop  there,  and  not  say  needlessly  that 
which  we  will  often  find  difficult  to  substantiate 
clinically,  and  which  is  unnecessary  in  a  set  of 
practical  instructions  intended  for  the  public. 

Dr.  Adami,  in  reply  to  Dr.  Kingston,  said  that 
this  subject  is  an  enormous  one,  and  one  that 
at  this  late  hour  of  the  evening  it  will  be  im- 
possible to  go  into  in  detail.  While  he  could 
not  now  enter  into  all  the  evidence  showing 
that  tubercle  is  always  obtained,  directly  or 
indirectly,    from     pre-existing    tubercle,     this, 


ho\v-.n\.r,  he  would  say,  that  in  every  case  of 
typical  tuberculosis,  if  one  takes  a  piece  of  the 
diseased  tissue,  be  it  lung  or  joint,  and  inocu- 
late it  into  a  guinea-pig,  he  will  have  set  up  a 
typical  tubercular  inflammation  in  which  bacilli 
shall  be  found.  In  regard  to  the  experiments 
of  Cruveillher,  they  are  on  a  par  with  those 
kindred  investigations  where  it  was  shown,  or 
supposed  to  be  shown,  that  tubercles  could  be 
produced  by  the  injection  of  particles  of  dust, 
or  inoculating  with  bits  of  paper,  string,  etc., 
and  of  all  these  only  the  one  thing  need  be 
said,  viz.,  that  they  were  made  before  the  dis- 
covery of  the  bacillus,  before  the  bacteriologi- 
cal method  had  come  into  use  in  such  investi- 
gations, and  as  such  ihey  are  imperfect  and,  he 
thought,  must  go  by  the  board.  In  fact,  it  is 
highly  probable  that  the  inflammation  which 
these  men  set  up  was  not  true  tubercular  in- 
flammation at  all,  and  therein  lay  their  mistake. 

In  laying  down  the  principle  alluded  to  we 
are  acting  in  accordance  with  the  views  held 
by  the  leading  minds  of  France,  of  Germany, 
of  England,  and  he  did  no;  think  there  was  in 
England  to-day  a  single  man  of  scientific  note 
who  disbelieves  in  the  bacillary  origin  of 
tuberculosis,  and  further  still,  we  are  acting  in 
accordance  with  the  views  held  by  the  majority 
of  this  Society. 

As  a  reason  why  every  case  of  tuberculosis 
must  be  derived  from  some  previous  case  of  the 
disease,  he  might  say  that  the  more  one  ex- 
amines the  habits  of  life  of  the  tubercle  bacillus, 
the  more  certain  one  becomes  that  they  will  not 
grow  at  a  temperature  but  three  or  four  degrees 
below  the  blood  heat,  even  if  they  be  cultivated 
upon  specially  prepared  broth.  Now,  the 
temperature  of  an  ordinary  room  is  always 
considerably  below  that  point,  and  consequent- 
ly bacilli  could  not  propagate  or  manage  to 
survive  beyond  a  certain  time  in  such  a  me- 
dium, and  so  we  may  infer  that  wherever  a  case 
is  found  it  must  iiave  originated  from  a  pre- 
ceding case.  In  fact,  Dr.  McEachran  pointed 
out  that  the  disease  was  not  confined  to  man, 
but  that  it  existed  and  was  prevalent  amongst 
animals.  It  is  one  of  the  four  great  scourges 
of  the  bovine  race.  In  joint  diseases,  therefore, 
we  must  net  be  content  with  looking  for  pre- 
vious disease  in  other  members  of  the  family, 
but  we  must  also  investigate  the  meat  supply 
as  well  as  the  milk  of  these  people. 

Dr.  GiRDWooD  said  that  supposing  the 
person  does  not  contract  the  disease  from  some 
preceding  case,  man  or  animal,  how,  then,  does 
the  tubercle  bacillus  become  developed,  unless 
by  spontaneous  generation,  which  at  th^ 
present  day  cannot  be  admitted. 


ir; 


THE   CANADA   MEDltAL'  RECORD. 


DISTRICT  OF  ST.   FRAx\CTS  MEDICAL 
ASSOCIATION. 

The  Association  held  its  regular  fall  meeting 
on  Oct.  lyih,  at  the  Continental  Hotel,  Sher- 
brooke,  P.Q. 

The  meeting  opened  at  2.30  p.m.  The  Presi- 
dent, F.  Austin,  M.D.,  in  the  chair. 

The  following  gentlemen  were  present  :  R.  A. 
D.  King,  Compton;  Thos.  LaRue,  Coaticooke  ; 
G.  A.  Coderre,  Megantic  ;  R.  H.  Phillimore, 
Cookshire ;  G.  A.  Bowen.  Magog  ;  G.  W. 
Powers,  Waterville  ;  C.J.  Edgar,  North  Hatley; 
F.  J.  Austin,  J.  D.  A.  McDonald,  F.  Pare,  I. 
Fregeau,  W.  S.  Smith,  J-  A.  M.  Elie,  J.  F. 
Rioux  and  J.  O.  Camirand,  Sherbrooke. 

On  motion  to  that  effect,  R.  H.  Phillimore, 
M.D.,and  Alex.  Dewar,  M.D.,  both  of  Cook- 
shire, wee  elected  members  of  iliis  Association. 
'  It  was  moved  by  Dr.  Austin,  seconded  by 
Drs.  Pare  and  King,  and  resolved  :  "  that  this 
Association,  through  its  Secretary,  tender  Dr. 
Meagher,  of  Windsor  Mills,  their  most  sincere 
and  heartfelt  sympathy  in  the  great  affliction 
which  an  all-wise  Providence  has  seen  fit  to 
visit  u])on  him  by  the  death  of  his  wife  on  the 
15th  inst." 

Dr.  Edgar  moved,  seconded  by  Dr.  Smith, 
that  part  of  the  funds  of  this  Society  be  used  for 
the  founding  of  a  pathological  department  in 
conn(ction  with  the  Society,  to  which  all  metn- 
bers  will  be  expected  to  contribute  material, 
and  to  have  access  thereto  when  so  desired. 

Tlie  President  then  gave  the  annual  address, 
the  following  being  a  few  points  touched  upon: 

•'Since  our  first  preliminary  meeting  on  the 
14th  Sept.,  1890,  we  have  had  6  regular  meet- 
ings, the  first  tvvo  of  these,  however,  being  taken 
up  with  framing  a  constitution,  by-laws  and  a 
tariff.  At  the  four  last  meetings,  no  less  than 
13  papers  were  read,  besides  reports  of  unusual 
cases  met  with  in  practice.  Many  of  these 
papers  were  of  great  interest,  and  showed  marks 
of  much  study  and  thought  in  their  prepara- 
tion. 

''Our  total  membership  is  now  43,  and  as 
there  are  about  70  or  75  members  of  the  pro- 
fession in  this  district,  there  remain  a  good 
many  stray  sheep  to  bring  into  the  fold. 

'•  From  our  Treasurer's  report,  it  appears 
there  is  deposited  to  the  credit  of  this  Associa- 
tion a  sum  considerably  over  $100,  and  it  is  a 
question  what  should  be  done  with  this  money. 
It  has  been  suggested  by  some  that  it  be  invest- 
ed in  books  to  form  the  nucleus  of  a  library  ; 
by  others,  that  it  should  be  used  to  pay  for  sur- 
gical instruments  n(>t  usually  kept  by  those  in 
general  practice,  but  which  might  at  any  time  be 
required  for  special  cases.  I  am  inclined  to 
the  latter  idea. 

"  I  am  quite  convinced  that  these  meetings 
have  been  of  much  benefit  to  those  members 


)vho  have  been  able  to  attend,  not  only  in  a 
jjrofessional  point  of  view,  but  also  because 
they  have  afforded  an  opportunity  which  many 
of  us  otherwise  would  not  have  had  of  meeting 
together,  making  each  other's  acquaintance  and 
spending  a  few  hours  in  social  intercourse, 
which  in  my  opinion  is  one  of  the  most  import- 
ant objects  of  these  meetings. 

"  We  have  much  to  be  thankful  for  in  that 
death  has  not  visited  any  of  our  members  during 
the  past  year,  and  that,  as  far  as  I  know,  we 
have  escaped  any  serious  illness  or  accident, 
though  it  is  with  much  regret  I  hear  our  es- 
teemed friend  Dr.  Meagher,  of  Windsor  Mills, 
has  to  mourn  the  loss  of  his  wife,  her  death 
h  iving  'aken  place  only  last  Sunday. 
:  "  It  is  with  much  pleasure  I  am  enabled  to 
say  our  respected  first  President,  Dr.  E.  D. 
Worthington,  is  still  among  us,  though  unable 
to  continue  his  useful  and  active  career  in  the 
profession." 

Dr  J.  O.  Camirand  then  read  a  paper  on 
"  Fractures  of  the  Patella,"  in  which  he  de- 
scribed the  various  modes  of  treatment  and 
apparatus  used  in  such  cases,  as  well  as  those 
Used  by  himself  in  the  cases  which  came  under 
his  care.  This  was  followed  by  a  discussion,  in 
which  Drs.  Austin,  King,  Powers  and  LaRue 
took  an  active  part. 

Dr.  G.  A.  Bowen,  of  Magog,  followed  with 
an  extremely  interesting  and  instructive  essay 
on  "  Hysteria,"  the  Proteus  of  the  medical 
faculty  and  the  nightmare  of  all  practitioners. 
Remarks  on  this  subject  were  made  by  Drs. 
Pare,  Austin,  Pov.ers,  Edgar,  McDonald  and 
Camirand. 

"  Chronic  Constipation "  was  the  subject 
chosen  by  Dr.  Powers,  of  Waterville.  The  Dr. 
treated  this  subject  in  a  highly  useful  and  prac- 
tical way,  affording  new  and  pertinent  ideas  as 
to  the  treatment  of  this  troublesome  ailment. 

The  following  gentlemen  will  read  papers  at 
the  next  meeting  : — Dr.  J.  D.  A.  McDonald, 
"Infantile  Diarrhoea;"  Dr.  R.  A.  D.  King, 
"Obstruction  of  the  Bowels;"  Dr.  F.  Pare, 
"  Cancer  of  the  Stomach  ;  "  Dr.  R.  M.  Canfield, 
"  Diphtheria." 

The  election  of  officers  for  the  ensuing  year 
was  then  proceeded  with,  and  resulted  as  fol- 
lows : — 

President,  Dr.  F.  Pare,  Sherbrooke,  P.Q. ;  ist 
Vice-President,  R.  A.  D.  King,  Compton  ;  2nd 
Vice-President,  C.  J.  Edgar,  North  Hatley ; 
Secy-Treas.,  J.  O.  Camirand,  Sherbrooke ; 
Assistant,  J-  D.  A.  McDonald,  Sherbrooke. 
Council — Thos.  LaRue,  Coaticooke  ;  G.  W. 
Powers,  Waterville  ;  J.  F.  Rioux,  Sherbrooke. 

On  motion  by  Dr.  LaRue,  seconded  by  Dr. 
Austin,  it  was  resolved  that  the  next  meeting 
of  this  Association  be  held  at  Coaticooke, 
P.Q.,  subject  to  notice  from  the  Secretary,  and 
the  meeting  then  adjourned. 

J.  O.  Camirand,  j\LD.,  Secy-Treas. 


THE   CANADA    MEDICAL   RECORD. 


119 


THE  CANADA  MEDICAL  RECORD. 
Published  Monthly. 


SHi>scription  Price,  $2.00  per  annum  in  advance. 

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Single 


EDITORS : 
A.  LAPTHOKN  SMITH,  B  A.M.D.,  M.RC.S.,  Eng.,  F.OS 

London- 
F.  WAYLAND  CAMPBELL,  MA-,  M.C.  L.R.C.P  .  Londou 

ASSISTANT  EDITOR 
ROLLO  CAMPBELL.  CM.,  M.D- 

.Make  all  Cheiiues  or  P.O.  Monev  Orders  for  subscription  or 
ailvertisiiig  payable  to  JOHN  LOVELL  &  SON,  23  St.  Xicbo- 
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sboulil  be  addressed. 

All  letters  on  professional  subjects,  books  for  review  and 
e.xcbaiiges  should  be  addressed  to  the  Editor.  Dr.  Lapthurn 
Smith.  248  Bishop  Street. 

Writers  of  original  communications  desiring  reprints  can 
have  them  at  a  trilling  cost,  by  notifying  JOKK  LOVELL  & 
SON,  immediatelv  on  the  acceptance  of  their  article  bv  the 
Editor. 

.MONTREAL,  FEBRUARY,  1894. 

THE  COLD  BATH  TREATMENT  OF 
FKBRILE  DISORDERS. 

During  the  last  few  years,  Brand's  method 
of  treating  fevers  by  the  use  of  the  cold  bath 
has  made  very  rapid  progress,  being  now 
adopted  in  many  hospitals  by  the  most  pro- 
gressive physicians  in  the  treatment  of  typhoid 
fever.  The  death  rate  seems,  without  doubt, 
to  have  been  considerably  reduced  thereby. 
Our  attention  has  been  called,  however,  to  the 
remarkable  effects  of  the  cold  water  treat- 
ment of  fevers  generally,  by  the  perusal  of 
an  e.xcellent  paper  by  Dr.  T.  K.  Holmes 
of  Chatham,  Ont.,  read  before  the  last  meeting 
of  the  Ontario  Medical  Association,  in  which 
he  refers  to  the  experiments  of  Lai:derBrunton, 
made  many  years  ago,  which  show  that  the 
heart  of  the  turtle  or  frog,  when  removed 
from  the  body,  will  have  its  beat  quickened  or 
slowed  by  exposure  alternately  to  heat  and  cold. 

These  observations  indicate  the  stimulating  j 
effect  of  heat  on  the  cardiac  sympathetic.  Dr.  ! 
Holmes  infers  from  this  that  blood  cooled  by 
the  cold  bath  inhibits  the  heart  and  the  respir- 
ation through  its  action  on  the  vagus.  Dr. 
Holmes  has  applied  this  treatment  in  a  new 
class  of  cases,  namely,  those  in  which  convul- 
sions are  accompanied  by  higli  temperature. 
The  results  were  most  satisfactory,  so  that  he 
has  come  to  regard  the  cold  bath  as  an  absolute 
specific  for  convulsions  coming  on  during  a 
febrile  attack.  ! 

Our  own  experience  very  fully  substantiates 
the  high  place  which  Dr.   Holmes  gives  to  the    ■ 


LOiu  waicr  ueaimtnt  of  feveis,  ahhough  in 
:  private  practice  the  objection  of  the  friends  of 
I  the  patient  to  immersing  them  in  a  cold  bath 
are  almost  insurmountable.  We  have,  how- 
ever, obtained  really  good  results  with  cold 
water  administered  in  oth  er  ways.  'I'o  begin 
with,  the  patient  is  fed  entirely  on  iced  milk, 
both  for  the  reason  that  they  will  take  a  much 
larger  quantity  of  this  nourishment  when  cold 
than  they  would  if  hot;  2nd,  the  raising  of 
two  quarts  or  more  of  milk  at  a  temperature 
of  33*'  up  lo  a  temperature  of  103°  causes 
the  abstraction  of  a  considerable  quantity  of 
heat;  3rd,  it  may  be  the  presence  of  iced  milk 
in  the  stomach  in  close  proximity  to  the  heart 
may  have  had  the  remarkable  inhibitory  in- 
fluence to  which  Dr.  Holmes  refers  in  con- 
nection with  the  use  of  the  cold  bath.  Besides 
this,  we  took  care  to  have  a  plentiful  supply 
of  ice  water  or  broken  ice  constantly  beside  tlie 
patient's  bed,  so  that  he  could  help  himself  as 
often  as  he  wished.  The  drinking  of  ice  water 
or  the  sucking  of  ice  in  turn  causes  intense 
thirst,  and  this  thirst  itself  is  made  use  of  to 
induce  the  patient  to  drink  still  larger  quan- 
tities of  ice  wat  er. 

Besides  these  means  of  keeping  down  the 
temperature,  pulse  and  respiration,  it  has  been 
our  custom  for  the  last  20  years  to  have  the 
patient  sponged  2  or 3  times  a  day  with  a  weak 
mixture  of  spirits  and  water,  the  moisture  being 
allowed  to  evaporate  instead  of  being  dried  off. 
There  are  few  patients  who  will  not  claim  that 
this  proceeding  is  exceedingly  grateful  to  them. 
By  these  means,  therefore,  the  practitioner  can 
keep  down  the  temperature  and  pulse  rate 
even  in  private  practice,  where  it  would  be 
impo  ssible  to  sufficiently  overcome  the  pre- 
judice s  of  the  friends  and  relatives  of  the 
patient  t  >  permit  of  the  employment  of  Brand's 
cold  bath  treatment.  The  beneficial  effects 
of  the  taking  in  of  large  quantities  of  cold 
water  in  addition  to  the  iced  milk  are  imme- 
diately seen  in  the  dis  appearance  of  the  high 
color  from  the  urine  and  also  of  the  dicrotic 
characteristic  of  the  pulse,  which  is  due,  of 
course,  to  insufficient  filling  o;  tension  of  the 
arteries.  Arterial  tension,  we  need  hardly  say, 
is  a  prime  factor  in  the  nourishment  of  the 
heart,  which  is  only  fed  by  the  coronary  arteries, 
which  in  turn  are  but  poorly  filled,  when  the 
pulse  is  dicrotic  and  the   arterial   tension  low_ 


I20 


THE   CANADA    MEDICAL    RECORD. 


BOOK    NOTICES. 

Duane's  Students'  Diction avy  of  Medicine. 
'1  he  Students'  Dictionary  of  Medicine  and 
the  Allied  Sciences.     Comprising  the  pro- 
nunciation, derivation  and  full  explanation 
of    Medical    Terms,    together    with    much 
collateral    descriptive    matter,    numerous- 
tables,  etc.     By    Alexander  Duane,  M.D., 
Assistant     Surgeon     to    the    New     York 
Ophthalmic  and    Aural  Institute ;   Reviser 
of  Medical  terms  for  Webster's  Internation- 
al Dictionary,     In  one  square  octavo  vol- 
ume   of  658    pages;    cloth,   $4-25;    l^^'f 
leather,  $4.50;  full  sheep,    $5.00.     Phila- 
delphia, Lea  Brothers  &  Co.,  1893. 
This  work   has   received  years   of  the  most 
painstaking   labor  of  a  gentleman  abundantly 
qualified  by  natural  gifts  and  special  training 
for   the  difificult  task  just  coiaipleted.    The  vol- 
ume is    one  of  high  merit,  and  we  anticipate 
for  it  rapid  recognition  as  the  standard  medical 
dictionary  for  students. 

Dr.  Duane's  experience  as  a  medical  lexico- 
grapher and  his  accurate  scholarship  are  suffi- 
ciently attested  by  his   position  as  Reviser  of 
Medical  Terms  for  Webster's  International  Dic- 
tionary.    In   the   present  work   he  has  under- 
taken  to  provide    medical  students    with    full 
information   concerning  every  word    they    will 
meet  in  acquiring  their  professional  education. 
The  vocabulary    is  exceedingly  liberal,  and  its 
fullness  is  paralleled  by  the  treatment  accorded 
to    each    word.      The    definitions    are    of   the 
"  explanatory  "  style,  including  not  only  a  stale 
ment  of  meaning,   but  likewise  much  descrip- 
tive matter  under   headings    which    would    be 
inadequately  represented  by  a  definition  however 
full.     Thus,    under    Diseases    are   given    their 
causation,     symptoms    and    treatment;     under 
important  Organs,  an  outline  of  their  structure 
and  functions  ;  under  each   Drug,  its  actions, 
uses  and  preparations,   the    information    being 
arranged  in  logical  order,  so  as  to  give  a  ration- 
al and  connected  idea  of  the  subject.     Exten- 
sive tables  of  Bacteria,  Muscles,  Arteries,  Veins, 
Nerves,    etc.,    are   included.      Each    word   is 
followed   by  its  correct  pronunciation   (a  new 
feature  in  works   of  this  class),  given  by  means 
of  a   simple   and   obvious   phonetic    spelling. 
Derivation,  an  unexcelled  aid  to  remembrance 
of  meanings,  is  likewise  fully  and  clearly  stated, 
Greek  letters  being  replaced  with   those  of  the 
English    alphabet,  for  the  convenience  of  those 
unfamiliar    with    Greek.     The    type    has  been 
carefully  selected  for  legibility,  and  each  page 
contains  an  extraordinary    amount   of  matter. 
Duane's   Medical   Dictionary  is  executed  on  a 
plan    embodying  in  a  high  degree  every  quali- 
fication of  value  to  students,  and  we  may  there- 
fore confidently  pi  edict  that  it  will  become  the 
standard  and  favorite  work  of  its  class. 


PAMPHLETS. 


The     Prevention     and      Management     of 
Pelvic     InflamxMation    in     Puerperal 
Women,  by  Horace  Tracy    Hanks,  M.D., 
Professor  of    Diseases  of   Women,     New 
York  Post-Graduate  School  and  Hospital; 
Surgeon  to  the  Women's    Hospital  in  the 
State  of  New  York ;  late   President   New- 
York      Obstetrical    Society  ;      late    Vice- 
President    New-York    Academy  of  Medi- 
cine;  and    Member  American  and   British 
Gynaecological     Societies,     etc.      Reprint 
from  American    Medico-Surgical  Bulletin, 
May,   1893. 
Mechanical    Aids  in    the    Treatment    of 
Chronic  Forms  of  Disease,  by  Geo.  H. 
Taylor,    M.D.,     author    of  "   Health    by 
Exercise,"  ''  Health  for  Women,"  "  Pelvic 
and      Hernial    Therapeutics,"    "  Manual 
Massage,"  etc.     Consulting    Physician  to 
The     Improved    Movement    Cure      Insti- 
tute,    71    Eist    59th  Street,   New    York. 
Copyright,   1893,  by  the  Improved  Move- 
ment Cure  Institute,    New    York,    George 
W.  Rodgers,  Publisher.    1893. 
Report  ON  Nasal  Surgery,  with  Illu.strated 
Casks.     By  M.    F.  Coomes,  A.M.,   M.D. 
Professor  of  Physiology,   Ophthalmology, 
Rhinology  and  Otology  in   the    Kentucky 
School  of  Medicine,  Louisville,   Ky.     Re- 
printed   from   the    American   Practitioner 
and  News.     Ljuisvillf,    John  P.  Morton 
&  Company,     1893. 
Erotopathia  (Morbid  Erotism).     Read  be- 
fore Section  on  Nervous    and  Mental  Dis- 
eases, Pan-American  Medical  Congress,  at 
Washington,    D.C.,    September   8,    1893. 
By  C.  H.    Hughes,  M.D.,   Executive  Pres- 
ident  of  the  Section,  and  President  of  the 
Faculty,    and     Professor    of    Neurology, 
Psychiatry    and    Electrotherapy.     Barnes 
Medical      College.       Reprint     from     the 
Alienest     and     Neurologist.     St.     Louis, 
October,  1893. 
Counter-Drainage  after  Cceliotomy.     By 
Horace  Tracy    Hanks,  M.D.,  New  York. 
Reprinted  from  the  Post-Graduate,  No.  4, 
1893. 
The   Treatment  of  Nasal  Duct   Obstruc- 
tion.    Read  in  the  section  on  Ophthalmo- 
logy at  the  Forty-Fourth  Annual  Meeting 
of    the    American    Medical     Association, 
By  Casey  A.  Wood,  CM.,  M.D.,  Professor 
of   Ophthalmology  in  the    Post-Graduate 
Medical     School,     Chicago  ;  Oculist  and 
Aurist  to  Cook  County  Hospital  ;  Oculist 
to  the  Emergency    Hospital  and    Alexian 
Bros.     Hospital.      Reprinted     from     the 
Journal  of  the  American  Medical  Associa- 
tion,  October  28,  1893.     Chicago  :    Pub- 
lished at  the  office  of  the  Association,  1893. 


e 


<# 


Vol.  XXII 


MONTRE  VL,  MARCH,  1894. 


No.  0. 


ORIGINAL   COMMUNICATIONS. 
VA\  Method— Forced  Kespiration        121 

SOCIETY  PROCEEDINGS. 

The    Montreal     ''edico-Chirurgieal 

Society 1-7 

Large  Scrotal  Hernia      li'T 

iMacroglossia \>' 

Poise  'ing  by  Sulphate  of  Copper  . . .  128 
Localizftd  Tuberculosis  of  AseeiuUng 
Frontal  Convolution— Tuberculosis 

of  one  Suprarenal 12S 

Uecto-ovarian  F!r=tula ]2'> 

White  Sarcoma  of  the  Retina 129 

Thoracic  Empytema 129 

ExophthalraicGoitre 129 

Case:?of  Cystic  i  "iseases  of  the  Ovaries  130 

Chronic  Salpingo  Oophoritis 130 

Pedunculated  Sub-peritoneal  Fibro- 

niyoina  :  Cystic  GiaafBan  Follicles.  131 
Multilocular  Ovarian  Cyst  of  great 
size  ;  Cvstoim  I'rolifefuin  Glandu- 

lare      .". 131 

Canadian  Medical  Association l;i2 


OOITTIB'JSrTS. 

Eleve'Uh  Internati  :m:il  Medical  Con- 
gress          ...   133 

Lecture  on  the  Conduct  of  Metlical 
Lite 133 

An  Antiseptic,  Analgesic  *nd  Calma- 
tive Admixture  137 

Chiss-r-  om  Xotes 137 

Higher  Medical  Education 139 


EDITORIAL. 

K()W  to  put  a  stop  to  Hereditary  Cri- 
minality      "...       140 


BOOK  NOTICES. 

A  Text  book  of  Physiology 14  I 

Anitoniy,  Descriptive  and  Surgical..  141 

Surgery 141 

February  Cosmopolitan 142 

An  American  Text-bonk  of  Gyneco- 
logy. Medical  and  Surgical  142 

E-seutials  of  Practice  of  .Medicine.. .  143 


PAMPHLETS  RECEIVED. 

The  After-treatment  of  Coeliotomv 

Cases . .".  143 

Care  noma  of  the  Uterus 143 

The  Surgery  of  the  Ureters 14.3 

A  Case  of  Mediastino-Pericarditis  in 

a  Child 143 

The  new  Treatment  of  Hernia 144 

Perineo-Vaginal  Restoration   144 

Lecture    upon    .Metallic   Interstitial 

Electrolysis     .. 144 

The  Limits  and  Requirements  of  Gy- 

najcology 144 

Hysterectomy  by  a  new  Method 14t 

Supra- Vaginal  Hysterectomy 144 

Some  Causes  and  Characteristics  of 

Neurasthenia    144 

Report  of  Two  Years'  Work  in  Abdo- 
minal Surgery  at  the  Kensington 

Hospital  for  Women  144 

Matliewfi'  Medieil  Quarterly 141 

Societe  d'Editions  Scientitiques 144 

Pub.ishers'  Department.     ...  139  &  144 


►rioiiidl    (L'ommunic.itions. 


FELL  METHOD— FORCED  RESPIR- 
ATION. 

By  Geo.  E.  Fell,  M.D.,  F.R.M.S., 
E.K-President  American  Microscopical 
Society,  etc.,  Buffalo,  X.Y. 

{Continued.) 

C.\SE    XLIV. — UR.    FELL. 

While  the  description  of  an  instrument 
may  appear  somewhat  detailed,  and  indi- 
cate that  the  method  in  operation  is  some- 
what difficult,  such,  in  this  instance,  is 
not  the  case.  All  there  is  to  forced  res- 
piration is  the  forcing  of  air  under  suitable 
pressure  and  control  ^^  ith  proper  periodic  in- 
termission, into  the  lungs.  It  can  only 
be  properly  done  with  suitable  apparatus. 
The  simplicity  of  the  method  should  give 
to  the  operation  its  widest  range  of  useful- 
ness ;  but,  to  become  practically  acquaint- 
ed with  it,  one  must  see  it  and  study  it 
before  he  can  understand  it.  With  proper 
instruction,  the  members  of  a  life  saving  or 
a  ship's  creio  could  be  taught  to  utilize  this 
valuable  method  of  saving  human  life.  I 
presume  before  the  "  conservative  "  {}) 
medical    profession  of  America  will  utilize 


this  method,  thousands  of  its  members 
must  have  their  attention  specially  called 
to  cases  of  resuscitation  through  its  em- 
ployment. After  the  results  obtained,  this 
should  not  be  required. 

Another  matter  I  may  refer  to  at  this 
time:  I  believe  all  will  admit  that  the 
greatest  credit  which  it  is  possible  to  ob- 
tain as  the  originator  of  a  method  of  wide 
range  of  applic  ibility  in  saving  human  life 
consists  in  the  largeness  of  the  list  of  lives 
saved  by  it,  and  the  just  appreciation  of 
its  value  by  your  fellow-man.  There  is  no 
higher  aim  that  we  as  physicians  can  con- 
ceive, than  that  of  preventing  the  vital 
spark  from  takiiig  leave  of  the  human  or- 
ganism. If  this  be  true,  it  does  appear  un- 
just, unfair  and  unth  mkful  that  credit 
should  be  withheld  from  those  who  are 
entitled  to  it,  and  that  the  medical  world,  in 
any  section,  should  use  these  methods  with- 
out the  greatest  care  in  giving  to  those  justly 
entitled  to  it  the  credit  due  them.  In  the 
mercantile  world,  dollars  and  cents 
"  count ;"  in  the  medical  profession,  reputa- 
tion only. 

This  is  the  only  payment  which  the 
profession  at  present  allow^s  those  who 
accomplish  results  oi  value  in  fields  unex- 
plored. Indirect  financial  benefit  is  not 
honest  gain.  On  this  account,  therefore, 
the  originallabors  of  physicians  should  be 


THE  CANADA  MEDICAL  RECORD. 


guarded  with  the  utmost  care  in  all  sec- 
tions of  the  globe.  The  following  quota- 
tions (with  additions)  from  a  paper  present- 
ed before  the  last  meeting  of  the  New 
York  State  Medical  Association  will  ex- 
plain my  reasons    for  the  above  remarks  : 

"  Through  the  kindness  of  Dr.  Thos.  H. 
Manley,  of  the  New  York  State  Medical 
Association,  Tarn  enabled  to  refer  to  an 
article  in  the  Proceedings  of  the  Paris 
Academy  of  Medicine,  under  the  date  of 
June  2,  1 89 1,  in  which  Dr.  J.  V.  Laborde, 
in  a  discussion  on  'Anaesthesia,'  regard- 
ing the  dangers  of  chloroform  narcosis,  re- 
commends forced  respiration,  and  has  de- 
vased  a  face -mask  with  which  to  perform 
the  operation.  This  face-mask  is  of  metal, 
w'ith  the  edges  surmounted  or  faced  wdth 
rubber,  and  includes  the  iiosc  and  moutJi. 
It  is,  '  to  all  intents  and  purposes,'  simi- 
lar in  detail  to  the  one  I  have  been  using 
for  some  years,  and  with  which  I  have 
saved  a  number  of  lives.  Dr.  Laborde 
speaks  of  his  invention  as  novel,  of  great 
future  value,  declaims  on  the  subject  never 
having  been  brought  up  for  discussion, 
-etc.  The  members  of  the  New  York 
State  Medical  Association,  who  have  been 
acquainted  w^ith  my  work  for  the  last  four 
years,  will  agree  that  our  Paris  physicians 
can  well  afford  to  look  westward  to  learn 
that  progress  is  not  confined  to  Continen- 
tal Europe.  It  is  quite  strange,  also,  that 
Dr.  Laborde  has  overlooked  the  state- 
ments of  Prof.  Horatio  C.  Wood,  in  his 
address  on  '  Ansesthesia,'  before  the  Berlin 
Congress,  1890,  in  w^hich  he  distinctly  calls 
attention  to  my  face-mask,  and  which  I 
had  been  using  for  two  years    previously. 

"I  am  also  astonished  by  the  statement 
in  the  Paris  Academy  Report,  that  noted 
French  physicians  have  been  using  my 
method  by  tracheotomy  with  remarkable 
success,  and  without  giving  any  credit  for 
its  practical  introduction  to  the  world  from 
this  side  of  the  Atlantic. 

"  At  the  Paris  Exposition  of  1888,  which 
had  a  department  to  illustrate  life-saving 
methods,  one  of  my  instruments  was  exhib- 
ited by  Mr.  George  M.  Bailey,  of  Buftalo, 
N.Y.,  who, having  witnessed  the  remarkable 
case  of  Julius  Barre,  in  which  instance  I 
respired  twenty-four  hours  for  my  patient 
before  he  was  able  to  breathe  for  himself, 
requested,  in  the  interests  of  progress,  the 
privilege  of  taking    it    abroad.     He    had 


with  him  reprints  of  my  articles  published 
in  the  Transactions  of  the  New  York 
State  Medical  Association,  which  were 
distributed  among  some  of  the  physicians 
and  jurors  interested  officially  in  the  Expo- 
sition. At  that  time,  through  ignorance  of 
the  value  of  my  method,  they  took  no  notice 
of  my  work  as  being  w^orthy  of  note  as  a 
life-saving  invention.  Even  the  medical 
representative  of  the  United  States  Govern- 
ment at  the  Paris  Exposition  did  not  see 
anything  of  value  in  it,  although  no  more 
remarkable  cases  are  recorded  in  the  annals 
of  medical  science  than  some  of  the  first 
reported  in  my  memoirs,  which  were  placed 
at  the  command  of  these  gentlemen,  but 
possibly  not  given  the  attention  they  de- 
served ;  but,  what  is  most  remarkable,  ap- 
propriated it,  utilized  it,  and  now^  claim  ori- 
ginality for  methods  Avhich  I  had  previously 
used  and  first  recommended  in  practical 
shape  to  the  medical  world." 

I  w^ould  not  speak  thus  pointedly  did  I 
not  believe  these  gentlemen  cognizant  of 
my  work  through  the  publications  left  at 
Paris,  It  ma}'  be,  however,  that  they  did 
not  see  them. 

Also,  let  me  refer  you  to  a  criticism  which 
was  made  some  time  ago  by  a  Dr.  Herzog, 
of  Hoboken,  in  which  he  called  attention 
to  an  instrument  having  been  devised  for 
forced  respiration,  some  twenty  years  ago, 
which  had  been  donated  to  the  Humane 
Society  of  London,  England.  The  appa- 
ratus consisted  of  one  or  more  cylinders  so 
arranged  as  to  force  air  into  the  lungs  and 
also  exhaust  it.  It  was  costly  and  cum- 
bersome and,  undoubtedly,  was  never  used 
to  save  human  life,  or,  if  it  had  been,  would 
likely  have  failed  ingloriously. 

In  justice  to  the  results  of  my  work,  I 
must  give  my  answ^er  to  the  article  in  ques- 
tion. I  stated  that  : — "  I  would  not  now 
be  surprised  if  someone  should  add  that 
Hippocrates  had  thought  of  forced  re- 
spiration, and  even  devised  an  apparatus 
to  perform  it  with,  John  Hunter  did 
both,  and  possibly  others,  but  we  have  no 
record  of  any  of  these  noted  men  having 
applied  their  invention  to  the  saving  of 
human  life.  See  Prof  Horatio  C.  Wood's 
remarks  in  his  address  before  the  Berlin 
Congress,  in  which  he  says  :  "  But  I  have 
not  found  that  either  Hunter  or  Richardson 
treated  by  forced  artificial  respiration  an 
actual  case  of   disease  or  poisoning."     If 


THE  CANADA  MEDICAL  RECORD. 


123 


these  well-known  phy>icians  failed  where 
I  succeeded,  am  I  to  ha\e  less  the  credit  ? 
In  all  this  appar.itus  a  grave  defect  exist- 
ed, in  my  opinion,  in  th  it  provision  was 
made  to  exhaust  the  air  from  the  lungs  ; 
this  complicates  the  apparatus,  and, further- 
more, is  not  in  accord  with  physiological 
conditions,  as  inspiration  is  a  forcible  mea- 
sure, while  expiration,  being  [)assive  and 
produced  by  the  elasticity  of  the  fibro- 
elastic  tissue  of  the  lungs,  does  not  call  for 
the  utilization  of  mechanical  means  to  pro- 
duce it.  1  also  believe  that  an  apparatus 
provided  with  means  for  exhausting  air 
from  the  lungs  would  prove  a  very  dan- 
gerous instrument  to  place  in  the  hand  of 
the  average  physician  in  an  emergency 
case. 

However,  ;/cc^;/d' will  question  that  Rich- 
ardson, Hunter,  the  designer  of  the  appa- 
ratus mentioned  in  Dr.  Herzog's  letter  and 
several  others  whom  I  could  cite,  have 
prepared  or  invented  instramcnts  for 
forced  respiration  upon  human  beings. 

With  all  their  labor,  what  did  they 
accomplish  ?  Was  a  single  human  life  saved 
by  them  .-'  Did  they  demonstrate  the 
wonderful  possibilities  of  the  method  .''  Let 
us  see.  After  my  first  operation  with  the 
instrument  used  in  my  physiological  labor- 
atory, and  with  which,  notwithstanding  its 
defects  or  adaptation  forthe  purpose,  I  had 
succeeded  in  keeping  my  patient  alive  for 
nearly  three  hours,  until  he  breathed  for 
himself,  I  looked  up  the  home  and  foreign 
literature  on  the  subject.  Nothing  was 
discovered  which  appeared  to  controvert 
the  fact,  that  I  was  justly  entitled  to  the 
credit  of  being  the  first  to  systematically 
and  practically  solve  the  question  of  the 
value  of  forced  reb[)iration  in  the  saving 
of  human  life  ;  or  that  I  had  demonstrated, 
as  one  physician  puts  it,  "that  air  can  be 
forced  into  the  lungs  without  any  damage 
to  them."  Whatever  has  been  accomplish- 
ed, also  should  be  stated,  was  without 
any  previous  knowledge  of  the  failures  in 
the  same  field  which  had  ante-dated  my 
efforts. 

I  can  say,  with  the  practical  knowledge 

,  obtained     from    operating     upon    human 

beings,  that  the  instruments  used  in  the 

physiological  laboratory  do  not  meet  the 

^  conditions  to  be  successfully  overcome  in 

breathing  for  a  human  beingfor  any  length 


jf  time.     They  may  answer    in  some  in- 


stances as  a  make-shift,  but  the  work  is 
carried  on  at  a  great  disadvantage,  and 
with  many  chances  in  favor  of  producing, 
instead  of  averting,  a  fatal  result.  They 
were  never  intended  to  be  used  upon 
human  beings.  The  instrument  with  face- 
mask,  originally  devised  by  myself  in  all  its 
practical  details,  and  wi.h  which  the  results 
detailed  in  this  paper  were  accomplished, 
was  founded  upon  the  experience  obtained 
in  my  first  case  ;  and  the  results  of  my 
labor  with  it  so  overwhelmingly  annihi- 
lates any  controversy  in  opposition  to  its 
use,  that  it  is  needless  to  do  more  than 
present  them  to  the  profession.  Had 
simil-ir  results  or  demonstration  been  accom- 
plished at  the  hands  of  others  in  the  past, 
nothing  could  have  prevented  them  from 
receiving  the  widest  publicity  in  the  medi- 
cal literature  of  the  day  ;  but  no  record  is 
found  which  detracts  from  the  practical 
value  and  originality  of  my  labors.  As  a 
physiologist,  I  was  acquainted  with  the 
apparatus  used  in  the  physiological  labo- 
ratory, from  the  simple  bellows  with  noz- 
zle poked  into  the  trachea  of  a  dc;g,  to 
the  more  complicated,  constant  Spiengle 
blower  with  interrjptor,  which  admittedly 
would  be  oi  no  use  as  an  emergency 
instrument. 

The  apparatus  I  hid  used  meets  .dl  the 
requirements  for  forced  respiration  in  man, 
with  or  without  tracheotomy,  and  in  the 
simplest  manner.  It  covers*  all  the  methods 
which  can  be  utilized  in  the  operation,  is 
adapted  to  be  used  out  of  doors  or  in  a 
cold  atmosphere,  but  may  be  modified  by 
an  arrangement  to  provide  a  constant  air 
supply  and  automatic  inspirator,  which 
would,  however,  increase  the  cost,  and  do 
away  with  the  emergency  feature  of  the 
apparatus,  as  now  used. 

Dr.  Herzog's  article,  possibly  without 
intent,  would  naturally  lead  to  the  infer- 
ence that  the  subject  is  old,  not  worth 
considering;  its  tenor  is  not  uncertain. 
The  truth  is  that  the  work  in  forced  respir- 
ation, prior  to  my  own,  and  running 
[  through  the  past  century  to  a  great  extent, 
had  simply  relegated  it  to  the  list  of  unjus- 
tifiable procedures.     Do  we  find  anything 

•  I  do  not  question  that  dirferent  mechanical  devices 
might  not  be  successfully  used  in  forced  respiration. 
They  would  not  simplify  the  operation,  and  now,  since 
the  demonstrations  of  its  value,  may  spring  up  as  original 
inventions. 


124 


THE   CANADA   MEDICAL   RECORD. 


previous  based  upon  results  recommending 
us  to  use  forced  respiration  after  all  other 
methods  of  artificial  respiration  had  failed  ? 
On  the  contrary,  we  do  find  in  every 
medical  work  treating  on  the  subject,  the 
"  Ready  Method  in  Asphyxia  of  Marshall 
Hall,"  the  highest  accepted  authority,  that 
we  viust  avoid  the  use  of  bellozvs  or  any 
forcing  instrument. 

Now,  I  propose  to  talk  plainly,  as  it  seems 
entirely  unnecessary  at  this  date  to  mince 
words  upon  this  subject.  The  practical 
introduction  to  the  world  of  the  value  of 
fm'ced  respiration  in  the  saving  of  human  life, 
the  demonstrations  %vhich  indicated  its  great 
possibilities,  must  be  accredited  to  an  Amer- 
icaft,  and  the  work  of  others  in  the  past 
had  nothing  to  do  with  the  results  obtained 
by  him  which  were  original  in  conception 
and  in  the  detail  of  the  method  of  prac- 
tical application. 

The  question  simply  amounts  to  the 
difference  between  failure  and  success  :  will 
the  credit  be  accorded  to  those  who  failed 
or  the  one  who  succeeded  .-'  In  this  Colum- 
bian year!  might  ask,  if  Christopher  Colum- 
bus had  prepared  his  ships,  but  not  sailed 
across  the  Atlantic,  zvould  he  have  discov- 
ered xAmerica  ? 

What  also  must  be  admitted  by  those 
w^ho  are  inclined  to  accord  justice  to  whom 
it  is  due  is,  that  the  practice  of  vivisection 
in  the  colleges  and  laboratories  of  the  land 
had  no  relation  whatever  to  the  saving  of 
human  life,  or  had  it  been  ever  taught  in 
medical  institutions,  systematically  or  other- 
wise, as  of  any  value  in  saving  human  life. 
For  over  eight  years  prior  to  my  first  oper- 
ation of  forced  respiration  upon  a  human 
being,  I  had  been  a  practical  vivisectionist  in 
the  physiological  laboratory,  and  during 
that  time  I  never  heard  it  even  hinted  that 
a  human  life  might  be  saved  by  the  labor- 
atory methods. 

It  was  in  the  field  of  paralysis  of  the 
respiratory  centres  from  opium  that  I  began 
my  work  with  forced  respiration,  and  the 
demonstrations  as  to  its  efficacy,  from  the 
first,  could  not  be  questioned.  Each  and 
every  case  saved  had  passed  beyond  the 
limit  ofhope,  sofarasall  known  and  system- 
atically applied  methods  of  resuscitation 
were  concerned.  To  be  denied  the  credit 
which  should  in  all  fairness  be  accorded  to 
the  practical  originator  of  a  method  of  such 
far-reaching   importance   in   the  saving  of 


human  life  is  what  I  could  not  and  will  not 
quietly  submit  to.  "  Honor,  gentlemen,  to 
whom  honor  is  due." 

Let  me  coirect  also  another  impression 
coming  from  high  authority  :  Dr.  John 
O'Dwyer,  who  advocated  intubation,  states 
that  there  are  serious  objections  to  the  use 
of  the  face-mask  and  tracheotomy  in  forced 
respiration.  (See  his  article,  Archives  of 
Pediatrics,  May,  1892.) 

The  majority  of  cases  upon  which  I  have 
operated  have  been  cases  of  opium  narco- 
sis ;  cases,  it  is  true,  which  offer  the  widest 
demonstrations  of  the  advantage  of  the 
method  in  its  long  continued  use,  and  yet 
it  must  be  borne  in  mind  that  the  life  of 
the  patient  is  not  out  of  danger  until  the 
poison  is  eliminated  from  the  system. 

Now,  I  am  quite  sure  that  neither  Dr. 
O'Dwyer  nor  any  other  judicious  physician 
would  recommend  a  method  which  would 
prevent  the  imbibing  of  fluids,  through 
which  means  we  may  most  readily  aid  elim- 
ination of  the  poison.  Intubation,  which 
he  recommended,  would  certainly  do  this 
in  preventing  closure  of  the  glottis,  and 
therefore  I  have  not  used  it ;  also,  it  is  a 
fact  that  one  of  the  difficulties  we  have  to 
contend  with  in  these  cases  is  the  danger  of 
vomited  fluids  entering  the  larynx  and 
obstructing  respiration.  I  must  contend 
that  in  such  cases  tracheotomy  offers  more 
hope  for  our  patient  than  intubation,  as 
there  is  no  interference  with  the  passage 
of  fluids  to  the  stomach.  Expeiience  has 
shown  again  that  intubation  will  be  sel- 
dom needed  when  the  face-mask  offers 
us  as  good  results  without  any  of  the  diffi- 
culties which  must  be  necessarily  met  with 
in       intubation.  The     objections     Dr. 

O'Dwyer  urged  against  the  face-mask  are 
not  in  many  cases  borne  out  in  actual  ex- 
perience ;  views  based  upon  practical  ex- 
perience must  be  conceded  as  of  more  value 
than  those  of  a  semi-hypothetical  nature. 
Nearly  to  the  present  time,  so  far  as  can 
be  ascertained,  I  have  probably  had  more 
systematic  operations  of  forced  respira- 
tion upon  man  than  all  the  rest  of  the 
physicians  of  the  world  combined.  What 
I  may  say  upon  this  subject  is  based  en- 
tirely upon  this  experience. 

Dr.  O'Dwyer  states  that :  "  In  forcing  air 
through  the  mouth   or  nose  of  an  insensi- 


ble patient;  the   tongue,   unless  secured,  i.< 
almost  certain  to  cause   obstruction,  or  th- 


THE  CANADA  MEDICAL  RECORD. 


12; 


vocal  chords  nia\-  be  forced  together  b\- 
in-rushing  air,  and  act  as  a  valve  as  in 
paraU'sis  of  the  abductor  muscles,  because 
there  is  no  expansion  of  the  glottis  as 
in  normal  inspiration."  This  does  not 
generall}'  hold,  I  can  safely  state,  from  the 
observations  I  have  made  and  now  repeat 
tersel)'. 

In  my  eleventh  case,  young  woman,  I 
used  the  face-mask  for  four  hours ;  my 
fifteenth  case,  female,  for  seven  hours  ; 
seventeenth  case,  female,  two  hours  ;  case 
nineteen,  c.ld  lady,  two  hours  ;  case  twenty- 
first,  female,  seven  hours  ;  case  twent}- 
second,  female,  four  hours  ;  twenty-fourth 
case,  male,  five  hours  ;  twenty  fifth  case, 
female,  two  hours.  In  all  these  cases,  and 
many  subsequent  for  the  time  mentioned, 
which  resulted  in  the  majority  of  instances 
in  saving  the  lives  of  my  patients,  there 
was  absolutely  no  interference  with  the 
air  passing  directi}-  to  the  lungs.  Further- 
more, the  chest  would  heave  and  fall  in 
many  cases  in  the  most  natural  manner. 
That  such  results  could  be  obtained  by 
the  cheap  apparatus  mentioned  in  "  The 
Year  Book  of  Treatment,"  1891,  page  193 
— Dr.  Wood  being  gi\"en  the  credit  as 
originator — and  lauded  as  the  best,  consist- 
ing of  a  face-mask,  a  few  feet  of  rubber 
tubing,  a  pair  of  bellows,  and  two  sizes  of 
intubation  tubes  (ordinarily  not  required), 
I  do  not  believe.  With  such  an  apparatus 
which,  it  is  stated,  could  be  used  by  "  un- 
skilled persons,"  I  am  quite  certain  I  would 
have  lost  many  of  my  patients.  In  the 
cases  referred  to,  if  too  great  pressure  was 
produced,  the  cesophagus  would  expand 
and  cause  stomach  inflation  ;  but  by  careful 
inspirations  for  a  time,  followed  by  pressure 
on  the  abdomen,  it  would  pass  away  with- 
out inconvenience. 

W  hat  appears  to  me  may  be  urged  as 
facts  of  value  in  this  connection  are  the 
following  :  The  passage  to  the  lungs  under 
ordinary  conditions  of  unconsciousness, 
except,  and  even  sometimes,  in  swallowing, 
is  always  open.  The  air  forced  into  the 
lungs  does  nor,  as  is  generally  believed, 
cause  a  closure  of  the  glottis  any  more  than 
the  deep  auto-inspiration  of  ordinary 
respiration.  Exceptions  ma}-  be  taken  to 
all  rules  of  course. 

If  forced  respiration  by  my  method, 
use  of  face-mask,  etc.,  be  carefully  con- 
ducted,  the  lungs  may  be  as  fully  inflated 


as  under  deep  auto-inspiration,  and  the  re- 
spirations kept  up  for  a  period  of  time  rang- 
ing from  one  to  ten  hour.-.,  according  to 
size  of  individual  and  degree  of  obesity. 
Thin,  spare  patients  appear  to  be  better 
subjects  than  those  of  opposite  build.  In 
the  few  cases  in  which,  from  continued 
work  with  complete  paralysis,  the  tongue 
has  fallen  back  and  occluded  the  larnyx, 
a  ligature  has  been  placed  through  it  and 
the  organ  held  forward.  Usually,  exten- 
sion of  the  neck  will  raise  the  glottis,  but 
cannot  always  be  relied  upon  ;  in  such 
cases  intubation  would  be  of  value.  After 
the  face  mask  has  failed  in  one  or  two 
instances,  I  have  saved  life  by  performing 
tracheotom}-,  which  was  called  for  through 
the  cases  being  narcotized  by  opium  (vide 
previous  remarks;. 

As  to  intubation,  it  may  have  its  place 
in  some  cases  of  forced  respiration,  but  to 
urge  its  value  over  the  use  of  the  face- 
mask  when  the  latter  has  accomplished  so 
much,  is  unwarranted. 

Dr,  J,  S.  McLain  of  Washington,  D.C., 
who  has  supplied  himself  with  an  appar- 
atus for  forced  respiration,  propounded  the 
following  questions,  which,  having  a  prac- 
tical bearing  upon  the  use  of  the  instru- 
ment, might  prove  of  value  to  others. 

First  Question  : — After  padding  the  face- 
cup  to  make  it  fit  the  face  of  the  patient, 
is  it  necessary  to  exert  considerable  pres- 
sure thereon  when  the  air  is  being  sent 
into  the  lungs,  to  keep  the  air  from  escaping 
at  sides  of  cup  }  The  amount  of  pressure 
will  vary  in  different  patients,  but  not  to 
a  great  extent  if  the  cup  fits  the  contour 
of  the  face  snugly,  or  it  is  padded  with  a 
piece  of  cloth  to  do  so.  I  have  used  the 
face-cup  on  men  with  a  moustache  or 
whiskers,  and  it  has  worked  well.  It  is  a 
mistaken  notion  that  much  pressure  of  air 
is  required  to  inflate  the  lungs  in  inspir- 
ation. The  artificial  lungs  which  I  have 
used  in  demonstrations  very  nicely  illus- 
trate this,  and  with  them  the  actual  pressure 
used  can  be  readily  obtained.  The  presence 
of  cyanosis  is  the  most  important  condi- 
tion which  calls  for  more  active  or  forcible 
inspiration.  In  producing  it,  it  should  be 
borne  in  mind  that  too  great  pressure  will 
distend  the  cesophagus  and  inflate  the  sto- 
mach and  intestines.  If  this  should  take 
place,  pressure  upon  the  abdomen  at  inter- 
vals will  relieve  the  condition,  so  as  not  to 


126 


THE   CANADA   MEDICAL   RECORD. 


prevent  the  descent  of  the  diaphragm  and 
interference  with  inspiration.  In  the 
majority  of  instances  I  have  not  found  it 
necessary  to  hook  up  the  tongue.  If  it 
falls  backward  and  prevents  the  air  from 
passing  to  the  lungs,  a  coarse  ligature  may 
be  passed  through  it,  carried  out  at  the 
side  of  the  face-cup  and  retained  in  piace 
with  very  little  trouble.  Sometimes,  but 
not  always,  by  raising  the  larynx  or  ex- 
tending the  head,  the  respirations  will  be 
facilitated.  My  experience  would  lead  me 
to  state  that  forced  respiration  by  the  face- 
mask  is  more  readily  applied  in  the  case 
of  lean  than  in  corpulent  individuals,  that 
the  difficulties  noted  above  are  hardly  to 
be  experienced  in  the  former. 

A  case  in  point  was  that  of  Mrs.  X , 

who  had  taken  eleven  grains  of  morphine  ; 
artificial  respiration,  Sylvester  method,  was 
of  no  avail ;  four  hours  of  respiration  Fell 
method  placed  the  lady  out  of  danger. 
In  this  instance  the  slightest  movement 
of  the  air  control  valve  would  cause  the 
chest  to  heave,  when  the  respiratory  cen- 
tres were  almost  completely  paralyzed ; 
the  marked  cyanosis  was  quickly  over- 
come, and  the  most  complete  control  of 
the  respirations  existed. 

Second  Question  : — Is  it  necessary, 
when  using  the  face- cup,  to  pry  the  mouth 
open  and  raise  the  tongue,  or  will  the  air 
enter  in  sufficient  quantity  through  the 
nostrils,  supposing  the  mouth  to  be  closed  ? 
In  the  majority  of  cases,  air  will  enter 
through  the  nostrils  in  sufficient  quantity 
to  supply  the  respiratory  needs.  If  the 
base  of  the  tongue  occludes  the  glottis,  a 
ligature  passed  through  the  tongue,  as 
stated,  will  aid  the  inspirations.  This  will 
be  seldom  required. 

The  object  of  presenting  this  paper  to 
the  members  of  this  Congress  is  that 
through  the  unquestioned  results  obtained 
by  the  methods  first  systematically  and 
practically  recommended,  and  by  giving  a 
clear  record  of  the  experiences  which 
brought  them  about,  they  may  be  readily 
taken  up  and  utilized  for  the  benefit  of  the 
profession  and  humanity. 

Dr.  Pepper,  the  worthy  president  of  this 
body,  gave  his  opinion,  to  the  effect  that  the 
reading  of  papers,  and  giving  demonst-a- 
tions  before  medical  bodies,  would  do  but 
little  towards  introducing  a  new  practice, 
so  that  it  would  be  generally    utilized    by 


the  profession.  He  urged  that  I  would 
succeed  better  by  placing  into  the  hands 
of  the  well-known  clinicians  of  the  coun- 
try a  few  instruments  at  cost  price,  and 
await  the  results  of  their  use.  This  I  will 
endeavor  to  do,  as  there  is  no  evidence 
that  instrument  manufacturers  will  do 
anything  with  the  apparatus  until  the 
clinici?ns  generally  have  demonstrated  that 
it  is  a  necessity  and  a  valuable  addition  to 
our  armamentarium.  More  than  this,  medi- 
cal opinion  must  be  moulded  so  that  it  will 
be  considered  hazardous  to  attempt  to  save 
life  without  proper  appliances  being  pro- 
v.'ded  beforehand.  A  physician  of  Syra- 
cuse, N.Y.,  telephoned  me  to  send  him  an 
instrument,  that  he  had  a  lady  patient  in 
danger  of  dying  from  an  over-do-e  of 
opium  or  morphia,  I  received  the  word 
two  or  three  hours  aftei'  it  was  sent,  and 
forwarded  by  express  the  only  instrument 
I  had  at  my  disposal,  offering  it  to  the 
party  at  less  than  the  actual  money  out- 
lay I  had  incurred  in  prep.uing  it.  Next 
day  the  instrument  came  back,  with  the 
statement  that,  while  the  physician  was  at 
the  depot  obtaining  it,  his  patient  died  ; 
that  now,  knowing  where  he  could  procure 
one,  he  would  wait  until  he  had  another 
patient  before  procuring  it.  If  the  second 
patient  comes  around,  he  will  undoubtedly 
have  another  death  certificate  to  fill  out. 

The  following  letter,  in  answer  to  an 
enquiry  of  Dr.  J.  Frank,  of  Chicago,  who  is 
supplied  with  an  apparatus,  may  be  of 
practical  value  to  anyone  desiring  to  use 
the  method:  "  Suppose  a  case  of  asphyxia 
from  any  cause,  as  opium  narcosis,  drown- 
ing, inhalation  of  gas,  a  case  of  shock  from 
any  cause  in  which  the  respiratory  cen- 
tres are  disturbed  or  in  v.'hich  the  respira- 
tions are  shallow  from  loss  of  vital  energy, 
and  in  which  the  Sylvester  or  any  other 
m  thod  or  artificial  respiration  has  failed 
or  is  of  no  value.  Use  the  apparatus  as 
follows,  with'  the  parts  in  the  following 
relations  to  each  other  :  Face  mask  or 
cup,  rubber  tube  connecting  it  with  air 
valve,  air  valve,  rubber  tube  connecting 
air  valve  with  belloAvs. 

With  your  patient  on  a  table,  bed  or 
fioor,  as  the  case  inay  be,  press  face-cup 
over  the  nose  and  mouih,  arid  have  bellow's 
worked  by  an  attendant  at  the  rate  of 
from  1 20  to  150  times  per  minute  for  an 
adult,   and   less   for   infant  or  youth.      For 


THE   CANADA   MEDICAL   RECORD. 


127 


each  three  movements  of  bellows,  press 
down  piston  of  air  valve,  which  permits  the 
air  to  pass  to  the  lungs,  bulging  out  the 
cheeks,  and  produces  an  inspiration.  Then 
release  piston  of  air  valve  for  three  move- 
ments of  bellows,  letting  the  air  pass  out 
of  lungs  and  pro  lucing  the  expiration  — 
keep  it  up.  If  C}'anosis  does  not  pass  away, 
make  the  inspiration  a  little  longer.  With 
the  air  valve  you  can  absolutel_^  control 
the  outward  or  inward  movement  of  the 
air,  <ind  by  watching, .if  attempts  at  respir- 
ation should  be  made  b}- the  patient,  you 
can  materially  assist  them  and  change  in- 
stantly from  one  to  the  other.  The  puff- 
ing out  of  the  cheeks,  heaving  of  the  chest 
and  vibration  of  the  vocal  chords  (slight 
snoring  sounds)  are  all  indicators  of  value 
in  the  progress  of  the  work.  This  method 
of  forced  respiration  in  such  a  case  is  do- 
ing more  than  to  keep  up  the  life  of  the 
patient  where  all  the  old  methods  of  Syl- 
vester, Marshall  llall  and  other  methods 
of  artificial  respiration  would  fail.  Through 
the  extra  quantity  of  oxygen  supplied  to 
the  blood  it  overcomes  to  a  degree  the 
effect  of  the  narcotic,  and  thus  enhances  the 
chances  of  recovery  of  the  patient.  In 
addition,  however,  all  methods  calculated 
to  tone  up  and  invigorate  the  heart  mus- 
cle and  system  generally,  with  those  cal- 
culated to  eliminate  the  poison  circulating 
in  the  system,  must  be  used.  Don't  fail 
to  try  forced  respiration  even  when  the 
prospects  for  successful  resuscitation  seems 
useless,  as  I  have  many  instances  in  which 
life  has  been  saved  when  the  indications 
gave  little  cause  for  hope. 

Now.  gentlemen  and  ladies,  I  was  in 
hopes  that  my  experience  at  the  Pan 
American  Medical  Congress  might  prove 
different  from  that  with  other  medical 
bodies  with  which  I  have  discussed  this 
subject,  but  I  have  found  it  the  sarne.  No 
special  recognition  which  has  resulted  in 
calling  the  method  into  general  use  has 
been  taken.  If  not  when  thirty  human  lives 
have  been  saved  by  a  procedure  not 
heretofore  intelligently  utilized,  will  it  when 
sixty  or  a  hundred  or  more  have  been 
saved  ?  I  have  given  to  the  world  a  simple, 
practical  and  thoroughly  valuable  method 
of  saving  life,  which,  had  it  been  utilized  in 
the  last  four  years,  after  ample  time  had 
elapsed  to  demonstrate  beyond  doubt  its 
value,  not  one  but  from  two  to  three  thou- 


sand lives  would  have  been  saved  which 
have  been  sacrificed  to  an  outrageous  con- 
servatism which  has  no  right  to  prevail 
among  intelligent  beings  at  the  present 
period.  The  reasonable  recognition  of  a 
procedure  which  has  accomplished  so 
much  would  interest  thousands  who  would 
not  give  it  a  thought  without  it,  and  do 
much  toward  bringing  into  general  use  a 
life-saving  method,  well  known,  but  lying 
dormant,  listless,  inadvertent.  I  ask  you 
in  all  earnestness,  if  this  great  American 
body  Ccin  do  better  than  give  this  subject 
the  consideration  it  deserves,  or  let  the 
opportunity  pass  to  somebody  of  equal 
or  greater  magnitude  to  do  it }  The 
results  of  my  work  will  continue  to  be 
added  to.  I  hope  to  live  to  see  them 
figured  in  the  thousands.  In  the  ordinary 
course  of  events  it  must  come.  I  appeal 
to  our  American  foreigners  here  to  have 
it  utilized  at  their  homes,  and  can  assure 
them  that  it  will  do  what  has  not  been 
accomplished  before,  and  exceed  their  most 
sanguine  anticipations  in  the  results  which 
are  ordinarily  obtained. 

72  Niagara  St.,  Buffalo,  N.Y. 


^ocictg    groccebings. 


THP:    MONTREAL      MEDICO-CHIRUR- 
GICAL  SOCIETY. 

Stated  Meeting,  May    12M,  1893. 

James   Stewakt,    M.D.,    President,    in  the 
Chair. 

Large  Scrotal  Hernia.  —  Dr.  Armstrong 
brought  before  the  Society  a  man  suffering 
from  an  enormous  hernia.  It  had  been  gradu- 
ally incieasing  for  the  last  twenty-four  years; 
a  truss  had  never  been  worn.  The  sac  seemed 
to  contain  the  greater  part  of  ihe  small  intes- 
tines, and  the  ring  was  large  enough  to  admit 
the  fingers  to  the  knuckles.  Dr.  Armstrong 
intended  to  transplant  the  cord  and  close  the 
opening. 

Dr.  Shepherd  referred  to  a  similar  case 
upon  whom  he  had  operated  several  years  ago. 
The  sac  contained  all  the  abdominal  contents, 
except  the  stomach  and  rectum.  The  testicle, 
which  was  cystic,  was  removed,  and  the  canal 
comjiletely  closed.  There  has  been,  no  re- 
turn. 

Macroglossia — Dr.  Shepherd  showed  an 
infant  of  six  months  suffering  from  an  extreme 


128 


THE   CANADA   MEDICAL   RECORD. 


degree  of  microglossia.  The  tongue  pro- 
jected about  two  iiiches  fr^  m  the  mouth,  and 
great  difficulty  was  exuerienced  in  feeding  the 
infiint.  He  proposed  to  remove  the  tongue 
with  the  ecraseur. 

Poisoning  by  Sulphate  of  Copper. — Dr. 
Wyatt  Johnston  exhibited  the  siomach  of 
a  man,  aged  28,  who  had  committed  sui'ide  by 
drinking  nearly  a  quart  ofa  saturated  solution 
of  sulphate  of  copper  from  a  battery  jar  in  the 
electric  works,  where  he  was  employed  as  a 
night  watchman.  Death  occurred  in  an  hour 
and  a  half.  The  siomach  and  intestines  had 
externally  a  leaden-blue  color,  ard  contained 
a  large  amount  of  pale  grayish-green  flccculeni 
fluid.  The  mucosa  had  the  appearance  of 
having  been  tanned,  and  was  stained  a  deep 
green  color.  Chemically,  the  contents  of  the 
stomach  were  found  to  consist  of  basic  or  sub- 
sulphate  of  copper.  Heart  muscle  and  liver 
parenchyma  looked  opaque  and  grayish.  No 
examination  for  cop])er  was  made  of  the^e 
organs. 

Dr.  W.  F.  Hamilton  said  that  the  patient 
had  been  admitted  to  the  General  Hospital 
shortly  before  death.  Large  quantities  of 
warm  water  and  mustard  failed  to  produce  em- 
esis.  He  seemed  to  suffer  from  extreme  pain 
and  difficulty  of  respiration,  owing  to  a  quan- 
tity of  mucus  in  the  throat.  Extremities  were 
cyanotic;  superficial  cajjillaries  were  marked- 
ly dilated.  There  were  some  mucous  and 
wateiy  stc  ols. 

Dr.  Mills  asked  if  there  was  any  evidence 
along  the  cc  urse  of  the  vessels  and  lacteals  to 
indicate  whether  the  salt  had  been  ab-o;bed 
into  the  blood. 

Dr.  Johnston  replied  that  there  were  no 
signs  to  indicate  that  absorption  had  taken 
place  j  no  naked-eye  changes  in  the  blood. 

Localized  Tuberculosis  of  Asce7iding  Fi  ontal 
Convoluti07i. — luoerculosis  of  one  Suprare- 
nal.—  Dr.  Adami  exhibited  the  drawing  of  a 
brain  recently  removed  by  him,  presenting  a 
peculiarly  rare  localized  tubercular  lesiun, 
affecting  the  centres  for  the  movements  of 
the  upper  limb  and  neck  of  the  left  side. 

The  patient,  a  woman  of  28,  phthisical  and 
a  morphine  maniac,  a  patient  of  Dr.  Stewart 
at  the  General  Hospital,  had,  for  two  days 
before  death,  suffered  from  repeated  attacks  of 
an  epileptic  nature,  in  which  there  were  con- 
vulsive movements  of  the  left  upper  extremity 
and  the  neck,  so  that  the  head  became  pulled 
down  to  the  left,  and  the  face  turned  partly  to 
that  side.  These  movements  were  executed 
with  great  rapidity,  as  many  as  145  contrac- 
tions of  the  extremity  being  recorded  per 
minute. 

At  the  autopsy,  there  was  found  old  phthisis 
of  both  apices,  and,  extending  from  there,  a 
condition  of  acute  tubercular  broncho-pneu- 
monia,   miliary    tubercles    of   relatively   large 


size  being  scattered  all  over  both  lungs. 
Both  the  kidneys  a  d  the  liver  presented  simi- 
lar tubercles,  while  the  medullary  substance  of 
the  right  suprarenal  contained  caseous  tub  r- 
ciilar  foci  oflaige  size.  The  left  suprareiial 
had  a  gray  softened  medulla,  but  was  not 
tuliercnlai. 

\  condition  of  great  intere.-.t  was  exhibited 
in  this  brain.  Ciireful  examination  and  sec- 
tion revealed  no  tubercular  affection  save  at 
one  spot — an  area  a  little  over  half  an  inch 
in  diameter,  situated  upon  the  right  ascending 
frontal  convolution,  at  either  apposed  side  of 
a  fold  forwards  in  that  convolution,  at  the 
level  of  the  sulcus  which  separates  the  superior 
from  the  middle  frontal  region  of  the  br.iin. 
Here  miliary  tubercles  sur  ounded  the  surface 
vessels,  and  the  tubercular  process  extended 
along  the  sheaths  of  the  branches  given  off  rom 
these,  and  formed  small  wedge-like  masse-', 
passing  through  the  gray  to  thj  outer  service 
of  the  white  matter.  Dr.  Ad.nni  pointe  1  out 
that  a  tubercular  lesion  of  such  small  diincn 
sions  affecting  so  di  .tinctly  one  group  of  asso- 
ciated movementswasalmost,if  notquite  unique. 
He  called  attention  to  the  fact  that  this  case 
supports  Ferrier's  conclusion,  reached  by  ex- 
perimental research,  that  the  area  for  the 
movements  of  the  neck  passes  backward  to 
the  ascending  frontal,  and  overlies  or  inter- 
mingles with  the  areas  for  movements  of  the 
upper  extremity. 

Recto-ovarian  Fistula. — The  same  case  pre- 
sented   another    rarely    recorded     condiiion. 
Upon  removal    of  the  pelvi-.-  organs  en  masse, 
it  was    found  that    both  ovaries  were  situated 
low  down  in  the  cavity,  and  were  there  bound 
to    the  vaginal    end  of  the  uterus    by  firm  old 
inflammatory   adhesions.     They   were    fibroid 
and  conti acted.     I'he  Fallopian  tubes  curved 
downward-  to  them,  and  did  not  present  sueh 
extensive  evidence  cf  inflammatory  disturbance. 
It  is  to  be  noted  that  the  left  tube  was    not  at 
its  extremity  in  close  attachment  to  the  ovary. 
Upon  attempting  to  cut  away  the  left  ovary, 
a  fistulous  track,  containing  foul-smelling  con- 
tents, was  opened,  and  upon  passing  a  sound 
into  this,  it   ev'v'^erged  into  the  rectum  at  a  ])oi.it 
about  33^2  inches  iibove  the  anal  orifice.     Th.e 
ovary  lay  curved  over  the  blind    end  of  this 
fistula,  which  was  i^  inches  in  length.     There 
had    been  so    much    inflammatory  change   all 
around  the  fistula,  that  it  was  not  possible  to 
recognize    microscopically  anything   but  firm^ 
fibrous  tissue  in  this  region  ;  however,    macro- 
scopically,   the  rather  thin    upper  wall  of  the 
fistula,  seen  from  above,  was  in  direct  connec- 
tion with,  and  indistinguishable  fiom,  the  rest  of 
the    ov.ry,  while,  clinically,  there  was  the  his- 
tory of  acute  ovarian  disturbance  several  years 
previously.      Hence,  it  may  safely  be    inferred 
that  this  was  a  true  recto-ovarian  fistula. 
Not    a    few    cases  of  tubo-ovarian   abscess 


THE   CANADA.   MEDICAL   RECORD. 


129 


bursting  into  the  rectum  are  on  record,  but 
here  the  tube  was  not  implicated,  and  Dr. 
Adami  held  that  the  fistula  could  only  be  ex- 
plained as  ihe  consequence  of  an  acute  suppu- 
rating oophoritis  or  perioophoritis  with  rupture 
into  the  rectum.  The  patient  had  complained 
of  no  recent  ovarian  or  rectal  trouble  ;  the  fis- 
tula, as  its  walls  showed,  must  have  been  of 
long  standing. 

Dr,  William  Gardner  had  never  met  with  a 
condition  of  recto-ovarian  fistula  as  described. 
Ovarian  abscess  without  involvement  of  the 
tube  is  extremely  rare. 

Dr.  Stewart  said  that  the  case  was  unique 
as  a  demonstration  of  the  location  of  the  motor 
areas. 

JVhite  Sarcoma  0/  the  Retina. — Dr.  BuLi  er 
exhiljited  the  specimen  and  gave  the  histoiyof 
the  case.  The  patient,  a  woman,  aged  49,  had 
a  subacute  glaucoma,  of  some  standing,  in  the 
right  eye.  A  year  and  a  half  ago  she  became 
suddenly  blind.  The  other  eye  was  absolutely 
healthy,  so  he  had  come  to  the  conclusion  that 
this  was  not  a  case  of  ordinary  glaucoma,  but 
that  the  blindness  was  due  to  some  cause 
antecedent  to  the  glaucoma.  The  lens  had 
becotne  quite  opaque,  thus  precluding  ophthal- 
moscopic examination,  and  making  the  diag- 
nosis difficult.  He,  however,  counselled  enu- 
cleation, which  was  done.  On  making  an  equa- 
torial section,  a  round  growth  was  seen  on  the 
fundus,  which  proved  to  be  a  white  sarcoma, 
a  condition  of  great  rarity.  The  rest  of  the  eye 
was  in  a  fairly  healthy  condition  ;  the  detach- 
ment of  the  retina   had  not  become  complete. 

Thoracic  E/npyoema. — Dr.  Alla.nt  read  a 
paper  on  this  subject,  dealing  with  the  surgical 
treatment. 

Dr.  Shepherd  thought  that  ordinary  cases 
following  pneumonia  got  well  after  aspiration. 
But  in  cases  where  incision  into  thorax,  with 
removal  of  one  or  more  ribs,  is  performed,  the 
operation  gives  great  satisfaction.  He  never 
washes  out  the  cavity,  except  when  the  pus  is 
fcetid,  as  he  considers  it  unnecessary  to  intro- 
duce foreign  matter. 

Dr.  McGanxox  said  that  there  was  a  great 
difference  of  opinion  about  washing  out  the 
cavity.  Some  say  that  the  procedure  causes 
shock,  but  he  thought  shock  might  be  due  to 
hgemorrhage.  A  weak  solution  of  peroxide  of 
hydrogen  could  never  do  harm,  and  might  be 
of  great  service. 

Dr.  Stewart  had  recently  seen  three  cases 
of  pneumonic  empyema,  and  none  had  been 
successfully  treated  by  aspiration. 

Stated  Meeting,  May  26th,  1893. 

Dr.  James  Bell,  2nd  Vice  President,  in  the 
Chair. 

Dr.  Arthur  Beers  was  elected  a  member. 
Exophthabu'c  Goitre. — Dr.     J.  B.  McCon- 


nell  presented  before  the  Society  the  patient, 
a  woman  45  years  of  age,  married  25  years,  4 
children,  the  youngest  being  5  years.  The 
trouble  began  in  the  summer  of '91,  when  she 
began  to  suffer  from  a  spasmodic  cough,  which 
seemed  to  arise  in  the  throat,  and  was  asso- 
ciated wi'h  a  great  deal  of  palpitation.  Dur- 
ing the  winter  following,  she  got  lid  of  the 
cough,  but  the  palpitation  grew  worse.  During 
the  summer  of  '92  the  palpitation  was  so  bad 
that  she  could  scarcely  lie  down.  She  noticed 
the  swelling  of  the  thyroids  first  about  Christ- 
mas, '92,  and  they  have  grown  gradually  larger 
ever  since.  In  the  spring  of  '92  siie  first 
observed  some  brown  pigment  spots  on  different 
parts  of  her  body  ;  since  then  they  have 
appeared  on  the  hands,  the  shoulders,  the 
inner  sides  of  the  thighs,  and  somewhat  less 
marked  on  other  parts  of  her  body.  Associated 
with  these  pigment  spot  are  ])atches  of  leuco- 
derma.  The  exophthalmos  is  not  as  yet  very 
well  marked  ;  it  is  becoming  more  so,  however, 
seeming  to  be  following  the  other  two  cardinal 
symptoms.  She  has  also  suffered  from  marked 
tremor,  which  has  been  a  little  better  of  late, 
several  days'  rest  seemingly  having  rendered  it 
quieter.  Her  pulse  ranges  from  90  to  120,  and 
is  very  irregular. 

Examination  shows  the  heart  to  be  consid- 
erably enlarged  ;  the  apex  beat  is  considerably 
to  the  left  of  the  normal  point. 

It  is  a  very  typical  case  of  Graves'  disease. 
The  pigmentation,  however,  does  not  appear 
to  be  a  veiy  common  complication.  In  Pepper's 
system  of  medicine  it  is  not  even  mentioned  ; 
Osier,  however,  speaks  of  it  as  one  of  the 
complications  of  this  disease. 

There  is  no  anaemia,  although  she  is  ema- 
ciated and  somewhat  pale  ;  the  corpuscles 
number  5,200,000  to  the  cubic  millimetre. 

Dr.  Adami  remarked  that  pigmentation  was 
very  common  in  the  cases  of  this  disease  he 
had  seen,  in  a  country  where  Graves'  disease 
appeared  to  be  paiticularly  common,  Lan- 
cashiie  It  was  looked  on  there  as  the  fourth 
cardinal  symptom.  Pigmentation  is  interesting 
as  showing  the  nervous  nature  of  exophthalmic 
goit:e,  and  brings  it  into  relation  with  more 
than  one  disease  in  which  there  is  some  affec- 
tion of  the  sympathetic  system.  Addison's 
disease  is  another  of  these. 

Dr.  Lapthorn  Smith  extolled  the  use  of 
the  galvanic  current  in  the  treatment  of  the 
disease,  comparing  it  to  quinine  in  malaria,  and 
mercury  in  syphilis.  He  cautioned  moderation 
in  the  turning  off  or  on  of  the  current,  remarking 
that  the  sympathetic  nature  of  the  trouble  is 
shown  by  the  tendency  of  the  patient  to  faint 
or  turn  pale  under  even  the  slight  shock  there- 
by incurred.  A  single  sitting  often  reduces  the 
size  of  the  tumor  quarter  of  an  inch.  A  lady 
afflicted  with  this  trouble,  and  in  whom  the 
tumor    is    so  large  as  to  obstruct    breathing, 


I30 


THE  CANADA  MEDICAl.  RECORD. 


had  been  accustomed  to  come  to  him  yearly 
for  several  years,  just  to  have  it  reduced,  it 
growing  again  in  the  mterim.  The  strength 
of  the  current  used  vaiies  from  lo  to  15,  and 
rarely  up  to  20,  milliamperes.  No  puncture  was 
ever  made,  simply  an  electrode  large  enougli  to 
cover  the  surface,  and,  to  effect  this,  it  is  better 
to  make  it  concave.  Clay  or  absorbent  cotton 
answer  very  well  for  its  manufactu-^e. 

Dr,  KiRKPATRiCK  related  the  history  of  a 
case  where  the  galvanic  ciirrent  had  been  ured 
with  results  corresponding  to  those  of  Dr.  Smith. 
The  patient  usually  stood  10  milHamperes, 
commencing  with  5,  and  gradually  increasing. 
In  the  Medical N  ws,  a  few  months  ago,  a  case 
Avas  mentioned  where  the  Faradic  current  had 
been  used  with  equally  gratifying  results.  On 
the  other  hand,  a  case  occurred  in  the  General 
H'  spital  some  time  ago,  where  the  constant 
current  had  been  used  without  any  result. 
Probably,  after  all,  it  is  only  in  a  certain  num- 
ber of  cases  where  it  is  of  use. 

Dr.  McCoNNELL  asked  on  what  principle 
galvanism  is  used  in  this  disease.  The  enla'ge- 
ment  of  the  thyroid  is  a  secondary  phenomenon. 
It  seems  to  b<^gin  in  some  affection  of  the 
sympathetic,  a  vaso-motor  paralysis  localized 
to  a  certain  extent ;  in  this  way  the  heart  is 
primarily  afftcted.  Goitre  and  other  symptoms 
seem  to  be  secondary  and  not  essential,  from 
a  causative  point  of  view.  Have  they  a]iplied 
the  current  with  a  view  to  reduce  the  enlarge- 
ment, or  has  the  sympathetic  been  galvanized? 

Dr.  L.  Smith  thought  galvanism  acts  as  a 
powerful  tonic  to  the  sympathetic.  He  be- 
lieved that  the  beginning  of  the  disease  is  a 
paralysis  of  the  vaso-motor  nerves  in  the  thy- 
roid, resulting  in  a  hypersemia  of  that  gland. 
Galvanism  acts  by  renewing  the  tone  to  these 
vessels,  and  the  fainting,  etc.,  which  are  ob- 
served to  follow  a  too  sudden  application  of 
the  current,  are  due  to  the  too  rapid  tighten- 
ing of  the  sympathetic  in  the  brain,  the  blood 
being  thus  temporarily  cut  off. 

Cases  of  Cystic  Diseases  of  the  Ovaries. — 
Dr.  Adami  had  recently  received  for  examina- 
tion a  very  interesting  series  of  cases  of  dis- 
ease of  the  Fallopian  tubes  and  ovaries,  and 
brought  some  of  them  before  the  Societj ,  in 
order  to  invite  discussion  upon  the  subject  of 
ovaiian  cystomata. 

Case  I.  Chronic  Saipifigo  oophoritis. — 
The  two  tubes  and  ovaries  exhibited  were  ob- 
tained by  Dr.  Alloway  from  a  woman  aged  38 
years,  who  had  been  married  11  years.  She 
had  been  twice  pregnant,  the  last  pregnancy 
occurring  11  years  ago,  when  there  was  evi- 
dence that  she  suffered  from  septic  peritoni- 
tis. Upon  examination  before  operation  the 
uterus  was  found  contracted,  the  ovaries  and 
tubes  enlarged,  fixed  and  acutely  tender  and 
painful  upon  pressure.  Dr.  Alloway  operated 
upon  May  22nd,  and  upon  exposing  the  parts, 


found  extensive  delicate  veil  like  adhesions 
binding  the  ovaries  to  the  surrounding  organs  ; 
firmer  adhesions  bound  the  ovaries  to  the  outer 
ends  of  the  tubes.  These  numerous  adhesions 
complicated  the  removal. 

Left  ovary  and  tube :  The  tube  was  tor- 
tuous and  ^  in.  in  diameter.  The  walls  ap- 
peared firm  and  greatly  thickened,  but  upon 
section  the  reverse  was  found  to  be  the  case, 
for  the  tube  was  greatly  dilated  and  thinned 
in  its  outer  half;  the  smaller  and  narrower 
proximal  half  alone  showed  thickening  of  the 
walls,  while  the  dilated  region  was  filled  with 
thick,  almost  solid,  inspissaied  pus,  which 
presented  no  cell  structure,  but  only  granular 
and  fatty  debris.  There  was  almost  complete 
stenosis  of  the  uterine  extremity  of  the  tube; 
the  ovarian  extremity  was  completely  occluded 
and  was  distended,  all  indications  of  the  fim- 
briae having  disappeared.  Upon  the  outer 
wall  (  f  the  tube  close  to  the  ovary,  there  was  a 
small  white  body  of  the  size  of  a  No.  12  shot; 
this,  when  opened,  was  seen  to  be  a  cyst  filled 
with  simi'ar  inspissated  cell  debris,  but  iin- 
connected  with  the  lumen  of  the  tube.  The 
ovary,  which  was  of  fair  size,  presented  in  the 
substance  of  its  inner  half  a  cyst  as  large  as  a 
pea.  This  possessed  a  well-marked  capsule, 
and  was  filled  with  similar  fatty  cell  debris. 
Apparently  this  was  the  remains  of  an  enlarged 
and  suppurating  Graaffian follicle.  The  outer 
half  of  the  ovary  was  almost  entirely  formed  of 
a  corpus  luteum,  with  thickened  sinuous  walls 
and  firm  central  area  containing  blood  pig- 
ment. 

The  right  tube  presented  a  condition  similar 
to  that  of  the  left.  It  was  enlarged  and  tortu- 
ous, and  its  occluded  extremity  was  adherent 
to  the  ovary.  There  was  the  same  almost  solid 
cheesy  material  filling  the  thinned  and  distend- 
ed outer  half ;  no  trace  of  the  fimbriae  could 
be  determined,  either  externally  or  coiled  within 
the  tube.  Immediately  below  the  tube  and 
to  its  outer  end  was  a  cyst  with  contents 
similar  to  those  of  the  tubes  and  cysts  already 
described.  The  outer  wall  of  this  cyst  was 
in  direct  contact  with  the  ovary,  and  it  was  a 
question  as  to  whether  this  was  of  ovarian  or 
ligamentous  origin.  The  ovarian  tissues  could 
not  be  traced  into  its  walls,  and  this,  together 
with  the  position,  favored  the  latter  view. 
The  right  ovary,  like  the  left,  contaiiied  a 
small  cyst  filled  with  cell  debris  and  an  old 
corpus  luteum,  and  neither  attained  to  the  di- 
mensions of  those  in  the  left  ovary. 

The  well-formed  veil-like  adhesions,  the 
nature  of  the  contents  of  the  tubes  and  abscess 
cavities,  the  complete  disappearance  of  the 
fimbriae,  all  indicate  a  peculiarly  long-standing 
condition,  as  also  did  the  history  and  sterility 
of  eleven  years'  standing,  but  the  most  in- 
structive feature  of  the  case  is  the  sc  ries  of 
cysts  here  presented,  for  these  masses  of  semi- 


THE  CANADA  MEDICAL  RECORD. 


■1^,1 


solid  fatly  material,  surrounded  by  definite 
capsules,  may  quite  rightly  be  described  as 
cysts.  Clearly,  there  had  been  a  tendency 
towards  the  formation  of  chronic  suppurative 
foci,  not  only  in  the  tubes  and  ovaries,  but 
also  around  them,  so  that  we  have  cysts  of 
inflammatory  origm  (i)  in  the  ovaries  them  ' 
selves,  starting  in  the  corpora  lutea,  (2)  in  the 
broad  ligament,  (3)  upon  the  outer  wall  of 
the  Fallopian  lube,  and  (4)  in  the  Fallopian 
tubes  ;  for  these  have  become  occluded,  and 
each  with  its  lumen  distended  by  old  inflam- 
matory products  may  be  looked  upon  as  cys- 
tic. 

Case  1 1 .  Pedunculated  Sub-pei'iton  al  Fibro- 

myotna:  Cystic  Graaffian  Follicles. — Here  was 

a  sub-peritoneal    fibm-myoma  attached  to  the 

posterior  portion  of  the    uterus  by  a  ligament 

ous  membrane,  which    allowed  it  to  be  quite 

distinct  and  separable  from  the  uierus.     The 

ovaries   in  this  case  also  showed  evidence  of 

disease.      The  right  one  was  of  fairly   normal 

size;  on  section,  a  cavity  with  a  sinuous  wall 

was  seen  ;  this  cavity  is  certainly  nothing  other 

than  a  large  corpus  luteum  which  has  undergone 

cystic  degeneration  and  is  now  being  absorbed, 

so  that  here  is  another  form  of  cyst  oftheovary. 

In  the  last  specimens  we  had  to  do  with  a  cyst 

which    resulted    from     the  suppuration    of  a 

Graaffian  follicle  or  corpus  luteum  ;  in  this  one 

we  have  a  corpus   luteum    which,  instead   of 

undergoing  its  normal  couise  of  enlargement, 

followed  by  atrophy,  has  increa'^ed  abnormally 

(it  was  at  least  30  millimeters  in  diameter).  The 

blocd  first  poured  out  had  become  absorbed, 

and  was  replaced  by  a  fairly  clear  fluid,    and 

only  now,  judging  from  the  sinuous  capsule,  was 

absorption  taking  place.  The  left  ovary  in  this 

case  showed  two  other  cystic  conditions.  One 

appeared  to  be  a  comparatively  recent  corpus 

luteum,  the  blood  pigment  still  being  in  it,  with 

little    crystalline    masses  of  hasmatoidin,    the 

centre  being  a  clear  cystic  space.     The  second 

was  a  simple  cyst  partially  filled  with  semi-solid 

broken-down  cell  matter,  the  rest  of  the  cavity 

being  filled  with  clear  fluid. 

Case  III.  Multilecular  Cvariaii  Cyst  of 
Great  Size  :  Cystoma  Froliferiim  Gland- 
ulare. — This  case,  sent  by  Dr.  Gaidner,  is 
inteiesting  on  account  of  its  great  size,  and  from 
the  fact  that  upon  first  sight  it  appeared  to  be 
one  huge  single  cyst,  completely  filling  up  the 
lower  abdominal  region.  There  were,  however, 
towards  ihe  lower  and  hinder  portion  a  few 
small  cysts  connected  with  it,  corresponding, 
it  would  seem,  to  the  region  of  the  original 
ovarian  tissue,  and  upon  the  anterior  wall  could 
be  felt  three  or  four  hardened  areas,  or 
"  plaques,"  the  largest  leing  several  inches  in 
diameter.  Upon  opening  the  large  cyst  and 
removing  the  mucoid  material  contained, 
these  flattened  plaques  could  be  seen  projecting 
lightly   into  the  interior.     The  specimen  had 


been  sent  in  order  to  determine  the  nature  of 
these  thickenings  of  the  wall. 

Waldeyer  has  divided  the  ovarian  cyst- 
adenomnta  into  two  classes,  which,  it  must  be 
admitted,  are  not  sharply  separated,  for  a  very 
large  ])ropc)rtion  of  ovarian  cysts,  if  carefully 
studied,  must  be  placed  under  both  of  his  head- 
ings. These  are:  (i)  that  of  the"  cystoma 
proliferum  papillare,"  in  which  the  connective 
tissue  of  the  wall  of  the  mother  cyst  undergoes 
great  proliferation,  forms  papillomatous  projec- 
tions, and  the  papillae,  covered  by  a  layer  of 
epithelium,  and  coming  into  contact  here  and 
there,  foim  thus  the  secondary  cysts  ;  (2)  in 
the  second  class,  or  that  of  the  "  cystoma  prolif- 
erum glandulare,"  it  is  tire  columnar  epithelium 
lining  the  mother  cyst  that  is  the  more  prolifer- 
ous, and  that  dip])ing  down  into  the  undeilying 
connective  tissue,  there  fc^rm  follicles,  which, 
becoming  occluded,  develop  into  the  secondary 
cysts.  Now,  the  plaques  in  this  specimen, 
when  examined  microscopically,  are  seen  to  be 
composed  of  a  relatively  S'l  all  amount  of  fibrous 
stroma,  enclosing  very  numerous  small  follicles 
and  cysis  lined  by  a  single  layer  of  columnar 
epithelium,  tending  to  invade  the  cajjsule  of 
the  mother  cyst.  Hence  to  this  extent  the 
tumor  must  be  classed  as  an  adenocystoma  of 
the  glandular  type. 

We  have,  therefore,  in  the  series  of  examples 
brought  before  the  Society,  a  not  uninstructive 
series  of  the  main  forms  of  cystic  growth  in  the 
ovary,  the  dermoid  cysts  alone  being  de- 
ficient. We  have  the  Graaffian  follicle,  which, 
owing,  it  would  seem,  to  coincident  inflam- 
mation in  and  around  the  ovaries,  forms  a 
corpus  luteum  of  great  size  and  aberrant 
course,  becoming  either  the  seat  of  inflammatory 
change  itself,  so  that  the  cavity  contains  even- 
tually broken  down  cell  material,  puriform 
debris,  or  again  becoming  a  cyst  of  moderate 
size  filled  with  clear  fluid.  And  again,  we  have 
a  very  fair  example  of  the  form  of  multilocular 
ovarian  tumor  of  the  more  important  tyi)e 
clinically,  with  regard  to  whose  etiology  there 
is  still  divergence  of  opinion. 

Are  the  multilocular  ovarian  cysts,  the  cyst- 
adenomata,  also  developed,  like  the  simple 
cysts  above  described,  from  GiaaflSan  follicles, 
or  have  they  another  origin  ?  The  fact  that 
the  columnar  epithelium  lining  them  is  of  a 
simple  type,  that  they  and  the  tumor  which 
they  form  are  of  an  embryonic  type,  and  that 
coincident  with  this  more  or  less  embryonic 
nature  the  tumors  are  of  fairly  rapid  growth 
and  incline  towards  malignancy,  are,  on  the 
whole,  against  the  view  that  they  develop  from 
mature  Graaffian  follicles.  And  with  Waldeyer 
and  .Malassez  it  is  generally  held  that  they  are 
developed  from  an  earlier  stage  ;  that  just  as 
the  Graaffian  follicles  themselves  originate  from 
processes  or  follicles  growing  inwards  from  the 
epithelium  "covering  the    surface  of  the  foetal 


I  ^2 


THE  CANADA  MEDICAL  RECORD. 


ovary,  so  these  tumors  ari?e  from  similar 
ingrowths  in  later  life  ;  and  Malassez  has  seen 
such  ingrowths  from  the  surface,  resembling  a 
cylinder  epithelioma.  On  the  other  hand, 
Ritchie  states  that  he  has  observed  the  ovum 
or  its  remnant  in  the  smaller  cysts  of  a  mubi- 
locular  tumor,  and  these  smaller  cysts,  like  the 
Graaffian  follicles,  have  limjiid  coi  tents  ;  while 
Ga'abin  has  seen  processes  similar  to  cylinder  ' 
e])ithelium  starling  from  Graaffian  follicles,  and 
not  from  the  surface.  There  is,  it  appeared  to  i 
I)r,  Adami,  no  inherent  iniprob.\bility  that  the  \ 
adenomatous  growth  should  start  from  the  adult 
(glandular)  follicles,  just  as  adenoma  or  carcin- 
oma of  the  mammary  gland  is  supposed  to 
start  from  adult  gland  tissue  in  the  mamma. 

The  matter  might  seem  to  be  one  of  minor 
import,  for  the  same  original  epithelium  is 
implicated  in  both  cases,  the  only  question 
being  as  to  the  stage  of  development  reached 
by  that  epithelium  at  the  moment  when  the 
tumor  begins  to  form.  Nevertheless,  it  is  one 
that  has  been  much  discussed,  and  a  series  of 
examples,  such  as  those  brought  before  the 
Society,  might  serve  to  start  and  illustrate  a 
discussion  on  the  subject. 

Dr     Alloway,   commenting   on  "Case  I" 
of  the  series  just  discussed  by  Dr.  Adami,  said 
that  since    her  last   childbirth,   ii  years   ago, 
when  she  had  puerperal  fever,  siie  suffered  from 
pelvic  pain,  so  seveie  as  to  almost  incapacitate 
her  for  work  ,  and  that  this  history  led  him  to 
suspect  that  she  had    wholly  intiamed    and  ad- 
herent ovaries  and  tubes,   and  that   there  was 
also  pus,  possibly  in  an  inspissiied  condition, 
in  the  tubes.     He  was  pleased  to  fi\id  such  was 
the  case.     In  the   operation    he    found    great 
difficulty  in   separating  the   adhesions,  which, 
from  their   density,  must  have    been  there  for 
years.     He  ligated  the  lubes  close  to  the  uterus, 
where  they  were  not  intiamed.     Good  recovery. 
Case  n  was    a   subperitoneal  fibro-myoma, 
which  is  much    more    common    in  the  negress 
than  in  the  white  woman.     The  uterus  was  in 
ante- version,  somewhat  enlarged  (9  centimetres 
in  depth),    but  not    sufiiciently    so  to  produce 
much    hemorrhage.     The    fact   of   the   tumor 
being  entirely  separated  from  the  uterus  simpli- 
fied the  operation  ;  it  was  only  connected  to  the 
uterus  by  a  ligamentous  band,  which  was  covered 
with  peritoneum, — in  fact,  by  a  sort  of  meso- 
metrium.    To  cause  the  complete  disappearance 
of  all  the  symptoms,  he  thought  it  beiter  to  bring 
on  the  menopause,  and,  to  do  this,  adopted  'J'ait's 
operation — the    removal   of    the   appendages. 
This,    where  the  uterus   is  not  very  much    en- 
larged,   is    adequate,    safer,    and,    therefore,   a 
better  operation  than   total    extirpation.     The 
tubes  were  found,  on  pathological  examination, 
to  be  chronically  inflamed. 


CANADIAN  MEDICAL  ASSOCIATION. 

A  good  many  years  ago  it  occurred  to  some  of 
the  members  of  the  pj-ofession  in  the  Dominion 
that  there  should  be  a  way  of  forming  a  closer 
bond  of  union  among  the  doctors  in  all  the 
provinces.  With  ihat  object  in  view,  a  Medical 
Conference  was  called,  with  delegates  from  each 
of  the  provinces,  to  consider  the  matter.  They 
met  in  the  Hall  of  Laval  University,  Quebec,  on 
Wednesday,  Oct.  9th  ;  Dr.  James  Arihur  Sewell, 
President  of  the  Quebec  Medical  Society,  was 
in  the  chair;  Dr.  Alfred  Belleau  acted  as 
secretary. 

After  some  preliminary  business  had  been 
transacted,  Dr.  Wm.  S.  Harding  of  St.  John, 
N.B.,  moved,  seconded  by  Dr.  Wm.  Marsden, 
Quebec,  Q.  :  *'  That  it  is  expedient  for  the 
Medical  profession  of  the  Dominion  of  Canada 
to  form  a  Medical  Association,  to  be  named  the 
Canadian  Medical  Association." — Carried. 

A  nominating  Committee  was  appointed  ; 
they  brought  in  a  report,  which,  after  some  dis- 
cussion and  one  or  two  amendments,  was 
adopted,  ihe  first  officers  of  the  Association 
being  ; — 

President:  Hon.  Charles  Tupper,  C.B., 
Halifax,  N.S. 

Vica-Ptesidents :  For  Quebec,  Dr.  Hector 
Peltier,  Montreal,  Q.  ;  N.S.,  Dr.  R.  S.  Black, 
Halifax,  N.S  ;  N.B  ,  Dr.  LeBaron  Botsford,  St. 
John,  N.B. ;  Ont.,  Dr.  E.  M.  Hodder,  Toronto, 
Ont. 

General  Secretary :  Dr,  Alfred  G.  Belleau, 
Quebec. 

Local  Secretaries  :  For  Quebec,  Dr.  W.  H. 
Hingston,  Montreal  ;  N.S.,  Dr.  Jas.  R.  De  Wolf, 
Halifax,  N.S.;  N.B.,  Dr.  W.  S.  Harding,  St. 
John,  N.B.  ;  Ontario,  Dr.  Wm.  Cannifif,  Belle- 
ville, Ont. 

Local  Lreasitrer  :  Dr.  Robert  Henry  Russell, 
Quebec. 

Thus  commenced  an  organization,  the  value 
of  which  cannot  be  over-estimated  by  the 
profession  of  the  Dominion. 

Since  these  large  and  successful  provincial 
societies  have  sprung  up,  it  has  been  thought 
that  the  work  of  the  Canadian  Medical  Associa- 
tion had  been  completed. 

Fortunately  for  the  profession  generally,  this 
has  been  held  by  but  a  limited  number,  and  up 
to  the  present  all  attempts  to  curtail  its  useful- 
ness have  failed.  During  the  last  few  years 
there  has  been  much  enthusiasm  over  the 
meetings,  and  attendance  has  been  large.  Next 
year  the  meeting  will  be  held  in  St.  John,  N.B,, 
some  time  in  September  ;  and  if  united  effort 
can  do  anythmg,  the  members  of  the  profession 
in  the  Maritime  Provinces  intend  to  make  this 
one  of  the  most  successful  meetings  the  Asso- 
ciation has  ever  known. 


THE  CANADA  MEDICAL  RECORD. 


133 


ELEVENTH    INTERNATIONAL    MEDI- 
CAL CONGRESS. 

A  letter  directed  to  the  undersigned  by  the 
Secretary  General  of  the  Eleventh  International 
Medical  Congress,  and  dated  December  19th, 
1893,  contains  the  following    communications  : 

"  American  members  will  pay  on  the  English, 
French  and  Italian  railways  single  fares  for 
double  journeys,  and  will  obtain  a  reduction 
of  twenty  per  cent,  on  fares  for  Italian  round- 
trip  tickets. 

"The  documents  required  for  their  identi- 
fication will  be  sent  to  you  in  January,  and 
Americans  intending  to  visit  the  Congress  will 
have  to  apply  to  you  for  them. 

"  Full  particulars  concerning  the  journeys 
will  accompany  the  documents. 

"Messrs.  Thos.  Cook  &  Son,  London, 
Paris,  Rome  and  Naples,  should  be  applied  to 
for  accommodation  and  for  tickets  for  the  excur- 
sions at  Rome,  Naples,  and  to  Sicily.  Such 
excursions  will  be  arranged  at  Rome  under  the 
guidance  of  Mr.  Forbes,  member  of  several 
scientific  societies  and  correspondent  of  the 
Tunes —  for  Naples,  three  days,  including 
Vesuvius,  Pompey,  Capri,  Sorrento,  Castella- 
mare,  Bajae,  etc. — for  Sicily,  ten  days  from 
Naples,  including  ]\Iessina,  Taormina,  Catania, 
Girgenti,  Siracuso,  Palermo,  and  return  to 
Naples. 

"The  fares  for  members  of  the  Congress 
will  be  considerably  reduced,  and  comprise 
hotel  accommodations,  carriages,  guides,  boats, 
etc. — about  70  frcs.  each  for  the  three  days, 
and  285  frcs.  for  the  ten  days. 

"  Full  particulars  concerning  these  excur- 
sions will  be  contained  in  a  leaflet  to  be  added 
to  the  instructions  and  documents  for  the 
journey. " 

From  former  communications  the  following 
are  herewith  quoted  :  The  members'  fee  is  five 
dollars,  that  of  their  wives  or  adult  relations 
two  dollars  each.  Checks  or  money  orders 
may  be  sent  to  Prof.  L.  Pagliani,  Rome,  Italy. 
Credentials  have  been  promised  in  the  near 
future.  When  they  arrive  (none  were  received 
last  year),  they  may  be  too  late  for  many  who 
have  started  or  are  about  to  start.  The  under- 
signed, who  is  not  informed  of  the  cause  of 
delay,  proposes  to  supply,  in  as  official  a  form 
as  he  thinks  he  is  justified  in  doing,  credentials 
which  are  expected  to  be  of  some  practical 
value.  The  North  German  Lloyd  has  promised 
to  recognize  them.  It  is  suggested,  besides, 
that  a  passport  may  increase  the  traveller's 
facilities. 

Only  the  North  German  Lloyd  (22  Bowling 
Green^  and  the  Compagnie  G^nerale  Trans- 
atlantique  (3  Bowling  Green)  have  thought  fit 
to  grant  any  reductions  to  Congressists. 


The  reduciions  on  Italian  railways  arc  avail- 
able from   March  ist  to  April  30th. 

A.  JACOBI,  M.D., 
no  W.  34th  Street,  New  York. 

T  iih  January,  1894. 


LECTURE     ON      THE     CONDUC  F    OF 

MEDICAL  LIFE. 

Bv  S.  Weir   Mitchell,  M.D.,  LL.D. 

A  soldier  was  asked  in  my  presence 
what  was,  in  warfare,  the  most  interest- 
ing thing.  He  said,  "Recruits  going  into  their 
first  battle."  What  he  thought  as  to  the  young 
soldier  I  feel  whenever  it  is  my  lot  to  see  a  mass 
of  men  about  to  turn  from  the  training  of  the 
schools  and  to  face  the  grim  realities  of  the 
physician's  life. 

Here  before  me  are  some  hundreds  of 
men  in  the  morning  of  existence.  Where  will 
the  noonday  find  you  ?  And  the  evening  hour, 
when  labor  is  over,  and,  looking  back,  the 
conscience,  undisturbed  by  new  ambitions, 
shall  make  up  the  ledger  of  a  life — will  it  leave 
you  weighted  with  the  debts  of  wasted  chmces 
or  rich  with  the  honest  interest  of  accumulated 
character?  That  the  veteran,  like  myself, 
should  look  with  a  certain  sad  curiosity  at  a 
group  of  young  soldiers  is  not  strange.  Here  are 
men  of  varied  individuality,  of  unequal  fortunes 
of  every  condition  of  life — some  for  whom  all 
their  ways  have  been  thus  far  made  easy,  some 
for  whom  life  has  been  always  hard.  Here,  at 
least,  within  these  walls  >ou  have  all  had 
equality  of  opportunity.  Let  me  hopefully 
presuppose  you  one  and  all  to  have  used  with 
diligence  the  precious  years  of  training.  You 
have  thought,  of  course,  of  what  you  want  to 
win.  You  vaguely  call  it  success — success  in 
life.  That  may  mean  many  things  you  did 
not  want  or  expect.  You  will  fail  where  you 
least  look  for  failure.  You  will  win  what  you 
never  dreamed  of  getting. 

I  shall  try  to  remember  only  that  you  are  all 
to  be  of  the  great  army  of  medicine.  First  of 
all,  I  own  for  you  the  wish  that  in  this  vast 
organized  body  you  shall  take  honest  pride. 
Through  it  you  will  earn  your  bread,  and,  I 
trust,  much  besides  a  mere  living.  That  you  may 
correctly  estimate  its  splendid  history,  tiat  you 
may  fitly  comprehend  the  opportunities  it  gives, 
let  us  look  a  little  broadly  for  a  time  at  some  of 
its  virtues  and  some  of  its  values.  I  could  wish 
that  you  were  really  taught  something  of  the 
wonderful  history  of  medicine.  I  have  myself 
ancestral  pride  in  the  splendor  of  its  conquests 
the  courage  and  heroism  of  its  myriad  dead. 
I  am  fond  of  saying  it  is  a  guild,  a  fellowship,  a 
brotherhood,  older  than  civilization.  It  had  a 
creed  of  moral  life  antique  when  Christ  was 
born.  No  other  organization  is  Hke  it.  Customs, 


134 


THE  CANADA  MEDICAL  RECORD. 


code  and  creed  seijuraie  ihe  lawyer  and  clergy- 
man of  different  lands,  but  we  in  all  lands  hold 
the  same  views,  abide  by  the  same  moral  law, 
have  like  ideas  of  duty  and  conduct.  From 
Japan  to  London  you  may  claim  medical  aid  for 
self  or  wife  or  chiH,  and  find  none  willing  to 
take  a  fee.  There  is  something  fine  and  gra- 
cious in  this  idea. 

I  once  asked  the  care  of  a  physician  I  never 
saw  or  heard  of  before,  in  a  German  town.  As 
I  was  about  to  pay  him,  a  card  dropped  from  my 
pocket-book.  He  glanced  at  it,  and  said,  "B'.it 
you  are  a  doctor  ;  I  can  take  nothing — noth- 
ing." I  remonstrated  in  vain.  "  No,"  he  said, 
"  you  will  make  it  up  to  some  other  doctor,"  I 
believe  that  I  have  paid  this  debt  and  other  like 
debts  with  interest.  I  hear  now  and  then  of 
men  who  break  this  beautiful  rule  which  makes  : 
prof^-^ssional  service  given  by  one  physician  to 
another  a  friendly  debt  for  which  the  whole 
brotherhood  holds  iiself  responsible.  Doctors 
are  said  to  differ,  but  these  bonds  of  union  and 
generous  amity  are  mysteriously  strong.  Try  to 
keep  them  so,  and  when  you  serve  medical 
men,  go  about  it  as  if  they  were  laymen.  Put 
away  all  thought  of  wasted  lime,  of  the  com- 
mercial values  of  what  you  give.  Ti-e  little 
biscuit  you  cast  on  the  waters  will  come  back  a 
cheerful  loaf,  I  consider  it  a  glad  privilege  to 
help  thus  my  brothers  in  meJicine,  and  let  me 
assure  you  few  are  more  heavily  taxed  than  I. 
And  there  is  another  privilege  your  profes- 
sion brings.  From  the  time  you  graduate  until 
you  cease  to  work,  whether  in  town  or  country, 
hospital  or  wretched  homes,  the  i)oor  will  claim 
from  you  help  in  time  of  sickness,  I'hey  will  do 
it,  too,  with  tranquil  certainty  of  gracioas  ser- 
vice on  your  part. 

The  greatest  of  moralists  has  said,  "  The  poor 
ye  have  always  with  ye."  I  think  He  meant  to 
speak  of  the  poor  as  representing  opportunities 
for  self-sacrifice  never  absent.  Of  a  certainty 
it  appUes  to  us.  The  poor  we  have  always  with 
us— the  sick  poor. 

On  every  Friday  I  conduct  the  clinical  out- 
service  at  the  Infirmary  for  Nervous  Disease. 
I  never  go  through  these  long  and  tiresome 
hours  of  intense  attention  without  feeling  that  it 
is  needful  to  put  some  stress  on  myself  that  I 
be  not  negligent  or  histy,  vexed  or  impatient, 
or  fail  as  to  some  of  the  yet  finer  qualities  of 
social  conduct,  I  want  you  a'so  to  feel  that 
such  self-watchfulness  is  needed.  These  early 
years  among  the  poor,  or  the  class  of  uncertain 
debtors,  are  apt  to  make  some  men  rude, 
uncareful  and  ill-tempered.  Most  honestly  do  I 
say  that  such  work  is  what  I  may  call  an  acute 
test  of  character. 

A  part  of  your  life-work  consists  in  giving  of 
your  best  to  those  who  cannot  pay.  A  part 
consists  in  work  for  honest  wages.  I  think  you 
happy  in  that  our  work  is  not   altogether  paid 


labor,  and  not  wholly  woik  wiihout  pay.  In 
both  are  chances  which,  rightly  used,  make  the 
good  better,  the  wise  wiser;  and  there  are  many 
sides  to  it  all. 

I  do  not  like  to  leave  this  subject  witliout  a 
living  illustration.  It  is  strange  and  interesting 
to  see  what  our  life  does  with  different  kinds  of 
men, 

I  once  went  through  a  hospital  ward  in 
France  watching  the  work  of  a  great  clinical 
teacher,  long  gray  in  the  service  of  the  sick.  It 
was  as  pretty  and  gracious  a  thing  as  one  could 
see.  The  examinations  were  swift,  the  ques- 
tions few  and  ready.  Clearly,  he  liked  his 
work.  A  kindly  word  fell  now  and  then  ;  faces 
lit  up  as  became  near.  Now  and  thin  he 
answered  a  patient  gr;ively  and  simply  where 
there  was  real  reason  to  do  so,  and  twice  I 
observed  that  when  he  did  this  he  sat  down,  as 
if  in  no  haste — a  nice  trait  of  gentle  manners. 
It  was  a  ward  of  women,  and  he  was  very 
modest — a  too  rare  thing  in  French  hospitals  in 
my  student  days.  When  he  went  away  his  in- 
terne told  me  that  he  had  been  very  sharp  with 
him  for  a  piece  of  neglect,  "■  but,"  said  the 
doctor,  "  he  never  says  a  word  of  blame  at  the 
bedside.''  In  fact,  this  great  physician  was  a 
gentleman — a  much  abused  word — but  think 
what  that  may  fully  mean;  a  man  in  the  highest 
sen>e  of  manhood — so  gentle  (good  old  English 
word)  that  every  little  or  large  act  of  duty  or 
social  conduct  is  made  gracious  and  beautiful 
because  of  the  way  of  doing  it. 

I  saw,  a  week  later,  a  great  FVench  surgeon  in 
his  clinic  of  women.  The  man  was  as  swift  and 
as  skillful  as  could  be.    He  was  also  ill-tempered, 
profane,      abrupt    and    brutally    immodest — a 
strong,  rough,  coarse    machme  ;   and    this  was 
what  the  medical  life  had  done  with  two  men. 
With  less  intellect  this   rude  nature  must  have 
altogether  failed  of  success  in  life.     He  did  not 
fail  being  a  man   of  overwhelming    fi)rce  and 
really  admirable    mental    organization;  and  so 
when  you  read   of  Abernethy's  roughness    and 
the  like,  pray  understand    that  such  great  men 
as  he  win  despite  bad  manners,  and  not  because 
of  them.     There  is  no  place  where  good  breed- 
ing and  social  tact — in  a  word,  habitual   good 
manners — are  so  much    in  place  as  at  the  bed- 
side or  in  the  ward.     When    Sir-Henry  Sidney 
wrote  a  letter  of  advice  to  his  son — the  greater 
Sidney,    Sir    Philip— he  said:     "  Have    good 
manners  for  men  of  all  ranks  ;  there  is   no  coin 
which  buyeth  so  much  at  small  cost." 

A  clever  woman  of  the  world  once  said  to 
me  :  "  I  sent  for  Dr.  A,  yesterday,  and  by  mis- 
take the  servant  left  the  message  with  Dr.  B. 
He  came  at  once,  and  rea.ly  he  was  so  well- 
mannered  and  pleasant  that  I  quite  forgot  what 
a  fool  he  is." 

I  know  men  who  have  had  large  success  in 
practice  chiefly  because  of  their  gentleness  and 


THE   CANADA   MEDICAL   RECORD. 


135 


sweetness  in  all  the  relations  of  life.  I  know  of 
far  more  able  men  who  have  found  life  hard  and 
the  winning  cf  practice  difficult,  simply  because 
tiiey  lacked  good  manners  or  wanted  tact.  We 
began  about  the  poor,  and  here  we  are  discuss- 
ing manners.  I  had  not  meant  to  say  of  it  so 
much,  but,  on  the  whole,  I  am  not  sorry.  Pray 
remember,  finally,  that  neatness  of  dress  and 
the  extreme  of  personal  cleanliness  are,  shall  I 
say,  a  sort  of  physical  g(Jod  manners,  and 
now-a-days  the  last  words  of  science  are  en- 
forcing these  as  essential  to  surgical  success. 

There  is  a  wise  proverb  of  the  East:  "  He  who 
holds  his  tongue  for  a  minute  is  wise  with  the 
wisdom  of  all  time."  I  am  fond  of  proverbs, 
and  this  is  full  of  meaning,  for  really  to  refrain 
from  instant  speech  when  irritated  is  victory. 
An  hour  later  you  are  sure  to  be  silent  enough. 
The  temptation  to  speech  is  momentary.  Above 
all,  try  not  to  talk  of  your  patients — even  with 
doctors.  It  is  usually  a  bore  to  be  told  of  cases, 
and  we  only  stand  it  because  we  expect  our 
own  boring  to  be,  in  turn,  endured  But  my 
ideal  doctor  who  reads,  thinks,  and  has  a 
hobby  will  not  need  to  gossip  about  patients. 
He  will  have,  I  trust,  nobler  subjects  of  con- 
versation. When  1  hear  a  young  man  talk  cases 
or  read  ihem  in  societies  with  heavy  detail  of 
unimportant  symptoms,  I  feel  like  saying  of 
him,  as  was  once  said  in  my  presence  of  one 
who  amply  justified  the  prediction,  ''  That  man 
has  a  remarkably  fine  foundation  for  dullness  in 
after  life." 

The  methods  of  note- taking  you  are  well 
taught,  and,  too,  I  hope,  the  best  ways  of  ex- 
amining your  cases.  As  to  this,  circumstances 
must  guide  you.  A  patient  is  often  a  bad  wit- 
ness, and  one  man  gets  at  the  truth  of  his  case — 
another  does  not. 

As  to  acute  cases,  it  is  immensely  valuable 
to  learn  through  concentration  of  attention  to 
be  rapid  without  omissions.  Dr.  Edward  Dal- 
ton  is  quoted  as  saying  to  his  class  :  "  After 
careful  and  repeated  auscultation,  percussion, 
palpation,  and  even  succussion  of  your  pa- 
tient for  twenty  minutes,  you  may  not  be  very 
tired.     He  is." 

As  you  go  on  in  practice  you  will  get  to  be 
fond  of  certain  drugs. 

Be  careful  of  this  habit,  which  has  its  reason- 
able side.  Even  the  best  of  us  fall  into  this 
therapeutic  trap.  I  once  met  in  consultation 
the  late  Prof.  Blank,  a  delightful  and  most  able 
physician.  As  I  came  out  of  the  house  I  fell 
upon  his  son,  also  a  doctor.  "  Ah  !  "  he  said. 
"  you  have  been  meeting  my  father;  I  am  sure 
he  advised  Plumer's  pills  " — an  old  mercurial 
preparation.     It  was  true. 

As  I  watch  the  better  medical  [)ractice,  I  see 
a  tendency  to  rely  less  upon  her  mere  drugs, 
and  more  and  more  sharply  to  question  their 
value. 

The  true  middle   course    is   to  be  sceptical 


as  to  new  drugs,  to  test  them  over  and  over 
l)efore  being  mentally  satisfied.  Nor  is  it  well 
to  run  into  the  extreme,  which  in  our  civil  war 
caused  an  order  forbidding  the  use  of  calomel, 
because  of  the  folly  and  indiscretion  with  which 
a  few  m'-n  had  used  it.  After  all,  one  of  the 
most  difficult  things  in  ours,  the  most  inexact  of 
sciences,  is  to  be  sure  of  the  value  of  a  drug. 
When  studying  the  poison  of  serpents,  I  found 
the  most  positive  printed  evidence  of  the  cer- 
tain value  of  at  least  forty  antidotes.  Not  one 
of  them  was  worth  the  slightest  considera- 
tion. Such  a  fact  as  this  makes  one  careful  of 
crediting  the  endless  cures  to  be  read  in  the 
journals. 

When  you  come  to  read  over  the  works  of 
the  great  masters,  dead  or  living,  and  to  see 
how  Sydenham  or  Rush,  Cardan  or  Bright,  did 
their  work,  you  will  be  struck,  as  I  have  been, 
with  the  great  stress  laid  upon  habits  of  living 
— what  shall  be  eaten,  diets,  exercise,  clothing, 
hours  of  work  and  rest.  Curiously  enough, 
these  dicta  are  more  often  found  in  their  records 
of  cases  than  as  positive  theses  ;  a  proof  that, 
in  his  practical  work,  a  man  may  be  better 
and  wiser  than  in  his  generalizations.  When, 
therefore,  you  come  to  deal  with  chronic  con- 
ditions, be  sure  to  learn  all  there  is  to  learn 
as  to  the  ways  of  men,  their  diet,  clothing, 
sleep,  work,  play,  wine  and  tobacco.  I  like  to 
make  a  man  describe  to  me,  with  minute  care, 
his  average  day.  Then  I  consider,  usually, 
how  much  of  what  is  clearly  wrong  may  be  set 
right  by  a  life  on  schedule.  After  that  comes 
the  considerate  use  of  drugs. 

The  desire  for  drugs  is  a  remainder  from 
barbarous  times.  It  is  m  :ch  in  the  way  of 
what  I  call  natural  medicine.  Z>o  this  and  do 
not  do  that  might  cover  a  large  amount  of  use- 
ful treatment  if  men  would  but  consider  the 
doctor  as  a  wise  despot  to  be  implicitly  obeyed. 
But  just  here  I  wish  to  add  that  the  very  men 
who  are  most  chary  as  to  drugs  are  those  who 
at  times  win  splendid  therapeutic  victories  by 
excessive  diets  or  heroic  use  of  powerful 
medicines. 

Much  nonsense  is  talked  about  the  injurious 
influence  of  drugs  until,  in  the  very  word  drug, 
there  is  a  malignant  sound.  Men  used  to  be 
over-bled  or  salivated.  This  does  not  occur 
now-a-days.  And  if  I  asked  your  whole 
faculty  how  many  people  they  have  seen  per- 
manently injured  by  mere  medication,  I  fancy 
they  might  be  puzzled  to  bring  to  mind  illus- 
trations of  such  mischief.  The  belief  is  another 
survival  of  conclusions  founded  on  premises 
which  perished  long  ago. 

Men  in  our  profession  fail  more  often,  owing 
to  want  of  care  in  investigating  cases  than  for 
lack  of  mental  power.  One  man  looks  at  the 
urine  carefully  once,  and  decides  ;  another  looks 
once  at  the  night  and  morning  water,  and  con- 
cludes ;  a  third    asks   that   there    be  made  no 


136 


THE   CANADA    ^[EDICAL    RECORD. 


change  in  diet  or  habits  for  a  week,  and  ex- 
amines the  urine  over  and  over,  both  night  and 
morning  secretion.  Of  course,  this  is  the  only 
right  way.  Troublesome  ?  Yes,  very  !  If  you 
do  not  want  to  practise  medicine  as  it  ought  to 
be  practised,  better  fai  to  get  some  business 
which  will  permit  of  indolent  intellectuation. 

A  friend  of  mine  had  a  consultation  in  the 
country  as  to  a  case  of  great  importance.  The 
attendant  fell  ill  and  could  not  meet  him.  My 
friend  went  over  the  case  with  care.  It  was  one 
of  persistent  headache.  He  took  home  urine 
of  the  night  and  morning,  and  wrote  word  that 
the  patient  had  ursemic  intoxication.  The  atten- 
dant said  "  No  ;  "  that  neither  casts  nor  albu^ 
men  were  in  the  urine  which  he  had  'hrice  ex- 
amined. At  last,  puzzled,  my  friend  asked  if 
he  had  studied  the  night  urine.  He  said"  No." 
And  here  was   the  mischief 

I  saw  to-day  a  woman  of  wealth  and  social 
importance  who,  for  years,  suffered  cruelly 
from  headache.  Now,  as  it  always  began  after 
an  hour  of  very  acid  vomiting,  a  dozen  of  the 
ablest  men  in  Europe  and  America,  who  were 
led  off  by  the  vomiting,  failed  to  take  in  the 
whole  possibilities,  and  did  not  question  the 
eyes.  But  a  little  country  doctor  did,  and  a 
tendon  or  two  clipped  put  that  woman  back  in 
state  of  health.  1  was  one  of  those  who  made 
the  mistake,  and  yet  I  have  written — was  per- 
haps the  first  to  write — on  the  eye  as  a  cause  of 
headaches  of  varied  type.  But  to  be  constantly 
complete  and  exact  in  all  examinations  i<,  I 
admit,  hard ;  nevertheless,  in  that  way  lies 
success. 

And  the  like  axiom  applies  to  treatment. 
You  are  taught  in  acute  disease  to  write  your 
directions  and  to  leave  no  possibility  of  change 
unprovided  for.  And  the  acutely  ill  are  prison- 
ers of  our  will.  But  how  many  men  think  it 
needful  to  write  out  a  schedule  of  life,  medi- 
cine, diet,  exercise,  rest  tor  cases  of  chronic 
disorder — I  do  not  say  disease.  I  never  tire  of 
urging  that  in  attention  to  minutiae  lies  the 
most  certain  success.  A  large  practice  is  self- 
destructive.  I  mean  that  no  over-busy  man 
can  continue  to  give  always,  unfailingly,  the 
kind  of  care  patients  ought  to  havc^.  But  that 
is,  as  I  said  in  my  first  lecture,  a  question  of 
enduring  energy,  and  of  a  firmly  made  habit  of 
dissatisfaction  witii  the  incomplete.  If  medicine 
consisted  only  in  mere  intellectual  endeavor  ; 
if  to  see,  hear,  feel,  weigh,  measure,  in  a  word 
know  all  there  is  to  know  of  a  case,  were  really 
all ;  if,  then,  we  only  had  to  say  do  this  or  that, 
one's  life  might  be  sufficiently  easy. 

In  time  of  peril,  or  under  stress  of  pain,  any- 
one, and  always  the  great  consultant,  can  se- 
cure absolute  obedience.  In  the  daily  current 
of  practice,  fancy  and  unbelief,  indolence,  pre- 
judice and  what-not  stand  in  our  way.  Busy 
men,  indulged  children,  hysterical  women  are 
your  worst  difficulties.     Then   come  into  play 


i  the  murai  qdaiiiies  wiiich,  in  union  with  ed' 
!  ucated  intellect,  make  for  the  triumphs  of  the 
I  great  healers  of  their  kind.  Are  you  gentle 
i  and  yet  firm  ?  Have  you  the  power  of  state- 
ment, which  is  so  priceless  a  gift,  the  capacity 
to  make  the  weak,  the  silly,  the  obstinate  feel 
as  you  speak  that  your  earnestness  rests  on 
foundations  of  kindness  and  of  thoughtful  in- 
vestigation of  their  needs  ?  Can  you,  in  a  word, 
make  people  do  what  you  want  ?  Have  you 
the  patience  to  wait  untroubled  by  the  follies 
of  the  sick,  to  bide  the  hour  when  you  can 
carry  your  point?  Have  you  the  art  to  con- 
vince the  mother  that  the  sick  child  is  the  last 
of  all  who  should  be  left  to  tiie  misery  of  self- 
indulgence?  Can  you  sit  by  the  bedside  and 
gently  satisfy  some  hystei'ical  fool  of  her  capa- 
city to  take  up  anew  the  reins  of  self-govern- 
ment ?  It  demands  earnestness.  It  means 
honest  beliefs.  It  exacts  such  rule  over  your 
own  temper,  such  good  manners  as  few  possess 
in  their  highe;-t  degrees  of  quality  and  quantity. 
Above  all,  it  means  that  dislike  of  defeat  which 
makes  the  great  soldier. 

A  fine  thing  in  our  professi  tn  that  mere 
hatred  of  defeat.  As  I  came  once  out  of  a 
consultation  with  Prof.  Gross,  he  said  :  "  Don't 
you  hate  it,  sir  ?  "  "  Hate  it;  what  ?  "  I  said. 
"Hate  what?  Oh,  to  spend  a  life  like  yours, 
or  mine,  and  be  beaten — puzzled — licked,  sir, 
by  a  miserable  lump  in  a  woman's  breast."  I 
always  liked  what  General  Sheridan  said  to  me 
years  ago.  I  asked  how  he  accounted  for  his 
constant  success  in  war.  He  hesitated,  and 
then  replied :  "  It  was  because  I  did  so  hate  to 
be  licked."  No  matter  whence  comes  this  feel- 
ing, it  is  valuable.  Cherish  it ;  never  lose  it. 
Find  reason  for  disaster,  but  learn  to  loathe  the 
result.  I  never  see  a  death  or  a  grave  failure 
to  cure  that  I  am  not  personally  hurt  by  it.  I 
say,  then,  "A  century  hence  this  will  be  other- 
wise ;"  for  as  I  am  proud  of  the  past  of  this 
great  guild,  so  am  I  full  of  glad  hope  for  its  fu- 
ture, when  it  shall  have  learned  the  conquest  of 
cancer  and  tubercle. 

I  have  come  half  unexpectedly,  as  I  draw  to 
a  close,  upon  this  grave  question  of  the  moral 
qualities  needed  for  the  noblest  success  in  med- 
cine.  It  would  lead  me,  and  easily,  to  talk  of 
of  the  code,  of  your  relations  to  the  secrets 
of  households,  to  the  criminal  law  as  to  wit- 
nesses, of  insurance  cases  and  the  like  ;  but  all 
of  this  I  must  leave  unsaid  ;  and  reject  the  pages 
in  which  I  had  said  something  of  the  ethics 
of  our  profession. 

You  have  chosen  a  life  inexorably  hard  in 
what  it  asks  of  soul  and  mind  and  body  ;  but  be 
that  as  it  may,  you  have  taken  upon  you,  I  surely 
think,  the  most  entirely  satisfactory  of  earthly 
pursuits.  I  have  seen  much  of  men  and  their 
ways,  but  nothing  I  have  seen  entitles  me  to 
think  there  is  any  truer,  better  way  of  serving 
God  and  man,  and  in  this  service  making  your- 


THE  CANADA  MEDICAL  RECORD. 


1.37 


self  what    you    ought   to     be. — From     Lniv. 
Medical  Magazine. 


AN     ANTISEPTIC,     ANALGESIC      AND 
CALMATIVE  ADMIXTURE. 

H.  B.  Pettingill,    M.D.,  Mystic    Flats,  sgth 
&  Broadway,   New  York  city,  in  an  article  on    j 
"  Intestinal  Antisepsis"  in  JVew  P/iar.  Prod.. 
gives  some  excellent  experience,  from  which  the 
following  is  selected  : 

•'  Dr.  Van  Valgah,  in  a  paper  on  the  'Caus- 
ation and  Treatment  of  Chronic  Diarrhoea,  '  in 
the  New  York  Medical  Record,  says  :  '  Having 
secured  as  nearly  as  we  can  a  clean  and  sweet 
state  of  the  digestive  tube,  our  next  object  is 
to  get  perfect  digestion  of  the  food  taken. 
This  is  an  aim  second  to  no  other  in  importance. 
Undigested  food  in  the  wrong  part  of  the  in- 
testine is  an  irritant.  Rapid  absorption  is  the 
chief  barrier  against  super-digestion,  fermen- 
tation and  putrefaction,  and  perfect  digestion 
is  the  essential  preliminary  to  the  easy  and 
healthy  performance  of  the  function  of  the 
mucous  membrane.'  Now,  with  this  condition 
of  affairs  and  the  administration  of  proper 
remedies,  we  can  expect  to  destroy  the  patho- 
genic bacteria,  and  the  resulting  toxines  can  be 
rendered  innocuous.  The  tyro-toxicons  of 
Vaughan  belonging  to  the  toxalbumen  type  are 
readily  destroyed  by  the  decomposition  of 
salol  in  the  intestinal  tract.  Salol  is  a  sahcy- 
late  of  phenol,  and,  as  said  before,  is  not  acted 
upon  until  it  passes  through  the  stomach,  and 
when  the  phenol  is  set  free  in  the  intestine  it 
has  its  maximum  antiseptic  power.  Now,  in 
addition  to  this,  we  have  the  calmative  and 
analgesic  effect  of  the  antikamnia,  which  effect 
is  so  often  necessary,  and  where  in  many  cases 
opium  is  contra-indicated. 

"  Every  physician  knows  full  well  the  advan- 
tages to  be  derived  from  the  use  of  antikamnia 
in  very  many  diseases,  but  a  number  of  them 
are  still  lacking  a  knowledge  of  the  fact,  that 
antikamnia  in  combination  with  various  reme- 
dies has  a  peculiarly  happy  effect ;  particularly 
is  this  the  case  when  combined  with  salol. 
Salol  is  a  most  valuable  remedy  in  many 
affections  ;  and  its  usefulness  seems  to  be  en- 
hanced by  combining  it  with  antikamnia.  The 
rheumatoid  conditions  so  often  seen  in  various 
manifestations  in  this  country  are  wonderfully 
relieved  by  the  use  of  this  combination. 

"Tiie  five  grain  tablet, containing  2^  grains 
each  of  antikamnia  and  salol,  is  recommended 
highly  in  the  treatment  of  cases  of  both  acute 
and  chronic  cystitis.  The  pain  and  burning  is 
relieved  to  a  marked  degree.  Salol  makes  the 
urine  acid,  and  clears  it  up.  This  remedy 
is  a  reliable  one  in  the  treatment  of  summer 
diarrhoea,  entero-coUtis,  dysentery,  etc.  In 
dysentery,  where  there  are  bloody,   slimy  dis- 


charges,.  with  tormina  and  tenesmus,  a  good 
dose  of  sulphate  of  magnesia,  followed  by  salol 
and  antikamnia,  will  give  results  that  are 
gratifying." 

In  closing  his  paper,  Dr.  Pettingill  adds : 
"  It  is  also  one  of  the  best  remedies  for  the  relief 
of  the  headache  and  pains  of  influenza  ('la 
grippe').  The  muscular  pains  which  so  often 
accompany  this  disease,  and  which  seem  to 
be  a  part  and  parcel  of  it,  are  often  relieved  at 
once  by  a  full  dose  of  this  combination.  Great 
reliance  can  be  placed  in  the  admixture  of 
tl.ese  two  drugs  in  those  diseases  in  which  the 
onset  is  sudden,  and  which  are  attended  with 
great  pain  and  hyperasthesia,  with  intense 
nervous  derangement,  particularly  when  the 
temperature  rises  to  102''  or  103°.  By  its  an- 
tithermic, analgesic  and  neurotic  properties,  it 
fills  a  want  scarcely  found  in  any  other  rem 
edy." 


CLASS-ROOM  NOTES. 

— Afitipyrine,  Prof.  Hare  says,  aids  the  elim- 
ination of  uric  acid  from  the  economy. 

— Cannabis  indica.  Prof.  Hare  says,  will 
often  be  found  to  be  very  useful  in  cases  of 
.][igrai>ie. 

— Prof  Wilson  says  that  only  the  severe 
cases  of  Rubella  or  Rotheln  are  followed  by 
desquamation. 

— Belladonna  locally  applied,  Prof.  Hare  says, 
will  be  found  very  useful  in  cases  of  localized 
Neuritis. 

— Surgical  Cases,  Prof.  Keen  says,  should 
be  dressed  as  seldom  as  the  safety  of  the  patient 
will  admit. 

— Prof.  Wilson  says  that  Gastro-intestinal 
Ulcers  occasionally  develop  during  the  period 
of  convalescence  of  an  attack  of  small-pox. 

— Syphilis,  if  it  be  due  to  vaccination.  Prof. 
Wilson  says,  will  have  the  chancre  in  all  cases 
appearing  at  the  point  of  vaccination. 

— Prof.  Montgomery  says  that  the  Uterus 
should  aliu ays  be  Sterilized  by  some  antiseptic 
after  an  instrument  has  been  introduced  into  it. 

— A  case  oi  Scirrhous  or  Atrophic  Cancer, 
seen  only  in  the  latter  stages  of  the  diicaso, 
should  not,  Prof.  Keen  thinks,  be  interfered 
with. 

— Adenomata,  according  to  Prof  Keen,  are 
painful  only  at  the  period  of  menstruation,  biit 
Sarcomata  are  painful,  independent  of  this 
period. 

— The  best  treatment,  according  to  Prof. 
Keen,  in  cases  of  Tubercular  Peritonitis  is  to 
open  the  abdomen  and  drain  for  a  long  period. 


138 


THE  CANADA   MEDICAL  RECORD. 


— Prof.  Parvin  says  that  all  drugs  which  by 
their  therapeutic  action  tend  to  increase  the 
Arterial  tetisioti  will  also  increase  the  flow  of 
the  milk. 

— As  a  rule,  Prof.  Keen  says,  in  every  four 
out  of  five  cases  of  J^istula  in  Ano,  the  patient 
will  be  found  to  be  o\  a  tubercular  character. 

— Malarial  Fever,  according  to  Prof.  Wil- 
son, will  be  rarely  met  with,  if  at  all,  in  those 
regions  in  which  the  temperature  does  not  rise 
above  60"^  F. 

— Glycerine  or  any  of  tlie  mineral  fats,  Prof. 
Wilson  says,  should  not  be  employed  by  in- 
unction in  the  skin  in  cases  of  Scarlet  Fever, 
but  fresh  animal  fats  should  be  employed  in 
making  inunctions. 

— Prof.  Hare  says  that  a  combination  of 
bromide  and  caffeine  will  often  cure  a  Headache 
that  neither  the  bromide  nor  the  caffeine  alone 
will  relieve. 

— Prof.    Parvin  says    that   two  hours  should 
be  allowed  to    elapse  before    active  .  measures 
are"instituted   toward  the  forcible    removal  of 
a  Reained  Flacenta. 

— Prof.  Parvin  thinks  that  the  Involution  of 
the  Sexual  Orga?is  after  confinement  takes 
place  [^more  rapidly  and  satisfactorily  if  the 
mother  nurses  her  child.         g^ 

— Prof.  Parvin  does  not  favor  the  adminis- 
tration of  ergot  during  the  Jhird  Stage  of  Labor 
unless  the  patient  be  a  habitual  bleeder,  if  hem- 
orrhage be  present. 

— The  Hemorrhage  occurring  in  cases  of 
laceration  of  the  cervix.  Prof.  Parvin  has  found, 
can  generally  be  controlled  by  the  injection  of 
hot  water  into  the  vagina. 

— Inability  to  Nurse,  Prof.  Parvin  says,  is 
often  due  to  heredity  ;  brought  on  by  the  fact 
that  a  number  of  successive  preceding  gener- 
ations did  not  nurse  their  offspring. 

— Unless  during  the  existence  of  an  epidemic 
of  smallpox,  a  child  who  is  suffering  from  a 
cutaneous  disease,  9r  who  is  otherwise  in  poor 
health,  should  not  be    Vaccinated. 

— Fifteen  to  twenty  grains  of  bismuth  and 
one  to  two  grains  of  carbolic  acid  administered 
every  hour  or  two,  Prof.  Hare  says,  will  be 
found  to  generally  stop  Refltx  Vomiting. 

— Fibromatous  Tumours,  Prof.  Keen  says, 
are  neither  painful  nor  tender  to  the  touch  ;  they 
are  also  slow  in  growth.  They  may,  he  says, 
by  pressure  on  adjacent  parts,  produce  pain. 

— The  eruptions  produced  by  the  inocula- 
tion of  Vaccine  Lymph  will  manifest  themselves, 
Prof.  Wilson  says,  twenty-four  hours  earlier,  if 
the  inoculation  has  been  performed  by  human 
lymph,  than  if  performed  by  the  bovine. 


— Prof.  Wilson  says  that  relapses  oi  Scarlet 
Fever  are  rare,  but  a  secondary  attack  may 
occur  at  some  later  period,  the  first  attack  not 
conferring  an  immunity  from  subsequent 
attacks. 

— Cannabis  indica,  according  to  Prof.  Hare, 
will  be  found  to  be  a  very<useful  drug  in  stop- 
ping the  Cough  of  Phthisis,  and  it  possesses 
the  advantage  over  opium  in  that  it  is  not  so 
depressant  to  the  system  in  general. 

— Sarcoma,  Prof.  Keen  says,  as  a  rule,  is  ^ 
disease  of  youth  and  not  of  old  age.  It  makes 
its  appearance  generally  during  the  period 
when  the  tissues  are  growing.  It  generally 
appears  between  the  age  of  twenty  and  thirty, 
more  so  than  after  forty. 

— Prof.  Parvin  says  that  during  the  Period 
of  Menstrjiation  the  condition  of  the  mother's 
milk  is  altered,  and  often  is  the  cause  of  an 
attack  of  colic  in  the  nursing  child.  But  as 
soon  as  the  menstrual  period  has  elapsed  then 
the  milk  returns  to  its  normal  condition. 

— Camphoric  acid,  according  to  Prof.  Hare, 
is  the  best  drug  that  can  be  used  in  controlling 
the  Nighisweats  of  Phthisis.  It  should  be 
taken  in  doses  of  twenty  to  thirty  grains,  and 
two  or  three  hours  before  the  time  that  the 
sweats  generally  come  on. 

— Anteflexion  of  the  Uterus,  according  to 
Prof.  Montgomery,  is  of  most  frequent  occur- 
rence in  women  who  have  never  borne  children. 
It  is  also  the  displacement  which  is  found  of 
most  frequent  occurrence  in  the  sterile  woman. 

— The  tumour  which  is  Scrofulous  in  char- 
acter, Prof.  Keen  says,  in  the  early  stages  will 
be  found  to  be  perfectly  movable,  but  in  the 
later  stages  it  will  be  bound  down  tight  and 
will  be  immovable,  due  to  its  having  infiltrated 
into  the  surrounding  tissues. 

— The  oxalateof  cerium,  either  alone  or  com- 
bined with  bismuth.  Prof.  Hare  says,  will  very 
often  be  found  to  stop  Excessive  vomiting. 
Especially  has  this  been  found  so  in  such  cases 
as  are  due  to  a  hyperacidity,  or  to  an  irritation 
of  the  mucous  membrane  of  the  stomach. 

— Prof.  Wilson  favors  the  treatment  of  Scar- 
let Fever  by  chloral.  Such  doses,  he  thinks, 
should  be  administered  as  to  keep  the  patient, 
under  its  hypnotic  influence  to  such  an  extent 
as  to  require  wakening  at  the  time  when  food 
or  medicine  is  to  be  a'dministered. 

— In  cases  of  Chancroids,  which  are  indolent 
in  healing.  Prof.  Horwitz  recommends  the 
following : — 

R.     Ung.  hydrarg.  nitrat.,         3J 
Ung.  iodoformi,  gij 

Ung.  zinci  oxidi,  §ss  M. 

Sig. — Apply  locally. 


THE  CANADA  MEDICAL  RECORD. 


139 


— Dr.  Davis  says,  under  frequent  disinfec- 
tions of  the  vagina,  and  irrigation  through  the 
rupture  with  boiled  water,  and  the  use  of  the 
tampon  or  drainage  tube,  a  large  number  of 
cases  o{  Partial  Rupttire  of  the  Uterus  will  re- 
cover. 

— In  Acute  Urethritis,    in  combination  with 
an  injection.    Prof.  Horwitz  recommends   the 
use  of  the  following,  in  capsule  : — 
R.     Cubebce,  gr.  v 

Copaibee,  gr.  x 

Salol,  gr.  X 

Pepsin,  gr.  j.  M. 

Sig. — One  three  times  a  day. 

— The  recurrence  of  Malignant  Growth, 
excepting  Sarcoma,  according  to  Prof.  Keen, 
rarely  appears  before  six  months  after  the 
operation,  and  if  such  a  recurrence  does  not 
take  place  within  three  years  after  the  operation, 
the  chances  of  its  not  recurring  at  all  are  the 
very  best. 

— Prof.  Parvin  calls  attention  to  the  fact 
that  in  opening  an  Abscess  of  the  Breast,  the 
incision  should  always  be  made  longitudinally 
and  not  transversely.  For,  he  says,  when  the 
opening  is  made  by  a  transverse  incision  more 
milk  ducts  will  be  destroyed  than  if  the  incision 
had  been  made  longitudinally. 

— For  Colic  in  Children^  especially  if  asso- 
ciated with  some  nervous  irritation.  Prof.  Hare 
recommends  the  following  (the  dose  is  for  a 
child  one  year  old)  : — 

R.     Chloral,  gr.  viij 

Sodii  bromid.,  gr.  xvj 

Syr.  lactucarii,  f5  ss. 

Aquse,         q.s  ad  f  5  j.  M. 

Sig. — Teaspoonful  not  oftener  than  every 
four  hours  during  the  night. 

HIGHER  MEDICAL  EDUCATION. 

In  pursuance  of  the  policy  recently  an- 
nounced in  the  resolution  to  be  presented  to 
the  American  Medical  College  Association, 
the  trustees  and  faculty  of  Rush  Medical  Col- 
lege have  decided  to  require  four  years  atten- 
dance at  college  from  students  who  begin  the 
study  of  medicine  this  year  with  a  view  to 
graduation  in  1898;  however,  those  who  have 
already  studied  medicine  one  year  or  more 
with  a  preceptor,  so  that  the  four  years  of 
study,  already  required,  will  be  completed  be- 
fore July,  1897,  may  graduate  after  three 
courses  of  lectures  as  heretofore.  To  encour- 
age proper  preliminary  study,  graduates  in 
arts  and  sciences  from  high  grade  colleges,  and 
graduates  in  pharmacy  and  dentistry  from  col- 
leges requiring  a  proper  amount  of  study  and 
two  full  courses  of  lectures  will,  until  further 
notice,  be  allowed  to  graduate  after  an  atten- 
dance on  only  three  courses  of  lectures. 


PUBLISHERS'  DEPARTMENT. 


PERTURBED  NERVOCS  FORCES— AN  UN- 
SURPASSED COMPOSER  AND  PAIN- 
RELIEVER. 

The  season  of  pneumonia,  typhoid,  bronchitis,  also  the 
recurring  epidemic  of  influenza,  while  not  so  malignant  as 
its  predecessor,  la  grii^pe,  still  makes  apropos  an  extract 
from  The  Medial  Summary,  It  says,  in  speaking  of 
the  action  of  aniikamnia  : — 

'•■  Thisdrug  has  a  well-earned  character  as  an  analgesic. 
It  is  one  of  the  few  among  the  many  claimants  for  favor 
that  have  successfully  stood  the  test  of  experience.  In 
a  case  of  acute  poly-articular  rheumatism  prominently 
affecting  both  knees,  where  there  was  great  swelling  and 
exquisite  tenderness  of  the  articulations,  two  ten-grain 
doses  at  an  interval  of  an  hour  procured  almost  complete 
relief,  followed  by  several  hours  of  restful  sleep.  This 
was  the  more  remarkable  as  after  one  or  two  more  doses 
there  was  comparatively  little  pain  experienced  to  the 
close  of  the  attack.  For  the  relief  of  nervous  headache, 
hemicrania,  menstrual  neuroses  and  neuralgias  in  general, 
it  cannot  be  over-praised.  In  the  prevailing  epidemic  of 
la  grippe  its  usefulness  as  a  pain-reliever  and  composer 
of  the  perturbed  nervous  forces  is  unsurpassed.  It  has 
become  indispensable,  and  doubtless  there  is  not  a  physi- 
cian acquainted  with  its  decisive  action  who  could  be 
induced  to  dispense  with  it.  Five  or  ten  grains  as  a  com- 
mencing dose,  then  two,  three  or  five  grains  every  three 
or  five  hours,  will  relieve  the  severest  cases,  in  a  few 
hours  causing  the  splitting  cephalalgia,  lumbar  and 
"eneral  muscular  pains  and  nervous  disquietude  to 
vanish.  On  the  whole,  it  abates  the  fever  and  subdues 
the  whole  assemblage  of  perturbed  activities  that  dis- 
tinguish la  grippe  as  no  other  agent,  or  combination  of 
agents,  has  ever  done,  producing  not  a  single  unpleasant 
symptom  and  leaving  no  sequelae.  Quinine  checks  ague, 
digitalis  energizes  the  drooping  heart,  ergot  promotes 
uterine  contraction,  but  their  action  is  no  more  nearly 
specific  than  is  that  of  antikamnia  in  its  sphere  of  useful- 
ness." In  line  with  and  supplementary  to  the  foregoing, 
Hucro  Engel,  A.M.,  M.D. ,  late  Lecturer  on  Electro-Thera- 
peutics, Jefferson  Medical  College,  Professor  of  Nervous 
Diseases  and  Clinical  Medicine,  Med.  Chir.  College,  and 
Consultant  in  Nervous  Diseases  at  St. Joseph's  Hospital, 
Philadelphia,  says  :  "  The  remedy  has  become  a  favorite 
with  many  members  of  the  profession.  'It  is  very  reliable 
in  all  kinds  of  pain,  and  is  quickly  acting  as  a  hypo- 
dermic injection  of  morphia.  It  is  used  only  internally. 
To  stop  pain,  five  grains  are  administered  at  once  ;  three 
minutes  later  the  same  dose  is  repeated,  and,  if  necessary, 
a  third  dose  given  three  minutes  after  the  second.  If  ten 
minutes  after  the  third  dose  the  remedy  has  had  a  decided 
effect,  but  a  little  of  the  pain  be  remaining,  a  fourth  dose 
of  gr.  V.  may  then  be  administered.  In  92  percent,  of  all 
cases  it  immediately  stops  the  pain. 

"The  following  is  an  excellent  prescription  in  la  grippe 
and  painful  bronchial  catarrh  : — 

i  I  U  Antikamnia  (genuine) i^  ij 

Mist.  Glycyrrh.  Comp 5  iij 

F.  E.  Rad.  Glycyrrh 5  ij 

Vini  Rubri  Gall q.  s.  ft.  3  vj 

"  M.  Sig- — Two  teaspoonfuls  every  three  hours. 

"  For  whooping-cough  in  a  child  four  years  old  : 

"  U     Antikamnia  Cgenuine) r.  xxxv 

"Divide  in  chart,  No.  xij. 

"Sig. — At  night,  one  powder  every  fifteen  minutes 
until  three  have  been  taken .  Administer  in  ddute  claret, 
or  port  or  sherry  wine . 

"As  an  antipyretic,  from  gr.  v.  to  gr.  x.  should  be 
given  every  ten  minutes  until  the  temperature  has  been 
reduced,  or  40  to  50  grains  have  been  taken,  when  the 
same  dose  is  repeated  at  longer  intervals,  until  the 
desired  effect  is  obtained." 


140 


THE   CANADA   MEDICAL   RECORD. 


THE  CANADA  MEDICAL  RECORD. 

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ASSISTANT  EDITOR 
ROLLO  CAMPBELL.  CM.,  M.D. 

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MONTEEAL,  MARCH,  1894. 


HOW  TO  PUT  A  STOP  TO  HEREDITARY 
CRIMINALITY. 

On    several    previous    occasions    we    have 
called  attention  to  the  stupidity  which  charac. 
terizes  society's  present  method  of  dealing  with 
habitual  criminals.      During  the  last  few  years 
the  view  has  been  steadily  gaining  ground  that 
impulse  to  crime  is  an  inherited  taint ;  that  the 
criminal  is  an  atavistic  creature  no  more  to   be 
blamed  for  his  acts  than  the  child   of  syphilitic 
parentage  to  be    called    to  account  for  his  un- 
lovely skin,  or  bones,  or  teeth  ;  and  yet   every 
year  several  hundred    thousand  habitual  crim- 
inals, who  have  been  convicted  several  times  of 
brutal  crimes,  are  allowed  to  go  forth  from  the 
prisons    to    sow    a    crop    of    several   hundred 
thousand  children,  who  will  be  born  criminals 
and  who  will  in  due  time  prey  on  society,  and 
require   in   turn   to   be  imprisoned  at  society's 
expense.     The  whole  tendency  of  science  at  the 
present  day  is  to  prevent  rather  than  to  go  on 
from  generation  to  generation  treating  disease. 
Thus  have  cholera,  the  black  plague,  small-pox 
been  almost  made  to  disappear  from  off  the  earth, 
and  before  many  years  we  will  be  able  to  say  the 
same  of  diphtheria,  scarlet   fever,    measles  and 
consumption.     Why  should   not  the  physician 
in   charge  of   social  disorders   take    the  same 
preventive  measures  ?  Why  go  on  eternally  impri- 
soning and  executing  the  aberrant  race  of  crim- 
inals, when,  by  a  simple  and  painless  operation, 
an  end  could  be  put  to  the  breed  forever  ?  Asep- 


tic castration  applied    to  every  man  or  woman 
convicted  twice  of  deadly  assault    or  highway 
robbery,  to  every  man  convicted  twice  of  rape 
or  other   abominable  crime,   would  forever  re- 
move from  them'the  power  to  inflict  their  beast- 
ly character  upon  thousands  of  innocent  babes 
condemned  from  their  birth  to  a  childhood  of 
misery  and  a  youth  of  crime.     There  is  nothing 
cruel  or  savage  about  the  idea  :  for  it  is  not  to 
be  compared  with  judicial  murder  which  society 
fully  justifies    for  her  own  protection.     On  the 
contrary,  castration  would  be  an  ideal  punish- 
ment, for  all  treatment  of  criminals  should  be 
directed    to     the     sole    object   of    preventing 
crime  in  the  future  rather  than  to  have  revenge 
for   it    in  the  past,  and   it  would   probably   in 
most  cases  convert  the  criminal   into,  a  gentle 
and  useful  member  of  society.     Not  only  would 
castration  empty  our  prisons  in  a  generation  or 
two  by  the    lack  of  supply  of  crimii,als,  but 
even  the  immediate  effects  upon  the  diminution 
of  crime  in  one  day  would  be  very  marked,  for 
the   deterrent   effect  of   this  penalty  would  be 
even   greater  than   the   penalty  of  deaih  itself. 
In  our  former  article  we  quoted  from  the  crim- 
inal statistics  in  England,  showing  that  one  crim- 
inal alone   left  behind  him  nearly  one  hundred 
descendants    to     occupy     the     prison     cells. 
We  feel   sure    that    this    remedy    has   only  to 
be  more  fully    considered    in    a  truly    philan- 
thropic light  in    order  to  receive  the  approval 
of  our  legislators  and  of  public  opinion  at  large. 
Without   castration,    society  must,    for  its  own 
protection,  continue  to  treat  cruelly  and  unjustly 
unborn  generations   of  wild   beasts  in   human 
form.     It  would  be   more   merciful  to  them  as 
well  as  to  their  innocent  victims  if  the  crim- 
inal  class    should,  by  the  above  means,  forever 
cease  to  be. 


BOOK    NOTICES. 

A  Text-Book  of  Physiglggy.  By  Michael 
Foster,  M.D.,  F.R.S.,  Prelector  in  Physi- 
ology in  the  Univ.  of  Cambridge  ;  Fellow 
of  Trinity  College,  Cambridge,  New 
(5  th)  American  from  the  5  th  Eng- 
lish edition,  thoroughly  revised,  with  notes 
and  additions.  In  one  handsome  octavo 
volume  of  1083  pages  with  316  illustra- 
tions. Cloth,  $4.50;  leather,  $5.50.  Phila- 
delphia :  Lea  Brothers  &  Co.,  1893. 
Both  teachers  and  students  of  physiology  in 


THE  CANADA  MEDICAL  RECORD. 


141 


America    are   under  deep    obligations    to    the 
publishers  for  having  undertaken  the  reproduc- 
tion in  this   country   of  such  a  costly  work  as 
this.     One  cannot  read  a    single  chapter  with- 
out  being   impressed  with    the  care  which  the 
author    has     bestowed  upon    it.     Apparently, 
nothing  that  is  known   up  to  the   present  year 
concerning  vital  processes  has  escaped  his  pains- 
taking  attention;   no    matter    how  trivial    the 
details,  they  receive  the  fuUtst  consideration. 
The  additions  which  have  been  made  to  this 
last  edition  are  cAused,  not  by  any  attempt  to 
enlarge  the  scope  of  the  work,  but  by  an  effort 
to   explain   more  fully  and     at   greater  length 
what  seemed  to    be  the  most  fundamental  and 
important  topics.  The  publishers  have  subject- 
ed it  to  the  searching  revision  of  one  of  the  fore- 
most American  professors  of  Physiology,  but  the 
American  editor,  we   are  glad    to  see,  has  not 
abused  his  right  to  make  additions,  there  being 
very  few  sentences  in    brackets,  but    he    has 
added  a  considerable  number  of  illustrations, 
which  greatly  help  to  explain  the  text.  He  would 
be  a   bold   critic   who    would  venture  to  find 
fault    with    the    work    of   the     distinguished 
Cambridge  professor,  and  for  our  own  part  we 
have  nothing  but  words  of  the  highest  praise  for 
the  classical  and  thorough  manner  in  which  the 
work  is  written,  as  well  as  for  the  liberality  of  the 
publishers  for  seUing  such  a  large  work,  and  one 
which  must  necessarily  be  very  costly  to  produce, 
for    the  extremely  moderate  price     mentioned 
above.      '1  he  same  work  can  only  be  purchas- 
ed by  the  student  in  England  in  five  volumes, 
costing  three  times  as   much  as  the  American 
edition.     That  the    students  of  America  have 
appreciated  the  enterprise  of  the  Lea  Brothers  is 
evidenced  by  their   having   rapidly    exhausted 
four  editions,  and  still  called  for  a  fifth  one  now 
before  them. 

Lea  Brothers  &  Co.  are  evidently  deter- 
mined to  maintain  the  lead  which  they  have 
held  long  as  the  principal  text-book  publishers  of 
America.  The  book  may  be  obtained  from  any 
bookseller. 

Anatomy,  Descriptive  and  Surgical.  By 
Henry  Gray,  F.R.S.,  Lecturer  on  Anat- 
omy at  St.  George's  Hospital,  L-ondon. 
New  American  from  the  thirteenth  enlarged 
and  improved  English  edition.  Edited 
by  T.  Pickering  Pick,  F.R.C.S.,  Examiner 
in  Anatomy,  Royal  College  of  Surgeons 
of  England,  In  one  imperial  octavo  vol- 
ume of  1 100  pages,  with  635  large  engrav- 
ings. Price  with  illustrations  in  colors  : 
Cloth,  $7.00  ;  leather,  $8.00.  Price  with 
illustrations  in  black  :  Cloth,  $6.00  ;  leath- 
er, $7.00.  Philadelphia  :  Lea  Brothers 
&  Co.,  1893. 

We  feel  safe  in  saying  that  no  Medical  work 
has  ever  had  so  large  and  attentive  a  circle  of 
readers  as  has  the  above. 


Since  1857  Gray's  Anatomy  has  unquestion- 
ably been  the  standard  text-book  on  its  sub- 
ject among  all  English-speaking  people.  The 
demand  for  thirteen  editions  has  been  utilized 
by  subjecting  the  work  to  the  searching  revi- 
sion of  the  foremost  anatomists  of  a  generation. 
In  no  other  way  is  accuracy  and  completeness 
to  be  attained  in  treating  of  so  complex  aiid 
detailed  a  science.  The  series  of  illustrations 
is  quite  as  famous  as  the  text.  Their  large  siz^ 
not  only  enables  the  various  parts  to  be  brought 
into  view,  but  also  allows  their  names  to  be  en- 
graved directly  upon  them.  Thus  not  only  the 
name,  but  the  extent  cf  a  part  is  indicated  at 
a  glance, — a  matter  of  obvious  importance  and 
convenience.  Many  new  illustrations  appear 
in  this  edition,  and  the  whole  series  has  been 
re-engraved  wherever  clearness  could  be  pro- 
mote ^.  The  liberal  use  of  colors  lends  added 
prominence  to  the  attachments  of  muscles,  to 
veins,  arteries  and  nerves.  The  work  is  also 
published  with  illustrations  in  black  alone. 

As  heretofore,  the  revision  has  been  most 
thoroughly  performed,  so  that  the  work  is  kept 
always  abreast  with  the  advances  of  its  science. 
Special  attention  has  been  paid  to  the  appli- 
cations of  anatomy  to  surgery,  and  the  work  is 
therefore  indispensable  to  all  who  find  in  the 
exigencies  of  practice  the  need  of  recalling  the 
details  of  the  dissecting  room. 

One  other  special  advantage  which  may  be 
claimed  for  this  edition  is  that  it  has  been 
published  in  this  country  exactly  as  it  appeared 
from  the  hands  of  the  English  editors,  and  is 
not  therefore  defaced  by  notes  and  comments 
of  an  American  one.  Gray"s  Anatomy  has 
reached  such  a  point  of  eminence  and  excel- 
lence that  no  other  work  can  take  its  place, 
and  it  is  doubtful  if  any  other  work  will  ever 
supplant  it.  As  more  and  more  stress  is  laid  up- 
on the  importance  of  making  anatomy  the  found- 
ation of  surgery,  the  medical  student  of  the 
future  will  probably  devote  more  and  more 
time  to  his  Gray,  so  that  the  volume  will 
become  indispensable  to  every  Medical  student. 
The  volume  before  us  is  a  great  improvement  on 
any  other  edition  we  have  ever  seen,  and  will 
no  doubt  meet  with  the  ready  sale  which  it 
deserves. 

Surgery.  By  Bern  B.  Gallaudet,  M.D.,  Dem- 
onstrator of  Anatomy  and  Clinical  I,ect- 
urer  on  Surgery,  College  of  Physicians  and 
Surgeons,  New  *York  ;  Visiting  Surgeon, 
Bellevue  Hospital,  New  York  ;  and  Charles 
N.  Dixon-Jones,  M.D.,  Assistant  Surgeon, 
Out-Patient  Department  Presbyterian 
Hospital,  New  York,  Being  the  final 
volume  of  The  Students'  Quiz  Series, 
edited  by  Bern  B.  Gallaudet,  M.D. 
Duodecimo,  291  pages,  149  illustrations. 
Cloth,  $1.75.  Philadelphia :  Lea  Bro- 
thers «&  Co.,  1893. 


143 


THE  CANADA  MEDICAL  RECORD. 


The  issuance  of  the  vohime  on  Surgery  marks 
the  completion  of  the  Students'  Quiz  Series. 
Like  its  twelve  companion  volumes,  it  is  the 
product  of  well-known  teachers  and  specialists 
in  New  York.  The  advantages  of  careful 
editorial  supervision  are  manifest  in  the  uni- 
formly excellent  presentation  of  the  matter  and 
in  the  compactness  attained  by  skillful  assign- 
ment of  subjects  in  the  original  plan  of  the 
Series.  The  volume  on  Surgery  is  largely  from 
the  pen  of  the  able  editor,  Dr,  Bern  B.  Gal- 
laudet,  though  many  of  its  sections  were  con- 
tributed by  Dr.  Charles  N.  Dixon-Jones.  It 
is  not  to  be  classed  with  "  compends "  or 
"  summaries,"  but  is  on  the  contrary  an  explan- 
ation of  the  principles  and  practice  of  surgery 
in  an  exceedingly  terse  style.  Its  tables  group 
a  large  amount  of  information  in  a  very  com- 
pact and  convenient  form.  The  volume  is 
richly  illustrated,  about  150  engravings  being 
printed  in  its  three  hundred  pages.  The  ex- 
ceedingly reasonable  price  indicates  the  expect- 
ation of  a  large  demand,  which  is  well  merited. 

The  book  is  remarkably  well  written  through- 
out, but  the  subjects  of  Inflammation,  Tumors 
and  Cysts,  Brain  Surgery  and  Abdominal  Sur- 
gery have  received  especial  attention.  By  avoid- 
ing discussion  on  all  mooted  points, the  size  of  the 
volume  has  been  kept  down  to  comparatively 
narrow  limits,  and  yet  an  immense  amount  of 
information  has  been  introduced.  Even  the 
old  practitioner  might  study  it  with  advantage, 
for  in  the  most  concise  manner  it  brings  the 
old  and  often  erroneous  views  of  twenty  years 
ago  thoroughly  up  to  date.  This  volume,  though 
the  last,  is  certainly  not  the  least  of  the  series ; 
indeed,  it  is  one  of  the  most  valuable  of  them 
all. 

February  "Cosmopolitan."  The  secret  of 
the  great  success  of  The  Cosmopolitan  is 
not  so  hard  to  find,  if  one  looks  carefully 
over  the  number  for  February.  A  story 
by  Yaldes,  the  famous  Spanish  novelist, 
the  first  from  his  pen  to  appear  in  any 
American  magazine,  is  begun  in  this  num- 
ber. Arthur  Sherburne  Hardy's  story, 
"  A  Rejected  Manuscript,"  is  charmingly 
illustrated  by  L.  Marold,  who,  we  believe, 
makes  his  first  appearance  in  the  magazines 
on  this  side  of  the  water.  A  profusely 
illustrated  article  on  the  designing  and 
buildingof  a  war-ship  appeals  to  the  inter- 
est taken  by  all  in  the  new  navy,  and  a 
thrilling  description  of  a  naval  combat, 
under  the  significant  title  :  "  The  Meloban 
and  the  Pentheroy,"  describes,  after  the 
manner  of  the  Battle  of  Dorking,  a  possible 
sea-fight,  the  outcome  of  which  is  watched 
by  the  entire  naval  world.  "  Gliding 
Flight  "  is  an  interesting  contribution  to 
the  problem  of  aerial  navigation  by  one 
who  has  studied  the  flight  of  soaring  birds 


in  the  East  for  twenty  years.  Elaine 
Goodale,  who  married  a  member  of  the 
Sioux  nation,  has  some  interesting  inform- 
ation of  Indian  Wars  and  Warriors.  T. 
C.  Crawford,  the  Washington  corres- 
pondent, gives  the  first  half  of  a  startling 
story,  under  the  title  of  '"The  Disappear- 
ance Syndicate."  The  poetry  in  this 
number  by  Sir  Edwin  Arnold,  Graham  R. 
Tomson  and  William  Young  is  unusually 
good.  The  departments  "  In  the  World 
of  Art  and  Letters  "  and  the  "  Progress  of 
Science,"  continue  to  have  as  contributors 
men  famous  in  both  continents. 

An  American  Text-Book  of  Gynecology, 
Medical     and      Surgical,      For      the 
use  of  Students     and    Practitioners.     By 
Henry  T.  Bvford,  M.D.,  John  M.  Baldy, 
M.D.,  Edwin   Cragin,  M.D.,   J.  H.  Ether- 
idge,    M.D.,     William     Goodell,    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. 
Edited  by  J.  M.  Baldy,  M.D.   Forming  a 
handsome    royal    8vo    volume,  with  360 
illustrations    in    text  and    37  colored  and 
half-tone  |)lates.  Price,  Cloth,  $6.00  ;  Sheep, 
$7.00  ;  Half  Russia,   $8.00.    W.  B.  Saun- 
ders, Publisher,  925  Walnut  St.,  Philadel- 
phia, Pa. 
In  this  volume    all    anatomical  descriptions 
excepting  what    is    essential  to   a  clear   under 
standing  of  the  text  have  been  omitted,  illustra- 
tions being  largely  depended  upon  to   elucidat- 
this  point.     It  will  be   found  thoroughly  prac- 
tical in  its    teachings,   and    is  intended,  as   its 
title  implies,  to  be  a  working  text-book  for  phy- 
sicians and  students.   A  clear  line  of  treatment 
has  been  laid  down  in  every  case,  and,  although 
no  attempt  has  been  made  to    discuss  mooted 
points,  still  the  most  important    of  these  have 
been  noted  and  explained  ;  and  the  operations 
recommended  are  fully  illustrated,  so   that  the 
reader  may    have  a  picture  of  the  proceduret 
described  in  the  text  under  his  eye  and  cannoe 
fail  to  grasp  the  idea . 

All  extraneous  matter  and  discussions  have 
been  carefully  excluded,  and  the  attempt  made 
to  allow  nothing  unnecessary  to  cumber  the 
text. 

The  subject  matter  has  been  brought  fully  up 
to  date  at  every  poiut,  and  the  work  is  as  near- 
ly as  possible  the  combined  opinion  of  the  ten 
specialists  who  figure  as  the  authors. 

The  work  is  well  illustrated  throughout  with 
wood-cuts,  half-tone  and  colored  plates, 
mostly  original  and  selected  from  the  author's 
private  collections. 

The  chapter  on  Technique  of  Gynecological 
Examination  is  especally  good.  This  chapter 
contains  the  most  recent  and  approved 
methods  of  preparation  of   the  operator,  assis- 


THE   CANADA   MEDICAL   RECORD. 


143 


tants,  nurses,  and  patient  for  operations, 
both  abdominal  and  vaginal ;  the  best  and 
most  reliable  methods  of  preparation  and  dis- 
infection of  sponges,  ligatures,  sutures,  and  in- 
struments. In  fact,  the  success  of  modern 
gynecological  surgery  rests  on  the  adoption  of 
the  principles  and  details  described  in  this 
chapter,  which  has  been  brought  fully  up  to 
date. 

Another  chapter  deserving  special  mention 
is  the  one  on  Pelvic  Inflammation,  which  is  con- 
sidered from  an  entirely  different  standpoint 
from  that  found  in  the  older  text-books.  The 
subject  is  covered  in  a  thoroughly  practical 
manner.  The  pathology  and  etiology  are 
cleaily  pointed  out,  the  result  described^  and 
the  management  and  treatment  in  all  places 
considered  in  detail.  The  old  and  confusing 
nomenclature  and  pathology  have  been 
dropped,  and  the  data  given  from  facts  as 
found  to-day,  insteadof  from  theory  and  tradi- 
tion. Salpingitis,  pyosalpinx,  hydrosalpinx, 
hematosalpinx,  pelvic  peritonitis,  and  pelvic 
cellulitis  are  also  included  under  this  chapter- 
heading. 

There  are  many  other  chapters  in  which  im- 
portant subjects  are  treated  in  a  manner  not 
usual  in  the  text-book,  so  that  the  work  is  of 
special  value  to  the  practitioner.  Much  of  the 
teaching  in  the  older  text-books  will  have  to  be 
untaught  m  the  light  of  modern  knowledge,  but 
in  this  work  such  is  not  the  case.  If  anything, 
in  a  few  cases  the  treatment  is  a  little  ahead  of 
the  timeS;  being  rather  more  rigorous  than  is 
always  warranted.  But  on  the  whole  the  views 
expressed  are  those  held  by  the  leaders  of 
gynecological  teaching  in  the  United  States. 
Considering  the  number  of  illustrations,  the 
cost  of  the  work  is  surprisingly  moderate. 

Essentials  of  Practice  of  Medicine. 
Arranged  in  the  form  of  questions  and 
answers.  Prepared  especially  for  stu- 
dents of  medicine.  By  Henry  Morris, 
M.D  ,  late  Demonstrator  Jefferson  Medi- 
cal College,  Philadelphia  ;  Visiting  Phy- 
sician to  St.  Joseph's  Hospital  j  Fellow- 
College  of  Physicians,  Philadelphia  ;  co- 
editor  Biddle's  Materia  Medica,  author 
of  Essentials  of  Materia  Medica,  etc,  etc. 
With  a  very  complete  Appendix,  on  the 
examination  of  Urine,  by  Lawrence  Wolff, 
M.D.,  Demonstrator  of  Chemistry,  Jef. 
ferson  Medical  College.  Colored  (Vo- 
gel)  urine  scale  and  numerous  illustra- 
tions. Third  edition,  revised  and  enlarged 
by  some  three  hundred  essential  formu- 
lae, selected  from  the  writings  of  the  most 
eminent  authorities  of  the  medical  pro- 
fession. Collected  and  arranged  by  Wil- 
liam M.  Powell,  M.D.,  Attending  Physi- 
cian to  the  Mercer  House  for  Invalid  Wo- 
men   at   Atlantic    City,  N.  J.     Philadel- 


phia :  W.  B.  Saunders,  925  Walnut 
Street.     1894.     Price  $2.00. 

The  fact  that  this  small  Manual  of  the 
Practice  of  Medicine  should  have  passed 
three  editions  since  its  issue  in  the  latter  part 
of  I S90  is  sufficient  guarantee  of  its  popular- 
ity, and  that  the  Author's  plans  have  not  mis- 
carried. 

Great  care  has  ben  exercised  in  the  re- 
vision not  to  increase  its  size,  and  thus  rob  it 
of  its  usefulness  to  the  student,  who  has  but 
little  time  for  large  and  exhaustive  works. 
All  obsolete  and  useless  matter  has  been 
omitted,  and  the  very  latest  physical  diagnosis 
and  treatment  substituted,  thus  bringing  the 
work  thoroughly  abreast  with  the  times. 


PAMPHLETS. 


The  After-Treatment  of  Cceliotomy  Cases, 
WITH  Special  Reference  to  Shock  and 
Septic  Peritonitis.  By  Eugene  Boise, 
M.D.,  Grands  Rapids, Mich.,  Gynaecologist 
to  St.  Mark's  Hospital ;  Fellow  of  the 
American  Association  of  Obstetricians  and 
Gynsepologists. 

Carcinoma  of  the  Uterus.  By  J.  M.  Baldy, 
M.D.,  Professor  of  Gynaecology  in  the  Phil- 
adelphia Polyclinic  ;  Surgeon  to  the  Gynae- 
cean  Hospital.  Reprinted  from  the  Pro- 
ceedings of  the  Medical  Society  of  the  State 
of  Pennsylvania,  May,  1893. 

The  Surgery  of  the  Ureters  ;  a  Clinical, 
Literary  and  Experimental  Research. 
Read  in  the  Section  on  Surgery  and  Ana- 
tomy at  Forty-fourth  Annual  Meeting  of 
the  American  Medical  Association,  June 
8,  1893,  by  Weller  Van  Hook,  A.B.,  M.D., 
Professor  of  Surgery  in  the  Chicago  Post- 
Graduate  Medical  School. 

A  Case  of  Mediastino-Pericarditis  in  a 
Child;  Secondary  Empyema;  Opera- 
tion; Death.  By  William  A.  Edwards, 
M.D.,  San  Diego,  California,  Fellow  of  the 
College  of  Physicians  of  Philadelphia, 
American  Pediatric  and  Philadelphia 
Pathological  Societies  ;  formerly  Instruc- 
tor in  Clinical  Medicine  and  Physician 
to  the  Medical  Dispensary  in  the  Uni- 
versity of  Pennsylvania;  Physician  to  St. 
Joseph's  Hospital  ;  Associate  Pathologist 
to  the  Philadelphia  Hospital  ;  and  Mem- 
ber Advisory  Council  for  the  Section 
on  Diseases  of  Children  of  the  Pan- 
American  Medical  Congress.  Reprinted 
from  the  International  Medical  Magazine 
for  June,  1893. 


144 


THE  CANADA  MEDICAL  RECORD. 


The  New  Treatment  of  Hernia.  By  Alex- 
ander Dallas,  M.D.,  New  York,  Fellow 
of  the  N.Y.  Academy  of  Medicine,  and 
the  N.Y.  State  Medical  Association  ;  Con- 
sulting Surgeon  to  Bayonne  Hospital, 
etc.,  etc.  Read  before  American  Medical 
Association,  at  its  annual  meeting  in  Mil- 
waukee, Wis.,  June  6th  to  9th,  1893. 

Perineo- Vaginal  Restoration.  By  Edward 
W.  Jenks,  M.D.,  LL.D.,  Professor  of  Gy- 
naecology, Michigan  College  of  Medicine 
and  Surgery ;  Fellow  of  the  American 
Gynaecological  Society ;  Fellow  of  the 
Obstetrical  Society  of  London,  etc.,  etc, 
Detroit,  Mich.  Reprinted  from  The  Amer- 
ican Journal  of  Obstetrics,  Vol.  XXVIII., 
No.  5, 1893.  New  York :  William  Wood 
&  Co.,  publishers,  1893. 

Lecture  upon  Mejallic  Interstitial  Elec- 
trolysis. By  Augustin  H.  Goelet,  M.D. 
Delivered  in  the  Course  of  Clinical  In- 
struction in  Gynaecological  Electro-Thera- 
peutics at  the  West  Side  German  Clinic, 
New  York.  Reprinted  from  the  Times 
and  Register. 

The  Limits  and  Requirements  of  Gyx.ecol- 
OGY.  By  Edward-W.  Jenks,  M.D.,  LL.D., 
•  Detroit,  Mich.,  Professor  of  Gynaecology 
in  the  Michigan  College  of  Medicine  and 
Surgery;  Fellow  of  the  American  Gynaeco- 
logical Society,  etc.  Reprinted  from  the 
Meaical  Record,  November  11,  1893. 
New  York  :  Trow  Directory  Printing  & 
Bookbinding  Co.,  201-203  East  Twelfth 
Street,  1893. 

Hysterectomy  by  a  Nf.w  Method,  which  is 
simple,  safe,  bloodless,  and  entirely 
obviates  the  necessity  of  either 'clamp, 
cautery,  or  ligature  ;  a  major  operation 
converted  into  a  minor  one  by  a  simple 
process  of  easy  dissection.  E.  H.  Pratt, 
M.D.,  LL.D.,  Chicago. 

Supra-Vaginal  Hysterectomy,  without  liga- 
ture of  the  cervix,  in  operation  for  uterine 
fibroids.  A  new  method.  Cases  of 
chronic  ovarian  abscess,  illustrating  the 
danger  of  delay  in  their  proper  manage- 
ment. Drainage  in  abdominal  surgery, 
its  unnecessary  and  excessive  use.  ^y 
B.  F.  Baer,  M.D.,  Professor  of  Gynaecology 
in  the  Philadelphia  Polyclinic.  Reprinted 
from  the  Aransactions  of  the  American 
Gynecological  Society,  Vol.  XVII.,  1892, 
and  the  Philadelphia  PolycUnic,  Jan.,  1893. 

Some  Causes  and  Characteristics  of 
Neurasthenia.  By  A.  D.  Rockwell, 
M.D.  Reprinted  from  \\\t  New  York  Medi- 
cal Journal  ^ox  November  18,  1893. 

Report  of  Two  Years'  Work  in  Abdom- 
inal    Surgery     at     the    Kensington 


Hospital  foR  Women',  Philadelphia.  By 
Charles  P.  Noble,  M.D.,  Surgeon  in  Chief. 
Reprinted  from  the  International  Medi- 
cal Magazine  for  December,  1893. 

Mathews'  Medical  Quarterly,  a  journal 
devoted  to  Diseases  of  the  Rectum,  Gas- 
tro-Intestinal  Disease,  and  Rectal  and 
Gastro-Intestinal  Surgery.  Joseph  M. 
Mathews,  M.D.,  Editor  and  Proprietor, 
Professor  of  Surgery,  Clinical  Lecturer  on 
Diseases  of  the  Rectum,  Kentucky  School 
of  Medicine,  etc.  Henry  E.  Tuley, 
M.D.,  Associate  Editor  and  Manager, 
Clinical  Assistant  to  the  Chairs  of  Prac- 
tice and  Diseases  of  Children,  Kentucky 
School  of  Medicine.  Louisville,  K.Y : 
printed  by  John  P.  Morton  &  Company. 
Copyrighted  by  J.  M.  Mathews,  M.D. 
Published  on  the  first  of  January,  April, 
July,  and  October.  Subscription  Price 
$2.00  per  year.  Single  copies,  55  cents. 
We  have  much  pleasure   in  welcoming    this 

excellent  quarterly  to  our  exchange  list. 

Society  d'Editions  Scientifiques,  Place 
de  I'Ecole-de-Medecin,  4  rue  Antoine- 
Dubois,  Paris.  Le  Massage  Vibr.itoire 
et  Electrique  des  Muqueuses  ;  sa 
technique, ,  ses  resultals  dans  le  tiaite- 
rpent  des  Maladies  du  Nez,  de  la  Gorge, 
des  Oreilles  et  du  Larynx,  par  le  Dr.  Paul 
Garnault  (de  Paris),  Docteur  en  mede- 
cine,  Docteur  es  sciences  naiurelles  (de 
la  Sorbonne),  Professeur  libre  d'Otologie 
et  Laryngologie,  Ancien  chef  des  Tra- 
vaux  d'Anatomie  et  d' Histologic  compa- 
rees  a  la  Faculte  des  Sciences  de  Bor- 
deaux. Avec  une  preface  du  Dr.  Michael 
Braun.  Un  volume  in  8  °  de  150  pages, 
broche,  avec  10  figures  daiis  le  texte. — 
Prix,  4  fr , 


The  Company  which  prepares  Dr.  W.  R.  Amick's 
chemical  treatment  for  pulmonary  diseases  has  established 
a  New  York  depository  at  114  Fifth  Avenue.  This 
move  is  necessitated  by  the  constantly  increasing  de- 
mand upon  the  Cmcinnati  laboratory  made  by  the 
physicians  in  New  \ork  and  vicinity. 

The  depository  is  simply  a  supply  bureau  for  the 
profession,  obviating  the  inconvenience  and  the  expendi- 
ture of  time  incidental  to  procuring  the  preparations 
from  Cincinnati.  The  offer  to  all  physicians  of  sufficient 
remedies  to  give  a  fair  trial  in  each  ease,  without  charge, 
will  be  continued,  and  test  packages  maybe  obtained 
from  the  New  York  depository. 


Granville  Ferry, 
Annapolis  Co.,  N.  S., 
26th  Jan.,  1894. 
Messrs.  John  Lovell  <s^  Son, 
Dear  Sirs  : 

Please  find  enclosed  P.  O.  Order  for  $2.83,  17  months 
subscription  to  The  Canada  Medical  Record  as  per 
bill  inclosed.  I  consider  the  Record  of  great  practica 
utility  to  me,  and  take  much  pleasure  in  asking  for  the 
reception  of  its  continued  issue. 

Very  truly  yours, 

J.\s.  A.  Coleman. 


f 


f 


Vol.  XXIL 


MONTREAL,  APRIL,  1894. 


No.  7. 


ORIGINAI,  COMMUNICATIONS. 

Case  of  Severe  Procidoiitiu  Uteri 
cureil  by  Vaginal  Hysterectomy  and 
Plastic  Operations  ou  the  Vagiin. .  145 

Thf  Profession,  the  Public  ami  the 
Code U7 

SOCIETY  PROCEEDINGS. 

American  Gyna-cological  Society. . .  153 

The  Nioutreal  MeJico-Chirurgicai  So- 
ciety    i^[} 

Abdominal  Section  after  Confine- 
ment     153 

Enucleation  of  Tumor  of  the  Thyroid 
Gland 157 

Fibroid  I'umor  of  the  Uterus   157 

Small  Fibroid  Tumors  of  the  Uterus 
and  Broad  Ligaments 157 

Grape  Tuberculosis  of  the  Peritone- 
um      157 

Ovarian  Hermoid 158 

Fibroid  Tumor  from  the  Sheath  of 
the  Femoral  Artery  with  Secondary 
Growth  within  the  Femur 158 

Perforatidu  of  the  Femoral  Artery 
and  Vein  in  Hunter's  canal  by  a 
bullet  wound 158 


OOIsTTEiTTS. 

A|ipcn(lioiti.<    15s 

Enlargi-d  Cilands  pressing  upon  the 
Trachea  from  a  case  of  Hodgkins' 
Disease 159 

Kenioval  of  (iasserian  Ganglion  for 
Facial  Xeuraljria    150 

Sub-diaphragmatic  AViscess ItjO 

Papillomatous  Cyst  of  the<>vary  — 
Ovario-Hysterectomy 161 

Snline  Enemata  lu  Post-partum  He- 
morrahge 161 

Hibernation  and  Allied  States  in 
Animals  and  Man  161 

Pyloroplasty « 162 

Carcinoma  of  the  Sudoriparous 
Glands  162 

Chronic  Abscess  of  Bone  163 

Tuberculosis  of  the  Liver  and  Ovi- 
duct of  a  P.geon        163 

Pyosalpiux  and  Gonorrhceal  Arth- 
ritis   '. 163 

Discussion  on  Dr.  Mills'  paper  on 
Hiberna'tion   164 

Statistics  of  Homicide  in  American 
Cities 164 

Death  Certification 1C4 

PROGRESS  OF  SCIENCE- 
Hernia  in  Children     165 


EDITORIAL. 

The  Physician's  Wife 165 

BOOK  NOTICES. 

Annual  of  the  Universal  Medical 
Sciences 166 

How  to  Use  the  Forceps 166 

Venereal  Memoranda  ......     166 

Syllabus  of  Lectures  on  the  Practice 
of  Surgery 167. 

Ninth  and  Tenth  Annual  Reports  of 
the  Bureau  of  Statistics  of  Labor 
of  the  State  of  New  Yorii  167 

A  Practical  Treatise  on  the  Office  and 
Duties  of  Coroners  in  Ontario,  etc.  167 

A  Practical  Treatise  ou  Nervous 
Exhaustion 167 

A  Treatise  on  Headache  and  Neu- 
ralgia   168 

A  Practical  Treatise  on  the  Diseases 
of  the  Hair  and  Scalp 168 

Transactions  of  the  College  of  Phy- 
sicians of  Philadelphia 168 


Scigfttal    ^ommnntcations. 

CASE  OF  SEVERE  PROCIDENTIA 
UTERI  CURED  BY  VAGINAL 
HYSTERECTOMY  AND  PLAS- 
TIC OPERATIONS  ON  THE 
VAGINA.* 

By   A.   Lapthorx    Smith,   B.A.,    M.D., 

M.R.C.S.  Eng.,  Surgeon   to  the   Woman's 

Hospital.     Gynecologist    t)  the   Montreal 

Dispensary. 

Mrs.  C,  aged  46,  mother  of  8  children, 
consulted  me  about  a  year  ago  at  the 
Montreal  Dispensary.  Her  condition  was 
a  pitiable  one.  The  uterus,  which  had  been 
badly  lacerated  at  her  first  confinement, 
was  enormously  enlarged  and  at  the  site  of 
the  laceration  the  everted  mucous  mem- 
brane of  the  cervical  canal  was  ulcerated  and 
discharging  a  thick.tenacious  secretion.  The 
vagina  was  also  very  much  thickened.  The 
"^sound  measured  a  uterine  depth  of  nearly 
six  inches.  This  poor  woman  had  to  work 
hard  and  stand  on  her  feet  for  fourteen 
hours  a  day,  and  when  she  did  sit  down, 
her  womb  would  stick  to  her  clothiag,  and 
sometimes  bleed  freely    when    it    was    de- 

*  Read  before  the  Medico-Cliiruigical  Society,  Montreal. 


tached.  The  womb  could  be  replaced 
after  some  little  effort  at  taxis,  but  it 
came  out  again  the  moment  she  assumed 
the  erect  position.  She  had  suffered  so 
much  and  so  long  that  she  readily  accept- 
ed my  proposition  of  an  operation,  provid- 
ed that  it  could  be  performed  at  her  own 
house,  as  she  had  a  great  dread  of  a  hos- 
pital. I  visited  her  home,  and  found  it  very 
small,  and  with  an  outlook  upon  a  yard 
full  of  privies.  Nevertheless,  it  was  decid- 
ed to  make  the  best  of  the  situation,  and  ac- 
cordingly on  the  15  th  May,  1893,  assisted  by 
two  of  my  post-grad  uate  pupils.the  operation 
of  vaginal  hysterectomy  was  performed.  It 
was  somewhat  annoying  on  our  arrival  to 
find  that  the  minute  instructions  to  remain 
in  bed  for  at  least  one  day  before  the 
operation  had  been  disregarded,  and 
that  the  patient  was  just  finishing  the 
scrubbing  of  the  floor  of  her  bedroom,  and 
we  had  to  wait  a  few  minutes  till  this  was 
finished  and  she  could  get  into  bed. 

The  external  genitals  were  shaved  and 
scrubbed  with  soap  and  water,  and  after- 
wards bi-chloride  i  in  lOOO,  as  was  also 
the  prolapsed  uterus  and  vagina.  The  cer- 
vix, which  wa^  badly  lacerated,  was  firmly 


146 


THE   CANADA   MEDICAL   RECORD. 


grasped  in  the  vulseHum,  and  firmly  held. 
A  circular  incision  was  then  rapidly 
made  around  the  cervix,  and  the  vagina 
was  easily  peeled  back  with  the  finger  all 
around.  Douglas'  cul  de  sac  was  then 
opened  with  the  scissors,  and  torn  lateral- 
ly with  the  fingers  until  the  broad  liga- 
ments were  reached  on  cither  side,  and 
the  peritoneum  ^\■as  sewed  to  the  vagina 
\\ith  catgut  sutures,  which  also  completely 
arrested  the  bleeciing  from  the  cut  edges 
of  the  vagina.  The  bladder  was  then  sep- 
arated from  the  uterus  with  the  finger  of 
the  right  hand,  until  it  had  reached  the 
finger  of  the  left  hand,  which  had  been 
introduced  from  the  posterior  opening 
and  hooked  over  the  broad  ligament. 
The  peritoneum  was  then  opened  with 
the  scissors  in  front  and  torn  lateralh',  as 
was  done  with  the  posterior  layer.  A 
few  stitches  were  then  made  to  bring  to- 
gether the  anterior  edge  of  the  vagina  and 
the  peritoneum.  This  left  the  uterus  held 
only  by  the  broad  ligament  on  each  side, 
which  was  then  transfixed  with  Cleveland's 
ligature  carrier  ;  and  stout  catgut,  \\hich 
had  been  rendered  thoroughly  aseptic 
by  soaking,  Avas  passed  through  and  tied 
with  three  knots.  A  considerable  num- 
ber of  sutures  were  used  in  each  side,  so  as 
not  to  take  too  much  tissue  in  each  one, 
and  the  broad  ligament  was  cut  free  from 
the  uterus,  as  the  sutures  advanced  farther 
and  farther  up.  When  the  middle  of  the 
broad  ligament  was  reached,  the  fundus 
was  brought  out  through  the  anterior 
opening,  which  enabled  me  to  tie  the 
upper  half  of  the  broad  ligament  without 
the  slightest  difficulty.  The  uterus  was 
then  removed.  It  was  found  afterwards 
to  measure  nearly  six  inches  in  length,  the 
sound  entering  over  five  and  a-half  inches. 
The  stumps  of  the  broad  ligament  were 
then  brought  together  with  catgut  stitches 
from  top  to  bottom,  and  Douglas'  cul  de 
sac  having  been  first  carefully  cleaned, 
the      vaginal     opening      was     accurately 


closed  with  a  running  catgut  suture,  and 
the  wound  was  dressed  with  dry  boracicacid 
and  a  light  piece  of  boracic  gauze.  As 
there  was  a  great  redundancy  of  the 
vaginal  mucous  membrane,  which  was 
enormously  thickened,  Hegar's  opera- 
tion, which  consists  in  denuding  the  trian- 
gular surface  on  the  posterior  vaginal  wall, 
was  then  performed.  The  apex  of  the 
triangle  extended  (uliy  half  way  up  the 
vagina,  and  the  extremities  of  the  base 
were  located  about  one  inch  and  a-half 
below  the  meatus,  so  that  quite  a  large 
area  was  denuded.  This  was  brought  to- 
gether with  three  rows  of  running  catgut 
sutures,  care  being  taken  with  the  last  row 
to  bring  the  cut  edges  of  the  vagina  ac- 
curately together,  as  also  the  edges  of  the 
vulva.  This  made  a  very  solid  perineal 
body,  and  had  the  advantage  of  requiring 
no  after-treatment,  the  catgut  being  left 
in  until  it  was  absorbed  or  melted  off. 

A  small  hypodermic  was  allowed  that 
afternoon  ;  the  patient's  water  was  drawn 
with  the  catheter  that  evening  ;  the  gauze 
was  removed  next  day,  after  which  the 
patient  received  no  treatment  whatever. 
She  suffered  no  pain,  and  it  was  with  the 
greatest  difficulty  that  she  was  kept  in 
bed  seven  whole  days,  at  the  end  of 
which  time  she  got  up  and  went 
about  her  household  duties  as  if  nothing 
had  happened.  She  did  not  seem  to  realize 
the  severity  of  the  operation,  thinking  it 
was  a  matter  of  course  that  she  would 
recover,  for  she  constantly  begrudged  the 
week  she  had  to  stay  in  bed. 

The  brilliant  success  in  this  case  has 
impressed  me  with  the  advantage  and 
safet}''of  thus  treating  all  cases  of  proci- 
dentia, accompanied  by  enlargement  of 
the  uterus.  If  the  uterus  were  not  enlarged 
I  would  certainly  give  the  preference  to 
ventro  fixation  ;  but  where  the  sound  en- 
ters over  three  and  a-half  inches,  the 
uterus  is  too  heavy  for  suspending  opera- 
tions, either  Alexander's  or  ventrofixation 


THE  CANADA  MEDICAL  RECORH. 


147 


to  give  satisfactory  results.  I  am  also  par- 
ticularly in  favor  of  combining  repair  of 
the  perineum  with  any  operation  for  dis- 
placement of  the  uterus. 


THE 


PROFESSION,  THE 
AND  THE  CODE. 


PUBLIC 


Au  address  delivered  by  vivitation  before 
the  Third  General  Meeting  of  the  Pan- 
Americcni  Medical  Congress,  WasJiington, 
Sept.  7,  1893, /y/  Ernest  Hart,  D.C.L., 
Hon,  Causa,  Editor  of  the  British 
Medical  Journal.,  London,  formerly  Dean 
and  Ophthalmic  Surgeon,  St.  Mary's 
Hospital,  London. 

Sir  Astley  Cooper,   one  of  the   greatest 
surgeons  and    most  accomplished    gentle- 
men of   the    last  generation,    was    in    the 
habit  of    addressing  every    candidate   for 
membership  of  the    Ro}'al  College  of  Sur- 
geons of  England,   of  which    he  was  presi- 
dent, somewhat    in  the  following   words: 
"  Gentlemen,  you  are  about  to  enter  on  a 
noble  and  difficult  profession;  your  success 
in   it  depends  on   three  things  :   first,  on  a 
good  and  thorough  knowledge  of  your  pro- 
fession ;  second,  on  an  industrious  discharge 
of  its  duties,  and  third,  on  the  preservation 
of  your   moral    character.     Without   the 
first, — knowledge, — no  one  can  wish  you  to 
succeed  ;  without  the  second, — industry, — 
you  cannot  succeed  ;  and  without  the  third, 
even  if  you  do  succeed,  success  can  bring 
you  no   happiness."      Those    words  might 
form  a  very  adequate    summary   text  for 
guidance  of  the  conduct  of  all  medical  men. 
And  it  might  conceivably  be  asked  whether 
there  is  any   necessity  for  a  more  detailed 
and  elaborate  code.     Indeed,  it  practically 
has  been  asked,  and  there  are  large  ques- 
tions   involved  in  the   decision.      On    the 
other  hand,  it  has,  from  time  to  time,  lately, 
in  our  country    been    found    necessary  to 
reinforce  and  strengthen  our  code  by  addi- 
tional declarations,  and  I  think  to  some  ex- 
tent in  yours  ;  the  need  for  a  stringent  up- 
holding and  development  of  the  code  has 
also   become    a    question   of  the    day.     I 
think  it  is  clear  that  if  ever  there  were  such 
necessity,  at  no  time  could   it  be  stronger 
than  at  the  present    moment.      For  under 
the  stress  of  the   modern  social    develop- 
ment,    under     pressure    of    the     modern 
temptation  for  advertising  and  the  severity 


of  competition,  in  view  of  the  arts  of  those 
who  make  advertisement  a  business  and  a 
profit;  in  presence  of  the  temptations  held 
out  to  draw  medical  men  from  the  ancient 
paths  of  modesty  and  self-efifacement,  there 
is  now  stronger  reason  than  ever  to  fortify 
ourselves  against  those  growing  and  innu- 
merable seductions  by  a  code  so  exact,  so 
far  reaching,  that  thephysican  need  never 
be  in  doubt  as  to  what  is  his  duty  in  any 
complication,  or  in  the  face  of  any  doubt- 
ful case  in  which  he  may  be  inclined 
to  give  himself  the  benefit  of  the  doubt. 
But,  fiist  of  all,  I  want  to  e'aborate  the 
view  that  our  rules  of  medical  etiquette 
stand  upon  a  logical  and  strong  basis,  and 
that  their  strict  enforcement  is  for  the 
benefit  of  the  public,  at  least  as  much,  if 
not  even  more,  than  for  the  benefit  of  the 
profession.  ^Medical  etiquette  has  been 
sneered  at  by  shallow  cynicism  as  mere 
trades  unionism.  It  is,  on  the  contrary,  a 
self-denying  code  which  is  made  in  the  in- 
terests of  pure  morality,  and  for  the  benefit 
of  the  public  far  more  than  for  the  in- 
terests of  the  profession.  This  allegation  of 
trades  unionism  is  the  converse  ofthat  of 
inutility,  which  those  who  are  prone  to  call 
themselves  of  the  younger  school  allege  ; 
but  not  even  the  youngest  of  us,  as  you 
know,  are  infallible,  and  in  this  matter  it  is 
the  youngest  who  are  most  likely  to  go 
wrong.  They  proclaim  themselves  liberals. 
Is  it,  however,  in  some  cases,  the  liberalism 
of  Gallio  .-'  Let  us  look  at  this  matter  from 
the  largest  and  most  liberal  standpoint. 
Let  'IS  begin  by  comparing  our  code  with 
the  standards   of  the  legal  profession. 

My  distinguished  friend,  Sir  Edward 
Clark,  lately  the  Solicitor  General  of  Eng- 
land, in  writing  to  me  on  the  subject  recent- 
ly, said  the  essence  of  the  matter  might  be 
summed  up  in  a  very  few  words  :  "  Every 
lawyer  ought  to  be  a  gentleman,  and  ought 
to  do  only  what  is  right  and  honest ;  if  he 
does  not,  other  men  ought  to  have  nothing 
to  do  with  him."  Notice  that  "  if  he  does 
not,  other  men  should  have  nothing  to  do 
with  him."  That  position  of  the  bar  is 
strengthened  by  this,  that  the  etiquette  of 
the  bar  is  absolutely  in  the  hands  of  the  bar 
circuits  and  attorney  general,  and  that  of 
the  solicitors  in  the  hands  of  the  Incor- 
porated Law  Society,  so  that  any  solicitor 
who  is  guilty  of  an  offence,  whether  as  a 
lawyer   or    as  a    gentleman,    can  be,    and 


148 


THE   CANADA   MEDICAL    RECORD. 


from  time  to  time,  is  not  only  temporarily 
suspended,  but  deprived  of  the  right  to 
practice  at  all.  In  a  case  tried  last  Jul}-  in 
England,  a  solicitor  in  a  certain  town  had 
been  the  proprietor  of  a  house  used  for  an 
immoral  purpose,  of  which  he  received  the 
rent.  That  was  considered  a  stain  upon 
his  character  as  a  gentleman,  and  for  that 
he  was  suspended  from  the  roll  and  exclud- 
ed from  practice.  So  that  we  have  at  least 
the  example  of  the  legal  profession,  who 
have  a  code  even  stricter  than  ours,  in  in- 
sisting upon  a  high  standard  of  honorable 
conduct  in  the  profession. 

Legal  etiquette  prescribes  certain  tech- 
nical acts  which  a  lawyer  must  not  do.  An 
eminent  American  lawyer,  whom  I  had  the 
pleasure  of  meeting,  mentioned  to  me  for 
example  that  he  may  not  conduct  a 
"  speculative  suit  ;"  that  is,  he  may  not  con- 
duct a  suit  in  which  his  pay  is  to  depend  on 
the  success  of  the  suit, — a  palpable  restric- 
tion on  his  liberty.  Liberty  is  a  blessed 
word,  but  compulsion  is,  under  certain  cir- 
cumstances, often  a  m^ore  blessed  word. 
The.  reason  for  this  rule  is  that  if  a  lawyer 
undertakes  such  a  suit  he  becomes  person- 
allyand  financially  interested  in  the  result, 
and  may  be  tempted  not  to  give  the  court 
all  the  aid  which  is  his  duty,  or  may  in  the 
end  lose  the  relations  of  harmony  and 
respect  which  are  indispensable  between 
the  Court  and  the  lawyers,  who  are  officers 
of  the  Court  and  are  bound  to  help  Justice 
to  duly  balance  its  scale. 

In  the  same  way  '.'champerty"  is  a  legal 
offence.  So,  too,  no  respectable  lawyer 
will  give  separate  advice  upon  a  case  which 
is  already  in  the  hands  of  a  colleague.  As 
between  advocate  and  advocate,  harmon\-, 
courtesy,  and  the  forms  of  friendship  must 
prevail  ;  and  at  any  time  they  must  in  the 
interest  of  the  client  be  able  to  come  to- 
gether and  to  seize  the  earliest  opportunity 
of  avoiding  litigation  by  compromise  or 
mutual  settlement,  where  it  is  possible  and 
right.  The  etiquette  of  the  bar  is  very 
strict,  and  is  closely  observed. 
^  Legal  etiquette  is,  like  medical  etiquette, 
a  code  of  honor  and  of  duty  by  which  the 
public  benefit ;  and  those  who  depart  from 
it  or  deride  it, — "  legal  shysters  "  I  think 
they  are  called  in  the  United  States, — are 
not,  any  more  than  medical  quacks,  those 
of  whom  their  country  or  their  profession 
have  most  reason  to  be  proud. 


I  will  pass  at  once  to  the  consideration 
of  our  code  of  medical  etiquette-  I  will 
ask  you  to  consider  whether  you  are  of  the 
opinion  that  it  is  safe  or  wise  to  cast  aside 
the  precedents  of  past  experience  and  to 
substitute  individual  judgment  for  settled 
rules.  If  man  were  a  purely  abstract  and 
perfectly  moral  intelligence,  no  doubt  few 
words  would  sufifice  to  legislate  for  his  daily 
needs.  Enough  to  say,  "  Do  unto  others 
as  ye  would  they  should  do  unto  you." 

But  medical  men  are  not  pure  creatures 
of  perfect  and  abstract  morality  any  more 
than  other  men.  They  have,  indeed,  certain 
advantages  from  the  outset.  From  the  very 
beginning  of  their  professional  life  it  is  im- 
pressed upon  them  by  their  teachers  that 
their  profession  is  a  mission  and  not  a  trade; 
a  mission  involving  frequent  self-sacrifice 
and  a  steadfast  regard  for  interests 
other  than  their  own.  In  this  they  are 
greatly  helped  by  the  force  of  precedent, 
by  the  example  of  those  around  them,  and 
of  the  leaders  whom  they  most  respect.  But 
even  these  are  inadequate.  Without  the 
aid  of  the  written  as  of  the  unwritten  law, 
even  the  best  of  men  are  apt  to  decide 
wrongly  iji  their  own  favor,  on  a  doubtful 
que.stion  of  ethics,  and  often  in  matters  and 
cases  where  there  are  settled  instructions  in 
the  code  which  would  guide  them  rightl)'. 
Let  me  read  to  you  a  few  of  the  rules  of 
our  College  of  Physicians,  which  command 
with  us  a  universal  adhesion  and  respect. 
I  do  so  only  as  an  example  of  the  conclu- 
sions to  which  many  years  of  observation 
of  the  impingement  of  the  forces  of  modern 
life  on  professional  duty  have  led  some  of 
our  wisest  heads.  I  will  refer  only  to  a  few 
as  follows  ; — 

"  No  candidate  shall  be  admitted  to 
examination  who  refuses  to  make  known, 
when  so  required  by  the  president  and 
censors,  the  nature  and  composition  of 
any  remedy  he  uses." 

"That  the  practice  of  medical  authors 
frequently  advertising  their  own  works  in 
the  non-medical  journals,  and  especially 
with  the  addition  of  laudatory  extracts  J9B 
from  reviews,  is  not  only  derogatory  to  the  ^ 
authors  themselves,  but  is  also  injurious 
to  the  higher  interests  of  the  profession," 

Again,  "  No  fellow,  member,  or  licen- 
tiate of  the  college  shall  officiousl}',  or  under 
color  of  a  benevolent  purpose,  offer  medical 
aid  to,  or  prescribe    for,  any  patient  whom 


THE   CANADA    MEDICAT,    RECORn. 


149 


he  knows  to  be  under  tlie  care  of  another 
doctor." 

A  further  rule  prescribes  that  no  physician 
sliall  himself  assume  any  special  designa- 
tion of  therapeutic  method,  such  as  homceo- 
path,  electropath,  h\'dropath,  or  counte- 
nance those  who  do  so. 

Again,  "A  physican  shall  have  no  in- 
terest in  a  secret  medicine,  and  that  he 
shall  always,  when  called  upon  b\-  the 
college,  disclose  ever)-  part  of  the  composi- 
tion of  his  medicines." 

"  If  it  shall  at  any  time  hereafter  appear 
or  be  made  known  to  the  president  or 
censors  that  any  fellow  or  member  of  the 
college  has  obtained  admission  into  the 
college,  or  that  any  licentiate  of  the  college 
has  obtained  the  license  of  the  college  b}' 
fraud,  false  statement,  or  imposition,  or  that 
any  fellow,  member  or  licentiate  has  been 
guilty  of  any  great  crime  or  public  immorali- 
ty, or  has  acted  in  any  respect  in  a  dishonor- 
able or  unprofessional  manner, ox  has  violated 
any  statute,  by-law,  or  regulation  of  the 
college,  relating  to  fellows,  members  or 
licentiates  as  the  case  may  be,  the  president 
and  censors  may  call  the  fellow,  member, 
or  licentiate  so  offending  before  them,  and 
having  investigated  the  case,  may  admonish 
or  reprimand,  or  inflict  a  fine;  or  if  they 
deem  the  case  of  sufficient  importance,  may 
report  the  case  to  the  college,  and  there- 
upon a  majority  of  two-thirds  ma}'  declare 
such  fellow  or  member  or  licentiate  to  be 
no  longer  a  fello\v.  member,  or  licentiate, 
as  the  case  may  be,  and  his  name  shall  be 
expunged." 

Let  us  consider  now  those  restrictions 
which  operate  to  forbid  a  medical  practi- 
tioner to  consult  with  "  homceopaths,"  and 
of  which  the  wisdom  has  been  by  some  dis- 
puted. We  do  not  believe,  and  we  cannot 
appreciate  the  medical  capacity  or  fitness 
to  undertake  the  treatment  of  disease  of 
those  who  hold  that  drugs  which  given  in- 
ternally will  produce  certain  symptoms  of 
disease  are  the  appropriate  remedies  for 
those  maladies.  For  instance,  medicines 
which  produce  skin  reddening  for  erysipe- 
las, leucorrhine  for  leucorrhoea  ;  syphiline 
for  syphilis.  We  do  not  agree  that  all  chro- 
nic maladies  arise  from  syphilis,  sycosis  or 
itch,  and  that  medicines  act  with  an  in- 
tensity proportionate  to  the  infinite  diminu- 
tion of  the  dose  ;  or  that  there  is  any  utility 
in   prescribing,   in  accordance   with    these 


principles,  say  adecillionthof  a  grain,  when 
we  all  know  that  a  dose  so  small,  if  taken  by 
every  being  on  the  globe  once  a  minute 
would  not  finish  the  grain  in  a  thousand 
years.  Nor  again,  do  we  believe  that  the  ac- 
j  tivity  of  medicine  increases  in  the  ratio  of  the 
number  of  shakes  gi\en  to  the  vessel  con- 
taining ir.  We  hold  that  we  have  nothing 
in  common  with  those  who  assume  to  base 
their  practice  and  theory  on  this  kind  of 
therapeutics.  Being  well  assured  that  these 
methods  and  this  theor\'  are  absolutely 
delusive,  the  negation  of  reason  and  the 
acme  of  folly,  it  would  be  useless,  decep- 
tive, and  contrary  to  good  faith  and  the 
public  interest  that  we  should  pretend  to 
consult  with  those  who  profess  them  and 
who  take  a  designation  derived  from  them, 
and  to  cover  with  the  respectability  of 
logical  science  what  the\'  are  pleased  to 
term  their  system  of  treatment.  Faith 
curing,  it  may  be,  but  in  that  too  we  can 
take  no  part  under  false  pretences. 

But  then  it  is  said.  What  if  the  physician 
or  surgeon  of  good  standing  is  only  called 
in  by  the  homoeopath  to  assist  in  diagnos- 
ing the  nature,  the  stage,  the  complications, 
or  name  of  the  disease  ."*  Ought  he  not  to 
give  this  help  for  the  patient's  sake  .''  The 
answer  is.  the  ph}sician  is  a  healer  ;  not  a 
reader  of  riddles  nor  a  Conner  of  conun- 
drums. He  is  there  not  to  give  a  name  to 
symptoms  or  pathological  conditions,  but 
to  heal  the  patient ;  and  if  he  knows  that 
his  solution  of  the  riddle  is  not  to  be  fol- 
lowed by  a  method  of  treatment  which  he 
considers  capable  of  attaining  that  result, 
he  would  be  infamoush-  wrong,  and 
he  is  always  wrong  when  he  gives  th'^ 
cover  of  his  accepted  position,  of  his  recog- 
nized ability,  and  of  his  professional  sanc- 
tion, to  what  becomes  under  such  circum- 
stances a  dangerous  farce  or  a  deliberate 
fraud.  The  riddle  is  read,  but  the  patient 
is  none    the  better. 

But  it  is  said,  ^Ia\-  a  regular  medical 
practitioner  not  be  called  in  to  perform  a 
difificult  surgical  operation.'  If  a  surgical 
operation  meant  only  cutting,  sawing,  and 
sewing,  it  would  be  a  plausible  excuse  for 
the  surgeon  accepting  the  responsibility  of 
acting  as  sawbones  to  a  quack.  But  there 
is  no  surgical  operation  which  does  not  in 
its  preliminary  stages,  and  may  not  in  its 
various  phases  and  sequel.',  require  con- 
comitant medical   consideration  and  treat- 


ISO 


THE   CANADA  MEDICAL   RECORD, 


ment,  or  in  \vhich  septic,  constitutional,  or 
accidental  complications  may  not  arise. 
The  surgeon  cannot  honorably,  in  the  in- 
terest of  his  client,  divest  himself  of  the 
responsibility  for  the  wise  and  faithful 
treatment  of  these  as  an  essential  pait  of 
his  operative  interference. 

I  have  used  the  word  quack.  It  is  a 
word  often  used  now  in  too  restricted 
a  sense.  This  is  Dr.  Johnson's  definition 
of  a  quack  :  "  A  boasted  pretender  to  arts 
which  he  does  not  understand  ;  a  vain, 
boasting  pretender  to  physic,  one  who  pro- 
claims his  own  medical  abilities  in  public 
places;  an  artful,  tricking  practitioner  in 
physics."  This  strikes  at  the  root  of  the 
matter,  now  as  then.  Observe,  here  is  no 
distinction  between  those  who  have  degrees 
and  those  who  have  not-  The  great 
lexicographer  makes  no  distinction ;  nei- 
ther do  I. 

The  essential  note  of  the  quack  is  love 
of  advertisement.  The  public  "  places  "  of 
Dr.  Johnson's  time  were  the  coffee-houses; 
they  are  now  the  newspapers.  Now  what 
are  the  ways  in  which  the  diplomaed  quacks 
adopt  the  methods  and  become  the  imita- 
tor, the  rival,  the  accomplice  of  the  un- 
diplomaed  .-'  You  may  know  them  by  their 
works.  They  are  the  gentlemen  who  put 
themselves  forward  to  be  interviewed,  and 
are  the  sham  Jupiters  and  willing  Mer- 
curies of  the  newspaper  world.  They  con- 
fide to  the  ubiquitous  reporter  what  is 
their  opinion  of  the  last  new  bacillus,  the 
last  new  anti-toxine,  or  invite  reporters 
to  their  amphitheatre  and  hospital  ward. 
All  this  is  only  an  outcome  of  the  venal 
desire  for  advertisement.  They  are  the 
gentlemen  who,  if  tiiey  have  the  good  for- 
tune to  attend  a  prize  fighter  or  a  ballet 
girl  or  the  ruler  of  a  State,  are  not  slow  to 
disclose  the  secrets  of  the  sick-room,  and 
all  for  the  pubhc  good. 

Now,  in  the  venerated  Oath  of  Hippo- 
crates, which  is  the  foundation  of  our  code 
of  today,  the  disciple  swears  to  impart  the 
knowledge  of  his  art  to  others  according 
to  the  law  of  medicine,  and  to  share  with 
his  colleagues  by  precept  and  every  other 
mode  of  instruction  all  that  he  knows.  He 
further  binds  himself  that  he  will  have  no 
medical  secret,  that  he  will  practise  his  art 
and  pass  his  life  with  purity  and  holiness, 
that  he  will  abstain  from  eve.y  voluntary 
aot  of  mischief  and    corruption,    and  that 


iv  hat  ever  in  connection  i^'itli  his  professional 
practice  he  sees  or  hears  in  the  life  of  men 
which  ought  not  to  be  spoken  of  abroad 
he  will  not  divulge.  "  While  I  continue  to 
keep  this  oath  unviolated,  may  it  be  grant- 
ed to  me  to  enjoy  life  and  the  practice  of 
the  art  respected  by  all  men  and  in  all  times. 
But  should  I  violate  this  oath  may  the  re- 
verse be  my  lot." 

This  is  the  spirit  of  the  modern  British 
code,  and  I  know  well  it  is  yours  also. 

We  have  dwelt  as  long  as  time  will 
allow  on  the  considerations  of  public  utility 
and  professional  duty  which  oppose  con- 
sultations with  homoeopaths  and  their  con- 
geners, nor  can  I  stay  long  to  discuss  the 
prohibition  of  open  advertisement.  The 
advertisement  in  the  lay  press  of  medical 
books  intended  for  the  profession,  the  sub- 
mitting of  technical  books  to  review,  the 
public  criticism  of  the  treatment  of  any 
disease  or  person,  the  thousand  and  one  acts 
in  fact  by  which  the  advertising  surgeon 
physician  seeks  to  gain  the  ear  and  favor 
of  the  public  b}-  means  of  notoriety  or  self- 
proclamation,  in  place  of  hard  honest  work, 
real  professional  worth,  and  the  judgment 
of  those  whose  knowledge  makes  them 
alone  competent  to  judge.  Self-advertise- 
ment is  the  note  of  the  quack.  It  is  as 
dangerous  to  the  public  as  hateful  to  the 
profession,  for  it  misleads  the  masses  by 
substituting  easily  purchased  notoriety  for 
merit,  and  covering  by  loud  talk  and  bom- 
bast and  plausible  pretences  the  emptiness 
of  the  shallow  pretender.  It  covers  also 
with  a  pseudo  respectability  the  venal  cor- 
ruption by  which  whole  columns  and  pages 
of  reading  matter  of  the  newspaper  are 
very  frequently  devoted  to  quack  nostrums 
and  "treatments" — save  the  mark — often 
of  the  most  fantastic,  false  and  dangerous 
character.  It  destroys  the  landmarks  of 
honor  and  reticence,  when  in  successive 
numbers  of  the  daily  and  weekly  papers 
are  found  •  the  lucubrations  of  these 
pests  of  society,  and,  alongside  of  them, 
the  interviews,  the  explanations,  and  the 
descriptive  narratives  put  forth  for  the 
public  good  by  reputable  physicians, 
a  propos  des  bottes,  but  hardly- veiled  self- 
advertisement. 

It  is,  however,only  fair  that  the  physician 
should  have  notice  of  the  oftence  or  its 
penalties,  and  that  this  salve  which  he  puts 
to   his  conscience   should    be    rubbed  oft" 


THE  CAXADA  MEDICAL  RECORD. 


i;i 


Hence  the  value  of  ''a  code."  We  have 
seen  that  the  medical  man  is  prohibited 
from  deriving  any  profit  directly  or  in- 
dircctlx"  from  an\- medicine  which  he  uses 
or  recommends,  and  from  tampering,  how- 
ever remotel)-,  with  secret  medicines.  If 
this  w ere  merely  an  abitrary  rule,  if  it  were 
not  at  least  as  much  for  the  benefit  of  the 
public  as  well  as  for  the  practitioner, 
there  might  be  ground  for  calling  it  in 
question.  But  it  is  a  rule  of  tlie  highest 
public  import. 

That  a  healer,  whose  judgment  in  pre- 
scribing should  be  clear  and  unbiased, 
should  possess  and  profit  b\'  a  secret  reme- 
dy is  as  obvious  a  source  of  public  peril  as  it 
is  a  heinous  offence  against  professional 
morality.  Every  physician  has  a  tradi- 
tional and  immemorial  right  to  expect  from, 
and  he  is  bound  to  give  to.  his  fellow-prac- 
titioners every  possible  aid  and  assistance 
in  the  treatment  of  disease  and  in  the  heal- 
ing of  the  sick.  He  has  received  such 
knowledge  from  his  predecessors;  he  daily 
and  continually  receives  it  from  his  col- 
leagues and  contemporaries,  to  whose 
knowledge  and  experience,  and  from  the 
results  of  whose  investigations  (openly 
stated  and  submitted  to  critical  discussion) 
he  owes  the  great  bulk  of  his  knowledge 
and  of  his  ability  to  practise  at  all. 

A  new  method  of  treatment,  a  new  drug 
or  a  new  dogma  in  medicine  is  like  a  new- 
doctrine  or  a  dogma  in  theology.  The  one 
is  as  much  a  means  of  physical  salvation 
as  the  other  is  of  spiritual  salvation.  The 
man  who  keeps  either  of  them  to  himself 
as  a  profitable  secret  for  his  own  mean  gain 
is  a  traitor  to  his  profession  ;  he  is  also 
a  traitor  to  humanit}-,  and  he  is  false  to  his 
mission.  It  is  fitting  that  the  code  should 
provide  for  such  cases,  and  that  the  penal 
clause  should  not  remain  a  dead  letter. 

But  it  is  sometimes  suggested  that 
the  usefulness  of  the  "secret""  drug 
may  be  so  great  as  to  overpower  and 
outweigh  morality,  and  call  for  its  pre- 
scription. I  put  St  to  \ou  all  :  is  there 
any  foundation  for  such  an  assump- 
tion in  the  w  hole  history  of  medicine  ?  In 
the  whole  history  of  the  past  can  we  recall 
any  example  of  a  secret  medicine  which 
had  aught  but  the  most  insignificant  value, 
or  could  not  easily  be  replaced  .'*  We  may 
take  even  the  most  famous,  such  as  the  fa- 
mous remed)-  of  Mr.  Stephen,  for  dissoK- 


ing  stone  in  the  bladder,  for  the  divulging 
ofwhich  eminent  men  petitioned  Parlia- 
ment for  a  grant  of /"s.ooo.  It  was  granted; 
and  what  do  we  read  of  the  remed}-  w  hen 
divulged  .'  That  it  consisted  of  calcined 
egg-shells  or  of  lime  obtained  by  a  filthy 
and  obscene  process.  Naturally,  and  like 
all  secret  remedies  when  divulged,  it  ceased 
to  cure.  Hartley  — the  famous  Dr.  Hart- 
ley— one  of  those  strenuous  supporters  of 
the  grant,  died  of  stone  in  the  bladder  after 
taking  two  hundred  pounds  of  the  remedy. 
In  our  day  there  is  no  such  thing  as  a  se- 
cret remedy  in  the  true,  or  in  any  other 
than  the  trade  meaning  of  the  word.  We 
doctors  know  the  composition  of  all  of 
them.  They  are  secret  only  to  the  gulli- 
ble public  to  whom  ihey  are  to  be  sold. 
Pain  annihilators,  blood-purifiers,  vegetable 
and  animal  extracts,  botanical  nostrums, 
invigorators,  electric  belts,  amulets  and 
chains,  Asiatic,  African  electrical  pills  and 
phials,  "  green,  blue  and  yellow  electricity' 
— there  is  nothing  secret  about  them. 
When  examined  in  our  private  or  public 
laboratories,  they  are  all  found  to  be  com- 
monplace in  composition  ;  or  if  they  have 
anything  not  well  worn  in  use,  it  is  merely 
the  name  of  some  indifferent  or  trivial  mat- 
ter,— Indian  grass  or  African  leaf  added, 
most  often,  and  chiefly  for  the  sake  of 
novelty.  These  secrets  are  .trade  devices, 
with  which  we  are  not  concerned.  Let  us 
visit  those  plnsicians  who  dabble  in  them 
with  the  severity  of  the  code.  I  don't 
think  that  is  asking  more  than  is  due  to 
the  honor  of  the  professional  body  and  the 
\\  elfare  of  the  public. 

In  respect  then  of  secret  medicines,  at 
least,  the  world  has  .up  to  this  date  lost 
nothing  by  the  stern  and  scornful  disap- 
proval with  which  the  medical  profession 
regards  these  trick}-  nostrums,  and  b}-  the 
punishment  with  which  they  visit,  and 
always  ought  to  visit,  those  who  sell  the 
honor  of  their  calling  and  the  free  com- 
munication of  medical  knowledge,  which  is 
the  birthright  of  mankind,  for  some  mess  of 
commercial  pottage. 

Finall}-,  I  will  sa}'  a  word  or  two  of  what 
is  known  as  the  etiquette  of  consultation. 
The  patient,  it  is  said,  and  is  said  cogently, 
has  the  right  to  determine  whom  he  shall 
consult,  and  to  change  his  medical  adviser 
if  he  desires  so  to  do.  No  one  will  dispute 
that.      But,  like  other  rights,   it    is  limited 


THE  CANADA  MEDICAL  RECORD. 


by  the  legitimate  claims  of  others  ;  and  a 
medical  practitioner  may  justly  object  if 
he  shall  be,  without  explanation  or  courtesy, 
superseded  in  attending  on  a  case.  In 
such  event,  moreover,  the  superseding 
practitioner  is  moralh'and  ethicalh'  bound 
to  take  due  care  that  the  same  courtesy 
and  respect  which  he  individualK'  would 
expect  to  receive  be  paid  to  his  discarded 
colleague,  not  only  by  himself,  but  by 
those  who  have  prcfessionally  consulted 
him. 

Every  day  cases  of  this  kind  occur;  few 
days  pass  without  bringing  to  me  some 
complicated  question  arising  out  of  them. 
The  pages  of  our  British  Medical  Journal 
are  full  of  such  questions.  Very  often 
all  I  have  to  do  is  to  sa}',  see  Code,  page 
so  and  so,  section  so  and  so,  and  that  de- 
cides both  the  practice  and  the  principle. 
Probably  if  that  is  the  case  with  us,  it 
might  occur  here  also,  and  not  less  fre- 
quently. Of  one  case  I  became  cognizant 
here  only  the  other  day.  An  eminent 
doctor  in  a  capital  city  of  the  United  States 
of  America  was  called  in,  came  and  saw  a 
patient  severely  ill,  said  he  would  return  ; 
when  the  family  physician  returned  in  the 
evening,  he  was  told,  "  But  you  are  not  any 
longer  in  charge  ;  Dr.  So-and-so  has 
charge  of  the  case.  "  He  said,  "  But  I  don't 
understand.  I  was  here  this  morning." 
"Well,  it  was  the  particular  wish  of — that 
the  consulting  physician  whom  you  called 
shall  take  charge,  and  you  are  not  wanted." 
Exit  family  doctor. 

Once  more  our  College  of  Physicians 
explicitly  directs  that  the  physician  called 
in  to  consultation  by  a  brother  practitioner 
shall  not  express  directly  to  the  patient  his 
individual  views  and  the  conclusions  at 
which  he  arrives,  but  that  whatever  he  has 
to  say  shall  be  said  after  consultation  with 
the  practitioner,  and  through  his  mouth  ; 
that  he  shall  behave  with  the  utm.ost  cour- 
tesy and  forbearance  to  such  practitioner,  to 
whom  shall  be  left  ail  explanations  and 
statements  of  the  conclusion  resulting  from 
the  consultation.  Were  it  otherwise,  were 
consultants  authorized  to  supersede  or  to 
snub  the  family  doctor,  the  public  client 
would  be  the  first  to  suffer.  For  anything 
which  creates  ill-will  or  unnecessary  friction 
between  consultant  and  family  practitioner 
tends  to  limit  the  range  and  frequency  of 
consultations.      Therefore   is    it    forbidden 


to  the  consultant  called  in  subsequently 
to  assume  the  sole  charge  of  that  patient, 
however  he  may  be  entreated  to  do  so,  or 
under  whatever  inducement.  Were  it 
otherwise,  the  attending  or  family  physi- 
cian could  not  call  in  a  consultant  without 
the  fear  being  before  his  eyes  of  losing  the 
charge  of  his  patient.  There  would  arise 
at  once  the  temptation  to  limit  and  restrict 
consultations,  and  this  would  be  an  impe- 
diment in  the  way  of  ascertaining  the  best 
means  of  cure  by  consultation.  The  strict 
observance  of  such  rules  and  of  the  whole 
code  as  to  consultations  may  sometimes  be 
something  of  a  personal  trial  to  the  patient, 
something  of  a  personal  loss  to  the  con- 
sultant ;  but  it  is  a  rule  which  is  of  infinite 
importance  to  the  public  welfare. 

The  maintenance  of  a  high  standard  of 
professional  honor,  the  acceptance,  adop- 
tion and  enforcement  of  a  detailed  code  of 
professional  etiquette,  the  agreement  by 
all  and  the  observance  by  every  individual 
of  the  whole  range  of  limitations  and  re- 
strictions, which  are  set  up  by  that  code 
and  by  the  logical  deductions  from  it, 
— these  things  are,  I  contend,  demon- 
strably as  valuable  to  public  welfare  as  for 
any  professional  interests  concerned  or 
supposed  to  be  concerned. 

I  infer  from  the  repeated  and  enthusias- 
tic plaudits  with  which  you  have  honored 
me,  that  the  opinions  and  conclusions 
which  I  have  ventured  to  bring  before  you 
have  agreed  with  your  sentiments,  and  are 
accepted  by  you  sympathetically,  and  that 
you  consider  them  opportune  and  proudly 
useful. 

I  have  been  encouraged  by  your  contin- 
uous signs  of  general  and  warm  approval 
to  speak  at  greater  length  than  I  had 
intended.  But  there  is  yet  much  more  to 
say.  In  thanking  you  now  for  this  most 
gratifying  ratification  by  the  unbroken 
plaudits  of  this  representative  general 
meeting  of  the  argument  which  I  have 
ventured  to  state,  it  seems  to  me  of  great 
importance  to  such  progress  or  fair  ethical 
development.  I  will  only  add  that  I 
•■hall  be  most  happy  to  hear  privately 
from  anyone  who  has  doubts  to  solve  or 
arguments  to  suggest  either  for  or  against 
or  in  supplement  of  those  which  I  have 
developed  before  you. 


THE   CANADA   MEDICAL   RECORD, 


AMERICAN  GYN.fiCO LOGICAL 
SOCIETY. 
New  York,  Eebruary  i,    1S94. 
Dear  Doctor  : 

The  next  meeting  of  the  Society  will  be  lieM 
in  \Vashington,  on  Tuesday,  May  29t!i.  Ac- 
cording to  the  resolution  adopted  at  the  last 
meeting,  the  morning  sessions  of  the  first  two 
days  will  be  devoted  to  the  discussion  of  the 
following  subjects  : 

1.  Extirpation  of  the  Uterus  in  Disease  of 
the  Adnexa. 

2.  The  Management  of  Face  Pre.sc-ntations, 

3.  Rui:)ture  of  the  Uterus  ;  Surg-cal  vs.  Ex- 
pectant Treatment. 

The  afternoon  of  the  third  day  will  be  devot 
ed  to  a  special  discussion  before  tlie  Congress, 
under  the  direction  of  the  American  Gynaeco- 
logical Society.     The  following  topic  has  been 
assigned  : 

The  Conservative  Surgery  of  the  Female 
Pelvic  Organs,  Referee,  Dr.  \Vm.  >L  Polk  ; 
co-referee.  Dr.  Wm.  Goodell. 

Since  there  will  be  time  for  only  twelve  or 
fifteen  i)apers  in  addition  to  the  above  discus- 
sions, those  gentlemen  who  desire  to  contribute 
are  requested  to  send  the  titles  of  their  papers 
to  the  Secretary  on  or  before  April  ist,  as  he 
will  be  compelled  to  liunt  the  number  to  the 
first  fifteen  which  he  receives. 

The  Fellows  are  reminded  of  the  By-Law  : 
"  All  papers  that  may  be  read  before  the  So- 
ciety, and  accepted  for  publication,  shall 
become  the  property  of  the  Society,  and  their 
publication  shall  be  under  the  control  of  the 
Council.  Such  papers  maybe  published  in  full 
in  medical  journals,  provided  that  they  are  also 
printed  in  the  Transactions." 

There  are  eleven  vacancies  in  the  list  t)f 
Fellows. 

Very  truly  yours, 

Henry  C.  Coe, 

Secretary. 

THE  MONTREAL  MEDICO-CHIRURGL 

CAL  SOCIETY. 

Stated  Meeting,  May  26,  1893. 

D.-J.  James   Bell,  2XD  Vice  President  in 
THE  Chair. 
Abdominal  section  after    Confinement. — Dr. 
Armstrong  read  a  pa|)er  on   this   subject  as 
follows  : 

Mr.  President  arid  Gentlemen — I  have  re- 
cendy  had  to  do  with  three  or  four  cases  which  in 
my  experience  are  not  common,  and  my  friend 
Dr.  Perrigo  has  had  to  do  with  one  of  a  some- 
what similar  ch '.r.ictL'r.  \Vc  ihi  1'-.  that  a  brief 
lehearsal  of  the  principal  points  will  be  of  inter- 


est to  the  Society,  and  hui)e  ih.it  the  discussion 
will  be  mutually  helpful  and  instructive. 

On  the  3rd  of  Ma.ch  last  Dr.  W.  G.  Stewart 
asked  me  to  see  with  him  a  lady  whom  I  had 
myself  previously  confined  three  or  four  times. 
Her  confinements  had  always  been  normal,  but 
her  recoveries  had  not  always  been  as  satis- 
factory as  could  have  been  desired.  She  had 
generally  recovered  slowly,  had  usually  had  a 
little  temperature,  and  some  soreness  and  teti- 
derness  over  tlie  uterus  and  ad  lexT,  but  nothing 
of  a  serious  character. 

Dr.  Stewart  told  me  that  her  lost  confinement 
had  been  a  normal  one  in  every  respect.  She 
did  well  afterwards, and  got  up  on  the  tenth  day. 
In  brief,  she  soon  afterwards  became  feverish, 
complained  of  some  abdominal  pain  and  sore- 
ness, and  went  to  bed.  During  the  next  four 
weeks  she  had  a  very  fluctuating  temperature, 
an  occasional  chill,  frequent  sweats,  and  suffi- 
cient abdominal  pain  to  require  pouliices  and 
opium  to  relieve.  When  I  saw  her  six  weeks 
after  confinement  she  had  a  temperature  of 
foi,5,  pulse  of  130,  small  and  weak,  andan  anx- 
ious expression.  The  abdomen  was  rounded, 
and  for  the  most  part  tympanitic.  In  the  left 
lower  abdominal  region  a  distinct  but  ill-defined 
mass  was  easily  felr,  which  was  lender  on  pres- 
sure. I  advised  an  exploratory  incision,  which 
was  consented  to.  Before  opening  the  abdo- 
men I  curetted  the  uterus,  swabbed  it  out  with 
a  solution  of  permanganate  of  jiotassium  and 
packed  with  iodoform  gauze.  On  openiig  the 
abdomen  the  omentum  was  found  adhe:eiit  to 
the  uterus  and  tube  of  the  left  side.  On  care- 
fully detaching  the  adherent  margin,  a  pus  sac 
was  found,  the  walls  being  formed  anteriorly  by 
the  omentum,  below  by  tlie  left  tube  and  ovary, 
and  above  by  knuckles  of  intestine.  The  pus 
was  carefully  removed,  the  tube  and  ovary  tied 
off,  as  well  as  fully  one-third  of  the  omentum, 
which  was  infiltrated  and  thickened.  The 
patient  made  an  excellent  recovery. 

The  tube  in  this  ca?e  was  brightly  injected, 
swollen  to  probably  twice  its  normal  size,  but 
there  was  not  evident  any  constriction,  and  it 
contained  no  pus. 

Case  II. — This  case  occurred  in  the  practice 
of  Dr.  J.  Perrigo,  and  I  am  indebted  to  hrm  for 
the  report  of  it.  Mrs.  S.,  referred  to  me  by  Dr, 
Tatlc}-,  March  11,  1893.  Chief  points  of  his- 
tory obtainable  were  :  Confined  five  weeks  pre- 
viously of  her  second  child  ;  attended  by  a  mid- 
wife ;  labor  normal.  On  seventh  day  developed 
severe  rigor,  \\'\\\\  temperature  of  104^  and 
quick  pulse.  From  this  date  rigors  frequent 
and  temperature  continuously  high.  Great 
pelvic  pain  on  left  side,  moderate  abdominal 
distension  ;  occasional  vomiting  and  diarrhcea  ; 
prostration  extreme.  Examination  disclosed  a 
tender  abdomen  with  a  large  mass  in  left  side 
of  pelvis,  a  soft  patulous  "  o%"  with  uterus 
adherent    to  mass.     No   fluctuation    could  be 


IS4 


THE   CANADA   MEDTCAL   RECORD. 


delected.  Patient  could  bear  very  little  pres- 
sure on  the  mass,  and  any  atiempt  to  move  the 
uterus  caused  intei.se  pain.  Patient  removed 
to  private  wird  of  Western  Hospital  on  March 
i2lh,  and  abdomin  il  section  performed  that 
day.  All  aseptic  precautions  taken  on  the  part 
of  operator,  assistants,  nurses  and  instruments. 
The  field  (.f  operation  also  made  asei)tic. 

Before  doing  the  section,  the  uterus  was  cur- 
etted and  some  decomi^osed  placental  tissue 
rcuioveJ,  This  was  done  very  gently,  but 
notwithstanding  the  care  taken,  the  fundus 
close  to  the  left  groin  was  peiforatcd,  so  soft 
were  the  uierine  wal's.  This  was  discovcre  I 
when  doing  the  section.  It  was  quite  small, 
and  there  was  no  h  moirhage  from  it.  The 
uterus  was  irrigated  and  p  icked  with  iodoform 
gauze..  Upon  section  the  right  side  of  pelvis 
was  found  healthy.  The  contents  of  the  left 
side  formed  one  mass  of  inflammatory  exuda- 
tion, all  the  structures  being  agglutinated  toge- 
ther, adherent  to  the  uterus  and  to  the  wall  of 
the  pelvis.  'I'he  lower  half  of  the  omentum 
showed  patches  of  ganjrene,  and  in  two  small 
points  were  attached  to  coils  of  intestines,  and 
its  left  and  lower  border  was  adherent  to  the 
abdominal  wall  and  to  the  mass  in  the  pelvis. 
The  omentum  was  first  detached  and  all  dis- 
eased portions  removed  Great  care  was  required 
in  separating  the  adhesions  lYom  the  intestines. 
No  injury  to  intestines.  The  tube  was  enlarged 
to  the  size  of  an  average  adult's  wrist  and  con- 
tained small  pockets  of  pus.  The  tubal  canal 
was  obliterated.  Ovary  of  normal  size  and 
gangrenous. 

The  tissues  were  so  friable  and  softened  that 
it  was  with  difficulty  ligatures  could  be  applied 
without  cutting.  The  thermo-cautery  was  freely 
used,  but  there  was  not  much  hemorrhage. 
Abdomen  flushed  and  drainage  tube  used.  Be- 
fore operation,  patient's  temperature  was 
103  2-5  and  pulse  130.  Operation  was  at  4 
p.m.,  and  was  an  hour  and  a  half  in  duration. 
Temperature  at  7  o'clock  same  evening  was 
993-5,  pulse  110.  Iodoform  gauze  removed 
Irom  uterus  day  after  operation. 

From  this  date  up  to  the  evening  of  the  sev- 
enth day  the  temperature  ranged  from  99^"  :to 
100*',  respiration  18  to  24,  pulse  96  to  104. 
Tube  removed  on  second  day.  no  discharge 
from  it,  and  incision  appeared  clean  and  heal- 
thy. On  evening  of  seventh  day  temperature 
went  up  to  io2'',puL-e  120,  respiration  26,  and 
had  a  restless  night,  although  passing  flatus 
freely.  On  the  morning  of  the  eighth  day  tem- 
perature was  normal  and  pulse  88,  but  in  the 
evening  the  temperature  went  up  to  103  1-5, 
pulse  120,  respiration  28.  The  incision  w^as 
examined,  and  appeared  healthy,  but  the  evi- 
dence of  pus  being  present  was  so  strong  that 
tw'o  of  the  central  sutures  were  removed  and 
about  half  a  pint  of  pus  evacuated,     The  open- 


ing ill  the  incision  caused  by  the  removal  of 
the  two  sutures  was  sufficiently  large  to  pass 
the  finger  in.  A  lar-ge  pus-cavity  was  discov- 
ered, which  had  followed  in  the  tract  of  the 
glass  drainage  tube.  The  cavity  was  well  irri- 
gated and  a  large  tube  in-^erted,  which  was 
cleansed  eveiy  two  hours.  From  this  date  the 
patient  convalesced  steadily,  interrupted  at 
times  by  her  own  misconduct. 

Case  III. — Presents  a  history  which  in  some 
respects  is  unique.  She  was  attended  during 
her  second  confinement  by  Dr.  K.  R.  England. 
Her  confinement  was  a  normal  one  in  every 
respect,  not  unduly  prolonged,  and  the  child 
was  born  alive  and  well.  Dr.  England  saw  her 
each  of  the  immediately  succeeding  nine  days. 
Her  recovery  was  all  that  could  be  wished. 
Her  temperature  and  pulse  were  normal 
every  day.  The  lochia  was  present  in  sufficient 
quantity  and  at  all  limes  free  from  odor.  Her 
breasts  w^ere  always  full  and  the  child  nursed 
well.  The  lacteal  secretion  was  always  suffi- 
cient for  the  child.  At  4  p.m.  on  the  ninth  day 
after  confinement  Dr.  England  paid  what  he 
intended  to  be  his  last  visit.  Her  temperature 
and  pulse  were  normal,  breasts  full,  lochia  get- 
ting scanty  and  odorl,  ss.  No  abdominal 
pain  or  tenderness  ;  it  was  soft,  and  bore  pali)a- 
tion  without  the  slightest  discomfort.  She  lay 
in  bed  with  her  babe  upon  her  arm,  well  and 
happy  and  hopeful.  At  10  o'clock  that  evening 
the  nurse  decided  that  her  patient's  bowels 
necdedmoving.  As  the  baby  had  a  little  loose- 
ness the  nurse  thought  that  an  enema  was  the 
proper  thing  to  give.  The  patient  objected 
strongly  to  this,  on  the  ground  that  after  her  fir^t 
confinement  she  had  had  an  enema,  and  that 
she  suffered  very  great  pain  for  48  hours  after- 
wards. Her  objection,  however,  was  overcome, 
and  the  enema  was  given.  She  was  almost 
immediately  seized  with  intense  abdominal  pain, 
with  great  general  tenderness,  and  vomiting. 
She  had  a  small  stool  almost  immediately,  and 
htr  bowels  did  not  move  afterwards.  The 
vomiting  persisted  and  soon  became  bilious. 
Hypodermics  of  0|)ium  were  gi\en  to  relieve 
the  pain.  The  abdomen  became  tymjjanitic, 
the  temperature  rose,  the  pulse  became  rapid 
and  shabby,  the  face  became  drawn  and  anx- 
ior.s,  and  it  was  evident  that  the  patient  was 
suffering  from  some  severe  lesion,  sufficient  to 
cause  a  condition  of  collapse.  I  saw  her  with 
Dr.  England  during  the  afternoon  of  the  next 
day.  I  thought  the  history  and  symptoms 
pointed  to  some  acute  obstruction  of  the  bow- 
els, possibly  a  v>j1vu1us.  Her  condition  was 
an  extremely  grave  one,  and  it  was  easily  seen 
that  if  anything  was  to  be  done  more  than  had 
already  been  done,  it  was  of  a  surgical  nature. 
An  exploratory  incision  was  advised,  and  with 
that  object  in  view  she  was  removed  to  a  pri- 
vate ward  in  the  Montreal    General    Hospital. 


THE  CANADA  MEDICAL   RECORD. 


155 


There,  wilh  the  assistance  of    Dr.    Sheplierd,  I 
opened  the  abdomen  by  a  median  incision. 

The  peritoneal  covering  of  the  intestines  was 
congested.  1  think  I  am  within  ilie  limits 
wiien  I  say  tliat  two  pints  of  thin,  pale  yellow, 
oJorless  pus  flowed  out.  After  thorough 
irrigation  the  uterine  a]'>pendiges and  appendix 
vermiformis  wire  examined  without  finding 
any  condition  that  was  thought  to  bear  a  causi- 
tive  relation  to  the  peritoniiis.  The  tube  and 
ovaries  were  tied  off  and  sent  to  Dr.  Adami, 
whos:e  report  upon  them  I  will  read.  This 
woman  was  moribund  when  the  operation  was 
begun,  and  died  ten  minutes  after  being  re 
moved  from  the  table,  or  just  24  hours  from 
the  giving  of  the  enema  and  onset  of  symptoms. 

The  following  is  Dr.  Adanii's  report  : 

Pathological  Laboratory,  INIcGill 
uxivf.rsitv; 

May  17th,  1S93. 

The  Fallopian  tubes  are  lather  more  capa- 
cious than  novmil;  their  epithelium  is  healthy  ; 
the  peritoneal  surface  layers  are  congested  and 
thickened. 

The  ovaries  present  no  suppura'ive  foci;  all 
that  can  be  said  of  them  is  that  they  ar:  more 
fibroid  than  they  ought  to  be — j^ossess  large 
tortuous  vessels  and  thickened  capsules.  Evi- 
dently, therefore,  the  jjeritoniiis  has  not  start- 
ed from  the  tubes  or  ovaries  in  this  case. 
Willi  kind  regards,  yours  sincerely, 

J.  George  Adaml 

Careful  search  was  made  for  volvulus  and 
hernia,  but  nothing  which  could  be  taken  for  a 
cause  was  found.  Thinking  that  perhaps  a 
small  perforation  existed  along  the  sigmoid  cr 
colon,  I  asked  one  of  the  house  physicians  to 
inject  water  into  the  rectum.  It  entered  freely, 
filled  the  colon,  and  passed  through  into  the 
ilium,  but  none  escaped  through  into  the  peri- 
toneal cavity.  I  was  obliged  to  close  the 
abdomen  without  determining  the  cause  of  the 
pathological  condition  present.  No  autopsy 
cov.ld  be  obtained.  From  the  sym]5toms  of 
obstruction  which  were  present,  and  the 
history  of  severe  pains  following  the  adminis- 
tration of  an  enema  afier  a  [)revious  confine- 
ment, I  am  inclined  to  think  that  in  some  way 
a  volvulus  of  the  sigmoid  was  produced  by  the 
enema  which  had  untwisted,  but  not  before 
some  pyogenic  micro-organisms  had  escaped 
into  the  peritoneal  cavi:y.  What  it  was — 
whether  the  bacillus  coli  or  one  of  the  proteus 
group,  described  by  Hauser  in  1885,  or  some 
other,  I  cannot  say,  as  unfortunately  none  of 
the  pus  was  saved  for  bacteriological  examin- 
ation. 

Dr.  Flexner,  Associate  in  Pathology  in  the 
Johns  'Hopkins  Hospital,  describes  in  the 
April  number  of  ihe  Jo. .us  Hopkins  Bullet  in 
a  case  of  peritonitis  occurring  in  a  patient,  the 


subject  of  chronic  disease,  thou, -lit  to  be  due 
to  the  action  of  the  proteus  vulgaris.  In  the 
same  paper  Dr.  Flexner  says  that  "  Foa  and 
Ponome  found  in  the  blood  and  organs  of  a 
man  dead  of  supposed  ha^morrhagic  infarction 
of  the  intestine  and  mesentery  and  thrombosis 
of  the  mesenteric  vein,  a  bacillus  which  they 
identified  as  the  proteus  vulg  ris." 

Case  IV. — A  patient  of  my  own  was 
attended,  for  me  in  my  absence  by  Dr.  Spend- 
love  in  Jurie,  1892.  It  was  her  third  confine- 
ment ;  labor  easy  and  rapid  ;  child  living  and 
healthy  ;  recovery  apparently  perfect  ;  no 
history  of  any  tubal  or  ovarian  trouble.  Two 
months  after  confinement,  while  in  apparent 
health  and  nursing  the  child,  she  was  suddenly 
seized  with  a  severe  rigor,  rapid  pulse,  and  a 
temperature  of  104,  tol'owed  by  pain  and 
tenderness  in  the  lower  abdominal  region. 
She  recovered  in  a  week,  so  far  that  the  pain 
and  tenderness  disappeared  and  pulse  and 
temperature  became  normal.  The  lacteal 
secretion  was  sufficient  for  the  child,  and  she 
resumed  her  household  duties.  In  fifteen  days 
she  had  a  similar  attack,  followed  in  ten  days 
by  another  ;  apparently  good  recovery,  only 
to  suffer  another  recurrence  ten  days  after- 
wards. The  third  attack  was  the  most  severe 
of  all.  In  addition  to  the  rigor,  high  temper- 
ature and  pain  and  tenderness,  there  devel- 
oped a  large,  soft,  lender  mass  on  each  side 
of  the  uterus,  easily  felt  by  bimanual  palpation. 
I  now  decided  to  open  the  abdomen.  On 
doing  so  I  found  a  large  tubo-ovarian  abscess 
on  each  side.  It  was  treated  in  tht  usual  way. 
and  a  rapid  and  perfect  recovery  followed. 
This  patient  is  now  in  better  health  than  she 
has  been  for  years. 

I  might  add  a  fifth  case  operated  on  in  the 
General  Hospital  some  two  years  ago,  followed 
by  recovery. 

Case  III  must  be  considered  separately 
from  the  rest.  The  symptoms  were  those  of 
obstruction.  Dr.  Adami,  in  his  report  upon 
the  tubes  and  ovaries,  sa^  s  they  cannot  be 
called  diseased,  and  that  we  must  look  else- 
where for  a  cause  of  the  peritonitis.  The 
cause  was  ap|  arently  a  temporary  condition, 
which  had  ceased  to  exist  at  the  time  of 
opera'. ion.  Remembering  the  symptoms  that 
followed  the  administration  of  an  enema  after 
the  first  confinement,  and  the  apparently 
causative  relation  of  enema  and  symptoms  at 
the  onset  of  her  last  illness,  I  think  that 
probably,  as  I  said  before,  a  volvulus  was 
produced  which  untwisted  befoie  we  inspe  cted 
that  region,  or  perhaps  it  was  untwisted  while 
we  were  looking  at  the  condition  of  the  uterine 
appendiges  on  the  left  side. 

The  two  lessons  to  be  learned  from  the 
other  four  cases  are,  first,  the  necessity  for 
greater  cautio.i  against  sepsis  when  attending 
confinements  or  miscarriages.     The  technique 


,56 


THE  CANADA  MEDICAL  RECORD. 


Relative  to  Case  No. 


of  a  case  of  niidwifeiy   should  more   closely  i 
resemble  iliat  lor  a  modern  siirgicil  cperaiicn.   i 
The  greatest  ca.-e  should  be  taken  to  render   . 
tlie    hands    of   the    nccoucheur   aseptic.      His   ; 
coat  and  underwear  should  be  above  sus])icion. 
The    ])aiient's    person   and    clothing  and   bed 
should  be  made  as  clean  as  circumstances  will 
permit.     A   napkin   or  towel  wrung  out   of  a 
liot  solution  of  corrosive   sublimate    i   in   2000 
sh.ould  be  used,  instead  of  the  old  diy  napkin, 
to   suppoit  the  pcrinaium.     'J'he  parts  should 
afieiwards  be  frequently  washed  by  the  nurse, 
who  should  be  impressed  witii  the  necessity  of 
having  clean  hands  her>elf. 

Secondly,  ih  se  cases  leacii  us  that  wlien 
sejjlic  infection  occurs,  great  care  should  be 
taken  to  discriminate  between  infection  Irom 
the  vagina,  torn  peringeum,  uterine  ca\  ity,  or 
torn  cervix,  and  inf.  ction  extending  up  and 
involving  the  Fallop'an  tubes.  'I'he  treatment 
should  aim  to  meet  ifficienily  the  pathological 
condition  present.  'J'he  experience  gai:'ed 
from  these  five  cases  dtmoristrntes  the  uility 
of  proper  surgical  tnatmeiit  in  properly 
selected  cases.  No  amount  of  vaginal  douch- 
ing or  curetting  and  irrigating  of  a  septic 
uterus  wi  1  save  a  woman  suffering  from 
ruptured  i)us  tubes,  with  intra-iieriloneal 
inflammation  and  abscess. 

But  the  history  of  these  cases  does  show 
that  sujgical  treatment  may  not  only  save  their 
lives,  but  restore  them  to  |)erfect  health. 
Thoroughly  cleanse  and  render  aseptic  the 
vagina  and  uterine  cavity,  and  then  if  there  is 
pus  in  the  abdomen,  open  that  cavity,  remove 
the  pus  and  diseased  tubes  and  infected  omen- 
tum, and  make  it  also  as  aseptic  as  possible. 

Dr.  England,  referring  to  Case  No.  3  of  the 
series  just  reported,  had  nothing  more  to  add 
to  what  Dr.  Armstrong  had  so  well  expressed. 
The  woman  had  a  very  satisfactory  puerperal 
period.  The  giving  of  the  enema  was,  or 
seemed  to  be,  the  beginning  of  her  pain,  which 
persisted  till  death.  He  saw  her  the  same 
night  as  the  enema  had  been  given,  and  even 
a  hypodermic  of  morphia  could  not  relieve  pain. 

Dr.  Lapthorn  Smith  dwelt  upon  the  neces- 
sity of  greater  care  being  exercised  by  the 
accoucheur  in  cleansing  the  hands,  and  for  this 
purpose  he  knew  ()f  nothing  better  than  perman- 
ganate of  potash  and  oxalic  acid 


he  did    not    agree 


with  Dr.  Armstrong  in  thinking  that  a  volvulus 
or  obstiuction  was  the  cause  of  the  trouble. 
Two  pints  of  pus  in  the  peritoneal  cavity  is 
more  than  could  be  manufactured  in  such  a 
short  time,  and  in  his  opinion  it  must  have 
been  locked  up  somewhere  in  the  form  of  an 
abscess,  and  during  the  administration  of  the 
enema  it  suddenly  burst  and  flooded  the  cavity 
Dr.  J.  C.  Cameron  said  that  Dr.  Armstrong's 
series  of  cases  seem  to  confirm  the  belief  that 
abdominal  section  is  sometimes  useful  in  local 


peritonitis,    and    that   it  is  always    hopeless  in 
general  se]>tic  peritonitis. 

With  reference  to  curetting,  he  said  that  this 
should  be  done  before  the  ])eritoniiis  was  set 
up.  Where  there  is  a  suspicion  of  any  portion 
of  the  placental  tissue  being  left  in  the  uterus, 
we  should  not  treat  a  rise  of  temperature  with 
douching.  Douching  is  not  sufficient  to  re- 
move any  adherent  membranes  or  placenta  ; 
nothing  but  the  curette  is  suflicient  in  such 
cases.  Here  in  Case  2,  if  the  curette  had  been 
early  used,  the  necessity  for  an  abdominal 
section  would  have  been  spared.  Interfere 
early  and  interfere  thoroughly  was  his  advice 
in  all  such  cases. 

He  was  not  in  accord  with  Dr.  Smith  in  his 
absolute  faith  in  permanganate  of  potash  and 
oxalic  acid  as  disinfectants.  He  thought  it  a 
dangerous  doctrine  to  set  forth  that  the 
thorough  use  of  those  agents  on  the  hands  does 
away  with  the  necessity  of  atiy  or  all  other 
precautions.  In  the  abstract  it  may  be  correct 
to  say  that  thorough  disinfeciiin  makes  pre- 
vious occupation  of  no  importance;  but,  in 
practice,  it  will  be  found  unjist  and  unwise  to 
counsel  men  that  they  may  leave  the  i)OSt- 
moitem  room  and  confine  a  woman  with  im- 
punity, provided  they  wash  their  hands  in 
permanganate  md  oxalic  acid.  It  will  be  found 
that  disinfection  comprises  much  more  than  the 
cleansing  of  the  fingers. 

Dr.  James  Bell  thoroughly  agreed  with  Dr. 
Cameron's  remarks  regarding  the  insufficiency 
of  manual  disinfection.  The  truth  of  this  is 
welbseen  in  the  hospital,  where  students,  ever 
apt  to  seize  upon  the  most  prominent  part  of 
the  technique,  often  confine  their  disinfection 
to  washing  the  hands,  etc.,  and  neglecting  other 
and  very  essential  precautions. 

Dr.  Ar>lstrong,  in  reply,  said  that  relative 
to  the  Dr.  Smith  belief,  that  the  hands  are  the 
only  source  of  infection  in  midwifery,  it  has 
lately  fallen  to  his  lot  to  see  three  cases,  two 
of  them  fatal,  occurring  in  the  practice  of 
accomplished,  faithful,  truthful  men,  who  assert- 
ed that  the  children  were  born  before  they 
reached  the  house  ;  that  they  never  touched 
the  vulv3,  never  made  a  vaginal  examination. 
Granting  that  the  hands  are  the  most  important 
part,  if  vou  have  a  dirty  field  of  operation, 
dirty  vulva,  if  you  have  fecal  matter  coming 
down,  no  matter  how  clean  your  hands  are,  you 
carry  over  the  g:rms  that  are  on  that  surface; 
you  must  have  everything  clean. 

In  regard  to  Case  3,  and  Dr.  Smith's  remarks 
about  the  two  pints  of  pus,  he  said  that  he  had 
no  knowledge  of  any  kind  of  peritonitis  that 
could  be  present  for  nine  days  and  give  no 
symptoms  ;  that,  at  the  operation,  puzzled  with 
the  obscurity  of  the  case,  the  incision  was  en- 
larged, and  a  most  thorough  examination  of  the 
cavity  and  its  contents  made,  with  a  view  to 
find  an  abscess  or   some  such  explanation  for 


THE  CANADA  MEDICAL  RECORD. 


157 


the  quantity  of  the  pus,  but  without  success. 
Ill  tlie  face  of  these  facts,  un'ikely  as  itappeared, 
the  conclusion  expressed  was  the  only  one  left 
them. 

In  leg.ird  to  operating  in  ])erilonitis,  he 
agreed  with  Dr.  Cameron  ;  still,  there  is  no 
other  hope  for  these  patients  ;  and  while  there 
is  even  the  shadow  of  a  chance  by  operating, 
he  felt  it  is  hird  to  refuse  to  undertake  such 
a  ste[). 


Stated  Afe:tiiig,  zoth   Oct.,  1893. 

Jamks  Bell,  M.D.,  Pri-sident,  in  the  Cit.\iR. 

Drs.  H.  B.  Carmichael,  C.  F.  Martin,  P.J. 
ilayes  and  T.  P.Shaw  were  elected  as  ordinary 
members. 

Enucleation  of  Tumor  of  the  Thyroid 
Gland. —  Dr  Shepherd  related  two  cases  of 
this  operation. 

Tile  first  was  performed  on  5th  July,  1893,  by 
culling  through  the  capsule  afier  ligating  the 
thyioi.l  arteries.  The  tumor  was  readily  shelled 
out,  and  the  haemorrhage  was  trifling.  The 
growiii  had  been  rapid  and  had  caused  increas- 
ing difficulty  of  breathing.  In  the  se  :ond  case, 
operated  on  29th  September,  1893,  the  growth 
was  larger,  and  extended  below  the  clavicle,  but 
was  easily  shelled  out.  Attached  to  it  were  a 
number  of  vessels  spreading  out  like  the 
brar.ches  of  a  tree,  but  none  of  them  req  li.eJ 
tying.  In  the  dissecting  roimi  he  had  recently 
seen  a  similar  tumor,  which  he  had  been  able 
easily  10  shell  out.  After  this  operation  there 
was  no  danger  of  any  cedema,  and  enucleation 
was  likely  to  be  the  operation  of  the  future. 

The  President  remarked  that  in  boih  Dr. 
Shepherd's  cases  the  growths  were  cystic.  He 
had  seen  Kraske  enucleate  an  adenoid  goitre 
extending  below  the  clavicle.  It  had  shelled 
out  quite  easily. 

Fibroid  Tumor  of  the  Uterus. — Dr.  L.apthorn 
Smith  showed  a  specimen  which  he  had 
removed  from  an  unmarried  lady  aged  34  years. 
The  bowels  h  id  always  been  regular — an  excep- 
tio  lal  circumstance  in  such  cases.  A  few  weeks 
ago  her  legs  became  swollen.  On  examination, 
a  diffuse  fibroid  tum  ir  was  found  occupy- 
ing the  posterior  wall  of  the  uterus  The 
transverse  diameter  of  uterine  cavity  was 
increased.  Patient  was  anteaiic.  Abdominal 
hysterectomy  was  performed  on  2nd  October. 
1893,  the  uterus  being  transfixed  at  the  level 
of  the  internal  OS.  No  co  nplications.  Highest 
temi)erature  was  ioo3<°  in  niDuth.  The  stump 
was  dressed  with  boracic  acid  and  was  free  from 
all  unpleasant  odor.  Pjiitoneum,  linea  alba 
and  skin  were  sutured  separately.  Conval- 
escence was  good. 

Small  Fibroid  Fumors  of  the  Uterus  and 
Broad  Ligaments. — Dr.  W.m.  Gardner  exhibit- 
ed this  specimen  removed  from  Mr-.  L.,  aged 
42,   married  13  years,  sjnt  to  him  by  Dr.   W. 


Grant  Stewart.  The  operation  was  exception- 
ally difficult,  owing  to  adhesion  of  the  entire 
omentum  to  the  anterior  abdominal  wall.  Two 
nodular  myomata  were  enucleated  from  tlie 
right  broad  ligament,  the  ovaiies  and  tubes 
removed,  and  the  uterus  amputated  by  the  flap 
mt  thod  after  ligating  the  uterine  arteries.  Thci  e 
was  considerable  oozing.  A  glass  drain  was 
iniioiuccd.  Four  hours  later  haemorrhage 
commenced,  but  was  checked  by  i)ouring  a 
sterile  solution  of  perchloride  of  iron  into  the 
tube.  The  tube  was  removed  in  48  hours,  and 
recovery  w'as  steady.  The  growths  in  the  broad 
ligament  ap])eared  to  be  distinct  from  the 
uterus. 

Grape  Tuberculosis  'fthe  Peritoneum. — Dr. 
.Ada.mi  exhibited  a  specimen  received  from  Dr. 
Gardtier. 

Dr.  Gardner  had  recently  performed  an  ex- 
ploraloty  laparotomy  upon  a  young  woman, 
where,  upon  opening  the  abdomen,  the  intes- 
tines, omentum  and  the  parietal  peritoneum 
were  found  to  be  studded  with  nodules  varying 
in  size  from  a  small  pea  to  that  of  a  grape.  There 
must  have  been  more  than  a  tiiousand  of'.her.e 
new  growths,  which  were  white,  firm  and  gobu- 
lar.  No  large  conglomerate  growth  could  be 
found  in  connection  with  the  ovaries,  uterus, 
intestines  or  other  organs.  In  removing  a  few 
of  the  growths  from  the  mesentery  they  were 
easily  separated  from  the  surrounding  tissue, 
and  upon  microscopic  examination  exhibited 
the  characteristics  of  tubercles.  The  masses 
were  subserous,  and  were  composed  of  tuber- 
cles of  a  peculiarly  chronic  type,  many  showing 
central  necrosis,  although  the  caseating  masses 
did  not  coalesce,  while  all  were  surrounded  with 
well  formed  layers  of  fibrous  tissues.  There 
were  numerous  giant  cells,  and  further  study 
demonstrated  the  presence  of  numerous  tuber- 
cle bacilli.  Dr.  .\dami  described  this  as  "  grape 
tuberculosis  "  from  its  similarity  to  the  "disease," 
or  tuberculosis,  of  cattle.  This  is  a  chronic  form 
of  tuberculosis.  He  exhibited  the  liver  of  a  calf 
just  received  by  him,  which  upon  its  surface 
showed  similar  grape-like  masses  of  tubercles. 

Dr.  Gardner  stated  that  the  patient  had 
been  sent  to  him  by  Dr.  Ewing  of  Hawkesbury. 
The  nodular  masses  and  thickened  omentum 
could  be  made  out  by  palpation.  After  watch- 
ing thecase  for  threew  eeks  tuberculosis  was  sus- 
pected, there  being  physical  signs  in  the  lungs 
and  a  rise  of  one  degree  or  more  in  the  evening 
temperature.  Operation  was  pei formed,  as  ex- 
perience had  taught  that  peritoneal  tuberculosis 
was  a  remediable    condition. 

Dr.  Shepherd  referred  to  a  man  under  his 
care  three  or  four  years  a  go,  where  the 
temperature  reached  loi*  daily  for  several 
weeks,  and  hardness  coulJ  be  felt  through  the 
abdominal  walls.  On  operation  he  had  found 
a  condition  almost  identical  with  the  specimen 
shown.       Some   of  the  masses  were  examined 


158 


THE  CANADA  MEDICAL  RECORD. 


microscopically,  and  pronounced  tuberculous. 
From  the  day  of  operation,  he  commenced  to 
improve.  The  temperature  soon  fell,  and  a 
year  later  he  had  gained  twenty  pounds  in 
weight. 

Dr.  Mills  liiought  the  benefit  was  explain- 
able through  the  effect  of  the  operation  upon 
the  nervous  system,  tiuis  indirectly  changing  the 
metabolism  of  the  whole  organism. 

Dr.  Smith  thought  the  improvement  might 
be  due  to  the  irritation  caused  by  the  entrance 
of  air. 

Dr.  Lafleur  was  surprised  to  find  this 
subject  regarded  as  r.ew.  Dr.  Osier  in  his 
monograph  on  tuberculous  peritonitis  states 
that  though  miliary  tuberculosis  does  not  get 
well,  chronic  forms  always  improve.  Ordinary 
])uncture  does  not  have  the  same  effect  as 
incibion.  He  considered  that  spontaneous 
healing  of  peritoneal  tuberculosis  also  took 
place. 

Di".  Adami  considered  that  the  "shock" 
which  follows  upon  abdominal  incision  suffices, 
to  explain  the  retrogression  of  the  tubercled 
It  is  well  known  that  exposure  of  the  perito- 
neum leads  loan  inflammatory  condition  of  the 
same,  to  dilatation  of  the  vessels  and  increased 
blood  supply  As  Professor  Roy  had  recently 
shown  in  "  shock  "produced  by  various  means, 
the  specific  gravity  of  the  blood  ri<es  rapidly, 
and  is  accompanied  by  increased  exudation 
into  the  perito  eal  cavity  and  dilatation  of  the 
mesentery  and  intestinal  vessels.  He  held  that 
with  this  inflammatory  or  sub-inflammatory 
condition  there  was  increased  nutrition  of  the 
tubercular  areas,  improved  state  of  the  cells,  and 
thereby  arrested  advance  of  the  tubercular 
process,  and  cicatricial  tissue  developed  so  as 
to  encapsule  the  tubercles.  In  ihe  chronic  cases 
such  as  that  exhibited  by  him,  there  was  already 
a  tendeiiCy  to  this,  so  that  slightly  increased 
vascularity  and  improved  nutriti(..n  would  turn 
the  scale  m  favor  of  the  organism  and  against 
the  micro-organism. 

Dr.  F.  W.  Campbell  thouglit  that  the  system 
could  be  permanently  influenced  by  shock,  and 
gave  illustrationb  in  support  of  this  view. 

Ovarian  Dermoid. — Dr.  Adami  exhibited  a 
large  dermoid  which  had  been  sent  to  him  by 
Dr.  W.  Gardner.  'J  he  tumor  measured  six 
inches  in  diamettr ;  the  walls  outside  showed 
membranous  adhesiop.s.  Upon  opening,  the 
cyst  was  found  to  be  filled  with  thick  fluid  with 
fatty  particles  floating  i)i  it  ;  and  when  this  had 
escaped,  the  cavity  was  seen  to  contain 
a  large  aniount  of  fatty  material  and  debris, 
and  a  relatively  very  large  quantity  of  loose 
hair  tending  to  be  arranged  in  balls.  The  walls 
were  irregularly  thickened,  and  in  them  was  a 
large  bone  of  irregular  shape,  consisting  of  a 
main  portion  2^  if.  in  length  and  '^■2  in.  in 
thickness.  Frotii  this  at  one  extremity  jiro- 
jected  two  wings,  of  which  the  larger  was  3  in. 


long,  while  the  smaller  bore  a  clump  of  three 
Well  developed  teeth  projecting  into  the  cyst. 
At  the  oiher  extremity  was  given  off  a  line  of 
three  small  flattened  bony  plates  united  toge- 
ther by  fibrous  tissue,  in  all  2}i  in.  long.  The 
main  mass  of  bone  was  hollow,  containing  to- 
wards its  outer  surface  a  subsidiary  cyst  also 
bearing  hair.  Into  it  projected  from  the  bony 
floor  a  cystic  glandular  mass.  This  large  bony 
mass  could  easily  be  felt  upon  abdominal  palpa- 
tion before  the  operation.  While  small  bony 
developments  in  ovarian  dermoids  ar-e  not  un- 
common, it  is  extreiiiely  rare  to  obtain  so 
large  a   mass    as  the  one   here  described. 

Dr.  \Vm.  Gardner  stated  that  clinically  the 
only  point  of  interest  was  that  the  portion  of 
the  pedicle  was  not  extreme  enougli  to  inter- 
fere with    the  circulation. 

Fibroid  Tumor  from  the  sheath  of  the 
Femoral  Artery,  with  secondary  crowth  within 
the  Femur — Dr.  Adami.  This  tumor  had 
been  removed  by  Dr.  Roddick,  who,  finding 
upon  his  first  attempt  at  simple  removal  that  it 
was  intimately  connected  with  the  sheath  of  the 
lower  end  of  the  femoral  artery,  determined  to 
amputate  the  leg  of  the  patient,  an  elderly  lady, 
and  cut  across  the  friiiur  at  the  junction  of  the 
upper  and  middle  thirds  of  the  bone.  The 
tumor  reached  Dr.  Adami  in  bad  condition, 
having  accidentally  been  laid  aside.  Its  struc- 
ture was  that  of  a  slow  growing  spindle-celled 
sarcoma,  which  in  parts  was  more  truly  fibro- 
matous,  and  which  throughout  shov.ed  a 
tendency  to  a  fasciate  arrangement  of  the 
constituent  cells.  No  secondary  growth  had 
been  niade  out  anywhere,  but  upon  making  a 
longiiudinal  section  of  the  removed  femur  there 
was  discovered  a  white  mass, the  size  of  a  Barcel- 
ona nut,  lying  somewhat  loosely  in  the  medulla 
of  what  corresponded  to  the  lower  part  of  the 
middle  third  of  the  bone,  and  this  upon 
microscopic  examination  was  seen  to  be  of 
sarcomatous  nature,  being  formed  of  spindle 
cells,  of  typical  form  towards  the  periphery, 
but  more  inter-nally  ]>ossessing  nuclei  which 
might  at  first  sight  be  mistaken  for  those  of  a 
myoma,  their  length  being  remarkable. 

Perforation  of  the  femoral  artery  and  vein  in 
Hunte/'s  catial by  a  bullet  wound. — Dr.  Bell. 
On  Sept.  1 6th,  1893,  the  patient,  a  boy,  was 
shot  in  the  thigh  by  a  i6-calibre  ball.  On 
bandaging,  the  bleeding  ceased,  but  the  pain 
in  the  thigh  prevented  walking.  A  few  days 
later  he  entered  hospital,  when  a  fusiform 
swelling  in  the  region  of  Hunter's  canal  was 
observed.  There  was  no  diffuse  pulsation,  but 
a  very  loud  bruit  on  auscultation.  One  and  a 
half  inches  of  both  vessels  were  removed.  On 
the  fifth  day  pulsation  could  be  felt  in  the  pos- 
terior tibial  artery. 

Appendicitis. — Dr.    James   Bell   exhibited 
specimens  from  the  following  seven  cases  : 
I.   Recurrent   case.     Operation  three  weeks 


THE  CAXADA   >rEDlCAL  RECORD. 


159 


afler  the  second  ait.  ck.     Peiforaiion  with  local 
abscess. 

2.  Operation  iS  liours  after  ihe  onset. 
Appendix  greatly  dilated  and  quite  gangrenous. 

3.  0|)eration  48  hours  af"tpr  onset.  Wide- 
spread abdominal  pain.  I'he  appendix  looked 
normal  externally,  but  was  full  of  grumous 
bloody  fluid. 

The  adjoining  lymph  glands  were  enlarged 
and  soft,  and  the  peritoneum  tedemati  us.  It 
-apiicarcd  to  be  aca^e  cf  caily  catarrhal  appen- 
dicitis witji  severe  lym]ihangitis. 

4.  C)peration  50  hours  after  on;  el.  Appen- 
dix gangrenous. 

5.  Operation  41  hours  after  onset.  Appen- 
dix perforated  and  gangrenous. 

6.  Operation  one  week  after  onset.  Appen- 
dix perforati-d.  Th.e  patient  was  in  a  septic 
condition,  and  subsequently  died. 

7.  Operation  two  weeks  afler  onset.  Ai)ptn- 
dix  perforated  with  local  abscess.  The  palient 
died  apparently  from  toxaemia  rathtr  than 
sej^iticgem'a. 

Of  the  gar.grencus  cases  none  had  died,  and 
of  the  catarrhal  cases,  two  died;  fo  thai  the 
milder  forms  appeared  to  be  by  no  means  so 
far  fiom  danger  as  is  generally  thought.  The 
marked  symptoms  in  gangrenous  cases  lead  to 
early  operation  while  the  milder  forms  are 
neglected. 

Dr.  Shepherd  referred  io  a  case  where  the 
appendix  was  apparently  only  a  little  thick- 
ened. Dr.  Johnston  had  found  it  filled  wiih 
pus  and  blood.  He  had  been  unfortunate  widi 
his  gangrenous  cases  three  having  died  un- 
relieved by  the  operation.  Oiieraiion  may  be 
performed  too  early,  before  there  is  a  line  of 
demarcation  formed. 

Enlarged  Glands  pressing  upou  the  trachea 
from  a  case  of  Hodgkin's  disease. — Dr.  Finlev 
exhibited  the  specimens  obtained  at  an  autopsy 
upon  a  man  aged  27,  and  gave  an  account  of 
the  case.  (The  patient  had  been  previously 
brought  before  the  Society  in  Oct.,  1890,  by  the 
late  Dr.  R.  L.  MacDonnell,  and  the  case  had 
been  published  in  the  International  Clinics  for 
Oct.,   1891.) 

The  disease  had  lasted  7  years.  The  earl- 
iest symptom  was  the  occurrence  of  urgent 
attacks  of  dyspnoea.  After  an  interval  of  two 
years  thess  attacks  recurred,  and  enlargement 
of  the  cervical  lymph  glands  was  noted.  The 
spleen  was  then  enlarged.  I'he  removal  of 
some  glands  from  behind  the  sternum  by  Dr. 
Shepherd  gave  relief.  In  1891  there  was 
stridor  and  dyspnoea,  with  enlargement  of  the 
cervical  and  axillary  lymph  glands,  the  size  of 
which  varied  consideiably  from  time  to  time. 
In  Dec,  1S92.  the  inguinal  glands  enlarged. 
Six  months  before  death  the  man  became  very 
weak  and  anemic,  though  tem|)orary  improve- 
ment fullowed  the  administration  of  Fowler's 
solution.     In  June,  1892,  the  blood  count  gave 


3.31 7, ceo  red  cells,  with  white  cells  i  .50,  mostly 
pol)nuc'ear.  In  Dec,  1892,  the  red  cells  were 
2,571,000,  no  leucocytosis.  Injune,  1893,  there 
w,:s  effusion  into  kfi  pleura,  and  the  patitut 
died  in  orthopncea.  At  the  auto])sy,  body  was 
emaciated,  and  showed  (arsenical  ?)  pigmen- 
tation cf  skin.  The  uachea  surrounded  by  a 
cluster  of  enlarged  glands  as  big  as  a  foetal 
head.  Lumen  of  trachea  compressed  to  a 
mere  chink,  and  mucosa  eroded.  Some  of  the 
glands  presented  softened  centres.  Relro-peri- 
tcneal  and  1  elvic  glands  enlarged  10  masses  of 
considerable  size.  Spleen  three  times  normal 
.'•ize.  Growth  infilirattd  lower  lobe  of  left 
lung.  Six  secondary  nodules  in  right  lung. 
Bone  marrow  of  ribs  and  sternum  grayish  red. 
The  seven  years  duration  of  the  case  was  rc- 
matkalle.  In  50  cases  tabulated  by  Gowers, 
only  one  exceeded  5  years.  Osier  gives  tlie 
duration  as  from  3  to  4  months  to  as  many 
years.  Possibly  the  continued  use  of  arsenic 
had  lengthened  life. 


Sta'ed  Meeting  A ov.  3'7/,  1893. 
James  Bell,  M.D.,  President,  ix  the  Ch.aik. 

Drs.  G.  A.  Berwick  and  J.  T.  Rcid  were 
elected  members  of  the  Society. 

Removal  of  Gasserian  Ganglion  for  Facial 
Neuralgia — Dr.  James  Bell  exhibited  a  woman 
upon  whom  he  liad  performed  th's  operation 
for  intractable  facial  neuralgia.  Krause's  opera- 
tion was  performed,  an  incision  being  made 
from  the  external  angular  process  to  point  in 
front  of  the  tragus  of  the  ear.  The  zygoma 
was  removed  with  bone  forceps.  In  trephining 
the  skull,  the  middle  meningeal  artery  was 
seized.  It  ran  in  a  foramen,  and  therefore 
some  bone  had  to  be  chipjjed  away.  The 
dura  was  separated  from  ihe  bone  down  to  the 
pe  rous  region,  the  brain  being  held  away  witli 
the  finger.  The  second  and  third  branches  of 
the  fifth  nerve  were  divided  at  the  foramina, 
and  reflected  backward  with  the  Gasserian 
ganglion  till  the  trunk  of  the  nerve  could  be 
cut  and  the  ganglion  and  attached  nerves  drag- 
ged away  with  the  forceps.  To  familiarize 
himself  with  the  operation  he  had  practised  it 
on  the  cadaver.  The  risks  of  operation 
were:  (i)  wounding  the  adjacent  vessels,  and  (2) 
trophic  changes  in  ihe  eye-ball.  To  avoid  the 
latter  the  eyelids  were  su cured  for  a  few  days. 
Except  for  loss  of  power  of  the  temporal  miis- 
cle,  paralysis  of  one  side  of  the  face  and 
slight  giddiness  lasting  a  few  weeks,  there  were 
no  bad  sympioms,  and  she  had  been  free  of 
pain  since  the  operation.  Previously  the  nerve 
had  been  stretched  without  any  relief  being 
obtained.  In  the  operation  known  as  "Rose's," 
the  foramen  ovale  is  approached  from  the  base 
of  the  skidl  by  an  incision  over  the  parotid 
region.     This  operation  is  more  difficult.      1-ive 


i6o 


THE   CANADA   MEDICAL    RECORD, 


cases  arc  icpoiled  by  ^Jr.  Rose  and  six  are 
repoited  of  Kra use's  opeiaiion — which  should 
really  be  called  Hardcy's  operation,  Hartley  of 
New  York  being  the  first  to  perform  it.  It 
was  too  early  to  judge  fully  of  the  results,  but 
cases  were  reported  free  of  pain  after  22 
month.s  where  stretching  and  external  neur- 
otomy had  failed. 

Discussion — Dr.  Stewart  had  seen  the 
patient,  and  regarded  medical  treatment  as  use- 
less. The  pain  was  intense,  and  had  been 
worse  since  the  stretching.  It  was  hard  to  say 
whether  the  cure  would  be  permanent. 

Dr.  Mills  thought  tha:  from  the  important 
nerves  involved  the  dizziness  noted  mi^ht  be 
owing  to  the  1  peration. 

Dr.  Lapthorn  Smith  had  found  benefit 
result  from  constitutional  treatment  by  iron 
and  tonics  in  c.  ses  ol  tic. 

Dr.  Bell,  in  reply  to  Dr.  Mills,  said  that 
dizziness  is  common  in  persons  confined  to 
bed  after  any  operation. 

Snb-diaphragmatic  Absces:, — Dr.  Adami  re- 
lated a  case  of  ihis  nature  due  to  su[)puration 
around  a  cancer  of  the  lower  part  of  the  oeso- 
phagus, as  follows  : 

It  is  not  a  little  noticeable  how  silent  are 
even  the  best  and  most  modern  text-books  upon 
the  subject  of  sub-diaphragmatic  abscess,  with 
a  silence  that  is  out  of  proportion  to  its  diag- 
nostic and  clinical  interest,  and,  it  maybe  added, 
to  its  relative  frequei.cy.  Doubtless  the  fact 
that  the  subject  cannot  be  treated  under  the 
heading  of  any  one  special  organ  leads  to  its 
being  neglected  in  well-ordered  text-books,  so 
that  information  has  siill  to  be  gathered  from 
scattered  papers.  Thus  ii  happens  that  although 
I  am  acquainted  with  a  fair  number  of  cases  in 
which  the  original  disturbance  has  originated  in 
connection  with  the  liver,  kidney,  spleen  or 
stomach,  I  have  been  able  to  find  none  present- 
ing the  anatomical  features  of  the  case  here 
recorded,  though  such  must  exist. -'^ 

The  patient,  L.  F.,  sixty-five  years  o'd,  was 
received  into  the  General  Hospital,  under  Dr. 
Molson,  upon  October  3rd,  in  a  state  of  Femi- 
coUapse.  All  that  could  be  ascertained  as  to 
his  previous  history  was  that  for  the  past 
four  or  five  days  he  had  been  suffering  from 
pain  in  tiie  epigastrium,  thirst,  lesiussness  and 
pains  in  the  joints.  He  died  within  twenty-fours 
hours,  before  time  had  been  allowed  for  a  full 
diagnosis.  The  pulse  was  almost  impercepii- 
ble,  there  was  a  large  area  of  cardiac  dullness, 
the  heart  sounds  could  scarcely  be  heard,  while 
no  murmur  could  be  detected.  Over  the  region 
of  the  liver  in  front  there  was  acute  pain  upon 
pressure.     The  respiratory  sounds  were  tubular. 


"  Petri,  Dissertation,  Benin.  186S,  quotes  a  case  of 
sub-diaphragnialic  peiforaiion  of  tlie  cesophagus  follow- 
ing upon  canci.r,  but  of  llie  extent  of  llie  succeeding  in- 
flammation 1  cannot  cle.irly  learn,  not  hiving  llie  original 
by  me- 


k  provisional  diagnosis  was    made  of  pericar- 
ditis. 

At  the  autopsy  performed  upon  October  5th, 
the  following  were  the  more  important  condi- 
tions observed.  The  skin  of  the  whole  body 
had  a  sliglit  yellowish  tinge.  The  pleural  cavi- 
ties contained  about  eight  ounces  of  clear  serum. 
The  lungs  were  very  oedematous,  showed  some 
slight  signs  of  anthracosis,  and  in  either  apex 
were  found  evidences  of  an  old  and  cicatrized 
tuberculous  condition.  The  pericardial  cavity 
was  enormously  distended,  the  fluid  was  milky 
with  numer  )us  flocculi  floating  therein.  The 
heart  was  covered  over  with  a  layer  of  inflam- 
mitory  lymph  ;  and  its  cavities  were  filled  widi 
well-formed  clots,  firm  and  rather  pale,  together 
with  some  fluid  blood.  The  lower  and  inner 
halfofthi  i:)arietal  pericardium  wis  thickened, 
and  upon  cutting  into  it,  down  upon  the  dia- 
])hragm  an  abscess  cavity  was  exposed  lying  be- 
tween d:aphragm  and  pericardium.  This  was  of 
irregular  shape,  and  c  jntained  a  quantity  of 
thick,  creamy  pus.  Upon  inspecting  the  abdo- 
men, a  large  abscess  was  found  b.^neath  th  ,' 
diapliragm,  having  in  its  centre  the  abdominal 
end  of  the  oesophagus  and  the  cardiac  end  of 
the  stomach.  This  extended  to  the  left  ed,4e 
and  under  the  surface  of  the  left  lobe  of  the  liver 
on  the  one  side  ;  on  the  other  it  almost  touched 
the  splenic  flexure  of  the  colon  and  the  surface 
of  the  spleen.  It  was  filled  with  a  thinner  greyish 
pus,  and  communicated  through  the  diaphragm 
with  the  supra-dia|)hragmatic  abscess.  The  car- 
diac orifice  of  the  stomach  was  discovered  to  be 
greatly  stenosed  and  ulcerated.  Further  inspec- 
tion revealed  that  there  was  a  ring  of  cancer- 
ous growth  implicating  the  gastric  mucous 
membrane,  and  forming  a  ring  varying  in 
breadth  from  2  to  3  cm.  around  the  cardiac 
orifice;  the  growth  extended  a  short  distance 
up  the  oesophagus.  Microscopical  examination 
showed  the  cancer  to  be  primarily  gastric  — 
that  it  is  to  say,  it  was  of  the  nature  of  a  co 
lumnar-celled  carcinoma.  It  infiltrated  all  the 
I  coats  of  the  stomach. 

No  actual  peifora: ion  of  the  stomach  or 
oesophagus  was  to  be  discovered. 

It  would  seem  evident  that  the  history  of  the 
ca^e  was  one  jjrimarily  of  cancer  of  the  cardiac 
orifice  of  the  stomach  leading  to  stenosis  ;  ulcer- 
ation of  the  cancer,  and  extension  of  the  septic 
process  through  to  the  serous  surface  of  the 
organ — or,  it  may  have  been,  perforation  above 
the  stenosed  area  by  a  fish  bone  or  other  fine 
spicule,  the  passage  closing  behind  the  foreign 
body  ;  suppuration  around  the  termination  of 
the  oesophagus  leading  to  a  sub-diaphragmatic 
abscess  ;  extension  of  the  process  through  the 
diaphragm  ;  inflammation  of  some  little  stand- 
ing of  the  outer  layers  of  the  parietal  ])ericar- 
diuiii ;  extension  through  the  pericardium  ; 
purulent  pericarditis;  death. 

ludging   from  the  condition  of  the  sub-dia- 


THE   CANADA   MEDICAL   RECORD. 


I6l 


l)liragmatic  abscess,  and  llie  want  of  the  well  de- 
fined boundary,  tin's  j-iad  of  late  been  extending 
rapidly. 

There  is  a  jiossibie  alternative  that  the  su|)ra- 
diaphragmatic  abscess  with  its  mure  creamy 
pus  was  of  the  earlier  origin,  hut  this  I  think  is 
imp;obable.  The  presence  of  the  gastro-oeso- 
pliageal  carcinoma  in  such  characteristic  rela- 
tionship to  tlie  surrounding  sub-diaphragmatic 
abscess  renders  the  former  the  more  likely 
course  of  events. 

Papillomatous  Cyst  of  the  Ovary  —  Ova'  io 
Hysterectomy — Dr.  Lapthorn  Smith  showed 
tliis  specimen  which  he  had  removed  from 
Mrs.  E.,  aged  30.  Enlargement  of  the  abdo- 
men was  first  noticed  by  her  husband  on  their 
wedding  day,  and  wrongly  attributed  to  preg- 
nancy. Examination  showed  that  the  uterus 
was  not  enlarged,  but  that  the  whole  of  the 
pelvis  was  occupied  by  a  large  cystic  tunioi . 
After  a  few  weeks  preparatory  treatment, 
la])arotoniy  was  performed  on  4tii  Oct.,  1893. 
The  lower  part  of  the  cyst  was  adherent  to  the 
Douglas  fossa.  The  uterus  was  removed  with 
the  tumor  at  the  level  of  the  internal  os. 
The  abdomen  was  flushed  with  water  at  100'' 
F.,  and  drainage  tijbe  inserted.  The  patient 
made  an  excellent  recovery.  The  tumor  is  n 
multilocular  cyst  of  the  left  ovary,  the  inner 
surface  covered  with  warty  growths.  Both 
ovaries  and  uterus  closely  adherent  and  the 
line  of  separation  is  difficult  to  deteimine. 
Fallopian  tubes  were  free. 

Dr.  WvATT  JoH.vsTOM  showed  the  inferior 
maxilla  of  a  drowned  woman  pronounced  by 
coroner's  jury  to  be  a  girl  of  18,  missing  for 
some  months,  and  was  claimed  as  identified 
by  an  article  of  jewellery.  The  wisdom  teeth 
in  this  case  were  fully  developed,  and  corres- 
ponded with  those  of  persons  thirty  years 
of  age ;  a  malformation  of  the  bicuspids  de- 
scribed in  the  missing  girl  was  also  present  in 
the  specimen,  but  it  was  in  all  probability  a 
case  of  mistaken  identity  in  spite  of  the  coin- 
cidence of  the  jewellery  and  malformation  of 
the  teeth. 

Saline  enemata  in  post-partuni  hemorrhage 
— Dr.  John  A.  Hutchinson  related  the  case 
as  follows  : 

I  wish  here  to  refer  to  a  case  of  severe  post 
partum  haemorrhage  occurring  in  practice  a 
short  time  ago,  which  illustrates  the  beneficial 
effects  of  saline  enemata : 

I  was  called  late  one  night  to  see  Mrs.  S., 
who  had  an  abortion  at  the  second  month,  and 
had  bled  profusely  for  several  hours.  On  ex- 
amination she  was  found  to  be  much  collapsed, 
and  presented  the  appearance  of  one  near 
death  from  loss  of  blood.  She  was  very 
blanched  and  aniemic,  with  a  pulse  of  1 40, 
weak  and  thready,  sighing  respiration  and  par- 
tially unconscious.  The  bleeding  had  stopped, 
but  there  was  danger  of  death  unless  something 
was  done  to  aid  the  circulation. 


It  seemed  a    Hivorable  case  for  transfusion, 
and  I  spoke    to  Dr     Roddick    v  ith    a  view  to 
having  this    done.     He  advised,  before  doing 
this,  to  try  saline  enemata.     This    I  did,  and 
used  the    same    solution    as    is    now    used  for 
transfusion  into  a  vein  or  artery,  that  is,    . 
Sodium  chloride  grs.  xcii. 
Liquor  soda  mxx 
Aqua  O  ii 

Half  of  this  solution  was  injected  and  well 
retained,  and  in  two  hours  after  the  other  pint 
was  given  and  retained. 

The  tempeiature  of  the  solution  was  gS'^F. 

The  hips  were  raised  to  allow  the  fluid  to 
gravitate  up  the  bowels. 

A  marked  improvement  resulted,  both  in 
pulse  and  respiration.  A  slight  rigor  ensued, 
follovedby  rise  of  temperature.  Since  that 
time  the  patient    has  made   a   good  recovery. 

The  advantage  of  tiiis  treatment  over  trans- 
fusion is  very  apparent,  in  the  fact  that 'it  can 
be  done  at  once,  as  tne  solution  is  easily 
obtained,  and  also  easily  administered,  while 
there  is  some  danger  in  transfusion,  particularly 
as  air  may  get  into  the  vein  or  artery.  Again, 
it  requires  some  training  in  manipulation  that 
the  every  day  practitioner  may  not  have,  and 
the  necessary  instruments  are  not  always  at 
hand  when  wanted. 

Since  this  case  occurred,  I  find  in  the  British 
Med.  Journal  of  the  14th  of  October,  that 
Warman  reports  the  treating  ot  28  cases  of 
post-partum  ha^aiorrhage  in  this  way.  In  his 
cases  he  only  uses  a  teaspoonful  of  salt  to  a 
quart  of  water,  and  at  the  temperature  of  the 
room,  which  he  thinks  causes  it  .  to  have  a 
more  rapid  effect  than  at  a  higher  temperature. 

He  also  states  that  the  saline  solution  has 
marked  haemostatic  properties,  and  recom- 
mends its  use  in  all  haemorrhages  except  those 
from  intestines. 

I  have  reported  this  case  because  I  think 
that  in  emergencies  of  this  kind,  this  treatment 
has  not  received  the  attention  its  importance 
demands.  Most  cases  are  treated  by  stimu- 
lants and  nourishment,  if  transfusion  is  not  done  ; 
but  by  the  absorption  of  this  saline  in  the 
bowel,  the  blood  vessels  are  quickly  supplied 
with  a  solution  that  certainly  takes  the  place 
of  the  lost  blood  at  a  critical  time  for  the  patient. 

Hibernation  and  allied  states  in  Animals 
and  Man — Dr.  Mills  read  a  paper  on  the 
subject,  published  in  the  transactions  of  the 
Royal  Society  of  Canada,  1892,  Section  IV, 
page  49. 

Besides  studying  cold-blooded  animals  and 
bats.  Dr.  Mills  had  made  observations  extend- 
ing over  a  period  of  five  years  on  woodchucks, 
one  of  which  presented  a  drowsy  or  torpid 
condition  from  November  to  April,  indepen- 
dently of  conditions  of  food  and  warmth.  An- 
other woodchuckdid  not  hibernate  at  all,  even 
when  kept  in  the    cold.     Three  remarkable  in- 


i6: 


THE   CANADA   MEDICAL   RECORD. 


stances  of  profound  lethargy  in  the  human 
subject  were  aKo  studied  under  th.e  direction 
of  Dr.  Mills.  One  of  these,  known  as  Sleepy 
Joe,  aged  60,  would  sleep  for  weeks  at  a  time, 
waking  only  to  take  food  and  void  his  excre- 
tions. Another  case,  that  of  John  T.,  of  a 
neurotic  family,  had  been  the  subject  of  melan- 
cholia. For  tlie  past  twenty  years  he  \\  mained 
in  a  somnolent  condition  from  September  to 
June  in  each  year.  His  temperatuie  was  ob- 
served to  be  96°  on  one  occasion.  Once  he 
was  aroused  by  application  of  an  electric  bat- 
tery, but  subsequently  this  failed  to  disturb 
him.  The  third  case  was  studied  with  Dr. 
Clark,  of  Kingston  Asylum.  The  patient,  a 
woman  of  over  60.  was  lethargic  for  nearly  20 
years.  Appetite  was  usually  good.  The  urine 
contained  one-tliird  the  normal  amount  of 
phosphates.  An  autops)  was  obtained,  the 
brain  being  found  hecithy.  The  lungs  con- 
tained tubercles. 

The  discussion    upon  this  paper  was  post- 
poned till  the  next  meeting. 


Stated  Metting,   i-jth  Nov..  1893. 
James  Bell,  M.D.,  President,  in  the  Chair* 

Dr.  George  Villeneuve  and  Dr.  R.  Tait  Mac- 
kenzie were  elected  members. 

Pyloroplasty — Dr.  Shepherd  exhibited  a 
patient  from  the  Montreal  General  Hospital, 
upon  whom  he  had  pei formed  pyloroplasty  in 
July  last.  A  diagnosis  of  dilatation  of  the 
stomach  with  stenosis  of  the  pylorus  had  been 
made  by  Dr.  Wilkins.  There  was  a  history  of 
stomach  trouble  for  15  years,  consisting  in 
recurrent  attacks  of  gastritis  lasting  from  two 
weeks  to  two  months,  with  occasional  vomiting 
of  blood;  between  these  attacks  he  enjoyed 
fair  health.  Three  months  before  entering 
hospital  he  had  an  attack  of  gastritis,  which 
was  not  recovered  from  as  usual,  the  stomach 
having  apparently  lost  the  power  of  passing 
solid  food  on  to  the  duodenum,  so  that  liquid 
food  only  could  be  employed  ;  afier  a  time  this 
was  also  rejected,  vomitmg  occurring  in  enor- 
mous quantities  at  intervals  of  two  to  three 
days.  On  entering  hospital  lie  weighed  only 
119  pounds.  Dr.  Shepherd  performed  the 
Heinicke-Mikulicz  operation  of  resecting  the 
scar  tissue  about  the  duodenum  and  bringing 
together  the  healthy  tissues  of  the  duodenum 
and  stomach,  rather  than  the  Italian  or  Loretti 
oi)eration  of  forcibly  dilating  the  pyloric  orifice. 
At  the  operation  the  pylorus  was  involved  in 
a  huge  fibrous  mass,  looking  like  scirrhus,  the 
orifice  being  too  much  constricted  to  admit 
the  point  of  the  little  finger.  For  six  days 
after  the  operation  the  man  was  fed  by  the 
bovr-el ;  afterwards,  fluid  nourishment  was  al- 
lowed by  the  mouth,  and  a  few  days  later  he 
was     allowed    ordinary    diet,    but    cautioned 


against  excess.  His  weight  was  now  179  lbs., 
or  a  gain  of  60  lbs.  from  the  time  of  entering 
hospital.  The  pylorus  appeared  to  be  acting 
normally.  No  vomiting  had  occurred  since  the 
operation.  The  highest  temperature  observed 
was  99  3-5.  Before  operation  the  stomach  was 
repeatedly  washed  out  with  boracic  lotion,  as 
salic\lic  lotion  was  considered  dangerous. 

Discussion — Dr.  Wilkins  said  that  while 
under  his  care  the  patient  had  not  improved 
on  a  peptonized  diet.  He  had  satisfied  him- 
self that  the  disease  was  non-malignant  and  was 
due  simply  to  the  cicatrization  of  an  ulcer.  This 
diagnosis  lias  been  confirmed  by  the  increase 
in  weight  since  the  operation.  He  congra- 
tulated Dr.  Shepherd  on  the  result. 

Dr.  Wesley  Mills  said  the  persistence  of 
vomiting  showed  that  anti-peristalsis  of  the 
stomach  took  place.  The  history  did  not 
clearly  show  whether  the  increase  in  weight 
was  due  to  increased  ingestion  of  food  or  im- 
proved powers  of  abs(jrption. 

Carcinoma  of  the  sudoriparous  glands — Dr. 
C,  F,  Martin  showed  this  specimen  : 

The  patient  from  whom  the  above  growth 
was  removed  was  a  contractor,  45  years  of  age, 
having  a  history  of  previous  good  health,  with 
the  exception  of  occasional  attacks  of  dyspepsia. 
No  history  of  syphilis,  nor  was  there  any  family 
history  of  cancer  or  other  tumor. 

Early  in  1890,' the  patient  observed,  for  the 
first  time,  a  small  lump  in  the  left  groin,  in  size 
equal  to  a  bean,  perfectly  painless,  which  he 
attributed  to  a  blow  received  in  this  region  some 
months  previously. 

The  growth  was  regarded  as  some  affection 
of  the  sebaceous  glands,  and  no  treatment 
other  than  the  application  of  iodine  was  adopt- 
ed for  over  a  year,  there  l)eing  no  appreciable 
alteraiion  in  the  character  of  the  tumor  during 
that  time. 

Towards  the  end  of  1892  it  gradually  in- 
creased in  size,  and  was  now  for  the  first  time 
painful,  the  patient  at  times  suffering  intensely. 
The  skin  too  showed  signs  of  irritation,  and  be- 
came adherent  to  the  growth.  This  condition 
became  progressively  worse,  and  removal  was 
recommended,  and  performed  November,  1893, 
by  Dr.  Roddick,  who  forthwith  sent  the  tumor 
to  the  McGill  Pathological    Laboratory. 

On  examination  the  growth  was  found  ir- 
regularly spherical  in  shape,  i^  inches  in 
diameter.  On  section  it  offered, considerable 
resistance  to  the  knife,  while  on  the  cut  surface 
were  seen  numerous  small  points  from  which 
a  greyish  turbid  fluid  escaped.  This  fluid, 
examined  under  the  microscope,  presented 
masses  of  irregularly  rounded  or  oval  cells, 
slightly  larger  than  pus  cells,  and  many  under- 
going fatty  and  granular  degeneration. 

Stained  sections  of  the  tumor,  cut  so  as  to 
include  the  adherent  skin,  showed  the  epider- 
mis to  be  only  slightly  affected,    there  being 


THE   CANADA    MEDICAL   RECORD. 


163 


but  a  slight  proliferation  of  tlie  epitheliiur, 
while  beneath  it  was  incrcAse.l  fibrous  tissue, 
a  condition  of  chronic  inflammation.  Bjneath 
this,  in  the  subcutaneous  tissue,  was  seen  the 
tumor  pioper,  presenting  the  usual  a|)pearance 
of  a  simple  carcinoma  ;  masses  of  large  irreg- 
ular cells  amid  extensive  areas  of  fibrous  tissue, 
in  an  alveolar  arrangement. 

On  closer  inspection  of  the  parts,  it  was 
found  that  the  growth  took  its  origin  from  the 
epithelial  lining  of  the  sudoriparous  glands,  in 
whose  ducts  could  be  seen  the  various  stages 
of  proliferation  of  cells,  while  in  the  neighbor- 
ing regions  were  the  appearances  of  an  alveolar 
cancer.  The  sebaceous  glands  presented  no 
abnormal  appearance,  nor  wcs  there  any  evi 
dence  to  p  )int  to  the  origin  of  the  tumor,  other 
than  that  suggested. 

Although  many  cases  of  adenoma  of  the 
sw^at  glands  are  said  to  have  been  falsely  re- 
garded as  carcinomatous,  there  is,  however, 
in  the  present  instance  so  typical  an  appearance 
of  an  alveolar  carcinoma  that  such  an  error  is 
quite  impossible,  and  the  tumor  cannot  be 
regarded  other  than  as  a  cancer  arising  from 
the  sudoriparous  glands. 

Dr.  Ad.-vmi  stated  that  the  tumor  had  at 
first  been  regarded  by  Dr.  Roddick  as  an  en- 
larged sebaceous  gland.  Subsequently  a  diag- 
nosis of  epitheliom  i  was  made.  He  had 
recently  shown  an  analogous  case,  when  what 
looked  Hkean  epithelioma  of  tiie  tongue  proved 
to  be  a  scirrhus  arising  from  some  of  the  muci- 
parous glands  of  that  organ. 

Chronic  abscess  of  bone — Dr.  Au.a.mi  showed 
a  knee  joint  resected  by  Dr.  Armstrong  at  the 
Montreal  General  Hospital  during  the  past 
summer.  The  patient  apparently  recovered, 
but  sinuses  formed,  and  kept  on  discharging  in 
increasing  quantities.  The  man  became  ema- 
ciated. Amputation  was  performed  by  Dr. 
Sutherland  two  weeks  ago.  Union  was  pretty 
well  advanced,  but  was  entirely  fibrous  in 
nature.  There  was  still  a  slight  movement 
between  the  bones.  On  making  a  section,  a 
number  of  small  abscesses  connecting  with  one 
another  were  found  situated  in  the  lower 
extremity  of  the  femur,  and  connected  with  the 
region  between  the  two  bones  from  whence 
they  discharged.  No  tubercle  bacilli  were 
found.  The  condition  appeared  to  be  one  of 
chronic  suppuration.  The  question  was  whe- 
ther these  abscesses  were  the  result  of  old  foci 
of  disease  not  detected  at  the  time  of  operation. 

Dr.  Armstrong  stated  that  the  patient,  a 
lumberman  about  35  years  of  age,  had  sustained 
some  slight  injuiy  of  the  joint,  but  was  able  to 
continue  work  for  about  six  months.  The 
joint  was  then  found  swollen  and  painful,  and 
evidently  extensively  diseased.  Immobiliza- 
tion of  the  limb  was  tried  without  benefit,  and 
so  Dr.  Fenwick's  excision  operation  was  per- 
formed.    Some   sinuses  which  persisted  were 


scraped  under  ether  two  or  three  tini-'s,  without 
benefit.  He  was  surprised  to  lean  that  no 
tubercle  was  fo m  J,  as  at  the  time  of  excision 
the  joint  had  all  the  naked  eye  appaaraices  of 
tuberculous  disease. 

Drf  Bell  suggested  the  possibility  of  the 
condition  being  originally  tuberculous,  the 
bacilli  having  subsequently  become  destroyed. 
He  was  of  opinion  that  the  abscesses  were 
the-e  at  the  time  of  operation,  but  did  not 
communicate  wiih  the  joint.  All  surgeons 
know  that  when  a  thin  slice  is  sawn  off  the  end 
of  a  bone,  liitle  foci  of  disease  are  noticed  in 
the  new  surficeexp  ised.  Had  always  thought 
it  strange  that  more  of  these  little  pockets  did 
not  lie  higher  up  in  the  bone  ;  in  this  case  it 
looked  as  if  they  had. 

Dr.  Shephe-^d  thought  that  the  abscesses 
were  present  at  the  time  of  operation.  The 
pain,  at  the  time,  was  much  more  severe  thin 
seemed  called  for  by  the  extent  of  the  joint 
disease. 

Tuberculosis  of  the  Liver  and  Oviduct  of  a 
Pigeon — Dr.  Wesley  Mills  exhibited  the 
specimen,  showing  what  extensive  disease 
could  exist  in  domestic  animals  in  apparent 
good  health.  The  bird  seemed  quite  well  till 
a  few  days  before  its  death. 

The  discussion  was  postponed  pending  a 
report  from  the  pathologist. 

Pyosalpinx  and  Gonorrhceal  Arthritis  — Dr. 
Lapthorn  Smith  exhibited  a  specimen  of 
double  pyos.ilpinx  in  a  woman  aged  42,  suffer- 
ing from  gonorrheal  rheumatism  of  the  right 
knee  joint.  The  patient  had  been  ill  ever  since 
her  marriage,  10  years  before.  Examination 
showed  the  uterine  appendages  filling  Douglas 
pouch  and  forming  a  tender  flictuating  miss 
the  size  of  an  orange.  While  in  hospital,  pre- 
paratory to  operation  in  June,  1893,  she 
suddenly  developed  high  fever,  swelling  of  the 
first  joint  of  the  right  fore-fingjr  and  scalding 
in  micturition.  Next  day  the  right  knee  be- 
came swollen  and  p  linful.  There  was  a  yellow 
purulent  discharge  from  the  urethra  and  vulva 
vaginal  glands.  Exploratory  puncture  of  the 
knee-joint  yielded  an  opalescent  serum  This 
was  not  examined  for  gonococci.  After  seven 
weeks  the  joint  was  still  stiff  and  painful. 
Temperature  then  normal.  In  October,  1893, 
coeliotomy  was  d  me  and  the  appendages  re- 
moved. The  tubes  were  found  distended  with 
p.is  and  closely  adherent.  Recovery  was 
good.  The  operation  was  followed  by  marked 
improvement  of  the  knee  joint,  and  the 
patient  made  a  rapid  recovery.  'I'he 
husband  admitted  having  recurrent  attacks  of 
gonorrhoea,  the  last  occurring  shortly  before 
tlie  wife  developed  the  above-mentioned  arthri- 
tic attack.  The  gonorrhceal  infection  prob^ 
ably  affectedthe  parenchyma  of  the  uterus, 
which   should     really    have    l)een   extirpated. 


164 


THE   CANADA    MEDICAL   RECORD. 


Dr.  Allowav  said  he  differed  from  Dr. 
Smith  as  regards  the  interpretaiion  of  ihe  mtt- 
astasis.  He  tlioiight  the  disease  of  the  knee- 
ioint  not  goiiorrhceal,  but  p)  remic,  and  that  the 
subsequent  occurrence  of  inflammation  in  the 
finger  joints  confirmed  this  view.  He  had 
seen  several  times  metastasis  of  tliis  nature 
following  pelvic  disease.  In  one  case  seen 
with  Dr.  Shepherd,  where  there  was  suppura- 
tion of  both  knee  joints,  the  remains  of  a  ne- 
crotic placenta  were  fuund  in  the  uterus.  On 
scraping  the  uterus  the  patient  recovered.  He 
did  not  think  the  joint  disease  in  Dr.  Smith's 
case  "was  due  to  the  gonococcus. 

Dr.  Smith  in  reply  stated  that  if  his  case 
had  been  pya^mic,  pus  would  have  been  found 
in  the  joint,  instead  of  only  an  opalescent  fluid. 
He  had  himself  thought  of  pyaemia,  but  the 
fact  of  the  pus  tubes  having  been  there  for  ten 
years  without  any  metastasis,  and  the  knee 
affection  appearing  after  an  attack  of  gonorr- 
hoea made  him  change  his  opinion. 

Discussioii  on  Dr.  Mills'  paper  on  Hi- 
bernation— Dr.  F.  W.  Campbell  mentioned  a 
case  of  duodenal  ulcer  where  the  subjective 
symptoms  had  disappeared  under  the  mental 
condition  induced  by  a  favorable  (though 
wrong)  diagnosis  being  given,  and  had  returned 
again  only  when  the  correctness  of  the  diag- 
nosis was  insisted  upon,  'i  he  diagnosis  was 
confirmed  bv  autopsy.  The  mental  condition 
seemed  to  determine  whether  pain,  etc.,  was 
felt  or  not. 

Dr.  GiRDwooD  told  of  the  doings  of  two 
woodchucks  formerly  in  his  possession.  These 
animals  did  not  hibernate. 

Dr.  Adami  asked  if  Dr.  Mills  had  tried  the 
experiment  of  feeding  the  animals  abundantly. 
Dr.  Mills,  in  reply,  stated  that  he  had  not 
been  able  to  prevent  hibernation  by  good  feed- 
ing. He  referred  to  some  interesting  work  by 
Carlier  on  the  histology  of  the  hedge-hog, 
showing  that  the  tissues  during  hibernation 
differed  from  these  in  the  normal  state  in  the 
following  particulars: — (1)  They  were  less 
readily  acted  on  by  nuclear  stains.  (2}  The 
cells  were  smaller.  (3)  The  leucocytes  of  the 
blood  were  diminished  in  number.  This  latter 
point  would,  theoretically,  make  the  animal 
more  susceptible  to  infection  than  when  not 
hibernating.  His  object  in  making  these 
studies  was  to  see  if  a  general  law  of  relation 
could  be  established  between  hibernation  and 
sleep.  It  was  possible  that  prima;val  animals 
lived  in  a  state  analagous  to  hibernation. 

Statistics  of  Homicide  in  American  cities — 
Dr.  Wyatt  Johnston,  who  read  a  1  aper  on 
this  subject,  had  found  the  annual  number  of 
homicides  (including  manslaughter  and  infan- 
ticide) per  10,000  living  to  be  ajjproxiraately 
*s  follows:  Central  Distiict  of  London,  .15; 
Vienna  .18;  Paris,  .19;  Philadelphia  and 
Liverpool,   .22;  Montreal,    .24;  Buffalo,   .2,2,  \ 


New  York,  .35;  Boston,  .43;  Toronto,  .50  ; 
Pittsburg;  .51;  Chicjgo,  .65;  Cleveland,  .66  j 
Birmingham,  .89;  St.  Louis,  1.38;  Louisville, 
1.58  ;  Charleston,  2.00.  These  estimates  were 
based  on  the  findings  of  inquests,  not  of  trials. 
The  greater  proportion  of  homicides  occurred 
in  the  Southern  States,  where  a  large  and  law- 
less negro  element  existed  and  where  concealed 
weapons  were  habitually  carried.  The  ap- 
parent low  homicide  rate  in  great  European 
cities  was  a  matter  of  surprise.  The  low  rate 
in  Montreal  might  be  due  to  the  peaceable 
character  of  the  people  and  the  absence  of 
concealed  weapons  rather  than  to  cases  being 
overlooked,  as  in  other  cities  the  majoiity  of 
homicides  were  from  such  easily  recognized 
causes  as  cuts,  blows  and  stabs.  Abortion 
and  poisoning  were  forms  likely  to  be  over- 
looked, and  a  proper  system  of  death  certifica- 
tion would  be  a  gieat  check  upon  homicides  of 
this  kind.  In  Boston  a  system  of  investigation 
of  all  deaths  from  peritonitis  in  all  women  of  the 
child-bearing  age  had  led  to  the  detection  of 
many  cases  of  abortion  previously  unnoticed. 

Mr.  QuiNN,  Q.C.,  Crown  Prosecutor,  who 
was  present,  said  he  thought  the  composition 
of  coront^rs'  juries  in  various  places  would  tend 
to  affect  tlie  statistics.  A  low  status  of  jury 
would  lessen  the  number  of  homicide  verdicts. 
Montreal  juries  rarely  gave  a  verdict  in  accor- 
dance with  the  evidence.  In  the  case  of  large 
cities  like  London,  many  homicides  probably 
occurred  when  the  bodies  were  never  found, 
and  this  might  partly  explain  the  apparently 
low  proportion.  The  means  of  concealing 
crime  increased  with  the  population.  He  had 
leason  to  believe  that  abortion  is  more  common 
in  Montreal  than  was  supposed.  The  criminal 
death  rate  reported  in  Montreal  was  not  the  true 
one.  All  deaths  should  be  reported  to  the 
health  oft'ce,  and,  unlesspropeily  accounted  for, 
the  matter  should  be  placed  in  the  hands  of  a 
medical  officer,  for  thorough  medico-legal  in- 
vestigation.- 

Dr.  GiRDWooD  agreed  with  Mr.  Quinn,  as  to 
death  certification.  In  the  Hooper  case,  a 
certificate  was  obtained  from  a  physician  who 
knew  nothing  about  the  woman  or  the  death. 
No  man  should  give  a  certificate  unless  he  had 
seen  the  person  during  life  01  had  made  some 
diagnosis. 

Dr.  Shlphekd  believed  that  many  cases 
reported  as  stillbirth  were  really  cases  of  infan- 
ticide. 

Death  Certification. — The  Secretary  read  a 
communication  from  Dr.  Labekge,  city  health 
officer,  asking  for  the  co-operation  of  the  Soci- 
ety in  securing  an  amendment  to  the  city  charter 
in  the  matter  of  certification. 

Dr.  Laberge's  letter  pointed  out  that  a  death 
certificate  could  be  given  by  any  relative  or 
friend  of  the  deceased,  practically  by  anyone 
at  all.     It  was   essential  that  these  certificates 


THE   CANADA   MEDICAL   RECORD. 


165 


should  only  be  signed  by  properly  qualified 
medical  men,  and  that  the  matter  of  deciding 
ivhelher  the  qualifications  of  the  signer  were 
satisfactory  and  the  certificate  properly  niade 
out,  as  regards  nosology,  should  be  left  to  C")m- 
peient  persons,  in.-tead  of,  as  at  present,  to  su- 
perintendents of  cemeteries,  whose  education 
hardly  fitted  ihem  for  these  important  duties. 

Upon  moti(  n  of  Dr.  F.  \V.  Ca.mpbei.l.  it  was 
resolved  to  refer  the  matter  to  the  council  of 
ti.e  Society,  and  such  oiher  persons  as  the 
council  might  select,  with  power  to  give  Dr. 
Laberge  such  advice  and  a-:sistance  as  seemed 
necessary. 

jprot^rcBS    of    ^cicnce. 

HERNIA  IN  CHILDREN. 
Wirt  {International  Medical  Magazine, 
February,  1894),  in  an  excellent  contribution 
on  hernia,  gives  the  following  table  of  the  rela- 
tive fre(|uency  of  ihe  different  forms  of  hernia  as 
found  in  19.756  cases  ireatcdin  the  Hospital  for 
IUii)iured  and  Crippled,  New  York  City  : 


Inguinal. . 
Umbilical. 
Femoral.  . 
Venlial.  . . 


Total..  19,756 


i)       ;    ^ 


14,9941 1X70 

569    919 

418,    717 

95    '74 


4348 

789 
26 

•3 


7H06 


8506 


4375 
379 

4754 


4686' 
56 


16,07613680  '  5176 

He  classifies  treatment  under  three  heads  : 
r.  General  treatment;  2.  Mechanical  support; 
3,  Operative  measures. 

Gmeral  treatment  is  directed  toward  the 
relief  of  the  conditions  causing  the  hernia,  as 
vomiting,  coughing,  calculus,  a  rectal  polypus, 
or  chronic  diarrhoea,  or,  when  necessary,  to 
tonic  treatment,  out-dcor  exercise,  etc. 

Mechanical  treatment  as  given  in  the  Hos- 
pital for  Ruptured  and  Crippled,  consists  in 
using  a  steel  spring  truss  for  all  reducible  cases 
except  umbilical  and  ventral.  The  Knight 
truss  is  used  most,  and  is  efficient  and  cheap. 
In  cases  cifficuh  to  hold,  the  Hood  truss  is 
employed,  and  in  the  worst  cases  a  combina- 
tion of  the  Knight  and  Hood. 

Umbilical  herni^e  are  treated  by  means  of  a 
wooden  button  held  in  place  by  rubber  ad- 
hesive plaster. 

Operation  for  hernia  requires  strict  anti- 
septic precautions,  great  care  in  dissecting  out 
the  sac  and  handling  of  the  su])ermatic  cor^l. 
The  sac  should  be  tied  off  well  down  in  the 
wound,  the  external  portion  removed,  and  the 
siumj)  returned  into  the  abdominal  caviiy. 
The  wound  should  be  closed  and  dressed  anti- 
septically,  and  over  all  a  plaster-of-Paris  spica 
should  be  applied  from  aiikle  to  umbilicus. 
The  casing  should  be  removed  in  eight  days, 
and  the  wound  then  dressed. 


THE  CANADA  MEDICAL  RECORD 

PuULISntU   MOMHLV. 


Sitl'S  li/'li'iji  J'rice,  $2.00  per  annum  in  ahance.      Stnt/le 
CopieK,  "id  c/k. 

EDITORS : 
A.  LAPTHORN  SMITH,  BA ,,  M.D.,  M.RC.S.,  Eng.,  F.O-S . 

London 
F.  WAYLAND  CAMPBELL,  M-A  ,  M.D.,  L.R.CP  ,  London 

ASSISTANT  EDITOH 
ROLLO  CAMPBELL,  CM.,  M.D. 

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exchanges  should  be  addressed  to  the  Editor,  Dr.  Lapthorn 
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Editor. 


MONTEEAL,  APRIL,  1894. 


THE  PHYSICI.\N'S  WIFE. 

We  thought  we  knew  something  abou\  the 
doctor's  wife ;  but  after  having  read  a  charming 
little  book  entitled  "  The  Physician's  Wife  and 
the  Things  that  pertain  to  lier  Life,"  by  Ellen  W. 
Firebaugh,*  we  must  C(;nfess  that  we  had  only 
a  very  faint  idea  of  all  the  beauties  of  her  char- 
acter. The  author  in  the  most  natural  and 
modest  manner  tells  her  own  feelings,  which  are 
1  robably  the  feelings  of  a  majority  of  her  sis- 
ters, amidst  all  the  vicissitudes  of  pleasure 
and  sorrow  which  go  to  make  up  the  daily  life 
of  the  country  doctor.  Xo  doctor  or  doctor's 
wife  can  read  this  book  without  exclaiming  at 
ahnost  every  page  :  "  How  true  to  life  the  de- 
scription is.''  Whether  it  is  her  efforts  to  keep  the 
doctor's  dinner  hot  without  spoiling  it ;  or 
talking  care  of  the  doctor  when  he  is  sick, — one 
of  the  most  difficult  tasks  she  has  to  perform  ; 
or  whether  she  is  describing  a  sick-bed  scene 
among  the  poor ;  or  her  fenr  and  trembling  at 
being  left  alone  in  the  house  while  the  doctor 
is  answering  a  midnight  sick  call,  her  descrip- 
tions are  always  graphic  and  interesting. 
Many  of  them  are  illustrated  with  sketches 
which  bring  them  still  more  home  to  ourselves. 
One  picture  shows  the  doctor's  first  meeting 
the  little  girl  who  is  to  be  his  future  wife ; 
another,  the  doctor  and  his  wife  in  their  easy 
chairs  drawn  close  to  the  grate  fiie,  and  enjoy- 


*Publibhed  by  F.  A.  Davis  *S>=  Co.,  Philadelphia, 


1 66 


THE   CANADA   MEDICAL   RECORD. 


ing  an  all  too  brief  rest  after  the  labors  of  the 
day  have  been  concluded,  and,  we  might,  add, 
before  the  labors  cf  the  night  begin,  'ihen  we 
see  the  doctor  at  the  dinner  table  wiih  a  couple 
of  medical  friends  beside  him,  while  the  doctor's 
wife  has  to  listen  patiently  whik-  they  are  talk- 
ing '-'shop."  In  the  latter,  howi.ver,  she  soon 
becomes  very  proficit.nt,  so  that  in  her  hus- 
band's absence  she  is  often  able  to  tell  an 
anxious  patient  what  to  do  unt'l  ihe  doctor 
comes.  Tt.e  country  d  -ctor  will  especially 
appreciate  her  descriptions  of  the  difficulties  of 
collecting  a  liitle  ready  cash,  and  of  being  so 
often  paid  with  a  load  of  pumpkins  or  turnips  ; 
and  will  sympathize  with  her  when  she 
tries  in  vain  to  obtain  the  assistance  of  some 
recalcitrant  debtor  who  when  ill  expects  to 
receive  the  best  of  care  and  medicine,  but  when 
well  begrudges  the  doctor  a  day's  work  on  his 
potato  patch  or  flower  garden.  Tht  doctor's 
w.fe  sees  human  nature  very  often  from  behind 
the  scenes,  and  she  has  in  the  volume  before 
us  described  what  she  has  seen  with  an  amus- 
ing but  not  unkindly  pen.  While  it  will  be 
most  enjoyed  by  those  for  whom  it  was  written, 
the  doctors'  wives,  it  will  not  be  without  value  to 
the  doctor  himself,  who,  after  reading  it,  will  be 
ready  to  admit,  if  he  has  not  doi.e  so  before, 
that  much  of  what  he  is  or  hopes  to  be  he  owes 
to  the  tender  care  and  comi)anionship  of  his 
better  half.  M^try  a  young  d  ctor  will  be 
induced  to  risk  the  unknown  troubles  of  a 
country  doctor's  life  when  he  learns  t  lat  they 
are  so  much  lightened  by  the  assistance  of  a 
country  doctor's  wife. 


BOOK  NOTICES. 

Annual      of    hie      Universal      Medical 
Sciences,  a  yearly  report  of  the  progress 
of  the  general  sanitary  sciences  throughout 
the  world.     E  lited  by  Charles  E.  Sajous, 
M.D.,  and   seventy   associate  editors,  as- 
sisted by  over  two  hundred  corresponding 
editors,     collaborators,     and     correspon- 
dents.    Illustrated       with     chromo-litho- 
graphs,  engravings,    and   m:ips.     In    five 
volumes.       Philadelphia.    1893.     The    F. 
A.  Davis  Company,   Publishers.      Annual 
Subscription,  $15. 
We   hope  our  readers  are  fully  acquainted 
with  the  excellencies  of   this   most  excellent 
Annual.     It   is  a  store  house  of  medical  pro- 
gress, a  liuic   saver  when  hunting  information, 
and,   in  the   highest  and  best  sense,  practical. 


Tlie  volumes  of  the  sixth  series  only  serve  to 
emphasize  our  previous  opinion  of  the  value 
of  the  Annual  to  every  reading  physician. 
The  editor's  residence  in  Paris,  in  the  interests 
of  the  Annual;  has  enabled  him  to  secure  the 
assistance  of  some  of  our  more  distinguished 
associates  in  Europe  on  the  editorial  staff, 
and  in  various  ways  to  strengthen  and  improve 
the  work. 

Wiih  the  appearance  of  each  new  series  our 
admiration  increases.  As  we  have  said  before, 
we  hardly  know  which  to  admire  most,  the 
financial  courage  of  the  publishers  or  the  un- 
remitting toil  of  the  editors.  These  thousands 
of  pages  come  direct  from  the  pen  of  the 
leading  men  in  Europe  and  America,  each,  in 
his  speciality ;  how  they  manage  to  find  the 
time  to  do  it  has  puzzled  us  more  than  once. 
Those  of  our  readers  who  have  purchased  this 
work  have  told  us  that  they  were  more  than 
satisfied  with  it  ;  for  those  who  have  not  seen 
it  we  may  mention  that  it  contains  the  gist 
of  the  thousands  of  articles  which  have  ap- 
peared in  the  medical  journals  throughout 
the  world  during  the  past  year,  so  that  there  is 
hardly  a  subject  one  can  think  of  that  has  not 
been  fully  noticed  in  the  volume  before  us. 
We  hope  that  it  will  receive  such  strong  sup- 
port from  the  profession  as  to  justify  the  pub- 
lishers in  undertaking  such  a  marvellous 
work. 

How  TO  Use  THE  Forceps,  with  an  introductoiy 
account  of  the   female  pelvis  and  of   the 
mechanism    of   delivery.    By     Henry   G. 
Landers,  A.M.,  M.D.,  Professor  of  Obstet- 
rics and  Diseases  of  Women  and  Children 
in  Starling   Medical    College,    Columbus, 
Ohio.     Revised  ani   enlarged  by  Charles 
Buchong,    M.D.,    Assistant   Gynecologist 
and  Pathologist  to  Demill  Dispensary,  New 
York.      Illustrated.      New    York:    G.  B. 
Treat,    publisher,  5  Cooper   Union,  1894. 
Price,  $1.75. 
In  our  experience  the  forceps  are  used  much 
too  often  ;  only  in  exccpMonal  cases  is  the  other 
extreme  met  with  in   which  they  are  not  used 
when  they  clearly  should  be.     'I'he  work   en- 
deavors to  show  when  and  how  ihey  should  be 
used  so  as  to  do  the  least  damage. 


VenerI'.al  Memoranda.     A    Manual  for   the 
StudentandPraciitioner.  By  P.  A.  Morrow, 
A.M.,  M.D.,  Clinical  Professor  of  Venereal 
Diseases  in  the  University  of  the  City  of 
New  York.    New  York :     William    Wood 
&  Company,  1894. 
It  must   be    the  experience  of  most  practi- 
tioners that  a  great  deal    of  time  is   lost  while 
driving  along  the  country  roads  in  summer  days, 
or  while  waiting  at  a  confinement  case  during  the 
night.  That  time  might  be  well  employed  if  one 


THK   CANADA    MKHTCAL   RKCORD. 


167 


only  had  so.netliing  ill  his  pocket  to  read.  To 
fill  this  very  want  the  publishers  have  i)rovided 
this  series  of  pocket  manuals,  of  which  the 
above  is  one  of  the  most  interesting.  It  mea- 
sures les.>  than  3  by  5  inches,  but  contains  over 
300  page-,  and  it  is  surprising  how  much  profit 
one  may  derive  from  the  study  of  it  during  one's 
spnre  momcnis.  ^^'e  arc  unable  to  slate  the 
price,  but  it  is  probably  very  moderate,  and  it 
can  be  obtained  through  any  bookseller. 


SvLL-.BUs  OF  Lectures  on  the  Pi-actice  of 
Surgery,  arranged  in  conformity  with  the 
American  lext-Book  of  Surgery.     By  N. 
Senn,  M.D.,  Pn.D  ,  LL.D.,  Chicago,  Pro- 
fessor of  the  Piactice  of  Surgery  and  Cli- 
nical Surgery  in    Rush    Medical  College  ; 
Professor  of  Surgery  in  the  Chicago  Policli- 
nic; Attending  Surgeon    to    Presbyterian 
Hospital  ;   Surgeon-in  chief  St.     Joseph's 
Hospital.    Philadelphia:  W.  B.  Saunders, 
925  ^Valnut  Street,  1894.     Price  $2.00. 
Every  teacher  of  surgery  must  have  fell  the 
need  of  some  short  guide  to  aid  him  in  the  lee-   I 
ture  room  in  presenting  the  various  subjects  in 
a  systematic,  clear,  succinct  and  practical  man-   ' 
ner.     '1  he  student  of  surgery  dining  Irs  early   i 
college  experiences  is  often  bewildered  by  what 
he  hears  and  reads,  and  keenly  experiences  that   ■ 
want  of  something  which  should  enable  him  to 
separate  the  chaff  from  the  wheat,  and  to  me-   ■ 
morize  facts  which  he  is  expected  to  retain  and   i 
apply  at  the   bedside  during   his  future  profes-   | 
sional  career.  This  little  book  has  been  written    | 
to  meet  these  requirements.     Its  contents  have   ' 
been  arranged  in  conformity  with  the  American    , 
Text-Book  of  Surgery,  which  in    less    than  a    ' 
year  has  achieved  an  unparalleled  popularity,    : 
both  among  teachers  and  students.  Wherever  the    - 
text  was  found  defective  facts  have  been  added 
names  of  authors  and  operations,  while  in  other 
places  subjects  not  belonging  within  the  limits 
of  the  practice  of  surgery  have  been  excluded. 
Recitations  are   gradually  displacing  didactic 
lectures,   and  it  is  the   author's  hope  that  the 
Syllabus  will  prove  of  special  value  for  this  me- 
thod of  instruction,  as  well  as  in  the  preparation 
of  the  student  for  the  final  examinations. 


Ninth    and  Tenth  Annual   HepOi-ts  of  the 
Bureau  of  Statistics  of  Labor  of  the  State  of 
New  York  for  the  year  1891,  in  2  volumes. 
We  have  to  acknowledge  the  receipt  of  the 
above  4  interesting  volumes  from  the  commis- 
sioner, Mr.  Thos.  J.  Dowling. 


A  Practical  Treatise  on  tie  office  and 
duties  of  Coroners  in  Ontario, and  the  other 
Provinces,  and  the  Territories  of  Canada, 
and  in  the  Colony  cf  Newfi  un^Lii.d,  with 
schedules    of  fees,    and    an    appendix    of 


forms.  Third  edition.  By  William  Fuller 
Alvcs  Boys,  LL.B.,  Junior  County  Court 
Judge  County  of  Simcoe,  Ontario.  Price 
$3.50  clolh  or  $4  in  half  calf.  Toronto  : 
The  Carsweli  Co.  (Limited),  law  publish- 
ers, etc.,  1893. 
This  work  is   specially  interesting  just  now 

when  we  are  trying  to  inlpI()^c  our  Coroner's 

laws  in  this  ])rovince. 


A  Practical  Treatise  on  Nervous  Exhaus- 
tion (Neurasthenia);    its  symptoms,  na- 
ture, sequences,  treatment.  '    By    George 
M.   Beard,    A.M.,  M.D.,    Fellow    of  the 
New  York  Academy  of  Medicine ;  of  the 
New  Yoik    Academy  of  Sciences;  Vice-f 
President    of  the  American  Academy    o 
Medicine  ;  Member  of  the  Ameiican  Neu" 
rological     Association  ;  cf  the    American 
Medical  Association  ;  the  New  York  Neu- 
rological Society,  etc.     Edited,  with  notes 
and  additions,  by  A.  D.  Rockwell,    A.M., 
M.D.,     Professor  of  Electro  Therapeutics 
in  the  New  York  Post  Graduate  Medical 
School  and    Hospital;  Fellow  of  the  New 
York  Academy  ;  Member   of  the   Ameri- 
can Neurological  Association  ;  of  the  New 
York  Neurological    Society,    etc.      Third 
edition,    enlarged.       New    York:  E.    B 
Treat,    5    Cooper  Union.      1894.     Price. 
$2.75- 
Neurasthenia    is    now  almost    a   household 
word,  and,  equally  with  the  term  malaria,  af- 
fords to  the  profession  a  convenient  refuge  when 
perplexed  at  the  recital  of  a  multitude  of  symp- 
toms seemingly  without  logical  connection  or 
adequate  cause.     The  diagnosis  of  neurasthe- 
nia,  moreover,  is  often    as    satisfactory  to  the 
patient  as  it    is  easy  to  the  physician,  and  by 
no  means    helps  to  reduce    the  number    who 
have  been    duly  certified   to  as  neurasthenic, 
and  who  ever   after,  with  an  air  too  conscious 
to  be  concealed,  allude  to   themselves  as  the 
victiins  of  nervous  exhaustion.     The  doctrine 
to  be  taught    and    strongly    enforced    is  that 
many  of  these  patients  are   not  neurasthenic, 
and  under  hardly  any  conceivable  circumstance 
could    they    become  neurasthenic.      They  do 
not  belong  to    the  type  out  of  which  neuras- 
thenia is    born,  either  mentally  or  physically. 
Many  of  them  are  unintellectual,  phlegmatic, 
and  intolerably  indolent,  and  are  pleased  at  a 
diagnosis  which  touches  the  nerves  rather  than 
the      stomach,    bowels    and  liver.       Instead, 
therefore,  of  rest,  quiet,  and  soothing  draughts, 
they  need    mental  and  physical  activity,  less 
rather  than  more  food,  depletion  rather  than 
repletion. 

These  patients  are  lithsmic  and  not  neuras- 
thenic. The  nervous  system  is  strong  enough, 
and  would  give  no  trouble  were  it  not  poisoned 
by  the  abnormaljproducls  of  digestion  that  en- 


i6S 


TilE    CANADA    MEDICAL   RECORD. 


ter  ihe  blood  and  circulate  freely  through  every 
tissue  of  the  body. 

Nevertheless,  there  are  many  casei  of  gen- 
uine nervous  exliaustion  occurring  equally 
among  merchants  and  society  ladies,  whose  edu- 
cation and  mode  of  life  have  given  too  great  a 
preponderance  to  the  functions  of  the  ner- 
vous systems  to  the  neglect  ofih  ■  digestion  and 
muscular  system.  Tiiese  cases  are  generally 
exceedingly  difficult  to  manage  for  obvious 
reasons.  The  book  will  therefore  be  of  great 
value,  coming  as  it  does  from  one  who  has 
had  such  a  large  experience  with  this  class  of 
cases. 


A  Treatise  on   Headachk  and  Neuralgia, 
including  Spinal  Irritation  and  a  Disquisi- 
tion  on  Normal  and  Morbid   Sleep.     By 
J.    Leonard  Corning,   M.  \.,    M.D.,  Con- 
sultant in  Nervous  Diseases  to  St.  Francis 
Hospital;  Fellow  of  the  New  York  Aca- 
demy of  Medicine  :  Member  of  the  New 
York  Neurological  Society,    etc.     Author 
of   "A   Treatise  on   Hysteria  nnd  Epilep- 
sy," "Local  Anesthesia,"  "  Brain  Rest," 
etc.     With    an  Appendix.     Eye  Strain  a 
cause  of  Headache,    by    David   Webster, 
M.D.,      Prof,    of  Ophthalmology    in    the 
New    York    Polyclmic  ;    Surgeon  to    the 
Manhattan    Eye   and  Ear    Hospila',    etc. 
Illustrated.     Third  edition.     New   York  : 
E.  B.  Treat,  5  Cooper  Union  ;   London  : 
H.  K.   Lewis,   136  Grower   Street.     1894. 
Price  $2.75. 
The  affections    treated    of  in    the   following 
pages  have  ever  shown  a    decided  predilection 
for    the  neurotic  portion    of    our  population. 
For  tiie  great  towns  of  the  Atlantic  seaboard, 
headaches  and    neuralgias     exhibit    a  special 
])reference.     To  the    nervous  exhaustion    and 
strain  incident  to  the  irregular  mode  of  life  and 
competition   of  the  great  cities    are  due,  in  no 
small  degree,  these  head  pains  so  often  the  pre- 
cursors   of    impending    nervous     bankruptcy. 
Tiie  same   causes,  in  conjunction  with  one  of 
the  most    trying  climates    to    be  found    in  the 
whole  world,  serve  also   to  give  rise  to  a  thou- 
sand aches  and  pains,  the  most  excruciating  of 
which  are  those  neuralgias  of  the  face  that  not 
infrequently  drive    the  victim  to    suicide  or  tiie 
madhouse. 

For  several  years  past  the  author  has  de- 
voted much  time  to  the  careful  study  of  these 
prolific  sources  of  human  misery.  He  lias  not 
done  this  in  a  spirit  of  mere  pathological  ana- 
lysis ;  but  his  endeavors  have  been  of  a  prac- 
tical kind,  every  thought  being  directed  to  the 
relief  atid  cure  of  these  distressing  affections. 
He  has  also  added  chapters  0.1  insomnia; 
relation  of  eye  strain  to  headaches  ;  and  the 
localization  of  the  action  of  remedies  on  the 
brain. 


A  Practical  Treaiseon   the  Disease.s   of 
the  Hair  and  Scai.p.     By  George  Thom- 
as Jackson,  M  D.,  Professor  of  Dermato- 
logy,   Women's     Medical   College,    N.Y. 
Infirmary  ;  Chief  of  Clinic  and   Instructor 
in     Dermatology,    College   of  Physicians 
and  Surgeons,  &zc.     New,  edition   revised 
and  enlarged.     New  York  :   E.  B.  Treat, 
5  Cooper  Union,  f8(;4.  Price  $2.75. 
In  this  edition  of  this  book  the    reader  will 
find  all  the  knowledge  about   the  hair  that  has 
been  gained   during  the    years  that  have   gone 
since  the  appearance  of  the   first  edition  of  this 
book   in  March,  18S7.      During    this  time   alo- 
pecia areata,  the  parasitic  diseases,  and  seborr- 
hoea    have   been  studied    with    great   care    by 
many  investigators. 

Every  page  of  the  old  edition  has  been  re- 
vised and  corrected  ;  new  articles  upon  folli- 
culitis decalvans,  leptothrix,  and  aplasia  pilo- 
rum  propria,  and  many  new  sections  to  the  old 
chapters,  have  been  added.  The  bibliography 
has  been  b.'ought  down  to  January,  1893,  and 
nine  new  illustrations  have  been  inserted  in  the 
text. 


Transac  ions  of  the  College  of  Physicians 

OF  Philadelphia.     Third  series,  volume 

the  fifteenth.   Edited  by  G.G.  Davis,  M.D. 

Philadelphia  :  Printed    for    the    College, 

This  volume,  which  does  great  credit  even  to 
this  distinguished  body,  contains  twenty-four 
articles  from  the  pens  of  such  men  as  C.  K.  Mills, 
Shoemaker,  Tyson,  Sinkler,  Noble,  Wool,  Hare, 
Cohen  and  Hirch. 

Tiie  president's  address  by  Weir  Mitchell 
and  the  memoirs  of  Hayes  Agnew  by  J. 
William  White  are  also  very  interesting.  Any 
young  man  who  has  the  good  fortune  to  read 
this  life  of  Agnew  cannot  fail  to  be  benefited 
by  its  perusal.  The  secret  of  his  success  is 
easy  to  find.  The  book  is  printed  for  the 
College,  but  we  trust  for  our  readers'  sake  that  it 
has  been  placed  on  sale  at  a  reasonable  price, 
for  it  contains  many  medical  gems. 


PUBLISHERS  DEPARTMENT. 

ART  GEM.S  (in  cji.ors)  FREE. 

Russell's  Art  Collections,  of  over  four  hundred  mag- 
nificent pictures,  size  lo  by  13,  are  issued  in  twenty- 
four  series,  each  containing  seventeen  full  page  pictures 
in  colors  (regular  price,  $  i  .00  per  Secies)  can  be  secured 
by  simply  asking  your  local  grocer  or  dry  goods 
merchant  (with  your  next  purchase  for  one  of  Taggarts' 
Art  Coupons.  If  he  cannot  supply  it  to  you,  have  him 
write  immediately  to  Frank  S.  Taggart  d-^Co-,  89  King 
St.  W.,  Toronto,  for  full  particulars,  and  we  will  see 
that  you  secure  an  Art  Coupon  through  him  free.  An 
enterprising  merchant  can  increase  his  trade  100  per 
cent,  by  usmg  Taggart's  Coupon  System. 


kna&ii 


Vol.  XXIL 


MONTRF  ^  ^     ^lAY,  1894. 


No.  8. 


ORIGINAL  COMMUNICATIONS. 

Cjiseof  Fiinctiouril  Moiii>i>legia  (Bra- 
chial^   169 

The  Galfaiio-Cautery  Current  ob- 
taineil  from  the  altenuitiug 
current  in  the  Street  172 


SOCIETY  PROCEEDINGS- 

American  ifedieal  Association    ....  1,71 
Kh'venth       international     Medical 

t'ongress 17.5 

^toiitreal  Meiiico-Ohinirgical  Society  175 

Insular  Sclero-sis 175 

I  'rcler  vs.  Appendix   17-5 

Ueform  in  Coroner  Law 175 

i'ibro-Cystic  Tumor  of  the  Uterus. . .  17tj 

Kupture  of  the  Kidney 176 

' '[leration  for  Gallstones 170 

,i.so  of  Epilepsy 176 

oUejie  ot  Physicians  and  Sm-geons, 

Quebec  176 

Labes  without  absence  of  knee-jerk.  176 
'  ouftenital  Polyijoid  Growth  of  Con- 
junctiva.    177 

-^mall  Pedunculated  Polyp  from  the 

left  Tonsil 177 

Mixed  Carcinoma  and  Sarcoma  of 
the  Peritoneum 177 


Doubli"'  irydroneiliinsis 177 

Oxalate  of  himi'  <'alculi   from  the 

Kidnevs.  .     .;..  178 

Semi-i""-'-  ,  ■,   .  ;  .    ■     i.g 

Emir  1  Tumor 178 

Kef"  Law .  178 

Blooki •'■'!>  Appen- 

dix ...  .......  182 

Death  Cen  182 

Specimens  i.    .           .;iue  Ap- 
pendages        182 

Ovarian  Tumor  Sin; u'.ating  a  Parova- 
rian Cyst 182 

nsematonia  of  Leii  I''allopian  Tube.  182 
Double   Pyosalpiux  with  Intestinal 

Fistnla 183 

Cholecy-;totomy 183 

Cases  of  Infection  in  Pneumonia  ...   184 
Danger  of  Hypodermic  Injection  of 

Morphia .184 

Transient  Swellinji  of  the  Right  Arm.  185 
Kuptm-ed  Tubal  Pri-gnancy  and  Ap- 
pendicitis   ". 185 

Intra-Capsula  Fracture  of  the  Femur 

in  a  Paralyzed  Limb ;.  18i) 

Copper  Nugget  iji  the  form  of  a  Skull- 

Cap 186 

Citse  of  Belladonna  I'oisoning. 186 

Suture  of  Tendons  in  the  Hand .  187 

Fictitious  Urticaria  187 


Induction  Coil  for  Utilizing  the 
Ordinary  Electric  Light  Current 
for  the  Thermo-Cantery 187 

The  Curative  Effect  of  Exploratory 
Laparotomy 188 

PROGRESS  OF  SCIENCE- 

A  Mechanical  Device  for  Illustrating 
the  Movements  of  the  Lung  in 
Penetrating  Wounds  of  the  Chest.  189 

Conservative  Treatment  of  Pyosal- 
pinx 190 

Tuberculous  Pleurisy . .  .■ 190 

Restricting  and  Preventing  the 
Spread  of  Tuberculosis. 190 

EDITORIAL. 

The  Universal  Language  of  the 
Future 191 

BOOK  NOTICES. 
Lectures    on    Auto-Intoxication    in 

Disease,  etc 191 

The      Johns       Hopkins      Hospital 

Reports 192 

PAMPHLETS  RECEIVED. 
A  Supplementary  Paper  upon  Supra- 
Vaginal  Hysterectomy 192 


frininal    ijoinnmnuations. 

CASE  OF  FUNCTIONAL  MONO- 
PLEGIA (BRACHIAL). 

Bv 

D.  Campbell   Meyers,   M.D.,   M.R.C.S. 
Eng.,  L.R.C.P.  Lend. 

"  The  history  taken  from  my  case-book  is 
the  following  : — 

Maud  B.,  set.  17,  unmarried,  book- 
binder's apprentice.  Family  history — father 
strong  and  healthy,  mother  nervous,  and  at 
times  she  has  been  very  melancholy,  feel- 
ing despondent  about  the  future.  At  one 
time  she  w'ould  weep  easily,  and  she  now 
has  attacks  of  laughter  which  she  finds 
difficult  to  control.  She  had  fits  when  a 
child,  in  which  she  would  fall  in  the  street. 
She  also  had  St.  Vitus'  dance.  She  is  the 
mother  of  nine  children,  all  of  whom  are 
healthy  except  patient.  Dr.  Baines  tells 
me  one  of  these  children  is  very  small  for 
his  age,  but  is  bright  intellectually.  No 
consumption  ;  no  insanity,  but  one  mater- 
nal aunt  childish. 

Previous    history. — Patient    has     never 
been  strong,  and  always  complaiiied   much 


I  of  her  back.  She  had  measles  eleven 
years  ago  ;  no  fits  of  any  kind.  Menstrua- 
tion began  at  14^,  and  continued  regularly 
till  present  illness. 

Present     illness      began     about    seven 
months  ago,  when  left  shoulder  got  w-eak, 
and    this    weakness    gradually   extended 
dow-n  left  arm.     Patient  says    it  came  on 
suddenly.     She  went   to  a    friend's  house 
to  tea,  and  while  at  tea  she  had  a  severe  pain 
ni    the  left  shoulder,  and    she  found    she 
could  only  move  it  with  pain.     There  was 
no    swelling    or   discoloration    about    the 
shoulder.     There  is  no  history  of  any  acci- 
dent, and  pitient  hashad  no  worry,  trouble 
or  fright  to  bring  it  on.     After  remaining 
at  home  a  few  days  the   pain  ceased,  ?nd 
she    returned   to   work,  but   this   she  was 
obliged  to  give    up  in  a  few'  days  owing  to 
weakness   of  the  left  arm.     Since  this  time 
she  has  been  unable  to  use  her  arm.     Her 
mother  says    she    is'  of  a  very    excitable 
nature. 

Examination,  Nov.  4th,  1893,  showed  an 
anaemic  but  well-developed  girl,  without  any 
muscular  atrophy.  She  has  marked  paresis 
of  w^hole  left  upper  limb.  She  can  move 
it  in  various  directions  but  without  much 
force.  Dynamometer  gives  left  hand  o, 
right  35.  Sensibility  to  pain  is  entirely 
absent  over   lower  part    of  left   hand.     It 


I/O 


THE   CANADA    MEDICAL   RECORD. 


extends  upwards  on  the  back  of  the  hand 
to  about  one  inch  above  knuckles,   and  on 
the  front  it  corresponds  to  lowest  fold  run- 
ning  across  the   palm.     The   entire   hand 
below  this  is  absolutely  anaesthetic,  includ- 
ing the  last  joint  of  the  thumb.     There  is 
no  haemorrhage  from  the  prick  of  a    pin. 
The   sensibility  on  the   upper  part  of   the 
hand  and  the  remainder  of  the  limb  is  quite 
normal,    and  the    sense  of  location  good. 
Triceps    reflex    is    not  obtainable.     Wrist 
reflex  present  but  not  exaggerated.      She  is 
wholly  unable  to  state  the  position  of  the 
fingers    of   left  hand,    eyes    being    closed. 
She  says  they  are  flexed   when  extended, 
and  vice  versa.     With  the  eyes  closed  she 
can   imitate  a  movement  given  to  her  left 
arm  only  approximately  with  her  right,  and 
in  placing  her  left  fore-finger  on  the  end  of 
her  nose  or  in  bringing  the  two  forefingers 
together  she  exhibits  a  certain  amount  of 
inco-ordination.     Left  leg  and  foot  normal 
as  to  muscular  sense  as  well  as  to  the  sense 
of  touch,  pain  and  location.     She  says  left 
ankle  is  a  little  weak,  and  that  it  turns  over 
occasionally    when  she    walks.      Muscular 
force  good,  but  perhaps  a  little  less  than  in 
right  leg.     Knee-jerks  normal    Other  limbs 
and    face    unafi"ected     in   any    way.     Eye 
discs  normal.      No    noticeable  contraction 
of  field  of  vision.     Central  vision  good,  and 
she  recognizes  colors  well.     Internal  organs 
healthy.     No  headache    of  late,    formerly 
she  had  some  in  frontal   region.      Tongue 
protruded  straight,    pulse  84  and   regular. 
Paralysis    is    flaccid,  and    no    rigidity    in 
any  part  of  the  limb.     Mother   says  that 
the  paralysis    has  been  much    the  same  as 
at    present    for     last     four     months.     Dr. 
ines,  who  kindly  sent  m.e  the  case,  tells 
■that    he  passed  a    current  of  150   mil- 
liamperes    momentarily  through  the  hand, 
without  evoking  the  least  sign  of  sensation. 
Nov.  7th,  Dynamometer.  Lefthand  lolbs., 
right  44.     Muscular  movements  performed 
with  greater    force    than    last    day.     The 
sensibility  of  the  hand  is  much   improved. 
She  can  now  feel  pin  prick  on  the  palmar 
surface  of  hand  and  fingers  but  not  on  the 
back.     The  joints  of  these  fingers  can  be 
twisted  without  causing  any  pain,  but  wrist, 
elbow  and  shoulder  joints  are  more  or  less 
sensitive.     Sense  of  weight  is  defective  in 
left  hand,  normal  in   right.     The  muscular 
sense    is    somewhat  improved.       Hearing, 
taste  and  smell  good.     Pharyngeal    reflex 


present.  No  trophic  disturbances  in  skin  of 
hand.  No  hysterogenous  zones.  I  applied 
static  electricity. 

Nov.  8th.  Dynam.  Left  hind,  eyes 
closed,  5  lbs.  ;  with  the  eyes  open,  1 1  lbs. 
Right  hand  2)^  lbs.  Voltaic  electricity  shows 
no  reaction  of  degeneration  in  the  muscles, 
and  the  induced  current  acts  normally. 
She  says  she  can  now  feel  the  electric  cur- 
rent in  the  hand. 

In  regard  to  diagnosis,  since  the  disease 
is    evidently  an    aff"ection    of  the    nervous 
system,   its  seat  must  therefore    be    in  the 
peripheral  nerves,  in  the  spinal  cord  or  in 
the  brain.      If  in  peripheral  nerves  we  must 
look  to  a  lesion  of  brachial  plexus  to  explain 
it.     The  absence   of  atrophy,  the    normal 
electrical  reactions,  the  absence  of  trophic 
trouble  and  the  peculiar  distribution  of  the 
anaesthesia,  which  is  entirely  difi'erent    to 
that  due  to  a  lesion  of  the  brachial  plexus, 
render    this    suggestion    untenable.      If   it 
were  a  lesion  of  the  cord  we  must  suppose 
it    strictly   limited  to    the    anterior  cornu, 
since  no  other  parts  of  the  body    are  dis- 
tinctly implicated.      An    inflammation    of 
the  grey  matter  here,  however,   would  cer- 
tainly   have  led   in   this   time  to  a  marked 
atrophy    of  the    muscles    and    reaction    of 
degeneration,   both  of   which    are    absent. 
A  disturbance  of  sensibility  and  the  loss  of 
muscular  sense,  together  with  the  absence 
of  a  febrile    onset,  quite  exckides  the  possi- 
lity  of   the    anterior  horn    in    the    cervical 
region  being  the  seat  of  the  trouble. 

We  now  have  the  internal  capsule  and 
cortex  of  the  brain  left,  an  affect'on  of  the 
medulla,  pores  or  cerebal  peduncle  not  re- 
quiring notice  from  the  peculiar  distribu- 
tion of  the  symptoms.  If  we  suppose  a 
sudden  organic  lesion  either  in  the  internal 
capsule  or  the  grey  substance,  we  would 
naturally  expect  some  apoplectic  symptoms 
which  are  entirely  wanting  in  the  case 
before  us.  An  organic  lesion  of  the  in- 
ternal capsule  producing  a  pure  brachial 
monoplegia  is  a  fact  almost  unknown.  It 
would  be  necessary  besides  to  suppose  the 
lesion  to  be  limited  strictly  to  the  anterior 
part  of  the  posterior  limb,  and  in  this  case 
there  would  be  no  disturbance  of  sensi- 
bility. 

There  now  remains  the  grey  substance 
or  the  subjacent  part  of  the  cerebrum  ovale 
to  be  considered.  A  lesion  here  sufficiently 
severe  and  strictly  limited    to  the   middle 


i 


THE   CANADA    MEDICAL    RECORD, 


171 


third  of  the  ascending  frontal  and  ascend- 
ing parietal  convolutions  would  undi)ubtedl}- 
have,  as  a  consequence,  a  brachial  mono- 
plegia, but  such  a  monoplegia  in  a  pure 
form,  without  any  implication  of  the  face, 
tongue  or  leg  at  any  time  is  almost  as  rare  as 
a  lesion  producing  the  same  effect  in  the 
internal  capsule.  Besides,  such  a  lesion 
must  be  followed  by  secondary  degenera- 
tion, which  .voulcT  be  marked  clinically  by 
a  certain  degree  of  contraction  in  the 
affected  arm,  and  also  by  an  exaggeration 
of  the  tendon  reflexes,  both  of  which  are 
absent  in  this  case.  Further,  if  we  sup- 
pose the  lesion  limited  to  the  middle  third 
of  the  Rolandic  area  alone,  how  are  we  to 
account  for  the  /-'/(^r/^iv/ sensory  disturbances 
here  met  with  ? 

A  consideration  of  these  facts,  together 
with  the  history  that  for  the  past  four 
months  the  patient's  condition  has  re- 
mained in  statiio  quo,  and  also  in  view  oj 
the  fact  that  her  condition  has  suddenly 
improved  (within  the  past  three  days)  both 
in  regard  to  the  diminished  extent  of  the 
sensibility  and  the  increased  force  of  the 
grasp,  shows,  I  think,  that  the  case  is  one 
of  a  functional  nature,  cerebral  in  its  origin. 
We  at  once  come  to  the  question,  should 
we  not  use  the  term  hysterical  rather  than 
the  more  extended  one  of  functional  mono- 
plegia ?  In  regard  to  this  question  the  re- 
searches of  the  late  Prof.  Charcot  in  hyp- 
notism are  extremely  interesting.  In 
hysterical  subjects  he  produced  by  hyp- 
notism a  complete  paralysis  limited  to 
the  arm,  with  loss  of  cutaneous  and  deep 
sensibility.  He  went  even  further  and 
produced  paralysis  and  sensory  loss  in  the 
limb,  segment  by  segment,  the  remaining 
portion  of  the  arm  being  unaffected.  In 
other  words,  he  produced  by  suggestion  a 
condition  precisely  like  that  met  with  in 
certain  cases  of  brachial  monoplegia,  which 
he  has  reported,  from  which  he  assumed 
that  a//these  cases  were  hysterical  paralysis. 
But  does  it  follow  from  this  that  the  same 
results  might  not  be  obtained  from  persons 
subjected  to  hypnotism  which  were  not 
hysterical  ?  I  believe  so,  and  the  absence 
of  other  hysterical  symptoms  in  this  case, 
such  as  a  peculiar  mental  condition,  hystero- 
genous  zones,  attacks  of  any  kind,  and  the 
limited  extent  of  the  deranged  sensibility, 
together  with  the  absence  of  any  marked 
affection  of  the  special  senses  or   derange-  | 


ment  of  the  pharyngeal  reflex,  lead  me  to 
think  the  case  one  of  a  functional  rather  than 
of  hysterical  paralysis. 

In  regard  to  the  location  of  the 
trouble,  Charcot  in  some  similar  cases 
which  he  has  published  placed  it  in  the 
middle  third  of  the  Rolandic  area,  with 
some  encroachment  on  the  adjoining  pari- 
etal lobule.  Bastian,  who,as  you  know,  does 
not  consider  the  Rolandic  area  as  being 
purely  motor  in  its  functions,  but  rather  a 
kinaesthetic  centre  (that  is,  a  centre  for 
sense  of  movement  impressions),  would,  I 
think,  explain  the  paresis  and  loss  of  mus- 
cular sense  by  a  lesion  of  the  Rolandic 
area,  but  the  disturbance  of  the  other  forms 
of  sensibility  he  would  explain  by  a  co- 
existing lesion  of  some  of  the  sensory 
fibres  in  the  posterior  part  of  the  internal 
capsule. 

Of  the  pathogenesis,  vaso-motor  de- 
rangement or  lowered  nutrition  seem  to 
me  the  two  most  probable  causes.  Al- 
though, according  to  Foster,  vaso-motor 
nerves  have  not  been  demonstrated  in  the 
arteries  of  the  brain,  this  negative  evi- 
dence, he  says,  is  not  to  be  too  much  relied 
on.  That  a  vaso-motor  spasm  in  the  brain 
should  exist  continuously  for  months 
seems  strange,  but  is  it  any  more  so  than 
that  the  same  spasm  should  exist  for  an 
equal  length  of  time  in  the  region  of  the 
body  affected  by  anaesthesia,  as  can  be 
demonstrated  by  the  absence  of  haemorr- 
hage following  slight  wounds  of  these  parts.-* 
Moreover,  the  sudden  disappearance  of 
long  continued  symptoms, which  sometimes 
occur  as  the  result  of  a  strong  emotion  or 
a  convulsive  attack,  would  certainly  seem 
to  indicate  that  no  serious  nutritive  lesion 
had   taken  place. 

This  case  presents  some  interesting 
points  (i)  as  to  the  cause,  a  pain  in  the 
shoulder  leading  to  its  paralysis  and  soon 
that  of  entire  limb.  That  an  injury  to 
the  shoulder  will  produce  these  symptoms 
is  well  known,  or,  further,  a  mere  slap  on 
the  shoulder  of  a  person  who  was  hypno- 
tized will  also  produce  it.  With  these 
facts  in  view,  would  we  be  justified  in  sup- 
posing that  a  sudden  pain  in  the  shoulder 
coming  on  without  obvious  cause  might 
so  react  on  the  brain  of  a  predisposed 
person  as  to  produce  a  similar  paralysis  .'* 
This  case  would  seem  to  indicate  it. 

(2)  The  affection  of  the   muscular  sense 


172 


THE  CANADA  IMEDICAL  RECORD. 


throughout  the  whole  paralyzed  part 
(although  most  intense  where  the  anaesthe- 
sia was  present)  would  certainly  bear  out 
Bastian's  assertion  in  regard  to  thekinaes- 
thetic  centre,  rather  than  the  theory  that 
the  Rolandic  area  is  purely  motor  in  its 
function.  (3)  The  distribution  of  the  an- 
sesthesia  is  remarkable,  and  is  just  the  con- 
verse to  one  of  Charcot's  cases,  in  which 
the  anaesthesia  extended  down  the  arm  to 
almost  exactly  the  point  where  the  loss  of 
sensibility  begins  in  this  case,  the  fingers 
and  part  of  the  hand  remaining  in  his  case 
unaffected.  (4)  The  difference  in  the 
pressure  on  the  c'\namom,eter  with  the 
eyes  open  and  closed  is  also  remarkable,  an 
additional  motor  power  evidently  being  de- 
rived from  the  visual  impulse. 

The  prognosis  is,  I  think,  favorable,  and 
a  complete    recovery  is    to    be  hoped    for. 

In  regard  to  treatment,  I  may  say  I 
have  applied  static  electricity,  and  she  is 
continuing  at  present  the  tonic  given  her 
by  Dr.  Baines.  I  may  add  that  I  believe 
much  good  will  be  derived  from  method- 
ical exercise,  and  that  moral  ti'eatment 
will  also  be  of  essential  benefit. 

The  patient,  when  presented  at  the  Clin- 
ical Society  this  evening,  Nov.  8,  1893, 
had  entirely  recovered  from  her  sensory 
symptoms.  The  anaesthesia  had  disap-- 
peared,  and  the  muscular  sense  so  im- 
proved that  she  could  imitate  movements 
given  to  left  arm  very  closely  with  the 
right.  The  muscular  force  had  improved, 
but  was  not  yet  normal.  I  may  also  add 
that  the  prick  of  a  pin  in  the  previously 
anaesthetic  area  was  followed  by  a  slight 
haemorrhage 

Toronto,  199  SimcoeSt. 

P.S.    The  patient  recovered  completely 
within  one  month  after  last  note. 


THE  GALVANO-CAUTERY  CUR- 
RENT OBTAINED  FROM  THE 
ALTERNATING  CURRENT  IN 
THE  STREET. 

By  a.  Lapthorn  Smith,  B.A.,  M.D., 
M.R.C.S.  England,  Vice-President  of  the 
American  Electro-Therapeutic  Associa- 
tion, Gynaecologist  to  the  Montreal  Dis- 
pensary, Surgeon  to  the  Woman's  Hos- 
pital, Montreal,  Canada. 


So  recently  as  ten    years  ago  electricity 
was  still  in  the  experimental  stage, — if  in- 
deed  it  may  not  be  said  to  be  so  still,  for 
every  day  we  are  finding  new  uses  for  it  and 
new  methods  of  handling  and  controlling  it. 
But  at  the   present   day  at  least  it  has  be- 
come a  commercial  commodity,  and  can  be 
purchased    in    almost  every  city  for  about 
three-quarters   of  a  cent  per    ampere  hour. 
On    the  other   hand,   the  galvano-cautery 
wiie  is  one  of  the  handiest  and   mo.^t  con- 
venient instruments  for    a  great   variety  of 
work  in  gynaecology,  as  it  is  in  laryni;ology 
and    dermatology.       For    certain    delicate 
little  operations,   such    as   the    removal   of 
vascular  growths  from   the  female  urethra, 
or  the  removal  of  portions  of  the  cancerous 
uterus,  or,  in  fact,  any  operation  where  we 
wish  to  cut  without   causing  hemorrhage, 
it  is  simply  invaluable.        Paquelin's    ther- 
mo-cautery  is  not  to  be  compared  with  it,  for 
the   galvano-cautery    wire   can    be  applied 
and  carefully  adjusted  while  cold,  and  then- 
by  the  touch  of  a  spring  it  becomes  red  or 
white  hot  as  long  as  desired,  and  it  can  be 
allowed    to    cool    before    being    removed. 
Moreover,  the  heat  can  be  regulated  to  any 
shade  from  straw  color  to  cherry    red   or 
pure  white,  which   is    not  so   easily  done 
with  any  other  form  of  cautery.     The  great 
objection   to  the  galvano-cautery  has  been 
so  far  that  it  has  required  a  very  expensive 
and   cumbersome    battery    to    be    carried 
around  with  it  in  order  to  obtain  the  supply 
of  current.     These  batterries  had   to  have 
a  very  high  potential  or  electro-motive  force 
as  well  as  a  large  amperage,  necessitating  the 
employment   of  a  strong  acid  and  violent 
chemical  action   on   the  zinc.     The    latter 
metal  became  rapidly  polarized  or  covered 
with   bubbles  of  hydrogen,   so  that  it  was 
necessary    to    have    a    bellows    constantly 
working    to    keep  the  liquid  in  motion  in 
order  to  wash  these  bubbles  off,  otherwise 
the  chemical   action   would  stop   and   the 
flow    of    the    current    would   cease.      The 
cleaning  and  renewal  of  this  batter}^  was  a 
dirty  and  expensive  business,  and  though 
improvements  were  constantly  being  made 
in    its  manufacture,  it    was    always    dirty, 
heavy,  and  constantly  getting  out  of  order, 
owing    to    corrosion    of  the    connections. 
The   advent   of   the   storage   battery    was 
gladly  welcomed,  for  although    it  weighed 
40  lbs.,  and  was    therefore    much    lighter 
than  the  acid  battery,  required  no  bellows 


THE   CANADA    MEDICAL   RECORD. 


^73 


for  stirring  up  the  liquid,  held  enough  cur- 
rent to  run  the  ciutery  for  any  ordinary 
operation,  and  could  be  rechargei-l  by 
means  of  half  a  dozen  or  a  dozen  gravity 
cells  such  as  are  used  in  the  telegrapii 
office.  But  even  with  the  storage  battery^ 
there  was  the  trouble  of  keeping  the  gra- 
vity cells  in  order,  for  they  are  eating 
themselves  up  continuously  night  and  day, 
whether  thev  are  being  used  or  not,  and 
the  repairing  of  them  is  dirty  and  expen- 
sive work.  Still,  by  keeping  the  gravity 
cells  in  the  cellar,  and  having  them  le- 
paired  and  cleaned  by  the  local  electrician 
or  telegraph  operator,  an.1  by  keeping  the 
portable  storage  battery  in  the  office  al- 
ways fully  charged,  the  inconveniences  were 
reduced  to  a  minimum,  the  high  first  cost, 
about  fifty  dollars,  being  the  strongest 
objection  to  it.  During  a  recent  visit  to 
New  York,  such  a  storage  battery  outfit 
was  seen  in  the  office  of  Dr.  Skene,  the 
celebrated  gynaecologist  of  B  ooklyn,  who 
stated  that  it  gave  great  satisfaction  and 
was  in  constant  use  for  the  treatment  of 
urethral  caruncles. 

Before  incurring  the  expense  of  this  in- 
stallation the  writer  consulted  Mr.  Shaw, 
of  the  Montreal  Electrical  Works,  302  St. 
James  -treet,  Montreal,  in  order  to  sej 
whether  it  was  not  possible  to  utilize  the 
ordinary  street  current  for  the  purpose. 
It  seemed  to  the  writer  that  if  it  would  heat 
up  a  carbon  wire  to  a  white  heat  in  a  vacuum, 
it  would  just  as  easily,  heat  up  a  platinum 
loop  in  the  air,  Mr.  Shaw  at  once  under- 
took to  c'onstruct  such  an  instrument,  and 
in  a  few  days  the  apparatus,  as  shown  in 
the  accompanying  cut,  was  placed  in  the 
writer's  hands,  at  a  cost  of  twenty  dollars. 
In  this  instrument,  which  only  weighs  a 
couple  of  pounds,  the  ordinary  house    cur- 


rent of  fifty-two  volts  is  passed  through  a 
very  long  coil  of  rather  fine  wire  and  then 
goes  back  to  the  main.  Owing  to  the  re- 
sistance or  holding  back  power  of  this  long 
wire,  a  considerable  quantity  of  electricity 
is  stored  up  in  the  wire.  If  another  long 
wire  were  coiled  around  this  first  one, 
having  'no  connection  with  it,  but  on  the 
contrary  separated  from  it  by  a  consider- 
able space,  this  second  coil  would  be 
charged  with  electricity  of  the  same  vol- 
tage, by  reason  of  the  induction — a  quality 
which  is  unpleasantly  noticed  in  the  tele- 
phone wire  when  it  passes  near  an  electric 
light  wire.  By  making  the  secondary  coil 
of  much  shorter  and  coarser  wire,  the  nature 
of  the  induced  current  is  converted  to  one 
of  much  less  voltage  but  of  much  greater 
amperage  or  quantity.  This  secondary 
coil  is  made  to  slide  over  the  primary  one 
so  as  to  become  more  or  less  charged  ;  by 
this  means  the  quantity  of  current  and  the 
degree  of  heat  in  the  cautery  loop  can  be 
most  delicately  regulate  J  to  suit  the  various 
circumstances.  There  is  no  danger  what- 
ever either  to  the  operator  or  to  the  patient, 
because  the  highly  dangerous  street  cur- 
rent of  one  thousand  volts  is  required  by 
law  to  be  reduced  to  the  perfectly  harmless 
and  safe  fifty -two  volt  current  before  it  is 
allowed  to  be  brought  into  the  house.  Or, 
more.properly  speaking,  the  one  thousand 
volt  current  does  not  come  into  the  house 
at  all,  a  small  portion  of  it  only  being  ab- 
stracted by  the  iron  boxes  seen  on  the 
poles,  and  called  converters,  and  which  52 
volt  current  is  in  turn  brought  down  to 
2  to  6  volts  by  the  transformer  under  notice. 
Thisgalvano-cautery  is  put  in  operation 
in  the  following  manner:  An  electric 
light  lamp  is  unscrewed  from  a  socket  and 
the-wire  from  the  coil  attached  byasimilar 


,,;f.^' 


174 


THE  CANADA  MEDICAL  RECORD. 


piece  to  that  on  the  lamp.  The  current 
now  circulates  in  the  long  coil  without 
producing  any  visible  effect.  The  second- 
ary coil  is  then  passed  over  it  ;  the  second- 
ary coil  is  now  charged  with  a  current  of 
great  amperage,  such  as  is  given  off  by  an 
acid  battery.  Still,  there  is  no  visible  sign 
of  it.  The  two  cords  from  the  cautery  in- 
strument are  connected  with  the  ends  of  this 
secondary  coil,  the  connecting  spring  is 
pressed  down,  and  the  platinum  wire  at 
once  becomes  white  hot,  because  it  is  such 
a  bad  conductor  that  the  electricity  rushing 
through  it  at  such  enormous  speed  causes 
sufficient  friction  to  make  it  hot.  As 
stated  at  the  beginning,  the  house  current 
costs  only  three-quarters  of  a  cent  per 
ampere  hour  ;  and  as  this  instrument  uses 
about  four  amperes  in  its  primary  coil,  it 
only  costs  three  cents  an  hour.  However, 
as  we  never  require  to  have  the  loop  heated 
for  more  than  a  few  seconds  at  a  time,  the 
cost  of  running  it  is  practically  nil, —  the 
first  cost  being  really  the  only  one-  In 
ordering  an  instrument,  it  is  only  necessary 
to  inform  the  manufacturer  of  the  voltage 
of  the  current  in  your  house,  and  to  send 
him  the  loop  or  loops  which  you  are  going 
to  use  ;  he  can  thus  adjust  the  length  of 
wire  to  give  every  shade  of  current  that 
may  be  required.  In  Montreal,  most  of 
the  physicians'  offices  are  supplied  with  the 
alternating  current  from  the  Royal  Electric 
Company,  and  this  is  the  current  used  by 
the  writer,  and  a  similar  current  is  also  sup- 
plied at  Quebec,  Hamilton,  Peterboro, 
Brockville,  Sherbrooke  and  many  other 
towns  where  this  instrument  can  be  equally 
well  applied  if  the  manufacturer  is  informed 
of  the  voltage.  In  any  case  the  writer 
would  advise  the  physician  to  purchase  his 
platinum  knives  and  loops  first,  and  send 
them  to  the  manufacturer,  or  else  have  the 
latter  procure  the  cautery  for  him,  so  that 
they  may  be  thoroughly  tested  together 
before  leaving  the  factory.  Dr.  Byrne  of 
Brooklyn,  recently  president  of  the  Amer- 
ican Gynaecological  Society,  has  obtained  a 
world-wide  reputation  for  his  skill  in  re- 
moving the  cancerous  uterus  with  the  gal- 
vano-cautery,  his  statistics  being  fully  equal 
to  those  of  the  best  operators  with  the 
knife  ;  and  it  is  probable  that  in  many  other 
departments  of  surgery,  the  scope  of  the 
galvano-cautery  will  be  greatly  enlarged 
when  it  becomes  generally  known  that  the 


mechanical  difficulties  have  been  entirely 
removed  by  means  of  this  ingenious  little 
instrument.  In  a  still  later  improvement 
just  out,  another  secondary  coil  is  slipped 
over  the  other  end  of  the  primary  coil,  for 
the  purpose  of  heating  a  small  lamp  for 
illuminating  the  cavity  in  which  the  cautery 
loop  is  being  used.  These  lamps  can  also 
be  supplied  in  various  candle  power  and 
voltages.  The  only  towns  in  which  this 
transformer  cannot  be  employed  are  those 
supplied  with  direct  or  continuous  cur- 
rent. 


^cciflg     mocccbings. 


AMERICAN  MKDICAL  ASSOCIATION. 

The  American  Medical  Association  wil] 
meet  in  San  Francisco,  June  5th,  1894. 

The  Transcontinental  railroads  have  made 
favorable  rates,  viz.,  $65.50  for  round  trip  from 
all  Missouri  river  ponits,  which  is  one  and  one- 
twelfdi  fare. 

The  Southern  Pacific  Comi^any's  rales  from 
Portland,  Ogden,  and  E\  Paso  are  one  fare. 

All  tickeis  sold  at  these  points  cany  five 
coupons  of  admittance  to  the  Mid-winter  Fair. 

The  roads  beyond  Missouri  river  points  are 
still  charging  about  one  and  a  half  fares. 

Cannot  our  brethren  east  of  the  Rocky 
Mountains  }  et  induce  the  Central  Traffic 
Association  and  'i'runk  Lines  to  equalize  these 
rates?  Several  agents,  in  response  to  our  cir- 
culars asking  fur  a  single  fare,  replied  favor- 
ably, but  slated  it  required  united  action  of  the 
several  Associations. 

An  extensive  itinerary  for  those  who  come 
from  the  Northern  and  Middle  States  is  pub- 
lished in  the  Journal  of  the  Association.  In  the 
April  number  of  the  Occidtuial  M edical  Times 
Dr.  Parkinson  has  published  an  extensive 
itiiierary  of  excursions  and  entertainments  in 
this  S:ate  for  Members  and  their  families  during 
and  after  the  meeting.  Those  who  come  from 
the  Southern  States  will  probably  come  over 
the  Santa  Fe  and  Sunset  route.  It  will  be  well 
for  them  to  come  early,  and  do  the  South- 
ern part  of  the  State  on  the  way  up,  and  then 
depart  via  the  Ogden  or  Shasta  route.  This 
will  afford  the  greatest  possible  opportunity  to 
note  the  varied  resources  of  the  Pacific  Coast 
and  the  variety  of  scenery  and  climates  within 
our  borders.  The  Colorado  Desert  through 
which  the  road  passes  is  312  feet  below  the  sea 
kvel,  with  a  dry,  hot  atmosphere. 

Going  out  over  the  Denver  and  Rio  Grande, 
one    reaches  an    altitude  of  10,500  feet ;  while 


THE  CANADA   MEDICAL  RECORD. 


175 


on  the  Sliasui  roate  the  road  passes  Caslle 
Crag  Tavern,  winding  around  the  base  (>\ 
Mount  Shasta,  wliose  summit  is  14, 144 feet  high, 
and  clad  in  eternal  snows. 

Colton  and  Riverside,  the  first  imi:)ortant 
points  reached  on  tlie  Sunset  route,  are  already 
far-famed  for  iheir  delicious  fruits  andextensive 
orange  groves  whicli  line  the  streets  and  high- 
ways for  many  miles. 

Drs.  M.  F.  Price  and  K.  D.  Shugart  of  the  local 
committee  on  reception  will  take  delight  in 
showing  them  to  visitors. 

From  here  to  San  Diego  and  Coronado  it  is 
only  four  hours  ride.  They  are  located  upon 
the  bay  in  the  extreme  southwestern  part  of 
the  State,  only  four  miles  from  the  Mexican 
border.  This  is  now  a  fashionable  all-theyear- 
round  resort  with  one  of  the  largest  and  best 
equipped  hotels  in  the  world,  its  main  dinmg 
room  having  a  c-ipacity  for  a  thousand  guests. 

Facilities  for  bathing  and  boating  in  the 
sheltered    waters     of  the   bay    are    unexcelled. 

Drs.  C.  M.  Fenn,  \V.  A.  Edwards  and  C.  C. 
Valle  of  the  local  committee  will  extend  every 
courtesy  to  visiting  members. 

Los  Angeles,  the  chief  city  in  the  South,  too 
well  known  to  need  any  d.scripiion  here,  is  only 
five  hours  tlistant  on  the  way  north.  Here  Drs. 
H.  Bert  Ellis,  H.  S.  Orme,  Walter  Lindley, 
Jos.  Kurtz,  J.  P.  Widney  and  \V.  L.  Wills  of  the 
committee  on  reception  will  be  delighted  to 
show  visitors  the  city  and  its  suburbs,  Pasadena, 
Santa  Monica  and  other  points  of  interest. 

Santa  Barbara,  another  charming  resort  by 
the  sea,  famous  for  its  adjacent  olive  groves,  in 
which  it  rivals  Palestine,  is  only  three  hours 
ride  fiom  Los  Angeles.  Here  Drs.  S.  B.  P. 
Knox,  J.  xM.  xMcNuliy  and  R.  J.  Hall  of  the 
local  committee  will  do  the  honors  of  the  occa- 
iion. 

Leaving  Santa  Barbara  by  rail,  the  next  point 
of  inter(;st  will  be  Bakersfield,  where  an  exten- 
sive system  of  irrigation  has  transformed  a 
desert  into  a  veritable  garden  of  Eden . 

Then  com^s  Fresno,  the  largest  and  most 
successful  vineyard  district  in  the  Slate,  where 
Drs.  Chester,  Rowell  and  A.  J.  Pedlar  of  the 
local  committee  will  pay  every  attention  to 
visitors. 

It  is  only  seven  hours  ride  from  here  to  San 
Francisco,  where  the  members  of  the  reception 
committee  will  meet  the  visitors  and  escort 
them  to  their  respective  hotels.  Those  who  come 
in  over  the  uonhern  routes,  via  Mount  Shasta, 
Caslle  Crags  Tavern,  Soda  Springs,  Chico,  and 
the  State  Capitol  at  Sacramento,  may  desire  to 
depart  by  th.e  Sania  Fe  or  Sunset  routes. 

R.  H.  PLUMMER, 

Chairman. 
San  FR..VNCI.SCO,  April  25,  1894. 


ELEVEN rH    INTERNATIUNAL 
MEDICAL   CONGRESS. 

We  are  sorry  to  learn  from  letters  received 
from  physicans  from  America  and  England 
who  have  attended  the  Congress  that  it  was  sad 
ly  mismanaged.  In  order  to  obtain  a  hearing  at 
all,  the  American  physicians  had  to  organize  a 
committee,  but  even  then  they  were  unable  to 
ol)tain  any  information  about  anything.  The 
programmes  were  unreliable,  there  being  several 
ediiions  and  each  one  different.  The  secretary 
of  the  American  section  describes  its  meeting 
simply  as  chaos  added  to  confusion. 
Among  those  present  we  notice  the  natii^s  of 
Dr.  A.  A.  Brown,  F.  Sheiiherd  and  F. 
Cornu  of  Montreal,  and  Drs.  Aniley,  Tobin 
and  Kitchen  of  Halifax.  It  is  stated  that  the 
maps  were  full  of  gross  errors,  and  that 
Italians,  who  were  stationed  around  in  i;ro- 
fusion  to  give  information,  would  tell  nothing 
wiihout  a  "tip,"  and  even  then  they  knew 
very  little.  This  was  a  great  contrast  to 
the  ninth  Congress  held  in  Washington  and  the 
tenth  held  in  Berlin,  at  both  of  which  the 
arrangements  were  nearly  perfect.  We  are 
sorry  to  see  that  the  place  fixed  upon  for  the 
next  meeting  is  Russia,  as  we  fear  very  few 
will  trust  their  lives  in  that  barbarous  country. 
Vienna  or  even  Montreal  would  be  a  much 
more  acceptable  and  more  accessible  place. 


MONTREAL  MEDICO-CHIRURGICAL 

SOCIETY. 

Sta'ed  Me  ting,  Decemberist,  1893. 

James  Bell,  M.D.,  President,  in  the  Chair. 

Insular  Sclerosis. —  Dr.  James  Stewart 
exhibited  a  boy  and  a  girl,  the  subjects  of  in- 
sular sclerosis. 

Discussion — Dr.  Smith  asked  if  there  was 
any  lamily  history  of  syphilis,  which  might  ex- 
plain both  the  sclerosis  and  optic  atrophy. 

Dr.  Bell  asked  if  the  disease  usually  occur- 
red in  families. 

Dr.  Stewart,  in  reply,  said  that  there  was 
no  history  of  syphilis  obtainable.  Syphilis,  as 
far  as  we  know,  has  no  connection  with  insu 
lar  sclerosis.  White  atrophy  of  the  optic  nerve 
is  simply  a  wasting  of  the  axis  cylinder  and 
not  like  atrophy  following  inflammation.  Only 
two  instances  are  recorded  where  two  brothers 
were  affected  with  insular  sclerosis. 

U-^eter  vs.  Appendix — Dr.  Smith  exhibited 
the  patient  from  whom  he  had  removed  last 
spring  what  was  thought  at  the  time  to  be  the 
ureter,  but  which  proved  to  be  the  appendix 
vermiformis.  The  patient  was  in  perfect  health, 
whatever  had  or  had  not  been  removed. 

Reform  in  Coroner  Zaw.-Dr.  Girdwood 
presented  the  report  of  the  special  committee 
appointed  to  consider  this  subject. 


The  com- 


1/6 


THE   CANADA   MEDICAL   RECORD. 


mittee  considei''ed  that  the  present  moment  was 
not  an  opportune  one  for  bringing  the  matter 
before  the  notice  of  the  Provincial  Government. 

After  some  discussion  it  was  decided  that 
the  committee  be  requested  to  prejjare  a  report, 
and  present  it  at  the  fohowing  meeting  of  the 
Society. 

Fibro- Cystic  Tumor  of  the  Uterus. — Dr. 
Smith  exhibited  the  specunen.  In  October, 
1893,  amputation  had  been  done  at  the  level 
of  the  internal  os.  There  had  been  a  local 
peritonitis  some  months  ago.  The  operation 
presented  no  difficulties.  The  abdomen  was 
not  flushed  out  after  operation,  contrary  to 
his  usual  practice.  Two  days  after  the  opera- 
tion acute  septicjeraia  developed,  and  the 
patient  died  the  following  day.  An  autopsy 
showed  great  distention  of  the  stomach  and 
intestines,  and  Dr.  Smith  himself  subsequently 
had  a  severe  septic  inflammation  beginning  in 
the  hair  follicles  of  the  back  of  the  hand, 
although  no  abrasion  could  be  seen.  The 
lesson  of  the  case  was  always  to  flush  out  the 
abdomen  after  operation. 

Dr.  Shepherd  said  that  few  surgeons  flush 
out  the  abdomen  now-a-days,  and  he  did  not 
himself  consider  it  necessary. 

Rupture  of  the  kidney. — Dr.  Wyatt  John- 
ston showed  two  specimens  of  ruptured  kidney. 
One  was  in  a  case  where  an  old  woman  was 
found  dead.  There  were  a  few  bruises  about 
the  head  and  arms,  but  no  serious  external 
signs  of  violence.  A  verdict  of  manslaughter 
had  been  rendered,  but  the  grand  jury  found 
a  No  Bill.  It  was  supposed  that  the  injury 
was  due  to  the  deceased  having  been  maltreated 
by  her  son.  In  the  second  case  the  rupture- 
was  caused  by  a  beam  falling  across  the  loins 
of  the  deceased.  A  diagnosis  of  ruptured  kid- 
ney was  made  during  life  by  Dr.  Sutherland,  as 
an  area  of  dullness  extended  to  the  umbilicus 
from  the  right  flank,  and  the  urine  contained 
blood.  In  this  case  the  injured  organ  was 
very  large,  the  other  kidney  being  so  small  that 
it  was  not  discovered  at  the  autopsy,  although 
the  ureter  could  be  traced  for  some  inches 
from  the  bladder. 

Operation  for  Gall  Ston  s — Dr.  Shepherd 
showed  a  phial  containing  over  500  gall  stones 
which  he  had  removed  three  days  before  from  a 
woman  aged  50.  Slie  had  suffered  for  many 
years,  and  recently  had  shown  signs  of  peri- 
tonitis. An  exploratory  incision  showed  a 
tense  gall  bladder,  which  on  puncture  contain- 
ed sour  pus  and  was  packed  with  gall  stones, 
which  were  removed  with  a  dinner  spoon,  after 
protecting  the  surrounding  tissues  by  packing 
them  with  sponges.  As  the  gall  bladder  could 
not  be  brought  to  the'  opening,  the  omentum 
was  stitched  to  it  so  as  to  form  a  channel  for 
the  bile,  of  which  much  was  passed. 

Case  of  Epilepsy — Dr.  E.  P.  Williams  read 
a  report  of  this  case  which  occurred  in  a  young 


man  21  years  of  age.  Father  and  mother  goiitv, 
brothers  and  sisters  healtliy.  When  2  years 
old  had  a  convulsive  seizure  followed  by  tran- 
sient left  hemiplegia.  Following  this,  slight 
convulsive  seizures  occurred  about  once 
a  week,  preceded  and  followed  by  mental 
dullness.  At  8  years  was  for  a  number  of  days 
unable  to  eat  or  swallow.  At  10  years  the 
attacks  were  preceded  by  an  aura-like  epigas- 
tric fullness,  and  he  would  fall  down.  Kx.  18 
years  the  frequency  of  the  fits  increased  to  one 
or  two  every  third  or  fourth  day.  Grasping  his 
wrists  would  sometimes  stop  an  attack.  Nitrite 
of  amyl  or  ammonia  inhalations  sometimes 
had  the  same  result.  Bromide  treatrtient  was 
continued  from  the  loth  to  the  2£st  year.  In 
Feb.,  1893,  he  had  a  moderately  severe  attack 
of  typhoid,  during  which  and  until  March  15, 
one  week  after  the  fever  subsided,  no  fits 
occurred,  -  (No  bromide  was  taken  during  the 
fever.)  During  convalescence  he  had  mild  fits, 
at  first  frequent,  afterwards  at  long  intervals, 
until  August,  when  the  fits  reappeared,  first  se- 
vere and  infrequent,  afterwards  milder,  and  at 
the  rate  of  20  per  month.  The  general  health 
and  mental  condition  remain  good. 

Discussion — Dr.  Mills  said  that  the  so- 
called  motor  area  would  soon  be  regarded  as  a 
reflex  or  sensori-motor  area.  The  fact  that  the 
fits  could  be  arrested  by  seizing  the  wrist  was 
in  favor  of  this  view. 

Dr.  F.  W.  Campbell  said  opinions  varied  as 
to  what  constituted  large  doses  of  bromide. 
Fie  knew  a  man  who  had  been  taking  drachm 
doses  three  times  daily  for  25  years  with  bene- 
fit. He  thought  iiitro  glycerine  might  be  of 
service. 

Dr.  Williams,  in  reply,  said  that  nitro- 
glycerine had  beeji  tried  f  jr  some  years  in  this 
case,  but  had  no  apparent  effect. 

College  of  Physicia?is  and  Surgeons,  Quebec 
— Dr.  J.  H.  B.  All\n  complained  that  it 
was  impossible  to  get  a  statement  of  account 
or  a  receipt  from  the  College,  and  that  about  a 
year  ago  the  accounts  had  been  sent  out  in  an 
offensive  manner  upon  post  cards. 

Dr.  F.  W.  Campbell  thought  that  tiie 
irregularities  were  due  to  the  action  of  the 
former  secretary. 

Stated  Meeting,  i  ^th  December,  1 893. 
James  Bell,  M.D.,  President,  in  the  Chair. 

Dr.  A.  G.  A.  Ricard  was  elected  an 
ordinary  member  of  the  Society. 

labes  loithout  absence  of  Knee-jerk — Dr.  d| 
FiNLEY  exhibited  a  man  who  had  suffered  for  -^ 
some  years  from  attacks  of  vomiting,  with 
extreme  pain  in  epigastrium.  He  also  had 
severe  pains  in  lower  extremities,  usually  altern- 
ating from  one  side  to  the  other,  and  pains 
over  forehead  and  trunk, described  as  "  just  like 
lightning."  There    was     diminution   of  sexual 


THE   CANADA    AfEDICAL    RECORD. 


1/7 


pjwer.  No  ataxia,  \>m  sliglit  muscular  wcuk- 
ness.  The  kn^e  retlexes  were  exaggerated  on 
bolli  sides.  The  pupils  were  slightly  uneven, 
and  showed  Argy'.e  Robertson  reaction.  There 
was  no  menial  disturbance. 

Dr.  Jas.  Bell  thought  that  th  ■  cord  area 
involved  could  not  be  that  usually  affected,  j 
Was  it  right  to  speak  of  the  disease  as  ataxia 
where  none  existed?  A  patient  wh  i  came  to 
him  recently,  under  the  impression  that  he  was 
suffering  from  stone  in  the  bladder,  presented 
all  the  symptoms  of  t.ibes. 

Dr.  Finley  in  reply  said  the  disease  was 
jirobably  in  the  pre-ataxic  stage.  The  Argyle 
Robertson  pupils  and  lightning  pains  made  it 
difficult  to  arrive  at  any  other  diagnosis.  There 
was  no  history  of  syphilis  obtainable. 

Congenital  Poly [> old groicth  of  Oo-'junctiva. 
— Drs.  BuLLER  and  Adami.  The  specimen 
was  taken  from  the  ocular  conjunctiva  of  the 
left  eyeball  in  a, child  3  months  old,  and  had 
existed  since  birth.  These  growtlis  occur 
either  as  low  white  circular  swellings  invading 
the  corneal  margin,  or  as  an  irregular  mass, 
springi.  gfrom  the  sclerotic  between  the  cornea 
and  the  outer  canihu?.  The  present  growth 
apparently  was  of  the  latter,  or  scleral,  variety. 
Its  attachment  to  the  eyeball  was  by  means  of 
a  thick  expansion  extending  slightly  into  the 
cornea.  The  growth  was  removed  with  as  little 
disturbance  as  possible  of  the  siirrounding 
tissue.  When  the  patient  was  removed  a  few 
days  later,  the  eye  hail  a  sati.sfactory  appear- 
ance. The  specimen  showed  under  the  micro- 
scope a  well  formed  epithelium,  with  corium  and 
subcutaneous  tissue.  This  tissue  was  loose  in 
the  centre  and  showed  a  cystic  space.  The 
epithelium  showed  spiral  and  coiled  glands, 
resembling  sweat  glands,  rather  than  those  of 
conjunctiva.  The  subcutaneous  tissue  showed 
well  formed  vessels,  with  fibrous  tissue  and 
what  appeared  to  be  degenerated  muscle  fibres. 
It  corresponded  therefore  rather  with  the  tissues 
of  th.e  outer  surface  of  the  eyelid  than  ihe 
conjunctiva,  but  was  of  too  simple  a  nature  to 
be  classed  as  a  true  dermoid. 

Discussion. — Dr.  Proudfoot  said  tu:!:ors 
of  this  kind  were  commonly  attached  to  the 
margin  of  the  cornea.  Recently  in  a  case 
treated  for  some  time  by  the  family  physician 
for  conjunctivitis  he  had  found  a  polypus 
lying  beneath  the  eyelid.  Polypi  si  metunes 
followed  injury  in  operation  of  the  conjunctiva. 

Small  pedunculated  polyp  from  the  left  tonsil. 
— Drs.  BiRKETT  and  Adami.  The  tumor  was 
taken  from  a  child  4  months  old,  and  was  ex- 
hibited owing  to  the  rarity  of  tonsillar  tumors. 
It  was  about  the  size  of  a  pea,  and  con- 
sisted microscopically  of  a  superficial  layer  of 
flattened  epithelium  with  subepithelial  connec- 
tive tissue,  beneath  which  were,  a  series  of 
glandular  alveoli,  separated  by  fibrous  septa. 
The  gland  tissue  is  that  of  typical  mucous  glands, 


and  shows  no  adenomatous  over-growth.  No 
excretoiy  ducts  were  made  out.  This  class  of 
tumor  had  been  frequently  descrilied  in  the 
soft  palate.  Growths  of  'he  t  )nsil  of  any  kind 
were  rare,  lymphoid  fibrous,  myomatous,  myxo- 
matous or  fatty  being  the  usual  forms.  Epith^'- 
lioma  was  more  frequent  than  sarcoma,  i  lie 
present  growth  was  benign. 

Mixed  Carcinoma  and  Sarcoma  of  the 
Peritoneum. — Dr.  Adami  showed  the  s|)ecimen 
from  a  man  who  died  of  jjeritonitis.  .At  the 
autopsy  an  enormously  enlarged  omentum  was 
found.  The  mesentery  was  also  invjlved,  but 
the  intestinal  tube  seemed  unaffected  except 
that  the  coils  were  matted  from  inflammation. 
The  diaphragm  was  thickened  and  infiltrated 
with  new  growth,  which  had  extended 
to  the  pleural  surface,  and  set  up  a  severe 
pleurisy.  The  pleural  cavities  contained  9  pints 
of  yellow  fluid.  Pericardium  and  lungs  free. 
Death  was  apparently  due  to  pressure  on  the 
heart.  Microscopical  examination  showed  tiie 
growth  to  be  sarcomatous  for  the  most  pan, 
but  in  places  there  were  definite  fibro  is  alveoli, 
containing  solid  masses  of  epithelial  cells — in 
other  words,  typical  scirrhus  cancer.  There 
was  therefore  a  combination  of  cancer  and 
sarcoma.  The  man  was  not  emaciated,  and 
had  almost  no  disturbance  of  health  up  to  ihe 
time  of  the  acute  peritonitis  and  pleurisy, 
which  caused  his  death. 

Dr.  Jas.  Bell  gave  the  following  history. — 
On  1 2th  Oct.,  1893,  the  man  was  suddenly 
taken  at  niglit  with  severe  abdominal  pain.  One 
week  later  he  was  admitted  to  the  .General 
Hospital,  and  a  diagnosis  of  acute  peritonitis 
made.  Some  evidence  of  an  al^dominal  growth 
caused  his  transfer  to  the  surgical  ward,  where 
an  explanatory  abdominjl  incision  was  made  ; 
bat,  as  the  case  was  unsuitable  for  operation, 
the  wou  !d  was  closed.  The  patient  died  the 
next  day.  Dr-  Bell  thought  the  sarcomatous- 
looking  tissue  referred  to  might  possibly  be  an 
early  embryonic  ttage  of  the  fibrous  tissue 
of  the  cancer's  stroma. 

Dr.  Adami  in  reply  said  that  conditions  of 
carcinoma  sarcomatodes  were  described  by 
pathologists,  when  the  stroma  was  sarcomacoas 
and  the  alveolar  contents  epithelial.  In  the 
present  case  there  was  no  primary  growth  in 
any  organ  where  epithelium  would  normally 
exist. 

Dr.  FiNLEY  said  there  was  a  history  of  a 
small  growth  having  been  thrice  removed  from 
the  inside  of  the  nose  in  the  present  case. 

Dr.  Jas.  Bell. — That  point  had  been  in- 
vestigated in  hospital,  but  it  appeared  that  the 
nose  was  only  touched  with  caustic. 

Double Hydron-phrosis. — Dr.  C.  F.  Martin 
exhibited  the  kidneys  and  bladder  of  a  man 
who  entered  hospital  with  symptoms  of  chronic 
renal  disease,  and  died  two  months  later  with 
urfemic   coma.     There   was    moderate  double 


178 


tHE  CANADA  MEDICAL  RECORD. 


hydroiuphiosis  and  dilat;iiii  n  of  ihc  uieiers. 
The  cause  of  the  hydronephrosis  appeared  to 
be  a  mass  of  inflammatory  fibrous  lissi.e  exter- 
nal to  the  bladder,  in  the  region  of  the  trigone, 
near  the  point  of  entrance  ot  the  meters.  This 
was  most  marked  on  the  left  side.  There  were 
also  numerous  constrictions  in  the  course  of 
the  ureters.  The  left  testicle  had  been  removed, 
and  there  was  a  large  sinus  in  the  Lft  ischio- 
rectal fossa. 

Dr.  Johnston  thought  the  ingenious  ex- 
planation offered  by  Dr.  Martin  to  be  correct. 
Dr.  Adami  said  that  the  statistics  of  hydrone- 
phrosis showed  that  many  cases  were  record- 
ed when  the  cause  was  not  explained.  Had 
the  dissection  made  by  Dr.  Martin  in  this  case 
been  more  frequently  practised,  peihaps  there 
would  not  be  so  many  mysterious  cases  on 
record. 

Oxalate  of  Lime  Calculi  from  the  Kidneys. 
— Dr.  Jas.  Bell  showed  some  large  stellate 
prickly  crystals,  apparently  oxa'ate  of  lime, 
removed  from  a  cyst  in  the  kidney  of  a  patient 
who  had  no  renal  symptoms  whatever. 

Semi-lunar  Cartilage. — Dr.  Jas.  Bell  al  o 
exhibited  a  portion  of  an  inner  semi-lunar 
cartilage  removed  from  the  knee  of  a 
man  who  had  sprained  his  knee  when  jumping 
from  a  carriage.  The  joint  was  locked  for  a 
time,  but  afterward  became  normal,  unt'l  a 
severe  exertion  once  more  displaced  the  cartil- 
age, and  the  joint  was  replaced  with  difiicuhy. 
A  few  days  later,  while  demonstrating  how  the 
accident  occurred,  the  joint  again  became  fixed 
and  could  not  be  reduced.  The  cartilage  was 
therefore  removed.  It  was  evident  at  the  opera- 
tion that  it  would  be  impossible  to  keep  the 
joint  in  place.  Cases  have  been  recorded  where 
the  joints  have  been  permanently  and  satis- 
factorily reduced  after  being  out  for  some 
years. 

Enucleation  of  Thyroid  Tumor. — Dr.  Jas. 
Bell  showed  a  small  fibro-cyslic  tumor  re- 
moved from  the  thyroid,  and  emphasized  the 
advantages  of  enucleation  as  contrasted  wiih 
extirpation  of  the  thyroid. 

Reform  of  the  Coroner  Law- — Dr.  Adami 
read  the  report  of  the  committee  upo  i  this 
subject  as  follows  : 

Your  Committee,  appointed  to  consider  the 
present  system  of  conducting  inquests  and  the 
modifications,  if  any,  which  may  wisely  be 
introduced  in  the  present  law  relating  to  in- 
quests, beg  to  present  to  the  Society  the  fol- 
lowing report  : — 

The  enquiry  into  and  determination  of  the 
cause  of  the  death  of  any  individual  or  indivi- 
duals, where  such  death  has  occurred  under 
circumstances  that  are  out  of  the  common,  is  a 
matter  that  does  not  come  under  the  cogni- 
zance of  the  Dominion  authorities,  save  and 
except  when  the  inquest  leads  to  a  finding  of 
death    by    criminal    act   or   criminal    neglect. 


Hence  (with  the  exception  that  whenever  such 
a  charge  is  brought,  the  depositions  taken  by 
the  coroner  must  be  transmit;ed  to  a  magistrate 
or  justice  of  the  peace,  and  the  coroner  must 
issue  a  warrant  against  the  person  or  persons 
charged,  etc.),  the  coroner's  procedure  is  a 
matter  outside  the  Dominion  Statutes,  and  it  is 
in  the  jjower  of  the  Legislature  of  the  Province 
of  Quebec  to  freely  modify  the  existing  law. 
Your  Committee  desire  to  draw  attention  to  this 
fact  at  the  outset,  for,  this  being  so,  the  task, 
of  intro  hieing  certain  urgent  mpdificaii.)ns,  or, 
indeed,  of  completely  altering  the  proce  lure, 
becomes  an  easy  one,  granted  that  the  mem- 
bers of  the  Provincial  Legislature  become 
assured  of  the  need  for  change. 

The  present  Priwincial  laws  respecting  en- 
quiries into  the  mode  and  cause  of  death  are 
based  essentially  upon  the  old  English  Common 
Law.  The  enquiries  are  ])laced  in  the  control 
of  coroners  appointed  by  the  Provincial 
Government,  a  coroner  f  )r  each  judicial  dis- 
trict. The  coroner  need  not  be  a  member  of 
either  the  legal  or  the  medical  profession, 
although  in  the  great  m  ijority  of  cases  he 
belongs  to  one  or  the  other. 

Upon  receiving  notice  of  a  de  ith  f  dlijwing 
u[)on  any  act  of  violence,  or  of  death  attended 
by  suspicious  circumstances,  it  is  his  duty  to 
make  a  preliminary  enquiry. 

Jf,  with  or  without  medical  aid,  he  comes  to 
the  conclusion  that  the  cause  of  death  is  to  be 
made  out  without  the  assumption  of  there 
having  been  either  criminal  act  or  criminal 
neglect,  he  can  order  the  interment  of  the  body. 
If,  on  the  other  hand,  he  is  led  to  suspect  that 
death  has  been  due  to  violent  or  unfair  means, 
or  culpable  or  negligent  conduct  of  others, 
under  circumstances  calling  for  investigation 
by  a  coroner's  inquest,  thai,  having  made  a 
sworn  deposition  to  this  effect  before  a  magis- 
trate, he  is  empowered  to  hold  an  inquest. 
What  these  "  circumstances  "  are  which  call  for 
investigation  is  not  defined  in  our  Statutes, 
tluy  being  left  to  the  coroner  to  determine. 
Having  made  the  deposition,  he  now  can 
summon  a  jury  and  hold  a  coroner's  court. 
He  is  empowered  to  call  befoie  him  such  wit- 
nesses as  in  his  opinion  can  throw  light  upon 
the  cause  of  death. 

The  jury  must  view  the  body  of  the  deceased, 
and,  if  the  majority  of  the  jury  desire  it,  tiie 
coroner  is  directed  to  instruct  that  an  autopsy 
be  performed  to  throw  some  light  upon  the 
cause  of  death.  Having  heard  all  the  evide.ice, 
the  coroner  sums  up,  and  leaves  it  to  the  jury 
to  bring  in  a  verdict,  and,  when  this  has  been 
delivered,  the  coroner  gives  an  order  for  the 
interment  of  the  body. 

The  coroner  is  paid  six  dollars  for  every 
inquest,  and  if  any  inquest  occupies  more  than 
two  days,  three  dollars  for  every  succeeding 
day.     The  practitioner  of  medicine  making  an 


tHE  CANADA  MEDICAL  RECORD. 


179 


external  examination  of  ihc  body  receives  five 
dollars,  making  an  autopsy  he  receives  ten 
dollars.  There  are  further  fixed  charges  for  the 
constable  who  summons  the  jury  and  the  wit- 
nesses, for  chemical  analyses,  for  hire  of  room 
to  be  used  for  the  inquest,  and  for  guarding  the 
the  body. 

This,  put  as  succinctly  as  possible,  is  the 
present  coroner's  law  for  the  Province  of  Que- 
bec. 

Several  objections  have  been  brought  against 
this  method  of  investigating  suspicious  deaths  ; 
and  despite  the  fact  that  the  law  as  now  admin- 
istered is  much  amended,  and  differs  in  many 
respects  from  the  law  of  a  few  years  back,  the  ob- 
jections still  retain  their  force.  Your  Committee 
would  point  out  what  it  considers  to  be  the 
most  serious  disadvantages  of  the  present  mode 
of  procedure. 

1.  T/ic  Cost. — Taking  the  returns  for  Mon- 
treal alone,  as  shown  by  Dr.  Wyatt  Johnston, 
the  cost  per  inquest — that  is  to  say,  per  case — 
is  decidedly  greater  than  in  London,  New  York 
or  Massachusetts.  The  rate  would  seem  to  be 
$22.00  in  Montreal,  $15.00  in  London^  $16.90 
Boston,  $12.80  in  Massachusetts  generally, 
$10.00  in  New  York  ;  and  this  notwithstanding 
the  fact  that  autopsies,  the  most  expensive 
individual  item  in  the  investigation  of  suspicious 
deaths,  from  three  to  four  times  as  frequent  in 
the  other  cities  as  they  are  in  Montreal.  Here, 
in  Montreal,  it  costs  more  to  maintain  a  dead 
body  in  the  care  of  the  coroner  than  it  does  to 
maintain  an  ordinary  live  individual  with 
healthy  appetite  at  a  first-class  hotel  for  the  same 
period.  Some  of  the  items  permitted  by  law  in 
the  coroner's  accounts  ought  to  be  lessened  or 
removed  altogether,  others  ought  to  pass  into 
general  police  accounts.  But  the  fact  remains 
that  the  system  is  as  expensive  as  its  results  are 
unsatisfactory,  and  that  the  chief  source  of  ex- 
pense is  the  legal  investigation  of  cases  which 
do  not  call  for  legal  investigation  at  all,  owing 
to  the  fact  of  death  not  having  been  due  to 
violence.  The  exclusion  of  cases  not  calling  for 
inquest  by  means  of  a  preliminary  medical  ex- 
amination seems  to  be  the  most  rational  means 
of  reducing  the  expenses. 

2.  Payment  by  Fees. — Your  Committee  is  of 
opinion  that,  as  a  matter  of  principle,  the  pay- 
ment of  the  coroner  according  to  the  number  of 
inquests  held  by  him  is  most  unsatisfactory,  and 
is  inimical  to  the  proper  carrying  out  of  en- 
quiries into  the  cause  of  death. 

Your  Committee  find  that  of  the  cases  of 
death  calling  for  a  coroner's  investigation  occur- 
ring in  the  various  large  towns,  from  50  per  cent, 
to  75  per  cent,  can  upon  preliminary  inves- 
tigation be  found  to  be  due  to  natural  causes. 
That  is  to  say,  the  more  careful  the  preliminary 
investigation  made  by  the  coroner,  and  the 
more  conscientious  and  expert  he  shows  himself 
in  the  performance  of  his  duties,  the  fewer  the 


inquests  hp  finds  it  necessary  to  hold,  and  the 
less  his  income  if  he  be  paid  so  much  per 
inquest.  While  if  it  so  happens  that  his  enquiries 
lead  him  to  suspect  the  frequent  occurrence  of 
any  one  form  of  crime  at  any  period,  as,  for 
example,  child  murder,  and  so  to  hold  an  in- 
creased number  of  inquests  upon  certain  classes 
of  cases,  immediately  he  lays  himself  open  to 
the  charge  of  seeking  to  increase  his  income. 
This  ought  not  to  be.  In  the  cities,  at  least,  the 
coroners  ought  to  receive  fixed  salaries. 

3.  The  Jury. — Under  the  presi,  nt  system,  the 
jury  in  Montreal,  with  rare  exceptions,  certainly 
cannot  be  said  to  be  a  capable  and  represen- 
tative assembly  of  citizens.  Men  engaged 
actively  in  any  form  of  business  prefer  to  employ 
any  subterfuge  rather  than  sit  for  what  may  be 
many  Lours  m  a  morbid  atmosphere,  for  no  re- 
turn whatsoever  save  discomfort  and  loss  of  time. 
The  consequence  is  that  too  often  the  jury  is  com- 
posed of  a  heterogeneous  collection  of  incapa- 
bies,  gathered  from  the  highways  and  bye-ways 
and  bar-rooms  of  the  neighborhood'.  The 
verdict  of  such  incapables  is,  time  after  time,  at 
variance   with  the  evidence  presented, 

4.  Viewing t/ie Body. — The  custom  of  viewing 
the  body  is  as  old  as  the  coroner  system.  It 
arose  at  a  time  when  violent  deaths  were  as 
many  as  doctors  were  few,  and  when  population 
was  everywhere  so  sparse  that  the  jury  had  an  im- 
portant part  to  play  in  determining  by  external 
examination  that  death  was  due  to  violence, 
and,  again,  in  identifying  the  corpse.  Now-a- 
days,  in  a  large  town,  it  is  highly  probable  that 
not  one  of  the  jury  will  have  known  the  deceased, 
and  the  determination  of  the  cause  of  death  may 
more  safely  be  left  to  medical  men.  In  any  case, 
it  is  easy  to  obtain  identification  by  means  other 
than  the  irruption  of  a  strange,  unseemly  rabble 
into  the  house  of  mourning.  The  general  feelin<^ 
throughout  the  community  is  that  this  intrusion 
into  the  circle  of  bereaved  relatives  in  the  very 
depth  of  their  trouble,  permitted  by  the  present 
law,  ought  to  be  prevented,  and  your  Committee 
urges  strongly  that  it  is  as  unnecessary  as  it  is 
unbecoming.  It  has  been  superseded  in  many 
States  by  a  system  of  sworn  afiidavit  of  the  fact 
of  death  and  the  identity  of  the  body,  and  this 
course  should  be  followed  here. 

5.  Suicide. — The  existing  law  does  not  de- 
mand inquest  in  cases  oifelo  de  sc  This  your 
Committee,  on  the  whole,  is  inclined  to  consi- 
der a  disadvantage.  The  general  opinion  of  the 
community  is  strongly  opposed  to  suicide,  and 
were  it  to  be  recognized  that  this  mode  of  death 
necessarily  involved  a  public  investigation, 
there  is  little  doubt  that  the  unpleasant  publicity 
of  thfe  subsequent  proceedings  would  act  as  a 
deterrent  in  not  a  few  cases.  As  a  matter  of  fact, 
suicide  is  on  the  increase  in  those  States  where 
this  deterrent  does  not  exist  or  has  of  late  years 
been  removed. 

6.  Medical  Evidence. — A  study   of  the  ver- 


i8o 


THE   CANADA   MEDICAL   RECORD. 


diets  bioughl  by  the  coroner's  juries  shows 
clearly  that  the  decision  of  points  of  medical  evi- 
dence is  a  matter  that  should  not  be  left  to  non- 
medical persons.  Statements  utterly  at  variance 
with  the  cause  of  death  assigned  have  been 
lime  after  time  accepted  blindly  by  coroner  and 
jury.  The  appreciation  of  rnedical  facts,  and 
the  opinions  to  be  formed  from  these  facts,  come 
properly  within  the  domain  of  the  medical 
expert.  It  cannot  be  expected  that  the  legal 
coroner  and  the  jury  should  without  fail  form  cor- 
rect oi)inions  upon  delicate  medical  problems. 
Another  point  with  regard  to  medical  evi- 
dence may  here  be  brought  forward.  The 
practitioner  who  is  called  to  testify  as  a  physi- 
cian differs  from  the  other  witnesses,  from  the 
fact  that  he  is  called  in  his  professional  capacity' 
The  value  of  his  evidence  lies  in  this,  that  he 
has  studied  the  condition  of  deceased  prior  to 
death,  and  his  evidence  must  depend  for  its 
value  upon  the  importance  of  these  earlier 
professional  studies  in  throwing  light  upon  the 
cause  of  death.  To  this  extent,  therefore,  his 
evidence  is  expert  evidence,  and  as  such  it 
ought  to  receive  a  recompense.  Bui  under  the 
the  present  system  no  fee  whatsoever  is  allowed 
save  for  external  or  internal  examination  of  the 
body  of  the  deceased.  The  medical  practitioner 
is  wrongly  treated  as  an  ordinary  witness. 

Your  Committee  strongly  approves  of  the 
plan  adopted  in  many  of  the  United  Stales,  of 
admitting  a  written  medical  deposition  of  fact 
or  opinion  as  evidenced  at  inquests  in  cases 
where  the  personal  attendance  of  a  medical 
witness  is  not  considered  necessary  by  the 
coroner. 

7.  2 he  Performance  of  Autopsies. — In 
all  the  large  class  of  cases  now  investi- 
gated before  juries  where  sudden  death  occurs 
without  the  siighest  external  lesion,  an  autopsy 
is  advisable.  Nevertheless,  with  an  exception 
to  be  presently  noted,  no  autopsy  can  be  p.-r- 
formed  unless  it  be  demanded  by  the  ir.ajority 
of  the  jury.  That  is  to  say,  the  jury  has  to 
express  itself  willing  to  waste  an  hour  or  more 
in  the  middle  of  its  proceedings,  so  that  acorape- 
tent  medical  man  may  be  called,  who  shall 
make  an  examination  into  the  slate  of  the 
viscera.  As  a  consequence,  the  jury,  in  the  first 
place,  shows  the  greatest  unwillingness  to  allow 
the  performance  of  autopsies,  and  will  rather 
return  a  wholly  unreliable  verdict.  In  the 
second  place,  the  medical  man  performing  the 
l)Ost-mortem  is  at  a  great  disadvantage,  for  he 
is  expected  to  keep  the  jury  waiting  as  little  as 
possible,  and  his  examination,  instead  of  being 
deliberate  and  careful,  is  hasty  and  liable  to  be 
imperfect.  Your  Committee  feel  assured  that 
were  the  coroner  allowed  full  pov/er  himself  to 
order  an  autopsy  in  all  doubtful  cases,  a  very 
large  proportion  of  cases  would  be  discovered 
in  which  there  would  be  no  necesiuty  for  holding 
an  inquest  and  summoning  a  jury.     Thereby  a 


very  large  expenditure  would  be  prevented,  an  J 
at  the  same  time  the  cause  of  death  would  be 
satisfactorily  estabished.  The  exception  re- 
ferred to  above  is  that  by  the  present  law  the 
coroner  is  permitted  to  order  an  autopsy  if  \\:: 
makes  an  affidavit  that  he  holds  the  autopsy  to 
be  necessary.  Unfortunatel-,  coroners  do  not 
seem  to  have  taken  advantage  of  this  permission, 
but  prefer  to  shelter  themselves  by  leaving  the 
matter  wholly  in  the  hands  of  the  jury. 

A   great    source    of  difificulty  in    connection 
with  the  [,-erformance  of  medico-legal  autopsies 
is  theabsenceof  any'Suitable  motguein  .Montreal, 
ai'd  some   measures    should  be  taken    without 
delay  to  remedy  this  defect,  which  also  hampers 
medico-legal   investigation  in  many  other  ways. 
8.   Prelimina'-y  Investigations. — In  all  cases 
of  suspicious  death,   the    first    question  to    be 
settled  is  what  has  been  the  immediate  cause  of 
death.    In  all   cases,  therefore,  the  first    point 
to  be  investigated  is  purely  medical.     It  is  true 
that  frequently  the  question  is  one  that  can  be 
answered    by    any    individual   endowed    with 
common  sense,  as,  for  instance,  when   a  corpse 
is  discovered  upon  the  railroad  track   minus  its 
head,  though  even  in  such  cases  serious  mistakes 
have  occurred  through  the  bodies  of  murdered 
persons  being  so  placed   as  to  give  an  impres- 
sion of  accidental  death.    i>ut  if  the  question  in 
certain  simple  cases  can  be  answered  by  a  lay- 
man as  well  as  by  a    professional  man,  there  is 
a  very  large   number  of  cases,  and  these  often 
the  most  important  from  a  medico-legal  aspect, 
where   a   correct    determination   can    only    be 
reached  by  a    well  qualified  medical    man,  and 
where  it  is  all  important  that  a  correct  answer  be 
gained  at  the  outset,  not  only  for  the  benefit  of 
the    relations    of  the   deceased    (that    they    be 
sheltere  1  from  the  least  breath  of  unnecessary 
suspicion),  but  also  for  the    benefit  of  the  Pro- 
vincial   Exchequer,  that  the    Province    be  not 
saddled  with  the  cost  of  an  inquest  leading  to 
no  result.     When  more  than  50  per  cent,  of  all 
deaths  which  coroners  are  called  upon  to  inves- 
tigate are  found  to  be  from  natural  causes,  it  is 
evident  that  die  majority  of  deaths  now  investi- 
gated require  no  legal  investigation  whatsoever, 
while,  on  the  other  hand,  as  indicated  above,  all 
such  deaths  demand  an  initial  investigation  by 
a  medical  man. 

9.  Criminal  Cases. — Under  the  existing  law, 
when  his  jury  brings  in  a  charge  of  murder  or 
manslaughter,  or  of  being  accessory  10  murder 
before  the  fact,  against  any  person  or  persons, 
the  coroer  must  issue  a  warrant  against  such 
person  or  persons,  rnd  send  him  or  them  before 
a  magistrate  or  justice  if  this  has  not  already 
been  done.  He  must  at  the  same  time  transmit 
the  depositions  taken  before  him  in  the  matter. 
•  To  all  intents  and  purposes,  the  trial  before 
the  magistrate  proceeds  as  though  no  previous 
inquiry  had  been  held.  The  coroner's  deposi- 
tions are  not  employed  as  evidence.       In  fact 


THE  CANADA  MEDICAL  RECORD. 


l8l 


:he  magistrate  treats  thec..^^  ..,  ; hough  he  Wtp. 
proceediiig  under  an  ordinary  wnriant. 

Il"  the    magistrate  confirms  ilie  charge,   tlie 
ase  is    sent  up  tu    tlie  Grand  Jury,  and    here 
gain  all  the  witnesses  are  once  more  sumni 
nd  ihe  evidence  is   repeated,    and  the  G 
jury  findinga  true  bill,  the  case  goes  before  \\\^ 
Petit  Jury,  and  again  the  evidence  is  repeated . 
It  appears  to  your  Committee  that  this  pr  ce- 
iure  is  singularly  cumbrous,  and  that,    bcsiij^ 
'.  irassing    the   witnesses,  it   alli.vvs  a 
arge  number  of  loop-lioles  of  escape  i 
caliy   guilty,   upon  some  legal  technicaluy  o: 
.uiliy  observance   of  legal   procedure.      You 
ommittee,  considering  thai  the  problem  i^f  iio', 
'lis  ])roccdure  maybe  simplified   is    a  parei\ 
-gal  one,  does  not  offer  any  suggestions  on  tlie 
litter. 

Taking  all  these  disadvantages  into  considera- 
:on,  and  being  especially  impressed  by  ih- 
;  at  the  earliest  stages   in  the    investigati' 
uspicious  death  must  of  necessity  be  of  a  nv^d:- 
:.\\  nature,  and  by  the   luriher  fact  that  where 
the  legal  proceedings  of   the  coroner  lead  to  a 
definite  charge  against  an  individual  or  indivi'.- 
als,    those   legal   proceedings  are    [ 
;-.ssed  over  unnoticed    by  the  higher 
our  Committee  have  come    to  the  cone; 
::iat  a  drastic  change  in  the  mode  r,f  inv,- 
tion  of  suspicious  deaths  is  ad 
Province. 

There  are  two  questions  which  naUirallv 
suggest  themselves  prominently  in  connection 
with  questions  of  coroner's  reform.  The  first  is. 
Should  the  coroner  be  a  physician  or  a  lawyer  ? 
and  the  second,  Should  the  office  of  coroner  b^ 
abolished  ? 

With  regard  to  the  qualifications  necessary 

for  coroners,  your  Committee  does  not  think  it 

necessary  to  dwell  upon  the  relative  advantages 

f  having  medical  or  legal  coroners,  although 

iiis'is  a  subject  of  dispute  which  has  now  been 

".  uitlessly  discussed  for  more    than  a  centiny, 

nd  will  in  all  hkeiihood   continue  to  be  so  as 

long   as   the  coroner   system  lasts.     We   wish 

simply   to  state    the  fact  of  the   existence    of 

.iversity  of  opinion  on  this  matter.  That  there 

iiould  be  any  question  as  to  whether  a  physi- 

ian  or  a  lawyer  would  make  the  best  coroner, 

mplies  that  in  either  case  there  must  be  serious 

isadvantages.     The   point  at  issue  here  is  the 

ame  as  the  question  :  Can  a  shoemaker   make 

vatches  belter    than  a   watchmaker  can   make 

-hoes? 

In  London,  a  settlement  of  the  question  has 
een  attempted  by  selecting  as  far  as  possible 
oroners  who  have  obtained  both  legal  and 
medical  qualitications.  This  plan  of  expecting 
the  coroner  to  be  a  Jackof all-trades  has  not 
much  to  recommend  it ;  and  the  lact  that  in 
London,  in  addition  to  the  doubly  qualified 
coroner,  there  are  thedeputy  coroners,  who  are 
obliLred   by  law  to  be    barristers,  and   all   the 


medical  expert  work  is  done  by  outside  medical 
men,  shows  that  matters  are  not  in  any  w^v 
simplified  even  by  having  the  coroners  who  a:'e 
at  once  both  lawyers  and  physicians. 

T,,e  only  rational  plan,  and  one  whose  advan- 
tages appear  never  to  have   been  questioned,  is 
that   adopted  on    the  Continent,  as  weil  as  in 
those  St.Ues  which  now  are  under   the  medical 
examiners'  system,  of  separating  as  far  as  possi- 
ble the  medical  and  legal  bide  of  the  investigation 
:!trusting  these  to  physicians  afld  lawyers 
lively.  Your  Committee  is  just  as  firmlv 
■ced  that  all  legal  questions  should  be  left 
^'>   lawyers,   as    that   all  medical   ones 
entrusted  to  m-,dical  men. 

w^c    -abolition   of  the  Office  of  Cor  one'-. 

Your  Committee  finds  that  in  those  States  «  here 

this    has  been   done,  the   i  revious  difticuliies 

seem  to  have  been  promptly  and  permanently 

emoved,  and  it  does  not  appear  to  have -been 

cessary  in  any  instance  to  revive  the  office. 

The  office  of  coroner    was  created  in    England 

while  that  country   was  in  a  lawless  state,  and 

when  police   regulations  and  courts    of  justice 

were  almost  non-existent.      Since  the   develop- 

:  ent  of  tjie   judicial  and   police   system,   the 

)roner's  office    has  Ljradually  come  to  fid  the 

nportant  function  of  fifth  wheel  to  the  car  of 

isiice.     It    has    been    retained    through    that 

•nservative  spirit  which  retains  the  cumbrous 

>ystem  of  pounds,  shillings  and   pence   for  the 

national  currency.     Many  of  the  Uni  ed  States 

are  still  in  that  primitive  and  lawless  condition, 

which  makes  the  office  of  coroner  a  useful  one. 

ha  more    highly  civilized  States    the   old 

er  system  is  rapidly  disappearing,  and  it  is 

practically  obsolete  in  five,  viz. :  Massachusetts, 

Rhode  Island,  Connecticut,  NewJerseyandNew 

Hampshire. 

As  to  whether  the  office  of  coroner  should  be 
aboHshed  in  our  own  Province,  we  have  no 
hesitation  in  stating,  as  medical  men,  that,  from 
i  medical  point  of  view,  the  office  is  simply  an 
absurdity,  which  constantly  interferes  with  the 
proper  employment  of  medical  science  for  judi- 
cial ends,  and  that  it  could  be  abolished  to- 
morrow with  marked  benefit  to  the  medical  side 
of  criminal  cases. 

The  fact  that  the  appointment  of  competent 
medical  experts  as  consultants  to  the  coroner's 
court  of  Montreal  during  the  last  year  has  neither 
prevented  nor  greatly  diminished  the  number  of 
those  palpably  absurd  and  unsatisfactory  ver- 
dicts, whicii  have  made  this  court  a  public 
laughing-stcck  in  past  years,  shows  that  some- 
thing must  be  radically  wrong  with  the  sy.-tem, 
which  must  be  remedied,  even  if  this  necessi- 
tates abolishing  the  office. 

On  the  other  hand,  we  do  noL  feel,  as  medical 
men,  competent  to  decide  as  to  the  possible 
effects  which  would  be  produced  by  this  change 
from  a  judicial  point  of  view.  If  the  office  of 
coroner  were  aholished,  the  legal  duties  would 


l82 


THE   CANADA   MEDICAL   RECORD. 


have  to  be  provided  for  in  someway,  the  details 
of  which  can  only  be  decided  by  persons 
thoroughly  conversant  with  the  workings  of  our 
criminal  law.  Furthermore,  the  abolition  of  the 
office  of  coroner  does  not  appear  to  your  Com- 
mittee to  be  absolutely  necessary  in  order  to 
secure  the  necessary  medical  reforms.  All  that 
is  really  necessary  is  to  do  away  withtiie  medical 
functions  and  responsibilities  of  the  coroner 
and  to  make  the  office  a  purely  judicial  one, 
only  dealfng  with  those  cases  where  there  are 
definite  grounds  to  suspect  death  from  violence 
or  negligence,  and  these  grounds  are  either 
strengthened  or  not  removed  by  the  examination 
of  a  medical  expert. 

We  would  therefore  recommend  : — 

1.  That  salaried  medical  examiners  be  ap- 
pointed to  investigate  all  deaths  occurring  under 
circumstances  calling  for  medico-legal  investi- 
gation under  any  Act,  and  that  these  officers  be 
given  authority  to  make  such  medical  exam- 
ination of  the  body  as  may  be  necessary  to 
determine  whether  death  was  due  to  violence 
or  not ; 

2.  That  in  every  case  the  medical  examiners 
report  the  result  of  their  examination  to  the 
coroner  or  other  judicial  officer  charged  with 
investigating  the  legal  side  of  such  cases,  who, 
in  case  of  violent  death,  shall  make  such  investi- 
gations and  take  such  measures  as  are  necessary 
for  the  proper  administration  of  the  law. 

If  necessary,  we  are  prepared  to  draft  an 
amendment  to  the  law  which  would  secure  the 
proper  carrying  out  of  this  system. 


(Signed,) 


G.  P.  GiRDWOOD. 

J.  George  Adami. 
E.  P.  Lachapelle. 
James  Bell, 


At  the  regular  meeting  of  the  Society  held  on 
Friday,  Dec.  15th,  1893,  this  report  was  unani- 
mously adopted,  and  it  was  resolved  that  a 
copy  of  the  report  be  sent  to  the  Attorney- 
General  and  to  each  of  the  medical  members 
of  the  Legislative  Assembly  and  Council  of  the 
Province  of  Quebec. 

Dr.  Bell  thought  the  Committee  had  acted 
wisely  in  not  undertaking  to  pronounce  upon 
the  legal  side  of  the  question.  Upon  motion 
of  Dr.  Girdwood  it  was  unanimously  resolved 
that  the  report  be  adopted  and  that  copies  be 
sent  to  the  Attorney  General  and  the  medical 
members  of  the  Legislative  Assembly  and 
Council  at  Quebec. 

Blood  stipply  of  vermiform  appendix.— -Dr. 
Bell  showed  for  Dr.  Shepherd  a  preparation 
showing  that  the  arterial  supply  of  the  appendix 
was  due  to  a  single  artery  which  did  not  anasto- 
mose with  any  neighboring  vessels,  hence  the 
readiness  with  which  sloughing  is  produce  in 
the  appendix. 


Stated  Meeting,  2()th  December,  1893. 
James  Bsll,  M.D.,  President,  intheChair. 

Drs.  S.  F.  Wilson  and  G.  H.  Raymond 
were  elected  members  of  the  Society. 

Death  Certification. — The  Secretary  stated 
that,  in  reply  to  Dr.  Laberge's  inquiry  regard- 
ing the  amendment  of  the  city  charter  in  the 
matter  of  death  certification,  the  following  reso- 
lution, framed  by  the  council  and  adopted  un- 
animously by  the  Society,  had  been  communi- 
cated to  Dr.  Laberge,  medical  health  officer  of 
Montreal  : — 

Resolved — i.  That  clause  17,  title  15  of  the 
charter  of  the  city  of  Montreal  be  so  amended 
that  all  certificates  of  death  must  be  given  by 
the  attending  physician,  the  city  health  officer, 
or  the  coroner's  physician  ; 

2,  That  all  such  certificates  of  death  be  reg- 
istered with  the  city  health  officer,  at  the  City 
Hall,  within  twenty-four  hours  of  the  death  of 
the  person  ; 

3,  That  no  body  be  buried  or  received  for 
burial  by  the  superintendents  of  cemeteries 
without  a  permit  from  the  city  health  officer  ; 

4,  That  such  penalties  be  enforced  as  to  en- 
sure the  carrying  out  of  this  law. 

Specimens  of  diseased  Uterine  AppeJi- 
dages. — Dr.  Martin  exhibited  the  following 
specimens  of  Drs.  AUoway  and  Adami  : — 

Ovarian  Tumor  Simulating  a  Parovarian 
Cyst. — K.  D.,  aged  30,  married,  was  operated 
or.  by  Dr.  Alloway  at  the  Montreal  General 
Hospital  on  i6th  August,  1893,  for  the  remov- 
al of  a  thin-walled  cyst,  situated  in  the  left 
broad  ligament,  and  apparently  monolocular. 
The  tumor  was  removed,  together  with  the 
left  ovary  and  broad  ligament.  The  appen- 
dages on  the  right  side  being  found  diseased, 
were  also  removed  and  ventrofixation  per- 
formed.' Recovery  was  good.  Examination 
of  the  specimens  by  Dr.  Adami  showed  that 
the  tumor,  though  apparently  monolocular, 
really  contained  several  small  accessory  cysts. 
The  left  ovary  was  enlarged  and  the  ovarian 
tissue  was  directly  continuous  with  that  of  the 
main  cyst,  which  was,  therefore,  evidently 
ovarian  in  origin.  The  right  ovary  was  enlarged 
and  showed  numerous  dilated  graafian  folli- 
cles forming  small  cysts,  all  situated  near  the 
surface,  and  containing  in  most  cases  gru- 
mous  blood-stained  fluid.  Both  tubes  were 
thickened,  the  right  being  dilated  and  contain- 
ing inspissated  purulent  fluid.  The  case  was  of 
interest  as  showing  a  general  tendency  to  cys- 
tic formation  of  the  ovaries. 

Hcematoma  of  Left  Fallopian  Tube. — W.  E., 
aged  34,  married,  had  borne  five  children,  and 
during  the  last  eighteen  months  had  aborted 
five  times.  Since  the  last  abortion  there  had 
been  a  continuous  bloody  discharge  from  the 
vagina.  The  patient  was  extremely  an3emic,and 
was  too  weak  to  walk.       When   examined,  in 


THE   CANADA   MEDICAL   RECORD. 


183 


tlie  Montreal  G  neral  Hos|)ital,  there  was  se- 
vere pain  in  the  hypogastric  and  inguinal  re- 
gions. A  s'-ft  movable  mass,  the  size  of  a 
fietal  head  at  the  6lh  month,  was  felt  behind 
the  uterus  and  to  the  left.  The  uterus  was 
anteveited.  On  6th  September,  1893,  the  ab- 
domen was  opened  in  the  mitldle  line  and  a 
small  elastic  tumor  attached  to  the  left  broad-  | 
ligament  found,  which  proved  to  be  full  of  blood 
and  clot.  The  left  tube  and  ovary  were  ligated 
and  removed  with  the  tumor.  Recovery  was 
good.  On  examinaiion  by  Dr.  Adami,  the 
tumor  proved  to  be  a  hcematoma  of  the  Fallo- 
pian tube.  The  external  surface  of  the  sac  was 
roughened,  inflamed  and  covered  with  organ- 
ized lym[jli.  The  inner  surface  of  the  sac  and 
contents  were  carefully  examined  for  foe'.al 
or  placenial  structures,  but  with  negative  re- 
sults. The  haematoma  was  evidently  of  chronic 
growth, and  appeared  to  h.ive  developed  as  a 
consequence  of  ch^'onic  inflammation  and  ul- 
ceration of  tl-.e  tube. 

Dr.  Alt.oway,  commenting  on  the  cases. 
said  :  It  was  interesting  to  know  that  a  cyst  of 
the  ovary  could  become  so  completely  sepai- 
atid  from  that  organ  and  so  simulate  a  parovar- 
ian cyst.  In  the  case  of  hematoma  the  -tube 
was  distended  to  the  size  of  his  wrist,  and  was 
ruptured  in  removal  It  so  resembled  a  tubal 
pregnancy  that  he  was  surprised  to  tind  no 
evidence  of  a  foetus,  but  now  believed  the 
bleeding  due  simply  to  rupture  of  the  blood 
vessels  during  tubal  inflammation.  There  was 
a  history  of  miscarriage  six  weeks  before  the 
opera  i  n. 

Doiibl-  Pyosalpynx  with  Infest  in./ 1  Fis'71- 
la. — Dr.  LiowAY  also  related  a  case  where 
the  appenda;^es  were  removed  from  a  woman 
suffering  from  severe  vaginitis  and  pelvic  peri- 
tonitis. Blood  and  pus  hadpnssed  by  the  bow- 
el. Both  tubes  were  greatly  dilated,  the  left 
being  fully  two  inches  in  diameter  and  filled 
with  pus  which  escaped  into  the  peritoneum 
during  the  operation.  The  pus  was  not  fcetid, 
and  no  bad  results  followed  this  accident.  The 
right  tube  was  thickened  into  a  dense  rigid 
cord,  passing  round  the  coils  of  intestine.  Both 
tubes  were  extensively  adherent  to  the  intes- 
tine and  the  eiitire  pelvic  contents  matted 
together.  Between  the  fimbriated  extremity 
of  the  right  tube  and  the  bowel  was  a  fistulous 
opening  of  the  diameter  of  a  five  cent  piece, 
which  was  clo.-ed  by  the  Lembert-Czerny 
method.  Another  opening  was  discovered  in 
ti.e  bowel  where  the  knuckle  of  the  tube  had 
become  adherent.  The  uterus  and  omentum 
were  utilized  m  closing  this.  The  extensive 
haemorrhage  was  arrested  by  pressure.  The 
pelvis  was  not  washed  out.  There  was  no  rise 
of  temperature  for  the  first  week,  when  there 
was  a  slight  rise  lasting  for  some  days  and 
accompanied  by  tympanitis.  At  the  present 
datC;  nine  weeks  after  operation,  she  appeared 


on  the  road  of  recovery.  Nothing  more  than 
a  local  peritnnitis  appeared  to  have  followed 
the  operation,  a'though  some  foecal  matter 
must  have  escaped  into  the  peritoneal  cavity. 
A  ghss,  and  later  a  rubber,  drainage  tube  was 
used.  A'  first  some  pus,  but  no  faeces,  passed 
through  these.  Starvation  diet  with  rectal  in- 
jection to  relieve  tympanitis  were  employed. 
Pyoctanin  and  [)eroxide  of  hydrogen  were 
used  as  antisei)iics. 

Discnsiion. — In  answer  to  Dr.  Gordon  Camp-, 
bell :     There  was  no  evidence  of  faeces    passed 
])er  vaginam.     To  Dr.  .Armstrong  :  The  omen- 
tum was  simply  brought  down,  not  sutured. 

Cholecystotomy. — Dr.  Armstrong  exhibited 
a  laige  solitary  gall  stone  removed  in  Septem- 
ber, 1893,  from  a  woman  aged  42.  Ten  years 
ago  she  had  her  firs',  attack  of  severe  pain, 
with  jaundice,  in  Harrogate  Hospital,  Eng- 
land, when  an  operation  was  suggested  but  de- 
clined. Since  then  she  had  attacks  of  biliary 
cohc  with  jaundice  about  every  six  months 
until  the  last  two  years,  since  when  they  occur- 
red monthly,  lasting  t.vo  weeks  at  a  time.  Pain 
severe  in  hypogastrium  and  right  hypochon- 
drium,  requirmg  morphia.  The  gall  bladder 
contained  some  pus,  its  walls  were  strong  and 
readily  sutured,  and  it  was  long  enough  to 
r'^ach  the  abdominal  wall.  On  palpation  no 
stone  could  be  felt  in  the  common  or  cystic 
ducts.  Recovery  uneventful,  the  only  un- 
favorable, point  being  the  persistence  of  the 
sinus,  although  there  was  satisfactory  evidence 
of  sufficient  bile  in  the  stools.  If  the  loss  of 
bile  proved  injurious  to  health,  the  only  opera- 
tion feasible  would  be  that  of  establishing  a 
communication  between  the  gall  bladder  and 
the  small  intes'.ine,  as  has  been  done  in  one 
case  by  McBurney. 

In  answer  to  Dr.  Lafleur  :  She  had  no  febrile 
attack  while  in  hospital,  but  said  herself  that 
some  of  the  previous  attacks  made  her  fever- 
ish. 

Dr.  F.  W.  Campbell  wondered  at  the  ex- 
cessive pain  in  this  case.  Pain  usually  arose 
from  small  stones  passing  along  the  duct,  and 
in  his  opinion  comparatively  small  stones  gave 
him  the  most  pain.  It  was  comforting  to 
think  that  if  serious  symptoms  of  obstruction 
arose,  surgeons  could  now  afford  permanent 
relief  by  operation. 

Dr.  LoCKHART  recalled  an  operation  he  had 
witnessed  on  a  woman  of  about  50,  when  only 
two  stones  were  found,  one  of  which  had 
two  facets,  having  possibly  been  turned  end 
for  end.     The  other  stones  had  three  facets. 

Dr.  Jas.  Bell  thought  the  contraction  of  the 
gall  bladder  upon  a  large  stone  would  easily 
account  for  the  pain.  With  renal  calculi  very 
large  stones  often  c.uised  no  pain,  while  in- 
tense agony  was  produced  by  very  small  ones. 
In  one  case  a  large  gall  stone  was  passed  by 
the  bowel,  which  must  have  ulcerated  through 
from  the  gall  bladder. 


1 84 


THE  CANADA  MEDICAL  RECORD. 


Dr.  Armstrong  asked  if  Dr.  Campbell's 
first  attatk  was  more  painful  than  subsequent 
ones. 

Dr.  Campbell  replied  that  such  was  not  the 
case.  He  thought  the  pai  i,  as  a  rule,  was 
only  produced  when  the  stones  entered  the 
ducts. 

Casrs  of  Infection  in  Pneumonia. — Dr. 
Gordon  Campbell  comnumicaitd  three  cases 
of  infective  pneumonia  in  a  family  as  follows  : — 
My  object  in  pieseniing  diis  leport  to  the 
So -ieiy  is  not  because  there  is  anything  of 
special  interest  in  the  three  cases  of  pneumo- 
nia in  th.-mselves,  but  from  the  apparent  de[)en- 
dencj  of  two  upon  the  ihiid  for  their  origin. 

Briefly,  the  history  of  the  three  is  as  fol- 
lows : — 

Case  I. — On  Sunday,  iglh  November,  Mrs. 
I).,  aged  30,  was  seized  with  a  severe  rigor 
foil- )wed  by  higli  fever  and  ^harp  pains  in  the 
!i.  ht  side.  I  st.w  her  on  the  22nd,  two  days 
after  ihe  onset,  and  made  out  the  usual  signs 
of  pneumonic  consolidation  of  the  base  of  the 
r  ghi  lung,  and  (iver  ihe  'iull  area  well  marked 
pleuritic  friction  rounds.  'I  emperature  104'^, 
P. 1 30,  R.  36,  and  a  small  amount  of  rusty 
expectoration.  The  j^yiexia  lasted  ten  days, 
falling  to  normal  in  the  course  of  48  hours, 
the  termination  being  accompanied  by  a  pro- 
fuse diarrhoea.  'J'he  whole  lung  ultimately  be- 
came involved  in  the  pneumonic  process,  and 
the  resolution  is  not  ytt  complete  4  weeks 
afier  ihe  fall  of  the  tempeiature. 

Case  IF. — Solomon  D.,  the  six  year  old  son 
of  No.  I,  was  seized  with  a  slight  chill  on  the 
afierncon  of  21st  Nov..  just  48  hours  after  his 
mother.  I  saw  him  the  following  day,  and 
four.d  the  early  physical  signs  of  pneumonia 
m  the  lett  base.  Temp.  103. S^^.,  P.  150,  R.  40. 
Here  also  in  two  days  the  whole  lung  was  in- 
volved, but  the  general  condition  remained 
good  througho  It,  although  the  respirations  for 
24li0urs  were  64  per  minute.  The  fever  lasted  7 
days,  coming  down  to  normal  the  morning  of 
the  29th.  Resolution  was  prompt  and  com- 
plete. 

Case  HI. — Charley  D.,  aged  4,  a  brother  of  / 
the  last,  was  seized  with  the  early  symptoms  ' 
on  the  evening  of  the  24th,  5  days  after  his 
mother  and  3  after  his  brother.  This  boy 
had  bttn  under  my  care  wiih  bronchitis  fiom 
the  4lhto  the  gdi  of  the  same  month  (Novem- 
ber). On  making  my  fiist  visit  to  the  above 
two  cases  on  the  22nd,  he  was  crying  with 
pain  in  the  head  and  neck,  and  I  examined  his 
chest  and  found  evidence  of  a  general  bron- 
chitis, with  a  temp,  of  loo'^,  R.  28  ;  the  two 
following  days  he  was  imi)roved,  but,  as  before 
mentioned,  on  the  evening  of  the  24th  he  be- 
came rapidly  worse,  and  by  tiie  26th  I  made 
out  all  the  usual  physical  signs  of  lobar  pneu- 
monia, extending  from  the  base  of  the  right 
lung  to  an  inch  above  the  nipple  in  front.  The 


fever  here  was  not  so  high  as  in  the  other  two 
cases,  and  fell  to  normal  on  the  fifth  day,  re- 
maining down  one  week,  then  an  evening  rise 
wa?  noticed,  and  he  developed  an  empysemia, 
which  has  been  treated  in  the  surgical  wards  of 
the  General  Hospital. 

In  the  first  case  the  cause  was  considered  to 
1  be  a  very  rapid  fall  in  temperature,  accompa- 
nied by  a  very  iiigh  wind,  to  which  the  patient 
had  been  exposed  while  insufficiently  clad. 
The  second  case  occurred  two  days  later,  and 
he  had  b.en  rn  good  health  up  to  the  time  of 
the  onset,  and  consequently  exposed  to  the 
i  same  aerial  conditioiiS  as  his  mother.  It  is  toihe 
third  case,  however,  that  the  most  interest  at- 
taches, for  he  had  not  bejn  outside  the  house 
door  for  three  weeks  previously,  and  on  my 
visit  I  had  examined  his  lungs,  and  found  r.oth- 
ing  but  a  rekindling  of  the  general  bronchitis, 
forwiiich  I  had  already  been  treating  him,  and 
it  was  no!,  until  two  days  later  that  the  pneu- 
monia developed.  The  whole  family  sleep  in 
one  room,  the  youngest  boy  in  the  same  bed 
wiih  his  mother,  and  consequently  there  was 
every  fixcility  for  infection,  pr  >vided  such  is 
possible,  and  I  think  in  liiis  particular  instanre 
we  are  forced  to  the  conclusion  that  Case  No. 
Ill  was  contracted  from  the  other  two,  and  in 
all  probability  No.  H  fro     No.  I. 

I'hat  pneumDriais  due  to  a  specific  micro- 
organism i-  now  generally  admitt-d,  but  cases 
which  can  be  definitely  shown  to  depend  dir- 
ec'tly  upon  others,  are  not  numerous  enough 
to  allow  one  to  neglect  putting  them  on  record. 
Dr.  F.  W.  Campbell  stated  that  when  the 
theory  of  the  infective  nature  of  pneumonia  was 
first  brought  out  10  years  ago,  he  found  that  he 
and  the  late  Dr.  Howard  were  treating  be- 
tW'.  en  them  seven  cases  where  the  disease  ap- 
peared to  have  been  transmitted  by  direct  in- 
fection. 

Dr.  Mt'RRow  had  recently  had  a  fatal  case 
of  pneumonia  in  an  old  man,  who  was  being 
nursed  by  his  sister.  At  his  second  visit  the 
sister  was  noticed  to  be  breathing  fast.  She 
became  very  il',  and  died  suddenly  a  few  hours 
later. 

Dr.  Jas.  Bell  had  reported  a  case  to  this 
Society  ten  years  ago.  A  hospital  orderly 
lived  in  a  small  upper  tenement  on  Mignonne 
street,  with  his  wife  and  wife's  brother.  The 
latter  came  home  one  day  with  a  very  severe 
pneumonia.  Two  or  three  days  later  the  or- 
derly was  stricken  with  pneumonia,  and  within 
a  few  days  the  wife  also  took  sick  with  the  same 
disease.  The  two  men  died  and  the  woman 
recovered. 

Dr.  Gordon  Campbell  said  that  what  speci- 
ally interested  him  was  the  fact  that  the  young- 
est child  was  in  the  house  all  the  time  for  three 
weeks  before  taken  ill,  and  was,  therefore,  not 
exposed  to  the  same  condition  as  the  mother. 
Danger  of  Hypodermic  injection  of  Morphia* 


THE  CANADA.   MEDICAL   RECORD. 


185 


— Dr.  F.  \V.  Camtukll  related  the  case  of  an 
old  lady,  Iiis  own  patient,  subject  to  attacks  of 
pleurodynia,  for  which  he  was  in  the  habit  of 
prescribing  minute  doses  of  opium.  In  his  ab- 
sence she  was  seized  with  severe  pain,  and  a 
neighboring  practitioner  who  was  called  in 
gave  her  a  hypodermic  injection  of  morphia. 
She  went  to  sleep  so  profoundly  that  her  friends 
were  alarmed.  Next  day  she  was  found  to  be 
suffering  from  complete  paralysis  of  the  bron- 
chial tubes,  and  the  phlegm  went  on  accumu- 
lating until  she  died  shortly  afterwards.  The 
relief  of  pain  was  not  the  only  object  to  be  con- 
sidered when  suddenly  called  to  see  a  case.  A 
hypodermic  needle  may  be  a  two-edged  sword, 
especially  when  used  on  the  aged. 

Dr.  W.  F.  Hamilton  asked  whether  the  pa- 
tient was  suffering  from  the  old  attack  of  pleur- 
odynia or  from  pneumonia  ?  How  much  opium 
was  used  in  the  hypodermic  injection  ?  and 
what  cause  was  assigned  in  the  death  certifi- 
cate ? 

Dr.  Campbell  did  not  remember  what 
cause  was  stated  in  the  death  certificate,  but 
thought  it  had  been  certified-  as  grippe.  She 
was  not  suffering  from  pneumonia  the  day  pre- 
vious. He  did  not  know  the  quantity  of 
opium.  The  patient  largely  regained  conscious- 
ness before  she  died. 


Sfa  ted  Meeting,  1 2  th  J  a  iiuary,  i  S  9  4 . 
James  Bell,  M.D.,  President,  in  the  Chair. 

Transient  SineUing  of  the  Right  Arm. — Dr. 
James  Bell  showed  the  patient,  a  woman  22 
years  old,  who  suffered  constantly  from  a 
painless  swelling  of  the  right  arm,  extending 
from  just  above  the  elbow  to  the  fingertips,  ac- 
companied by  slight  muscular  stiffness  of  the 
forearm.  There  was  nothing  abnormal  in  the 
circulation  or  innervation  of  the  part.  The 
swelling  was  first  noticed  six  months  ago,  and 
diminished  when  the  arm  was  kept  at  rest  for 
a  few  days,  but  came  on  again  when  she 
began  to  use  it.  An  exploratory  incision 
on  middle  third  of  radius  outer  border,  made 
two  months  ago,  revealed  nothing  unusual.  He 
was  unable  to  make  a  diagnosis. 

Dr.  Armstrong  had  seen  the  case,  and  was 
unable  to  throw  any  light  on  its  causation. 

Dr.  Shepherd  thought  the  condition  hyster- 
ical and  due  to  mechanical  obstruction,  surrep- 
titiously produced,  to  the   venous    circulation. 

Dr.  Wesley  Mills  thought  Dr.  Shepherd's 
explanation  possible,  and  had  noticed  in  talk- 
ing with  the  patient  that  she  was  very  ready 
to  adopt  and  repeat  symptoms  suggested  to 
her.  Engorgement  of  the  capillaries  could, 
however,  also  be  produced  through  nervous 
influence.  In  nervous  persons,  according  to 
Dr.  West,  transient  tumors  sometimes  sud- 
denly appear  in  the  region   of  the  axillary  ar- 


tery.    The  present  case  might  possibly    be    of 
nervous  origin. 

Dr.  GuRohad  treated  the  patient  for  some 
time  on  iron  without  benefit. 

Dr.  Ja.mes  Bell  thought  the  obstruction 
must  be  mechanical,  whether  produced  volun- 
tarily or  by  something  along  the  course  of  the 
veins. 

Ruptured  Tubal  Pregnancy  and  Appendi- 
citis,— Dr.  Armstrong  exhibited  a  ruptured 
Fallopian  tube  with  ovary  attached.  Lying  at 
the  bottom  of  a  sort  of  sac,  at  the  point  of 
rupture,  was  a  small  object  which  appeared  to 
be  the  foetus.  The  patient,  a  married  woman 
aged  34,  was  the  mother  of  seven  children.  In 
August,  1893,  she  had  what  appeared  to  be  a 
mild  attack  of  appendicitis.  She  made  a  good 
recovery  after  ten  days  in  bed,  and  remained 
well  till  2Sth  Nov  ,  1S93,  when  she  was  sudden- 
ly seized  with  severe  abdominal  pain  and 
slight  diarrhoea,  and  when  seen  one  hour  later 
was  in  an  extreme  condition  of  shock.  On 
removal  to  hospital  her  condition  was  so  much 
improved  that  the  contemplated  operation  was 
not  performed,  and  she  was  able  to  return 
home  in  ten  days.  On  5th  Jan.,  1894,  she  was 
suddenly  seized  with  intense  abdominal  pain, 
vomiting  and  slight  diarrhoea,  followed  by  col- 
lapse, and  was  operated  on  to-day  (Jan.  12th). 
Ruptured  tubal  pregnancy  was  suspected  in 
spite  of  the  history  of  a])pendicitis  in  August. 
The  abdomen  was  found,  on  opening,  to  be 
full  of  blood.  The  right  tube,  which  was  sur- 
rounded by  clots  and  debris,  was  at  once  liga- 
ted  and  removed.  On  Dr.  Bell's  suggestion, 
the  appendix  was  removed  and  examined.  It 
was  enlarged,  and,  on  opening,  a  blood  clot 
was  found  in  its  centre.  The  diagnosis  was 
made  specially  obscure  by  the  fact  that  the 
menstruation  had  not  been  disturbed,  except 
for  a  pause  of  a  week  after  the  commencement 
of  the  October  period.  The  flow  was  then  re- 
sumed, and  went  on  to  its  normal  term  of  4  or 
5  days.  Although  the  pathology  of  ruptured 
tubal  pregnancy  has  been  known  .since  1814, 
it  is  only  1 1  years  since  Tait  performed  his 
first  operation,  since  which  time  he  has  oper- 
ated on  33,  saving  all  but  one,  his  first  case. 
This  fatal  result  Tait  attributed  to  his  neglect- 
ing to  tie  the  bleeding  tube  before  cleaning  out 
the  abdomen.  Intra-peritoneal  htematocele 
is  specially  dangerous,  as  the  blood  does  not 
clot,  but  goes  on  escaping  unless  relieved  by 
the  surgeon.  Extra-peritoneal  cases  were  much 
less  dangerous.  Dr.  Armstrong  thought  the  ab- 
domen should  be  opened  in  every  case  of  col- 
lapse following  severe  abdominal  pain. 

Dr.  Gurd  referred  to  a  case  of  his,  where  Dr. 
Gardner  had  operated.  The  pain  was  intense. 
The  clot  resembled  black  currant  jelly.  The 
case  recovered. 

Dr.  England  mentioned  a  case  seen  with 
Dr.  Armstrong-,  when  the  presence  of  blood   in 


1 86 


THE  CANADA  MEDICAL  RECORD. 


the  abdomen  had  been  diagnosed  from  the 
dull  note  in  the  dependent  part  of  the  abdo- 
men. The  perforation  was  situated  near  the 
uterus.     Recovery  was  good. 

Dr.  Lafleur  had  seen  a  case  at  the  Johns 
Hopkins  Hospital  where  the  presence  of  blood 
was  revealed  by  aspiration.  Upon  operation, 
the  case  proved  to  be  a  ruptured,  tubal  preg- 
nancy complicated  with  chronic  ulcerated  ap- 
pendicitis. 

Dr.  Gordon  Campbell  had  seen  Dr.  Arm- 
strong's case  one  hour  and  a  half  after  the  com- 
mencement of  the  first  attack.  The  pain  was 
pretty  high  up,  a  little  to  the  right  of  the  um- 
bilicus.    There  was  no  dullness  or  tumor. 

Dr.  Wesley  Mills — Intra-venous  injec- 
tion appears  to  be  indicated  when  collapse  is 
severe. 

Dr.  Armstrong,  in  reply,  said  ihat  in  his 
expeiience  dullness  and  tumor  were  only  met 
with  in  extra-peritoneal  cases  ;  when  the  pri- 
mary rupture  is  intra-peritoneal.  the  blood  is 
diffused  between  the  coils  of  intestine. 

Intra-Capsular  Fracture  of  the  Femur  in  a 
Paralyzed  Limb. — Dr.  James  Bell  exhibited 
the  specimen,  and  related  the  history  of  a  man 
68  years  old,  who  had  been  the  subject  of  in- 
fantile paralysis.  The  fracture  occurred  in 
the  paralyzed  limb.  Afier  eight  weeks'  treat- 
ment by  extension  with  the  long  splint  he  was 
about  to  be  discharged,  as  there  was  no 
hope  of  restoration  of  function  in  the  origi- 
nally useless  limb.  He  contracted  a  pneumo- 
nia,and  died  nine  weeks  after  the  accident.  The 
bone  did  not  show  the  slightest  attempt  at  re- 
pair. In  a  normal  state  of  nutrition  consider- 
able attempt  at  union  would  be  expected  after 
nine  weeks  immobilization.  Absence  of  union 
in  this  case  was  doubtless  due  to  the  paralysis. 
Dr.  Bell  thought  that  even  in  very  old  patients 
sufficient  union  to  ensure  a  serviceable  limb 
is  to  be  hoped  for,  and  disapproved  of  the  ad- 
vice given  in  text-books  to  make  no  attempt 
at  treatment  if  very  old.  In  one  case  of  his  a 
lady,  aged  94,  recovered  sufficiently  to  walk 
about  after  nine  or  ten  months. 

Dr.  Armstrong  referred  to  a  case  in  his 
practice,  when  a  lady  92  years  old  got  suffi- 
ciently well  to  walk  about,  ihough  no  treatment 
at  all  was  attempted.  He  asked  if  Dr.  Bell 
had  ever  seen  bony  union  in  these  cases. 
^  Dr.  Shepherd  thought  that  the  cases  which 
got  well  were  those  where  impaction  was  pres- 
ent. It  is  in  cases  where  manipulation  for  pur- 
poses of  diagnosis  is  employed  that  the  patients 
never  get  well,  as  the  impaction  is  thus  broken 
up.  Manipulation  should  never  be  used  in 
such  cases. 

Dr.  F.  W.  Hamilton  had  been  present  at 
the  autopsy  on  Dr.  Bell's  case.  There  was  a 
purulent  arthritis  of  the  joint. 

Dr.  Bell  fully  agreed  with  Dr.  Shepherd's 
remarks.  He  had  not  seen  many  specimens 
of  bony  union  in  old  persons. 


Dr.  McGannon  did  not  see  how  a  diagnosis 
could  be  made  without  manipulation.  He  had 
resorted  to  it  in  the  case  of  a  woman  of  58,  and 
after  treatment  of  a  plaster  of  Paris  bandage 
h:;d  secured  good  union. 

Dr.  Gordon  Campbell  referred  to  Treves 
sign  of  a  lax  condition  of  the  fascia  lata  on  the 
affected  side,  as  being  of  great  value  in  the  di- 
agnosis of  intra-capsular  fracture. 

Dr.  Shepherd  thought  that  a  diagnosis 
could  be  made  by  observing  the  relation  of 
the  trochanter  to  Nelaton's  or  Bryant's  test 
lines.  He  would  rather  make  an  error  in  diag- 
nosis than  run  the  risk  of  crippling  the  patient 
for  life. 

Copper  Nugget  in  the  Forni  of  a  Skull- Cap. 
— Dr.  James  Guerin  showed  this  specimen, 
found  in  the  Calumet  Mines,  4,200  feet  below 
the  surface.  It  was  stated  that  near  it  were  found 
two  other  pieces  of  copper,  one  having  the  out- 
line of  a  foot,  the  other  that  of  a  tibia,  according 
to  the  description  of  a  medical  man.  The 
resemblance  to  a  skull  was  very  striking  ;  but 
if  it  was  a  skull,  how  did  it  get  there,  and  why 
was  it  converted  into  copper? 

Dr.  Girdwood  thought  the  specimen  merely 
a  piece  of  copper  ore. 

Case  of  Belladonna  Poisoning. — Dr.  Elder 
was  summoned  on  23rd  Dec,  1893,  to  see  a 
woman  aged  45,  who  was  stated  to  have  sud- 
denly fallen  in  a  fainting  fit  while  at  breakfast.  — 
She  was  lying  down.  The  face  was  suffiised.  jfl 
There  was  intense  throbbing  of  the  vessels  ■ 
of  the  neck.  The  pupils  were  so  dilated  that 
scarcely  any  iris  could  be  seen.  Belladonna 
poisoning  was  at  once  suspected,  especially  as 
a  liniment  of  equal  parts  of  extract  belladonna 
and  glycerine  was  being  prescribed  for  another 
member  of  the  family.  It  transpired  that  by 
mistake  a  dessert  spoonful  of  this  had  been 
taken.  A  few  moments  later  she  said  that  her 
eyes  "  felt  as  if  dropping  out."  She  soon  be- 
came unconscious.  Her  stomach,  which  was 
nearly  empty,  was  thoroughly  evacuated  with 
the  stomach  pump  and  washed  out  with  four 
quarts  of  water.  Afterwards  half  a  grain  of 
morphia  was  given  hypodermically,  which 
promptly  contracted  the  pupils.  The  pulse  was 
at  first  160  and  breathing  rapid,  afterwards  the 
pulse  became  slower  but  weaker,  and  breathing 
deeper  and  stertorous.  Hypodermics  of  brandy 
and  ether  were  employed  as  stimulants.  At 
times  respiration  almost  stopped,  but  would 
revive  upon  pressing  the  epigastrium.  At  3  p.m., 
at  suggestion  of  Dr.  Blackader,  ./^  gr.  nitrate 
of  strychnine  was  given.  At  6  p.m.  she  had 
recovered  consciousness  and  was  able  to  pass 
her  urine.  After  this  her  recovery  was  rapid. 
On  the  following  day,  while  breathing  near  her 
husband's  eyes,  he  declared  that  he  suddenly 
became  blind.  His  pupils  were  certainly  dilated, 
possibly  from  absorption  of  the  drug  exhaled  by 
the  patient's  lungs.  One  of  the  hypodermic 
punctures  produced  a  slough. 


THE  CANADA   MEDICAL   RECORD. 


187 


Dr.  Blackader  thought  the  recovery  due  to 
the  prompt  treatment  and  the  nature  of  the 
mixture.  The  presence  of  so  much  glycerine 
would  delay  absorption.  There  was  not  an  exact 
antagonism  between  opium  and  belladonna,  and 
the  use  of  either  as  an  antidote  for  the  other 
should  be  made  very  cautiously  for  fear  of  an 
overdose,  as  both  opium  and  belladonna  in 
large  doses  acted  as  cardiac  and  respiratory 
depressants.  Dr.  Wood  thinks  that  the  conse- 
cutive use  of  several  drugs  having  the  same 
action  is  preferable  to  a  single  jihysiological 
antidote.  He  did  not  advise  the  use  of  pilocar- 
pine in  the  present  case,  as  it  would  not 
stimulate  the  respiratory  centre.  We  have  no 
drug  which  will  exactly  cover  the  symptoms  of 
another  drug. 

Dr.  DrCow  mentioned  a  case  of  poisoning 
by  cedar  oil,  where  the  symptoms  were  weak 
pulse,  unconsciousness,  rigidity  of  the  muscles 
of  the  jaw,  and  epileptiform  convulsions.  The 
stomach  was  emptied,  and  hypodermics  of  ether 
and  brandy  given.  One  case  of  this  form  of 
poisoning  has  been  recorded. 

Dr.  F.  W.  Hamilton  related  a  case  of  bella- 
donna poisoning  when  a  dose  of  belladonna 
liniment  was  given  by  a  nurse.  An  emetic  of 
mustard  produced  prompt  emesis.  Two  hours 
later  the  only  symptoms  remaining  were  slight 
dilatation  of  the  pupils  and  dryness  of  the 
throat. 

Dr.  Proudfoot  referred  to  a  case  of  bella- 
donna poisoning  from  application  of  atropine 
to  the  conjunctiva.  Personally  he  once  by 
mistake  took  an  overdose  of  belladonna  and 
bromide  mixture  while  suffering  from  whooping 
cough.  Blindness,  giddiness  and  faintness  came 
on,  but  passed  off  in  three  hours  without  treat- 
ment. 

Dr.  GiRDWooD  asked  Dr.  Elder  if  there  was 
suppression   of  urine. 

Dr.  Wesley  Mills  reported  some  mild  cases 
of  atropine  poisoning  which  had  recovered 
without  treatment.  In  one  chronic  case 
polyuria  was  noticed.  In  the  dog's  heart,  atro- 
pine i^revents  vagus  inhibition,  and  pilocarpine 
restores  that  function.  Further  experiments 
upon  the  antagonism  of  the  two  drugs  were 
needed. 

Dr.  Gordon  Campbell  had  seen  a  case  of 
poisoning  in  a  child  from  application  of  atro- 
pine to  the   conjunctiva. 

Dr.  Elder,  in  reply. — The  quantity  of  urine 
was  not  measured.  There  was  no  suppression. 
The  symptoms  may  have  been  modified  by  the 
morphine  given.  There  was  no  rash  04i  the 
skin  and  no  delusions.  Until  the  physiological 
action  of  atropine  was  experimenially  worked 
out,  the  treatment  of  such  cases  must  remain 
experimental. 


Stated  Meetings  January  26t/i,  1894. 
Dr.  James  Bell,  President,  in  the  Chair. 

Suture  of  Tendons  of  the  Hand. — Dr.  Bell 
exhibited  a  man  o;i  whom  he  had  operated  four 
weeks  previously.  The  patient  had  fallen 
through  a  plate  glass  window  and  cut  the  tissues 
of  the  palm  and  wrist  severely,  the  superficial 
and  deep  flexor  tendons  as  well  as  the  ulnar 
vessels  and  nerves  being  severed.  Owing  to 
an  interruption,  the  divided  ulnar  nerve  was 
overlooked  at  the  time.  The  wound  was 
therefore  re-opened  next  day  and  the  nerve 
sutured,  perfect  sensation  in  the  fifth  and  inner 
side  of  the  ling  finger  being  obtained.  Suf- 
ficient movement  was  now  present  in  the  hand 
to  show  that  the  action  of  the  tendons  was 
fully  established.  In  repairing  the  injury,  the 
superficial  and  deep  tendons  had  been  sutured 
separately,  but  Dr.  Bell  believed  the  result 
would  have  been  just  as  good  had  the  cut  ends 
simply  been  united  en  masse. 

Fictitious  Urticatia. — Dr.  Gordon  Camp- 
bell showed  a  man  in  whom  he  had  detected 
this  condition  accidentally  while  examining  the 
chest.  The  slightest  scratch  brought  out  dis- 
tinctly raised  reddish  wheals  within  less  than 
five  minutes.  This  was  demonstrated  before 
the  Society.  The  condition  was  most  marked 
in  the  skin  of  the  back,  but  was  also  present 
over  the  chest,  abdomen  and  limbs.  Dr.  Camp- 
bell stated  that  the  rareness  of  this  condition 
was  probably  largely  owing  to  the  fact  that,  as 
in  the  present  case,  the  patients  were  not  incon- 
venienced by  it,  and  therefore  not  aware  that 
they  suffered  from  it,  and  it  was  only  dis- 
covered by   accident. 

Dr.  Foley  considered  the  disease  one  of  the 
commonest  skin  affections. 

Dr.  Orr  asked  if  the  patient  had  shown 
evidences  of  being  subject  to  the  ordinary 
mettle  rash. 

Dr.  Campbell  replied  that  the  man  was  not 
aware  that  he  ever  had  any  skin  disease  at  all. 

Induction  Coil  for  Utilizing  the  Ordiyiary 
Electric  Light  Curre?it  for  the  Thermo- 
cautery.— Dr.  Lapthorn  Smith  exhibited  an 
apparatus  invented  by  Mr.  Shaw  and  manu- 
factured by  the    Montreal  Electric   Company. 

The  instrument  can  be  connected  with  the 
socket  of  any  incandescent  lamp  by  simply 
screwing  in  a  plug.  The  current  can  be  regu- 
lated with  ease,  and  arranged  so  as  to  heat 
the  platinum  knives  or  loops  to  any  degree 
required.  There  was  no  possibility  of  danger- 
ous electric  shock  being  given.  The  apparatus 
was  very  cheap,  costing  only  $20.00,  the 
current  costing  i^  cents  per  hour.  The 
apparatus  had  been  employed  with  satisfactory 
results  for  the  last  two  years  by  several  Mon- 
treal physicians,  but  not  being  aware  of  this.  Dr. 
Smith  had  nearly  invested  in  a  much  more 
expensive  apparatus   made  iu  New   York,  and 


1 88 


THE  CANADA  MEDICAL  RECORD. 


SO  wished  lo  save  other  members  incurring  a 
useless  expense. 

Dr.  Shepherd  read  a  paper  upon  "  The 
Curative  Effect  of  Exploratory  Laparotomy," 
which  is  as  follows  : 

It  has  been  known  for  years  that  in  certain 
cases  the  mere  performance  of  abdominal 
incision  has  some  remarkable  effects  on 
growths  and  other  conditions  of  the  abdomen. 
This  has  been  widely  recognized  especially  in 
cases  of  tuberculosis  of  the  peritoneum.  In 
1889,  Mr.  Lawson  Tait  {EdinburKh  Medical 
Jouf .)  drew  attention  to  the  fact  that  certain 
diseases  of  the  abdomen  seem  to  yield  to  surgi- 
cal treatment  applied  to  them  by  accident,  and 
that  he  had  more  than  once  seen  tumors, 
often  of  large  size,  disappear  after  a  mere  ex- 
ploratory mcision.  These  cases  he  reported  at 
the  time,  but  his  statements  were  not  believed. 
The  cases  in  which  he  had  seen  tumors  disap- 
pear in  this  way  were  chiefly  in  connection  wiih 
the  liver,  spleen  and  head  of  the  pancreas.  From 
the  number  of  cases  of  this  kind  observed  by 
him,  Mr.  Tait  is  satisfied  that  the  disappearance 
is  not  a  mere  coincidence,  but  that  the  opening 
of  the  petitoneal  cavity  has  a  direct  influence  in 
setting  up  the  process  of  absorption  of  the 
tumor.  Everyone  knows  that  after  the 
smallest  wound  of  the  peritoneum,  an  intense 
thirst  is  set  up,  which  lasts  for  some  days,  and 
that  this  thirst  is  not  set  up  after  opening  any 
other  serous  cavity,  or  in  wounds  of  the 
abdomen  where  there  is  no  injury  of  the 
peritoneum.  Mr.  Tait  relates  a  number  of 
remarkable  cases  in  this  paper.  One  case 
particularly  deserves  mention.  A  lady,  set. 
54,  had  an  abdominal  section  performed  for 
supposed  gall  stones  or  possibly  cancer  of 
the  liver.  The  liver  was  found  covered  with 
large,  hard  nodules,  one  of  which  closely 
imitated  the  lump  which  had  led  to  the  diag- 
nosis of  distended  gall  bladder.  The  case  had 
so  much  the  appearance  of  malignant  disease, 
that  no  hopes  were  given  of  her  recovery. 
Contrary  to  expectation,  however,  the  patient 
completely  recovered,  and  was  alive  and  well 
several  years  after.  A  number  of  other  cases 
are  also  given.  In  no  less  than  three  out  of 
four  cases  of  greatly  enlarged  spleen,  tumor 
disappeared  without  more  being  done  than 
opening  the  abdomen  and  examining  the 
growth,  and  in  one  case  of  tumor  of  head  of 
pancreas,  with  great  emaciation,  exploratory 
incision  resulted  in  entire  disappearance  of  the 
tumor  in  five  or  six  weeks,  and  complete 
restoration  to  former  health.  In  the  case 
of  supposed  cancerous  nodules  of  the  liver, 
the  evidence  would  have  been  much  stronger 
had  Mr.  Tait  excised  a  portion  for  microscopic 
examination.  It  is  hard  to  believe  that  there 
was  malignancy  in  any  of  the  cases,  but  the 
fact  remains  that  the  gross  clinical  appear- 
ances were  those   of  malignancy,  and  that  the 


observers  were  skilled  in  recognizing  the 
noimal  appearance  of  the  organs.  It  is 
possible  that  some  of  the  lesions  may  have 
been  due  to  syphilis.  In  1891,  Dr.  J.  White, 
of  Philadelphia,  published  in  the  Annals  0/ 
Surgtry  an  interesting  and  exhaustive  paper 
on  the  "Curative  Effects  of  Operation /<?r  se^' 
and  came  to  the  conclusion  that  epilepsy, 
certain  abdominal  tumors,  peritoneal  effu- 
sions, and  also  tubercle  were  benefited  by 
these  operations,  and  though  one  of  the 
possible  factors  was  anaesthesia,  also  psychical 
influence,  relief  of  tension  and  reflex  action 
may  enter  into  the  therapeutics  of  these  cases. 
He  does  not  think  accident  or  coincidence 
explains   them. 

Pierre  Delbet  {Bull,  de  la  SocieU  Alchemique 
de Paris,  Oct.  and  Nov.,  1892)  reports  the 
case  of  a  child,  set.  2J  years,  whose  health 
had  been  failing  for  some  months.  On  ex- 
amination, a  large,  smooth,  firm  tumor  was 
found  on  the  right  side  of  the  abdomen  ex- 
tending from  the  costal  cartilages  to  the  iliac 
fossa.  The  diagnosis  of  sarcoma  or  carcinoma 
of  liver  was  made.  An  exploratory  operation 
was  performed,  and  the  tumor  was  found  to 
be  an  enlarged  right  lobe  of  the  liver,  pale  in 
color,  with  violaceous  marblings.  Enlaiged 
glands  were  found  in  the  hepatic  omentum. 
Punctures  were  made,  but  revealed  nothing. 
The  result  was  immediate  and  surprising ;  in 
three  days  the  child  regained  appetite  and 
cheerfulness,  the  liver  rapidly  decreased  in 
size  and  returned  to  normal  in  two  months. 
The  character  of  thd  enlarged  liver  was  reveal- 
ed later,  when  syphilitic  gummata  appeared  on 
forehead  and  scalp. 

Dr.  Wm.  White  in  the  elaborate  article  in  the 
Annals  of  Surgery,  referred  to  above,  cites 
may  cases  where  exploratory  abdominal 
incision  relieved  symptoms  of  pain,  vomiting, 
etc.,  and  also  some  cases  of  tumor,  which 
shrank  away  after  operation,  although  at  the 
time  the  operator  considered  them  malignant 
and  gave  a  hopeless  prognosis . 

Prof.  Von  Mosetig.  of  Vienna,  in  1888,  show- 
ed a  case  where  he  had  perfoimed  exploratory 
laparotomy  some  time  before  for  a  tumor 
which  filled  the  whole  pelvis  ;  it  was  quite  fixed, 
and  removal  was  not  attempted,  so  the  wound 
was  closed.  To  his  surprise,  when  examined, 
14  days  later,  he  found  the  tumor  had  shrunk 
to  half  its  former  size,  and  it  continued  to  dim- 
inish, so  that  when  shown  to  the  Imperial  So- 
ciety of  Physicians  at  Vienna,  it  was  no  larger 
than  a  man's  fist.  He  thought  the  disappear- 
ance might  be  due  to  the  intense  hypersemia 
observed  during  the  operation  ;  in  the  same 
way  sometimes  sarcomata  maj^  disappear  under 
the  influence  of  severe  erysipelas.  Cases  also 
occur  where,  for  a  time,  in  malignant  cases  great 
improvement  takes  places  as  the  result  of  ex- 
ploration, but  these  cases  always  relapse  and 
the  patient  soon  succumbs. 


THE  CANADA  MEDICAL  RECORD. 


189 


In  this  connection  I  shall  now  relate  a  case 
of  which  I  had  personal  experience.  It  is  as 
follows  : 

In  October,  1S91,  I  was  consulted  by  Mrs. 
B.,  a  nurse,  act.  28,  spare  in  habit  and  of  a  san- 
guine temperament,  for  a  tumor  she  had  re- 
cently felt  in  the  neighborhood  of  the  umbili- 
cus. She  had  always  been  healthy,  had  been 
married,  and  was  the  mother  of  one  child  net.  8 
years.  Never  had  any  miscarriage  and  no  his- 
tory of  syphilis.  No  tubeiculosis  in  family, 
never  had  any  jaundice,  nor  had  she  ever  had 
anything  like  severe  colic.  For  some  time  has 
not  been  feeling  well  and  not  up  to  her  work  ; 
has  frequent  elevations  of  temperature  and  oc- 
casional sweats  ;  her  appetite  good,  and  there 
are  no  symptoms  pointing  to  any  affection  of 
the  stomach,  no  vomiting  or  dyspeptic  symj)- 
toms. 

Notes  of  Examination, — On  examining  her 
in  the  recumbent  position,  a  tumor  the  size  of 
an  orange  is  felt  to  the  right  and  a  little  above 
the  umbilicus.  This  tumor  is  smooth,  very 
lender  to  the  touch  and  moves  with  the  respir- 
ations. It  can  be  pushed  to  the  left  side,  under 
left  costal  cartilage,  and  to  the  right  apparently 
under  the  edge  of  the  liver.  Jn  fact,  the  tumor 
is  very  freely  movable.  Occasionally  the  tumor 
is  very  painful,  ard  it  is  always  tender  to  the 
touch.  I  did  not  examine  her  again  until  Dec. 
20th,  as  she  had  in  the  meantime  gone  about 
her  nursing  duties  in  the  hospital,  but  these  she 
soon  found  too  much  for  her,  and  she  was  com- 
pelled to  take  to  her  bed.  Her  temperature 
was  carefully  registered  and  she  was  closely 
observed.  Her  temperature  was  always  101° 
at  night  and  100°  in  the  morning.  Every 
other  day  she  had  a  severe  sweat.  She  said 
she  felt  more  comfortable  up  than  in  bed,  for 
then  she  had  her  corsets  on,  and  these  when 
tightly  laced  kept  the  movable  tumor  in  its 
place.  On  examining  her  waist,  a  well 
marked  line  of  constriction  was  seen  to  pass 
immediately  above  the  tumor  when  it  was  in  its 
normal  position.  It  was  thought  that  the  tumor 
was  caused  by  a  lacing  lobe  of  the  liver,  with 
probably  an  enlarged  gall  bladder  beneath. 
Not  getting  any  belter,  and  being  anxious  to 
have  something  done,  she  consented  to  an 
exploratory  incision. 

Operation^  Dec.  27,rd,  1891. — An  incision  was 
made  in  the  median  line  above  the  umbilicus, 
and  the  left  lobe  of  the  liver  was  immediately 
come  down  upon.  On  examination,  a  portion 
of  this  lobe  was  seen  to  be  quite  abnormal  in 
appearance  and  very  definitely  marked  off  from 
the  healthy  part  by  a  distinct  line.  This  ab- 
normal portion  of  the  liver  commenced  at  the 
great  fissure  where  the  round  ligament  entered, 
and  extended  upwards  to  a  furrow,  correspond- 
ing to  a  lacing  furrow,  and  to  the  left  it  reached 
to  the  edge  of  the  left  lobe,  where  the  lateral 
ligament  leaves    the  liver.     This    portion  was 


thick,  somewhat  puckered  on  its  surface  as  if 
from  cicatricial  contraction.  It  was  of  a  deeper 
color  than  the  rest  of  the  liver.  A  needle 
entered  into  the  cicatricial  part  with  difficulty, 
but  in  other  pans  no  resistance  was  offered  to 
the  entrance  of  the  needle.  On  holding  the 
lobe  between  the  finger  and  thumb,  well  marked 
nodules,  like  masses  of  new  growths,  were  felt. 
Adherent  to  this  part  of  the  liver  weie  some 
portions  of  omentum.  On  removing  these,  the 
liver  bled  freely,  and  hemorrhage  could  only  be 
stopped  by  apphcation  of  the  cautery  ;  indeed, 
this  abnormal  portion  differed  from  the  ordinary 
cirrhotic  lacing  lobe  in  that  it  was  exceedingly 
vascular.  There  was  some  intention  of  remov- 
ing this  diseased  portion  of  the  liver,  but  it  was 
decided  not  to  do  so,  because  the  pedicle  was 
so  broad  and  the  parts  were  so  vascular,  so  the 
wound  was  closed. 

The  patient  after  operation  had  some  pain 
for  24  hours  and  distension,  but  went  on  to  an 
uneventful  recovery.  After  the  exploratoiy  in- 
cision she  had  no  more  tenderness,  and  after 
the  first  day  no  more  pain.  Her  sweating 
ceased  and  her  temperature  became  absolutely 
normal.  On  examining  her  a  few  weeks  after 
operation  the  tumor  could  still  be  felt,  but  it 
was  immovable.  She  soon  returned  to  her 
work  and  complained  no  more, — in  fact,  she  was 
perfectly  cured,  and  when  last  heard  from,  some 
short  time  ago,  she  was  in  perfect  healtii  and 
able  to  perform  all  her  duties  as  superintendent 
of  a  hosi^ital.  The  tumor  disappeared  within  a 
year  of  the  operation— or  at  least  cuuld  not  be 
felt. 

Thinking  the  case  might  be  of  specific  origin, 
I  put  her  on  potassium  iodide  for  some  time, 
which  may  have  had  something  to  do  with  the 
disappearance  of  the  tumor. 

{To  be  Contifiued.) 


Iroi^ccBS    of    Science* 


A  MECHANICAL  DEVICE  FOR  ILLUS- 
TRATING THE  MOVEMENTS  OF 
THE  LUNG  IN  PENETRATING 
WOUNDS  OF  THE    CHEST. 

Dr.  Andrew  H.  Smith,  of  New  York  City, 
showed  before  the  American  Climatological 
Association  an  apparatus  which  consists  of  two 
bellows,  operated  by  a  handle  common  to  both, 
representing  the  thoracic,,  cavities,  and  each 
containing  an  elastic  bag  representing  the  lung. 
The  top  of  each  bellows  is  of  glass.  A  slot  on 
each  side,  covered  by  a  slide,  represents  a 
wound  of  dimensions  variable  at  pleasure. 
Tubes  representing  the  bronchi  and  trachea 
connect  the  two  bags.  With  the  slot  of  one 
side  wide  open  and  the  bag  on  that  side  discon- 
nected   from    its   fellow,    it   is   seen    that    the 


I  go 


THE   CANADA   MEDICAL    RECORD. 


movements  of  the  bellows  are  without  effect 
upon  the  bag.  But  when  the  connection  is  re- 
established, it  is  evident  that  the  bag  receives 
air  from  its  fellow  when  the  handle  is  depressed, 
and  that  it  collapses  when  the  handle  is  lifted, 
its  movemenls  being  exactly  the  reverse  of 
those  of  the  bag  on  tlie  other  side.  When  the 
device  representing  the  glottis  is  partly  closed, 
this  reverse  movement  is  very  marked. — Inter- 
national Medical  Magazine,  February,  1894. 


CONSERVATIVE  TREATMENT  OF  PYO-  | 
SALPINX.  j 

KoUock  (^International  Medical  Magazine,  \ 
February,  1894)  calls  atttention  to  the  changes 
made  in  the  treatment  of  pyosalpinx  within  the 
last  year  or  two,  and  mentions  cases  treated  by 
the  conservative  method  which  have  been  re- 
ported by  Polk,  Pryor,  Krug,  Bo.dt  and 
Dudley. 

He  claims  that  by  this  method  the  tube  and 
ovary  of  the  non-affected  side  and  also  the  dis- 
eased tube  may  often  be  saved.  He  says 
further,  "  My  experience,  while  limited  com- 
pared to  that  of  others  mentioned,  has  been 
sufficient  to  convince  me  that  the  conservative 
system  of  practice  is  bringing  us  to  that  period 
when  the  mutilations  of  women,  once  supposed 
to  be  necessary,  should  cease.  This,  we  think, 
will  be  accomplished ;  as  we  also  believe  that 
abdominal  surgery,  in  the  hands  of  such  men  as 
Sanger,  Porro,  Kelley,  Price,  and  others,  will  put 
an  end  10  the  barbarous  and  murderous  practice 
of  resorting  to  craniotomy  arnd  embryotomy  on 
the  living  foetus." 

He  then  reports  four  cases  of  pyosalpinx, 
three  of  which  were  entirely  relieved  without  re- 
sorting to  coeliotomy. 


cases.  Then  the  progress  is  slow,  and  hence 
the  duration  of  life  much  greater  than  in  pul- 
monary tuberculosis.  The  symptoms  of  the 
terminal  stage  are,  however,  more  distressing. 
The  dyspnoea,  the  breast  pang  and  chest  con- 
striction, the  internal  suggestions  of  dragging  or 
pulling,  as  upon  organs,  are  agonizing  to  wit- 
ness. The  harassing  cough  is  most  weakening 
to  the  patient.  Tuberculous  peritonitis,  of 
sluggish  type,  adds  to  the  severity  of  the  termi- 
nal sy  m  ptoms. ' ' — International  Medical  Maga- 
zine, February,  1894. 


TUBERCULOUS  PLEURISY. 

J.  LI.  Musser  contributes  notes  on  six  cases 
of  tuberculous  pleurisy.  Some  of  the  different 
modes  of  onset  are  given  :  i.  By  a  series  of 
acute  attacks  ;  2.  Acute  bilateral  pleurisy  with 
effusion;  3.  It  may  develop  insidiously,  or 
secondary  to  genital  tuberculosis.  He  distin- 
guishes tuberculous  pleurisy  from  pulmonary 
tuberculosis  by  the  amount  of  pleuro-pulmonic 
invasion,  by  the  age,  absence  of  extreme  hectic 
and  extreme  emaciation,  by  the  character  of  the 
sputum  and  absence  of  bacilli,  by  the  unpro- 
ductive cough,  extreme  chest  pain,  and  chest 
deformity. 

The  writer  considers  that  "It  is  always 
cheering  to  make  out  tuberculous  pleurisy  when 
in  the  midst  of  much  pulmonaiy  tuberculosis. 
First,  the  probability  of  a  cure  is  very  much 
greater  than  in  other  forms  of  tuberculosis.  Se- 
cond, a  partial  cure  can  be    promised  in  many 


RESTRICTING  AND  PREVENTING  THE 
SPREAD  OF  TUBERCULOSIS. 

Dr.  Hermann  M.  Biggs  summarizes  his  re- 
port to  the  New  York  Board  of  Health  on 
Tuberculosis  as  follows : 

r.  Tuberculosis  is  a  contagious  disease,  and 
is  distinctly  preventable. 

2.  It  is  acquired  by  direct  transmission  of  the 
tubercle  bacilli  from  the  sick  to  the  well, 
usually  by  means  of  the  dried  and  pulverized 
sputum  tloating  as  dust  in  the  air. 

3.  It  can  be  largely  prevented  by  simple  and 
easily  applied  measures  of  cleanliness  and  dis- 
infection. 

The  Sanitary  Committee  recommended  that 
the  Board  adopt  the  following  resolutions: 

Resolved,   That  this   Board  urge    upon    the 
hospital  auihoriiies   of  fhe  city  of  New  York 
the  importanceof  separation,  so  far  as  possible,,! 
in  the  hospitals  of  this    city   of  persons  suffer-| 
ing  from   pulmonary    tuberculosis   from  those 
affected  with  other  diseases,  and  urge  that  pr( 
per  wards  be  set  apart  for   the  exclusive  treat- 
ment of  this  disease ;  and  be  it  further : 

Resolved,  That  the  Commissioners  of 
Charities  and  Correction  be  recommended  to 
take  such  steps  as  will  enable  them  to  have 
and  control  a  hospital  to  be  known  as  "The 
Consumptive  Hospital,"  to  be  used  for  the 
exclusive  treatment  of  this  disease,  and  that  as 
far  as  practicable  all  inmates  of  the  institutions 
under  their  care  suffering  from  tuberculosis  be 
transferred  to  this  ho.spital. 

This  movement  of  the  Board  of  Health  of 
New  York  City  is  a  splendid  step  in  the  right 
direction.  It  is  a  crying  shame  and  a  disgrace 
to  this  age  of  medicine,  believing  as  doctors  do 
in  the  contagiousness  of  tuberculosis,  allowing 
cases  of  bronchitis,  pneumonia,  tvphoid  fever, 
and  all  other  so-called  medical  cases  to  be 
treated  in  the  same  ward  as  the  tuberculous 
patients.  If  a  separate  hospital  cannot  be 
supplied,  at  least  separate  wards  should  be 
used  by  tuberculous  subjects.  A  small  hospital 
located  on  one  of  the  knobs  to  the  south  of 
Louisville  would  be  a  great  place  for  tubercu- 
lous patients.  Out-door  occupation  allied  with 
pure  air  would  go  far  to  aid  any  plan  of  treat- 
ment put  into  practice  for  their  benefit. 


THE   CANADA   MEDICAL   RECORD. 


191 


THE   CANADA  MEDICAL  RECORD 

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EDITORS  : 
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ASSISTANT  EDITOR 
ROLLO  CAMPBELL,  CM.,   M.D. 

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MONTEEAL,  MAY,  1894. 

THE  UNIVERSAL  LANGUAGE  OF  THE 
FUTURE. 

The  necessity  of  having  one  language  that 
would  pass  current  among  scientific  or  learned 
people  all  over  the  globe  was  discussed  at  a 
recent  meeting  at  the  New  York  Academy  of 
Medicine,  when  one  gentleman  read  a  paper  on 
the  advantage  of  Greek  as  a  universal  language- 
While  we  cannot  agree  with  him  on  either  of 
the  dead  languages  Greek  or  Latin,  sve  are 
heartily  in  favor  of  either  French  or  English,  as, 
practically  speaking  these  two  languages  are  in 
daily  use  throughout  the  world.  English  of 
course  is  already  an  almost  universal  language, 
it  being  the  language  of  North  America,  the 
British  Isles,  Australia,  New  Zealand  and  a  large 
portion  of  India.  All  that  would  be  required 
to  make  it  entirely  universal  would  be  for  the 
government  of  each  country  to  exact  that  Eng- 
lish be  taught  in  the  public  schools,  in  addition 
to  the  mother  tongue  :  thus  in  Russia,  English 
and  Russian;  in  Germany,  Enghsh  and  German  ; 
in  France,  English  and  French ;  in  Italy,  Eng- 
lish and  Italian,  and  so  on.  We  could  thus 
meet  as  scientists  of  any  profession  and  have  a 
common  language,  familiar  to  all.  English  is  not 
only  the  most  used  language  in  the  world,  but  it 
is  the  language  of  commerce,  and  thus  is  under- 
stood wherever  the  ships  of  Great  Britain  or 
America  trade.  It  is  the  language  which  could 
be  made  universal  with  the  least  expenditure  of 
effort,  very  different  from  the  acquirement    of 


Latin  or  Greek,  which  would  be  a  herculean 
task.  The  necessity  for  some  such  arrange- 
ment was  very  forcibly  demonstrated  at  the 
recent  Congress  in  Rome,  where  we  see  by  our 
exchanges  that  only  papers  read  in  Italian  re- 
ceived a  hearing.  We  presume  the  same  thing 
will  happen  in  Russia,so  that  these  International 
Congresses  will  degenerate  into  national  ones, 
and  thus  the  principal  object,  namely,  the  inter- 
change of  medical  thought,  will  be  completely 
lost  sight  of.  Instead  of  having  four  official 
languages,  we  trust  that  the  next  Congress  wU 
only  have  two,  namely,  English  and  French. 


BOOK  NOTICES. 

Lectures  on  Auto-Intoxication  in  Disease, 
OR  Self-Poisoning  of  the   Individual. 
By   Ch.  Bouchard,  Professor  ot  Pathology 
and    Therapeutics,  Member  of  the  Acad- 
emy   of  M-edicine,    and    Physician  to  the 
Hospitals,  Paris.     Translated,  with  a  Pre- 
face,   by    Thomas    Oliver,    M.A.,    M.D., 
F.R.C.P.;  Professor  of  Physiology,  Univer- 
sity of  Durham  ;    Physician   to  the  Royal 
Infirmary,  Newcastle-upon-Tyne  ;  and  Ex- 
aminer in  Physiology,  Conjoint  Board  of 
England.     In   one   octavo     volume;    302 
pages.     Extra     cloth,     $1.75    net.    Phila 
delphia  :  The  F.  A.  Davis  Co.,  publishers 
1914   and    1916    Cherry  Street. 
Death  frequently    carries    off  in  a  few  hours 
or  days  individuals  who  are  in  the  prime  of  life 
and  in  apparent    good    health,    and  at  wliose 
post-mortem  the  most  careful  examination  fails 
to  reveal  alterations   of  structure   such  as  can 
explain  the  fatal  stroke.     Epidemics,  not  of  a 
specific   character,    but   traceable  to    poisoned 
water  or  food,  have   unexpectedly  appeared  in 
certain    neighborhoods ;    or     members     of    a 
marriage  party    have  died  without  much  warn- 
ing, death  being  attributed,  and  very  properly, 
to  some   article  of    diet    partaken    of    at   the 
wedding-feast.     These  are  the   cases  that  have 
aroused  public    opinion   and  awakened  profes- 
sional interest  in  a   subject  toward  the  elucida- 
tion of  which  the  pathological  chemist  has  vied 
with  the  bacteriologist. 

Bouchard,  in  his  •'  Auto-Intoxication,"  clearly 
indicates  to  us  that  man  is  constantly  standing, 
as  it  were,  on  the  brink  of  a  precipice;  he  is 
continually  on  the  threshold  of  disease.  Every 
moment  of  his  life  he  runs  the  risk  of  being 
overpowered  by  poisons  generated  within  his 
system.  Self-poisoning  is  onh'  prevented  by 
the  activity  of  his  excretory  organs,  chiefly  the 
kidney,  and  by  the  watchfulness  of  the  liver, 
which  acts  the  part  of  a  sentinel  to  the  mater- 
ials brought  to  it  by  the  portal  vein  from  the 
alimentary  canal.     Disease    is    not  something 


192 


THE  CANADA  MEDICAL  RECORD. 


aUoticlhcr  apart  fioni  ihe  individual.  Tiie 
patient  and  his  disease  are  too  often  found 
living  under  identical  conditions. 

A  very  interesting  chapter  is  the  one  on  auto- 
intoxication as  a  cause  of  mental  diseases. 
We  have  more  than  once  called  attention  in  our 
editorial  column  to  the  relation  of  constipation 
to  slight  forms  of  mental  disease.  Altogether 
the  book  is  rich  in  explaining  the  causes  of 
disease  and  the  antiseotic  treatment  of  them. 


The  Johns  Hopkins  Hospital  Reports.  Vol. 
HI.,  Nos.  7,  8,  9.  Report  in  Gynecology, 
H.  Baltimore  :  The  Johns  Hopkins  Press, 
1894. 

These  reports,  contributed  in  the  main  by 
Howard  Kelly,  admirably  illustrated,  and  with 
tabulations  which  show  how  minor  a  detail  is 
expense  in  the  publications  of  Johns  Hopkins 
Hospital,  are  deservingof  high  praise,  as  show- 
ing the  clinical  methods  of  a  keen,  skillful  expert, 
and  as  illustrating  his  ingenuity  in  combating 
complications  and  new  conditions  as  they  arise 
in  the  course  of  his  practice.  The  readers  of 
current  literature  are  already  familiar  with  the 
value  of  these  papers,  as  they  have  appeared 
elsewhere. 

Kelly  describes  his  method  of  measuring  the 
conjugata  vera  by  external  direct  method,  and, 
by  comparison  with  internal  measurements, 
shows  that  there  is  not  a  difference  sufficiently 
great  to  be  of  any  practical  importance.  The 
illustrations  show  the  method  at  a  glance. 

The  possible  errors  in  diagnosis  from  devia- 
tions of  the  rectum  and  sigmoid  flexure  asso- 
ciated with  constipation  are  pointed  out.  It  is 
shown  that  such  abnormal  position  is  especially 
prone  to  be  associated  with  fajcal  stasis.  A 
number  of  cases  are  illustrated,  showing  how 
readily  the  tumor  incident  to  this  condition 
may  be  mistaken  for  diseased  conditions  of  the 
parametrium,  tubes,  or  ovary.  This  article  is 
extensively  illustrated. 

Forty-five  cases  of  operation  for  the  suspen- 
sion of  retroflexed  uterus  are  reported,  all  re- 
covering. The  author  states  that  there  are  two 
distinct  classes  of  patients  in  which  the  opera- 
tion is  applicable, — first,  in  young  nullipara  suf- 
fering from  pelvic  pressure,  backache  and  dys- 
menorrhoia,  in  whom  the  retroflexion  has 
existed  for  a  number  of  years ;  second,  in  mul- 
tipara in  whom  the  retroflexion  is  acquired. 
Not  only  was  there  lecovtry,  but  in  nearly  all 
cas;.-s  very  great  improvement  in  general  con- 
dition. 

Mary  Sherwood  contributes  a  paper  upon 
"  Potassium  Permanganate  and  Oxalic  Acid  as 
Germicides  against  the  Pyogenic  Cocci,"  show- 
ing that  permanganate  alone  in  saturated  solu- 
tion will  not  destroy  the  staphylococcus  pyo- 
genes aureus.  With  oxalic  acid  at  a  temperature 
of  40"  tu  45^  C,  sterilization  of  infected 
threads  by  an  exposure  of  one  minute  to  its 
action  is  accomplished. 


S'.aveley  reports  a  number  of  complications 
occurring  in  cases  of  abdominal  section  through 
the  presence  of  intestinal  worms.  Six  cases  are 
recorded,  one  resulting  fatally.  In  all,  reflex 
disturbances  were  most  marked. 

Under  the  head  "  Gynaecological  Operations 
not  involving  Coeliotomy,"  eight  hundred  and 
thirty-eight  operations  were  performed  on  six 
hundred  and  thirty-one  patients.  There  is  an 
elaborate  tabulation  of  these  cases. 

One  of  the  most  ingenious  contributions  is 
an  article  upon  the  employment  of  an  artificial 
retropusition  of  the  uterus  in  covering  extensive 
denuded  areas  about  the  pelvic  floor.  Six 
cases  are  cited. 

Murray  writes  a  useful  article  upon  "  Pho- 
tography applied  to  Surgery." 

Russell  presents  the  result  of  his  work  in 
urinalysis    in  gynaecology. 

Robb  insists  upon  the  importance  of  em- 
ployingana^sthesiain  the  diagnosis  ofintra-pelvic 
conditions,  and  proves  his  points  by  an  analysis 
of  some  two  hui.dred  and  forty  cases. 

Kelly  describes  his  method  of  direct  pressure 
for  the  resuscitation  of  persons  from  chloroform 
asphyxia.  This  seems  to  offer  no  advantages 
over  methods  already  practised,  and  does  not 
absolutely  provide  for  the  patulousness  of  the 
respiratory  tract  in  so  far  as  the  mouth  and 
nose  are  concerned. 

One  hundred  cases  of  ovariotomy  performed 
in  women  over  seventy  years  of  age  are  tabu- 
lated ;  twelve  cases  died.  Of  the  three  patients 
over  eighty,  all  recovered.  There  is  a  tabulation 
of  abdominal  operations  performed  at  the 
Gynaecological  Department  from  March,  1890, 
to  December,  1892.  The  operator  calls  at- 
tention to  the  fact  that  at  first  drainage  was 
frequently  used,  but  towards  the  last  has  been 
almost  completely  abandoned,  the  glass  tube 
being  given  up  altogether  in  favor  of  gauze. 
Over  five  hundred  cases  are  recorded. 

A  record  of  deaths  occurring  in  the  Gynaeco- 
logical Department  is  appended, — first,  deaths 
without  operation  ;  next,  deaths  following  gynae- 
cological   operation. 

These  reports  are  most  valuable,  not  only 
because  of  their  direct  teaching,  but  because 
they  illustrate  how  the  immense  material  of  a 
large  hospital  can  be  best  utilized  for  the  gen- 
eral education  of  the  profession. 


PAMPHLETS  RECEIVED. 

A  Supplementary  Paper  upon  Supra- 
vaginal Hysterecfomv,  by  the  new 
method,  with  report  of  additional  cases. 
By  B.  F.  Baer,  M.D.,  Professor  of  Gynse- 
cology  in  the  Philadelphia  Polyclinic  and 
College  for  Graduates  of  Medicine,  etc. 
Reprinted  from  Transactions  of  the  Ameri- 
can Gynaecological  Society,  Vol.  XVIII., 
1893. 


m 


Vol.  XXII 


MONTREAL,  JUNE,  1894. 


No.  9. 


OEIGINAL  COMMUNICATIONS. 

Mfdicil  Evidence 193 

Some  Unusual  Svmptoius  in  Siiinal 
Caries    190 


SOCIETY  PROCEEDINGS. 

:Moutreal  Medico-Chirurgical  Society  200 

Hiemorrliagic  Typhoid 201 

Kujitured  Tubal  Pregnancy 201 

Leucbaiiiia 201 

Atresia   of  Vagina,    Hajmatonietra, 

Hysterectomy  203 

Aortic  Aneurism 204 

Purulent  Pericarditis  witli  Necrosis 

of  the  Sternum  204 

Epilepsy— Abscess  and  Cyst  of  Brain 

—Trephining     and     Exploratory 

Puncture 205 

Caleitied  Plates  from  the  Pleura  in 

Emi>venia 205 

Cancer  of  the  Body  of  the  Uterus. . .  205 

Albuminuria  of  Pregnancy 205 

Scarlatina  205 


PROGRESS  OF  SCIENCE. 

Ligation  of  the  base  of  the  Broail 
Ligaments  per  vaginam,  including 
the  Uterine  Arteries  for  Fibroids 

of  the  Uterus 208 

The  Parasite  of  Cancer  209 

Traumatic  Periostitis 209 

Operative    Treatment   for  Stone  in 

the  Bladder. 211 

Personal  211 

EDITORIAL. 

Antipvrin  and  Antif ebrin 212 

The  Stamping  out  of  Cholera. 212 

The  Cause  of  Jaundice 213 

Shall  the  Clergj- Pay 213 

Notes  from  Our  Exchanges 213 

Subcutaneous  Ligature  for  Varico- 
cele   214 

Ingrowing  Toe-Xail 21o 


BOOK  NOTICES. 
The   Year-Book    of   Treatment  for 


1SP4. 


215 


New  Aid  Series  of  Manuals  for  Stu- 
dents and  Practitioners 215 

PAMPHLETS  RECEIVED. 

Le  (iros  Mai  du  iloven-Age  et  la 
Syphilis  Actuelle...". 215 

Opium  and  Catharsis  after  Alxlom- 
inal  Section 216 

A  Series  of  Wools  for  the  ready  de- 
tection of  Color  Blindness 216 

Opinions  of  the  Press  on  a  Bill,  «&c..  21G 

Hysterectomy  by  Morcellement  and 
the  ^'agina'l  Route  in  Pelvic  Oper- 
ations, in  place  of  Laparotomv  or 
the  Ab<lominal  Method ". . . .  216 

The  Interrupted  High-^'oltage  Pri- 
mary, or  Mixed  (Jurrent 216 

Retinitis  Albuminuria 216 

The  Relation  of  the  Patellar  Tendon 
Reflex  to  some  of  the  Ocular  Re- 
flexes found  in  General  Paralysis 
of  the  Insane 216 

Clinical  History  of  a  Case  of  Si>iniUe- 
celled  Sarcoma  of  the  Choroid, 
^vith  a  studv  of  the  Microscopic 
Condition  of  "the  Growth 216 

The  Alienist  and  Neurologist  for 
April 216 


Irigfnal    ^0mmttntcattons. 


MEDICAL  EVIDENCE. 

A  Paper  read  by  Robert  Mark,  M.D., 
F.R.C.P.S.K.,  Coroner,  Otiazua,  before 
the  Rideau  and  Bath-lmrst  Medical 
Association. 

Mr.  President  and  Members  of  the  Rideau 
and  Bath-hurst  Medical  Association  : 

In  response  to  an  invitation  from  our 
esteemed  Secretary,  I  beg  to  submit  a  short 
paper  on  Medical  Evidence. 

The  giving  of  evidence  dates  from  a  very 
early  period  in  the  world's  history,  when 
by  legal  enactment  individuals  were  dis- 
allowed to  take  the  law  into  their  own 
hands,  but  were  required  to  bring  their 
case  before  a  judge  ;  where  the  accuser, 
the  accused  and  the  witnesses  met  face  to 
face,  and  the  judge  passed  sentence  accord- 
ing to  the  evidence. 

Since  June  15,  12 15,  when  King  John 
gave  to  his  people  the  great  Magna  Charta, 
trial  by  jury  has  been  the  privilege  of  all 


under  British  rule,  under  which  arrange- 
ment \hQ Judge  is  obligated  by  oath  to  pass 
sentence  according  to  the  verdict  of  the 
jury ;  and  the  jury  are  sworn  to  bring  in  a 
verdict,  without  fear  or  favor,  according  to 
the  evidence;  and  the  ivitness  in  the  solemn 
presence  of  Almighty  God,  pressing  the  book 
of  Holy  Writ  to  his  lips,  swears  he  will  tell 
the  truth,  the  whole  truth,  and  nothing 
but  the  truth. 

Ordinary  zcitnesses  are  only  required  to 
state  facts  of  which  they  have  a  personal 
knowledge,  but  upon  skilled  and  scietitijic 
witnesses  iveigJitier  responsibilities  rest; 
their  opinions  are  often  demanded  to  eluci- 
date matters  that  are  obscure  to  the  ordi- 
nary mind. 

The  medical  witness  enters  upon  his 
work  of  investigation,  realizing  the  solemn 
responsibilities  that  rest  upon  him  not  only 
to  present  naked  facts,  that  would  impress 
the  mind  of  the  most  casual  observer,  but 
to  unearth  hidden  facts  essential  to  a 
right  understanding  of  the  case,  and  place 
them  in  an  understandable  form  before  the 
public  mind. 


194 


THE   CANADA   MEDICAL   RECORD. 


He  is  obligated  to  tell  the  truth,  the 
whole  truth,  which  demands  the  exercise 
of  all  the  power  he  possesses  to  ascertain 
all  the  facts  bearing  on  the  case  that  it  is 
possible  iox  him  to  reveal ;  a  lack  of  fidelit}' 
on  his  part  may  lead  to  the  escape  of  the 
guilty  or  the  infliction  of  punishment  upon 
the  innocent. 

On  the  loth  of  October,  1890,  I  received 
a  telegram    from  the  Crov.n    Attorney  of 
Prescott    and    Russell,  dated    Cumberland^ 
— the  scene  of  the  noted  murder  of  ]\Iary  and 
Eliza    McGonigle — saying  :     "  Wanted  — 
come  at  once,  to  make  post  mortem  exami- 
nation."    On  reaching  Cumberland,  I  was 
met  by  the  Crown    Attorney  and  Provin- 
cial Detective    Grier,    and  in  the    name  of 
the  Croiun    was  specially   re  que  steel  to  put 
forth  every  exertion,  so  that  by  my  medical 
evidence    I    should  aid  the    Crown    in    a 
righteous  conviction    of  the   guilty  party. 
Associated  with  Dr.  Fergusson  and  Dr. 
Janson   I    made  a  post  mortem  examina- 
tion on  the  bodies  of  both  girls  : 

Mary  apparently  about  14  years  of  age, 
and  Eliza  12  years. 

Mary — From  a  superficial  examination  I 
found  on  the  left  side  of  the  crown  of  the 
head  a  cut  about  i  inch  in  length  ;  it  pene- 
trated the  periosteum  of  the  skull.  The 
skull  was  not  fractured.  Under  the  right  eye 
there  were  two  cuts  ;  the  upper  was  trans- 
verse, about  3_^  inch  long.  I  found  it, 
deepest  nearest  the  eye  ;  the  lower  cut  was 
oblique,  and  about  \yi  inch  long,  in  form 
the  same  as  the  one  above.  The  cuts  on 
the  scalp  and  face  were  made  by  some 
blunt  cutting  instrument,  similar  to  wounds 
I  have  found  in  my  surgical  practice  made 
by  a  man  breaking  a  heavy  water  jug  on 
the  head  of  a  woman,  and  another  case 
where  the  head  and  face  were  cut  with  a 
lathing  hammer.  Stones  with  \ery  sharp 
edges  were  found  near  the  bodies. 

On  the  neck  of  Mary  there  were  deep 
red  discoloration.s,  intensified  immcdiatelv 
over  the  windpipe,  on  both  sides  ;  the  small- 


est  discoloration  was  on  the  right  side,  as 
if  made  by  a  human  thumb.  Discolorations 
on  the  left  side  were  more  extensive,  as  if 
made  by  human  fingers.  Eliza  had  pre- 
cisely the  same  mark  on  her  throat,  only 
they  were  apparently  made  by  the  left  hand. 
The  trachea  yielded  easily  to  the  touch; 
the  hyoid  bone  was  broken. 

The  internal  examinations  of  the  bodies 
of  ]\Iary  and  Eliza  revealed  similar  coneli- 
tions:  the  eyes  were  infused  with  blood  ;  the 
tongues  very  much  swollen,  and  dark  red  ; 
the  veins  in  the  temporal  regions,  also  the 
sinuses  and  vessels  of  the  brain,  were  very 
much  congested  ;  the  lungs  were  also  con- 
gested ;  the  right  cavity  of  the  heart  was 
full  of  blood  ;  the  stomach,  bowels,  kidneys, 
bladders,  ovaries,  uterus  were  normal. 

The  external  genitals  were  terribly  lacer- 
ated, the  vaginal  canal  opened  to  view. 
Posteriorly,  there  were  extensive  abrasions 
in  sight,  the  mucous  membrane  being  torn, 
the  capillaries  ruptured  and  blood  deposited 
on  the  injured  surface. 

By  digital  examination  of  the  vagina  of 
Mary  I  found  the  canal  elongated  on  the 
left  side  and  two  of  the  three  coats  rup- 
tured, a  pocket  formed  by  violent  pressure. 
By  a  similar  examination  of  the  vagina 
of  Eliza,  I  found  similar  abrasions  in  the 
canal,  but  discovered  an  opening  about  an 
inch  in  diameter  through  its  walls  into  the 
abdominal  cavity  between  the  bladder  and 
the  rectum. 

We  carefully  removed  the  external  and 
internal  genitals.  I  placed  them  in  scaled 
jars,  and  upon  reaching  Ottawa,  rem  n-ed 
secretions  from  both  vaginas,  and  made 
careful  microscopic  examinations  for  sper- 
matozoa, and  with  two  associate  M.Ds, 
found  them  in  Eliza,  but  did  not  find  them  in 
Mary.  I  saw  them  on  two  future  occa- 
sions in  company  with  other  M.Ds.,  who 
recognized  the  spermatozoa  at  the  same 
time  as  I  did. 

I  infer  Eliza  was  the  first  ravished,  and 
male  seed  left  \\ithin  the  vagina  ;  any  sur- 


I 


THE   CANADA    MEDICAL    RECOkh. 


195 


plus  seed  upon  the  penis  would,  I  conclude, 
be  deposited  upon  the  external  genitals  at 
the  time  of  the  violent  entrance  into  Mary. 
I  am  satisfied  that  one  mind  guided  two 
hands,  which  grasped  two  throats,  exactly 
in  the  same  wa}%  and  guided  one  penis  in  en- 
tering two  vaginas — in  both  cases  entering 
somewhat  to  the  right  and  passing  over 
somewhat  to  the  left  of  the  neck  of  the 
uterus ;  in  the  one  case  making  a  severe 
rupture  through  the  walls  into  the  abdom- 
inal cavity,  in  the  other  case  rupturing 
two  of  the  three  coats,  and  abnormally 
stretching  the  third,  forming  a  pocket.  I 
here  presented  the  jar  containing  the  geni- 
tals. 

The  hands  of  Eliza  were  severel)- 
wounded,  the  skin  gouged  out  of  the 
knuckle  of  the  index  finger  of  the  right  hand  -• 
there  were  slighter  wounds  on  the  same 
finger  between  the  second  and  third  joints  ; 
the  left  hand  was  more  severely  injured.  The 
wounds  could  have  been  inflicted  b}' strong 
nails  on  human  fingers. 

At  the  L'Orignal  Assizes  I  said,  when 
under  oath  at  the  inquest  I  was  closely 
questioned  as  to  the  w-ounds  on  Eliza's 
hands  and  the  nails  on  the  fingers  of  the 
suspect  Laroque,  I  was  sure  that  similar 
enquiry  would  be  made  at  the  Assize  trial 
here  to-day,  so  I  placed  a  tissue  paper 
under  the  hands  of  Eliza,  and  made  a  care- 
ful tracing  of  both  hands,  then  placed  the 
transparency  upon  the  hands,  and  with 
pencil  tracing  showed  the  form  of  the  nails, 
and  by  pencil  shadings  showed  the  size 
and  situation  of  the  wounds. 

But  I  was  convinced  that  such  a  crude 
representation  would  not  be  acceptable  to 
the  learned  counsel  for  the  defence,  so  I 
conferred  with  the  Crown  Attorney,  sub- 
mitting to  him  my  purpose  to  amputate  the 
hands,  take  them  to  Ottawa,  and  obtain  a 
life-size  photograph  of  the  same. 

Cards. — At  this  moment  I  presented 
a  copy  to  the  Judge,  another  to  the  jury, 
and  the  third  to  the  counsel  for  the  defence, 


remarking  at  the  time  I  obtained  the 
photos,  I  apprehended  the  learned  counsel 
for  the  defence-would,  upon  their  production 
here,  ask  mc  :  "  Do  you  swear  that  you 
were  present  when  these  photos  were 
taken .'' "  I  could  answer  yes  ;  but  he 
would  likely  ask  me  :  "  Can  you  swear  that 
}'ou  understand  the  art  of  photography  ? " 
I  should  have  to  answer,  "  No,  not  in  all  its 
details.  " 

I  apprehended  I  should  be  asked  :  "  Can 
you  swear  that  the  artists  did  not,  by 
malice,  or  mistake,  make  some  of  the  shad- 
ings deeper  than  necessary,  to  present  a  true 
representation  of  the  wounds  .''  " 

I  knew  I  could  not  so  swear,  so  I  relin- 
quished my  intention  of  THEN  burying  the 
hands  in  the  grave  of  the  murdered  girls, 
and  resolved  to  preserve  them  in  spirits 
until  the  close  of  this  trial.  I  then  handed 
the  sealed  jar  containing  the  wounded 
hands  to  the  clerk  of  the  Court,  who  placed 
them  in  clear  view  of  the  judge,  the  jury, 
and  the  accused,  and  they  remained  there 
till  the  trial  w^as  ended  and  sentence  pro- 
nounced. 

I  remarked  further: — While  under  oath 
at  the  inquest  I  was  asked  to  examine  the 
finger-nails  of  the  suspect  Laroque,  which 
I  did,  and  declared  under  oath  that,  in  my 
opinion,  Eliza's  hands  could  have  been 
wounded  as  found  by  human  nails  such  as 
were  on  the  fingers  of  Laroque.  I  then 
foresaw  that  six  months'  rest  from  work 
and  six  months'  trimming  with  a  penknife, 
the  suspect's  nails  would  be  very  much 
more  changed  in  form  at  this  assize  than  at 
the  time  of  the  inquest ;  so  I  took  casts  or 
impressions  of  the  finger-nails  on  both  hands 
of  the  accused  Laroque  in  soft  putty,  after- 
wards taking  plaster  of  Paris  impression  of 
said  finger-nails,  which  were  concave  in  the 
putty  and  convex  in  the  plaster.  I  placed 
both  before  the  judge  and  jury,  showing 
the  chisel-like  nails  on  the  hands  of  La- 
roque at  the  time  of  the  inquest,  being  six 
months  before  the  assizes. 


196 


THE   CANADA    MEDICAL   RECORD. 


I  questioned  if  on  the  hand  of  one  man 
in  a  hundred  thousand  you  could  find  such 
strong,  sharp,  chisel-like  nails  as  on  the 
accused  Laroque. 

I  was  asked  ,  could  not  two  men  have 
seized  the  girls  by  the  throat  ?  I  replied  : 
"  No  ;  it  would  be  impossible  for  two  men 
to  leave  the  marks  I  found  upon  their 
throats,  unless  one  was  left-handed." 

The  learned  Counsel  for  the  defence 
asked  me,  as  I  had  found  evidence  of  an 
emission  of  male  seed  in  the  vagina  of  Eliza, 
had  there  been  a  second  emission,  would 
not  the  seed  have  been  weaker  than  the 
first  ?  I  answered  ;  "  No,  no  more  than  rifle 
ball  No.  I  5  would  be  weaker  than  rifle  ball 
No.  I  fired  from  a  repeating  rifle." 

The  learned  Counsel  for  the  defence  asked 
me  could  one  man  hold  the  girls'  throats, 
and  also  ravish  the  two  girls.  I  said  :  "  Yes  ; 
with  such  injuries  to  the  hyoid  bone  and 
trachea,  breathing  would  be  suspended^ 
a  flash  cross  the  eye,  a  rumbling  sound  in 
the  ear,  consciousness  almost  instantane- 
ously lost,  and  the  victims  be  as  helpless  as 
if  chloroformed. 

The  learned  Counsel  for  the  defence  asked 
me  was  it  likely  the  accused  would  ravish 
the  girls  when  so  nearly  dead  ;  I  said  yes  ; 
remarking  it  is  only  this  week  we  learned 
through  the  press  that  in  a  recent  battle 
women  were  slain  as  well  as  men,  and  the 
victorious  soldiers  returned  and  ravished 
the  bodies  of  the  dead  women,  and  I  in- 
ferred that  it  was  more  probable  that  the 
prisoner  would  ravish  the  body  of  a  female 
nearly  dead,  than  for  a  soldier  to  ravish  the 
corpse  of  a  woman. 

The  learned  counsel  asked  me  :  "  Do  you 
swear  these  girls  died  from  asphyxia  .'' "  1  re- 
plied :  "  No,  my  learned  friend.  T  presume 
you  vie  with  me  in  an  admiration  of  the  work 
by  Tidy  on  Medical  Jurisprudence,  in  which 
he  wisely  and  truly  remarks  : 

"  '  We  begin  to  die  at  the  head,  or 
"'We  begin  to  die  at  the  heart,  or 
'*' We  begin  to  die  at  the  lungs.' 


"The  McGonigle  girls,  from  the  injuries 
inflicted  on  their  throats,  began  to  die  at 
the  lungs,  and  in  about  twenty  or  thirty 
minutes  died  at  the  heart ;  the  primary  cause 
of  their  death  was  asphyxia,  but  mental  and 
physical  shock  tended  to  produce  death  in 
the  brain  and  heart." 

I  admit  the  removal  of  the  parts  of  the 
bodies,  the  preservation  of  the  same  and 
their  presentation  at  the  assizes  may  be 
pronounced  by  some  as  a  very  unusual 
proceeding,  if  not  an  unheard-of  act  pre- 
viously performed  by  a  medical  expert. 
But  in  my  defence  I  submit  the  words 
relating  thereto  which  fell  from  the  lips  of 
the  learned  judge. 

His  Lordship  Judge  McMahon,  in  his 
address  to  the  jury,  said  :  '  Photographs 
have  been  produced,  and  Dr.  Mark,  with 
that  care  which  I  am  very  glad  to  see  was 
exercised  in  this  case,  took  the  precaution 
to  amputate  the  hands  of  one  of  the  girls 
so  that  the  jury  might  see  exactly  the 
struggle  she  was  making  in  order  to  pre- 
vent the  accomplishment  of  the  diabolical 
deed  which  was  then  being  perpetrated." 

By  His  Lordship's  special  request  in  these 
words  :  "  Could  you  make  it  convenient 
to-day  to  bring  the  vessel  containing  the 
genijais,  etc.,"  His  Lordship  remarking  he 
desired  to  clearly  understand  the  injuries 
in  their  minutest  details,  "  so  as  to  write  up 
the  case  fully  and  clearly  in  his  report,  "  he 
kindly  remarked  after  the  trial  he  had 
seldom  heard  medical  expert  testimony 
given  with  such  great  care  and  with  so 
much  satisfaction  as  by  Dr.  Robert  Mark  at 
the  Laroque  trial. 


I 


SOME  UNUSUAL  SYMPTOMS 
SPINAL  CARIES. 


IN 


A  Lecture  delivered  at  The  City  Orthopcsdic 
Hospital,  Hat 1 071  Garden,  London,  by 
Noble  Smith,  F.R.C.S.  Ed.,  Surgeon 
to  the  City  OrtJiopccdic  Hospital,  and 
Snrgeon  to  the  All  Saints  Children's 
Hospital,  London. 

In  discussing  this  subject  I  have  upon 
many  occasions  referred  to  the  uncertainty 


THE  Cy^NADA   MEDICAL   RECORD. 


197 


of  the  symptoms  of  this  disease,  and  point- 
ed out  that  there  are  a  large  number  of 
instances  in  which  typical  symptoms  of 
caries  do  not  exist. 

Pain,  for  instance,  is  a  very  uncertain 
symptom.  1  need  not  refer  to  the  peculiai- 
ities  of  pain  in  an  ordinary  case,  as  they 
will  be  well  known  to  all  surgeons  having 
experience  of  this  subject ;  but  I  would 
again  call  attention  to  cases  in  which  pain 
is  either  very  slight  or  entirely  absent.  I 
have  known  caries  to  progress  to  a  ver}- 
considerable  amount  of  deformity,  and  even 
abscesses  to  form  without  any  pain  occur- 
ring. 

I  have  recorded  several  such  cases,  and 
therefore  I  will  not  dwell  longer  upon  this 
point. 

High  temperature  is  a  very  important 
symptom,  and  is  of  especial  value  in  cases 
where  the  diagnosis  is,  as  far  as  other  signs 
are  concerned,  doubtful.  In  acute  tuber- 
cular caries  there  is  very  often,  but  not 
always,  a  rise  in  temperature.  The  follow- 
ing case  well  illustrates  this  subject  : 

Miss  E.  H.,  a  very  delicate-looking  girl 
aged  16,  began  to  suffer  severe  pain  in  the 
lumbar  region,  in  April,  1893,  and  had 
gradually  got  worse. 

When  I  first  saw  her,  August  9th,  she 
had  recently  recovered  from  influenza,  but 
the  temperature  had  risen  again  to  102''  in 
the  morning  and  103"^  in  the  evening.  It 
had  been  so  for  the  previous  fourteen  days. 
There  was  at  first  a  question  as  to  some 
specific  fever.  I  found  projection  of  the 
twelfth  dorsal  and  the  first  lumbar  verte- 
bra;, and  great  pain  in  that  region  and 
below  it.     The  spine  was  very  rigid. 

The  case  was  obviously  one  of  caries,  and 
I  thought  that  the  high  temperature  was 
the  effect  of  tubercular  disease.  Dr.  Seton, 
who  had  charge  of  the  case,  coincided  with 
my  opinion.  I  anticipated  a  lowering  of 
the  temperature  as  soon  as  the  spine  Avas 
thoroughly  fixed.  The  chart  of  this  case 
is  very  interesting.     The  day  following  the 


application  of  the  "adjustable  metal  splint," 
the  appliance  which  you    have  seen    used 
with  such  good  effect  at  this  Hospital,   the 
temperature  dropped  from  102*^  and   103^^, 
which  it  had  been  for  eighteen  days,  to  2^ 
lower  in   the  morning,  and  to  i''  lower  in 
the  evening,  gradually  decreasing  during 
the  succeeding  days.     After  each  fresh  ad- 
justment   there   was    a    small    temporary 
improvement  in  the  temperature,  but  after 
the  drop  of  the  first  four  days  it  remained 
practically  the  same  for  nearly  six  weeks, 
when  a   further   improvement  took  place, 
•after  which  the  temperature  remained  very 
steady,  a  fraction  above  the  normal,  and 
a  w'eek  later  it  became  perfectly  normal,  and 
has   remained  so.     At  the  date  when  this 
practically  normal  temperature  was  attain- 
ed, I  had  just  succeeded  in  so  arranging  the 
apparatus  that  it  proved  a  perfect  support 
in  all  postures  of  the  body.     The  spine  had 
been  gradually  subsiding  to    a  position   in 
which  it  now  remained  fixed  ;   the  patient 
had  been  also  improving  in  every  other  way 
— in  healthy  appearance,  in  gradual  lessen- 
ing of  pain,  and  having  a  better  appetite. 
The  patient's  listlessness  and  disinclination 
to  do  anything  for  herself,  and  some  other 
symptoms,    had  led  the    relations  to   con- 
sider that  some  at    least  of  her  symptoms 
were  hysterical.     This    view   I   could    not 
agree  with,  and  the  hysterical   symptoms 
all  disappeared  with  the  disappearance  of 
the   high  temperature  and  with  the  other 
improvements. 

This  seems  a  very  characteristic  case  of 
active  tuberculosis  of  the  spine  ;  but  from 
treatment  by  local  fixation,  and  with  gen- 
eral medicinal  and  dietetic  remedies  the 
patient  continues  to  improve,  and  there 
seems  every  probability  of  a  cure  being 
effected. 

The  temperature  should  be  regularly 
taken  in  all  cases  of  caries.  I  have  found 
it  a  valuable  diagnostic  symptom  ;  a  slight 
rise  perhaps  of  about  one  degree  of  tem- 
perature only  often  being  present  in  caries 


igS 


THE  CANADA  MEDICAL  RECORD. 


when  the  diagnosis  has  been  otherwise 
doubtful.  Certainly  one  meets  with  many 
cases  of  caries  in  which  no  rise  of  temper- 
ature can  be  detected,  but  upon  more  ex- 
tended observation  in  this  matter  I  have 
no  doubt  very  valuable  statistics  may  even- 
tually be  obtained. 

Then,  again,  as  regards  RIGIDITY,  there 
is  usually  more  or  less  rigidity  of  the  spine 
in  the  neighborhood  of  the  disease,  and 
this  is  an  important  symptom  in  the  early 
stages  of  caries.  It  is  the  result  chiefly  of 
muscular  spasm  from  reflex  action,  or  vol- 
untary muscular  action  to  prevent  pain,  but 
may  also  occur  from  the  exudation  of  the 
products  of  inflammation.  Rigidity  in 
caries  of  the  spine  is  not,  however,  so  clearly 
defined  as  it  is  in  cases  of  inflammation  of 
the  more  movable  joints,  as  the  hip  and 
knee,  and  in  many  cases  it  cannot  be  very 
clearly  detected.  If  the  disease  be  situat- 
ed in  the  lower  dorsal  or  in  the  lumbar 
vertebrae,  causing  slight  posterior  projection 
in  these  regions,  it  may  be  a  question 
whether  the  projection  is  the  result  of  pos- 
terior curvature  from  weakness  of  the  liga- 
ments of  the  spine  or  from  caries.  Under 
such  circumstances  the  presence  or  absence 
of  rigidity  should  be  determined.  The 
patient  should  be  placed  in  the  prone  posi- 
tion, when,  if  the  case  is  one  of  weakness 
only,  the  projection  disappears,  whereas, 
if  inflammation  exists,  the  projection  re- 
mains more  or  less. 

Careful  elevation  of  the  legs,  while  the 
patient  lies  in  the  prone  position,  will  in- 
tensify this  result.  Movements  in  other 
directions  will  also  generally  be  found 
limited  as  a  consequence  of  the  rigidity 
when  caries  is  present. 

In  cervical  disease  the  rigidity  shows  it- 
self in  stifi'ness  of  the  neck  muscles,  and 
this  often  aff"ects  the  head,  laterally  produc- 
ing wry-neck.  There  is  usually  a  great 
difi"erence  between  wry-neck  from  caries 
and  that  from  permanent  muscular  con- 
traction.     In  the   latter   it  will    probably 


have  existed  for  a  long  time,  and  there  will 
be  little  or  no  pain,  or  at  least  of  a  less 
distressing  nature  ;  there  will  be  firm  and 
unalterable  contraction  of  the  sterno-mas- 
toid  alone,  and  the  face  may  be  atrophied 
on  the  depressed  side  and  the  features 
distorted.  In  caries,  other  muscles  as  well 
as  the  sterno-mastoid  will  probably  be  af- 
fected, and  the  head  will  be  held  in  a  man- 
ner more  expressive  of  pain,  and  support 
of  the  head  wall  relieve  the  contraction  and 
the  pain  to  some  extent. 

In  simple  torticollis  the  movements  of 
the  head  are  only  restricted  in  one  direction  ; 
in  caries  the  head  is  kept  in  one  position, 
but  not  commonly  restricted  in  any  if  care- 
fully handled,  because,  in  torticollis  from 
caries,  movements  in  any  direction  are 
painful,  whereas  in  true  torticollis,  pain,  if 
any,  only  occurs  from  movement  in  one 
direction.  Rest  in  bed  for  a  few  days  will 
often  relieve  the  torticollis  of  caries. 

In  the  latter  afi"ection  there  may  be  a 
condition  of  spasm  in  the  contracted  mus- 
cles, and  in  adults  it  may  be  difficult  to 
distinguish  between  this  disease  and  "spas- 
modic torticollis."  I  have  known  torti- 
collis having  all  the  characteristics  of  the 
simple  aff"ection  to  exist  in  a  child  for  many 
months  before  it  was  recognized  as  a 
symptom  of  disease  of  the  bones.  Inflam- 
mation of  lymphatic  glands  of  the  neck 
alone  may  produce  torticollis,  and  this  may 
be  very  diflicult  to  distinguish  in  its  early 
stages.  In  caries  of  the  cervical  vertebrae 
there  may,  however,  be  very  free  move- 
ment. 

In  caries  occurring  in  the  dorsal  or  lum- 
bar regions,  rigidity  may  be  observed  in 
the  psoas  muscles  (or  in  one  psoas  onl}'), 
being  perhaps  associated  with  psoas  ab- 
scess, and  this  may  produce  lordosis  in- 
stead of  posterior  projection.  Such  cases 
must  be  distinguished  from  simple  local 
inflammation  of  psoas  muscles,  which  is 
not  always  very  easy  ;  however,  the  latter 
condition  is  rare. 


lllli   CANADA   MEDICAL   RECORD. 


199 


These  cases  also  may  be  mistaken  for 
hip  disease. 

In  both  instances  other  char.icteristic 
s}'mptoms  of  the  indivitlual  aft'ection  must 
be  depended  upon.  In  hip  disease  it  may 
be  remarked  that  the  stiffness  of  the  joint 
exists  in  every  direction,  as  well  as  in  ex- 
tension ;  Net  in  some  cases  of  lumbar  dis- 
ease the  hip  is  found  very  stift".  and  the 
diagnosis  may  be  extremely  difficult. 

Then,  again,  the  lumbar  region  ma\'  be 
very  stiff  in  hip  disease. 

There  may  be  a  certain  amount  of  rigid- 
ity in  lateral  curvature,  especiall}' in  rachi- 
tic cases.  In  rachitic  kyphosis,  rigidity 
may  be  very  considerable,  and  quite  like 
that  in  caries. 

Nerve  symptoms,  the  diihcultics  in 
walking  occurring  at  a  comparatively  early 
stage  of  this  disease,  the  subsequent  loss 
of  power  over  the  muscles,  the  pain  and 
some  other  symptoms,  denote  lesions  more 
or  less  severe  of  the  nerves ;  the  motor 
nerves  are  chiefly  affected,  commencing 
with  weakness  in  the  legs  and  increasing 
until  complete  paralysis  of  motor  power 
takes  place. 

The  range  of  these  nerve  symptoais  de- 
pends upon  the  pouti)n  of  the  disease, 
almost  always  being  limited  to  the  nerves 
proceeding  from  the  diseased  bones  and 
below  that  position. 

In  paralysis  froai  cervicil  disease  the 
arms  may  be  affected,  and  all  p3\ver 
of  motion  below  may  be  lost.  Herpes- 
zoster  may  occur. 

Spasmodic  movements  of  the  limbs 
may  become  a  troublesome  symptom,  the 
legs  jerking  suddenly  without  giving  the 
patient  any  warning.  The  thighs  may  be 
jerked  into  a  severely  flexed  position,  or 
S[)astic  paralysis  may  take  place.  E.x- 
aggeration  of  the  reflexes  is  an  early  symp- 
tom of  the  commencing  paraplegia,  the 
knee  jerk  being  especially  increased,  and 
ankle  clonus  ma\-  be  iound  to  exist. 


Although  both  legs  arc  usuall\-  attacked 
I  simultaneously,  one  leg  may  be  aftected 
I  before  the  other,  or  in  a  greater  degree,  or 
i  even  one  leg  alone  may  suffer.  Paralysis 
i  of  the  diaphragm  may  occur.     When  pain 

in  the  course  of  the  nerves  precedes  par- 
I  alysis,  this  shows  that  irritatio  1  of  the 
I  nerve  roots  occurred  prior  to  complication 
I  of  the  cord,    and  precludes  any    supposed 

disease    originating     in     the    cord    itself. 

(Gowers) 

Abscess — There  is  a  great  deal  to  be  said 
about  the  peculiarities  of  abscess,  and  in 
considering  this  subject  it  is  as  well  to 
remember  that  in  any  case  a  piece  of  bone 
detached  from  the  diseased  vertcbrre  ma}' 
cause  special  symptom ^  and  give  rise  to 
considerable  pain  and   irritation. 

There  is  hardly  any  direction  in  which 
an  abscess  may  not  extend,  simulating  a 
great  variety  of  other  disorders,  and  es- 
pecially should  its  similarit}' to  hip  disease 
be  remembered. 

Moreover,  the  abscess  nn\-  even  pene- 
trate to  the  hip  joint  itself,  ulcerating 
through  the  capsule,  and  may  thus  set  up 
disease  in  that  joint. 

Then,  again,  abscess  in  hip  disease  may 
simulate  that  of  caries.  We  may  have 
psoas  abscess  from  disease  of  the  kidney, 
and  a  lumbar  abscess  has  b:ea  produced 
by  a  foreign  body  which  has  been  swallow- 
ed, as  recorded  by  Mr.  Nicholls,  Brighton 
and  Sussex  Medico-Chirurgical  Society, 
February  3rd,  1S87.  In  pointing  out  these 
few  instances  of  a  variation  from  the  typi- 
cal symptoms  of  spinal  caries,  it  is  impossi- 
ble in  a  short  paper  to  do  ju-tce  to  the 
subject,  but  I  trust  I  have  written  sufficient 
to  call  attention  to  the  matter,  and  to  show- 
that  great  caution  should  be  exercised  by 
the  surgeon  before  forming  a  definite 
opinion  as  to  the  nature  of  any  particular 
case  of  spinal  disorder. 


200 


THE   CANADA   MEDICAL   RECORD. 


focictg    ^roccetJiti^s. 


THE     MONTREAL     MEDICO-CHI  RUR- 
GICAL  SOCIETY 

Statcil  Meeting^  January  26th,  1894. 

Dr.  James  Bell,  President,  in  the  Chair. 

No  doubl  the  benefit  derived  from  simple  in- 
cision, without  any  other  procedure,  is  due  in 
many  cases  to  the  moral  effect  of  the  operation 
itself,  or  expectation,  as  in  metallic  therapy, 
and  this  accounts  for  the  marvellous  cures  re- 
ported as  following  the  application  of  the  new 
and  extraordinary  methods  of  treatment,  such 
as  foith  cure,  visits  to  shrines,  laying  on  of  hands, 
etc.  Many  of  the  diseases  thus  healed  being 
those  of  the  imagination  are  cured  by  imagina- 
tion. Again,  certain  operations  on  the  eye 
have  relieved  nervous  symptoms,  and  trephining 
the  skull  without  further  procedure  has  tem- 
porarily cured  epilepsy.  This  would  explain 
the  disappearance  of  pain  and  tenderness  after 
exploratory  incision,  but  not  the  disappear- 
ance of  tumors  or  alterations  in  temperature,  so 
other  causes  must  be  looked  for,  such  as  those 
suggested  by  Dr.  White,  viz.,  rehef  of  tension, 
reflex  action,  etc.,  or  perhaps  some  causes  work- 
ing in  ways  mysterious,  and  of  which  we  know 
nothing,  but  to  which  we  give  such  names  as 
altered  nutrition,  trophic  disturbance,  nervous 
influence,  etc.,  etc.  No  doubt  these  cases  in  time 
receive  suitable  explanation,  but  at  present  we 
are  in  the  dark  as  regards  them.  In  many 
cases  such  symptoms  as  pain  and  tenderness 
with  general  discomfort  may  be  due  to  ad- 
hesions which  at  the  time  of  the  operation  are 
released;  for  instance,  in  the  case  I  reported 
above,  the  omentum  was  adherent  to  the  liver, 
and  its  release  may  have  banished  the  pain  and 
tenderness.  In  many  cases  of  nephralgia,  ex- 
ploratory incision  has  caused  relief.  I  myself 
have  had  several  such  cases,  but  in  every  case  the 
kidney  was  more  than  usually  movable,  and  now 
I  think  the  explanation  is  generally  accepted, 
that  in  cases  of  nephralgia,  where  no  calculus 
is  found,  the  cause  of  the  pain  is  due  to  twisting 
of  the  ureter  of  a  more  than  usually  movable 
kidney,  and  that  operation  tends  to  fix  the  kid- 
ney in  place. 

No  doubt  many  of  you  here  will  be  able  to 
add  to  the  cases  I  have  narrated,  and  perhaps 
some  of  you  may  be  able  to  explain  them  more 
satisfactorily  than  the  reader  of  the  paper. 

Discussion. — Dr.  Smith  thought  the  curative 
effects  were  due  to  the  improved  nutrition  re- 
sulting from  stimulation  of  the  peritoneum  at 
the  time  of  the  operation. 

Dr.  Wm.  Gardner  had  seen  excellent  resul  is 
follow  exploratory  laparotomy  in  two  cases  of 
tuberculous  peritonitis.  These  were  already 
reported  to  the  Society.  In  a  case  of  grape 
tuberculosis    of  the   peritoneum,   he    recently 


reported,  the  patient  was  in  no  wise  benefited, 
but  this  case  had  advanced  pulmonary  tuber- 
culosis as  well,  which  would  alter  the  prognosis. 
He  doubted  whether  malignant  disease  of  the 
abdomen  was  benefited  by  this  operation,  and 
had  never  himself  seen  any  improvement  in 
such  cases. 

Dr.  Johnston  asked  if  the  patient  had  been 
informed  of  the  negative  result  of  the  operation. 

Dr.  Springle  suggested  that  the  improve- 
ment in  Dr.  Shepherd's  case  might  be  due  to 
the  application  of  the  cautery  to  the  liver.  He 
wished  to  know  what  time  had  elapsed  in  Dr. 
Shepherd's  cases  as  in  a  recent  case  of  reported 
cure  of  malignant  disease  by  laparotomy  there 
was  a  subsequent  relapse. 

Dr.  Wesley  Mills  said  that  he  had  a  theory 
explaining  the  beneficial  results  in  these  cases 
which  Yit  hoped  to  bring  before  the  notice  of  the 
Society  at  some  future  time. 

Dr.  Jas.  Bell  stated  that  he  was  sceptical 
with  regard  to  the  curative  effects  oflaparotomy. 
In  cases  reported  as  having  got  well,  the 
diagnosis  was  usually  obscure,  and  this  was 
true  of  Dr.  Shepherd's  case.  He  wished  to  ask 
Dr.  Shepherd  if  he  had  ever  known  of  a  case, 
in  his  own  experience  or  that  of  others,  where 
a  tumor  of  undoubted  malignancy  had  disap- 
peared as  a  result  of  exploratory  laparotomy. 
In  malignant  disease  the  symptoms  were  some- 
times temporarily  arrested  after  a  laparotomy. 
Tuberculous  peritonitis  was  a  self-limiting 
disease. 

Dr.  Shepherd,  in  reply,  said  that  the  patient 
was  informed  of  the  fact  that  nothing  radical 
had  been  done  at  the  operation.  The  cauteriz- 
ation had  been  so  slight  that  it  was  impossible 
to  believe  it  had  any  influence  at  all.  He  had 
not  intended,  in  his  paper,  to  introduce  the 
question  of  the  curative  effects  of  laparotomy 
in  tuberculosis.  He  had  seen  cases  which 
improved  after  laparotomy,  but  thought  they 
would  have  got  well  in  any  case.  The  operations 
had  been  done  because  the  disease  was  believed 
to  be  something  else.  He  thought  Dr  Bell  had 
misunderstood  his  statement  as  to  the  relation 
between  exploratory  incisions  and  malignant 
disease  of  the  peritoneum.  He  did  not  assert 
at  all  that  malignant  disease  had  been  cured  in 
this  way.  On  the  contrary,  he  had  said  that 
Mr.  Tait's  case  would  be  much  stronger  if  a 
microscopic  examination  had  been  made.  Still, 
those  deficiencies  in  the  evidence  do  not 
explain  away  the  fact  that  something  does  take 
place.  Tumors  have  disappeared — not  malig- 
nant ones,  perhaps, — and  processes  which  had 
previously  invalided  a  patient  have  been  ar- 
rested. In  his  own  case  apiece  of  the  tumor 
was  not  taken  for  examination  simply  because 
its  great  vascularity  rendered  severe  bleeding 
likely.  Of  the  other  cases  referred  to,  in  a 
good  many  the  improvement  had  persisted  for 
several  years;  in  others  a  few  months  only  had 
now  elapsed.     It  was  hard  to  say  if  the    arrest 


THE  CANADA   MEDICAL   RECORD. 


201 


of  malignant  disease  after  operation  was  due  to 
the  operation.  He  would  like  to  hear  the  new 
theory  which  Dr.  Mills  had  referred  lo,  even  if 
only  a  partial  statement  could  be  given. 

Dr.  Wesley  Mills  considered  it  unsatis- 
factory to  bring  forward  new  views  without 
having  at  hand  sufficient  evidence  to  sui)port 
them.  He  might  say,  however,  that  he  would 
explain  the  matter  by  reflex.  He  thought  we 
explained  too  little,  rather  than  too  much,  by 
this  agency.  For  his  part,  he  believed  life  itself 
to  be  a  retlex  phenomenon.  In  the  question 
under  discussion  the  reflex  acted  on  the  blood 
vessels,  the  cells,  and  in  fact  on  •  the  whole 
metabolism.  He  disagreed  with  the  agnostic 
standpoint  taken  by  Dr.  Bell. 

Hicmorrhagic  Typhoid. — Dr.  Adami  brought 
forward  the  results  of  an  autopsy,  presenting  a 
peculiarly  rare  condition,  performed  upon  a 
patient  ret.  19,  who  had  been  admitted  to 
the  General  Hospital  in  November  with 
empyema,  under  Dr.  Molson,  had  ben  trans- 
ferred to  the  surgical  wards  under  Dr.  Bell,  and 
there  had  been  operated  upon,  a  silv^er  drainage 
tube  being  inserted.  The  empyematous 
condition  under  daily  drainage  improved 
greatly,  but  the  patient  continued  weak,  with 
indications  of  pneumonic  disturbance  of  the 
left  lower  lobe.  A  week  before  death  symptoms 
of  peritonitis  supervened,  with  eventual 
diarrhoea,  incontinence  of  faeces  and  great 
distension  of  abdomen.  The  patient  died  eight 
weeks  after  ad.mission.  The  continued  ema- 
ciation aroused  suspicions  of  tuberculosis, 
while  the  septic  nature  of  the  temperature  chart 
seemed  to  render  it  not  impossible  that  the 
empyema  of  the  lower  half  of  the  right  pleural 
cavity  had  led  to  a  subdiaphragmatic  abscess 
with  subsequent  extension  and  peritonitis. 

At  the  autopsy,  neither  of  these  conditions 
was  found  present ;  the  empyema  had  healed 
with  firm  fibrous  adhesion  of  the  lowest  lobe  to 
the  chest  wall.  But  there  were  typical  evi- 
dences of  typhoid.  The  last  twelve  inches  of  the 
ileum  contained  five  ulcers,  three  of  which  had 
undergone  perforation,  although  two  of  the  three 
perforations  were  covered  externally  by  thick, 
inflammatory  lymph.  The  typhoid  was  com- 
plicated with  hemorrhages.  Petechial  and 
ecchymotic  haemorrhages  were  found  most 
widely  distributed  : — Subcutaneous  (mostly  on 
chest,  neck,  and  upper  extremities)  :  along  the 
course  of  the  alimentary  canal ;  gums,  tongue, 
tonsils  ;  oesophagus,  stomach,  small  intestines 
and  large  intestines,  being  particularly  numer- 
ous in  the  jejunum  and  ileum,  and  these  both 
submucous  and  subserous ;  in  the  heart  (both 
subendocardial  and  subpericardial)  ;  in  the 
substance  and  on  the  surface  of  the  liver  and 
kidneys  ;  in  the  right  suprarenal  (sub-capsular)  j 
in  the  retro-peritoneal  lymph  glands  ;  in  the 
bladder  (both  submucous  and  subserous),  and 
again    in   the  consolidated  lowest    lobe  of  the 


right  liing.  There  had  been  a  more  ])rofuse 
hremorrhage  into  the. pelvis  of  the  ri^^ht  kidney. 
Cultures  from  the  organs  gave  a  pre])onderancL* 
of  the  coli  bacillus. 

Dr.  Bell  said  that  on  Jan.  loth  there  was 
great  pain  and  distension  of  the  abdomen, 
followed  by  collapse  and  subnormal  temper- 
ature. Perforative  peritonitis  was  diagnosed, 
but  it  was  thought  to  be  possibly  due  to  the 
burrowing  of  pus  from  the  empyema  into  the 
a  I  domen. 

Rjipttirfd  Tubal  Pregnancy — Report  on  the 
ovum. — Dr.  Adami  reported  the  result  of  the 
examination  of  the  specimen,  5.5  nun.  long, 
attached  to  the  wall  of  the  ruptured  Fallopian 
tube  exhibited  by  Dr.  Armstrong  at  the  last  :neet- 
ing.  It  showi  d  very  great  evidences  of  degener- 
ation, and  all  that  could  be  said  was  that  it  n.ore 
closely  lesembled  an  embyonic  structure  than 
any  other  object.  There  were  no  signs  of  foetal 
membranes  surrounding  ii.  Serial  sections  had 
been  made,  and  showed  that  the  object  was 
bilaterally  symmetrical  and  nourished  by  a 
vascular  pedicle  attached  to  the  wall  of  the  sac. 
There  were  no  structures  which  could  be  dis- 
tinctly recognized  as  foetal  organs,  although  the 
cell  structure  as  a  whole  was  of  distinctly 
embryonic  type.  In  a  normal  embryo  of  this 
size,  numerous  organs  would  be  reco)gnizable. 
It  was  possible  that  degenerative  changes 
and  invasion  by  leucocytes  accounted  for  the 
discrepancy.  The  object  was  certainly  not  a 
tumor  or  parasite.  The  inner  surface  of  the 
sac  in  the  neighborhood  showed  papilire, 
though  no  typical  chorionic  villi  were  met 
with. 

Dr.  Mills  referred  to  some  experiments  in 
artificially  changing  the  environment  of  ova. 
These  had  led  to  astonishing  anomalies  in  the 
ova.  He  thought  the  object  in  the  {present 
case  to  be  an  ovum. 

Dr.  SiMiTH  considered  that  the  specimen  was 
an  ovum. 

Dr.  Armstrong  remarked  that  the  history 
ofthe  case  was  that  of  a  ruptured  tubal  preg- 
nancy. 

Leiichcemia. — Drs.  Finlev  and  Adami  re- 
ported this  case  as  follows  : — 

We  venture  to  bring  forward  the  present  case, 
not  because  we  feel  absolutely  convinced  as  to 
the  correctness  of  the  diagnosis  (though  at  the 
same  time  it  is  difficult  to  see  what  other  diag- 
nosis satisfies  all  the  details  of  the  case),  but 
because  it  seems  to  us  that  the  uncommon 
clinical  history  and  the  appearances  discovered 
at  the  autopsy  are  w  irthy  of  being  placed  upon 
record.  For  the  very  full  report  of  the  case 
we  are  indebted  to  Dr.  Mackenzie,  house 
physician  of  the  Montreal  General  Hospital. 

S.  D.,acleaf  mute,  but  nevertheless  a  bright  and  in- 
telligent-looking girl  of  eleven  years  of  age,  was  born 
and  lived  till  she  ^vas  seven  years  old  in  California. 
The  mother,  who    is    a    robust    woman,  has  had   four 


202 


THE   CANADA   MEDICAL   RECORD. 


cliildien  and  no  miscaiiiages,    the  father  is   altvp  and  has 
some  pulmonary  affection. 

The  third  day  after  birth  a  large  swelling  formed 
iindtr  the  left  ear  and  advanced  forward  to  the  cheek. 
This  was  poulticed,  and  discharged  a  large  quantity  of 
pus.  She  was  a  sickly  infant, and  suffered  much  from 
colic.  At  eleven  months  old  she  had  an  attack  of 
whooping  cough  ;  when  she  was  two  years  of  age  it  was 
noticed  that  she  could  not  hear.  At  four  she  suffered 
from  measles,  and  at  the  outset  of  this  attack  occurred  the 
first  haemorrhage,  three  cupfuls  of  blood  being  vomited. 
Next  morning  there  was  a  slighter  ha-matemesis,  and 
after  this  her  condition  was  very  weakly.  When  she 
was  seven  years  old  she  vomited  up  a  teacupful  of  blood 
without  any  premonitory  sympt'Mns,  and  v\ithout  s.rious 
disturbance  to  her  health.  At  eight  she  suffered  a 
double  ru].ture,  for  which  she  afterwards  wore  a  truss. 
For  the  past  five  years  her  general  health,  if  not  robust, 
has  been  fair ;  she  has  been  able  lo  drive  the  cattle  on 
the  farm,  has  had  a  good  appetiie,  and  has  not  suffered 
either  from  diaiihoea  or  from  haemorrhoids. 

Recently  she  was  admitted  to  the  Mackny  Institute, 
and  there  learned  to  articulate  a  few  words. 

Upon  December  3oih  last,  she  gave  evidence  of  feel- 
ing unwell,  and  spat  up  some  n.ucus  stained  wiih  blood  ; 
later  in  the  day,  while  in  the  housekeeper's  arms,  she 
brought  up  a  large  quantity  of  blood,  estimated  at  about 
two  quarts ;  she  became  very  faint.  Saline  enemata 
were  given  with  good  effect,  and  she  was  confined  to 
1  ed  until  January  1st,  when  she  was  admitted  to  the 
General  Hospital  under  Dr.  Finley. 

Here  her  condition  was  found  to  be  one  of  marked 
ancemia  ;  the  temperature  was  normal,  the  pulse  120, 
small  and  regular,  the  tongue  large  and  fissured  along 
the  median  line,  with  small  fissures  branching  off. 

Upon  examination  of  the  abdomen,  some  fullness  was 
noticed  iu  the  left  hypocliondrium,  and  an  oval  tumor 
was  made  out,  extending  from  the  costal  margin  to  just 
below  and  to  the  right  of  the  umbilicus,  while 
to  the  left  it  extended  back  to  the  line  upwards  from 
the  middle  of  the  crest  of  the  ilium.  It  could  be  palp^^ted 
bi-manually  and  was  movable.  The  dullness  extend- 
ed upwards,  merging  apparently  into  an  area  of  thoracic 
dullness,  whose  upper  margin  was  2  inches  above  the 
nipple. 

The  liver  dullness  was  diminished,  being  y/z  inches 
across  in  the  right  mammary  line. 

The  heart  lay  in  normal  position  ;  both  apex  and 
pulmonary  systolic  murmurs  were  present,  soft  in 
character . 

The  blood  was  pale  and  scanty,  the  amount  of 
hamoglobin  was  reduced  to  38  per  cent.,  the  red  cor- 
puscles reduced  to  2,240,000,  the  white  increased  to 
1,200,  and  in  some  specimens  of  blood  examined  by  Dr. 
Finley,  the  propoition  of  white  to  red  had  risen  to  i 
to  80.  No  change  in  the  character  of  the  corpuscles 
was  not  iced. 

The  urine  was  normal,  though  small  in  quantity  (16 
ozs.  in  24  hours).  The  stools  were  normal,  one  mass  was 
of  daik,  blood-stained  color,  and  with  it  came  a  little 
blood-stained  fluid.  The  larynx  was  normal,  the 
dram  of  the  left  ear  concave. 

The  patient's  condition  improved  in  hospital ;  upon 
the  5th  she  was  bright  and  cheerful,  and  seemed  to  have 
gained  in  strength.  At  half  past  five  she  had  her  supper 
of  bread  and  milk.  This  seemed  to  bring  on  nausea, 
and  after  a  few  minutes  she  vomited  with  scarcely  an 
effort  20  ozs.  of  bright  blood,  which  rapidly  clotted. 
She  was  immediately  given  ice  to  suck,  an  ice-bag  was 
placed  upon  the  epigastrium,  and  ergoiin  was  injected 
subcutaneously.  Ten  minutes  later  a  smaller  quantity  of 
blood  was  vomited.  A  stool  passed  at  the  time  of  the 
first  hemorrhage  was  normal  and  bloodless.  Saline 
enemata  were  now  given.  At  620  a  third  hemorrhage 
occurred,  followed  by  three  more  ;  altogether,  48  ozs.  of 


blood  was  brought  up  from  the  stomach.  The  patient 
suffere  I  from  great  epigastric  pain,  and  gradually  sank, 
dying  at  1.35  a.m.  on  the  6th. 

We  have  entered  into  all  these  details  in 
order  lo  throw  as  much  light  as  possible  upon 
the  condition  found  at  the  autopsy.  This  was 
performed  eleven  hours  after  death. 

Autopsy. — The  body  was  found  fairly  well  developed 
and  of  large  proportions  for  the  age  of  the  girl  (eleven 
years).  There  was  no  excessive  fat  :  the  abdomen  was 
sunken ,  The  organs  in  the  ihor.icic  cavity  were  verv 
pale,  there  was  a  little  clear  fluid  in  both  peritoneal  and 
pleurnl  cavities.  The  blood  present  in  all  the  cavities 
was  fluid,  and  presented  a  peculiarly  pale,  diluted 
appearance.'  The  heart  was  normal,  the  lungs  rather 
sodden  and  cedematous. 

Upon  opening  the  abdominal  cavity,  the  small  intes- 
tines and  other  organs  showed  extreme  pallor.  The 
large  intestines  were  distended  and  filled  with  almost 
clear  fluid  (the  result  of  saline  enemata  given  shortly 
before  death).  The  liver  was  wholly  letrncted  behind 
the  ribs,  save  that  below  the  ensiform  caitilage  the  left 
lobe  showed  for  the  extent  of  three-quarters  of  an  inch. 
The  spleen,  which  was  of  a  dull  pale  bluish  color  with 
well  rounded  edges,  extended  forward  and  downward  to 
within  an  inch  of  the  umbilicus. 

The  result  of  the  examination  of  the  various  organs 
was   as   follows : 

The  spleen  measured  20  x  8  x  3.5  cm.  and  weighed 
4logrms.  The  surface  showed  a  !eticulaied  fibrous  con- 
dition. The  splenic  vessels  at  the  hilus  weie  large,  but 
not  abnormally  thick  ;  there  was  no  local  evidence  of  in- 
terference with  the  circulation  of  the  organs.  Upon 
section  the  trabecula;  were  distinct  and  )iromintnt ;  the 
pulp  was  relatively  scanty  and  pale,  while  the  Malpighian 
bodies  were  not  prominent .  The  microscopic  examina- 
tion bore  out  these  naked  eye  characters,  the  most  notice- 
able feature  being  the  general  interstitial  fibrosis  more 
marked  in  some  regions  than  in  others,  although  every- 
where the  trabeculre  were  enlarged. 

The  liver  was  small,  with  sharp,  irregular  edges,  and 
weighed  only  610  grm. — one-half  as  much  again  as  the 
enlarged  spleen.  'I'he  organ  was  very  pale  and  had  a 
distinctly  cirrhotic  appearance.  On  section,  however, 
much  of  the  fibroid  change  appeared  to  be  superficial, 
and  while  the  organ  was  firm  and  cut  firmly,  i)ut  few 
bands  of  fibrous  tissue  cnuld  be  made  out  passing  from 
tl  e  surface  deep  into  the  substance.  Here  and  there  were 
small,  isolated  (ibroid  pat.  hes  in  the  liver  tissue.  The  gall 
bladder  was  small  and  covered  by  an  unusual  layer  of 
fat,  more  than  0.5  cm.  in  thickness.  The  ducts  were 
pervious.  Microscopically  the  main  characteristic  of 
sections  of  the  organ  was  its  leuchremic  appearance  ;  the 
capillaries  throughout  were  large  and  ea'-ily  recogniz- 
able, though  there  was  not  the  slightest  indication  of 
central  atrophy  of  the  cells,  of  nutmeg  liver  ;  contrari- 
wise, it  was  difficult  lo  recognize  the  individual  lobules. 
The  capillaries  contained  an  undue  number  of  leucocytes 
— in  fact,  certain  of  them  were  completely  injected  with 
these  corpuscles.  In  addition,  the  organ  was  markedly 
cirrhotic,  hut  the  cirrhosis  was  not  of  tiie  common  type. 
There  was  not  anything  approaching  to  a  framework  ol 
increased  fibrous  tissue,  but  here  and  there  were  isolated 
patches  of  fibrous  overgrowth,  many  perilobular,  while 
some  were  within  the  lobules.  The  growth  was  of  various 
periods  ;  some  of  the  patches  were  of  well  formed  fibrous 
tissue,  but  there  were  occasional  areas  of  recent  cirrhosis 
with  small  cell  infiltration. 

Certain  capillaries  in  the  heart  muscle  showed  also 
this  injection  with  leucocytes  ;  otherwise  the  heart 
muscle  was  normal,  save  that  it  showed,  where  the 
fibres  were  cut  transversely,  peculiarly  well  marked 
vacuolation.     This  vacuolation  is    frequently  to   be  no- 


tHE  CANADA  MEDICAL  RECORD. 


203 


ticed  in  tlie  c.iuliac  nmscle  lil)res  of  cliiKlren,  ;iikI  it  is 
questionable  whether  it  should  '  e  regarded  as  a  pathol)- 
gic.il  condition. 

Beyond  their  pallor,  the  kidneys,  which  weighed  each 
90  gims.,  piesented  nothing  calling  for  remark,  either 
macro-or  microscopically,  nor  was  there  anythini;  notice- 
able in  the  other  ahlominal  and  pelvic  organs  with  the 
exc  ption  of  the  intestine;. 

The  slom-ich  contained  S  ozs.  of  clotted  blood.  There 
was  no  ulceration  or  evidence  of  localized  or  general  in- 
flammation. Careful  e.\amination,  both  by  the  naked 
eye  and  by  the  microscope,  failed  to  reveal  any  ruptured 
vessel  or  cause  for  tlie  hemorrhage,  which  wculd  seem, 
therefore,  to  have  been  of  cajiillary  origin. 

The  jejunum  showed  blood-stained  hamorrhagic 
patches  in  its  mucous  membrane,  which  varied  in  length 
from  two  feet  to  seven  or  eight  inches,  and  were  separ- 
ated from  one  another  by  areas  of  apparently  normal  in- 
testine. The  ileum  was  similarly  affected,  but  to  a  less 
degree.  In  neither  could  any  special  ha-morrhagic  point 
or  lUjitured  vessel  be  discovered.  The  ccecum  was 
normal,  the  appendix  thickened,  its  mucous  membrane 
reddened  and  apparently  inflamed  ;  the  follicles  were 
slightly  enlarged.  The  large  intestine  and  rectum  were 
normal. 

There  wasno  noticeable  enlargement  of  the  mesentiric 
or  other  lymph  glands.  The  marrow  of  the  sternum  was 
red,  but  not  increa  ed  in  extent.  It  had  not  the  dirty 
reddish  grey  coli:r  characteristic  of  leuchoemia.  It  may 
be  added  that  the  bram  was  not  examined. 

Two  conditiof.s  might  possibly  explain  the 
clinical  and  other  conditions  of  this  case: 
cirrhosis  (  f  the  liver  and  leuchsmia.  But  there 
is  much  that  can  be  brought  against  the  former 
possibility.  While  enUirgement  of  the  spleen 
is  frequently  assoc  ated  with  cirrhosis,  that 
enlargement  is  only  moderate,  and  does  not 
approach  to  the  extent  discovered  in  this  case. 
Again,  cirrhosis  fits  in  ill  with  the  history  of 
hasmaiemesis,  manifesting  itself  at  irregular  in- 
tervals over  a  period  of  seven  years  ;  and  wliile 
t'le  liver  was  undoubledly  cirrhotic,  the  fibroid 
change  was  not  of  either  ihe  ordinary  or  c-.n- 
genital  syphilitic  type. 

On  the  other  hand,  much  may  be  said  in  favor 
of  leuchffimia.  The  spleen  was  distinctly  of  the 
leuchsraic  type  ,;  its  large  size  and  fibroid  con- 
dition are  both  characieristic  of  splenic  leuch- 
temia.  The  injection  of  the  capillaries  in  liver 
and  heart  are  in  favor  of  this  diagnosis;  the 
hjemorrhages  from  tlie  stomach  and  intestines 
also  support  it.  The  absence  of  any  marked 
swelling  of  the  lymphatic  glards  orofgreyi-h 
red  softening  of  the  sternal  mairow  is  not 
against  it.  Still,  there  are  diflicuhies  in  con- 
nection with  this  view  of  the  case.  Leuch?emia 
in  children  generally  runs  a  rapid  course,  and  if 
this  be  a  case  of  the  disease,  we  are  almost 
bound  to  assume  that  it  has  had  a  duration  of 
four,  if  not  of  seven  years,  the  first  haemorrhage, 
of  a  type  similar  to  the  last,  having  occurred 
when  the  child  was  four  years  old.  Again, 
while  the  proportions  of  white  to  red  corpuscles, 
as  determined  by  Dr.  Finlcy,  had  b.come  in- 
creased from  the  normal  of  i  in  300  to  i  in  80, 
it  cannot  be  said  that  this  is  a  very  g^eat  in- 
crease, especially  when  the  facts  are  taken  into 


account  that  correspondingly  there  was, 
through  the  antecedent  great  haemorrhage,  a 
diminution  of  the  red  corpuscles  10  less  than 
half  the  nornnl  number,  and  that  one  expects 
to  find  a  post  hemorrhagic  increase  of  the 
white  corinisclcs. 

Nevertheless,  in  certain  c  iscs  of  leuchxmia. 
the  ntimber  of  leucocytes  present  in  the  blond  is 
capable  of  great  variation  from  time  to  lime; 
and  taking  into  account  the  very  typical  spleen 
and  the  condition  of  the  liver,  1  am  inclined 
to  (or.sider  that  this  mu>t  be  regarded  as  a  case 
of  chionic,  or  it  mny  be  termed  interinittent, 
leuchaemia,  in  which  it  has  happened  that  the 
observations  upon  the  blood  have  been  made  at 
a  time  when  tliere  has  been  a  relatively  small 
increase  in  the  number  of  white  corpuscles. 
The  stale  of  the  liver  appears  to  me  to  sustain 
this  view.  Apart  from  the  capillaries  with  their 
injection  of  leucocytes,  the  curious  cirrhotic 
condition  of  this  organ,  with  its  isolated  areas 
of  fibroid  change,  some  old  and  well  developed, 
sone  comparatively  recent,  some  external  to 
the  lobules,  some  within  the  lobules — all  tliis 
is  what  might  be  expected  to  res^ult  from  capil- 
lary emboli  produced  from  time  to  time  in  the 
organ  by  masses  of  leucocytes. 

Dr.  LocKHART  had  seen  the  case  three  days 
prior  to  admission  ;  she  was  lying  near  a  poo! 
of  blood  which  looked  normal  in  appearance. 
Ice  to  the  epigastrium  and  perfect  quiet  were 
ordered.  Later  on,  repeated  saline  enemata 
were  given  with  a  wonderful  improvement  each 
time  in  the  pulse,  lasting  for  half  to  three- 
quarters  of  an  hour.  During  the  afternoon  she 
had  three  more  haemorrhages  aggregating 
nearly  a  quart. 

Dr.  Lakleur  said  the  number  of  leucocytes 
varied  greatly  at  different  periods  in  the  history 
of  leuchcemic  cases.  He  asked  what  were  the 
conditions  of  the  lymphatic  glands  throughout 
the  body,  and  of  the  bone  marrow. 

Dr.  Adami  said  that  the  spleen  measured 
20  X  8x  3^  cm.  There  was  nothing  noticeably 
wrong  with  the  lymphatic  glands.  The  bone 
marro.v  showed  nothing  abnormal.  The 
difiiculty  in  adopting  ihe  theory  of  leuc'  emia 
was  that  she  must  in  ihat  case  have  had  the 
disease  since  infancy. 

Atresia  of  Vaghia,  Hiematoinetra,  Hyster- 
ectomy.— Dr.  \Vm.  Gardner  exhibited  the 
specimen,  taken  from  a  girl  of  sixteen,  with  a 
histoiy  of  violent  pain  and  vomiting  occuiring 
])eriodically  at  intervals  of  about  three  weeks, 
A  firm  tumor  could  be  felt  in  the  hypogastrium. 
No  vaginal  canal  was  present,  though  the  labia 
were  r.ormal.  As  no  evidences  of  a  vag'na 
could  be  obtained  by  rectal  exami  la'ion, 
abdominal  hysterectomy  was  done  by  the 
method  of  tying  off  the  broai  ligaments.  The 
uterus  was  found  to  be  greatly  hypertro|)h  el 
and  was    full  of  blood,    the   right    tube    was 


204 


THE  CANADA  MEDICAL  RECORD. 


normalj  and  the  left  distended  with  blood.  The 
depth  of  the  uterus  was  from  8  to  lo  incb.es. 
The  blood  measured  over  ij4  pints  and  had 
the  ordinary  characters  of  retained  '  menstrual 
fluid.  Such  extreme  conditions  were,  he  believed, 
extremely  rare.  The  operation  was  a  success. 
Aorfu-  Aneurism. —  Dr.  E.  P.  Williams 
showed  this  specimen,  which  had  been  sent  by 
Dr.  H.  P.  Shaw,  of  Perth,  Ont. 

G.  B.,  ffit.  56,  was  for  many  years  foreman  on 
some  dredging  operations,  and  occasionally 
acted  as  diver.  Picviously,  at  the  age  of  twenty- 
one,  he  had  malarial  fever,  and  at  twenty-five  an 
attack  of  acute  rheumatism.  Since  then  he  has 
had  seveial  acute  attacks  and  constant  chronic 
rheumatism.  He  come-  of  a  healthy,  long-lived 
family,  and  has  healthy  children  of  his  own. 

During  the  summer  of  1892  he  suffered  from 
anorexia  and  insomnia,  and  on  the  ist  of 
November  he  suddenly  felt  a  sharp  pain  in  the 
right  mammary  region,  "  like  shoving  in  a  red 
hot  iron  and  drawing  it  out  again." 

The  pain  was  paroxysmal  and  severe  for  five 
days,  then  the  attacks  occurred  about  every 
third  or  second  day. 

On  Jan.  i,  1893,  he  noticed  for  the  first  time 
a  small  tumor  in  the  right  mammary  region, 
which,  from  time  to  time,  would  swell  u])  and 
"  lift";  the  skin  over  it  would  become  r^d  and 
tender,  and  then  the  paroxysms  of  pain  began 
at  the  tumor,  back,  right  shoulder  and  arm. 
After  three  or  four  -hours  the  ribs  seemed  to 
''lift"  and  the  pain  would  cease. 

Upon  examination  at  the  Montreal  General 
Hospital  under  Dr.  Wilkins,  a  prominent  pul- 
sating tumor  was  found  proji.cting  forwards 
about  5  cm.,  and  covered  by  reddened,  oede- 
matous  skin.  'J  he  most  prominent  part  was 
firm,  but  the  tumor  w^as  soft  and  compressible. 
The  ribs  were  not  felt  under  the  tumor. 
Dullness  extended  slightly  beyond  its  outli  e. 
Pulsation  was  synchronous  with  the  heart 
beat,  a  sharp  systolic  rise  followed  by  a  quick 
fall;  a  slight  systolic  blow  after  the  first  sound 
was  heard  over  the  swelling,  while  the  second 
sound  is  heard  distinctly. 

Tracheal  tugging  could  be  obtained. 
The  apex  beat  was  at  the  fifth  left  interspace, 
and  almost  imperceptible.  The  sounds  were 
normal,  the  aortic  slightly  accentuated.  Pulse 
72,  of  low  tension;  the  radials  were  slightly 
thickened  and  pulsated  equally.  Respirations 
20.     Eyes   normal. 

After  leaving  the  hospital  the  patient  returned 
to  his  home.  Dr.  H.  P.  Shaw,  who  attended 
him,  states  that  the  pain  became  almost  intoler- 
able, only  relieved  by  chloroform.  Dyspnoea 
was  severe  and  almost  constant.  The  tumor 
was  tense  and  heavy,  requiring  support  by  ban- 
daging. 

The  temperature  ranged  from  loi''  to  104". 
On  November    10,  after  several    attacks  of 
syncope,    he    became    unconscious,  and    died 
comatose  two  days  later. 


At  the  autopsy,  three  hours  after  death,  a 
firm  clot  was  found  in  the  aorta  extending  from 
the  aortic  ring  as  far  as  and  into  the  great 
vessels  of  the  neck,  and  projecting  through  the 
orifice  of  the  aneurism.  The  sac  was  filled 
with  soft  clot.     Both  lungs  were  gangrenous. 

The  heart  appears  to  be  of  average  size  with 
normal  cavities  and  valves.  The  aorta  is  dil- 
ated, measuring  at  the  ring  3  in.  in  circum- 
ference; one  inch  fuither,  6)^  in.,  and  an  inch 
beyond  the  left  subclavian,  4^  in.  It  is  rough, 
and  shows  irregular  nodules  of  atheroma,  some 
breaking  down,  some  undergoing  calcification. 

The  great  vessels  of  the  neck  are  also  athero- 
matous, measuring  : — Ijinominate,  2  in.  ;  L. 
carotid,  ij^  in.  ;  L.  subcUviin,  i^  in.  in 
circumference. 

Three  inches  from  the  aortic  ring  in  the 
anterior  wall  of  the  aorta  is  a  circular,  thick- 
edged  orifice,  4^  in.  in  circumference,  com. 
munica'ing  with  an  aneurismal  sac  of  large  «:ize- 

In  the  course  of  its  growth  the  sac  probably 
became  firmly  attached  to  the  wall  of  the  thorax, 
and  then  gradually  eroded  through  the  ribs  and 
intercostal  structures  to  f)rm  a  false  aneurism 
covered  by  the  skin. 

The  posterior  wall  consists  of  the  remains  of 
the  dilated  arterial  coat,  which  is  firmly  united 
to  the  inner  thoracic  wall  in  a  circular  manner, 
the  diameter  being  5^  in.  from  the  midsternum 
to  the  right  axilia,  and  from  the  second  to  the 
fifth  ribs. 

Outside  the  thorax,  the  dilatation  extends 
further  in  all  directions,  being  about  8^  in.  in 
diameter,  as  far  to  the  left  as  the  left  costal 
cartilages,  and  from  the  upper  border  of  the 
first  rib  to  the  lower  border  of  the  sixth. 

The  anterior  wall  is  formed  by  the  skin 
which  is  thin  and  vascular,  especially  over  the 
central  portion. 

Into  the  sac  project  the  rough  ends  of  the 
eroded  and  broken  3rd,  4th  and  5th  ribs,  and 
the  edge  of  the  sternum,  which  is  rough  and 
eroded  between  the  3rd  and  4th  costal  cartil- 
ages. There  are  also  bits  of  semi-detached 
bone  and  adherent  portions  of  more  or  less  or- 
ganized clot. 

Stated  Meeting,  February  ()th,  1894. 

James  Bell,  M.D  ,  President,  in  theChair, 

Dr.  Robert  Wilson  was  elected  a  member  of 
the  Society. 

Purulent  Pericarditis  with  Necrosis  of  the 
Sternum. — Dr.  C.  F.  Martin  showed  the 
specimens  obtained  at  an  autopsy  ui)on  a  male 
infant  17  days  old  who  had  died  of  purulent 
pericarditis.  The  labor  was  premature  at  8 
months,  and  the  child  sickly  at  birth.  There 
I  was  a  sinus  in  the  prsecordial  region,  close  to 
I  the  sternum,  leading  directly  to  the  pericardial 
sac,  which  contained  some  purulent  fluid  and 
flakes  of  lymph.      There   was  necrosis  of  the 


THE  CANADA  MEDICAL  RECORD. 


205 


i 


Sternum,  which  appeared  to  be  the  origin  of 
the  trouble,  as  the  ])rocess  there  appeared  of 
earlier  date  than  that  in  the  pericardium.  There 
was  no  evidence  of  syphilis  or  tubercle  and  no 
sign  of  infection  through  the  umbilical  cord.  The 
external  portion  of  the  cord  had  not  been 
detached,  but  was  represented  by  a  small 
shrivelled  body  2.5  cm.  long. 

Dr.  E)vANS  related  ihe  history  of  the  case. 
The  parents  were  both  healthy  and  the  labor 
had  been  easy.  The  child  was  small  and  sickly 
at  birth,  weighing  only  3  lbs.  15  oz.  On  the 
5th  day  it  was  noticed  to  be  nursing  badly  ; 
on  the  8th  a  small  pimple,  frrm  which  pus 
cculd  be  squeezed,  was  noticed  over  the  ster- 
num. On  the  13th  day  an  abscess  was  opened 
in  this  region.  Subsecjuenly  a  probe  passed 
into  the  deeper  part  of  this  abscess,  entered  a 
sinus  leading  into  the  pericardium,  and  the 
heart  beats  could  be  n  gistered  by  the  move- 
ments of  the  piobe. 

Dr.  Bell  asked  if  ihe  incision  made  in 
opening  the  abscess  had  been  continued  down 
to  the  pericardium. 

Dr.  Evans  replied  that  such  was  not  the  case, 
the  communication  with  the  pericardium  had 
been  discovered  a  day  or  two  later. 

Epilepsy — Abscess  and  Cyst  of  Brain — 
T  ephining  and  Exploratory  Puncture, — Drs. 
Bell  and  Adami  exhibited  the  specimens 
obtained  at  the  autopsy  in  this  case,  and  gave 
the  clinical  history. 

Discussion. — Dr.  Jas.  Stewart  had  seen  the 
case  once  in  consultation.  He  thought  the 
results  of  the  postmortem  did  not  lessen  the 
pn  bability  that  the  symptoms  were  due  to 
irritation  of  the  motor  area,  and  thouglit  that 
the  cyst  was  the  cause.  .After  the  operation  he 
had  thojght  the  diagnosis  was  wrong,  but  the 
autopsy  showed  that  it  was  right  after  all.  It 
was  not  necessary  for  the  lesion  to  be  actually 
situated  within  the  motor  area  in  order  to 
irritate  it.  He  thought  that  there  must  still 
be  some  lesion  not  yet  discovered  (possibly  of 
the  internal  capsule),  as  the  cyst  would  not 
account  for  the  paralysis.  He  thouglit  the  case 
could  not  be  fully  discussed  at  present,  as  the 
report  was  not  complete.  The  electrical  reac- 
tions were  normal. 

Dr.  Mills  thought  we  were  too  rigid  in  our 
interpretation  of  what  we  mean  by  the  motor 
area,  and  that  it  really  is  a  sensoii-motor  area. 
The  time  has  come  to  look  for  a  wider 
definition  which  will  include  such  anomalous 
cases  as  the  present. 

Dr.  WiLKiNS  said  that  the  ganglion  cells  of 
the  cord  were  probably  involved,  as  shown  by 
the  wasting  of  the  muscles. 

Dr.  Adami  said  that  it  had  not  been  possible 
to  examine  the  cord.  The  examination  of  the 
brain  was  not  finished,  as  the  specimen  was  not 
fully  hardened. 

(The  discussion  was  postponed.) 


Calcified  Plates  from  the  Pleura  in  Empy- 
ema.— Dr.  Adami  exhibited  some  calcareous 
plates  removed  from  the  pleura  after  resection 
of  the  5th  and  6th  ribs.  These  looked  like 
exfoliations  of  bone,  but  proved  on  examina- 
tion to  be  merely  deposits  of  calcareous  salts  in 
the  thickened  pleura  following  empyema. 

Dr.  Bell. — The  patient  was  a  man  aged  48, 
who  gave  a  history  of  a  pimple  having  burst 
8  months  ago  on  the  5th  intercostal  space 
anteriorly.  Since  then  pus  had  flowed  from 
the  wound.  On  resecting  the  ribs  there  was 
no  appearance  of  exfoliation,  but  the  empyemal 
sac,  which  had  a  capacity  of  about  one  pint, 
was  lined  with  these  bony-looking  plates. 
Though  the  history  only  dated  8  mondis  back 
it  was  possible  that  the  disease  had  existed 
unperceived  for  some  months  or  years.  The 
patient  was  a  tuberculous  subject. 

Cancer  of  the  Body  of  the  Uterus. — Dr.  Wm. 
Gardner  showed  the  specimen  from  an  un- 
married woman  aged  55.  There  was  a  history 
of  pain  and  bleeding  coming  on  some  time  after 
the  menopause,  and  which  had  lasted  6^  years. 
He  had  seen  the  patient  2^  years  ago,  and 
found  the  uterus  enlarged.  The  cervix  was 
normal.  Upon  curetting,  some  friable  material 
was  obtained,  which  proved  to  be  cancer  on 
microscopic  examination.  Operation  was  ad 
vised,  but  refused.  The  patient  afterwards 
went  to  Europe  and  acted  as  courier  to  a  parly 
of  tourists.  Ten  months  ago  she  was  examined, 
and  some  material,  which  was  shown  to  be 
cancer  microscopically,  again  removed  from 
the  uterus.  Consent  to  operation  was  again 
refused,  but,  owing  to  the  severity  of  the  pain 
and  hremort-hage,  was  afterwards  consented  to. 
The  operation  was  through  the  abdomen,  as  the 
vagina  was  narrow  and  atrophic.  There  were 
no  adhesions.  Near  the  fundus  were  two  small 
pedunculated  sub-mucous  myomata,  one  of 
which  was  partly  calcified.  Recovery  was 
uneventful. 

Dr.  Smllh  thought  that  in  any  woman  in 
whom  uterine  haemorrhages  recommenced  a 
year  or  more  after  cessation  of  the  menses,  the 
rase  should  be  considered  as  cancer  until  the 
contrary  was  proved. 

Albuminuria  of  Pregnancy. — Dr.  Smith 
showed  some  specimens  of  urine  showing  the 
rapid  disappearance  of  a  large  amount  of 
albumen  in  the  urine  after  delivery.  The 
patient  had  nearly  lost  her  life  a  year  ago  from 
puerperal  eclampsia.  Subsequently,  on  becom- 
ing pregnant,  her  urine  was  examined  weekly, 
and  as  it  suddenly  began  to  be  highly  album- 
inous in  the  fifth  month,  in  consequence  of  a 
slight  chill  followed  by  convulsions,  labor  was 
at  once  induced,  and  the  urine  became  nearly 
free  from  albumen  in  a  few  days.  These  cases 
should  never  be  allowed  to  goon  to  full  term. 
Dr.  Spier  read  a  paper  upon  scarlatina, 
based  upon  his  observations  of  100  cases  of  this 
disease  as  follows  : 


io6 


THE  CANADA  MEDICAL  RECORD. 


Tlie  first  one  hundred  cases  treated  in  the 
Montreal  General  Hospital  during  the  present 
epidemic  may  be  divided  into  the  following 
classes  : 

(rt)  Of  mild  cases,  showing  all  the  symptoms 
of  scarlet  fever  with  a  moderate  fever  and  a 
little  failure  of  the  general  health,  there  were 
forty. 

(^)  Of  moderately  severe  cases,  with  a  high 
temperature,  a  severe  angina  and  intense  rash, 
with  considerable  depression,  there  were 
twenty-nine. 

(t)  Of  severe  cases  with  a  continued  high 
temperature,  ulceration  and  destruction  of  the 
tissues  of  the  throat  and  involvement  of  tlie 
glands  of  the  neck,  there  were  thirty-one. 

In  over  50  per  cent,  of  the  mild  and  mod- 
el ate  cases,  convalescence  set  in  on  the  fourth 
or  fifth  day  by  crisis,  the  temperature  falling 
in  a  few  hours  two  or  three  degrees,  then  by 
lysis  reaching  normal  by  the  end  of  a  week  or 
ten  days.  In  a  few  cases  the  temperature  fell 
to  normal  in  twenty-four  hours.  The  remainder 
of  the  cases  reached  the  normal  by  a  gradual 
lysis  in  from  five  to  ten  days. 

The  rash  in  many  cases  presented  peculiar 
appearance?.  In  many  of  the  mild  cases  it 
was  apparently  absent  or  very  transient,  or  ap- 
peared only  in  certain  parts  of  the  b'idy,  chief- 
ly on  the  neck  and  chest,  in  the  form  of  erythe- 
ma. In  three  cases  minute  red  spots  without 
a  general  redness  appeared. 

In  the  moderately  severe  cases  the  rash  as 
a  rule  piesented  the  appearances  generally  de- 
scribed, but  two  or  three  presented  a  distinctly 
jiapular  rash,  these  papules  being  specially 
distinct  on  the  back  of  the  hanus  and  fore- 
arms. 

Among  the  severe  ca-es,  anomalous  raslies 
were  common.  One  case  presented  a  papular 
hitmorrhagic  rash  over  the  whole  body  without 
any  distinct  coloration  of  the  skin  between. 
Two  or  three  cases  had  very  numerous  small 
vesicles  over  the  whole  body.  The  case  of  a 
young  child  presented  the  appeaiance  of  an 
acute  exfoliative  dermatitis. 

The  throat  in  mild  cases  showed  as  a  rule 
redness  and  some  slight  swelling  of  the  soft 
palate  and  tonsils.  In  the  severe  cases  the 
whole  palate,  pharynx  and  tonsils  were  intensely 
red  and  covered  with  sticky  mucus.  In  the 
most  severe  cases  ulceration  and  destiuciion  of 
the  tissues  occurred,  accompanied  by  a  foetid 
odor.  In  these  cases  also  the  glands  of  the 
neck  became  swollen  and  inflamed,  frequently 
running  on  to  suppuration.  A  general  ]:)\'a;mia 
has  been  frequently  set  up. 

In  one  case  sloughing  of  the  tonsils  and  cel- 
lular tissues  of  the  pharynx  occuried,  leaving 
the  muscles  of  the  pharynx  clearly  dissected 
out.  In  another  case  an  abscess  developed 
behind  the  soft  palate,  which  was  evacuated 
by  an  opening  through  it  with  immediate  relief 


A  large  number  of  cases  presented  a  diph- 
theritic appearance.  This  was  most  common 
among  the  moderately  severe  cases  but  was  also 
conmion  in  the  very  severe  cases.  They  were 
always  accompanied  by  enlargement  of  the 
glands  of  the  neck  which  very  occasionally  went 
on  to  suppuration.  1  his  diphtheritic  condition 
occurred  in  8  per  cent,  of  the  cases. 

The  digestive  system  was  not,  as  a  rule,  much 
disturbed  except  the  appetite  was  lost.  Vomit- 
ing was  persistent  for  four  or  five  days  in  four 
cases.  Diarrhoea  was  troublesome  in  three  cases 
early  in  the  disease.  In  fatal  cases  it  frequent- 
ly set  in  during  the  last  three  or  four  days. 

The  complications  and  sequrelse  have  been 
numerous  and  varied. 

The  most  frequent  and  most  dangerous  was 
inflammation  of  the  glands  of  the  neck.  This  oc- 
curred in  19  per  cent,  of  the  cases.  The  most 
dangerous  was  that  form  with  an  ulcerated  con- 
dition of  the  throat.  It  generally  ran  on  to  sup- 
puration, and  was  by  far  the  most  frequent  cause 
of  death,  five  deaths  occurring  from  this  cause, 
while  only  three  recovered. 

A  less  important  form  was  that  accompany- 
ing the  pseudo-diphtheritic  angina.  This  only 
went  on  to  suppuration  in  one  case,  and  caused 
no  deaths.  These  two  forms  have  occurred  in 
the  first  two  weeks  of  the  disease.  Three  per 
cent,  of  the  cases  suddenly  developed  an  acute 
inflammation  of  these  glands  during  the  third 
week  of  convalesence.  It  set  in  with  chill  and 
high  fever,  and  a  raoid  enlargement  of  the 
glands  took  place.  In  two  cases  complete  re- 
covery took  place  by  the  third  day,  but  one  ran 
on  to  suppuration. 

Acute  nephritis  occurred  in  8  per  cent,  of  the 
cases,  coming  on  insidiously  in  the  third  or  fourth 
week.  Death  occurred  in  two  cases  with  com- 
plete suppression  of  urine  and  convulsions.  In 
five  cases  a[)parent  complete  recovery  took 
place  after  two  or  three  weeks.  One  case,  the 
only  one  in  which  dropsy  was  markedly  present, 
became  chronic. 

Otitis  media  occurred  in  six  per  cent,  of 
cases  most  frequently  witli  the  pseudo-diphther- 
itic angina,  but  occasionally  with  the  mildest 
cases.  It  may  occur  at  any  time  during  the 
first  four  weeks  of  the  disease. 

True  diphtheri  I  has  bean  present  in  four  cases, 
but  cases  have  been  fr^qaently  coming  into  the 
hospital  suffering  from  diphtheria,  and  evidently 
only  shortly  convalescent  from  scarlet  fever. 

.Arthritis  was  common  following  this  disease. 
A  large  number  complained  of  slight  pain  in 
one  or  more  joints.  Three  per  cent,  have  suf- 
fered from  severe  attacks  resembling  acute  rheu- 
matism with  fever  and  swelling  of  the  joints. 
In  one  case,  double  hip  joint  disease  rapidly  de- 
velo|)ed  with  dislocation  of  the  heads  of  both 
femurs  upwards  and  backwards.  There  was 
no  evident  formation  of  pus. 

In    another  case    a   so-called  white  swelling 


THE   CANADA    MEDICAL   RECORD. 


207 


became  purulent ;   :n[)id  and  extensive  destruc- 
tion of  the  joint  followed. 

Mitral  disease  developed  in  two  per  cent,  of 
the  cases. 

A  purulent  discharge  from  the  vagina  occur- 
red in  two  young  children  during  the  filth  week, 
which  disappeared  in  a  few  days. 

A  distinct  relaj^se  occurred  in  one  case  at 
the   end   cf  the    first    week   of  convakscence. 

The  whole  course  cf  the  second  attack  was 
very  severe,  while  the  primary  attack  was  very 
mild. 

Ten  per  cent,  of  the  cases  treated  died,  the 
causes  being  as  follows  : 

Nephritis,  two  deaths  ;  ulcerated  condition 
of  the  throat  with  involvement  of  the  glands 
and  |')yiemia,  five  deaths  :  diphtheria,  one  death; 
pneumonia,  one  death  ;  and  one  death  due  ap- 
parently to  the  intensity  of  the  poison. 

All    but   one    death    have    occurred    among 
young  children,  though  fully  25  per  C(.ni.  of  the 
patients  have  been  adults. 
The  adult  who  died  was  a  chronic  drunkard. 

7 abulation  cj  Cases. 

Mild 40 

Moderately  severe 29 

Severe 31 

100 

Co  m plication  s. 

Well  marked  inflammatory  enlargement  of  the  glands 

of  the  neck ig 

Aciile  nephritis 8 

Otitis  media 6 

Diphtheria 4 

Severe  arthritis  simulating  acute    rheumatism 3 

Mitral  disease   2 

Pneumonia 1 

Relapse 1 

I?tat/is. 

Malignant  scarlatina ,  i 

Acute  nephritis 2 

General  pja;mia ^ 

Diphtheria i 

Pneumonia i 


Discu-sioji. — Dr.  E.  P.  Lachapellk  referred 
to  the  seveie  epidemic  of  scarlatina  now  going 
on  in  Montreal  since  October  last.  The  reported 
weekly  ii.ortality  was  at  present  20  to  30,  but 
the  real  mortality  was  much  larger,  as  a  large 
number  of  cases  were  improperly  certified.  An 
inspection  made  by  the  Provincial  Board  of 
Health  showed  that  the  medical  profession  was 
mainly  responsible  for  this  unfortunate  state  of 
affairs,  as  it  was  impossible  for  the  health 
authorities  to  do  anything  unless  they  knew  of 
the  cases.  In  Montreal,  two-thirds  of  the  phy- 
sicians never  report  cases  of  infectious  disease 
at  all.  ^Vhelher  this  was  because  they  do  not 
think  of  it,  or  do  not  care,  or  object  to  do  it, 
the  result  is  very  bad.  No  one  has  any  doubt 
to-do)   as  to  the  contagiousness  of  scarlatina  or 


the  duly  of  medical  men  to  report  cases,  if  the 
heads  of  familie.':,  who  are  also  responsible, 
neglect  to  do  it.  If  only  a  few  men  report,  they 
suffer  in  consequence.  If  the  profession  arc- 
lax  in  regard  to  one  contagious  disease,  they 
will  be  so  in  regard  to  others.  The  public  is  at 
the  mercy  of  the  physician.  He  hoped  the 
Society  would  pass  resolutions  insisting  upon 
the  necessity  of  all  cases  being  reported. 

Dr.  Lafleur  said  that  he  always  reported 
such  cases  as  soon  as  a  diagnosis  was  made,  but 
that  many  days  often  elapsed  before  the  house 
was  placarded. 

Dr.  Allen  mentioned  a  case  where  he  had 
attended  a  patient  in  a  boarding  house.  Upon 
the  statement  of  a  member  of  the  household, 
the  board  of  health  disinfected  the  house  and 
removed  the  placard,  although  the  patient  went 
on  desquamating  for  two  weeks  subsequently. 
Dr.  JoHNSTOX  thought  there  were  too  few 
phybicians  in  the  staff  of  the  City  Health  office. 
Most  of  the  disinfection  and  visiting  appeared 
to  be  left  wholly  to  sanitary  policemen  without 
any  supervision,  hence  rnistakes  were  often 
made.  Work  of  this  kind  should  be  carried 
out  under  medical  direction. 

Dr.  Kenneth  Camekon  stated  that  his  ex- 
perience in  this  epidemic  had  changed  his 
previous  opinion  that  scarlatina  is  a  mild 
disease.  His  first  case  was  one  of  the  hjem- 
orrhagic  form,  and  was  fatal  in  6  hours.  He 
thought  the  infection  was  largely  spread  by 
mild  cases  which  were  not  diagnosed.  He  had 
seen  several  instances  in  school  children  in 
whom  the  occurrence  of  dropsy  had  first  drawn 
attention  to  the  real  nature  of  the  case. 

Dr.  BuLLER  estimated  from  the  statement 
made  by  Dr.  Lachapelle,  that  there  must  be 
500  cases  occurring  weekly.  This  probably 
would  give  one  or  more  cases  in  every  street  in 
the  city.  He  would  advocate  stopping  the 
whole  public  school  system,  and  so  calling 
public  atteniion  to  the  necessity  of  providing 
some  proper  means  of  quarantining  cases.  The 
supineness  of  the  local  health  board  could  only 
be  overcome  by  taking  strong  measures  such  as 
would  arouse  publ'c  indignation. 

Dr.  McCoNNELL  stated  that  the  local  health 
board  was  not  blameless ;  as  for  scarlatina 
patients,  there  was  no  other  provision  for  con- 
veying them  to  hospital  than  the  public  cabs 
Ciiildren  were  allowed  to  return  to  school  within 
two  or  three  weeks  from  the  commencement  of 
an  attack.  The  health  officer  should  see  to  if 
that  such  does  not  occur  within  at  least  six 
weeks.  He  had  little  faiih  in  the  utility  of 
sulphur  fumigation  when  clothing  and  bedding 
were  not  disinfected  by  heat,  ^^uch  can  be  done 
to  prevent  the  spread  of  the  disease  through  a 
building  by  the  floating  panicles  of  cuticle,  if 
antiseptic  ointments  were  used  during  the  period 
of  desquamation.  Creolin,  carbolic  acid,  salicv- 
lic  acid  and  rosorcin  may  be  used  :  the  latter  has 


2o8 


THE  CANADA  MEDICAL  RECORD. 


the  additional  action  of  promoting  a  more 
rapid  peeling,  so  that  this  process  may  be  com- 
pleted one  or  two  weeks  earlier  than  the  ordmary 

period. 

Dr.  Smith  agreed  with  Dr.  McConnell  s  state- 
ments. He  made  a  practice  of  using  carbolized 
vaseline  and  giving  a  hot  bath  every  24  hours, 
and  tried  to  promote  sweating.  He  gave  copi- 
ous drinks  of  water  to  flush  out  the  kidneys. 

Dr.  Mills  said  that  whatever  were  the  short- 
comings of  the  local  health  bmrd,  we  should 
not  take  shelter  behind  them.  There  had  been 
a  beiious  delinquency  on  the  part  of  the  pro- 
fession, and  we  might  as  well  admit  it.  He 
would  recommend  that  a  deputation  of  the 
Society  wait  upon  the  City  Council  and  urge 
the  adoption  of  suitable  measures  for  restraining 
the  epidemic.  Most  of  the  cases  in  school 
children  could  be  watched  through  the  co-opera- 
tion of  the  family  physician.  To  close  the 
schools  would  produce  a  panicy  condition 
prejudicial  to  the  community. 

Dr.  Armstrong.— The  reason  why  cases  are 
not  reported  is  that  two  families  out  of  three 
object  to  having  it  done,  and  point  out  that 
their  neighbors'  cases  are  not  reported.  Pla- 
carding is  of  no  use,  as  intelligent  people  will 
warn  others  of  the  danger,  and  ignorant  people 
will  pay  no  heed  to  it.  Nothing  was  accom- 
plished by  the  antiquated  methods  of  disinfec- 
tion which  constitute  the  only  resource  of  the 
local  health  board  ;  they  make  a  little  stink  and 
do  nothing  more.  Disinfecting  was  properly 
done  only  when  the  family  physician  went  to  the 
trouble,  personally,  of  explaining  how  it  should 
be  carried  out,  and  superintended  it  himself. 

Dr.  Lachapelle  could  not  agree  with  Dr. 
Armstrong.  Two  wrongs  do  not  make  a  right. 
Whatever  might  be  the  faults  of  the  local  board, 
the  profession  was  mtich  to  blame.  If  we,  as 
a  profession,  had  done  our  duty,  we  would  have 
more  right  to  complain.  He  approved  of 
placarding,  as  it  was  hkely  that  servants  would 
not  do  their  duty  in  warning  people,  whereas  a 
placard  warned  everyone  of  the  danger.  He 
did  not  think  the  situation  was  severe  enough 
to  warrant  such  a  step  as  closing  the  schools, 
and  the  well  children  would  run  just  as  much 
risk  at  home.  The  Society  might  depend  upon 
the  Provincial  Board  of  Health  doing  their  duty, 
however  unpleasant  it  might  be. 

Dr.  Gordon  Campbell  said  that  some 
weeks  ago,  in  a  house  fumigated  by  the  city 
health  ofiicials,  the  clothing  had  not  even  been 
stripped  off  the  infected  bed.  Some  weeks 
later  another  case  developed  in  this  house. 
In  St.  Cunegonde  absolutely  nothing  was  done 
when  cases  were  reported. 

Dr.  Bell,  in  summing  up  the  discussion, 
said  that  if  we  first  took  the  mote  fiom  our  own 
eye  we  would  be  better  prepared  to  remove 
the  beam  from  that  of  the  local  health  board. 
While  sympathizing  with  what  Dr.  Armstrong 


had  said,  still  even  when  put  in  a  false  position, 
the  members  of  the  profession  should  be  guided 
by  their  strong  sense  of  duty,  and  do  all  in  their 
power  to  check  the  spread  of  the  disease.  The  Jj 
present  was  a  good  time  for  the  Society  to  ex-  ^ 
press  itself  strongly  to  the  incoming  municipal 
council.  It  was  simply  disgraceful  that  Mon- 
treal had  no  place  for  quarantining  scarlet  fever, 
and  through  the  absence  of  such  a  place 
we  were  now  losing  50  lives  weekly,  not  to 
speak  of  those  who  were  afflicted  with  life-long 
consequences  in  the  shape  of  affections  of  the 
ears  or  kidneys.  He  would  suggest  that  the 
matter  be  referred  to  the  Council,  with  power 
to  add  to  their  number  and  instructions  to  act. 
Upon  motion  of  Dr.  Mills,  it  was  unani- 
mously resolved  that  the  Council  should  asso- 
ciate themselves  with  Dr.  Lachapelle,  and 
should  take  whatever  action  appeared  necessary. 


ko^rtss    of    ^cicnce 


LIGATION     OF    THE    BASE     OF    THE    M 
BROAD  LIGAMENTS  PER  V  AGIN  AM, 
INCLUDING    THE     UTERINE  ARTE- 
RIES     FOR      FIBROIDS       OF      THE 
UTERUS. 

Dr.  Augustin  H.  Goelet,  of  New  York,  in  a 
contribution  to  the  Amcric-an  Medico  Surgical 
Bulletin,  June  ist,  reports  favorably  upon  this 
operation  in  his  hands  for  the  control  of  uter- 
ine haemorrhage  and  reduction  of  fibroid 
growths.  He  believes  it  should  be  done  in 
lieu  of  hysterectomy  when  that  operation  would 
involve  loo  great  a  risk,  and  as  a  preliniinary 
step  with  a  view  of  avoiding  the  necessity  of 
the  more  hazardous  operation.  When  exten- 
sive attachments  have  not  been  formed  which 
afford  additional  nutrition,  considerable  reduc- 
tion has  resulted  even  in  growths  of  large  size. 
When  the  operation  has  been  done  for  smaller 
growths  the  result  has  been  more  satisfactory. 
In  some  instances  complete  atrophy  has  been 
reported.  This  result,  as  well  as  arrest  of  the 
uterine  haemorrhage,  is  accounted  for  by  the 
diminished  nutrition  furnished  the  uterus  and 
these  growths  by  interference  with  the  blood 
supply  and  nerve  supply  which  are  included  by 
ligation  of  the  base  of  the  broad  ligaments.  It 
is  estimated  that  the  uterine  arteries  furnish 
the  uterus  with  two-thirds  of  its  blood  supply, 
and  it  is  reasonable  to  expect  that  a  profound 
effect  will  be  produced  upon  that  organ  and 
growths  arising  from  the  walls  if  this  is  sud- 
denly cut  off. 

The  sole  danger  in  the  operation  is  the  risk 
of  including  the  ureters  in  the  ligatures,  as  they 
pass  down  beind  the  uterine  arteries  only  half 
an  inch  from  the  cervix,  and  are  consequently 
in  the  field  of  operation.     Dr.  Goelet  suggests, 


THE  CANADA  MEDICAL  RECORD. 


209 


as  a  preliminary  step,  to  elimmale  this  risk, 
that  bougies  be  passed  into  the  ureters  through 
the  bladder.  He  admits,  however,  that  a  care- 
ful operator  accustomed  to  working  in  this  re- 
gion may  easily  avoid  the  ureters. 

The  technique  of  the  operation  as  described 
by  Dr.  Goelet  shows  an  important  departure 
from  the  usual  method  followed.  Instead  of 
ligaling  each  artery  in  only  one  place  on  a  level 
with  the  internal  os,  he  applies  a  second  and 
often  a  third  ligature  to  the  artery  on  each  side 
as  it  ascends  along  the  side  of  the  uterus,  the 
result  of  which  is  to  cut  off  the  compensating 
blood  supply  from  ovarian  artery  to  the  lower 
part  of  the  uterus. 

Dr.  Goelet  gives  all  the  credit  of  priority  to 
Dr.  Martin  of  Chicago,  who  has  recently  sug- 
gested and  popularized  the  operation  and  per- 
fected its  technique,  but  states  that  he  first  lig- 
ated  the  uterine  artery /ev  vaginam  on  one  side 
in  January,  18S9,  i^  ^^^  ^^^^  °f  ^  large  fibroid 
the  size  of  a  seven  months'  pregnancy,  with  a 
view  of  diminishing  the  size  of  the  gr  jwlh  by 
reducing  the  blood  supply.  The  artery  on 
the  other  side  was  not  ligated  because  the  posi- 
tion of  the  tumor  made  it  inaccessible.  Six 
months  later  the  tumor  was  one-third  smaller, 
and  was  giving  no  inconvenience. 

He  quoted  his  last  case  operated  upon,  to 
show  how  promptly  uterine  haemorrhage  may 
be  controlled  by  this  operation. 


I 


THE  PARASITE  OF  CANCER. 

On  several  occasions  we  have  called  atten- 
tion to  the  investigations  of" Professor  Adam- 
kiewicz,  of  Vienna,  since  they  promised  to 
throw  more  light  on  the  obscure  etiology  of 
carcinoma.  In  his  latest  article,  which  is 
published  in  the  Wie?ier  Medizinische  Presse, 
the  author  formulates  the  results  of  these 
investigations  as  follows :  "  The  true  and 
characteristic  element  of  cancer  is  a  coccidium. 
From  it  originate  spores  (larvge),  which  in  turn 
develop  into  coccidia  and  amoeba;.  Metas- 
tases are  produced  by  migration  of  the  larvae, 
coccidia  and  amoebae  to  different  parts  of  the 
body.  The  development  of  larv»  takes  place 
within  the  epithelial  and  endothelial  cells  of 
the  diseased  area.  The  parasite,  when  devel- 
oped, lives  outside  the  cell  and  forms  an 
integral  portion  of  the  cancerous  tumor.  It 
destroys  the  epithelia,  but  never  causes  them 
to  proliferate,  and  it  seems  probable,  therefore, 
that  what  appear  to  be  epithelial  prolifera- 
tions are  frequently  colonies  of  coccidia  and 
amoeba;."  Adamkiewicz  calls  this  parasite  the 
coccidium  sarcolytus,  and  considers  it  identical 
with  the  epithelial  cell  of  cancer.  Korotneff, 
who  has  followed  a  similar  line  of  investigation, 
reaches  essentially  the  same  results.  He  goes 
even  further  and  gives  a  minute  description  of 
the  cancer  parasite  and  its  mode  of  develop- 


ment. Viewed  with  his  eyes,  this  formidable 
animal  when  fully  formed  is  a  gregarine,  having 
a  bulbous  anterior  end  and  terminating  pos- 
teriorly in  a  sort  of  tail.  It  is  rarely,  however, 
that  the  larvae  develop  into  gregarines  ;  usually 
they  grow  into  a  coccidium  or  amoeba. 

Whatever  practical  value  be  attached  to 
these  observations,  they  are,  at  any  rate,  strik- 
ingly original  and  deserving  of  careful  con- 
sideration. Looked  at  from  another  point  of 
view,  they  illustrate  exceedingly  well  the  con- 
tradictory character  of  the  evidence  afforded 
by  microscopical  research  in  some  diseases. 
As  seen  by  one  observer,  the  tissues  of  a 
cancerous  neoplasm  consist  of  proliferating 
epithelial  cells,  while  to  another,  equally  care- 
ful, these  same  cells  assume  the  appearances  of 
a  destructive  parasite.  The  nuclei  of  the  cell 
in  the  one  case  become  the  larvK  of  the  cocci- 
dium in  the  other.  How  can  these  differences 
be  explained?  There  certainly  seems  an 
element  of  optical  delusion  involved  in  the 
question. 


TRAUMATIC  PERIOSTITIS. 
By  B.  M.  RiCKETTS,  M.D.,  Cincinnati,  O. 

Having  had  a  number  of  such  cases  under 
my  observation,  two  or  three  of  which  have 
gone  from  bad  to  worse,  I  am  led,  on  this 
occasion,  to  speak  of  the  good  results  following 
prompt  surgical  interference.  That  the  peri- 
osteum may  be  diseased  independently  goes 
without  saying.  That  it  is  susceptible  to 
injuries  of  any  kind  there  seems  to  be  no 
doubt.  That  the  serous  effusion  as  the  result 
of  inflammatory  changes  becomes  purulent 
under  certain  conditions  has  been  well  estab- 
lished, even  where  there  is  no  apparent  con- 
nection externally.  There  is  no  class  of 
injuries  that  present  so  great  a  number  of 
opportunities  for  the  study  of  this  disease  as 
railway  injuries.  The  prompt  interference  in 
cases  where  there  is  a  serous  effusion  not  only 
shortens  the  course  of  the  disease,  but  greatly 
lessens  the  liability  of  the  bony  structures 
becoming  involved. 

This  interference  consists  in  making  o:ie  or 
more  incisions  through  the  entire  thickness  of 
the  periosteum,  depending  upon  the  amount  of 
tissue  involved.  The  evacuation  of  fluid  of 
any  character,  under  these  circumstances,  is 
always  attended  with  most  gratifying  results, 
and  I  feel  sure  that  the  premises  and  investi- 
gations of  Mr.  Oilier  have  been  the  greatest 
means  of  arriving  at  these  conclusions.  While 
the  periosteum  in  its  normal  condition  is  tough 
and  inelastic,  it  is  not  so  in  as  great  a  degree 
when  thickened  by  inflammatory  processes. 
The  effects  of  inflammation  upon  this  mem- 
brane is  to  cause  it  to  become  several  times  its 
normal  thickness,  the  changes  being  the  same 


2IO 


THE   CANADA   MEDICAL   RECORD. 


as  in  any  inflammatory  process.  The  pain  is 
sometimes  excruciating  and  persistent,  and  if 
the  pressure  upon  the  bone  is  not  reHeved 
soon  after  the  effusion  takes  place,  there  is 
great  danger  of  bony  necrosis,  which,  when 
once  estabhshed,  may  have  no  limit.  Espe- 
cially is  this  so  about  the  epiphyses  and  the 
apophyseal  lines.  The  further  the  injury  is 
upon  the  epiphysis  from  the  apophyseal  line, 
the  greater  the  danger  to  bony  destruction  ;  in 
other  words,  the  softer  the  bony  tissue  involved, 
the  less  resistance  it  has  to  abnormal  changes. 
Unfortunately,  the  softest  bony  tissue  is  found 
near  the  articular  surfaces;  hence  the  great 
danger  to  joints  when  these  tissues  are  the 
least  involved. 

It  has  been  customary  to  postpone  surgical 
interference  where  the  periosteum  is  involved 
near  articular  surfaces.  1  am  thoroughly  con- 
vinced that  this  procrastination  has  been  the 
occasion  of  many  joints  being  needlessly 
involved.  The  nearer  the  articular  surfaces 
the  more  prompt  the  surgeon  should  be  in 
removing  fluid  of  any  character,  either  supra 
or  sub-periosteal.  As  stated  before,  the  perios- 
teum is  tough  and  inelastic,  and  in  nature's 
great  effort  to  absorb  any  kind  of  fluid,  espe- 
cially about  the  epiphyses,  there  is  great  danger 
of  their  destruction.  It  is  better,  in  these 
days  of  antiseptic  surgery,  to  take  our  chances 
for  a  good  result  in  the  evacuation  of  these 
fluids  under  these  circumstances,  than  to  leave 
them  in  the  hands  of  mother  Nature.  True, 
she  does  her  work  at  times  rather  perfectly, 
but  there  are  times  when  she  must  be  assisted, 
and  I  look  upon  this  condition  as  demanding 
prompt  attention. 

It  has  been  my  fortune  to  have  several  of 
these  cases  under  observation,  a  few  of  which 
I  have  been  enabled  to  treat  from  this  stand- 
point, and  I  feel  assured  that  the  good  result 
following  in  each  of  these  cases  has  been  due 
to  the  early  evacuation  of  the  effusions.  Who 
would  hesitate  to  freely  incise  a  felon,  which  is 
nothing  more  or  less  than  an  acute  jjeriostitis 
due  to  trauma?  If  it  is  good  in  one,  it  must 
surely  be  good  in  the  other.  This  rule  holds 
good,  not  only  in  trauma,  but  in  periostitis 
from  any  cause,  unless  it  be  syphilitic.  There 
are  certainly  conditions  of  this  form  of  perios- 
titis in  which  much  good  v/ould  be  obtained 
from  free  incisions,  viz.  :  In  cases  of  persistent 
pain  which  have  defied  the  anti-syphilitic 
remedies.  In  this  connection  I  will  say  that  I 
am  led  to  believe  that  tuberculosis  is  the  cause 
of  80  per  cent,  of  all  the  cases  of  periostitis. 

Case  I.  Female,  aged  40,  weighing  about  240 
pounds,  fell  in  her  yard,  striking  the  inner  and 
middle  portion  of  the  left  lower  leg  on  a  box. 
She  complained  of  acute  pain  in  this  locality 
for  two  days  before  I  was  consulted.  There 
was  considerable  tenderness  and  swelling;  tem- 
perature   99°       It  was  necessary  Uj  give  her 


morphia  to  relieve  the  pain  ;  elevation  and  hot 
applications  were  of  no  benefit.  This  state  of 
affairs  continued  for  seven  days,  when  I  pre- 
vailed upon  the  patient  to  allow  me  to  make  a 
free  incision.  This  would  have  been  done  on 
the  fourth  day  had  it  not  been  for  her  husband's 
interference.  Under  the  influence  of  chloro- 
form I  made  an  incision  two  inches  in  length 
directly  down  upon  the  tibia,  not,  however,  un- 
til after  I  had  explored  with  the  needle  showing 
that  fluid  was  present.  The  moment  the  pe- 
riosteum was  incised,  about  two  ounces  of  serous 
fluid  escaped,  I  introduced  my  finger,  and 
found  that  the  bone  was  denuded  for  an  area 
of  about  one  inch.  This  was  to  me  a  most 
remarkable  condition.  The  periosteum  was 
very  much  thickened,  and  gave  evidence  of 
degeneration.  I  believe  that  had  I  delayed  the 
operation  for  a  week  or  so,  there  would  have 
been  suppuration  resulting  in  the  destruction 
oi  both  the  periosteum  and  bony  structure. 
Her  recovery  was  uninterrupted,  and  she  was 
upon  her  feet  with  a  cane  at  the  end  of  the  -^ 
third  week.  ^ 

Case  2.  A  man,  aged  44,  weighing  about 
160  pounds,  in  stepping  from  a  street  car  struck 
the  shin  bone  upon  the  platform.  He  did  not 
pay  much  attention  to  it  for  a  few  hours,  but  as 
the  pain  became  gradually  worse  I  was  consult- 
ed for  its  relief.  It  was  also  necessary  in  this 
case  to  administer  morphia  to  accomplish  this 
purpose. 

On  the  following  day  he  found  it  necessary 
to  take  to  his  bed,  where  he  remained 
for  two  days,  at  the  end  of  which  time  he 
felt  that  necessity  compelled  him  to  proceed  on 
his  journey.  The  swelling  and  tenderness  in- 
creased until  the  entire  tibia  seemed  to  be 
involved.  He  went  from  under  my  care,  but 
consulted  me  one  year  after,  when  I  found  that 
the  tibia  was  very  much  enlarged,  that  the 
entire  leg  had  been  gradually  involved,  that  he 
had  done  no  work  whatever,  and  that  the  suf- 
fering at  times  had  been  very  severe.  I  report 
this  case  as  one  where  free  incisions  were  not 
made,  and  to  show  the  result  of  not  making 
ihem.  This  bone  will  be  20  per  cent,  larger 
than  its  associate,  and  will  always  be  more  or 
less  troublesome  for  years  to  come.  Had  the 
patient  remained  under  my  care,  and  submitted 
to  the  operation  that  I  advised,  I  firmly  believe 
that  the  present  slate  of  affairs  would  not  exist. 

Case  3.  Male,  aged  33,  of  rather  good 
habits,  occupation  clerical,  struck  the  right  arm 
j  upon  his  desk,  causing  but  little  inconvenience 
until  after  the  first  twenty -four  hours.  The 
pain  was  rather  severe  and  dull  in  its  character. 
There  was  considerable  tenderness  and  but 
little  swelling,  showing,  to  ray  mind, 
that  the  swelling  was  not  in  proportion 
to  the  amount  of  pain,  indicating  that  the 
fluid  was  beneath  the  inelastic  periosteum.  It 
was  necessary  to  put  his  arm  in  a  sling,  as  he 


THE  CANADA.  MEDICAL  RECORD. 


T  I 


would  not  consent  to 
down  upon  the  bone, 
became  more  severe. 


have  an  incision  made 
However,  as  the  paui 
he  gladly  consented  on 
the  fourth  day  to  allow  mc  this  privilege. 

Under  the  influence  of  chloroform  I  made  an 
incision,  about  a  quarter  of  an  inch  in  length, 
down  through  the  periosteum,  which  allowed 
about  half  an  ounce  of  bloody  serous  fluid  to 
escape.  The  acute  pain  did  not  again  occur, 
although  it  was  necessary  to  place  the  arm  in 
plaster-of-Paris  with  an  o|)cning  in  it  over  the 
incision.  A  small  pYobe  was  occasionally 
introduced  through  the  incision  down  upon  tiie 
bone,  that  the  fluid  might  have  easy  exit. 
This  was  not  done  after  the  first  forty-eight 
hours.  The  swelling  of  the  arm,  which  had  by 
this  time  somewhat  increased,  gradually  dimin- 
ished. I  feel  certain  that  had  tliis  incision  not 
been  made,  the  epiphysis  of  the  ulna  would 
have  became  involved,  thus  seriously  affecting 
the  elbow  joint.  The  arm  was  kept  in  plaster 
for  two  weeks,  when  it  was  removed,  and  motion 
in  the  joint  was  found  perfect. 

Case  4.  Young  man,  22  years  old,  a  brake- 
man,  allowed  his  knee  to  be  caught  between 
bumpers.  It  is  a  question  as  to  the  amount  of 
space  between  the  bumpers.  The  draw-bar  of 
the  tender  of  a  locomotive  is  always  stronger 
than  that  of  any  other  car,  so  that  it  does  not 
have  any  spring,  otherwise  I  believe  the  knee 
would  have  been  crushed  and  amputation  been 
necessary.  However,  the  epiphyses  of  the 
tibia  and  femur  being  injured  made  ii  necessary 
to  give  the  parts  complete  rest.  Here  is  a  case 
where  the  pressure  was  so  uniform  that  there 
was  no  particular  part  of  the  periosteum  or 
bone  involved.  The  force  was  not  sufficient 
to  seriously  affect  either,  so  that  at  the  end  of 
three  days  he  was  able  to  get  about  on  crutches, 
which  were  used  for  two  or  three  weeks.  The 
tenderness  about  the  external  condyle  of  the 
tibia  and  femur  was  rather  acute,  and  there 
seemed  to  be  some  question  as  to  the  extent  of 
involvement,  that  is,  whether  or  not  there  was 
the  presence  of  periosteal  effusion.  This,  lam 
certain,  did  not  exist  sub-periosteal.  The  fact 
that  the  course  was  short  and  the  pain  slight 
led  me  to  believe  that  the  effusion  was  so  hm- 
ited  that  operative  interference  was  not  neces- 
sary. This  is  a  case  where  it  was  not  necessary 
to  resort  to  any  surgical  interference  other  than 
complete  rest  and  the  constant  aj^plication  of 
heat.      The  International  Joitnia I  0/  Surgery. 


I 


OPERATIVE  TREATMENT  FOR  STONE 
IN  THE  BLADDER. 

Briggs  {International  Medical  Mac^azine, 
February,  1894)  contributes  a  most  interesting 
article  on  this  subject,  giving  his  personal  ex- 
perience with    two   hundred   and    eighty-four 


cases  of  stone,  and  discussing  the  various 
methods  of  operation. 

He  performed  lithoirity  on  five  patients,  all 
of  whom  recovered,  but  were  very  impatient 
over  the  amount  of  time  required  for  treatment. 
He  then  tried  litholapaxy  on  ten  adult  cases; 
in  two,  death  resulted  from  renal  complications. 
He  selects  this  method  of  operation  under 
four  conditions  :  i.  .Adult  patients ;  2.  Capa- 
cious and  tolerant  urethra  ;  3.  Small  or 
medium-sized  stone,  or,  if  large,  of  soft  consis- 
tence ;  4.  Bladder  capacious  and  free  from 
severe  and  persistent  inflammation. 

He  prefers  lithotomy  in  children,  and  has 
performed  the  operation  on  seventy-six  children 
under  sixteen  years  of  age,  and  all  recovered 
but  one. 

The  supra-pubic  operation  he  performed  on 
seven  cases  for  the  removal  of  very  large,  hard 
calculi ;   resulting  in  recovery  in  five. 

Forty-four  operations  by  the  bilateral  method 
resulted  in  ten  deaths.  He  then  chose  a  modi- 
fication of  the  median  operation  suggested  by 
Civiale  in  1829,  and  called  by  him  the  medio- 
bilateral  method.  He  has  performed  that 
operation  one  hundred  and  seventy-one  times, 
with  a  result  of  one  hundred  and  sixty-seven 
recoveries  and  four  deaths,  three  of  the  num- 
ber not  being  attributable  to  the  operation. 

Tiie  advantages  of  the  operation  given  are 
briefly  :  i.  It  opens  up  the  shortest  and  most 
direct  route  to  the  bladder ;  2.  It  divides  parts 
of  the  least  importance  \  3.  It  is  almost  a  blood- 
less operation  ;  4.  It  affords  a  sufficiently 
capacious  passage  for  the  removal  of  any  calcu- 
lus ;  5.  It  reduces  the  death  rate  to  the 
minimum. 

In  conclusion,  Briggs  makes  the  following 
statements  :  "  r.  No  method  of  operation  is 
adapted  to  all  cases;  2.  Thorough  preparatory 
treatment  is  essential  to  success ;  3.  Litho- 
lapaxy is  the  operation  when  the  patient  is  an 
adult  with  a  capacious  and  tolerant  urethra, 
with  a  bladder  free  from  severe  chronic  cystitis, 
and  with  a  small  or  medium-sized  stone,  or,  if 
large,  of  soft  consistence ;  4.  The  supra-pubic 
is  the  best  operation  for  large  and  hard 
calculi;  5.  The  medio-bilateral  should  be  chosen 
in  all  other  conditions,  because  it  is  the 
easiest,  safest  and  best." 


PERSONAL. 


Dr.  Emory  Lanphear,  for  many  years  editor 
of  Kansas  City  Medical  Index,  has  resigned 
the  chair  of  Operative  Surgery  and  Clinical 
Surgery  in  the  Kansas  City  Medical  College, 
and  has  removed  to  St.  Louis.  He  makes  the 
change  in  order  to  become  Professor  of  Surgery 
in  the  St.  Louis  College  of  Pnj-sicians  and 
Surgeons,  one  of  the  oldest  and  strongest 
medical  schools  of  the  West. 


212 


THE  CANADA  MEDICAL  RECORD. 


THE  CANADA  MEDICAL  RECORD 

Published  Monthly. 


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EDITORS : 
A.  LAPTHORN  SMITH,  BA,,  M.D.,  M.R.C.S.,  Eng.,  F.O-S. 

London 
F.  WAYLANJD  CAMPBELL,  M.A  ,  M.D.,  L-RCP  .  London 

ASSISTANT  EDITOR 
ROLLO  CAMPBELL,  CM.,   M.I). 

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Editor. 


MONTREAL,  JUNE,  1894. 

ANTIPYRIN  AND  ANT  IFEBRIN. 

According  to  the  report  of  the  United  States 
Consul,  the  above  drug  is  manufactured  exclu- 
sively under  the  Knorr  patents  by  the  color 
works  at  Hoecheb  in  Germany.  It  is  estim- 
ated that  seventy-five  tons  of  this  preparation 
are  sold  annually,  representing,  according  to  an 
authority,  a  value  of  $  r  ,45  2,000,  the  greater  part 
of  which  is  clear  profit.  Apart  from  the  ready 
solubility  of  antipyrin,  it  does  not  appear  to 
have  any  advantages  over  antifebrin  or 
acetanilide,  which  latter  drug,  not  being  patent- 
ed, is  sold  for  almost  one-sixteenth  the  price 
of  the  patented  antipyrin.  The  price  of  anti- 
pyrin is  of  course  kept  up  by  the  law  of  supply 
and  demand,  and  if  there  was  less  demand  for 
it,  the  price  would  soon  come  down.  For  those 
who  attend  the  poor  the  price  of  antipyrin  at 
$16.00  a  pound  is  almost  prohibitive  when 
compared  with  antifebrin  at  $1.00.  Many  re- 
gard antifebrin  as  safer  than  antipyrin  ;  at  any 
rate,  the  addition  of  a  small  quantity  of  alcohol 
to  each  dose  not  only  renders  antifebrin 
soluble  in  hot  water,  but  also  counteracts  its 
depressing  action  on  the  heart.  It  is  perhaps 
the  best  analgesic  in  dysmenorrhoea  due  to 
spasm  of  the  tubes  or  uterus,  while  for  relieving 
the  pangs  of  the  first  stage  of  labor  we  have 
found  nothing  to  surpass  it.  In  no  case,  how- 
ever, is  it  safe  to  exceed  three  or  four  ten-grain 
powders  a  day.  Its  solubility  and  activity  are 
greatly   increased   by  its   thorough  trituration 


with  equal  parts  of  sugar  of  milk ;  but  its 
compression  into  tablets  seems  to  diminish  the 
rapidity  of  its  action.  When  taken  in  a  fine 
powder,  dry  or  with  cold  water,  the  action  of 
antifebrin  varies  with  the  condition  of  the 
stomach  ;  we  have  found  it  to  act  most  quickly 
when  taken  after  a  meal,  or  when  the  stomach 
contains  a  certain  amount  of  acid. 

THE    STAMPING   OUT  OF  CHOLERA. 

It  has  been  known  for  the  last  ten  years  at 
leist  that  Mecca  was  the  great  manufacturing 
centre  of  cholera  germs  for  the  whole  world, 
and  yet  so  fanatical  were  the  Mahomedans  in 
their  faith  in  the  miraculous  powers  of  the  holy 
well  at  that  place,  that  the  Turkish  government 
did  not  venture  to  enforce  the  most  ordinary 
precautions  suggested  by  sanitary  science.  The 
holy  well  was  found  to  be  nothing  better  than 
a  cess-pool,  and  that  to  drink  its  polluted 
waters  was  almost  certain  death,  and  yet  the 
iliou sands  of  pilgrims  continued  to  drink  it 
and  die.  The  British  government  has  been 
blamed  in  some  quarters  for  not  using  her 
great  influence  in  order  to  have  the  holy  well 
closed  up,  but  it  must  be  remembered  that  her 
rule  in  the  East  has  only  been  possible  through 
her  proverbial  justice  and  toleration  of  the 
various  religious  beliefs  of  her  subjects,  and  on 
this  particular  subject  of  the  holy  well  there 
were  millions  of  people  who  were  fanatical 
believers.  At  last,  however,  the  Turkish  govern- 
ment has  agreed  to  purify  the  holy  well  at 
Mecca,  and  the  British  government  has  adopted 
quarantine  regulations  on  the  Red  Sea  port,  so 
that  very  soon  we  may  expect  to  hear  that 
cholera  has  disappeared  from  the  face  of  the 
earth.  Now  that  the  fact  is  becoming  more 
generally  known  that  the  only  way  to  contract 
cholera  is  to  drink  it,  more  care  will  be  taken 
to  secure  a  pure  water  supply.  It  was  a  piti- 
ful example  of  official  ignorance  a  year  or  two 
ago  to  see  half  a  dozen  steamers  in  New  York 
harbor,  each  with  a  thousand  or  more  people 
on  board,  and  compelled  to  remain  there  drink- 
ing the  water  which  had  been  taken  on  board  at 
Hamburg  from  a  river  which  was  known 
to  be  polluted  with  cholera.  And  yet  the 
authorities  wondered  that  new  cases  made  their 
appearance  on  board.  The  simple  emptying 
and  disinfection  of  the  tanks  and  the  refilling 
of  them  with    clear  water  would  have    saved 


THE   CANADA   MEDICAL   RECORD. 


213 


many  lives  and  millions  of  dollars.  If  the 
axiom  were  burned  inlo  the  brain  of  all 
sanitary  officials,  that  "  one  cannot  get  cholera 
unless  he  drinks  it,"  a  pure  water  supi)ly  would 
be  the  quickest  means  of  stamping  out  the 
disease. 

THE  CAUSE  OF  JAUNDICE. 

In  Quain's  Dictionary  of  Medicine  there  is 
an  article  by  Dr.  Murchison  on  "  Jaundice 
independent  of  Mechanical  Obstruction  of  the 
Bile  Ducts,"  which,  according  to  the  editor  of 
the  American  Association  Joinnal  is  already 
obsolete.  Recent  experiments  have  shown 
conclusively  that  apart  from  mechanical  ob- 
struction of  the  bile  ducts,  bile  never  appears 
in  the  blood  ;  and  that  when  the  bile  cannot 
flow  through  its  normal  channels  into  the  in- 
testine, it  enters  the  lymphatics  of  the  liver,  and 
is  conveyed  by  the  lymph  channels  into  the 
thoracic  duct  and  thence  into  the  bL  od. 
Experiments  have  been  made,  which  show  that 
when  the  bile  ducts  are  ligatured,  bile  promptly 
appears  in  the  urine ;  but  when  the  bile-mak- 
ing liver  is  completely  removed,  no  bile  is  made 
and  none  is  to  be  found  in  the  blood  or  excre- 
tions. The  question  is  an  important  one 
because  of  the  great  advances  which  have  been 
made  in  the  surgery  of  the  gall  bladder  and  bile 
duct,  and  cases  of  jaundice,  which  would,  not 
long  ago  have  rapidly  proved  fatal,  are  being 
cured  every  day  now  by  prompt  resort  to  sur- 
gical measures  for  the  removal  of  the  obstruc- 
tion. 

SHALL  THE  CLERGY  PAY  ? 

This  is  a  question  which  is  being  pretty 
generally  discussed  in  the  Medical  journals, 
and  has  therefore  excited  a  good  deal  of  inter- 
est. At  one  time  when  clergymen  took  a  vow  of 
poverty,  and  charged  nothing  for  their  minis- 
tration but  gave  their  sacred  message  freely, 
without  money  and  without  price,  it  was  becom- 
ing that  in  return  they  should  have  all  their 
wants  supplied  in  the  same  generous  way. 
But  now  all  this  has  changed  ;  the  minister  of 
the  gospel  makes  his  business  contract  with  a 
congregation  for  such  remuneration  as  the  law 
of  supply  and  demand  dictates;  and  the  docter 
who  attends  his  church,  or  who  is  married  by 
him,  or  ii,  buried  by  him,  or  has  his  children 
christened  by  him,  receives  his  bill  for  it,  or  if 


he  does  not  receive  a  bill  is  expected  to  send 
the  money  all  the  sam  \  In  fact,  no  one  does 
anything  for  the  doctor  for  nothing,  and  indeed 
he  is  generally  charged  the  outside  figure  for 
every  service  rendered  to  him,  and  no  one 
does  anything  for  nothing  for  him  except 
another  doctor,  and  even  then  the  quality  of 
the  service  is  not  always  first  class.  Many 
clergymen  receive  very  large  nett  salaries,  nnd 
are  quite  able,  and  it  must  be  said  quite  willing, 
to  pay  for  services  rendered  them  and  their 
family.  The  doctor  has  perhaps  enough  to  tax 
his  benevolence  to  the  utmost  in  attending  the 
widow  and  the  orphan  and  the  hundreds  of  oihers 
who  have  been  left  destituie,  without  attending 
for  nothing  those  who  are  comparaiively  well  off. 


NOTES    FROM  OUR  EXCHANGES. 

We  see  by  the  Medical  Press  and  Circular, 
31st  Jan.,  1894,  that  a  well-known  general 
practitioner  in  Dublin  is  furnishing  the  finan 
cial  backing  to  an  establishment  of  lady  barbers 
which  has  been  recently  opened  in  that  city.  At 
one  time,  of  course,  all  physicians  were  barbers, 
and  we  suppose  that  this  is  a  case  of  "  rever- 
sion." 


The  family  doctor  sometimes  feels  it  his  duty 
to  advise  his  patients  to  leave  a  house  on  ac- 
count of  its  unsanitary  condition.  For  doing 
this,  an  action  for  libel  and  damages  was  re- 
cently taken  against  a  Dr.  Feunlhet,  of  Heme 
Bay,  England,  by  the  owner  of  the  house.  A 
verdict  was  given  with  costs  in  the  Doctor's 
favor. 

OPHTHALMIA. 

In  a  recent  article  on  an  epidemic  of  gra- 
nular lids  in  some  of  the  English  schools,  Mr. 
Jonathan  Hutchison  concludes  by  saying :  "  I 
do  not  wish  to  be  considered  as  an  alarmist, 
but  as  a  cause  of  blindness  on  the  continent 
the  ophthalmia  of  granular  lids  stands  second 
only  to  the  ophthalmia  of  mfants.  Our  duty  is, 
first,  to  be  well  informed  ourselves  and  then 
to  inform  the  public.  The  profession  generally, 
and  not  only  ophthalmologists,  must  learn  to  ap- 
preciate the  importance  of  the  problem  before 
us."  We  are  happy  to  say,  that  owing  to  the 
greater  purity  of  the  air  of  our  cities,  and  also 
to  the  better  feeding  and  less  crowding  of  our 
school  children,  this  disease  is  almost  unknown 
in  Canada.  Ophthalmia  neonatorum  is  occa- 
sionally seen,  but  this  will  soon  be  stamped  out 
when  the  custom  of  giving  a  bichloride  vaginal 
douche  before  delivery,  as  practised  at  the  Pres- 
ton Retreat,  shall  have  become  more  general. 


214 


THE   CANADA    MEDICAL   RECORD. 


^  It  appears  that  physicians  in  England  receive 
a  fee  from  the  Health  Department  for  every 
notification  they  send  of  cases  of  contagious 
disease.  If  physicians  here  who  are  asked  to 
perform  this  very  disagreeable  task  without 
any  remuneration  were  also  paid,  no  doubt  the 
number  of  cases  reported  would  be  very  much 
greater.  As  long  as  there  is  no  contagious 
diseases  hospital  to  take  the  patients  to,  we  do 
not  think  that  notification  is  of  much  benefit  to 
the  community. 


It  is  the  fashion  at  present  to  abuse  the  Hospi- 
tals and  Dispensaries  for  allowing  themselves  to 
be  abused  by  those  who  are  able  to  pay.  At  a 
recent  discussion  on  tliis  subject  before  the 
Practitioners  Society  of  New  York  (A".  V.  Me- 
dical Record,  3rd  Feb.,  1894),  the  general 
opinion  was  expressed  that  it  was  quite  ex- 
ceptional for  these  charities  to  be  abused.  The 
Medical  schools  required  clinical  material,  and 
in  rettirn  for  being  thus  made  use  of,  those  who 
went  to  the  clinic  received  advice  an 4  medi 
cine.  This  was  very  little  for  either  part  to  thank 
the  other  for.  In  our  opinion,  they  generally 
have  to  put  up  with  a  great  deal  of  discomfort 
and  loss  of  lime  m  order  to  obtain  attendance 
which  was  not  always  of  very  much  value. 
Then  again  it  depends  very  much  upon  the 
fees  asked  by  the  young  practitioner,  whether 
people  in  very  moderate  circumstances  were 
poor  enough  to  have  to  go  to  the  dispensaries 
or  not.  A  great  many  could  afford  a  half  a 
dollar  twice  a  week  who  certainly  cannot 
afford  two  dollars  a  visit,  and  for  two  visits  a 
day.  Those  who  grumble  most  at  the  dispen- 
saries are  the  young  doctors,  and  yet  they  need 
have  nothing  to  fear  from  the  former,  provided 
they  would  place  their  feei  within  the  reach  of 
the  mass  of  the  people. 


We  have  more  than  once  pointed  out  some 
of  the  advantages  of  the  practitioner's  return- 
ing to  the  good  old  custom  of  dispensing  his 
own  medicine,  the  principal  ones  being  that  by 
so  doing  he  would  see  his  patient  at  least  every 
week,  instead  of  never  seeing  him  again  ;  second, 
if  he  cured  the  patient,  the  latter  would  recom- 
mend his  friends  to  consult  tlie  doctor  instead 
of  obtaining  a  counter-prescription  from  the 
druggist;  third,  he  would  avoid  the  danger 
of  having  his  patient  fall  into  the  hands  of  the 
patent  medicine  man,  whose  wares  fill  up  every 
available  corner  in  the  druggist's  shop  ;  and 
fourth,  he  would  be  much  surer  that  his  patient 
would  get  the  medicine  he  wished  him  to  have, 
instead  of  something  else  which  the  young  drug 
clerk  might  consider  equally  as  good  or  even 
better.  But  there  appears  from  the  reports  of  a 
recent  trial  in  the  courts  to  be  still  another  reason 
why  the  doctor  should  beware  of  sending  his 
patient  to  a  druggist  shop,     A  few  months  ago  a 


physician  with  a  large  practice  in  the  west  end  of 
Montreal  sent  a  man  to  a  druggist  for  some  medi- 
cine for  his  wife,  whom  tiie  doctor  was  engaged  to 
confine  and  whom  he  was  then  attending.  The 
druggist,  while  filling  the  doctor's  prescription, 
told  the  man  that  the  doctor  was  not  competent 
to  confine  his  wife,  as  he  had  once  tapped  a 
lady  who  was  pregnant,  having  mistaken 
pregnancy  for  dropsy.  The  husband  went  home 
and  told  this  to  his  wife,  and  so  alarmed  her 
that  she  at  once  discharged  the  doctor  and 
engaged  another  one.  The  husband  was  also 
a  member  of  a  large  lodge  of  several  hundred 
members,  of  which  lodge  the  doctor  was  the 
medical  adviser,  and  at  the  next  meeting  of  the 
lodge  communicated  the  story  of  the  lapping 
to  other  members  in  open  lodge,  with  the  result 
that  the  doctor  was  dismissed  from  the  lodge. 
The  druggist  also  told  another  patient  of  the 
same  doctor's  that  his  prescription  was  no  good 
and  that  the  doctor  was  no  better.  The  doctor 
then  sued  the  druggist  for  five  thousand  dollars 
damages,  with  the  unexpected  result  that  he 
lost  the  suit,  and  had  to  pay  the  costs,  although 
it  was  proved  that  the  tapping  story  was  a 
falsehood  manufactured  out  of  whole  cloth. 
The  moral  of  this  episode  is  that  it  is  a  very 
dangerous  thing  to  send  patients  who  have 
perfect  confidence  in  their  doctor  to  a  drug  store, 
where  their  confidence  may  be  shaken  and 
where  their  patronage  may  be  alienated  away 
to  another  doctor  in  whom  the  druggist  has  an 
interest.  It  would  have  been  better  for  the 
retail  druggists  in  general  if  this  particular  one 
had  confessed  his  fault  and  thrown  himself  on 
the  clemency  of  the  court  and  the  physician 
whom  he  had  wronged,  rather  than  that  they 
should  glory,  through  their  pursuit,  in  the 
victory  of  a  great  wrong  which,  it  was  not  denied, 
there  had  been    committed. 


SUBCUTANEOUS  LIGATURE  FOR 
VARICOCELE, 

Dr.  E.  F,  Tucker  has  employed  the  follow- 
ing with  success :  An  ordinary  stout  needle, 
about  two  inches  long,  and  the  necessary 
ligatures  are  all  the  instruments  required.  The 
needle,  threaded,  is  made  to  pierce  the  scro- 
tum from  before  backward,  between  the  vas 
deferens  and  the  veins,  one  end  of  the  ligature 
being  drawn  clear  through.  The  eye  end  of  the 
needle,  which  is  still  on  the  thread,  is  re-in- 
troduced through  the  hole  of  exit,  and  carrying 
the  thread  with  it  is  made  to  pass  outside  of 
the  vtins  and  under  the  dartos,  and  out  again 
through  the  hole  of  entrance,  this  end  of  the 
ligature  drawn  through,  the  needle  unthreaded, 
and  the  ligature  tied.  By  thus  using  the  blunt 
end  of  an  ordinaiy  needle  to  carry  the  ligature 
back  about  the  veins,  there  is  no  danger  of 
piercing  a  vein  or  of  puckering  the  skin  of  the 


THE  CANADA  MEDICAL  RECORD. 


15 


scrotum  included  accidentally  in  the  ligature. 
It  does  away  with  the  necessity  of  Reverdin's 
needle  or  any  of  its  modificaiions,  thereby 
diminisliing  the  chances  of  sepsis,  which  are 
necessarily  attached  to  the  use  of  any  me- 
chanical needle,  and  adding  to  the  general 
simplicity  of  ihe  operation.  In  all  other  par- 
ticulars the  Ojteration  should  be  performed  as 
described  by  Dr.  Keyes. — ^fcd.  Record. 


INGROWING  TOE-NAIL. 

Dr.  M.  A.  Veeder  has  made  use  of  a  method 
for  the  past  ten  years  which  answers  well  in  the 
ordinary  run  of  cases  and  also  in  certain  cases 
of  onychia  : 

It  consists  simply  in  cutting  a  piece  of  or- 
dinary felt  plaster,  sold  for  use  in  cases  of 
corns  or  bunions,  so  as  to  be  the  exact  size 
and  sliape  of  the  nail  about  which  the  ulcer- 
ation is  located.  The  bit  of  plaster  thus 
shaped  and  fitted  to  the  nail  is  to  be  firmly  at- 
tached thereto,  so  as  to  press  aside  the  over- 
lapping granulations  from  off  the  nail.  By 
holding  it  in  this  position  a  minute  or  two, 
until  it  dries  and  adheres  firmly  to  the  nail,  it 
becomes  strongly  fastened  and  will  stand  con- 
siderable rough  usage,  but  as  an  additional 
security,  a  strip  of  isinglass  plaster  is  wrapped 
three  or  four  times  around  the  toe,  including 
the  felt.  If  properly  applied,  the  lelief  is  im- 
mediate, and  the  cure  is  complete  as  soon  as 
the  thinned  and  jagged  edge  of  the  nail  under- 
lying the  granulation  has  grown  out  to  its 
normal  size. — Med  News,  Jan.  27,  1894. 


BOOK  NOTICES. 

The  Year-Book  of  Treatment  for  1894.     A 
Comprehensive    and  Critical    Review  for 
Practitioners   of    Medicine   and    Surgery. 
In  a    series    of  twenty-four    chapters,  by 
eminent  specialists.     In  one  1 2mo.  volume 
of  497  pages.   Cloth,  $1.50.  Philadelphia  : 
Lea  Brothers  «Sc  Co.,  1894. 
In  the    ten   years  of  its    publication,    The 
Year-Book  of  Treatment  has  firmly  established 
itself  as  an    invaluable   aid   for  all  those    who 
(Jesire  to  keep  posted  on  the  current  additions 
to  the  world's  knowledge  of  the  management  of 
disease.     The  word  "  treatment  "  is  construed 
in    its     broadest    sense,    including   medicine, 
surgery,    gynaecology,     obstetrics,    paediatrics, 
and  all  the  specialties,  in  a  series  of  twenty- 
four  chapters,  each  contributed  by  a  gentleman 
emhient  in  his  assigned  subj.'Ct.     Bacteriology 
and    hygiene  are    compendiously    dealt  with, 
and  the  Summary  of  Therapeutics  for  the  y  ar 
presents    this  most  important    subject  in  the 
most  available  form  for  use.     The  various  arti- 
cles   are  sufticiently  detailed  for   all    practical 
purposes,  but  references  to  original  papers  are 


given  for  the  convenience  of  those  desiring  to 
make  extended  research . 

The  volume  contains  a  '•  Selected  List  of 
New  Books,  New  Editions  and  Translations," 
which  will  give  the  reader  a  knowledge  of  the 
latest  and  best  literature  under  each  head. 
The  Index  of  Authors  Quoted  and  Index  of 
Subjects  complete  and  close  a  volume  which  is 
authoritative,  well  arranged,  serviceable  for 
every  medical  man  and  universally  avail- 
able owing  to  its  very  moderate  price. 


The  address  of  Dr.  S.  Weir  Mitchell,  to  the 
American  Medico-Psychological  Association, 
with  appended  letters  from  prominent  neurolo- 
gists, will  appear  in  the  July  issue  of  the 
Journal  of  Mental  and  Nervous  Diseases,  which 
should  be  read  by  all  Physicians. 


New  Aid  Series  of  Manuals   fok  Si-udents 
AND  Practhioners. 

As  publisher  of  the  '■'Standard  Serels  of 
Question  Compends"  together  with  an  intimate 
relation  with  leading  members  of  the  med'cal 
profession,  Mr.  Saunders  has  been  enabled  to 
study,  progressively,  the  essential  desideratum 
in  practical  "  self-helps "  for  students  and 
physicans. 

This  study  has  manifested  that,  while  the 
published  ''  Question  Compends"  earn  the 
highest  appreciation  of  students,  whom  they 
serve  in  reviewing  their  studies  preparatory  to 
examination,  there  is  special  need  of  thorough- 
ly reliable  hand-books  on  the  leading  branches 
of  Medicine  and  Surgery,  each  subject  being 
compactly  and  authoritatively  written,  and  ex- 
haustive in  detail,  without  the  introduction  of 
cases  and  foreign  subject-matter  which  so 
largely    expand  ordinary  text  books. 

The  Saunders  Aid  Series  will  not  merely  be 
condensations  from  present  literature,  but  will 
be  ably  written  by  well-known  authors  and 
practitioners,  most  of  them  being  teachers  in 
representative  Atnerican  colleges.  This  new 
Series,  therefore,  will  form  an  admirable  collec- 
tion of  advanctd  lectures,  which  will  be  invalu- 
able aids  to  students  in  reading  and  in  compre- 
hending the  contents  of  "recommended"  works. 

Each  Manual,  comprising  about  250  pages 
(5  1-2  x  8  inches),  will  further  be  distinguished 
by  the  beauty  of  the  neru  type;  by  the  quality 
of  the  paper  and  printing  ;  by  the  copious  use 
of  illustrations  ;  by  the  attractive  binding  in 
cloth  and  by  the  extremely  low  price,  which 
will  uniformly  be  $1.25  per  volume. 


PAMPHLETS  RECEIVED. 

Le  Gros  Mal  du  Moyen-Age  et  la  Syphilis 
AcTUELLE,  PAR  Dr.  F.  Bui^et.  Avec  une  pre- 
face du  Dr.  Lancereaux,  Medecinde  I'Ho- 


I 


2l6 


THE   CANADA    MEDICAL   RECORD. 


tel-Dieu,  Membre  de  i' Academic  de  Me- 
decine,  Professeur  agrege  a  la  Faculte,  Che- 
valier de  la  Legion  d'Honneur.  La  syphilis 
a  Ninive  et  a  Babylone.  Manuscrits  rela- 
tifs  a  la  pathologie  sexuelle  du  Moyen-Age, 
ce  qu'il  fallait  entendre  alors  par  le  mot 
Icpre.  Recrudescence  de  la  debauche  dans 
touies  les  classes  de  la  societe  ;  anecdotes 
curieuses  et  poesies  relatives  au  culte  de 
Venus  et  a  ses  consequences.  Le  "  quatre- 
vingt-tieize  de  la  Verole  "  ou  epidemic  de 
Naples  (1493-96).  La  medication  actuelle 
comparec  aux  formules  empiriques  dc 
I'epoque  feodale.  Discussion  scicntifique 
de  tous  les  procedes  mis  en  usage  depuis 
400  ans.  Le  traitement  leplus  nouveau. 
Moyen  prescrvatif.  Paris  :  Societe  d'Edi- 
TioNS  SciENTiFiQUES,  4  ruc  Antoiuc- 
Dubois,  1894.  Tous  droits  reserves. 
For  those  of  our  readers  interested  in  syphi- 
lis and  who  are  familiar  with  the  French  lan- 
guage, this  small  work  will  prove  a  treat. 

Opium  and  Catharsis  after  Abdominal 
Section.  By  Eugene  Boise,  M.D.,  Grand 
Rapids,  Mich.  Reprint  from  the  New 
York  Journal  of  Gynaecology  and  Obstet- 
rics. 

A  Series  of  Wools  for  the  Ready  Detec- 
tion OF  "Color  Blindness."  By  Char- 
les A.  Oliver,  M.D.,  Philadelphia,  Pa. 
Reprinted  from  American  Ophthalmologi- 
cal  Society  Transactions,  1893. 

Opinions  of  the  Press  on  a  Bill  to  estab 
lish  a  Bureau  of  Public  Health  within  the 
Dejiartment  of  the  Literior  of  the  United 
States.  Prepared  by  the  National  Quaran- 
tine Committee  of  the  New  York  Academy 
of  Medicine.  John  J.  O'Brien  &  Son, 
Steam  Book  and  Job  Printing  Establish- 
ment, 397  Fourth  Avenue,  New  York. 
1894. 

Hysterectomy  by  Morcellement  and  the 
Vaginal  Route  in  Pelvic  Operations, 
IN  place  of  Laparotomy  or  the  Abdom- 
inal Method.  By  Geo.  J.  Engelmann, 
M.D.,  St.  Louis,  Professor  of  Diseases 
of  Women,  Missouri  Medical  College  and 
Post-Graduate  School  of  Medicine  ;  Fellow 
American  G)  njecological  Society,  Southern 
Surgical  &  Gynaecological  Association, 
British  Gynaecological  Society,  etc.  Re- 
printed from  Transactions.     1893. 

The  Interrupted  High-Voltage  Primary, 
or  Mixed  Current.  By  George  J. 
Engelmann,  M.D.,  of  St.  Louis.  From 
the  Medical  News,  February  3,  1894. 

Retinitis  Albuminuria.  By  L.  Webster 
Fox,  M.D.,  Professor  of  Diseases  of  the 
Eye  in  the  Medico-Chirurgical  College, 
Philadelphia.  Reprinted  from  'Phe 
Times  and  Register. 


The  Relation  of  the  Patellar  Tendon  Re- 
flex to  some  of  the  Ocular  Reflexes 
FOUND  IN  General  Paralysis  of  the  In- 
sane.    By  Charles  A.  Oliver,  M.D.,  Pnila- 
delphia,    Pa.       Reprinted  from   American 
Ophthalmological     Society    Transactions 
1893. 
Clinical    History  of    a   Case   of  Spindle- 
celled  Sarcoma  of  the  Choroid,  with 
A  study  of  the  Microscopic  Condition 
OF  the  Growth.    By  Charles  A.  Oliver, 
M.D.,    of  Philadelphia,    Pa.       Reprinted 
from  Proceedings  American  Ophthalmolo- 
gical Society,   1893. 
The  Alienist   and    Neurolog[st  for  April 
contains  :  "  Insanity  in  Relation  to  Law,"  byC. 
H.  Hughes,  M.D.,  St.  Louis;  On  the  Means   of 
Preventing  and  Evading  Insanity,"  by  William 
\V.  Ireland,  M.D.,  Edinburgh;  "  Neuratrophia, 
Neurasthenia  and  Neuriatria,"  by  C.  H.  Hughes, 
M.D.,  St.    Louis;   "Bilateral    Paralysis   of   the 
Facial  Nerve,"   by    Dr.  Monjoushko,    Russia; 
"  The  Criterion    of  ResponsibiHty  in    Insanity," 
by  H.  C.  Brainerd,  Los*^   Angeles,  Cal,  ;    "  The 
Education  of  the  Feeble-Minded."   by   H.  M. 
Greene,   Lawrence,     Kansas  ;   "  CurabiHty    of 
Inebriety,"  by  John  G.  Reed,  M.D.,  Cincinnati, 
Ohio ;    Editorials,    Selections,    Hospital  Notes, 
Reviews,  etc.    C.   H.    Hughes,   M.D,,    editor, 
rooms    421-2-3  Commercial  Building,  St.  Louis. 
Subscription  :  $5.00   per  annum  ;  single  copies, 
$1.50. 


That  an  unwarranted  substitution  of  one  remedy  for 
another  is  occasionally  practised  by  some  druggists,  there 
seems  to  be  no  question.  That  this  is  morally  wrong, 
is  equally  true  ;  but  that  it  is  frequently  a  crime  in  the 
eyes  of  the  law,  and  as  such  is  punishable,  seems  to  have 
been  lost  sight  of  by  some   of  those  who  may  practise  it. 

Jiut  the  fact  that  such  have  enjoyel  immunity  from 
prosecution  is  no  guarantee  that  they  can  continue  their 
speculation,  even  on  a  small  scale,  without  detection 
and  its  consequences. 

Frank  A.  Ruf,  of  the  Antikamnia  Chemical  Company, 
has  recently  been  in  New  York  and  Chicago,  and  states 
that  he  has  made  arrangements  for  a  thorough  system  of 
investigation  throughouc  the  country,  and  tliat  counsel 
has  been  employed  to  prosecute,  both  civilly  and 
criminally,  all  who  persist  in  furnishing  a  substitute  as 
and    for  antikamnia. 

The  Antikamnia  Company  proposes  doing  this  with- 
out vindictiveness,  and,  mdeed,  with  none  but  the  most 
friendly  feeling  to  the  druggist.  Even  where  a  druggist 
has  allowed  himself  to  be  persuaded  into  the  practice, 
their  first  step  will  be  to  confer  with  him  in  the  interest 
of  mi  tual  protection.  Following  that,  they  propose,  if 
necessary,  notifying  every  physician  in  the  city  of  the 
name  and  address  of  the  offender,  with  the  recommenda- 
tion to  avoid  him  if  honest  goods  are  desired.  The  sub- 
stitute obtained  by  the  investigators,  together  with  the 
name  of  the  dispenser,  will  be  shown  to  the  physician, 
thus  protecting  the  honest  druggist.  The  more  flagrant 
cases  will  be  given  to  their  attorney  for  proceedings  in 
law. 

Mr.  Ruf  said  in  regard  to  the  matter:  "  We  are 
simply  detei  mined  that  the  honest  druggist  shall  be  pro- 
tected ;  that  the  physician  and  patient  shall  be  protect- 
ed ;  and  lastly,  that  our  own  interests  shall  not  be 
trampled  upon." — Druggists'  Circular. 


jRe   fenai^i 


Vol.  XXII. 


f. 


MONTRE.\L,  JULY,  1894. 


No.  10. 


ORIGINAL  COMMUNICATIONS. 

Deiiiuiistraticni  ot  Intestinal  Ana.stn- 
niosis  with  the -Murphy  Buttuu 217 

SOCIETY  PROCEEDINGS. 

American    Eleetr<>TlieraiieiUie   As- 

r  sociation 218 

Ameriean  Public  Health  Association  21S 
^Montreal  Medico-Chirirrgical  Society  219 

Choltsterine  Cyst  of  the  Testis ".  2U) 

Sui»ernutnerary  Digits  in  the  Pig's 

Manus "  219 

Boat-shaiie<l  Negro  Skull 220 

Skeleton   of   Hawk    with    .Multiple 

Fiactures  220 

Necrosed  Polj-pus  of  the  Uterus 220  I 

(Jaucer  of  the"  Uody  of  the  Uterus'..  .  220  I 
•.•steo-Sarconia  of  "the  Tibia  and  Fi- 
bula   220 

Poisoning  possibly  from  Lead,  after 

eating  Canned  Tomatoes ' 220 

Intestinal     Anastomosis    with    the 

Murphy  Button  221 

Amcebic  Abtcess  of  the  Liver 221 

Xanthoma  Tuberosum  222 

Arthrectomy 223 


Fro^s  with  the  Cerebi  iiin  removed  .  223  I 

Comi>leto  I  )ouble  Ureter ,  224  | 

Mitral  anil  Tricuspid  Stenosis 225 

Wound  of  the  Heart  220 

Congenital  Detects  ot   the  Anterior  | 

Pillars  of  Fauces   22G  I 

PROGRESS  OF  SCIENCE-  I 

Well  Sized  Up 257  ; 

Forms  of  Peritonitis 227  1 

Snrgical  Items 2 J7  , 

The  Tre:itment  of  IJurns 228 

The  relation  of  Pelvic  Disease  and 

Psvchical  Disturbances  in  Women.  229 

Class-Uooni  Notes 229 

Potassium  Permanganate  as  an  Im-         | 

mediate  Antidotelo  Morphia 231  i 

Recent  Suggestions  in  Therapeutics.  2.32 

Pathological  Society  <>t  London 235 

EtUnbiu-gh    Jledico-Chirm-gical    So-         j 

ciety 236  ! 

Kecent  Suggestions  in  Therapeutics.  23G 

EDITORIAL. 

Canadians  in  the  L'nited  States. . 237  i 

Canadian  Medical  Association . .  257,  238  : 


A  New  Bill  for  the  Establishment  of 
a  National  Bureau  of  Health 238 

BOOK  NOTICES. 

An  International  System  of  Electro- 
Therapeutics 239 

An  American  Text-Book  Of  the  Dis- 
eases of  Children 240 

PAMPHLETS  RECEIVED. 

Leprosy 240 

Report"  on  the  Leprosy  Question  in 

Louisiana ." 240 

Rectal  Strictui-e  of  Puerperal  Origin 

relieved  by  Laparotomy 240 

Calcified  Tumors  of  the  Ovarv iio 

Six  Cases  of  Appendicitis ". 240 

The  Surgery  of  the  Hand 240 

Sarcoma  of  the  Kidney .  240 

The  Paralyzing  Action  of  Strychnine  240 
The  Indications  for  Operative  Inter- 
ference   in    E.xtra-Uterine    Preg- 
nancy    240 

Atfections  of  the  Eye  Apparently 
ilependeut  upon  L'terine  Derange- 
ment     : 240 

Ophthalmia  Neonatorum,  &c 240 


i 


©rtgfnal    ^ommttntcattons. 

DEMONSTRATION        OF       INTES- 
TINAL ANASTOMOSIS  WITH  THE 
MURPHY  BUTTON. 

By  a.  Lapthorn  Smith,  M.R.C.S.  Eng., 
Surgeon  to  the  Women's   Hospital,  Gy- 
necologist to  the  Montreal  Dispensary. 
While     attending   the      Pan-American 
Congress    at  Washington    a  few    months 
ago,     I   had   the  pleasure  of   making  the 
acquaintance   of  one  of  the    brightest  men 
in  the  medical  profession  to-day.    This  gen- 
tleman's paper  was  near  the  end  of  the  list, 
and  he  was  just  barely  able  to  secure   a 
hearing  lor  it ;  but   he  had  not  read    very 
far  when    the   audience    was    completely 
taken    by  storm,  each    one    inquiring    of 
his  neighbor    who   the    reader  was.    The 
answer  I  received  to  my  enquiry  was  that 
he  was  Murphy's  button.     As  I  had  never 
at  that  time  heard  of  Murphy's   button,  I 
was  not  much  the  wiser.     While  returning 
on  the  train  I  made  his  acquaintance,  and 
had  this   ingenious   invention  thoroughly 
explained  to   me.     For  the  sake  of  those 
among   us  who  are  frequently  called  upon 
remove  portions  of  gangrenous  intestine 


during  operations  for  strangulated  hernia, 
and    to    obtain  anastomosis  between  gall 
bladder  and  intestine  in  case  of  obstruction 
of  the    common    bile    duct,   or    between 
stomach  and  intestine  in  case   of  stricture 
of  the  pylorus — for  the  sake  of  these  gentle- 
men as  well  as  their  patients  I  deem  it  my 
humble  duty  to   bring  this  device  to  their 
intimate  notice.     The  buttons  are  made  in 
three  sizes.     A  button  consists  oftwosmall 
circular   bowls ;    size    No.  2    measures   as 
follows  :— diameter  25  m.m.,  depth  8  m.m. 
There  is  sweated  into  a  circular  opening 
12  m.m.  in  diameter,  at  the  bottom  of  the 
bowl,  a   cylinder    15   m.m.  in  length  with 
female  thread  on  its  entire  inner   surface. 
The  cylinder  extends  perpendicularly  from 
bcttom  of  bowl.     There   is  an  opening  in 
the  male  bowl,  in  which  is  sweated  a  similar 
and  smaller  cylinder  of  a  size  to  easily  slip 
into  female  cylinder.     There  are  two  brass 
springs  soldered  on  either  side  of  the  inner 
surface  of  the  lower  end  of  the  male  cylin- 
der, which  extend  almost  to  the  top,  where 
small   points  of    them    protrude    through 
openings  in  the  cylinder  ;  these  points  are 
destined  to  catch  the  screw  thread  when 
the  male  cylinder  is  pressed  into  the  female 
cylinder,  and  thus  hold  the  bowls  together 


2l8 


THE   CANADA    MEDICAL   RECORD. 


at  any  point  desired.  To  separate  them 
again  they  are  simply  unscrewed.  A  small 
brass  ring,  with  a  thin  though  not  a  cutting 
edge,  to  which  is  attached  a  wire  spring,  is 
placed  in  the  male  bowl  and  retained  in 
position,  projecting  7  m.m.  above  the  edge 
of  the  bowl.  This  is  held  up  by  the  wire 
spring,  and  is  there  for  the  purpose  of  keep- 
ing up  continuous  pressure  until  the  entire 
tissue  between  the  edge  of  the  bowl  is  cut 
off.  There  are  four  openings,  5  m.m.  in  dia- 
meter, in  the  side  of  each  bowl  for  drainage. 
We  then  have  two  hemispherical  bodies 
held  together  by  imaginating  cylinders. 
These  hemispheres  of  the  button  are  in- 
serted in  slits  or  ends  of  the  viscera  to  be 
operated  ojn.  A  running  thread  is  placed 
around  the  slit  in  the  viscus,  so  that  when 
it  is  tied  it  will  draw  the  cut  edges  within 
the  clasp  of  the  bowl.  A  similar  running 
thread  is  applied  to  the  slit  in  the  viscus 
into  which  the  other  half  of  the  button  is 
inserted,  and  the  bowls  are  then  pressed 
together.  The  pressure  atrophy  at  the 
edge  of  the  bowl  is  produced  by  the  elastic 
pressure  of  the  brass  ring  supported  by 
the  -wire  spring.  The  opening  left  after 
the  button  has  liberated  itself  is  the  size 
of  the  button.  As  I  think  you  will  readily 
admit,  this  method  of  anastomosis  has 
several  advantages  over  bone  plates,  catgut 
rings,  rubber  rings,  sutures,  etc.  Among 
them  :  ist,  it  retains  its  position  automati- 
cally ;  2nd,  it  is  entirely  independent  of 
sutures  ;  3rd,  it  produces  a  pressure  atrophy 
and  adhesion  of  surfaces  at  the  line  of 
atrophy  ;  4th,  it  insures  a  perfect  apposi- 
tion of  surfaces  without  the  danger  of  dis- 
placement ;  5th,  it  is  applicable  to  the 
lateral  as  well  as  to  the  end  to  end  ap- 
proximation ;  6th,  it  produces  a  linear  cica- 
trix, and  thus  insures  a  minimum  of  con- 
traction ;  and  7th,  in  the  extreme  simplicity 
of  its  technique,  which  makes  it  a  specially 
safe  instrument  in  the  hands  of  the  every- 
day practitioner  as  well  as  the  more 
dexterous  specialist. 


AMERICAN    ELECTRO-THERAPEUTIC 
ASSOCIATION. 

The  fourth  annual  meeting  of  the  American 
Electro-Therapeutic  Association  will  be  held 
in  New  York,  September  25th,  26th  and  27th, 
at  tlie  New  York  Academy  of  Medicine. 

Members  of  the  Medical  Profession  are  cor- 
dially invited  to  attend. 

William  J.    Herdman,    M.D., 

President. 

Margaret  A.  Cleaves,  M.D., 

Secretary. 


AMERICAN        PUBLIC       HEALTH 
ASSOCIATION. 

Secretary's  Office, 

Concord,  N.H.,  June  30,  1894. 

(Preliminary  Circular.) 

The  twenty-second  annual   meeting    of  the 

American    Public  Health  Association  will  be 

held  at  Montreal,  Canada,  September,  25-28, 

1894. 

The  regular  sessions  will  be  in  Association 
Hall,  Y.  M.  C.  A.  Building,  Dominion  square, 
opposite  the  Windsor  Hotel.  The  following 
topics  have  been  selected  for  consideration  at 
this  meeting  : 

L  The  Pollution  of  Water-Supplies . 

II.  The    Disposal  of  Garbage   and  Refuse. 

III.  Animal  Diseases  and  Animal  Food. 

IV.  The  Nomenclature  of  Diseases  and 
Forms  of  Statistics. 

V.  Protective  Inoculations  in  Infectious 
Diseases. 

VI.  National  Health  Legislation. 

VII.  The  Cause  and  Prevention  of  Diphthe- 
ria. 

VIII.  Causes  and  Prevention  of  Infant  Mor- 
tality. 

IX.  The  Restriction  and  Prevention  of 
Tuberculosis. 

X.  Car  Sanitation. 

XI.  The  Prevention  of  the  Spread  of  Yellow 
Fever. 

Upon  all  of  the  above  subjects  special  com- 
mittees have  been  appointed ;  therefore  all 
pipers  upon  these  topics  should  be  presented 
to  the  appropriate  committee  in  season,  to  be 
incorporated  as  a  part  of  the  report  of  the  com- 
mittee, if  deemed  advisable. 

The  Executive  Committee  announces  the 
following  additional  subjects,  upon  which  pap- 
ers are  invited  : 

XII.  On  the  Education  of  the  Young  in  the 
Principles  of  Hygiene. 


THE   CANADA    MEDICAL   RECORD. 


219 


XIII.  Private  Destruction  of  Household 
Garbage  and  Refuse. 

XIV.  Disinfection  of  Dwellings  after  Infec- 
tious Diseases. 

XV".  Inspection  of  School  Children  wiih 
reference  to   the  Eyesight. 

Pai)ers  will  be  received  on  miscellaneous 
sanitary  and  hygienic  subjects,  but  preference 
v/ill  be  given  t^  the  topics  announced  above. 
All  persons  who  purpose  to  ])resent  papers 
at  the  next  meeting  of  the  Association  will  be 
governed  by  the  following  By-Laws  of  the 
Executive  Committee  : 

"4.  All  papers  presented  to  the  Association. 
must  be  either  printed,  typewritten,  or  in  plaini 
handwriting,  and  be  in  the  hands  of  the  Secre- 
tary at  least  twenty  days  prior  to  the  annual 
meeting,  to  insure  their  critical  examination  as 
to  their  fulfilling  the  requirements  of  the  Associ- 
ation. 

"5.  If  any  paper  is  too  late  for  critical  ex- 
air.ination,  said  paper  may  be  so  far  passed 
upon  by  the  Executive  Committee  as  to  allow 
its  reading;  but  such  paper  shall  be  subject  to 
publication  or  non-publication,  as  the  Executive 
Committee  deem  expedient. 

"  6.  All  papers  accepted  by  the  Association, 
whether  read  in  full,  by  abstract,  by  title,  or 
filed,  shall  be  delivered  to  the  Secretary  as 
soon  as  thus  disposed  of,  as  the  exclusive  pro- 
perty of  the  Association.  Any  paper  presented 
to  this  Association  and  accepted  by  it  shall  be 
refused  publication  in  the  transactions  of  the 
Association  if  it  be  published,  in  whole  or  in 
part,  by  permission  or  assent  of  its  author  in 
any  manner,  prior  to  the  publication  of  the 
volume  of  transactions,  unless  written  consent 
is  obtained  from  the  Publication  Committee. 
"  7.  Day  papers  shall  be  limited  to  twenty 
minutes,  and  evening  papers  to  thirty  minutes, 
each." 

Invitations  extended  to  individuals  to  pre- 
pare papers  for  the  Association  do  not  imply 
their  acceptance  by  the  committee,  merit  alone 
determining  that  question. 

The  Local  Committee  of  Arrangements  has 
already  commenced  work  to  insure  a  large  and 
profitable  meeting.  All  communications  re- 
lating to  local  matters  should  be  addressed  to 
Dr.  Elzear  Pelletier,  Secretary  Local  Commit- 
tee of  Arrangements,  No.  76  St.  Gabriel  street, 
Montreal,  Canada.  Circulars  will  be  issued  in 
ample  time,  giving  information  relating  to 
transportation    and  hotel  rates,  etc. 

Blank  applications  for  membership  may  be 
had  by  addressing 

Irving  A.  Watson, 

Secretary. 


MONTREAL  MEDICO-CHIRURGICAL 
SOCIETY. 

Staled  Meeting,   2yd  Feb.,   1894. 

Jamfs  Bell,  M.D.,  President,  in  the  Chair. 

j  Cholesterin  Cyst  of  the  Testis. — Dr.  Adami 
I  exhibited  a  cysl  of  the  tunica  vaginalis  testis, 
removed  post-mortem,  which  contained  two 
ounces  of  a  clear  fluid,  full  of  pure  cholesterin 
crystals.  The  history  of  the  case  was  that  the 
patient,  a  man  advanced  in  years,  was  brought 
into  the  hospital  with  paralysis  of  the  left  side, 
and  with  deviation  of  the  eyes  to  the  right. 
He  rapidly  lost  consciousness,  and  after  linger- 
ing a  few  days,  died.  At  the  autopsy  a  large 
hjemorrhage  was  found  in  the  corpus  striatum. 
There  was  a  condition  of  general  arterio-sclero- 
sis,  granular  kidneys,  emphysematous  lungs  and 
hypertrophied  heart.  On  the  right  testicle 
there  was  a  large  cyst,  apparently  in  front,  of 
the  organ  and  full  of  fluid.  The  walls  were 
thickened  and  atheromatous  and  contained 
calcareous  plates . 

The  question  as  to  the  origin  of  the  choles- 
terin was  difficult  to  answer.  Cholesterin  in 
large  quantities  may  be  found  in  connection 
with  dermoids  and  with  atheromatous  degenera- 
tion, but  in  both  cases  the  crystals  are  almost 
always  found  associated  with  fatty  debris.  Old 
chronic  hydroceles  are  recorded  also  as  show- 
ing atheromatous  conditions  of  their  walls,  and 
occasionally  containing  large  quantities  of 
cholesterin.  Such  is  jDrobably  the  nature  of 
the  cyst  in  question,  but  how  and  why  the 
crystals  are  deposited  in  large  quantities  re- 
quires further  explanation. 

Dr.  Johnston  had  seen  cysts  in  various 
parts  of  the  body  which  were  lined  with  squa- 
mous epithelium  and  contained  cholesterin. 
He  had  seen  one  such  cyst  situated  deep  in 
the  cervix  uteri. 

Dr.  Adami  said  that  atheromatous  cysts  are 
found  in  connection  with  the  scalp,  but  in  such 
cases  fat  and  broken  down  tissue  are  among 
the  coiitents,  while  in  this  case  there  was  no 
fat  or  debris. 

Dr.  Shepherd  exhibited  the  following  speci- 
mens : — 

(i)  Supernumerary  Digits  i?i  the  Pig's 
Manus. — Two  pig's  fore-feet  were  shown,  each 
with  a  supernumerary  digit.  In  each  case  the 
digit  was  the  lost  poUex,  and  with  it  was  re- 
produced, to  its  full  size,  the  os  trapezium, 
which,  in  the  normal  manus  of  the  pig,  is  a 
small  rudimentary  ossicle.  Dr.  Shepherd  re- 
marked that  the  re-appearance  of  the  lost  digit 
in  the  pig's  manus  was  not  very  uncommon, 
and  said  that  the  normal  manus  consisted  of 
two  hanging  toes,  the  second  and  fifth,  and 
the  toes  which  reached  the  ground,  the  third 
and  fourth,  so  that  when  a  supernumerary  digit 


220 


THE   CANADA   MEDICAL   RECORD. 


was  seen  it  was  always  the  lost  pollex,  and  with 
it  was  reproduced  the  os  trapezium  of  the 
carpus.  A  couple  of  years  ago  he  presented 
to  this  Society  a  specimen  of  a  pig's  manus 
having  a  pollex  and  pre-pollex,  six  digits  in  all, 
a  variation  which  was  of  greater  rarity  than 
the  one  above  described. 

(2)  Boat- Shaped  Negro  ^/Cv///.— The  skull 
was  that  of  a  full-blooded  negro,  and  with  a 
very  small  cranial  capacity — in  fact,  micro- 
cephalic, and  very  prognathous.  The  skull  was 
long  and  very  narrow,  and  of  the  form  usually 
described  as  scaphoid.  This  was  due  to  the 
absence  or  early  obliteration  of  the  sagittal 
suture,  hence  the  transverse  growth  being  pre- 
vented, a  great  increase  takes  place  in  the 
vertical  and  longitudinal  direction,  thus  giv- 
ing the  vault  of  the  skull  a  boat-shaped  shape. 
This  was  well  shown  in  the  specimen  exhibited. 
At  the  site  of  the  anterior  fontanelle  the  bone 
was  raised  into  a  prominent  boss,  due  no  doubt 
to  the  later  ossification  at  this  point.  This  form 
of  skull  is  said  to  be  common  amongst  the 
Scotch,  hence  the  term  "  long-headed  Scotch- 
men." 

(3)  Skelelo7i  of  Hawk  with  Multiple  Frac- 
tures.— Thi?  specimen  exhibited  healed  frac- 
tures of  the  femur,  breast  bone  and  the  radius 
and  ulna  of  each  wing.  The  fractures  had  been 
no  doubt  due  to  shot,  as  one  pellet  was  found 
in  the  breast  bone  and  another  in  the  right 
bronchus.  The  amount  of  callus  thrown  out 
was  enormous,  being  necessary  to  unite  the 
fractured  ends  of  the  bones  which  were  a  con- 
siderable distance  apart. 

Necrosed  Polypus  of  the  Uterus. — Dr.  Lap- 
thorn  Smith  exhibited  the  specimen  which  he 
had  removed  from  a  woman  fifty-five  years  of 
age,  the  menopause  having  occurred  several 
years  before.  For  two  weeks  the  patient  had 
suffered  from  a  profuse  fcetid  discharge.  Her 
physician  found  a  large  mass  in  the  vagina, 
which  was  easily  broken  and  bled  profusely,  so 
he  thought  that  the  disease  was  cancer.  Dr. 
Smith  found  that  the  mass  was  movable,  and 
under  an  anesthetic,  when  he  had  removed  a 
large  quantity  of  necrosed  tissue,  discovered 
a  pedicle  springing  from  the  fundus,  and  which 
was  easily  removed.  After  thorough  disinfec- 
tion, the  uterus  was  stuffed  with  iodoform 
gauze  ;  the  patient  made  a  complete  recovery. 
Dr.  Smith  pointed  out  that  the  foetid  discharge, 
accompanied  by  hemorrhage,  rendered  the 
suspicion  of  cancer  very  strong,  especially  in  a 
woman  so  long  past  the  menopause. 

Ca?icer  of  the  Body  of  the  Uterus. — Dr.  Lap- 
THORN  Smith  exhibited  a  specimen  of  exten- 
sive cancer  of  uterus,  in  which  the  disease  was 
confined  to  the  body,  the  cervix  showing  no 
appearance  of  being  affected.  The  patient  had 
suffered  from  haemorrhage,  coming  on  several 
years  after  the  menopause.  Portions  of  tissue 
removed  by  the  curette  proved  the  disease  to 
be  cancer. 


Ostco- Sarcoma  of  the  Jibia  and  Fibula. — 
Dr.  Hingston  exhibited  a  tibia  and  fibula,  in 
which  large  excavations  were  situated  deep  in 
the  substance  of  the  bones  near  their  heads. 
The  patient  had  come  to  him  five  months  before, 
with  a  large,  hard  swelling  at  the  back  of  the 
knee.  Recognizing  the  malignant  character  of 
the  growth,  operation  was  advised,  but  the  man 
would  not  submit  until  three  days  ago,  when  the 
leg  was  removed  by  the  circular  operation,  a 
little  above  the  condyles  of  the  femur.  There 
were  large  cavities  on  the  posterior  surface  of 
the  bones  just  below  their  articulating  surfaces, 
where  the  tumor  had  been  removed,  and  the 
periosteum  was  detached  for  some  distance  on 
both  bones.  The  appearance  of  the  bones 
would  lead  one  to  suspect  strumous  disease, 
had  not  the  history  of  the  case  and  the  presence 
of  the  tumor  pointed  unmistakably  to  osteo- 
sarcoma. 

Poisoning.,  possibly  from  Lead,  after  eating 
Canucd  loinatoes. — Dr.  Johnston  and  Mr. 
Wolff  reported  a  case  of  a  girl,  aged  seven, 
who  was  taken  violently  ill  with  vomiting  and 
collapse  within  two  hours  after  eating  a  large 
quantity  of  tomato  soup.  Of  the  other  mem- 
bers of  the  family  who  had  eaten  the  soup,  the. 
mother  suffered  from  headache  and  nausea, 
while  the  rest  were  unaffected.  The  child  died 
within  sixteen  hours.  At  the  autopsy,  no  na- 
tural cause  of  death  was  found,  but  chemical 
analysis,  made  independently  by  Dr.  Ruttan 
and  Mr.  C.  F.  Wolff,  showed  the  presence  of  a 
large  quantity  of  lead  within  the  liver.  The 
case  was  of  interest  owing  to  the  frequency  of 
poisoning  from  canned  goods,  and  the  rarity 
with  which  any  evidence  pointing  to  the  ab- 
sorption of  mineral  substances  had  been  estab- 
lished by  analysis  of  the  viscera. 

Dr.  T.  D.  Reed  considered  the  evidence  of 
lead  from  the  tomato  can  being  the  cause  of 
death  in  this  case  quite  inconclusive.  Canned 
goods  are  used  in  enormous  quantities,  and 
death  from  the  lead  in  them  is  unheard  of 
Fatal  acute  poisoning  from  any  lead  salt  is 
extremely  rare,  several  drachms  per  day  of  lead 
acetate  are  giv^en  therapeutically,  and  quanti- 
ties of  one  ounce  have  failed  to  cause  death. 
The  entire  amount  of  solder  ni  a  tin  would  only 
represent  a  very  few  grains  of  lead.  The  few 
cases  of  death  from  canned  goods  heretofore 
reported  have  been  attributed  to  decomposition 
of  the  contents  of  the  can,  but  in  this  case,  as 
the  material  was  boiled  into  soup,  it  is  difficult 
to  accept  the  eating  of  the  tomatoes  as  the 
cause  of  death.  Most  persons  carry  about 
with  them  in  their  bodies  a  small  quantity  of 
lead. 

Dr.  Johnston  replied  that  the  remaining 
contents  of  the  can  could  not  be  obtained. 
He  pointed  out  that  though  large  quantities  of 
the  acetate  may  be  taken  with  impunity,  some 
other  salts,  notably  the  chromate,  were  highly 


THE  CANADA  MEDICAL  RECORD. 


221 


I 
i 


poisonous.  Some  such  poisonous  salt  may 
have  been  jjresent  in  this  case. 

Dr.  HiNGSTON  remarked  that  the  carbonate, 
which  is  a  poisonous  salt,  may  be  formed  from 
the  decomposition  of  the  acetate. 

Dr.  F.  W.  Campbell. suggested  that  theiatal 
result  might  have  been  due  to  decomposition 
of  the  torriaioes,  and  referred  to  two  cases, 
that  had  recently  come  under  his  care,  of 
severe  poisoning  from  eating  canned  salmon. 
He  pointed  out  that  many  years  ago  Dr.  Joseph 
Workman  recommended  drachm  doses  of  the 
acetate  of  lead  for  post  partum  haemorrhage, 
and  he  recalled  a  case  which  appeared  to  be 
acute  lead  poisoning  following  this  treatment. 

Ifitestinal  Anastomosis  with  the  Murphy 
Button. — Dr.  Lapthorn  Smith  demonstrated 
the  method  of  using  this  instrument  for  rapidly 
and  effectually  securing  union  between  two 
portions  of  the  intestinal  canal,  while  leaving  a 
lumen  for  the  passage  of  the  contents.  The 
instrument  consists  of  two  metal  discs,  each 
having  a  central  orifice  about  1.50  cm.  in  dia- 
meter. Each  is  attached  to  a  portion  of  the 
bowel  by  having  the  free  edges  of  the  bowel 
drawn  inward  over  it  by  a  purse-string  suture. 
The  discs  are  then  approximated  and  held  in 
position  by  means  of  a  spring  which  keeps  up 
a  continuous  pressure  upon  the  serous  surfaces 
until  union  takes  place,  after  which  the  com- 
pressed tissues  slough  away  and  the  button  is 
passed  with  the  fceces.  The  advantages  of  this 
device  are  the  rapidity  and  ease  with  which  the 
operation  is  performed,  the  certainty  of  union, 
a  large  opening  for  the  passage  of  the  bowel 
contents  while  the  union  is  taking  place,  and 
the  little  or  no  tendency  to  subsequent  con- 
striction. 

Avuebic  Abscess  of  the  Liver. — Drs.  Finley 
and  Adami  exhibited  the  specimens  and  gave 
the  history  of  the  case  as  follows  : 

The  patient,  a  negro,  jet.  37,  was  admitted 
to  hospital  upon  January  31st,  1894,  complain- 
ing of  pain  in  the  right  side  and  weakness. 
The  chief  facts  relating  to  his  medical  history 
were  that  he  had  lived  for  eleven  years  in 
Texas,  and  he  had  acted  as  cook  on  a  vessel 
trading  between  Quebec  and  South  America, 
and  that  he  had  also  spent  some  time  in  Aus- 
tralia, He  had  never  suffered  from  diarrhoea 
for  more  than  a  day  or  two  at  a  time,  and  had 
never  had  dysentery.  He  had,  however,  two 
febrile  illnesses,  each  lasting  about  three 
months,  some  years  previously. 

The  present  illness  began  a  month  previous 
to  admission,  with  febrile  symptoms  and  diarr- 
hoea. Some  pain  in  the  right  side  and  weak- 
ness, together  with  nausea  and  vomiting,  were 
also  present,  but  he  had  not  taken  to  bed  be- 
fore his  admission  to  hospital. 

On  examination  the  temperature  was  ioi|*^, 
the  tongue  was  coaled  ;  there  was  no  jaundice. 


The  intercostal  spaces  over  the  liver  were 
full,  and  there  was  marked  tenderness  in  the 
right  epigastric  region.  Hepatic  dullness 
began  at  the  5th  rib,  extending  down  for  about 
6  inches.  Posteriorly  there  was  dullness  from 
the  angle  of  the  scapula  downwards.  Friction 
could  be  detected  over  the  right  infra-mammary 
region.  The  abdomen  was  otherwise  normal. 
The  urine  was  of  a  deep  sherry  color,  42  ozs. 
in  24  hours  ;  it  contained  no  bile,  albumen  or 
sugar. 

During  the  ten  days  that  the  patient  was 
under  observation  the  temperature  remained 
almost  constantly  at  102,  and  there  were  no 
chills  or  sweats.  The  hepatic  dullness  during 
this  period  rose  to  the  3rd  rib,  and  pus  was 
withdrawn  by  the  aspirator.  Upon  February 
1 2th,  Dr.  Bell,  after  preliminary  aspiration, 
opened  the  abscess  posteriorly  in  the  9th  space, 
and  resected  the  rib,  allowing  about  50  oz.  of 
pus  to  escape.  The  patient  did  fairly  well  for 
some  days,  but  sank  rather  rapidly,  and  died 
upon  February  i8th,  six  days  after  the  opera- 
tion. Numerous  actively  moving  amoebae  were 
found  in  the  pus,  together  with  much  debris 
and  a  few  leucocytes  and  red  blood  corpuscles. 

The  stools  were  examined  foramosb^  during 
life,  with  a  negative  result. 

It  is  unnecessary  to  give  all  the  details  of  the 
autopsy,  which  was  performed  upon  the  day  of 
death.  Suffice  to  say  that  upon  external  ex- 
amination there  could  be  seen  a  wound  in  the 
ninth  interspace  and  posterior  axillary  line  in 
the  right  side  ;  this  led  through  the  region  of 
the  resected  ninth  rib  to  the  liver,  and  from  it 
could  be  expressed  whitish  necrosed  tissue 
together  with  some  pus. 

Upon  opening  the  thorax,  the  right  lung  was 
found  firmly  adherent  over  all  its  surface,  and 
greatly  contracted  and  diminished  in  size. 
The  adhesions  were  firm  and  close.  It  was 
found  that  the  incision  into  the  right  lobe  of 
the  liver  had  passed  through  the  diaphragm  ; 
but  in  consequence  of  the  firm  nature  of  the 
adhesions  between  diaphragm  and  costal  wall, 
the  pleural  cavity  presented  no  signs  of  acute 
recent  disease,  and  had  apparently  been  in  no 
wise  disturbed  by  the  passage  across  of  the  con- 
tents of  the  hepatic  abscess.  The  liver,  which 
weighed  2650  grm.,  was  greatly  enlarged,  both 
upwards  and  downwards.  It  extended  three 
finger  breadths  below  the  costal  margin,  was 
of  a  fawn  color,  and  presented  here  and  there 
upon  the  upper  surface  of  the  lobes  frequent 
small  white  patches — necroses  or  abscesses — 
averaging  2  mm.  in  diameter.  The  falciform 
ligament  was  well  to  the  left  of  the  ensiform 
cartilage,  the  right  lobe  being  especially  en- 
larged. In  the  substance  of  the  right  portion 
of  the  right  lobe  was  a  large  abscess,  with  thick 
necros»*d  walls  and  irregular  and  shreddy 
internal    surface.        This   extended    from    the 


22; 


THE  CANADA  MEDICAL  RECORD. 


under  surface  of  the  organ  to  within  2  cm.  of 
the  upper  and  outtr  surface  of  the  lobe;  its 
breadth  from  side  to  side  was  12  cm.,  and  from 
above  downwards  it  was  15  cm.  (6  inches) 
across.  Throughout  the  rest  of  the  right  lobe 
there  were  scattered  a  few  other  secondary 
abscesses  ;  the  largest  of  these  was  15  mm.  in 
diameter. 

Theintestmes  were  markedly  congested.  In 
the  jejunum  were  a  few  subcutaneous  hemor- 
rhages. Upon  examination  of  the  large  intes- 
tine no  signs  could  be  made  out  of  any  dysen- 
teric lesions.  Close  to  the  ileo-cgecal.  valve 
was  a  small  whitish  patch,  which  gave  rise  to 
the  suspicion  that  there  was  a  ciacatrix,  but 
upon  closer  examination  the  most  that  could  be 
discovered  was  that  here  the  mucous  membrane 
was  softened  and  thin,  with  no  ulcerous  or  old 
inflammatory  conditions.  Here,  then,  as  not 
unfrequently  occurs,  the  amoebic  abscesses  of 
the  Hver  were  present,  without  any  indica- 
tion of  dysenteric  intestinal  lesions,  either  dur- 
ing life  or  at  the  autopsy.  It  is  to  be  noted, 
however,  that  the  hepatic  flexure  of  the  colon 
was  in  close  contact  with,  and,  in  fact,  ad- 
herent to,  that  portion  of  the  under-surface  of 
the  right  lobe  of  the  Hver,  which  was  under- 
going necrosis. 

Beyond  that  the  heart  presented  the  condi- 
tion of  early  pericarditis,  and  that  the  kidneys 
showed  some  acute  parenchymatous  nephritis, 
the  condition  of  the  other  organs  does  not  call 
for  remark. 

Stained  sections  of  the  liver  and  slough 
showed  the  presence  of  amcebce  ;  these  were  best 
shown  by  staining  with  methyl  blue,  and  were 
faintly  stained  by  haematoxylin.  In  the  abscess 
cavity  and  its  walls  were  numerous  masses  of 
streptococci.  These  were  evidently  of  secon- 
dary growth,  for  the  abscess  contents  were 
singularly  free  from  pus  cells,  being  mainly 
formed  of  broken  down  cheesy  matter.  Micro- 
scopic examination  of  the  walls  of  the  colon 
showed  no  evidence  of  necrosis. 

In  this  case,  therefore,  the  presence  of  fever, 
of  hepatic  enlargement,  pain  and  tenderness, 
suggested  the  presence  of  purulent  inflamma- 
tion in  the  neighborhood  of  the  liver.  That 
this  was  so  was  confirmed  by  the  result  of 
aspiration.  Whether  the  abscess  was  sub-dia- 
phragmatic or  in  the  liver  substance  was  de 
termined  by  the  discovery  of  the  amceb?e  in  the 
removed  fluid.  These  indicated  clearly  that 
the  origin  of  the   disease  was  in  the  liver  itself. 

The  failure  to  find  amcebae  in  faeces  was  ex- 
plained at  the  autopsy  by  the  absence  of  any 
dysenteric  ulcers  or  necrosis  in  the  colon. 

This  case  gains  an  additional  interest  from  the 
fact  that,  so  far  as  we  know,  it  is  the  first  re- 
corded in  Canada  in  which  the  amoibai  coli 
have  been  demonstrated  in  an  hepatic  abscess, 
if  not  in  the  hving  body  generally. 

Dr.   Lafleur  stated  that  this  was  the  first 


case  of  the  kind  reported  in  Canada.  The 
presence  of  abscess  without  dysentery  is  not  at 
all  unusual.  He  had  seen  three  cases  in  Balti- 
more, which  began  as  abscess  of  the  liver,  and 
in  which  it  was  only  secondarily  discovered 
that  the  patient  suffered  from  dysentery,  and,  in 
fact,  this  was  so  slight  that  it  did  not  form  an 
important  part  of  the  disease,  the  lesions  in  the 
bowel  being  very  secondary  and  unimportant 
compared  with  those  in  the  liver.  The  ana- 
tomical picture  in  this  case  was  exactly  like 
that  he  had  observed  in  a  good  many  fatal 
cases  of  liver  abscess,  in  which  the  amoebae 
seemed  to  be  the  cause  of  the  disease,  and 
he  had  no  doubt  that  the  microscopical  exam- 
ination would  be  found  to  correspond.  The  pus 
of  the  abscess  really  consists  of  masses  of 
sot'tened  necrosed  material,  and,  as  a  rule,  un- 
less there  has  been  a  coincident  infection  by 
pyogenic  organisms,  the  leucocytes  are  very  few 
in  number.  He  added  that  since  he  had  writ- 
ten his  share  to  the  contribution  on  "  Amoeba 
in  ]  )ysentery,"  there  have  appeared  in  Ger- 
many and  Austria  a  number  of  works  upon  the 
subject,  which  seem  to  favor  the  existence  of 
a  distinct  form  of  dysentery  caused  by  the 
amoeba  coli,  and  which  confirm  the  work  done 
in  Baltimore. 


Stated  Meetings  March  ()t/i,  1894. 

A.  D.  Blackader,  First  Vice-President,  in 
THE  Chair. 

Dr.  O.  F.  Mercier  was  elected  a  member  of 
this  Society. 

Xanthoma  Tuberosum. — Dr.  Shepherd 
showed  a  case  and  gave  the  history  as  follows  : 
— The  patient  was  a  woman,  aged  fifty,  who 
had  suffered  severely  from  jaundice,  and  was 
at  present  jaundiced.  'I  hree  weeks  before,  she 
had  noticed  some  yellowish-looking  tubercles 
under  the  skin,  which  were  of  the  size  varying 
from  that  of  millet  seeds  to  that  of  peas.  These 
grew  larger,  and  others  appeared  in  the  normal 
lines  and  folds  of  hand,  and  often  on  the  sur- 
faces of  phalangeal  joints  ;  here  the  tubercles 
were  fused  together  into  a  raised  yellowish 
band,  which  were  subepithelial.  These  growths 
looked  as  if  they  contained  fluid,  but  on  prick- 
ing them  it  was  seen  that  they  were  dense  and 
fibroid  in  character.  Latterly,  tubercles  of 
same  character  had  appeared  on  the  elbows  and 
knees  and  also  on  the  lips  and  side  of  nose. 
They  were  excessively  painful  when  touched 
and  pressed,  and  itched  a  great  deal.  The 
hands  were  continually  perspiring.  Dr.  Shep- 
herd said  this  was  a  somewhat  rare  disease, 
and  was  more  common  in  women  than  men, 
being  often  but  not  constantly  associated 
with  jaundice.  The  tubercles  are  not  con- 
nected with  the   sebaceous  glands,  as  seen  by 


THE  CANADA  MEDICAL  RECORD. 


223 


their  ajipcaring  so  abuiidanily  in  the  palms  of 
the  hands.  They  are  no  doubt  growths  of  con- 
nective tissue  witli  fatty  degeneration,  this  giv- 
ing the  yellow  ai)pearance.  They  sometimes 
occur  in  the  throat  and  fauces,  trachea,  heart, 
etc.  Treatment  is  of  little  avail.  'J'he  patches 
often  disappear  spontaneously. 

Dr.  Adami  had  made  only  a  cursory  exam- 
ination of  p<^rtions  of  the  growths  that  had  been 
sent  to  him,  but  would  give  a  full  report  to  the 
Society  at  a  later  date. 

Dr.  BuLLER  had  seen  a  great  many  cases  of 
xanthelasma  of  the  eyelids,  and  he  thought  that 
there  must  be  some  marked  underlying  differ- 
ence between  the  pathological  processes  of  this 
disease  as  found  in  the  eyelids  and  in  the' other 
parts  of  the  body.  In  these  cases  he  had 
never  found  any  tenderness  of  the  diseased 
portion,  nor  could  he  ever  elicit  any  history  of 
sick  headache  or  hepatic  affection,  though  he 
always  made  careful  enquiries. 

Dr.  Foley  enquired  whether  the  growth  was 
strictly  confined  to  the  corium  or  whether  it 
penetrated  into  the  deeper  structure  ;  he  also 
asked  if  cholesterin  crystals  were  present. 

Dr.  Adami  replied  that  as  the  corium  and 
fibrous  tissue  below  was  very  indefinite,  Dr. 
Foley's  question  was  difficult  to  answer;  no 
cholesterin  was  found. 

Arthiectomy. — Dr.  Armstrong  brought 
before  the  Society  a  man  in  whom  a  particu- 
larly favorable  result  had  been  obtained  of  an 
arthrectomy  of  the  knee-joint,  a  partial  inci- 
sion having  been  performed  last  September. 
As  could  be  seen,  the  man  walked  well  and  had 
a  considerable  amount  of  motion  in  the  joint  ; 
the  patella  was  also  quite  movable.  The 
operation  was  performed  by  the  transpatellar 
incision,  the  sections  being  reflected  up  and 
down,  the  tubercular  disease  was  shaved  off 
the  patella  and  condyles,  the  patella  was  then 
sutured  and  the  wound  closed  without  drain- 
age. The  portions  removed  were  submitted  to 
Dr.  Adami,  who  reported  them  to  be  tubercu- 
lar. They  seemed  to  resemble  the  dry  atro- 
phic form  of  tuberculosis  which  sometimes 
occurs  in  arthritic  joints,  the  caries  s'cca  of 
Volkmann. 

The  history  of  the  case,  which  presented 
many  points  of  interest,  was  as  follows  : — The 
man  came  to  the  hospital  early  last  spring, 
complaining  of  severe  pain  and  practical  im- 
mobility of  the  knee-joint.  This  pain  was  so 
severe  that  hypodermics  of  morphia  were  re- 
quired to  relieve  him.  There  was  very  marked 
atrophy  of  the  joint,  which  was  then  even  more 
plainly  seen  than  at  present,  the  measurement 
being  one  to  one  and  a  half  inches  less  than  on 
the  sound  side.  At  the  same  time,  when  the 
knees  were  ]jlaced  together  one  could  hardly 
tell  which  was  the  diseased  joint,  the  outlines 
of   the   affected   one   being   perfectly   normal, 


there  was  no  cedema,  no  puffiness,  no  redness 
to  indicate  disease. 

In  the  absence  of  physical  evidence,  Dr. 
Armstrong  hesitated  to  operate,  and  sent  the 
man  home  after  the  pain  had  become  some- 
what relieved.  He,  however,  shortly  after- 
wards began  again  to  annoy  his  family  physi- 
cian, who  sent  him  back  to  the  hospital  with  an 
urgent  request  that  something  should  be  done. 
The  operation  was  then  performed,  with  the 
result  already  mentioned. 

The  case  is  of  interest  as  showing  a  relation- 
ship between  joint  disease  and  arthritic  atrophy, 
the  pain  and  atrophy  being  here  more  marked. 

Dr.  Armstrong  then  cited  the  history  of  a 
case  of  hip'joint  disease,  presenting  very  simi- 
lar features,  which  he  had  met  during  last 
summer.  Here  also  pain  and  atrophy  were 
the  only  symptoms.  With  Dr.  Shepherd  he 
had  examined  the  patient  under  ether  several 
times,  without  being  able  to  decide  on  operation; 
but  as  the  great  pain  was  wearing  the  man 
down  to  a  shadow,  he  at  last  opened  the  joint, 
and  found  distinct  tubercular  disease  in  the 
floor  of  the  acetabulum,  and  the  head  of  the 
femur  was  in  a  condition  of  caries. 

The  result  had  been  very  favorable,  and  Dr. 
Armstrong  regretted  that  he  could  not  find  the 
man  to  bring  him  before  the  Society. 

Dr.  Shepherd  had  seen  the  case  with  Dr. 
Armstrong,  and  from  the  external  appearances 
no  one  would  have  thought  that  there  was  a 
tubercular  condition  present  in  the  joint. 
From  the  experience  gained  from  this  case  he 
would  be  more  ready  to  open  such  joints  in 
future. 

Dr.  James  Stewart,  on  being  asked  to  ex- 
press his  views  on  arthritic  atrophy,  thought 
that  there  was  but  little  to  be  said  on  the  sub- 
ject ;  there  are  explanations  for  all  forms  of 
atrophy  except  this  one.  Some  hold  that  its 
nature  is  that  of  a  reflex  process,  but  this  is  a 
convenient  term  to  use  when  we  know  nothing 
about  a  subject,  and  such  is  probably  the  case 
here. 

Frogs  with  the  Cerebrum  removed. —  Dr. 
Mills  and  Dr.  Morrow  exhibited  two  frogs 
deprived  of  the  cerebrum,  and  demonstrated 
that  they  were  capable  of  co-ordinated  move- 
ments of  the  most  complicated  kind,  including 
Goltz's  "  balancing  experiment,"  i.e.,  the  frogs 
would,  when  a  surface  on  which  they  were 
resting  was  gradually  tilted,  move  in  order  to 
maintain  their  position.  They  would  also  turn 
over  when  placed  on  their  back.  The  frogs 
had  been  operated  on  about  a  month  pre- 
viously, and  during  all  this  time  had  never 
made  one  spontaneous  (voluntary)  movement; 
they  had  not,  e,  g.,  attempted  to  leap  out  of 
the  dish  in  which  they  had  been  sitting  under  a 
water  tap.  This  showed  that  the  removal  of 
the  cerebrum  abolished  voluntary  movement, 
but  that  all  the  mechanism  necessary  for  co- 


224 


THE   CANADA   MEDICAL   RECORD. 


ordinatcd  movements  remained.  These  frogs 
were  shown  especially,  because  it  would  appear 
that  certain  changes  in  the  nutrition  of  the  ani- 
mals had  taken  place  leading  to  necrosis  of  the 
skin,  etc.,  and  ulceration.  On  one  occasion, 
when  the  surroundings  had  been  changed,  one 
of  the  frogs  had  shown  tonic  spasm  of  the 
limbs.  This  reminded  Dr.  Mills  of  what  Prof. 
Goltz  had  told  him,  when  a  worker  in  his 
laboratory  in  1S84,  that  many  of  the  dogs 
whose  cerebrum  had  been  operated  on  died  in 
convulsions  weeks  or  months  afterwards.  The 
frogs  in  question  had  been  in  only  fairly  favor- 
able surroundings,  and  had  been  given  a  little 
food  a  few  times,  but  food  was  of  minor  conse- 
quence to  frogs  in  winter.  A  frog  that  had  not 
been  operated  on,  and  kept  under  somewhat 
similar  circumstances,  was  shown  and  seen  to 
be  in  a  very  different  state  of  health.  Dr. 
Mills  thought  the  operation  had  greatly  lowered 
the  vitality  of  the  frogs,  ard  this  was  one  of 
the  chief  lessons  conveyed. 

Dr.  WiLKiNS  was  of  the  opinion  that  a  por- 
tion of  the  cerebrum  remained  intact  in  these 
frogs,  as  they  had  made  an  attempt  to  get  away, 
which  action  involved  a  series  of  movements, 
iniplying  volitional  power,  and  volitional  power 
cannot  exist  with  no  portion  of  the  cerebrum 
intact.  In  a  frog  with  the  entire  cerebrum  re- 
moved, on  stroking  the  flanks  a  single  croak 
is  elicited,  but  the  debilitated  condition  of  these 
frogs  may  explain  the  absence  of  the  sound. 
Dr.  Mills  had  expressed  a  doubt  about  frogs 
swallowing  each  other,  but  the  speaker  thought 
that  he  was  mistaken.  He  had  more  than 
once,  in  his  own  laboratory,  upon  opening 
frogs  found  bones  in  their  stomach,  and  on  one 
occasion  he  had  positive  evidence  that  frogs  do 
eat  each  other,  for  on  hearing  a  splash  and  a 
croak  he  hurried  to  where  the  frogs  were  kei-t, 
and  found  one  frog  with  the  hind  legs  of 
another  sticking  out  of  his  mouth,  and  which 
he  immediately  removed.  He  thanked  Dr. 
Mills  for  his  demonstration,  and  hoped  that  he 
would  bring  similar  cases  before  the  Society  in 
future. 

Dr.  Adami,  referring  to  the  length  of  time 
that  the  frogs  had  lived,  quoted  a  Russian 
observer  who  kept  a  pigeon  alive  a  whole  win- 
ter after  the  removal  of  the  cerebrum.  He 
further  suggested  that  as  an  explanation  of  the 
double  movements  spoken  of  by  Dr.  Wilkins, 
the  severity  of  the  stimulus  was  sufficient  to 
account  for  it. 

Dr.  Mills,  in  reply,  thought  that  Dr.  Wil- 
kins was  confounding  the  actions  of  frogs  with 
the  cord  only  remaining  with  those,  as  in  the 
present  case,  with  cord  and  medulla.  Whether 
it  would  turn  out  that  these  frogs  had  the  whole 
cerebrum  removed  ornot,  he  had  certainly  seen 
cases,  in  which  the  whole  cerebrum  had  been 
removed,  act  in  a  manner  similar  to  these. 

Complete  Double  Ureter. — Dr.  Adami  read 


the  report  of  the  case,  and  showed  the  speci 
men.  . 

Although  ihe  condition  of  multiple  ureter  is 
one  of  comparatively  frequent  occurrence,  it 
would  seem  that  in  nearly  all  the  cases  re- 
corded of  this  abnormality,  fusion  of  the  ureter.s. 
forming  a  single  canal,  had  taken  place  before 
perforation  of  the  bladder  wall.  The  entrance 
into  the  bladder  of  accessory  ureters  by  separ- 
ate openings  is  a  condition  which  authorities 
on  the  subject  are  unanimous  in  regarding  as 
extremely  rare.^  Gangolphe^  states  that  in  his 
search  of  medical  literature,  he  was  able  to  find 
only  two  examples.  His  search  must  have 
been  incomplete,  for  we  have  met  with  about 
a  dozen  recorded  cases  in  all — sufficiently  few, 
however,  to  merit  that  the  two  cases  in  hand  be 
described. 

Of  these,  one  was  discovered  in  a  recent 
autopsy  at  the  Royal  Victoria  Hospital,  on  the 
body  of  a  man  aged  65.  The  right  kidney  in 
this  case  was  normal ;  the  left  exhibited  more 
than  one  abnormality.  There  were  two  renal 
arteries.  The  upper,  of  small  size,  was  given  off 
from  the  side  of  the  aorta  just  above  the  level 
of  the  coeliac  axis.  This  passed  into  the  sub- 
stance of  the  cortex3  of  the  upper  part  of  the 
kidney  upon  its  anterior  and  upper  surface, 
and  half  way  along  its  course  gave  off  the  left 
supra-renal  artery.  The  main  renal  artery  left 
the  aorta  at  its  normal  point  of  origin,  and 
divided  into  three  branches,  of  which  the 
lowest  passed  in  front  of  the  renal  vein,  and 
sub-divided  into  three  branches. 

The  kidney  presented  two  pelves.  The 
ureter  of  the  upper  one,  which  was  the  smaller, 
passed  down  behind  the  vessels,  and  crossed 
in  front  of  the  inferior  ureter.  Half  an  inch 
before  reaching  the  bladder  wall  the  ureters  be- 
came fused  externally,  but  at  the  same  time 
the  canals  remained  distinct.  It  was  not  possi- 
ble to  pass  a  pin  probe  from  one  to  the  other, 
nor  could  fluid  injected  into  one  ureter  be 
found  to  pass  into  the  other  under  any  condi- 
tions. The  ureter  given  off  from  the  lower 
pelvis  may  be  considered  as  the  main  duct,  in- 
asmuch as  it  was  slightly  larger,  while  its  open- 
ing into  the  bladder  was  in  the  usual  position, 
and  corresi)onded  to  that  of  the  single  ureter  of 
the  right  side.  The  superior  and  accessory 
ureter  opened  into  the  bladder  by  means  of  a 
small,  but  distinct,  slit-like  aperture,  situated 
half  an  inch  below,  and  to  the  inner  side  of  the 
main  orifice  in  the  line  between  that  and  the 
urethral  orifice. 

The  second  case  is  a  specimen  obtained  from 
a  female  body  by  Dr.  Shepherd,  of  McGill 
University.  This  has,  for  many  years,  been  in 
the  Museum  of  the  Medical  college,  and  has 
never  been  recorded. 

1  Klebs  Path.  Aval.  ii.  page  678  (1876);  Rokitansky  Path. 
Aiiat.  Syd.  Soc.  ii,  p.  211  ;   Koerster  Path.  Anat.  p.  523  (1865). 

2  Lyon  Medicale,  No.  26,  1883. 

3  An  artery  piercing  the  cortex  is  said  to  occur  in  i  in  7  bodies 
examined. 


THE  CANADA  MEDICAL  RECORD. 


■-:> 


With  the  exception  that  the  kidney  liere  pre- 
sents a  more  clearly  lobulated  appearance,  and 
that  there  is  no  arterial  abnormality,  the  case  is 
almost  identical  with  the  preceding.  The  re- 
duplication occurs  only  on  the  left  side,  there 
are  two  pelves,  the  upper  being  the  smaller, 
the  superior  ureter  crosses  in  front  of  the  in- 
ferior, and  its  separate  orifice  is  also  along  the 
edge  of  the  Trigone,  in  front,  and  to  the  inner 
side  of  the  main  orifice,  between  that  and  the 
urethra. 

It  is  a  curious  fact  that  in  nearly  all  the  re- 
corded cases  of  this  peculiarity  it  has  occurred 
in  the  /e/l  side.  The  two  cases  just  mentioned 
are  on  the  left  side  ;  Tangl's'  celebrated  case, 
and  Gangolphe's^  likewise  occurred  on  this 
side.  Baum3  has  lately  published  a  case  in 
which  it  occurred  on  the  right  side.  There 
may  be  no  special  significance  to  be  attached 
to  this  /<'/?-sided  tendency,  but  still  it  appears 
to  obtain. 

Dr.  Shepherd  had  met  with  a  great  many 
cases  of  abnormal  blood  supply  of  the  kidney. 
and  partial  double  ureter,  but  the  only  other 
case  that  he  had  seen  of  complete  reduplicat  on 
was  the  one  taken  by  Dr.  Adanii  from  the 
museum  to  compare  with  the  case  reported. 

Mitral  and  Tricuspid  Stenosis, — Dr.  Fix- 
ley  exhibited  a  heart  in  which  both  mitral  and 
tricuspid  stenosis  was  well  marked.  The  ori- 
fice of  the  mitral  valve  admitted  the  tip  of  thj 
little  finger,  that  of  the  tricuspid  the  first  finger. 
The  changes  in  the  left  ventricle  were  not 
marked  ;  if  anything,  its  cavity  was  somewhat 
smaller  and  its  walls  thin  ;  the  right  ventricle, 
while  its  walls  were  slightly  thickened  and  its 
cavity  dilated,  did  not  present  that  extreme  de- 
gree of  enlargement  commonly  found  in  mitral 
stenosis  ;  the  right  auricle  was  the  largest  of  al! 
the  cardiac  cavities.  The  lungs  presented 
numerous  reddish  patches,  which  on  micro- 
scopical examination  proved  to  be  hasmorrhagic 
infarcts. 

The  following  is  the  history  of  the  case  : — 
The  patient,  a  female,  aet.  ^t,,  was  admitted  to 
the  Montreal  General  Hospital  in  November, 
1893,  for  pain  in  the  side  and  cough.  She  had 
suffered  from  repeated  attacks  of  sore  throat, 
sometimes  going  on  to  suppuration,  but  had 
never  had  rheumatism  or  chorea.  Dyspnoea 
on  exertion  had  been  present  for  three  months 
before  her  admission.  She  had  never  had 
haemoptysis.  The  family  history  presented  no 
feature  of  imporfance,  and  there  were  no  rheu- 
matic tendencies.  The  present  illness  began 
four  days  previous  to  admission,  with  a  slight 
chill,  cough  and  pain  in  the  right  side. 

Physical  Examination. — Moderate  emacia- 
tion, sHght  cyanosis  of  lips  and  cheeks,  with 
stellate  venules    on  face.      Temperature  sub- 

1  Virchow's  Archiv.  118  (1889)  p.  414. 

2  Loc.  rit. 

3  Archiv.  of  Gyaoekol.  42,  p.  339  (1892^ 


normal.  Cardiac  impulse  forcible  and  some- 
what heaving  over  lower  sternal  region.  Apex 
in  fifth  space  }{  inch  inside  nipple.  Marked 
presystolic  thrill  at  the  apex.  Cardiac  dullness 
normal.  A  harsh,  rumbling  presystolic  mur- 
mur is  heard,  but  to  inner  side  of  the  apex, 
and  localized  over  a  space  two  inches  in 
diameter.  The  first  sound  is  abrupt,  greatly 
accentuated  and  snapping  in  character.  A 
soft  systolic  murmur  is  heard  between  the  low- 
er sternal  area  and  the  nipple.  The  pulmonary 
second  sound  is  enormously  accentuated  and 
reduplicated.  Below  the  angle  of  the  scapula 
on  the  right  side,  dullness,  feeble  breathing, 
with  diminished  vocal  resonance  and  fremitus. 
A  small  quantity  of  clear  serum  was  drawn  off 
a  kv}  days  later  with  a  hypodermic  syringe. 
The  first  sound  at  the  tricuspid  area  is  feeble. 
The  pulse  ro2,  small,  regular  and  of  low  ten- 
sion. The  other  organs  are  normal,  and  the 
urine  reddish  yellow  in  color,  s.g.  1025,  "o  al- 
bumen or  casts.  Ordered  digitalis  m.x.  ler  in 
die. 

Nov.  14. — Fluid  in  pleura  reaches  fourth 
rib  in  front.  Temperature  99  to  100  in  the 
morning  and  about  ico  at  night,  became  nor- 
mal at  this  date.  Digitalis  dropped  on  account 
of  vomiting. 

Feby.  15. — The  presystolic  murmur  and 
thrill  disappeared,  and  ten  days  later  pulse 
became  extremely  weak,  i)aroxysmal  attacks  of 
intense  dyspnoea  and  cyanosis  came  on,  death 
resulting  apparently  from  cardiac  failure. 
Tile  urine  averaged  20  to  30  ozs.  daily  whilst 
under  observation.  There  was  at  no  time  any 
cedema  of  the  extremities  or  serous  sacs. 

The  physical  signs  left  no  doubt  that  the 
mitral  valve  was  narrowed,  but  there  was, 
daring  life,  no  evidence  made  out  indicating 
disease  of  the  tricuspid.  On  looking  back, 
however,  on  the  case,  he  was  inclined  to  think 
that  the  systolic  murmur  heard  in  the  lower 
sternal  area  was   possibly    a  tricuspid  sound. 

It  was  impossible  to  find  the  onset  of  the  dis- 
ease— there  was  no  history  of  rheumatism ; 
but  judging  from  the  condition  of  the  cardiac 
orifices,  it  must  have  been  of  a  good  many 
years'  standing,  and  the  case  furnishes  another 
instance  of  the  extreme  degree  to  which  car- 
diac disease  may  advance  and  yet  compensa- 
tion is  maintained.  A  point  of  interest  in  con 
nection  with  the  first  sound  of  the  lieart  in  mi- 
tral stenosis  is  the  cause  of  its  peculiar  snapping 
character.  It  is,  perhaps,  difficult  to  give  any 
satisfactory  explanation.  The  point  has  been 
much  debated,  and  many  authors  think  that 
the  thickened  condition  of  the  valve,  in  itself, 
would  preclude  the  possibility  of  its  emitting 
such  a  sound.  Recently  a  paper  has  been 
published  by  Fenwick  and  Overend  in  Am. 
Jour.  Med.  Sc,  1S93,  staling  that  the  peculiar- 
ity of  the  first  sound  of  the  heart  occurring  in 
mitral  stenosis  is  really Jdue  to  the  closure  of 


226 


THE   CANADA   MEDICAL   RECORD. 


the  liicuspid  valve  in  tlie  hyperlrophoid 
right  ventricle.  The  present  case,  however, 
certainly  negatives  such  a  view  as  the  tricuspid 
valves  are  rigid,  and  yet  the  first  sound  was 
as  shaip,  snapping  and  loud  as  in  cases  of  un- 
complicated mitral  stenosis. 

Dr.  Martin  had  examined  the  lungs,  and 
found  a  rather  curious  condition  resembling 
somewhat  broncho-pneumonia,  but  sections 
proved  the  condition  to  be  only  hjemorrhagic 
mfarction,  with  slight  desquamation  of  the  epi- 
thelium. 

Dr.  Lafleur  remarked  that  the  specimen 
was  of  interest,  as  all  records  show  tricuspid 
stenosis  to  be  a  rare  lesion.  With  reference  to 
Dr.  Finley's  suggestion  as  to  the  possibility  of 
there  being  regurgitation  through  the  tricuspid 
valve — if  such  had  been  the  case,  there  must 
have  been  pulsation  of  the  veins  ;  he  asked  if 
such  a  condition  had  been  noticed.  With  re- 
gard to  the  situation  of  a  systolic  murmur  as 
indicating  tricuspid  disease,  it  is  not  of  diagnos- 
tic value. 

Dr.  FiNLEY  replied  that  there  was  very  slight 
pulsation  of  the  veins  which  seemed  to  come 
from  below,  but  certainly  was  not  a  very  mark- 
ed condition — but  as  there  are  so  many  forms 
of  pulsation  of  the  vessels  of  neck,  he  did  not 
lay  much  stress  upon  this  condition. 

H  ou?id  of  the  heart — Dr.  Shepherd  report- 
ed the  case  as  follows  : — In  the  summer  of 
1892  he  was  summoned  to  a  case  where  it  was 
said  the  patient,  who  had  alcoholic  mania,  had 
pushed  two  needles  into  his  heart.  The  patient 
when  seen  was  lying  on  the  floor,  and  seemed 
in  gieat  distress,  but  calmly  told  the  doctor 
that  he  had  tried  to  kill  himself  by  pushing 
needles  into  his  heart.  On  examining  the  re- 
gion of  the  heart  with  every  beat  the  skin  over 
the  apex  seemed  to  be  pushed  up  by  something 
beneath  ;  this  felt  like  a  needle.  An  inch  out 
from  this  another  needle  could  be  felt  deep 
down  in  the  intercostal  space.  The  patient 
said  that  he  had  pushed  both  needles  out  of 
sight  beneath  the  skin  with  a  sharp  end  of  a 
file.  Dr.  Shepherd  made  an  incision  over  the 
needle  in  the  apex  of  heart,  and  by  pressing  in 
a  needle  holder  caught  the  end  of  the  needle 
and  pulled  it  out.  The  second  needle  was  ex- 
tracted with  greater  difficulty  on  account  of  its 
depth,  both  layers  of  intercostal  muscle  having 
to  be  cut  before  the  needle  was  reached. 

'^I'he  patient  during  the  operation  gave  no  evi- 
dence of  pain.  The  needles  were  small  darn- 
ing needles,  measuring  a  little  over  two  inches 
in  length.  The  patient  never  suffered  any 
trouble  from  the  injury,  and  was  as  well  next 
day  as  ever.  The  wounds  both  healed  by  first 
intention. 

Dr.  Mills  spoke  of  the  condition  known  as 
delirium  cordis  set  up  by  wounding  certain 
points  in  the  heart,  and  referred  to  the  sugges- 
tion  made  by  a  writer  in  the  Medical  News 


some  years  ago,  to  make  use  of  this  procedure  to 
restore  the  heart's  action  after  chloroform  syn- 
cope, but  he  thought  that  this  step  would  be  of 
doubtful  value,  as  the  heart  may  or  may  not  re- 
cover from  this  condition  of  delirium. 

Dr.  L.4FLEUR  recalled  the  specimen  of  a 
bullock's  heart,  exhibited  by  him  four  years  ago, 
in  which  a  large  wire  had  forced  its  way  from  the 
stomach  into  the  heart,  penetrating  the  ventri- 
cle and  auricle.  There  was  evidence  that  this 
process  had  existed  for  some  time,  as  the  wire 
had  worn  a  regular  groove  for  itself  in  the  ven- 
tricular muscle.  Septic  infection  has  been  set 
up  from  the  communication  with  the  stomach. 

Dr.  Shepherd  referred  to  a  paper  read  by 
Dr.  Praeger,  before  the  Canada  Medical  Asso- 
ciation, in  which  lie  mentions  a  case  of  chloro- 
form syncope  which  was  restored  by  sticking  a 
needle  into  the  heart. 

Coiige7iiial  Defects  of  the  Anterior  Pillars 
of  Fajices. — Dr.  H.  D.  Hamilton  read  the 
re[)ort  as  follows: — I  have  been  furnished, 
through  the  courtesy  of  Dr.  George  W.  Major, 
with  this  report  of  a  somewhat  rare  malforma- 
tion, which  it  is  proposed  should  here  be  put 
on  record .  It  is  interesting  as  a  curiosity  and 
also  because  of  the  practical  importance  of  diag- 
nosing it  from  other  affections. 

J.  C,  member  of  the  civic  police,  25  years 
of  age,  a  subject  of  laryngeal  phthisis,  was  re- 
ferred by  Dr.  Molson  for  local  treatment  on 
8th  Dec,  i8go,  to  the  Department  for  Diseases 
of  Nose  and  Throat,  Montreal  General  Hospi- 
tal. 

On  examination,  the  anterior  pillars  of  the 
fauces  presented  two  longitudinal  slits  or  fis- 
sures, the  left  being  slightly  the  larger,  and 
measuring  half  an  inch  in  length  by  about  316 
of  an  inch  in  width  at  the  widest  part.  These 
openings  were  of  a  somewhat  oval  form  ex- 
tending down  to  the  base  of  the  tongue,  and  as 
the  tonsils  were  deficient,  the  condition  was 
very  easy  of  observation.  There  was  no  evi- 
dence of  cicatricial  tissue  anywhere,  the  edges 
of  the  opening  being  smooth,  and  presenting 
the  natural  appearance  of  the  surroimding 
parts. 

In  the  Archives  of  Otology  for  January, 
1892,  Max  Toeplilz,  of  New  York,  reports  a 
case,  and  states  that  the  literature  on  the  sub- 
ject contains  but  six  similar  observations  up  to 
that  date. 

'I'he  cases  so  far  recorded  have  been  :  (i)  by 
Walters  in  1859. 

(2)  J.  Solis  Cohen,  in  the  Medical  Record 
of  1878,  and  also  in  the  2nd  edition  of  his  work 
on  Diseases  of  the  Throat,  where  the  condition 
is  explained  as  a  separate  investment  of  the 
fibres  of  the  palato-glossus  muscle. 

(3)  Lefferts  reports  a  case  in  the  Philadel- 
phia Aledical  Neivs  iox  1882,  besides  commu- 
nicating privately  with  Toeplitz  regarding  two 
unpublished  cases  in  1890. 


THE  CANADA  MEDICAL  RECORD. 


227 


(4)  Chiari  reports  a  case  in  August,  1884- 
(Monatschrift  fur  Ohrenheilkund)  ;  (5)  Schap- 
ringer  another  in  1884;  (6j  Clarborne  another 
in  tlie  American  Jounial  of  Medical  Sciences 
of  1888,  one-sided.  One-sided  defects  have 
also  been   noted  by  Schapringer  and   Ttephtz. 

Dr.  BiRKF.TT  had  seen  a  case  referred  to  him 
by  Dr.  Buller  where  the  congenital  defects 
existed  on  one  side  only.  There  are  a  number 
of  such  cases  on  record,  but  as  yet  no  explana- 
tion as  to  how  they  occur  has  been  satisfac- 
tory. 


lro$|rc6S    of    sciciue. 


WELL  SIZED  UP. 

Rev.  J.  B.  Hawthorne,  of  this  city,  said 
in  his  sermon,  February  iSth  :  "7/  all 
the    thieves    were     put   into    the    chain-gang 

to-morrow, //    would    shut     the     doors 

of  real  estate  offices  and  thin  the  ranks  of  the 
leiial  and  medical  fraternities.'"  In  regard  to 
the  real  estate  business,  Dr.  Hawthorne  pro- 
bably speaks  by  the  card,  because  he  has  been 
interested  in  some  land  schemes  himself  in  a 
quiet  way  as  a  "  side  line "  to  the  sacred 
ministry.  He  therefore  knows  the  tricks 
of  the  trade.  We  do  not  know  what  motive  or 
experience  prompted  the  good  doctor  in  his 
stricture  upon  the  medical  fraternity.  The 
only  relation  that  we  know  of  which  he  has 
sustained  toward  the  medical  profession  has 
been  to  receive  free  medical  attention  for  him- 
self and  family  whenever  occasion  required. 
Such  insinuations,  therefore,  as  the  above  come 
with  very  poor  grace,  and  savor  of  the  meanest 
ingratitude.  And  all  of  this,  too,  from  a  man, 
a  minister,  who  owns  or  did  own  a  large  part 
of  the  stock  in  a  patent  medicine  humbug. 
King's  Royal  Germetur,  which  consists  only  of 
the  addition  of  one  pint  of  hydrochloric  acid, 
costing  twenty  cents,  to  a  barrel  of  water, 
costing  nothing,  the  mixture  selling  for  one 
dollar  a  quart !  The  doctor  ironically  selected 
for  his  text  that  morning,  "  ZTi?  that  is  ivithout 
sin  among  you,  let  him  cast  the  first  stoned 
We  think  that  this  great  evangel  of  all  that  is 
good  and  honest,  who  poses  as  the  public 
censor,  might  make  a  personal  application  of 
his  text  with  considerable  advantage. — Atlanta 
Medical'and  Surgical  fournal. 


I 


FORMS  OF  PERITONITIS. 

Dr.  Roswell  Park  {Med.  Age)  concludes  : 
First.    There  is  no   such    thing  as  an  idio- 
pathic peritonitis.     Every  so-called  case  has  a 


defir.ite  origin,  which,  however,  it  may  not 
always  be  possible  to  easily  determine. 

Second.  Many  cases  of  non-iraumatic  peri- 
tonitis have  iheir  origin  in  the  female  pelvic 
organs,  and  usually  belong  to  the  staphylo- 
coccus and  strc-ptococcus  forms  ;  but  some  of 
them  are  really  cases  of  colon  infection. 

lliird.  Tliose  cases  which  depend  upon 
perforation  after  ulceration,  escape  of  gallstone 
into  the  peritoneal  cavity,  and  lesions  of  this 
general  nature,  fall  into  the  septic  or  putrid 
forms. 

fourth.  Peritonitis  due  to  internal  obstruc- 
tion or  strangulated  hernia  is  usually  due  to 
colon  infection. 

Fifth.  Cases  of  peritonitis  which  do  not 
originate  in  the  manner  already  referred  to 
almost  invariably  proceed  from  the  appendix 
vermiformis,  and  of  all  these  a  larger  pro- 
portion are  cases  of  pure  colon  infection. 

Sixth.  The  larger  proportion  of  these  are 
fatal  unless  surgical  procedures  be  used. 

Seventh.  In  every  case  of  peritonitis  for 
which  obvious  cause  is  lacking,  the  ileocecal 
region  should  be  carefully  examined,  if  sus- 
pected should  be  explored,  and  this  exploration 
may  well  be  made  under  an  anesthetic  with  all 
conveniences  at  hand  for  the  most  formidable 
kind  of  operative  procedure. 


SURGICAL  ITEMS. 

In  parasitic  affections  of  the  skin,  chronic 
eczema  and  the  like,  Dr.  W.  D.  Cutter  recom- 
mends the  following :  Chloral,  carbolic  acid 
and  tincture  of  iodine,  equal  parts.  It  should 
be  used  cautiously  owing  to  the  danger  of  pro- 
ducing severe  inflammation. — Ca/iada  Lancet. 

Applied  on  lint  or  absorbent  cotton  to  a 
bleeding  surface,  chloroform  promptly  stays 
the  flow,  acts  as  a  direct  stimulant  to  the  pa- 
tient, and  leaves  no  blood  crust  to  fall  off  and 
reproduce  hemorrhage. — Medical  Press  and 
Circular. 

In  inoperable  cases  of  cancer  of  the  uterus 
Depres  (Amer.  Jour.  Med.  Sciences)  injects 
refined  petroleum  into  the  growth.  These  in- 
jections are  painfuL  but  cause  speedy  separ- 
ation of  sloughs,  drying  of  ulcerated  surfaces 
and  cessation  of  odor.  They  are  also  of  ser- 
vice in  cases  of  abscess,  and  in  acute  vaginitis 
injections  of  three  to  five  ounces  produce  a 
cure  in  six  days. 

"  Many  times,"  says  Dr.  F.  Byron  Robinson 
{Med.  Herald),  '•  I  have  watched  Mr.  Tait  open 
an  abdomen,  explore  and  pronounce  malignant, 
and  then  he  would  say  to  his  nurse,  'Give  me 
a  needle  and  thread.'  He  would  close  the  ab- 
domen without  attempting  to  remove  a  ma- 
lignant  growth,"  with  a  hopeless   recovery.     I 


228 


THE   CANADA   MEDICAL   RECORD. 


am  more  and  mo;e  inclined  to  do  as  Mr.  Tail 
does,  and  that  is  n^  t  to  kill  patients  with  sur- 
frery.  Any  patient  that  is  ahiiost  sure  to  die 
had  better  die  without  surgery.  It  is  a  black 
eye  to  surgery  to  lose  a  patient  at  any  time. 
In  all  forms  of  tumors,  early  surgery  is  the  only 
kind  that  can  be  hopeful." 

Surgeon's  plaster,  according  to  the  North- 
luestcrii  Lancet,  is  a  simple  and  reliable  remedy 
for  chilblains.  It  is  especially  serviceable  when 
the  feet  are  attacked,  and  is  easily  applied  to 
the  big  toe  and  heel.  A  salicylated  plaster  is 
of  great  value,  as  it  helps  any  decorticated 
spots  to  heal.  The  plaster  is  applied,  and  al- 
lowed to  remain  on  for  three  days,  when  the 
trouble  will  be  found  cured.  After  this  it  will 
possibly  have    to  be   renewed  on   account  of 

soiling  easily.  .    ,      ■,    ^ 

Dr.  GOODELL  i^Mcd.  News)  pleads  for  greater 
conservatism  in  the  treatment  of  diseases  of 
the  uterine  adnexa,  and  advises  that  an  effort 
be  made  to  restore  a  woman's  health  by  re- 
sorting to  other  than  operative  procedures. 
He  states  that  the  artificial  menopause  induced 
by  operation  is  often  attended  with  more  se- 
rious complications  than  those  that  are  not 
rarely  observed  in  the  natural  change  of  life  ; 
and  that  in  the  majority  of  women  that  have 
been  "castrated"  the  sexual  impulse  soon 
abates  in  intensity,  much  sooner  than  after  the 
natural  menopause,  and  that  in  many  cases  it 
wholly  disappears. 

Dr.  Herman  Mvnter  calls  attention  to  the 
fact  that  only  sterilized  water  should  be  used 
on  the  brain,  because  it  is  extremely  sensitive 
to  antiseptics. 

Finney  sutured  in  place  the  ends  of  the  ring 
and  middle  fingers  seven  hours  after  they  had 
been  cut  off  by  a  machine.  Firm  union  took 
place  within  two  weeks.  When  seen,  at  the 
end  of  three  years,  motion  and  sensation  were 
complete.  Antiseptics  were  avoided  because 
they  form  a  thin  layer  of  coagulation-necrosis, 
which  might  interfere  with  union.— /"/^^'-^  Hop- 
kins I^uUetin. 

Patients,  the  subject  of  pulmonary  phthisis  or 
other  lesions  of  the  air-passages,  by  which  the 
sensibility  of  the  passages  is  greatly  increased, 
when  having  to  undergo  operations  neces- 
sitating the  use  of  an  anaesthetic,  stand  chloro- 
form much  better  than  ether. — American  Fract. 
and  News. 

Dr.  Maurice  Fichardson  {Boston  Med. 
and  Surg.  Jonr.,  No.  7,  1894)  says  that  the 
prognosis  in  uncomplicated  cases  of  pyosalpinx, 
in  which  the  tubes  are  not  greatly  enlarged  and 
can  be  tied  and  removed  without  infecting  the 
peritoneum,  is  very  much  like  that  after  remov- 
ing the  appendix  in  the  interval  between 
attacks.  The  operation  is  very  similar,  and 
the   danger   of   hemorrhage    or    infection    not 

unlike. 

As  a  dressing  for  condylomata  in  women,  Dr. 


C.  E.  Warren  {Med.  Fortnightly)  recommends 
the  following  ointment  which  is  applied  after 
cauterization  : 

R     Beliadonnseext  gr.  xvi 

I  Cocain?e  hydrochlorat gr.  xxxvii 

Vaseline f    ii 

M.  Sig  : — For  external  use. 


THE  TREATMENT  OF  BURNS. 

By  J.  W.  LiNDSEY,  M.D., 
Of  Claysburg,  Pa. 

I  have  no  doubt  that  your  method  of  treat- 
ment of  burns,  advocated  in  the  December  issue 
of  the  College  and  Clinical  Record,  would  be 
a  good  one  in  the  hospital  or  in  a  rich  family ; 
but  where  you  have  poor  people,  and  are  at  a 
great  distance  from  hospitals,  the  object  is  to 
do  good  work  skillfully  and  with  the  smallest 
expense  possible.  Allow  me,  therefore,  to 
present  what  is  partially  a  new  as  well  as  a  very 
successful  mode  of  treating  burns. 

I  was  recently  called  on  about  two  o'clock 
P.M.  by  a  brother  of  a  young  man  set.  18  years, 
who  lived  about  five  miles  from  here.  He 
stated  tome  that  his  brother  had  been  making 
fire  in  an  old  Dutch  oven,  and  used  oil,  and 
when  he  set  the  can  away,  possibly  eight  or  ten 
feet  from  the  oven,  and  lighted  it,  it  ignited  and 
exploded,  pouring  the  oil  almost  all  over  the 
entire  front  surface  of  his  limbs  from  the  knees 
to  his  umbilicus  and  between  his  thighs,  then 
leaving  a  space  of  about  six  or  seven  inches, 
and  involving  the  whole  breast.  His  arms  and 
hands  were  burned  up  to  the  shoulders,  and 
his  right  hand  was  so  badly  drawn  and  burned 
that  the  tendons  of  all  his  fingers  were  jumped 
over  the  last  joints.  His  tongue  was  greatly 
swollen  and  burned,  so  that  the  outer  coating 
came  off;  his  lips  were  about  three  times  as 
thick  as  normal.  The  left  side  ot  the  face  and 
ear  were  badly  burned,  and  the  hair  of  his  head 
was  almost  entirely  burned  away. 

His  penis  and  scrotum  were  also  badly  burned, 
and  for  seven  days  it  was  necessary  to  use  a 
catheter ;  the  scrotum  was  swollen  as  large  as 
three  fists,  and  the  penis  as  thick  as  a  man's 
arm.  He  was  breathing  forty-eight  times  a 
minute,  and  when  breathing  he  would  whistle 
so  that  you  could  hear  him  twenty-five  to  thirty 
feet  away. 

I  gave  him  ^  gr.  sulphate  morphia  every  three 
or  four  hours  until  asleep.  I  reduced  the  ten- 
dons of  his  hand  to  their  normal  places,  and 
dresst-d  him  with  the  following  mixture: 

R.     Sodii  bicarbonatis,  .^xvj 

01.  Hni,  Oij. 

This  made  a  heavy  paste,  which  I  left  on 
until  the  next  day.   I  then  used  : — 


THE   CANADA   MEDICAL   RECORD. 


229 


R.     Sodii  bicarb.,  5xvj 

Acidi  carbolici,  3j 

01.  lini,  Oij.  M. 

Fiat  ungiientum. 
SiG. — Spread   over  the    entire   surface  of  the 
burn. 

1  kept  this  on  for  three  or  four  days. 
In  a   few   days  I   dissected  all    the    burned 
tissues  away  except  on  the  penis  and  scrotum, 
which  I  left  for   about  ten  days  to  two    weeks, 
when  it  healed  off  itself. 

I  then  dressed  him  with  the    following  oint- 
ment : — 


51V 
Oj. 


M. 


R.     lodoformi, 
Zinci  oxidi, 
01.  lini, 
Fiat  unguentiim. 
SiG. — Apply  on  muslin  over  the  affected  sur- 
faces . 

After  a  week  I  substituted    the  following  :  — 

R.  Balm  of  Gilead  buds  juice,  Oj 
Sheep's  tallow,  3  iv 

Rosin,  -  I  j 

]5eeswax,  3  ss.  M. 

Fiat  unguentum. 

SiG. — Apply  on  muslin  cloths  once  or  twice 
a  day. 

On  the  20th  day  I  made  passive  motion  of 
the  elbows  and  fingers,  and  so  on  until  the  3rst 
day,  when  all  was  healed. 

I  did  no  skin  grafting,  and  had  no  trouble, 
as  all  the  healing  was  in  good  condition  trom 
the  beginning.  Granulations  were  set  up  very 
early,  and  continued  in  a  healthy  condition. 

He  is  not  crippled  in  any  manner  except  the 
weakness  of  his  breast,  but  the  muscles  and 
mammary  glands  were  all  burned  away,  and  as 
a  consequence  he  has  not  much  strength.  As 
for  marks,  there  are  very  few,  none  that  show 
on  the  face  or  ear  ;  and  on  his  hands  a  slight 
redness  is  discernible,  but  there  are  no  scars. 
Co//,  and  C/in.  Record.        f 


I 


THE  RELATION  OF  PELVIC  DISEASE 
AND  PSYCHICAL  DISTURBANCES 
IN  WOMEN. 

By  George  H.  Rohe,  M.D., 

Superintendent  of  the  Maryland  Hospital  for  the  Insane. 

In  this  report  for  1892,  I  gave  the  detailed 
history  of  eighteen  case's  of  insanity  in  women, 
in  whom  the  uterine  appendages  were  removed 
for  ovarian,  tubal  or  other  pelvic  disease.  Since 
that  report,  four  additional  cases  were  operated 
upon .  A  review  of  the  cases  will  show,  that 
even  in  apparently  the  most  hopeless  cases  a 
beneficial  effect  upon  the  mental  functions  is 
obtained  by  the  removal  of  a  persistent  source 
of  local  irritation.  Thus  is  one  case  of  hystero- 
epilepsy  with  violent  maniacal  attacks,  lasting 
over  eight   years,  complete  recovery  was   ob- 


tained. In  four  cases  of  puerperal  insanity,  two 
of  over  five  years'  standing,  three  recoveries 
followed  the  operation,  and  the  remaining  case 
was  greatly  improved.  Three  cases  of  profound 
melancholia  recovered  sufticieiitly  to  be  dis- 
charged from  the  hospital.  In  nearly  every 
case  operated  on,  decided  physical  and  mental 
improvement  were  noted.  While  no  clai  n  is 
made  that  gynaecological  operations  arc  generally 
indicated  in  insane  women,  it  is  held  that  where 
sufticient  disease  exists  to  demand  treatment  on 
its  own  account,  the  mental  disturbance  of  liie 
l)atient  should  be  an  additional  reason  for  early 
and  effective  interference.  In  the  present  con- 
servative tendency  among  gynascologists,  there 
is  danger  of  delaying  radical  measures  too  long 
If  this  delay  is  injudicious  in  the  sane,  as  I  firmly 
believe  it  to  be,  it  is  no  less  in  the  insane, 
where  recovery  of  mental  health  may  be  re- 
tarded or  rendered  impossible,  by  hesitancy 
or  neglect. 

I  have  been  subjected  to  criticism,  some  of 
a  rather  savage  character,  for  my  work  in  this 
line.  Some  of  my  critics  know,  confessedly, 
little  of  the  great  advances  made  by  modern 
gynaecology,  while  others  were  no  less  ignorant 
of  the  results  of  recent  studies  of  mental  patho- 
logy. I  have  refrained  from  replying  to  these 
criticisms  because  I  could  afford  to  await  results. 
The  facts  here  presented  will,  lam  sure,  be 
regarded  by  all  unprejudiced  minds  aS' sufticient 
answer  to  the  criticisms  upon  my  course.* — 
7/ic  Co//.  a>id  C/i?i.  Record. 


CLASS-ROOM  NOTES. 

— Prof.  Keen  says  that  Ga//stones  occur 
three  times  as  often  in  women  as  in  men. 

— Syphilis,  Prof.  Brinton  says,  predisposes 
to  the  non  union  of  Fractured  Bones. 

— Prof.  Keen  says  Jaundice  is  a  rare  com- 
plication met  with  in  cases  of  abscess  of  the 
liver. 

— Prof.  Wilson  says  Human  Vaccine  Lympli 
retains  its  vitality  longer  than  the  bovine  lymph. 

— Prof.  Parvin  says  that  the  labor  occurring 
at  the  birth  of  a  male  child  is  generally  longer 
than  that  of  a  female. 

— Prof.  Wilson  says  if,  in  cases  of  typhoid 
fever,  symptoms  of  Peritonitis  arise,  opium 
should  be  administered  freely. 

— Prof.  Parvin  says  a  woman  suffering  from 
Uterine  HeniorrJiage  bears  opium  better  than 
almost  under  any  other  condition. 

— Prof.  Parvin  thinks  that  the  Lochia/  Dis- 
c/iarge  is  less  in  women  who  nurse  their  children 
than  in  those  who  do  not. 

— Prof.  Wilson  says  that  the  tendency  in 
children,  during  an  attack  of  Enteric  Rever, 
is  to  constipation  and  not  to  diarrhoea. 

*The  excellent  table  accompanying  this  paper,  and 
amply  confirming  the  writer's  conclusions,  is  unavoidably 
omitted. 


230 


THE   CANADA   MEDICAL   RECORD. 


— Digitalis,  Prof.  Hare  says,  should  not  be 
administered  in  the  presence  of  high  fever,  as 
it  does  not  act  when  such  fever  exists. 

— Prof.  Wilson  says  that  Diphtheria  is  a 
disease  of  all  climates  and  seasons,  but  thnt 
civilization  predisposes  to  its  occurrence. 

— One  of  the  most  common  complications 
occurring  during  an  attack  of  Infltienza^  Prof. 
Wilson    says,  is    broncho-pneumonia. 

Antipyrine,    phenacetin,     and   acetanilide 

are  the  best   drugs,    Prof.  Hare  says,  that  can 
be  employed  for  the  relief  of  nervous  pain. 

— All  conditions  of  Flatulence,  especially 
gastric  flatulence,  Dr.  Salingei-  says,  will  be 
found  to  be  greatly  benefited  by  dermalol. 

— Grave  cases  oi  Jaundice  occurring  in  re- 
cently born  children,  Prof.  Parvin  regards  as  a 
sign  that  septic  infection  has  taken  place. 

— Vomiting  which  is  present  at  the  onset 
of  an  attack  oi  Scarlet  Fever,  Prof.  Wilson  says, 
will  generally  subside  of  its  own  accord. 

—  Decreased  arterial  tension  and  increased 
venous  pressure  both  cause  Dropsy,  and  in 
both  conditions  Prof.  Hare  says  digitalis  is 
indicated. 

— Arsenic,  Prof.  Hare  says,  has  been  found 
to  be  useful  in  stopping  the  vomiting  occurring 
in  those  suffering  from  Cancer  of  the  Stomach. 

— Prof.  Wilson  says  Human  Lymph  should 
not  be  taken  from  a  child  under  liiree  months 
of  age  if  it  is  desired  to  use  it  for  inoculating 
other  cases. 

— Prof.  Keen  is  of  the  opinion  that  there  is 
scarcely  any  i?^;//^;/  Tumor  that  may  not  under- 
go degeneration  and  become  malignant  in 
character. 

— In  administering  the  bitartrate  of  potas- 
sium as  a  purgative,  Prof.  Hare  says  that  the 
compound  jalap  powder  should  always  be 
comlDined  with  it. 

— Malignant  Tumors  of  the  breast.  Prof. 
Keen  says,  seldom  appear  before  the  age  of 
thirty  five,  excepting  sarcoma,  which  may 
appear  at  any  age. 

— Prof.  Hare  says  it  is  well  always  to  com- 
bine with  chloral  hydrate  a  bromide,  as  the 
chloral  increases  reflex  irritability,  which  the 
bromide  will  prevent. 

— If  during  the  administration  of  Chlorofoi  m 
the  pupils  suddenly  become  dilated,  Prof.  Hare 
says  there  is  great  danger  of  sudden  death  taking 
place. 

—  Vaccination,  Prof.  Wilson  says,  should  be 
performed  in  three  places,  since  the  greater 
the  amount  of  pox  produced  the  greater  is  the 
immunity  that  follows. 

— Cases  of  Diabetes  occurring  in  gouty 
persons,  Prof.  Hare  says,  have  been  found  to 
be  greatly  benefited  by  the  administration  of 
arsenic  combined  with  lithia. 

— Prof.  Hare  says,  that  it  is  much  better  to 
Reduce  the  Temperature   in   cases  of  fever  by 


the  aid  of  cold  baths  or  sponging,  than  by  the 
employment  of  antipyretic  drugs. 

— In  Removing  a  Placenta  from  its  attach- 
ments to  the  uterus,  Prof.  Parvin  thinks  that 
it  is  dangerous  to  pull  on  the  cord  during  the 
period  that  the  uterus  is  contracting. 

■ — Enlarged  glands,  in  cases  of  Carcinoma^ 
should  always  be  removed,  Prof.  Keen  says, 
at  the  time  when  the  tumor  itself  is  removed, 
if  they  be  accessible  in  any  manner  possible. 

— As  a  rule,  Prof.  Keen  says,  Chronic  Obstruc- 
tion of  the  Bowel  is  generally  at  or  below  the 
ileo-cffical  valve,  while  an  Acute  Obstruction  is 
generally  at  or  above  the  ileo-caecal  valve. 

— Prof.  Brinton  says,  that  the  Non-union  of 
a  Fractured  Bone  is  often  due  to  the  fact  that 
on  account  of  the  low  vitality  of  the  patient,  the 
callus,  after  having    formed,  is  absorbed  again. 

— Hemorrhage  occurring  in  a  patient  two  or 
three  weeks  after  the  delivery  of  a  child  has 
occurred,  is  very  frequently  caused.  Prof. 
Montgomery  thinks,  by  retroversion  of  the 
uterus. 

— Alcohol  should  be  administered  to  patients 
suffering  from  Diphtheria,  and  as  a  rule  it  will 
be  found  that  they  are  able  to  take  large 
amounts  without  manifesting  any  bad  symptoms. 

— In  all  cases  in  which  a  Spontaneous  Frac- 
ture of  a  bone  occurs,  without  undue  force 
having  been  applied  to  it,  Prof.  Keen  says, 
malignant  disease  of  the  bone  should  always 
be  suspected. 

— Prof.  Parvin  has  observed  that  Excessive 
Development  in  the  size  of  the  female  breast 
is  of  a  more  frequent  occurrence  than  a  total 
absence  of  the  breast.  But  both  conditions  are 
very  rare. 

— Dr.  Da  Costa  says  that  plugs  of  gauze 
soaked  in  a  strong  solution  of  antipyrine  will 
be  found  very  efficient  in  stopping  Hemorrhage 
from  the  nose,  the  antipyrine  acting  as  a  good 
styptic. 

— Prof.  Parvin  says  Eclampsia,  occurring 
in  a  pregnant  woman  before  labor,  is  fatal  in 
about  fifty  per  cent,  of  cases,  while  if  it  occurs 
after  labor,  it  is  fatal  only  in  about  eight  per 
cent,  of  the  cases. 

— Diarrho'a  due  to  Proctitis,  Prof.  Hare 
says,  will  often  be  cured  by  injections  of  the 
chlorate  of  potassium  in  the  strength  of  twenty 
grains  to  the  ounce, — one  ounce  to  be  injected 
at  a    time. 

— Quinine,  Prof.  Hare  says,  will  have  no 
beneficial  effect  in  cases  of  malarial  fever,  un- 
less it  be  given  soon  enough  before  the  occur- 
rence of  an  attack,  so  that  it  will  be  absorbed 
before  the  attack  manifests  itself. 

— Prof.  Solis-Cohen  says  that  one  of  the  best 
Throat  Washes  in  cases  of  degeneration  of  the 
epithelium  is  five  grains  of  bicarbonate  of 
sodium  to  the  fluid  ounce  of  water,  which  mix- 
ture is  to  be  used  as  a  gargle. 

— All  cases  of  ulcers  which  will   not  yield  to 


THE   CANADA   MEDICAL   RECORD. 


231 


i 


treatment,  Prof.  Keen  says,  should  be  suspected 
of  being  mah'gnant  in  character,  excepting  when 
the  ulcer  be  on  the  leg  and  is  due  to  a  varicose 
condition  of  the   veins. 

— In  making  a  Digital  Examination  in  a 
case  of  face  presentation,  great  care  must  be 
exercised  by  the  obstetrician  ;  it  must  be  made 
very  .gently,  so  that  no  injury  be  inflicted  to  the 
face,  especially  to  the  eyes. 

— Prof.  Parvin  thhiks  that  a  woman,  who 
after  delivery  has  -x pulse  above  100  per  minute, 
is  in  danger  of  having  a  uterine  hemorrhage, 
and  the  obstetrician  should  not  leave  her  until 
the  pulse  has  decreased  in  number. 

— Prof.  Wilson  says  the  following  spray  will 
be  found  useful  in  DiJ>hthe?ia  : — 

R.     Caflfeinte,  gr.xx 

Sodii  bicarb.,  gr.v 

Aquaj,  q.  s.  ad  fsij.         M. 

SiG. — Apply  locally  as  a  spray  to  the  mem- 
brane. 

— Prof.  Hare  says  the  proper  amount  of 
Bismuth  to  be  administered  in  cases  of  exces- 
sive diarrhoea,  or  in  cases  of  excessive  irrita- 
bility of  the  stomach,  is  at  least  ten  grains, 
and  sometimes  as  much  as  sixty  grains  must  be 
given. 

— Prof.  Wilson  fears  the  use  of  the  chlorate 
of  potassium  in  cases  of  Diphtheria,  not  only 
on  account  of  it  not  influencing  the  disease 
favorably,  but  more  on  account  of  the  injurious 
effect  which  it  exercises  on  the  kidneys. 

— Prof.  Keen  thinks  that  the  majority  of  the 
cases  of  Appendicitis  need  no  surgical  inter- 
ference. The  reason  that  so  many  cases  prove 
fatal  which  have  been  operated  on  is  due  to 
the  fact  that  surgical  interlerence  has  been 
done  too  late. 

— In  true  Angina  Pectoris,  Prof.  Hare  says 
the  heart  feels  as  if  it  were  contracted;  while 
in  Pseudo-angina  Pectoris  the  heart  gives  a 
sensation  to  the  patient  as  if  it  were  in  an 
expanded  condition,  too  large  for  the  cavity 
in  which  it  is  contained. 

— The  higher  up  a  Volvulus  of  the  bowel 
has  taken  place,  the  less  will  be  the  amount  of 
urine  voided,  Prof.  Keen  says.  It  is  due  to  the 
fact  that  the  higher  up  the  volvulus  occurs, 
the  less  will  be  the  amount  of  absorption  that 
will  take  place  from  the  bowel. 

— Prof.  Hare  says  in  very  obstinate  Chronic 
or  Subacute  Rheumatism,  which  will  not  yield 
to  the  ordiirary  treatment,  cimicifuga  will 
sometimes  do  good,  especially  in  cases  in  which 
the  rheumatism  is  situated  in  the  muscles 
rather  than  in  the  joints  themselves. 

The  following  local  application.  Prof. 
Hare  says,  will  be  found  serviceable  in  cases 
oi.  Bronrhitis,  occurring  in   infants,  associated 

ith  some  nervousness  : — oil  of  amber  one  part, 
and  olive  oil  three  parts.  This  to  be  applied 
to  the  back  and  front  of  the  chest. 


— For  the  nervous  symptoms  occurring  in 
children  suffering  from  Cholera  Infantum, 
Dr.  Ashton  says  hypodermic  injections  of 
morphia,  sulphate,  gr.  zjy^—  do  and  atropine 
sul])hale,  gr.  siu — -,:m  will  be  found  useful,  but 
their  effect  must  be  carefully  watched. 

— Prof.  Keen  says  that  after  a  patient  has 
passed  through  an  attack  oi  Renal  Colic,  the 
bladder  should  always  be  evacuated  by  a 
Bigelow  or  some  similar  evacuator,  so  as  to  rid 
the  bladder  of  the  stone,  which  if  not  ren  oved 
may  form  a  nucleus  for  the  formation  of  a  large 
stone. 

— Prof.  Parvin  says  that  Fomiti/ig  occurring 
during  the  first  stage  of  labor  is  regarded  by 
some  as  a  good  omen.  But  if  vomiting  occurs 
during  the  second  stage,  accompanied  by 
cessation  of  labor  and  with  exhaustion  of  the 
patient,  the  immediate  delivery  of  the  child  is 
indicated. 

— Prof.  Wilson  recommends  the  following 
treatment  of  Rheumatic  Fever  : — fifteen  grains 
each  of  the  salicylate  of  sodium  and  bicarbonate 
of  sodium  every  hour  until  the  urine  becomes 
distinctly  alkaline.  Then  stop  the  bicarbonate 
and  continue  the  salicylate  until  the  pain  and 
fever  disappear. 


POTASSIUM  PERMANGANATE  AS  AN 
IMMEDIATE  ANTIDOTE  TO  MOR- 
PHIA. 

The  discovery  of  a  reliable  antidote  is  at  all 
times  a  practical  and  decided  step  forward  in 
medical  knowledge  and  in  the  direct  application 
of  relief  to  human  suffering.  These  thoughts 
occur  to  us  at  this  time,  in  view  of  the  recent 
public  exhibition  of  the  fact  that  the  effects  of 
morphia  may  be  counteracted  by  an  antidote 
that  does  not  act  through  any  relation  to  the 
power  of  mydriatic  and  myotic  antagonism,  as 
may  atropia  when  similarly  employed. 

Our  esteemed  contemporary,  the  Boston 
Medical  and  Surgical  Journal,  in  its  issue  of 
February  ist,  1894,  gives  a  detailed  account  of 
the  personal  experience  of  a  New  York  physi- 
cian in  this  hne  of  investigation,  and  expresses 
its  well-founded  views  on  the  procedure  and  the 
antidotal  action  of  the  remedy  employed.  From 
these  we  freely  quote. 

At  a  meeting  of  the  Medical  and  Surgical 
staff  of  the  West  Side  German  Clinic,  42nd 
Street,  New  York,  Dr.  William  Moor,  one  of 
the  physicians  to  the  clinic,  against  the  earnest 
protestations  of  those  present,  swallowed  three 
grains  of  sulphate  of  morphia  in  solution,  and 
immediately  afterward  drank  a  solution  of  four 
grains  of  permanganate  of  potassium  in  four 
ounces  of  water.  He  was  carefully  watched, 
but  none  of  the  ordinary  effects  of  morphia  on 
the  system  were  observed,  and  he  has  since 
stated  that  he  experienced  no  ill  effect  whatever 


232 


THE   CANADA    MEDICAL   RECORD. 


from  the  poisonous  dose  taken .  Dr.  Moor  had 
made  a  special  study  of  therapeutics  and  toxi- 
cology previous  to  the  demonstration  mentioned, 
and  had  experimented  with  rabbits,  and  also  on 
his  own  person.  He  at  first  took  an  eighth  of 
a  grain  of  morphia,  then  a  quarter  of  a  grain, 
then  half  a  grain,  and  finally  three-quarters  of  a 
grain ;  and  when  he  took  permanganate  of 
potassium  afterward^  there  was  no  apparent 
toxic  effect  from  the  morphia.  In  his  demonstra- 
tion at  the  German  Clinic  he  would  have  been 
perfectly  willing,  he  says,  to  take  six  grains  of 
morphia  instead  of  three.  Morphine,  or  any  of 
the  salts  of  opium,  he  claims,  is  immediately 
rendered  harmless  by  contact  with  the  perman- 
ganate. The  antidote  at  once  seeks  the  poison, 
passing  by  the  other  substances  in  the  stomach. 
The  soluble  salt  is  acted  upon  by  the  perman- 
ganate 75,000  times  more  quickly  than  albumin, 
and  several  thousand  times  more  quickly  than 
peptone.  Of  course,  the  antidote  should  be 
administered  as  promptly  as  possible  after  the 
morphia  is  taken. 

Since  this  demonstration,  it  has  been  claimed 
that  the  honor  of  the  discovery  is  really  due  to 
Dr.  William  Condy,  of  London,  and  that  Dr. 
J.  B.  Mitchell  and  other  writers  have  referred 
to  the  efficacy  of  permanganate  of  potassium 
as  an  antidote  ;  but,  at  all  events,  it  is  certainly 
true  that  its  action  in  this  regard  has  never  been 
generally  recognized  by  the  profession.  Lacerda 
recommended  permanganate  as  an  antidote  to 
serpents'  poison.  Experiments  indicate  that 
it  destroys  the  constitution  of  such  poisons 
when  brought  into  direct  contact  with  them, 
but  when  introduced  into  the  general  system 
does  not  control  their  action.  Dr.  Moor  is  now 
engaged  in  making  a  series  of  experiments  to 
test  the  power  of  the  permanganate  as  an  anti- 
dote against  strychnia,  cocaine,  and  other 
poisons.  In  the  case  of  the  first-named,  its 
action  is  said  to  be  much  slower  than  upon 
morphia. 

Morphia  is  well  known  to  be  a  powerful  re- 
ducing agent,  and  it  is  doubtless  by  oxidation 
that  the  permanganate  acts.  As  with  serpent 
poison,  so  with  morphia,  it  is  undoubtedly 
essential  that  the  permanganate  should  enter 
into  direct  contact  with  it.  After  the  morphia 
has  been  absorbed,  the  permanganate  can 
have  no  action  upon  it.  This  physiologico- 
chemical  restriction  necessarily  limits  very 
much  any  value  as  an  antidote  which  it  may 
be  proved  that  it  possesses.  Really,  as  we 
already  hinted,  the  most  surprising  thing  about 
this  incident  which  has  attracted  much  atten- 
tion in  the  daily  press  is  the  fact  that  the 
action  upon  each  other  of  two  substances,  whose 
properties  are  so  well  known  as  are  those  of 
morphia  and  permanganate,  should  not  long 
since  have  been  accurately  determined  and 
described  and  generally  recognized.  As  a 
matter  of  fact,  the  usual  therapeutic  text-books 


and  toxicologies   are  silent  on   this  subject. — 
Ed.    Coll.  and  Clin.   Record. 


RECENT  SUGGESTIONS  IN  THERA- 
PEUTICS. 

Asiatic  Cholera. — Two  or  three  tumblerfuls 
daily  of  infusion  of  black  coffee,  strong  and  hot, 
causes  impiovement  in  patient's  condition, 
increases  secretion  of  urine  and  strengthens 
pulse.  (Prof.  D.  P.  Duebelier,  Vratch,  No. 
42,  1893.) 

Diphtheria. — One-half  to  i  teaspoonful  sj>. 
turpentine  four  times  daily.  Also,  Tr.ferri- 
mur.^  3J  (31  grammes)  ; /^/^.yy.  chlorat.^  giss 
(6  gtammes)  ;  ac.  viiir.  dil.,  ,^ij  (8  grammes)  ; 
glycerin,  q.  s.  ad  |  iv  (124  grammes).  Tea- 
spoonful  every  three  hours;  swab  throat  with 
mixture.  (C.  Ferdinand  Durand,  Archives 
of  Pediatrics,  January,  1894.) 

Acetous  vjpor,  applied  by  the  author  in  one 
case  as  follows  :  One  quart  (litre)  of  malt-vine- 
gar placed  in  a  steam-kettle  on  fire,  pouring  a 
stream  of  vapor  into  the  room  ;  the  child  was 
covered  by  an  umbrella  to  focus  the  steam ; 
tonsils  and  pharynx  painted  with  brandy  every 
two  minutes  until  cough,  expectoration  and 
drowsiness  occurred.  (W.  A.  Greet,  British 
Medical  Journal,  January  27,  1894.) 

Calomel,  i  to  5  grains  (0.065  to  0.32  gram- 
mej,  every  five  hours,  according  to  age  of  pa- 
tient ;  catharsis  checked  by  Dover's  t>owder. 
(W.  R.  McMahan,  Nortlnuestern  Lancet,  Jan- 
uary 15,  1894.) 

Corrosive  sublimate  solution,  i  to  2  per 
1000  ;  Laplace's  solution  {corrosive  sublimate, 
I ;  tartaric  acid,  5  ;  to  water,  1,000) ;  or,  cor- 
rosive sublimate,  i  ;  common  salt,  6 ;  water, 
1,000 ;  2  drachms  (8  grammes)  every  four 
hours  used  as  a  spray  ;  gargle  with  thymol, 
boric  acid,  or  lime-water.  (Esciierich,  Wie- 
ner klinische    Wochenschrift,  vol.  vi,  1893.) 

Dysmenorrhcea. — If  congestive  or  inflam- 
matory, <r//ra/i' ^/;w/  and  quinine,  i  gramme 
(151^  grains)  ;  alcohol  (90  per  cent.),  10  gram- 
mes (2^  fluidrachms)  ;  water,  190  grammes 
(6  fluidounces)  ;  one  teaspoonful  before  meals 
in  a  little  water  or  white  wine,  during  inter- 
menstrual period.  During  period,  salicylate 
of  soda  and  analgesin,z.d,  0.15  gramme  (_J^ 
grain)  every  two  hours,  alternated  with  tincture 
viburnum  prtinifolium,  2  grammes  (31  min- 
ims) ;  Elixir  of  Garus,  30  grammes  (i  fluid- 
ounce  ;  syrup  oi peppermint,  15  grammes  (3^ 
fluidrachms)  ;  distilled  water,  100  grammes 
(3K  fluidounces).  If  pain  be  intense,  with 
excitement  and  insomnia,  give,  ac  bed-time, 
hydrate  of  chloral  and  bromide  of  strontium, 
aa  6  grammes  (i}^  drachms ;  tincture  of  can- 
nib  its  Indie  a,  15  drops  ;  syrup  of  orange-peel, 
60  grammes,  i^  fluidounces).     Tablespoonful 


THE   CANADA   MEDICAL   RECORD. 


233 


in  a  little  fresh  water,  second  dose  during  night, 
if  necessary.  If  stomach  is  fLXtigiied,  injection 
oi  chloral  hydrate^  4  grammes  (i  drachm),  and 
water,  200  grammes  (6J2  liuidounces).  Opium 
not  to  be  employed  in  women  with  tendency 
to  constipation,  as  it  increases  tympanites  and 
dyspeptic  symptoms  If  absolutely  nacessary, 
use  following  injection  :  Laudanum  (Syden- 
ham's), 20  drops  ;  pulverized  camphor^  0.20 
gramme  {i]/{  grains)  ;  yolk  of  egg,  i  :  water, 
200  grammes  (6^  fluidounces).  To  be  admin- 
istered at  night  three  hours  after  last  meal. 

If  membranous,  above  injection  each  evening, 
or  tincture  oi asafcetida^  5  grammes  {\]i  fluid- 
rachms)  ;  tincture  oi  belladonna,  20  drops; 
laudanum  (Sydenham's),  10  drops  :  lukewarm 
water,  100  grammes  (35^  fluidounces).  Every 
four  hours  until  flow  appears,  vaginal  injection 
of  water  at  45^  0.(113^  F-),  2  litres  (quarts) ; 
essence  of  thyme,  20  drops,  (A..  I.utaud, 
Journal  de  Medecine  de  Paris,    December  31, 

Epilepsy. — Injection  to  be  given  in  intervals 
of  attacks  :  Chloral,  2  grammes  (^2  drachni)  ; 
bromide  of  potassium,  2  grammes  (^^  drachm); 
yolk  of  egg,  i  ;  water,  200  grammes  (6 14  oun- 
ces). If  due  to  syphilis,  general  treatment  ; 
mercurial  frictions,  6  grammes  (1^,2  drachms) 
of  ointment  daily  for  three  weeks  or  longer,  with 
iodide  of  potassiu?n  in  progressive  doses  (2,  8, 
10  grammes — ^2,  2,  2)2  drachms — daily). 
When  epileptic  symptoms  cease,  mixed  treat- 
ment :  for  one  month,  3  mercurial  frictions  with 
iodide  of  potassium ;  for  two  months,  after 
meals,  a  tablespoonful  of  the  following  mixture : 
Bromide  of  potassium,  30  grammes  (i  ounce)  ; 
phosphate  of  sodium,  20  grammes  (5  drachms)  ; 
bitter  orangtpeel,  vin  deLtmel,  eacii  250  gram- 
mes (8  ounces).  If  menstrual,  tz;//*///;-///,  0.75 
gramme  (12  grains);  bicarbonate  of  sodium, 
0.25  gramme  (4  grains)  ;  for  i  cachet, — 3  daily, 
I  in  six  hours.  Digitalis,  0.15  to  0.25  gramme 
(2^  to  4  grains)  of  powdered  leaves,  to  be 
added  if  there  is  arterial  hypotension  ;  injec- 
tions of  10  drops  of  laudanum  for  abdominal 
pain.  (Lemoine,  Revue  generale  de  clinique 
et  de  therapeutique,  p.  626,  1893.) 

Opium  treatment  as  prescribed  by  Flechsig : 
Extract  of  opium,  15  grains  (i  gramme)  daily 
for  six  weeks  ;  then  bromide,  30  grains  (2  gram- 
mes) four  times  a  day.  (De  Garmo,  Post- Gra- 
duate, January,  1894.) 

5.  Potass,  bromidi,  3  ss  (16  grammes);  tinct. 
belhidonme,  jiij  (12  grammes)  ;  infusi  gentiance 
CO.,  ad  3  viij  (248  grammes).  M.  Sig.  :  Cap.  3  ss 
(15  grammes)  ter  in  die.  5  Campli.  ?nonobrom., 
gr,  xlviij  (3  grammes)  ;  ext  gentiance,  q.  s.  ut  ft. 
massa,  et  div.  in  pil.  no.  xij.  Sig.  :  Cap.  unam 
I  hora  somni.  (Prof.  D.  Campbell  Black,  i9r/- 
ytish  Medical  Journal,  January  6,  1894.) 

Erysipelas  of  Llmbs. — Patient  ansesthet 
ized,  affected  parts  incited,  fluid  pressed  out, 
and  60-per-cent.  ointment  or  solution  of  ichth- 


yol  rubbed  into  wounds.  A  layer  of  ointment 
is  applied,  covered  by  gauze  or  wool,  and  Hmb 
suspended  vertically.  Dressing  changed  twice 
daily.  (Felsenthal,  Zeitschrift  fiir  Kinder- 
heilkunde,  December,  1S93.) 

Facial,  of  the  petechial,  copper-colored  type: 
Local  applications  of  ;V////o't?/ ointment.  Gene- 
ral treatment  :  Cold  baths,  methodically  given, 
milk  and  alcohol  forming  part  of  diet ;  if  cardiac 
symptoms,  injections  of  neutral  sulphate  of 
sparteine,  o.  10  gramme  (i3/^  grains)  in  twenty- 
four  hours,  divided  in  three  doses.  (Juhel- 
Renoy  and  BoLOGSOSiE,  Archives  generales  de 
medecine,  January,  1S94) 

Local  applications  of  compresses  soaked  in 
solution  of  corrosive  sublimate,  1  to  1000,  as 
hot  as  patient  can  bear,  renewed  as  often  as 
possible.  Sulphate  of  quinine  internally;  diet 
of  soup  and  milk.  (E.  L.  Labanowski,  ^r- 
c hives  de  medecine  et  de pharmacie  milit aires, 
January,  1894.) 

Pilocarpine,  \  grain  (o.oi  gramme)  by  in- 
jection, with  from  15  to  30  minims  (i  to  2 
cubic  centimetres)  of  fluid  extract  oi pilocarpus 
three  times  daily.  In  cases  marked  by  general 
asthenia  or  cardiac  degeneration,  quinine  and 
iron,  with  topical  applications  of  iehthyol  oint- 
ment. (A.  A  EsHNER,  Philadelphia  Polycli- 
nic, January  13,  1894.) 

Creasote,  2  drops  in  acacia  emulsion,  i 
ounce  (30  grammes)  internally  every  three 
hours,  in  teaspoonful  doses  ;  lead-iuater  and 
laudanum  externally.  Improvement  in  two 
days ;  complete  cure  in  five  days.  (J.  W. 
Collins,  Columbus  Medical  Journal,  t^tc^va- 
ber,  1893.) 

Erysipelas  of  the  Newborn. — Sprays  and 
hot  apphcations  of  ^tf/vV  acid,  with  injection 
twice  daily  of  20  grammes  (5  fluidrachms)  of 
salt  water  or  artificial  serum  into  subcutan- 
eous cellular  tissue.  (Lemaire,  These  de 
Paris,  1893.) 

Guaiacol. — Of  value  in  various  infectious 
diseases  of  children.  To  lower  febrile  temper- 
ature, 2  to  3  grammes  (^  to  i  drachm)  ex- 
ternally on  anterior  surface  of  superior  ex- 
tremities. Effect  lasts  from  four  to  six  hours, 
accompanied  by  more  or  less  abundant  pei- 
spiration.  No  untoward  eftects.  but,  being  as 
yet  in  the  period  of  probation,  caution  in  its 
use  is  recommended.  (Federici,  Revue  men- 
siLcll-.  des  maladies  de  tenfance,  January,  1894.) 

Iodoform, — Formulae  in  use  by  author. 
Iodoform  gauze:  Soak  a  piece  of  gauze,  ten 
metres  in  length,  previously  sterilized  by  boil- 
ing, in  following  solution  :  Sulphuric  ether,  700 
grammes  (223.^  fluidounces);  glycerin,  100 
grammes  (33^  fluidounces)  ;  iodoform,  50 
grammes  (1^2  fluidounces).  Wring  out  and 
hangup  in  dark  room  at  temperature  of  30  ° 
C'.  (86*^  F,).  Ethereal  solution  of  iodoform 
for  injections  :  Sulphuric  ether,  95  or  90 
parts ;  iodofornr,    5    or     10    parts.     Iodoform 


234 


THE   CANADA   MEDICAL    RECORD. 


vaseliii  :  White  vnscliti^  90  to  97  grammes  (3 
to  3j^  ounces);  triturated  iodoform,  10  to  3 
grammes  (2}-^  to  ^  drachms).  Iodoform 
Collodion:  10  grammes  (2)^  drachms); 
iodoform,  i  gramme  (i5j<:  grains).  Hard 
iodoform  crayons  (formula  of  the  Bichat  Hos- 
pital) :  Powdered  iodoform,  10  grammes  (2^ 
drachms) ;  giim  tragaca/ith,  0.50  gramme  (7^ 
grains)  ;  \)\xxe  glyceri/i,  sterilized  water,  aa  q.  s. 
as  little  as  possible.  Soft  iodoform  crayons  : 
iocfoform,  S  gra.mmes  (2  drachms)  ;  ^^/<7//«  or 
cacao-luitter,  2  grammes  (31  grains).  (Ter- 
rier, L' Union  Medicate,  December  30,  1893.) 

Meningocele  Removed  by  Operation. — 
Child  about  6  weeks  old.  Tumor  three  and 
one-half  inches  in  height,  eight  and  one-half 
inches  in  circumference  at  largest  part.  Slight 
hydrocephalic  enlargement  of  head.  Base  of 
tumor  and  adjacent  scalp  shaved  and  cleansed 
antiseptically ;  5  ounces  (155  grammes)  of 
clear  fluid  withdrawn.  Skin  divided  by  two 
curved  incisions  at  base,  separating  tumor 
slightly  from  meninges  which  were  transfixed, 
and  cut  across  to  a  similar  on  either  side.  In 
doing  so  a  small  slice  of  brain-subsiance  was 
removed.  Several  small  vessels  ligated,  owing 
to  haemorrhage.  Membranes  and  skin  united 
separately  by  carbolized-silk  sutures,  wound 
dressed  with  dry  lint,  firm  support  being  main- 
tained by  several  strips  of  Mead's  plaster. 
Sutures  from  membranes  and  ligatures  removed 
on  eighth  day.  Ten  monihs  after  operation, 
child  well-nourished,  stout,  bright,  and  in  per- 
fect health,  except  that  hydrocephalus  has 
markedly  increased.  (P.  H.  MacGillivray 
Australian  Medical  Journal,   October,  1893.) 

Migraine. — When  due  to  anaemia  :  Fhena- 
cetin,  10  grains  (0.65  gramme)  ;  sodium  bicar- 
boftat",  10  grains  (0.65  gramme).  M.  ft.  i 
chart.  (De  Gar.mo,  Fost- Graduate,  January, 
1894.) 

Rheumatism. — Compresses  soaked  in  solu- 
tion o{ salicylic  acid,  20  grammes  (5  drachms)  ; 
alcohol,  ICO  grammes  (3^  ounces)  ;  castor  oil, 
200  grammes  (6^  ounces),  night  and  morning, 
to  affected  joints.  Addition  of  5-per-cent. 
chloioform  sometimes  useful.  Salicylic  acid 
present  in  urine  twenty  minutes  after  applica- 
tion of  compresses.  (RuEL,  ^,7;//^  Medicate 
de  la  Suisse  Roman  de.  No.  8,  1893). 

When  not  desirable  to  give  salicylic  acid 
internally,  give  by  rectal  mjection  through  the 
oesophageal  tube,  passed  eight  inches  into  rec 
tum:  90  to  120  grains  (6  to  8  grammes)  sodii 
salicyL;  25  minims  (1.6  grammes)  tinrt.  opii ; 
3  ounces  (93  grammes)  water.  (Erlanger, 
Dcutsches  Arcliivfw  klinische  Medecin^  B.  li, 
H.  2  and  3.) 

Ehctricity;  as  follows:  When  joirits  are 
painful,  current  of  10  to  2c  milliamperes,  in 
various  directions,  from  ten  to  twenty  minutes. 
When  motion  is  difiicult  and  muscles  are  wast- 
ing,   negative  pole  to  muscles  and  nerves,  in- 


terrupting current  frequently  to  cause  contrac- 
tion. Tender  points  touched  with  positive  pole 
and  constant  current  or  faradic  brush  every 
two  or  three  minutes.  (Massy,  Archives 
d' Electricitt  Medicate,  November  15,  1893.) 

Acute  Articular  :  Asaprol,  in  cachets  of 
0.50  to  I  gramme  (7^  to  15)^  grains),  or 
solution  of  asaprol,  15  grammes  (^  ounce)  ; 
water,  250  grammes  (8  fluidounces).  From  3 
to  6  teaspoonfuls  in  twenty-four  hours,  in 
sweetened  water  flavored  \w\ih  anisette  ox cur- 
acao.  Excellent  results  in  15  cases  of  acute 
and  21  cases  of  subacute  rheumatism. 

The  following  may  also  be  employed  in  suit- 
able cases:  Salicylate  of  sodium,  15  grains 
(^  ounce)  ;  water,  250  grammes  (8  fluid- 
ounces).  From  4  to  8  tablespoonfuls  in 
twenty-four  hours  in  sweetened  water,  to  which 
a  small  quantity  of  brandy,  cherry  cordial,  or 
runi  has  been  added.  If  but  4  gr.ammes  (i 
drachm)  of  salicylate  of  sodium  are  g^ven  daily, 
doses  every  four  hours;  if  8  grammes  (2 
drachms),  every  two  hours.  Diuretics  to 
facilitate  elimination  of  drug.  Continued 
in  doses  of  2  to  4  grammes  (^  to  i  drachm)  for 
ten  days,  to  prevent  relapse.  (Dujardin- 
Beaumetz,  Bulletin  general  de  Therapeutique, 
January   15,  18^4.) 

Tabes  Dorsalis. — For  lif^htning  pains, 
phenacitin,  0.50  gramme  (7^  grains)  in  wafers 
every  half-hour  until  4  grammes  (i  drachm) 
have  been  given.  If  not  well  borne  phenozone 
hypoderm  atically ,.  or  hydrochlorate  of  morphine 
combined  with  sulphate  of  atropine  hypoder 
matically.  (Grasset,  fournal  de  Medecine  de 
Paris,  No.  48,  1893.) 

Traumatic  Tetanus. —  Chloral,  7  grains 
(0,45  gramme)  hourly,  with  4  drops  of  freshly- 
prepared  fluid  extract  of  calabar-bean  every 
two  hours,  brought  about  recovery  in  five 
weeks  in  a  boy  of  10  years.  (Radcliffe, 
Medical  Press  and  Circular,  January,  3,  1894. 

Whooping-Cough. — Bronioform,  lauded  by 
various  authors  in  this  affection,  may  cause 
toxic  symptoms  unless  care  be  observed  in  its 
administration.  The  last  dose  in  the  bottle 
may,  owing  to  the  weight  and  insolubility  of 
bronioform,  contain  an  excess,  no  matter  in 
what  way  it  may  be  suspended.  This  last  dose, 
therefore,  should  be  thrown  away,  or  the  drug 
supplied  in  a  pure  form,  the  nurse  being  in- 
structed to  supply  each  dose  separately.  (F  W. 
Burton-Fanning,  British  Medical  Journal, 
January,  6,  1894.J 

Hydrochlorate  of  quinine,  three  times  daily, 
at  6  A.M.,  2  P.M.,  and  10  p.m.  Dose,  o.oi 
gramme  (^  grain)  for  each  month  of  child's 
age,  o.io  gramme  (i^  grains)  for  each  year; 
not  more  than  0.40  gramme  (6  grains)  for  child 
cf  4  years.  When  improvement  occurs,  reduce 
to  two  doses  daily ;  after  complete  cure,  one 
dose  at  night  for  some  time.  Of  special  value 
when   pulmonary    complications   are   present. 


THE   CANADA   iMEDICAL   RECORD. 


235 


(Baron,  Annalcs  dc  la  Soc let c  medic o-chirur Al- 
caic lie  Liege,  December,  1893.) 

F/ienacetin,  8  grains  (0.52  gramme);  glycerin, 
3  ounces  (93  grammes).  Half  a  teaspoonful 
to  a  child  i  year  old  every  two  hours  until 
paroxysms  become  fewer  and  less  intense.  (G. 
G.  Thornton,  Medical  Brief.  February, 
1894.) —  Universal  Medical  Journal. 


I 


PATHOLOGICAL  SOCIETY  OF  LONDON. 

Meeting  of  December  19,  1893. 

Dr.  SoLTAU  Fenwick  presented  a  specimen 
of  diphtheria  of  the  stomach  from  a  child  of  3 
years  who  had  suffered  from  ci'oup.  Dyspnoea 
coming  on,  tracheotomy  was  performed,  but 
death  followed  next  day.  At  the  post-mortem 
examination,  primary  laryngeal  diphtheria  was 
-  found,  extendmg  down  into  the  finer  ramifica- 
tions of  the  bronchial  tubes,  the  tonsils,  phar- 
ynx, and  oesophagus  being  free  from  the  dis- 
ease. The  stomach  was  entirely  lined  with 
membrane,  extending  into  the  pylorus  a  dis- 
tance of  one-third  inch.  The  lymphoid  tissue 
of  the  mucous  membrane  itself  was  consider- 
ably increased.  'I  he  interesting  features  of  the 
case  were  the  involvement  of  the  entire  surface 
of  the  stomach,  the  absence  of  membrane  in 
the  pharynx  and  cesophagus,  the  complete 
anorexia  and  vomiting,  and  the  absence  of 
free  hydrochloric  acid  from  the  contents  of  the 
stomach.  Diphtheria  of  the  stomach  is  rare, 
and  occurs  almost  always  in  connection  with 
pharyngeal  diphtheria  in  children.  Mr.  S.  G. 
Shattock  had  seen  a  similiar  case,  in  which 
the  oesophagus  had  been  free. 

Mr.  BowLBY  showed  for  Mr.  Paul,  of  Liver- 
pool, a  tooth-bear  i?ig  dermoid  of  the  face.  The 
patient,  a  boy  of  5  years,  was  born  with  an  ir- 
regular patch  of  skin  on  the  left  cheek,  in 
which  a  tooth  appeared  some  six  months  prior 
to  observation  and  removal.  The  tumor  had 
no  connection  with  the  bone,  and  no  teeth 
were  missing  from  the  jaws.  The  tooth  was 
a  left  upper  lateral  incisor,  and  beneath  it  there 
was  a  second,  smaller,  and  corresponding  to 
that  of  the  permanent  set. 

Dr.  Felix  Semon  and  Mr.  S.  G.  Shattock 
reported  the  sequel  of  a  case  of  anomalous 
tumo>  of  the  larynx,  which  they  had  brought 
to  the  notice  of  the  society  in  May,  1891.  The 
growth  sprang  from  the  left  arytaeno-epi- 
glottidean  fold,  and  appeared  like  an  angioma. 
After  removal  by  the  galvano  caustic  loop 
it  was  seen  to  be  a  delicate  papilloma  incased 
in  a  shell  of  partly  fresh,  partly  organized 
blood-clot.  The  authors  had,  at  the  time, 
called  attention  to  the  unusual  situation 
of  the  tumor,  to  its  structure,  which  was  more 
like  that  of  papillomata  of  the  bladder  than  of 
the  upper   air-passages,  and  to  the  unique  fact 


of  spontaneous  haimorrhages  occurring  in  con- 
nection with  and  the  formation  of  a  blood-shell 
around    the   papillary   growth.     Four   months 
after   operation   there  was  a  recurrence  of  the 
growth,  and  in  a  month  and  a  half  it  was  larger 
than    it    had  been    originally.     It     was  again 
removed  in  the  same  manner,  and,  evidences  of 
malignancy  being    present,    subhyoid  pharyn- 
gotomy  was  performed  and  the  tumor  radically 
removed.     The  patient,  a  man  of  44  years,  died 
four  days  after  operation.     At  the  post-mortem 
examination,  oedema  and  intense  congestion  of 
the    brain  were   found,  but    no  cause    for  this 
condition  could  be  determined.     Histologically 
the  growth  was  papillary,  delicate  and  thickly 
incased   with  blood-clot,    extensions    of  which 
passed  between  the  different  processes  compos- 
ing  the  tumor.     The    investing   epithelium  of 
the  mucous  membrane  was  quite  distinct  from 
that   of  the   growth,    consisting  of    stratified 
squamous  cells,  while  the  other  was  made  up  of 
cubical  or  cylindrical  cells,  not  more  than  one 
layer  in  thickness  in  some  places.    The  growth 
projected   beyond   the  general  surface,  and  in- 
filtrated the    deep  parts,    resembling   in  this  a 
columnar-celled  or  duct  carcinoma  of  the  breast, 
with  which  the  authors  compared  it,  regarding 
it  likely  that  the  growth  arose  from  the  mucous 
glands.     Assuming  this  to  be  the  origin,  in  the 
process  of  growth,  a  portion  projected  from  the 
surface,  allowing  of  removal,  while  it    extended 
deeper,  infiltrating  the  structures  below  the  level 
of  the  mucous  membrane,  and  beyond  the  reach 
of  operation.     The  haemorrhage  was  explained 
by    the   delicacy  and  vascularity  of  the  tumor. 
This  is   the  first  case  described  in  which  a  pri- 
marily malignant  disease  of  the  larynx  simulated 
in   its   early  stages  an  angioma.     Mr.  Lennox 
Browne,  who    had  previously  stated  that  this 
tumor  might  have  been  an  instance  of  the  trans- 
formation of  benign  into  malignant  growths  by 
endo-laryngeal   operations    with    the    galvano- 
cautery,  withdrew  this  statement  after  the  record 
of  the  histological  examination. 

Dr.  Rolleston  reported  three  cases  of  me- 
diastinal abscess  if  I  cotifiection  with  the  cesopha 
gus.  The  first  patient  was  a  woman  of  30 
years,  who  suffered  from  sore  throat,  and  who 
presented  a  swelling  on  the  right  side  of  the 
neck  above  the  clavicle.  There  was  some  dys- 
phagia, and  pus  mixed  with  blood  was  coughed 
up.  Death  occurred  from  haemorrhage.  The 
cause  of  suppuration  was  obscure,  there  being 
no  disease  of  the  bones.  In  the  second  case 
suppuration  followed  a  stricture  due  to  a  cor- 
rosive poison,  and  took  place  around  the  middle 
of  the  oesophagus.  The  third  case  was  in  a  man 
of  50,  who,  following  a  violent  effort,  was  seized 
with  pain  and  vomiting.  Pleural  effusion  de- 
veloped in  left  side,  and  death  occurred  in  two 
days.  The  cause  of  the  perforation  of  the 
oesophagus  was  not  known,  though  apparently 
it  bore  some  relation  to  the  violent  effort. 


2\6 


THE   CANADA   MEDICAL   RECORD. 


EDINBURGH    MEDICO-CHIRURGICAL 
SOCIETY. 

Meeting  of  December  6,  1893. 

Dr.  Graham  Brown  called  attention  to  cer- 
tain changes  in  the  circulation  caused  by 
pyrexia.  In  order  to  determine  the  viscosity 
of  the  blood  at  different  temperatures,  he  has 
devised  an  ingenious  apparatus  by  which  the 
rate  of  blood-flow  can  be  directly  calculated. 
By  means  of  a  formula  he  is  able  to  determine 
the  rate  of  flow  of  distilled  water  at  any  temper- 
ature, given  the  rate  of  flow  at  another.  This 
formula  holds  good  for  water,  solutions  of 
serum-albumen,  serum-globulin,  phinogen,  and 
blood-plasma.  If,  however,  detibrinated  blood 
were  used,  the  results  were  not  in  accord,  since 
heat  decreased  its  viscosity  much  more  than 
when  the  same  fliid  did  not  contain  the  corpus- 
cular elements.  The  calculations  of  the  author 
seem  to  indicate  that  in  fever  the  heart  would 
have  about  one-tenth  less  work  to  do  in  driving 
the  blood  through  the  vessels,  solely  taking  into 
account  its  decreased  viscosity. 

Mr.  A.  G.  Miller  showed  two  patients  with 
strumous  disease  of  the  extremities,  whom  he 
had  treated  by  Bier's  ;/<?z£/  method  of  passive 
congestion.  One  patient  had  suffered  from  lupus 
vulgaris  of  both  feet.  One  leg  treated  by  pas- 
sive congestion  healed  sooner  than  the  other, 
which  had  been  treated  without.  A  tourniquet 
should  be  applied  with  sufficient  force  to  stop, 
in  great  part,  the  venous  return,  lengthy  appli- 
cations being  of  more  service  than  short 
alternations  of  pressure  and  relaxations.  The 
method  is  bastd  upon  the  theory  that  conges- 
tion exercises  an  influence  upon  the  growth  of 
tubercle  bacilli,  as  evidenced  by  the  fact  that 
a  congested   lung  rarely  becomes  tuberculous. 

Dr.  Caird  showed  a  case  in  which  he  had 
performed  JVietze/'s  gastronomy.  The  oper- 
ation was  begun  in  the  usual  manner,  and  an 
opening  large  enough  to  admit  an  ordinary 
lead-pencil  was  made  into  the  stomach.  An 
India-rubber  tube  of  the  same  size  was  in- 
troduced and  stitched  to  the  walls  of  the  stomach 
with  catgut,  the  tube  being  then  enveloped  in 
the  walls  for  a  short  distance  and  stitched 
around  it  so  as  to  form  a  sort  of  oesophagus. 
The  tube  was  then  brought  through  the  wound 
which  was  stitched  around  it  in  the  usual  way. 
The  tube  thus  entered  the  stomach  in  a 
totuous  manner,  thus  preventing  loss  of  food 
by  regurgitation  or  vomiting. 


RECENT  SUGGESTIONS  IN  THERA- 
PEUTICS. 

AMENORRHOiA. — If  due  to  an?emia  :  R  Qui- 
nin.  sulphat.,  .^iij  (4  grammes)  ;  tinct.  ferri 
chtorii/i,  siss  (46  grammes)  ;  aquce  dest.,  giv 
(124  grammes).     M.    Teaspoonful  four    times 


daily.  If  nervous  symptoms  and  headache, 
bromides;  if  hysteria,  7nusk,  asafi'tida,  and 
camphor-gum.  (William  Henry,  St.  Louis 
Medical   and    Surgical  fournal,   December, 

1893-) 

AN.T.MIA. — When  due  to  defects  in  digestion  : 
3  Hcemogallol,  3ij  (8  grammes)  \fel,bovisinsp,, 
r.  xl  (2.60  grammes)  ;  ext.  pancreatini,  3  ij 
(8  grammes) ;  strychnia  sulp.,  gr.  j  (0.06 
gramme)  ;  caffei/ue  mur.,  .^j  (4  grammes) ;  ext. 
colocynth.,  gr.  x  to  xx  {0.65  to  1.30  grammes)  ; 
ext.  tarax,,  3J  (4  grammes).  M.  et  fiat  pil  xl. 
Two  t.  i.  d.  after  meals.  If  overstimulation 
from  strychnine  and  caffeine,  reduce  dose  to  i 
capsule  t.  i.  d.  before  meals.  (W.  H.  Pokter, 
Fost-Graduate,  December,  1893.) 

Cancer. — Caustics  :  officinal  solution  of 
chloride  of  zinc ;  Michel's  paste  ;  sulphuric 
acid  dSi^  asbestos  ;  Bongaid's  paste — chloride 
of  zinc ,  arse?iic,  corrosive  sublimatCy  and  other 
substances  made  into  paste  with  wheat-flour. 
Surgery  to  be  rarely  resorted  to.  (Rodman, 
American  Practitioner  and  News,  December 
2,  1893.) 

Chancroids  of  Female  Genitals. — Tho- 
roughly wash  away  secretions  fiom  ulcer,  and 
neutralize  with  antiseptic.  Cleanse  twice  daily 
with  hot  antiseptic  douches  of  bichloride  of  mer- 
cury, I  to  3000,  or  5  per  cent,  carbolic  acid. 
Apply  carbolic  acid  C.  P.  ;  and  when  ulcers  are 
small  and  not  too  close  to  bladder  or  meatus 
urinarius,  use  a  strong  caustic  {iiitric  acid) 
until  all  diseased  tissue  is  destroyed.  Neutra- 
lize acid  with  solution  of  potassium  hydrate  or 
bicarbonate  of  soda  ;  apply  iodoform,  aristol, 
acetanilid,  boric  acid,  or  other  good  antiseptic. 
(E.  C.  Davis,  Atlanta  Medical  and  Surgical 
fournal,  December,  1893.) 

Endometritis. — Curettage,  with  use  of  endo- 
uterine  injections  of  an  alcoholic  solution  of 
euphorin  and  sterilized  olive-oil  in  equal  parts. 
The  liquid  is  injected,  by  means  of  a  Braun 
syringe,  immediately  after  curetting,  and  every 
four  or  five  days  afterward,  until  cure  results. 
This  treatment  is  successful  where  curettage 
alone  is  inadequate.  (Pinna-Pintor,  Rassegna 
d'ostetricia  e  ginecologia,^o.  10,    1893.) 

Influenza. — Benzol,  in  form  of  emulsion, 
in  lemonade,  5  minims  (0.32  gramme)  every 
two  and  a  half  hours.  General  discomfort  dis- 
appears about  two  hours  after  first  dose. 
Temperature  normal  within  twenty-four  hours. 
(Wm.    Robertson,    Laticet,    November    11, 

1893-) 

Mental  Diseases. — Duboisme  2l%  a  sedative 
is  prompt  in  action  and  easy  of  administration. 
To  be  used  preferably  in  the  evening.  Espe- 
cially indicated  in  acute  insanity  and  alco- 
holism and  in  violent  mania.  Dose,  i^  milli- 
grammes (^  grain),  maximum ;  5^  milli- 
gramme /j^  grain),  minimum.  (Mongert, 
Monograph,  Milan,  1893.     Tip.  Capriolo.) 


THE   CANADA    MEDICAL   RECORD. 


-'37 


THE  CANADA  MEDICAL  RECORD 
Published  Moxtuly. 


Su^jscrif'tion  Price,  $2.00  per  annum  in  adrance.     Single 
Copies,  20  cts. 

EDITORS  : 

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London 
F.  WAYLAND  CAMPBELL,  M-A  .  M.D.,  L.R.C.P.,  Londou 

ASSISTANT  EDITOK 

ROLLO  CAMPBELL.  CM.,  M.D- 

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Editor. 


MONTEEAL,  JULY,  1894. 

CANADIANS  IN  THE  UNITED  STATES. 

During  a  recent  visit  to  the  Pacific  Coast  we 
were  greatly  impressed  at  meeting  so  many 
Canadian  graduates  settled,  and  for  the  most 
part  doing  remarkably  well,  all  through  the 
United  States.  One  hardly  knows  which  lo 
admire  the  more  :  the  average  high  character 
scientifically  and  morally,  of  the  Canadian  gra- 
duates, or  the  generous  manner  in  which  they 
have  been  received  and  welcomed  by  our 
wealthier  neighbors.  It  is  true  that  most  of 
them  are  now  naturalized  American  citizen-^, 
but  we  cannot  for  that  reason  cease  to  take  a 
deep  interest  in  their  welfare  and  success.  It 
was  especially  pleasing  to  see  at  the  San  Fran- 
cisco meeting  of  the  American  Medical  Associ- 
ation a  former  Canadian,  and  a  graduate  of 
Queen's  College,  Kingston,  awarded  the  high- 
est honor  in  the  gift  of  the  profession,  namely, 
the  election  to  the  position  of  president  for  the 
ensuing  year.  In  some  of  the  cities,  such  as 
Detroit,  more  than  half  of  the  practitioners 
are  Canadians,  while  in  others,  such  as  San 
Francisco  and  Chicago,  many  of  the  most 
prominent  physicians  have  come  from  one  or 
other  of  the  provinces  of  Canada.  It  was  also 
very  pleasing  to  note  the  general  elevation  of 
the  standard  of  medical  education,  all  over 
the  United  States.  As  everyone  is  aware,  some 
of  the  finest  medical  schools  in  the  world  were 
to   be  found    in  New  York,  Philadelphia  and 


Boston  many  years  ago.  But  at  the  i-ame  time,- 
graduates  from  medical  schools  with  only  two 
six  months  courses  of  study  were  allowed  to 
practise  inmost  of  the  States.  All  this  is 
changed,  and  since  a  few  years  one  Slate  after 
another  has  required  that  its  practitioners 
shall  have  studied  for  three  and  in  some  casts 
four  years  before  being  allowed  to  practise. 
In  bringing  this  much  desired  state  of  affairs  to 
pass,  two  men,  we  think,  chiefly  deserve  the  cre- 
dit,—one  who  is  still  living  and  full  of  honors, 
Dr.  Osier,  formerly  of  Montreal,  but  now  of 
Baltimore  ;  and  the  other,  Dr.  Ranch,  of  the 
Illinois  State  Board  of  Health,  who  unfortun- 
ately has  since  paesed  away.  By  the  aid  of  the 
powerful  pens  of  the.se  two  men,  the  one  in 
the  East  and  the  other  in  the  West,  the  Medi- 
cal Profession  of  the  United  States  bids  fair  in 
a  few  years  to  be  second  to  none  in  the  world, 
for  character  and  learnins:. 


CANADIAN  MEDICAL  ASSOCIATION. 

We  lake  special  pleasure  in  calling  the  atten- 
tion of  our  readers  to  the  annual  meeting  of  the 
above  Association,  which  is  to  be  held  this  year 
at  St.  John,  New  Brunswick,  on  the  22nd  of 
August.  The  latter  month  has  been  chosen 
instead  of  September,  because  it  was  thoi  ght 
that  it  would  be  more  convenient  for  the  major- 
ity of  members  to  get  away  for  their  holidays 
;.t  that  time.  We  earnestly  hope  that  every 
practitioner  in  Canada  will  make  an  effort 
to  attend  this  meeting.  We  should  remem- 
ber that  it  is  a  national  society,  and  it  will  only 
be  by  our  united  efforts,  either  in  reading  papers 
or  being  present  to  listen  to  them  and  discuss 
them,  that  the  Association  can  become  worth v 
of  the  nation.  The  railway  rate  will  be  either 
a  single  fare  for  the  return  trip,  about  thirteen 
dollars,  or  at  most  a  fare  and  a  third,  about 
eighteen  dollars.  After  the  meeting  there  are 
delightful  side  trips  up  the  St.  John  River,  or  up 
the  Kennebecasis,  or  across  the  Bay  of  Fundy 
to  Windsor  and  Halifax,  or  over  to  Portland 
and  Orchard  Beach.  Unless  word  is  received 
to  the  contrary,  those  who  intend  being  present 
should  pay  the  full  single  fare,  and  obtain  a  re- 
ceipt for  the  same  before  starting.  On  present- 
ing this  to  the  Secretary  at  the  meeting  they 
will  obtain  an  order  for  the  return  trip  at  one- 


238 


THE   CANADA   MEDICAL   RECORD. 


third  lare.  Tr.e  profession  of  St.  John  is  noted 
for  its  hospitality,  while  the  list  of  papers  pub- 
lished elsewhere  guarantees  that  the  meeting 
will  prove  an  intellectual  feast.  We  trust  that 
the  medical  men  rf  Montreal  and  neighboring 
towns  will  send  a  contingent  large  enough  to 
be  worthy  of  the  occasion,  and  to  show  that  we 
are  as  willing  to  make  considerable  sacrifices 
in  order  to  attend  the  meeting  when  held  in  the 
East  as  we  expect  our  brethren  to  be  when  it  is 
their  turn  to  leave  home.  Let  everyone,  then, 
make  a  special  effort  to  attend  the  meeting  at 
St.  John  on  the  22nd  August,  when  we  feel  sure 
they  will  be  amply  repaid. 


CANADIAN    MEDICAL    ASSOCIATION. 

Elaborate  preparations  are  being  made  in 
St.  John,  N.B  ,  for  the  reception  of  the  Cana- 
dian Medical  Association  on  Aug.  22nd  and 
23rd  next.  The  gathering  will  probably  be 
one  of  the  largest  the  Association  has  ever 
had.  From  reports  that  come  in  from  time  to 
time  it  is  believed  that  the  profession  of  the 
Maritime  Provinces  will  turn  out  almost  to 
a  man.  From  Montreal,  Toronto  and  points 
fuither  West  there  will  be  large  delegations. 

The  following  are  some  of  the  papers 
promised  :  Cases  in  practice — R.  J.  McKechnie, 
Nanaimo,  B.C.  ;  A  Year's  Experience  in  Appen- 
dicitis—Jas.  Bell,  Montreal  ;  A  Case  of  Tuber- 
culosis of  Arm  of  14  years'  standing  cured  by 
inoculation  with  erysipelas— W.  S.  Muir,  Truro, 
N.S.  ;  The  Treatment  of  Diseases  of  the  Ovaries 
and  Fallopian  Tubes— A.  Lapthorn Smith,  Mon- 
treal; Intestinal  Antisepsis  in  Typhoid  Fever — 
D.  A.  Campbell,  Halifax,  N.S.  ;  The  Use  and 
Abuse  of  the  Various  Cautery  Agents  in  the 
'I'reatmcnt  of  Nasal  Affections— E.  A.  Kirk- 
patrick,  Halifax,  N.S. ;  The  Present  Status  of 
Asthenopia— F.  BuUer,  Montreal;  Eye-Strain 
Headaches— S.  H.  Morrison,  St.  John,  N.B. ; 
Note  on  Epilepsy- W.  H.  Hattie,  Halifax, 
N.S. ;  Influence  of  Mind  on  Disease— J.  A. 
McKay,  Watfor,  Ont.  ;  Miners  heart— R.  A. 
H.  MacKeen,  Cow  Bay,  Cape  Bi-eton,  N.S.  ; 
Address  in  Surgery — S.  F.  Black,  Halifax, 
N.S.  ;E.  C.  Praeger,  Nanaimo,  B.C.;  Some 
Functional  Derangements  of  theLiver —  F.  E. 
Graham,  Toronto  ;  Treatment  of  Certain  Forms 
of  Uterine  Haemorrhage- F.  S.  Bibby,  Port 
Hope  ;  Address  in  Medicine— Wm.  Bayard,  St. 
John,  N.B.  ;  Ophtnalmic  and  Aural  Cases — 
Stephen  Dodge,  Halifax,  N.S. ;  Lengthened 
Sittings  in  Lithaplaxy — S.  Francis  Teed,  Dor- 
chester, N  B. 

Papers  will  be  read  in  the  order  in  which 
they  are  received  by  the  Secretary.   It  is  impor- 


tant that  those  intending  to  contribute  papers 
will  communicate  with  the  Secretary  at  an 
early  date. 


A  NEW  BILL  FOR  THE  ESTABLISH- 
MENT OF  A  NATIONAL  BUREAU    OF 
HEALTH. 

The  new  Bill,  prepared  by  Committee  of 
the  New  York  Academy  of  Medicine,  for  the 
establishment  of  a  National  Bureau  of  Health 
in  the  Department  of  the  Interior,  promises,  if  ^ 
it  meets  with  favorable  consideration  in  Con-  fl 
gress,  to  give  to  the  country  the  most  satisfac- 
tory national  health  organization  that  has  yet 
been  proposed. 

The  Bureau,  in  accordance  with  the  provision 
of  the  Bill,  would  consist  of  a   Commissioner  , 
appointed  by  the   President,  and  an  Advisory 
Council  made  up    of  delegates,  one  from  each     «S 
State,    designated  for  this    service  by  the  res-     T 
pective  governors. 

If,  as  might  reasonably  be  expected,  the 
members  of  the  Couiacil  are  selected  from  the 
State  Boards  of  Health,  there  would  then  be 
brought  to  the  support  of  the  national  organiz 
ation  the  influence  of  a  body  of  men  each  of 
whom  has  a  well-recognized  position  in  his  own 
community  and  a  legitimate  influence  upon 
the  representatives  of  his  State  in  Congress. 
Their  presence  on  a  national  board  would  go 
far  to  remove  the  vague  fears  that  have  pre- 
vailed in  some  quarter  as  to  the  tendency  of  a 
purely  central  oi-ganization  to  usurp  powers, 
which  could  more  safely  and  wisely  be  left  to 
local  authoiities. 

The  duties  of  the  Bureau  would  be  to  collect 
and  diffuse  information  upon  matters  affecting 
the  public  health,  including  statistics  of  sickness 
and  mortality  in  the  several  States;  the  investi- 
gation of  experimental  and  other  methods  and 
means  of  prevention  of  the  causes  of  diseases  ; 
the  collection  of  information  with  regard  to  the 
prevalence  of  contagious  and  epidemic  diseases, 
both  in  this  and  other  countries ;  the  publica- 
tion of  the  information  thus  obtained  in  a 
weekly  bulletin  ;  to  prepare  rules  and  regula- 
tions for  securing  the  best  sanitary  condition  of 
vessels  from  foreign  ports,  and  for  the  preven- 
tion of  the  introduction  of  infectious  diseases 
into  the  United  States,  and  their  spread  from 
one  Slate  into  another,  which  rules,  when 
approved  by  the  President  of  the  United 
States,  shall  have  the  force  of  law;  and  to  as- 
certain, by  a  suitable  system  of  inspection,  that 
these  rules  are  properly  carried  out  and  en- 
forced ;  to  advise  and  inform  tiie  several  de- 
partments of  the  government,  and  executive 
and  health  authorities  of  the  several  States  on 
such  questions  as  may  be  submitted  by  them 
to  it,  or  whenever,  in  the  opinion  of  the  Bureau, 


THE  CANADA.  MEDICAL  RECORD. 


239 


such  advice  and  inlbrniation  may  tend  to  the 
j)rescrvaiion  and  improvement  of  the  public  | 
health ;  and  in  general  to  be  the  agent  of  the  ' 
general  government  in  taking  such  action  as  | 
will  most  effectually  protect  and  promote  the  j 
health  of  the  people  of  the  United  States.  j 

The  Act  provides  that  this  Bureau    shall  be  I 
responsible  for  the  making  of  those   rules  and  | 
regulations  which  are  the  foundation  of  systems  ; 
of  quarantine  between  the  various  States  of  the  I 
Union    as  well   as    between  nations  ;  yet  these 
rules,  having  first  received  the  approval  of  the 
President,    are    to    be   executed,    as    hitherto, 
under   the    supervision    and   authority  of  the 
Treasury  Department.     While  this  limitation  of 
ihe  Treasury  Department  to  purely  executive 
functions   may   be    distasteful   to   the  Marine- 
Hospital  Service^  it  can  hardly  be  claimed,  on 
the  other  hand,  that  this  body  could  adequately 
perform  the  multifarious  duties  above  set  forth. 
One  function  is   bestowed  upon  the  Bureau, 
which   is  peculiar  to  this  bill,  and  would  pro- 
bably be  of  great   benefit — the    duty   of  the 
Bureau  to  inspect  and  report  upon  the  conduct 
of  the  quarantine  establishments  formed  under 
the  provisions  of  this  Act. 

State  and  municipal  authorities  are  permitted 
to  enforce,  if  they  so  elect,  such  measures  as 
are  directed  by  the  President,  in  accordance 
with  the  recommendations  of  the  Bureau  ;  but 
if  such  authorities  fail  or  refuse  so  to  QO,  then 
the  President  shall  enforce  the  rules  by  such 
means  as  may  seem  appropriate  to  him. 

T  e  quarantine  sections  of  the  Bill  have, 
evid  ntly,  been  very  carefully  framed;  and  fol- 
low closely  the  provisions  of  Senator  Harris's 
bill.  No  member  of  the  Senate  has  been  more 
interested  in  public  health  legislation  than  the 
member  from  Tennessee,  nor  is  there  anyone 
whose  opinion  would  have  more  weight  in  that 
body. 

The  Bureau  is  especially  directed  to  take  such 
action,  by  correspondence  or  conference,  as  will 
tend  most  effectually  to  secure  the  co-operation 
ofState  and  local  boards  of  healthjin  establishing 
.nd  maintaining  accurate  systems  of  notifica- 
tion of  the  existence  and  progress  of  contagious 
and  infectious  diseases,  and  to  extend,  if 
possible,  such  systems  to  foreign  countries. 

In  general,  the  motive  that  appears  to  have 
prevailed  in  the  making  of  this  Bill  is  the  one 
which  has  led  to  the  most  useful  public  health 
bodies  which  the  country  has  so  far  had.  That 
is  to  say,  the  intention  seemed  to  have  been  to 
create  a  central  health  authority,  the  business 
of  which  shall  be  the  collection  of  all  sanitary 
knowledge  and  the  prompt  diffusion  of  the 
same. 

ilf  this  Bureau  is  able  to  deserve  the  confi- 
dence of  the  country,  experience  with  similar 
bodies  tells  us  that  executive  functions  will 
from  time  to  time  be    given  to  it.     The  almost 


gress  is  involved  may,  ])ossibly,  prevent  this 
nev,'  measure  from  receiving  the  consideration 
it  fairly  deserves;  but  the  bill  has  been  so 
carefully  prepared  and  so  wisely  framed  that 
we  hope  it  may  be  insistently  presented  at 
Washington  until  favorable  action  is  taken. — 
Boston  Medical  and  Sur?ical Journal,  March 
8,  1894. 


BODK  NOTICES. 

An  International  System  of  Electro- The- 
rapeutics :  for   Students,  General  Practi- 
tioners  and   Specialists.     By    Horatio  R. 
Bigelow,    INI.D.  ;    and  thirty-eight     Asso- 
ciate   Editors.      Thoroughly     illustrated. 
In  one  large  Royal   octavo   volume,  1160 
])ages.     Extra    cloth,    $6.00   net;    sheep 
$7.00  net ;  half-Russia,  $7.50  net.      Phila- 
delphia :  The  F.  A.  Davis  Co., publishers, 
1914  and  1916  Cherry  Street. 
This  splendid  work  is  the  first  and  so  far  the 
only   one  of  its  kind,   and  has  come    none  too 
soon  when   we  consider  that  almost  ten  thous- 
and   physicians     within    the    borders    of  the 
United  States  alone  make  use  of  electricity  as  a 
therapeutic  agent  daily.     Many  others   find  oc- 
casional use  for  it.      The  surgeon,  the  ophthal- 
mologist, the  demist  and  the  gynaecologist, — in 
fact,  the  specialist,  iiTwhatever  field,  finds  it  a 
valuable  aid  to  treatment.     It  is   the  mainstay 
of  the  neurologist,  both  in  diagnosis  and  treat- 
ment, and  the  rapid  increase  of  exact    know- 
ledge   in   this   branch   of  medical  science    is 
largely  due  to  the  service  it  has  rendered.     The 
more  familiar  we  become  with  the  manifesta- 
tions of  electric  energy,  the  more  do  we  recog- 
nize its  adaptions  to  the    requirements  of  dis- 
eased conditions. 

It  is  this  lack  of  familiarity  on  the  part  of 
the  members  of  the  IMedical  profession  with  the 
laws  of  electro-physics  and  physiology,  more 
than  any  other  cause,  that  has  retarded  the 
progress  of  electro-therapeutics.  The  time  has 
come  when  the  study  of  electro-therapeutics 
can  no  longer  be  delayed.  This  very  complete 
work  will,  it  is  hoped,  supply  the  much  needed 
information  in  a  very  accessible  form,  the 
thirty-eight  associate  editors  being  men  of  i  11- 
ternational  reputation  in  their  several  depart- 
ments. Among  the  Canadian  contributors 
are  Dr.  Wesley  Mills  and  Dr.  Lapthorn  Smith 
i  of  Montreal ;  among  the  French  are  Dr.  Larat 
and  Tripier  of  Paris  ;  and  among  the  English, 
Dr.  Inglis  Parsons  of  London,  and  Henry 
McClure,  England.  The  United  States  of 
course  furnish  the  bulk  of  the  articles  from 
the  pens  of  Franklin  H  Martin  of  Chicago, 
Augustin  H.  Goelet  of  New  York,  A.  D. 
Rockwell  of  New  York,  Massey  of  Philadel- 
phia, Mary  Putnam  Jacobi  of  New  York,    and 


240 


THE  CANADA  MEDICAL  RECORD. 


many  other  well  known  writers.  The  hook  is 
well  printed  and  illustrated,  and  we  congratu- 
late both  the  Editor  and  Publisher  in  the  suc- 
cessful issue  of  what  must  have  been  a  most  ar- 
duous undertaking. 


An  American  Text-Book  of  the  Diseases 
OF  Children.  Including  special  chap- 
ters on  essential  Surgical  subjects  ;  Dis- 
eases of  the  Eye,  Ear,  Nose  and  Throat  ; 
Diseases  of  the  Skin  ;  and  on  the  Diet, 
Hygiene  and  General  Management  of 
Children.  By  American  teachers. 
Edited  by  Louis  Starr,  M.D.,  Physician  to 
the  Children's  Hospital,  and  Consulting 
Pcdiatrist  to  the  Maternity  Hospital, 
Philadelphia  :  late  Clinical  Professor  of 
Diseases  of  Children  in  the  Hospital  of 
the  University  of  Pennsylvania;  Member 
of  the  Association  of  American  Physicians 
and  of  the  American  Pediatric  Society ; 
Fellow  of  the  College  of  Physicians  of 
Philadelphia,  etc.  Assisted  by  Thompson 
S,  \Vestcott,  M.D.,  Attending  Physician 
to  the  Dispensary  for  Diseases  of  Chil- 
dren, Hospital  of  the  University  of  Penn. 
sylvania ;  Physician  to  Out-Patient  De 
partment,  Episcopal  Hospital  ;  Fellow  of 
the  College  of  Physicians  of  Philadelphia. 
Forming  a  handsome  Royal  8vo  volume 
of  nearly  1200  pages.  Profusely  illus- 
trated with  wood-cuts  and  28  half-tone 
and  colored  plates.  •  Price  :  cloth,  $8.00. 
Philadephia  :  W.  B.  Saunders,  925  Wal- 
nut Street.     1894. 

The  editor  of  this  work,  Dr.  Louis  Starr  of 
New  York,  has  long  been  a  well  recognized 
authority  in  diseases  of  children.  In  the  pres- 
ent volume  he  has  associated  with  himself  some 
sixty  of  the  best  writers  in  Canada  and  the 
United  States  on  Pedratrics.  The  result  is  a 
classical  work  embracing  everything  connected 
with  these  diseases,  including  their  etiology, 
symptomatology,  diagnosis  and  treatment. 
There  are  also  chapters  on  feeding,  hygiene, 
therapeutics  and  the  prevention  of  disease. 
In  order  to  make  it  still  more  complete,  there 
are  additional  chapters  on  diseases  of  the  eye, 
the  ear,  the  skin,  the  nose  and  throat,  the 
anus  and  rectum,  circumcision,  tracheotomy, 
intubation,  vesical  calculus,  venereal  disease 
and  allied  subjects.  The  work  does  infinite 
credit  alike  to  the  authors  and  to  the  publisher, 
who  has  spared  no  expense  to  m?.ke  his  part 
of  it  second  to  none. 


PAMPHLETS. 

Our    readers  may  generally  obtain  a  copy  of 
these  valuable    re -prints  free  by  applying 
to  the  authors. 
Leprosy.  By  Isadore  Dyer,  Ph.B.,  M.D.,  Der- 
matologist to  Charity  Hospital,  New  Or- 
leans, La.    Reprinted  from  the  May,  1894, 
number  of  the  Texas  Medical  Journal. 
Report  on  the  Leprosy  Question  in  Louisi- 
ana.   By  Isadore  Dyer,  Ph.B.,  M.D.,  Der- 
matologist  to  Chnrity    Hospital,  New   Or- 
leans, La.   Reprinted  from  the  Proceedings 
of  the  Orleans  Parish  Medical  Society,  June 
meeting. 
Rectal  Stricture  of  Puerperal  Origin,  re- 
lieved  BY    Laparotomy.     By    N.  Stone 
Scott,  M.D.,  Cleveland,  Ohio.'  Consulting 
Surgeon    to  the  City   Hospital  ;    Visiting 
Physician  to  Charity  Hospital ;  Professor 
of  Genito-Urinary  Diseases,  University  of 
Wooster.      From    the    Medical    Record, 
26th  August,  1893. 
Calcified  Tumors  of  the  Ovary,  by  J.  Whit- 
ridge    Williams,     M.D.,  Associate  in  Ob- 
stetrics, Johns  Hopkins  University.    (With 
two    illustrations.)    Reprinted    from    The 
American     Journal    of     Obstetrics,     vol. 
xxviii.,   No.   I,  1893.  New  York:   William 
Wood  &  Company,  publishers,  1893. 
Six  Cases  of  Appendicitis.  By  W.  T.  Dodge, 
M.D.,  of  Big  Rapids,  Michigan,  Physician 
and   Surgeon    to  Mercy   Hospital.    From 
Tiie  Medical  News,  May  12,  1894. 
The  Surgery  of  the  Hand.  By  Robert  Abbe, 
M.D.,   Surgeon    to    St.    Luke's  Hospital. 
Reprinted   from   the   New  York    Medical 
Journal  for  January  13,  1894. 
Sarcoma    of    the    Kidney;  its    operative 
treatment.     By  Robert  Abbe,    M.D.,  of 
New  York,  Surgeon  to  St.  Luke's  Hospital. 
The  Paralyzing  Action  of  Strychnine.     By 
Thomas  W.^Poole,  M.D.,   M.C.P.S.  Ont. 
Reprint  from   American    Medico-Surgical 
Bulletin,  February  15,  1894. 
The    Indications    for    Operative     Inter- 
ference IN  Extra-Uterine  Pregnancy. 
By   Marcus    Rosenwasser,    M.D.,  Cleve- 
land, O.     Reprinted   from  the  American 
Gynaecological  Journal,  Toledo,  Ohio,  July 
1893. 
Affections  of  the  Eye  Apparently  Depend- 
ent   upon  Uterine  Derangement.     By 
Richard    H.     Derby,    M.D.    {^oith    three 
illustrations.)     Reprinted  from  N.Y.  Eye 
and  Ear  Infirmary  Reports,  Jan.,  1894. 
Ophthalmia  Neonatorum  ;  Contraction  of 
Eyelids;    Glaucoma;    Grattage    for 
Granular  Lids.     By  L.  W^ebster    Fox, 
M.D.,  Professor  of  Ophthalmology  in  Med- 
ico-Chirurgical    College    of   Philadelphia. 
Reprinted  from  the  Medical  Bulletin. 


mm^^i 


Vol.  XXII, 


MONTREVL,  AUGUST,  1894. 


No.  11. 


ORIGINAL  COMMUNICATIONS. 

Mi.sease  >>i  the  I^aias  a  Coiniilioalion 

ill  Kiiideiiiic  Intluonxa  or  Grijipe. .  "341 
INrorjibiuism  in  .Meili<-al  Men  242 

SOCIETY  PROCEEDINGS. 

American    Ele<tiii-Theiai>eiiti<-'   As- 

osociation 247 

^Itintreal  Meilioo-Chinirgical  Society  24S 

Talipes  Equino- Varus 24S 

Talipes  Varu.s 248 

.Multiple  Fracture  of  the  Pelvi.s  and 

Fracture  of  the  Femur  248 

Coniiiouml  Depresseil  Fracture  of  the 

Occipital  Bone 248 

Penetrating 'Hullet   Wound  of  the 
Brain  in  the  Left  Frontal  Region. .  249 

I'ulmonal/'erebral  Abscess 249 

Gallstone 251 

Angiosarcoma  of  the  Lung 251 

Melanotic  .Sarcoma  of  the  Foot 254 

A  Case  of  Appendicitis 254 

Acute  Leukseniia . .  255 

Typhoid  Fever  with  Double  Pneu- 
monia   255 

Tlie  Causation  of  Inflammation  of 
the  Brain 256 


OOIsTTElTTS. 

PROGRESS  OF  SCIENCE. 

Infornuition  for  Consuiiiiitivos   anil 

those  living  with  them 2.5C 

Circular  of  Information  to  Physi- 
cians reganling  the  Me;usures 
ailopted  by  the"  Board  of  Health 
for  the  Prevention  of  Tuberculosis 

in  the  City  of  Xew  York 2.57 

When  to  Operate  for  Squint  258 

The  Treatment  of  Pulmonary  Tuber- 
culosis .with  Professor  Koch's  Tu- 
berculin    2.53 

A  Case  of  Multiple  Osteo-Kcchon- 

droma 258 

A  Case  of  Acromegaly 250 

A  Case  of  Khim  )phy ma 2.50 

An  Improved  Cell  of  Glass  and  Cellu- 
loid for  the  Preservati"n  and  Kxhi- 
bitiun  of  Macroscopic  Eye-Speci- 
mens   2.50 

Surgerv  of  the  Trifacial  ;Serve 250 

Cla.<s-Room  Notes 200 


BOOK  NOTICES. 

Tumors.  Inm.cent  and^Ialignant 263 

Des  Peurs  Maladives  uu  Phobies  ...  203 
Transactions  of  the  American  Petlia- 

tric  Society 2t>? 

Saunders'  Question  Compends  N".  18.  2i'r4 
A  .Manual  of  Therapeutics  '204 

!  pamphletFreceived. 

Three  Year-'  Experiencf  with  the 
Electrical  Treatment  of  Fibroid 
Tumors  of  the  I'tenis  "-'04 

Abstract  of  two  articles  tri-ating  of 
Progress  in  Midwifery '204 

A  Case  of  Double  Vagina,  with  Oper- 
ation        -204 

Surgical  Shock  'Mt 

Xon  Xocere 2G4 

Acute  Puerperal  (Cellulitis  and  True 
Pelvic  Abscess 204 

Teno-Suture  and  Tendon  Elongation 
and  Shortening  by  Open  Incisinn  .  "204 

Habits  of  Posture  a  Cause  <  >f  Defor- 
mitv  and  Displacements  of  the 
Uterus 2W 


EDITORIAL. 

Pocket  Boroughs  in  Hospitals 261 

A  Hospital  for  Consumptives 262 

Personals "262   '    Publishers'  Department 


^cigfnal    ^ommuntc^tions. 

DISEASE  OF  THE  EAR  AS  A  COM- 
PLICATION IN  EPIDEMIC  INFLU- 
ENZA OR  GRIPPE. 
Bj'  Laurence  Turxbull,  M.D.,  Ph.   G., 
PJiiladelphia,  Pa.,  Aural  Surgeon  to  the 
Jefferson  Medical  College  Hospital,  etc. 
During    the    epidemic    of  influenza    or 
grippe  in  1889-90,  and  1891,  we  treated  a 
large   number  of  cases  of  ear  disease  both 
in  the  hospital  and  in  priv^ate  practice,  and 
reported  the  same  in  the  J'^irgifda  Medical 
Journal. 

In  most  of  the  cases  there  was  earache 
followed  by  acute  otitis  media,  with  a 
hemorrhagic  inflammation  of  the  mem- 
brana  tympani,  passing  into  perforations 
of  the  membrana  tympani,  the  result  of  a 
micro-organism  migrated  from  the  naso- 
pharynx. In  some  of  the  cases  there  were 
double  perforations  with  more  or  less  re- 
flex irritation  of  the  brain,  and  some  in- 
volvement of  the  mastoid,  followed  by  tis- 
sue abscess  situated  just  beneath  the  corti- 
cal layer.  There  was  pain,  chill,  and  more 
or  less  fever,  followed  by  perforation  of 
the  membrana  timpani  ;  at  first  a  mucous 


and,  after  a  time,  a  discharge  of  pus.  In 
almost  all  the  cases  there  was  a  feeble  cir- 
culation, irregular  pulse  and  weak  heart. 

Instead  of  yielding  promptly  to  the  or- 
dinary   treatment  by  sterilized    cleansing 
with    a    solution    of  biborate  of  soda  and 
glycerine,   cocaine  solution  at  night  to  re- 
lieve pain,  it  had  to  be  followed  by  carbolic 
acid   with   boric  acid   and    aqua  pura  and 
careful  inflating  of  the  middle   ear.     Most 
of  the  recent  cases  were  protracted    for 
three,  four,  and  even  six  weeks,  and  .some 
longer.    Then  the  apophysis  of  the  mastoid 
became  painful,  and  still  more  so  on  pres- 
sure.    The  insufflation  of  air  diminishes  the 
pain   for  a  length  of  time  but  leaves  the 
apophysis  sensitive  to   touch,   then  we  re- 
sort  to   the  following  prescription ;  Baths 
for  the  ear,  of  alcohol  at  90  per  cent,   con- 
taining 20  grammes  of   pulverised    boric 
acid,  or  a  super-saturated   solution  which 
Lowenberg    introduced   into    use  for    the 
past  twelve  years  with  success  in  this  class 
of  cases. 

In  the  adults  there  was  a  large  less  of 
the  membrana  tympani  of  a  pyriform  shape. 
The  nose,  throat  and  Eustachian  tubes  were 
inflamed  and  irritated,  requiring  spraying 
with  a  solution  of  aqua  hydrogentii  dcoxide 


242 


THE   CANADA    MEDICAL    RECORD. 


3  per  cent,  solution  with  half  water,  until 
all  secretions  were  removed,  while  the  pain 
was  relieved  by  cocaine  at  night,  and  then 
toning  the  part  with  liquid  albolene  and 
menthol,  equal  parts,  of  this  using  2  to  5  of 
the  albolene.  This  treatment  had  a  most 
happy  effect  upon  the  second  stage  of 
the  rhinitis.  Tonics  had  also  to  be  freely 
administered.  Simple  elixir  of  U.  S.  P. 
with  phosphate  of  iron  and  strychnia, 
omitting  the  quinia  and  substituting salacin. 
Salacin  acts  as  a  mild  tonic,  reduces  tem- 
perature, excites  perspiration  and  relieves 
the  catarrh  and  hypersemia  of  the  naso- 
pharyngeal mucous  membrane.  The 
quinia  is  apt  to  increase  the  tinnitus'aurium, 
which  was  one  of  the  annoying  symp- 
toms. 

Ever  since  1891,  there  have  been  more 
or  less  sporadic  cases  as  sequelae  of  this 
distressing  malady.  In  a  case  which  we 
visited  very  recently  in  consultation,  the 
daughter  of  a  physician,  a  girl  three  years 
old,  following  an  attack  of  grippe  both  ears 
discharged  pus  and  both  membranes  were 
perforated.  She  was  pale  and  feeble,  and 
had  been  been  in  her  room  for  three  weeks. 
The  posterior  nares  were  so  much  affected 
that  a  young  physician  thought  from  the 
symptoms  she  had  adenoids  and  proposed 
their  removal.  We  found  no  indications 
of  such  growth,  but  irritation  of  the  mucous 
membrane  extending  from  the  pharynx 
into  the  Eustachian  tubes.  This  unfor- 
tunately had  not  been  attended  to,  and  the 
tubes  had  not  been  kept  free.  This  can  so 
easily  be  done  and  should  never  be  ne- 
glected, for  by  simply  passing  a  short  rub- 
ber tube  of  four  or  five  inches,  armed  with 
a  nozzle,  into  the  nose,  and,  while  the  child 
cries,  blow  with  the  mouth  piece,  this  will 
open  the  tube,  which  should  be  kept  open 
every  day  after  cleansing  the  nostrils  and 
ears. 

The  child  had  no  appetite  for  food  and 
was  weak.  We  therefore  ordered  essence 
of  beef  and  eggs  soft  boiled,  as  this  latter 


is  the  only  perfect  food  we  have.  The  es- 
sence of  beef  acts  as   an  admirable  stim- 

I  ulant,  using  a  quarter  of  a  teaspoonful  of 
"Armour's    Extract"  to  a    cup    of  warm 

.  water,  adding  a  little  salt  to  this  makes  a 
nice  drink  and  few  children  will  refuse  it 
We  also  ordered  the  wash  before  referred  to 
and  the  tonic.  It  is  wonderful  what  large 
doses  of  strychnia  can  be  given  in  these 
feeble  conditions  following  grippe,  so  as  to 
tone  the  heart  and  improve  the  appetite 
and  digestion.  This  child  vv^as  reported 
well  after  two  weeks  treatment. 

CONCLUSIONS. 

First.  There  is  a  peculiar  inflammation 
of  the  ear  termed  influenzal  otitis. 

Second.  It  almost  always  commences 
with  hemorrhagic,  dark  blue  or  black 
bullae  seen  in  the  lower  posterior  segment 
of  the  membrana  tympani. 

Third.  After  a  time  a  perforation  of 
the  membrana  tympani  takes  place  with  a 
discharge  of  bloody  muco-serous  fluid. 

Fourth.  The  pain,  which  is  severe  before 
the  perforation,  is  not  entirely  relieved  by 
it,  and  continues  assuming  more  of  a  neu- 
ralgic character.  There  are  subjective 
noises  (tinnitus  aurium)  such  as  pounding, 
hammering  and  roaring,  and  if  not  pro- 
perly treated  by  inflation  or  by  PoHtzer's 
douche  or  the  catheter,  remain  after  all  the 
inflammation  has  ceased. 

Fifth.  Fatal  results  may  follow  from 
meningitis,  abscess  of  the  brain,  and  more 
frequently  sinus  phlebitis.  Such  cases  we 
are  called  upon  to  diagnose,  being  sent  to 
our  clinic  as  abscess  of  the  brain. — P/ii/- 
adelphia  Medical  and   Surgical  Reporter. 


MORPHINISM  IN  MEDICAL  MEN. 
Read  in  the  SectioJi  on  Practice  of  Medicine 
at  the  Forty-fifth  Annual  Meeting  of  the 
American  Medical  Association,  held  at 
San  Francisco,  June  5-8,  1894.  By  J. 
B.  Mattison,  M.D.,  Medical  Director 
Brooklyn  Home  for  Habitues. 
It  is  a  fact — striking  though  sad — that 


THE  CANADA  MEDICAL  RECORD. 


243 


more  cases  of  morphinism  are  met  with 
among  medical  men  than  in  all  other  pro- 
fessions combined.  It  is  too  true  that  a 
very  large  proportion  of  cases  in  general 
are  found  in  our  own  fraternity. 

In  a  paper  "Opium  Addiction  among 
Medical  Men,"  presented  in  the  Medical 
Record,  eleven  years  ago — June  9,  1883^ 
reference  was  made  to  the  dismissal  within 
a  week  of  a  half  dozen  doctors  recovered 
from  the  disease,  and  attention  called  to 
the  surprising  frequency  with  which  it 
occurs  in  this  particular  class.  Another 
decade  of  professional  work  exclusively 
given  to  the  betterment  of  such  patients 
has  brought  no  decrease  in  this  number  ; 
indeed  the  reverse  has  quite  steadily  obtain- 
ed, so  that  in  a  paper,  "  The  Ethics  of 
Opium  Habitues,"  Medical  and  Surgical 
Reporter,  Sept.,  1888,  in  a  restuiic  oi  300 
cases,  we  noted  1 18  doctors,  and  of  125  most 
recently  under  my  care,  62  were  medical 
men  ;  and  the  latest  reference  to  my  record 
shows  a  still  larger  proportion,  being  more 
than  70  per  cent. 

Again  and  again  I  have  been  asked  with 
surprise,  "  Why  do  doctors  so  often  fall 
victims  to  morphia,  when  they  more  than 
all  others  should  know  the  risk  attending 
its  use.-*"  Various  factors  makeup  the 
answer  to  this  query.  Insurance  statistics 
prove  that  medical  men  attain  a  shorter 
average  lease  of  life  than  those  of  other 
professions,  and  the  causes  th:.t  tend  to  this 
lessened  longevity  play  a  part  in  the  rise  of 
morphinism.  It  is  also  true  that  the  wear 
and  tear  of  their  calling  provoke  a  large 
share  of  painful  non-fatal  disorders.  Neu- 
ralgia, in  one  or  other  of  its  protean  forms 
— especially  migraine — which  leads  the  list 
in  the  genesis  of  this  toxic  neurosis,  occurs 
among  physicians  with  a  frequency  that 
may  well  excite  surprise.  Add  to  this  the 
anxious  hours,  the  weary  days  and  wakeful 
nights  which  the  experience  of  every  busy 
doctor  so  often  involves,  and  which,  though 
acting  indirectly,  still  swell  the  sum  of  cau- 


sative conditions  in  this  chronic  toxemia, 
and  little  wonder  that  we  have  a  soil  special- 
ly rich  for  a  sorrowful  harvest  if,  unhap- 
pily, the  seed  be  sown. 

It  has  been  asserted  that  medical  men 
become  morphinists  through  their  calling 
involving  frequent  handling  of  morphia, 
but  that  statement  in  my  opinion  is  not 
true.  Erlenmyer  shares  in  this  disbelief. 
Druggists,  whose  vocation  largely  exposes 
them  to  the  same  risk — more  so  in  the  city 
than  the  doctor— do  not  often  become  mor- 
phinists. 

A  cause  peculiar  to  the  medical  man  in 
some  cases  is  that  careless  curiosit}'  which 
prompts  him — generally  a  junior — to  note 
the  effect  of  morphin  upon  himself,  and  in 
so  doing  incur  the  risk  of  addiction.  Ober- 
steiner  refers  to  such  cases.  A  young  phy- 
sician asserted  that  while  on  hospital  duty 
a  patient  was  dismissed  who  had  suffered 
from  carcinoma  of  the  stomach  and  been 
treated  with  morphia  injections.  Next  day 
he  returned,  begging  for  more,  as  otherwise 
be  must  die.  This  was  in  1869,  when 
chronic  morphinism  and  its  results  were  less 
known  than  now.  As  the  doctor  was  in- 
clined to  think  the  patient  was  romancing, 
he  tried  the  experiment  upon  himself  to 
ascertain  the  effect,  became  a  morphinist 
and  never  recovered.  Another  case  was  that 
of  a  young  physician,  who,  being  assistant 
in  a  physiological  laboratory,  thought  him- 
self an  interesting  subject  for  experiment. 
More  than  one  doctor  whose  disease  had  a 
like  origin  has  been  under  my  care. 

Another  cause  obtains  with  physicians 
to  the  same  extent  as  in  non-medical  men, 
that  is  the  all-too-frequent  use  of  morphia 
which  the  modern  practice  of  medicine  in- 
volves. Of  this  there  is  no  question.  Indeed 
it  holds  more  largely  with  the  doctor  than 
with  the  layman,  for  the  former  fully  aware 
of  the  opiate's  power  to  ease  pain,  pressed 
by  his  duties  to  get  relief  with  the  least 
possible  output  of  time,  and  declining  to 
make  himself  an  example  of  the  precepts 


244 


THE  CANADA  MEDICAL  RECORD. 


tendered  his  patient,  as  to  the  value  of 
patience  under  suffering,  that  will  permit  the 
using  of  non-opiate  remedies,  or,  if  the 
morphia  be  demanded,  which,  at  least,  will 
secure  its  giving  at  infrequent  intervals,  or 
alternating  with  other  anodynes,  and  so 
lessen  the  risk  of  addiction — lacks  a  certain 
inhibitory,  so  to  speak,  protection  which 
serves  as  a  shield  to  the  non-professional 
patient. 

Still  another  genetic  factor,  and  in  my 
opinion  the  one  which  outranks  all  others 
relative  to  the  frequency  of  this  disease  in 
medical  men,  is  their  ignorance  or  unbelief 
as  to  the  subtle,  seductive,  snareful  power 
of  morphia.  It  is  to  me  quite  beyond 
belief  that  any  doctor  fully  realizing  how 
swiftly  and  how  surely  the  trebly  perni- 
cious power  of  this  drug  takes  one  cap- 
tive will  deliberately  give  himself  up  to 
a  servitude  galling  alike  to  body  and  mind, 
and  which  in  most  cases  ends  only  with 
life.  Such  a  suicidal  course  is  opposed  to 
reason,  to  common  sense  and  to  fact. 

In  expressing  this  disbelief  you  will  quite 
likely  infer  my  skepticism  as  to  the  common 
opinion  regarding  the  ethical  status  of  our 
confreres  whose  ill-starred  fortune  has 
brought  them  such  a  wretched  result.  I  have 
long  held,  and  still  hold,  with  steadily 
growing  belief  based  on  nearly  twenty-five 
years  study  of  this  disease,  and  an  acquain- 
tance intimate  more  or  less  with  the  his- 
tory of  many  hundred  cases,  that  medical 
men  do  not  become  morphinists  from  an 
innate  propensity  to  evil,  from  a  merely 
vicious  desire  to  indulge  in  the  pleasures  of 
the  poppy— pleasures  which,  be  it  never 
forgotten,  soon  and  surely  give  place  to  its 
pains —  but  rather  that  they  are  impelled 
thereto  by  force  of  physical  conditions  that, 
with  the  largely  prevailing  failure  to  realize 
the  risk  incident  to  incautious  morphia  using 
are  practically  beyond  control.  This  phase 
of  the  subject  need  not  detain  us,  for  it  has 
been  noted  with  detail  in  two  papers,  "The 
Ethics  of  Opium  Habitues,"  Brooklyn  Me- 


dical Journal,  August,  1888,  and  Medical 
and  Surgical  Reporter,  September,  1888. 

In  reviewing  the  various  causes  of  mor- 
pliinism  in  medical  men,  the  most  hopeful 
feature  is  the  fact  that  they  are  largely  pre- 
ventable. In  this  lies  the  strongest  incen- 
tive to  presenting  this  paper,  the  largest 
promise  that  it  may  do  good. 

Regarding  the  cause  first  cited — the  wear 
and  tear  of  an  over-active  professional  life 
— we  must  be  specially  sanguine  who  would 
expect  to  improve  conditions  along  this 
line  to  an  extent  likely  to  largely  lessen 
such  untoward  result;  though  it  cannot 
be  denied  that  the  cares  of  a  medical  calling 
are  less  exacting  than  a  decade  or  two  ago, 
and  so  figure  less  as  a  genetic  factor  in  this 
disease  ;  yet  I  am  bound  to  confess  the 
outlook  much  more  encouraging  should 
careful  and  concerted  effort  be  made  to 
make  less  active  the  other  causes  to  which 
we  have  referred. 

Regarding  the  misdirected  zeal  of  the 
hapless  seeker  after  self-evidence  of  the 
effects  of  morphia,  we  can  only  again  warn 
him — and  earnestly — that  the  experiment 
is  fraught  with  danger,  and  the  rash  act  may 
prove  his  ruin,  for  the  spark  thus  applied 
may  set  aflame  that  which  will  only  be 
extinguished  with  life.  He  is  a  fool  who 
does  it,  and  the  truly  wise  man  will  curb  his 
spirit  of  inquisitive  research  along  this  line, 
if  only  on  the  score  of  personal  w^ell-being  ; 
besides  no  such  self-sacrifice  is  called  for, 
inasmuch  as  the  peculiar  effects  of  mor- 
phia, both  as  to  blessing  and  bane,  are  now 
quite  patent  to  all. 

No  one  who  has  given  the  subject  special 
thought  will  be  likely  to  question  an  asser- 
tion that  the  use  of  morphin  in  the  medical 
practice  of  to-day  is  in  excess  of  what  an 
actual  need  demands.  And  in  direct  pro- 
portion, more  or  less,  to  this  excess  stands 
the  increase  of  morphinism.  As  a  factor, 
appl)'ing  to  cases  in  general,  it  outranks  all 
others,  though  as  regards  medical  men  it 
holds  in  my  opinion  second  place.  Custom 


THE  CANADA   MEDICAL   RECORD. 


245 


and  convenience  share  in  its  causation. 
Custom,  because  experience  has. brought  a  ; 
beHef  in  the  anodyne-soporific  power  of 
morphia,  which,  while  well  founded,  has  not  i 
been  attended  by  an  equally  well  grounded 
belief  in  its  possible  power  for  ill.  Con\e- 
nience,  because  its  promptly  pronounced 
effect  favors  it  as  first  choice  when  speedy 
relief  is  desired,  and  especially  where,  as  too 
often  happens  with  the  younger  men  in  the 
profession,  the  wish  to  score  such  a  brilliant 
result  as  may  prove  a  stepping  stone  to 
rapid  professional  advancement  outweighs 
a  due  regard  for  untoward  remote  effect, 
from  which  appreciation  a  frequent  giving 
of  morphia  or  any  opiate  should  never,  it 
is  well  to  say,  be  exempt.  This  is  a  truism 
the  force  of  which  should  never  be  for- 
gotten. 

Leading  all  others  as  a  genetic  factor  in 
morphinism  in  medical  men,  is  their  failure 
to  realize  the  insidious  power  of  morphia  to 
speedily  get  a  grip,  disburbing  and  destruc- 
tive alike  to  functional  well-being  of  brain 
and  brawn,  and  in  almost  every  instance 
one  too  great  to  be  broken  by  any  self- 
effort  they  can  command.  At  this  writing 
I  am  consulted  by  a  young  physician  whose 
case  emphasizes  this  point.  Sixteen  months 
ago  death  left  him  wifeless  and  childless. 
In  a  specially  unhappy  moment  of  his  grief 
he  took  a  dose  of  morphia.  It  acted  kindly, 
brought  transient  relief  from  his  mental 
pain.  A  week  went  by  before  the  second 
dose  was  taken,  and  then — the  old  story: 
Quite  mistaken  as  to  the  poppy  power  and 
his  own  strength  to  resist—again  and  again 
till  his  capture  was  quite  complete.  Com- 
menting on  his  case  he  assured  me  he  knew 
the  risk  attending  morphia  taking,  and 
never  should  have  incurred  it  had  he  fully 
realized  how  direful  the  result  of  that  risk 
to  him  would  be. 

It  is  quite  beyond  credence  that  a  doctor 
gifted  with  sound  sense  would  wittingly 
put  his  neck  in  such  a  noose.  Granting 
this,  the  only  reason  for  taking  such  a  peri- 


lous hazard  is,  as  before  asserted,  an  inade- 
quate appreciation  of  the  morphia's  power 
to  enthrall. 

Touching  this  point,  enlarged  experience 
confirms  an  assertion  made  teii  years  ago, 
that  "  the  subtly  ensnaring  power  of  mor- 
phia is  simply  incredible  to  one  who  has 
not  had  personal  observation  or  expe- 
rience." One  of  the  finest  specimens  of 
physical  manhood  we  ever  knew,  a  physi- 
cian who  survived  the  horrors  of  Salisbury 
prison  when  the  death  rate  averaged  80 
per  cent.,  fell  a  victim  after  only  one  month's 
hypodermic  using.  Since  then,  case  after 
case  has  been  under  my  care  in  which  the 
initial  stage  was  still  shorter.  The  most 
notable  was  an  athlete  of  superb  physique, 
who  withstood  the  rigor  of  an  arctic  winter 
as  surgeon  to  a  polar  expedition,  and  then 
went  down  before  a  three  weeks'  daily 
quarter  grain  dose  of  morphia  to  ease  the 
pain  of  an  injured  ankle  ! 

So  much  for  the  genesis  of  this  disorder. 
What  the  remedy  }  It  is  easy  to  moralize 
on  the  weak  will — as  many,  mistakenly,  are 
wont  to  put  it — of  our  hapless  brother  living 
under  this  blight,  but  talk  about  "  weak 
will"  as  a  reason  why  strong  men  succumb 
to  morphia — and  I  make  bold  to  say  that 
the  man  does  not  live  who  under  certain 
conditions  can  bear  up  against  it  —  is 
twaddle.  Far  better  is  it  to  face  the  fact 
that  morphinism  finds  most  often  its  favor- 
ite victims  in  the  noblest  profession  known, 
and  then  recognizing  the  causes  that  make 
this  fact,  bestir  ourselves  to  such  precept 
and  practice  as  will  tend  to  remove  this 
blot  on  the  scutcheon. 

Can  this  be  done  ^  Very  largely,  yes 
In  this  hopeful  belief  lies  the  one  redeem- 
ing feature  of  the  prevalence  of  this  toxic 
neurosis  in  our  own  guild.  Morphinism  is 
on  the  wane  in  my  opinion,  and  I  am  op- 
timistic enough  to  think  the  day  not 
distant  when  it  will  be  largely  a  thing  of 
the  past.  But  to  reach  this  happy  result 
it  becomes  the  bounden  duty  of  every  phy- 


246 


THE  CANADA  MEDICAL  RECORD. 


sician  to  inculcate  by  teaching  and  by  ex- 
ample the  paramount  importance  of  the 
causes  we  have  cited  that  tend  to  the  rise  of 
this  disease. 

Two  points  call  for  special  comment. 
These  are  the  over  use  of  morphia  and  the 
under  thought  of  its  danger.  Regarding 
the  latter,  let  me  warn  with  all  the  weight 
1  can  command  every  doctor  who  may  be 
dallying  with  this  drug,  or  who  may  think 
its  self-taking  called  for— and  this  warning 
holds  with  special  force  if  the  subdermic 
method  be  practised — let  me  warn  him  that 
he  is  inviting  disaster  by  jeopardizing  inte- 
rests vital  to  his  well-being,  and  let  me  urge 
him  to  pause  and  to  ponder  well  whether, 
despite  this  warning,  he  dare  take  such 
risk.  Let  him  not  be  blinded  by  an  under 
estimate  of  the  poppy's  power  to  ensnare. 
Let  him  not  be  deluded  by  an  over-confi- 
dence in  his  own  strength  to  resist  ;  foralong 
this  line  history  has  repeated  itself  with 
sorrowful  frequency,  and — as  my  experience 
will  well  attest^ — on  these  too  treacherous 
rocks  hundreds  of  promising  lives  have  gone 
awreck. 

I  have  no  wish  to  pose  as  an  alarmist, 
but  I  tell  you,  gentlemen,  that  many  a  doc- 
tor who  gives  himself  a  daily  hypodermic 
dose  of  morphia  for  a  fortnight  will  come 
perilously  close  to  the  danger  line — beyond 
which  bondage  begins. 

Let  him  not  chance  it ;  rather  let  him, 
if  the  opiate  demand  be  imperative,  consign 
its  giving  to  other  hands  ;  let  it  be  by 
mouth  ;  and  oftener  let  it  be  codeine,  which 
as  an  anodyne  and  soporific  has  not  yet  had 
the  measure  of  merit  it  deserves,  and  which, 
as  tending  to  tolerance,  is  vastly  less  riskful 
than  morphin.  In  a  paper  before  the 
American  Medical  Association  two  years 
ago,  "The  Prevention  of  Morphinism  " 
(reprint  at  command,  and  by  the  reading 
of  which  I  would  have  every  one  of  you 
the  gainer),  attention  was  called  to  the 
value  of  codeine.  Enlarged  experience 
has  confirmed  the  opinion  then  expressed, 


and  while  I  am  glad  to  note  the  demand 
for  it  is  steadily  increasing,  I  earnestly  urge 
its  still  larger  use  as  one  of  the  most  pro- 
missing  factors  to  favor  a  decline  of  the 
morphin  disease. 

Regarding  the  over  use  of  morphia,  never 
was  there  so  little  excuse  for  it  as  now, 
for  never  were  the  means  at  command 
to  ease  pain  and  bring  sleep  equal  to  those 
of  to-day.  Modern  medicine  is  richly 
equipped  in  this  regard,  and  if  these  re- 
sources be  fully  availed  of,  it  will  go  far 
in  a  decrease  of  this  ill. 

As  tending  to  this,  teachers  in  medical 
schools  should  realize  that  they  have  oppor- 
tunity to  wield  great  influence  for  good,  and 
by  word  and  deed  they  should  improve  it. 
To  do  so  would  strike  right  at  the  root  of 
this  evil,  for  I  truly  think  the  junior  mem- 
bers of  the  profession  are  the  greatest 
sinners  in  this  regard  ;  and  if  by  timely 
counsel  from  their  preceptors  and  college 
instructors  the  thousands  who  year  after 
year  begin  a  medical  career  can  be  brought 
to  believe  the  danger  incident  to  an  incau- 
tious or  needless  giving  of  morphia,  and 
then  shape  their  practice  in  keeping  with 
that  belief,  the  good  work  will  be  largely 
done. 

Slowly  yet  surely  the  therapeutic  trend 
is  in  this  direction.  More  and  more  the 
older  medical  men,  impelled  by  larger  wis- 
dom or  an  experience  often  unhappy,  are 
quitting  the  syringe,  more  and  more  rarely 
are  they  using  morphia.  The  influence  of 
this  example  must  make  itself  felt  on  the 
younger  men,  and  when  to  this  is  added 
the  teaching  we  have  commended,  the  dawn 
of  a  better  day  will  not  be  distant.  May 
that  good  time  coming  soon  come, — 
Journal  American  Medical  Association. 


— In  trephining  for  Inveterate  Headache, 
Prof.  Keen  says,  if  nothing  abnormal  be  found, 
the  dura  should  be  siitched  together  and  the 
wuund  closed,  but  ihe  builon  of  bone  should 
not  be  replaced,  and  occasionally  good  results 
will  follow. 


THE  CANADA  MEDICAL  RECORD. 


247 


Or) 

»0detj)     j|roceet)tn0S. 


AMERICAN    ELECTRO  THERAPEUTIC 
ASSOCIATION. 

The  following  is  the  preliminary  programme 
of  the  American  Electro-Therapeutic  Associa- 
tion, which  will  hold  its  fourth  annual  meeting 
at  the  New  York  Academy  of  Medicine,  New 
York,  Sept.  25th,  26th  and  27th. 

President's  address,  Dr.  W.  J.  Herdman, 
Ann  Arbor,  Mich.,  Professor  of  Diseases  of 
the  Mind  and  Nervous  System  and  Electro- 
Therapeutist  in  the  University  of  Michigan. 

Report  of  Committees  on  Scientific  Ques- 
tions. 

On  Standard  Coils,  Dr.  W.  J.  Morton,  New 
York. 

On  Standard  Meters,  Dr.  Margaret  A. 
Cleaves,  New  York. 

On  Standard  Electro-Static  or  Influence 
Machines,  Dr.  W.  J.  Morton,  New  York. 

On  Constant  Current  Generators  and  Con- 
trollers, Dr.  W.J.  Herdman,  Ann  Arbor,  Mich. 

On  Standard  Electrodes,  Dr.  A.  Lapthorn 
Smith,  Montreal. 

Stand  and  Electrode  for  Static  Electricity, 
Exhibit  of  same.  Dr.  Lucy  Hall-Brown,  Brook- 
lyn, N.Y 

On  Electric  Light  as  a  Therapeutic  and 
Diagnostic  Agent,  Dr.  Margaret  A.  Cleaves, 
New  York. 

The  Constant  Current. 

Physics. — Current  Distribution,  Mr.  W.  J. 
Jenks,  M.I.E.E.,  New  York. 

Physiological  Effects,  Prof.  H.  E.  Djlbear, 
President  Tuft's  College,  Boston,  Mass. 

Therapeutic  Uses — General,  Dr.  A.  D. 
Rockwell,  New  York. 

Gynaecology, 

The  Galvanic  Current  in  Catarrhal  Affections 
of  the  Uterus,  Dr.  G.  Button  Massey,  Phila- 
delphia. 

Suites  e'loignees  du  traitement  electrique 
conservateur  Gynjecologie.  Grossesses  con- 
secutives,  Dr.  Georges  Apostoli,  Paris. 

Metallic  Electrjlysis.  M.  le  Docteur  Georges 
Gautier,  Paris.  Dr.  W.  J.  Morton,  New  York. 
Dr.  Margaret  A.  Cleaves,  New  York.  Dr.  A. 
H.  Goekt,  New  York. 

Treatment  of  Urethral  Stricture,  Report  to 
date,  Dr.  Robt.  Newman,  New  York. 

Diseases  of  the  Eye,  Electro-Therapeutics  of, 
Dr.  L.  A.  W.  Alleraan,  Brooklyn,  N.  Y. 

Notes  on  Goitre  and  Improvements  in 
Apparatus  for  treatment  of  same,  Dr.  Chas.  H. 
Dickson,  Toronto. 

Diseases  of  the  Throat,  Dr.  D.  S.  Campbell, 
Detroit,  Mich. 

The  Action  of  Electricity  on  the  Sympa- 
thetic, Dr.  A.  D.  Rockwell,  New  York. 

Diseases  of  the  Nervous  System, 


The  treatment  of  Neuritis  by  tlie  Galvanic 
and  Faradic  Currents,  Dr.  Landon  Carter  Gray, 
New  York. 

Electric  Sanitation,  Prof.  John  W.  Langley, 
Ph.  D.,  Case  School  of  Science,  Clleveland,  Ohio. 

Pliysics  of  the  Electric  Light  in  relation  to 
Organized  Matter,  Prof.  John  O.  Reed,  Ph.  M., 
Mich. 

Hydro-Electric  Methods,  Asst.  Prof,  of 
Physics,  University  of  Physics,  and  Appliances, 
Dr.  Margaret  A.  Cleaves,  New  York. 

Special  Hydro-Electric  Applications,  Dr. 
Margaret  A.  Cleaves,  New  York. 

The  Hydro-Electric  Therapeutics  of  the 
Constant  Current,  Dr.  \V.  S.  Pledley,  Brighton, 
England. 

Induction  Currents. 

Inteurupted  Curjr.ents. — Physics,  Physio- 
logical effects.  Dr.  W.J.  Engelmann,  St.  Louis, 
Mo. 

Therapeutic  Uses. — General  Faradization, 
Dr.  A.  D.  Rockwell,  New  York. 

Gynecological,  Dr.  A.  H.  Goelet,  New 
York.  Dr.  H.  E.  Hayd,  New  York.  Dr.  A. 
Lapthorn  Smith,  Montreal. 

Sinusoidal   Current. 

Physics,  Mr.  A.  E.  Kennelly,  F.R.A.S., 
Philadelphia. 

Physiological  Effects,  Dr.  W.  J.  Herdman, 
Ann  Arbor,  Mich.  Dr.  J.  H.  Kellogg,  Battle 
Creek,  Mich. 

Therapeutic  Uses.  Dr.  Margaret  A.  Cleaves, 
New  York.  Dr.  \Vm.  Jas.  Morton,  New  York. 
Dr.  J.  H.  Kellogg,  Battle  Creek,  Mich.  Dr. 
Holtbrd  Walker,"  Toronto.  Dr.  A.  H.  Goelet, 
New  York. 

Le  Courants  Alternatifs;  leur  transforma- 
tion; leur  mesure  et  leurs  application  thera- 
peutiques,  M.  le  Docteurs  Gautier  et  Larat, 
Paris. 

On  the  Sinusoidal  Current  Method  of  Regu 
lation  the  E.M.F,  and  Resultant  Current,  Dr.- 
Lucy  .Hall-Brown,  Brooklyn,  N.Y. 

Static  and  Static  Induced. 

Physics,  Prof.  Edwin  Houston,  Ph.  D., 
Philadelphia. 

Physiological  effects, 

Therapeutique  UsES.*-General  Therapeu- 
tique  Uses,  Dr.  Wm.  Jas.  Morton,  New  York. 

The  Treatment  of  Chorea,  Dr.  D.  R.  Brower, 
Chicago. 

Static  induced.  Dr.  Margaret  A.  Cleaves, 
New  York. 

High  Frequency  Currents  derived  from  static 
Machines  as  per  Method  d'Arsonval,  Dr.  J.  H. 
Kellogg,  Battle  Creek,  Mich. 
In  Memoriam. 

Dr.  Wm.  F.  Hutchinson,  Providence,  R.l. 
Dr.  Robt.  Newman,  New  York.  Dr.  John 
Chambers,  Indianopolis,  Ind.  Dr.  Plymon  S. 
Hayes,  Chicago.  Dr.  W.  J.  Herdman,  Ann 
Arbor,  Mich. 


248 


THE   CANADA   MEDICAL   RECORD. 


THE  MONTREAL  MEDICO-CHI RURGI- 
CAL  SOCIETY. 

Stated  Meeting,  March  2  7,rd,   1894. 

James  Bell,  M.D.,  President,  in  the  Chair. 

Dr.  David  B.  Alexander  was  elected  an  ordi- 
nary member. 

Talipes  Equine-  Varus. — Dr.  Bell  brought 
before  the  Society  a  man  from  whom  he  had 
removed  the  greater  part  of  the  tarsus  for 
talipes  equino-varus.  The  patient,  a  farmer, 
47  years  of  age,  had  not  suffered  any  great  in- 
convenience up  to  seven  years  ago,  being  able 
to  walk  fairly  well  on  the  outer  side  of  the 
dorsum  of  the  foot.  At  that  time  a  large  bur^a 
which  had  developed  over  the  dorsum  of  the 
right  foot  became  inflamed  and  suppurated. 
Since  then  sinuses  had  persisted,  and  he  had  not 
been  able  to  walk  with  any  degree  of  comfort, 
and  has  been  frequently  under  treatment.  In 
January  last  he  came  to  the  Montreal  General 
'Hospital  for  the  purpose  of  having  the  bursa 
treated,  but  as  in  all  probability  the  disease  had 
extended  down  to  the  tarsal  articulations,  the 
more  radical  operation  of  tarsectomy  was 
advised.  After  some  hesitation  he  submitted 
to  this  operation  for  the  correction  of  the  de- 
formity. At  the  operation,  the  astragalus  was 
first  removed,  then  the  scaphoid,  then  a  small 
portion  of  the  head  of  the  os  calcis,  then  the 
cuboid,  and  finally  to  make  the  correction  com- 
plete, the  tip  of  the  external  malleolus  and 
portion  of  three  cuneiform  bones  were  removed. 
Unfortunately  a  case  of  erysipelas  had  been 
operated  upon  on  the  same  table  half  an  hour 
before,  and  though  every  precaution  had  been 
taken  to  disinfect  the  surroundings,  the  patient 
contracted  that  disease.  This  prevented  splints 
from  being  applied  in  the  usual  way,  so  that 
there  is  a  little  more  turning  in  of  the  foot  than 
usual,  but  the  result  is  very  satisfactory,  almost 
perfect. 

Talipes  Varus. — Dr.  Bell  showed  a  young 
man,  twenty-one  years  of  age,  upon  whom  he 
had  operated  for  this  condition.  The  patient 
had  been  for  several  years  incapacitated  for 
hard  work,  and  lately  had  been  unable  to  work 
at  all.  The  left  foot  was  very  much  worse 
than  the  right.  Five  weeks  ago  an  osteotomy 
was  performed  above  the  ankle  joint,  turning 
in  the  foot  and  correcting  the  deformity.  The 
object  was  to  bring  the  centre  of  gravity  down 
through  the  centre  of  the  foot  instead  of  through 
the  inner  border. 

The  difference  between  the  two  feet  when 
seen  from  behind  was  very  well  marked. 

This  operation  was  introduced  by  Trende- 
lenberg  a  few  years  ago,  and  has  practically 
superseded  all  others  for  serious  cases  of  flat 
foot,  which  for  one  reason  or  another  cannot 
be  treated  by  appliances.     Trendelenberg  had 


observed  that  in  certain  cases  of  Pott's  fracture 
when  care  had  not  been  taken  to  correct  the  de- 
formity at  the  time  of  the  accident,  a  condition 
resembling  flat-foot  had  resulted.  These  cases 
he  treated  by  osteotomy,  and  subsequently  he 
extended  the  operation  to  cases  of  flat-foot. 

Multiple  Fracture  of  the  Pelvis  and  Fracture 
of  the  Femur. — Drs.  Kirkpatrick  and  Wil- 
liams presented  a  mounted  specimen  which 
consisted  of  the  pelvis,  the  last  lumbar  vertebra 
and  the  upper  half  of  the  left  femur.  In  the 
sacrum  a  fracture  extended  from  the  right  ala 
at  the  auricular  surface,  which  shows  numeious 
splintered  fragments,  through  the  five  right 
foramena  to  the  transverse  process  of  the  first 
coccygeal  vertebra.  On  the  left  side  the  bone 
showed  many  small  splinters  and  incomplete 
fissures,  especially  on  the  anterior  surface,  ex- 
tending in  the  same  manner  as  far  as"the  fourth 
lateral  foramen.  The  left  inferior  articular 
process  of  the  last  lumbar  vertebra  is  also 
fractured.  On  both  sides  the  superior  rami  of 
the  pubis  showed  transverse  comminuted 
fractures.  At  the  junction  of  the  rami  of  the 
pubis  and  ischium  on  the  right  side  and  through 
the  ramus  of  the  ischium  on  the  left  are  trans- 
verse fractures.  The  left  inferior  ramus  of  tlie 
ptibis  also  shows  an  incomplete  transverse 
fissure  on  its  anterior  surface.  The  left  femur 
sustained  a  transverse  comminuted  fracture  at 
about  the  centre  of  the  shaft. 

The  man  from  whom  the  specimen  was 
obtained  was  employed  in  excavating  earth, 
when  a  large  mass  (400  lbs.)  of  frozen  earth 
and  shale  fell  on  his  side  and  thigh,  crushing 
him  to  the  ground.  Eour  men  lifted  the  man 
and  carried  him  to  a  bench.  He  was  con- 
scious, and  after  recovering  from  the  primary 
shock  was  able  to  sit  up  ;  he  said  that  his  left 
leg  was  broken.  Death  occurred  two  hours 
later  from  shock  or  nervous  injury,  not  from 
hiemorrha^e. 


Stated  Meeting,  April  dth,  1894. 

James  Bell,  M.D.,  President,  in  the  Chair. 

Compound  Depressed  Fracture  of  the  Occi- 
pital Bone. — Dr.  Bell  exhibited  a  boy,  aged 
six,  who  in  August  last  had  fallen  into  an  ex- 
cavation and  had  sustained  a  compound  de- 
pressed fracture  of  the  left  occipital  bone.  He 
was  seen  a  few  minutes  after  the  accident  by 
Dr.  Grant  Stewart,  who  observing  that  he 
was  rapidly  falling  into  a  condition  of 
coma  sent  for  Dr.  Bell,  who  had  him  taken  to 
the  Montreal  General  Hospital,  where  he 
operated.  After  shaving  the  head  he  proceeded 
to  elevate  the  depressed  portions  of  the  bone, 
the  edges  being  chiselled  away,  so  as  to  make 
an  elliptical  opening,  half  an  inch  in  the  short 
and  one  inch  in  the  long  diameter.  The  dura 
mater  was  torn  and  a  large  clot  (about  four 
ounces)  was  found  lying  upon  the  brain,  but  no 


THE   CANADA   IVIEDICAL   RECORO. 


249 


active  bleeding  was  discovered.  Up  to  this 
time  no  ani'esthetic  had  been  given,  but  it  was 
found  necessary  to  administer  chloroform  to 
finish  the  operation.  The  boy  made  an  unin- 
terrupted recovery,  and  was  discharged  about 
six  weeks  after.  Since  his  return  home  his 
mother  has  noticed  deafness  in  the  left  ear. 
some  uncertainty  about  his  gait,  and  incon- 
tinence of  urine  during  sleep,  which  condition 
did  not  exist  before  the  examination.  No  ex 
mination  of  the  ears  had  been  made. 

Pciu'ti-ating   Bullet    IVoiind  of  the  Brain  in 
the  Left  Frontal Rei:,ion. — Dr.  Bell  also  exhi- 
bited a  little  girl,  aged  5  years,  who,  while  play- 
ing, had  become  possessed    of  a  loaded  twenty- 
two  calibre  English   revolver,    which    she  had 
accidentally    discharged     while    resisting    the 
attempts  of  an   elder  sister   to    take    it    from 
her.     Dr.    Hutchison   saw    her    shortly    after- 
wards and  sent  her  soon  after  to  the  Montreal 
General  Hospital,  where  she  was  given  chloro- 
form and  the  wound  exposed.     The  bullet  had 
penetrated    the   left  frontal  region,    three-quar- 
ters of  an  inch  to  the  left  of  the  middle  line 
and  the  same  distance  above  the  supra  orbital 
ridge,    going  completely    through     the    skull, 
causing  a  circular  depressed  fracture  of  about 
a  quarter  of  an  inch  in  diameter.     The  outer 
fragments  of  the  bone  were  removed  by  forceps 
and  the  wound  enlarged  with  a  chisel.     Forceps 
were  than   passed  in  carefully  along  the  track 
of    the    bullet,    and  several  spicules  of  bone 
removed   from   a   depth  of  two  inches   in  the 
brain  substance.     Blood  clot,  pieces  of  broken 
down    brain  matter  and  fresh  blood  were  also 
removed,   when  on  passing  the  forceps   in,  the 
bullet  could  be  distinctly   felt   at  a  distance  of 
two  and   half  inches  from  the  surface ;  several 
attempts  were  made  to  grasp  it,  but  failed,  and 
considering  the  region  in  which  it  lay,  near  the 
anterior   cornua  of  the  ventricle,  Dr.  Bell  con- 
cluded that  the   risks  involved  in  persevering 
in  attempts  to  extract  it  were  too  great ;  there- 
fore,  after   carefully    cleansing    the   wound,  a 
glass  drain  was  inserted  directly  into  the  brain 
substance   and   kept    in  for    seventeen    days, 
being    shortened  on  two   different   occasions. 
For  the  first  four  days  the  temperature  oscil- 
lated between  90°    and    100°,  but-  afterwards 
remained  normal.     The  child  made  an  unevent- 
ful recovery  and  was  discharged  on  Feb.  26. 
From  the  time  she  left  the  hospital  she  had  been 
absolutely  well  and   is  now  going   to   school. 
Dr.   Bell  recalled  a  similar  case  which  he  had 
reported  to  the  Society  in  the  session  of  1879- 
1880,   of  a  man  who  deliberately  shot  himself 
in  the   temple,  and  from    which  the  bullet  had 
never   been    removed.     This    patient   died  of 
phthisis   two    years  later,    and  at  the  autopsy 
the  bullet  was  found  lying  within   half  an  inch 
of  the  falx  cerebri. 

Dr.  Proudfoot,  having  made  a  cursory  ex- 
amination   of  the    boy,  found    that  the    watch 


placed  against  the  child's  ear  could  be  heard 
distinctly,  whereas  if  it  was  removed  the 
slightest  distance,  the  sounds  could  not  be 
heard  at  all.  Whether  this  was  due  to  conduc- 
tion through  the  bones  he  could  not  say,  but 
apparently  the  nervous  portion  of  the  ear  was 
all  right.  He  suggested  that  the  difticulty  in 
hearing  might  be  accounted  for  by  a  catarrhal 
condition  of  the  middle  ear  brought  on  by  wet 
dressings,  and  which  would  disappear  on 
treatment. 

Dr.  Hutchison  had  seen  the  second  case, 
the  girl,  half  an  hour  after  the  accident  had 
occurred.  The  child  did  not  show  any  symp- 
tons  of  brain  injury.  He  put  her  under  chlo- 
roform, examined  the  wound,  and  having 
found  that  the  bullet  had  entered  the  bram, 
concluded  to  send  her  to  the  hospital.  He  saw 
her  again  after  her  return  from  the  hospital, 
and  the  mother  now  states  that  she  is  even 
more  precocious  than  before  the  accident. 

Pubnonal  Cerebral  Abscess. — Drs.  Adami 
and  Fin  LEV  reported  a  case  as  follows  : 

T.  W.,  aet.  16  years,  by  occupation  a  painter, 
became  ill  on  February  23rd,  suffering  from  a 
severe  cold,  which  made  him  take  to  his  bed. 
He  left  his  bed  the  next  day  but  was  forced  to 
return,  the  cold  having  increased  in  severity, 
there  being  a  pronounced  cough  with  expecto- 
ration and  frontal  headache.  This  was  fol- 
lowed by  pain  in  the  chest,  high  fever  and  the 
expectoration  of  blood-stained  sputum.  When 
he  was  admitted  into  the  General  Hospital 
upon  March  9th,  these  symptons  had  disap- 
peared, and  nothing  was  to  be  detected  in  the 
chest  save  a  few  crepitant  rales  at  the  base. 
There  was,  however,  great  feebleness,  with 
obstinate  constipation.  The  right  pupil  was 
larger  than  the  left,  without  there  being  any 
disease  of  the  fundus.  There  was  no  evidence 
of  renal  disease.  The  patient  became  gradu- 
ally comatose  with  coma  vigil.  The  pulse 
continued  unaltered  at  84,  the  respirations 
were  28  per  minute,  only  increasing  at  the  last 
moment,  the  temperature  was  100".  The 
patient  died  six  days  after  admission. 

At  the  autopsy  performed  fifteen  hours  after 
death,  the  trachea  was  found  greatly  congested 
with  thin  blood-stained  mucus  covering  its  sur- 
face. The  bronchi  were  reddened  and  affected 
with  bronchitis,  the  upper  lobes  of  both  lungs 
were  oedematous,  the  lower  lobes  of  both  lungs 
were  heavy  to  the  feel  and  fairly  firm,  they 
were  greatly  congested  but  at  the  same  time 
crepitant.  At  the  root  of  the  right  lung  was  a 
suppurating  bronchial  gland. 

In  the  heart  the  one  point  deserving  notice 
was  the  condition  of  the  coronary  arteries ; 
these,  while  not  definitely  atheromatous,  were 
greately  dilated,  their  walls  having  undergone 
fibroid  thickening.  There  were  small  patches 
of  fatty  change  in  the  first  part  of  the  aorta, 
with  more  distinct  atheroma  in  the  lower  and 
dorsal  and  abdominal  aorta. 


250 


THE  CANADA  MEDICAL  RECORD. 


In  the  alimentary  tract  the  only  markedly 
abnormal  condition  was  the  presence  of  a  sup- 
purative tonsillitis.  The  liver  was  somewhat 
fatty,  the  pancreas  firm  and  fibroid,  with  dilated 
and  tortuous  artery,  the  spleen  small  and  fibroid 
with  wrinkled  capsule,  the  kidneys  large  and 
long  with  diminished  antero-posterior  diameter, 
distended  arteries,  finely  granular  surface, 
lessened  cortex,  and  with  a  small  cyst  upon 
the  surface  of  the  right  organ.  Beyond  these 
conditions,  nothing  noticeable  was  observed. 
Save  for  the  suppurative  tonsillitis  and  the  state 
of  the  lungs,  the  condition  of  the  organs  was 
what  is  expected  to  be  found  associated  with 
the  arterio-sclerosis  of  advancing  age. 

Coming  now  to  the  brain  it  was  noticed  that 
upon  removal  of  a  skull  cap  of  abnormal  thick- 
ness, the  left  hemisphere  seemed  to  bulge 
more  than  the  right,  and  convolutions  were 
more  flattened.  Upon  removal  of  the  organ 
the  vessels  at  the  base  were  found  markedly 
atheromatous,  even  to  the  end  of  the 
fissure  of  Sylvius.  Around  the  roots  of  the 
anterior  cranial  nerves  there  was  a  purulent 
meningitis  extending  in  front  to  the  olfactory 
bulbs,  behind  it  reached  as  far  back  as  the 
line  joining  the  points  of  egress  of  the  5th 
nerves. 

Upon  opening  the  lateral  ventricle  of  the  left 
side,  it  was  found  to  contain  a  large  quantity 
of  fairly  clear  or  semi-transparent  greenish 
muco-pus ;  in  the  region  of  the  posterior  cornu 
this  extended  for  several  centimetres  outwards 
into  the  white  matter  of  the  brain,  forming  a 
channel  with  smooth  walls;  this  did  not  extend 
into  the  grey  matter.  The  choroid  plexus  was 
thickened  and  cedemalous.  In  the  substance  of 
the  left  hemisphere,  opposite  to  the  junction  of 
the  temporal  and  parietal  lobes,  there  was  a 
large  cavity  in  the  white  matter,  containing  pus 
of  a  like  clear  mucoid  greenish  character. 
Its  walls  were  of  reddish-blue  colour  and  were 
necrotic.  The  right  ventricle  contained  a 
large  cast  of  whitish  green  pus  extending  over 
the  whole  of  the  mid-region  of  the  ventricle. 
In  the  white  substance  opposite  to  the  ascend- 
ing frontal  convolutions,  and  upon  the  level  of 
the  junction  of  the  upper  and  middle  frontal 
lobes  was  another  abscess  the  size  of  a  hazel 
nut ;  this  extended  quite  superficially  into  the 
grey  matter,  less  than  i  cm.  of  wall  remaining. 
It  contained  similar  greenish  contents,  and  had 
walls  undergoing  necrosis.  There  was  further 
a  small  abscess  containmg  but  a  few  drops  of 
pus  in  the  posterior  poition  of  the  right  optic 
thalamus.  The  pus  present  in  the  left  vsntricle 
extended  down  into  the  third  and  fourth  ven- 
tricles. On  cutting  into  the  cerebellum  the 
left  lobe  was  found  normal;  the  right  lateral 
lobe  was  the  seat  of  another  abscess  with  well- 
defined  walls,  filled  with  necrotic  material, 
associated  with  the  same  pale  greenish  pus  ; 
this   was  5  cm.    in  the    greatest   diameter  and 


about  3  cm.  wide,  being  of  oval   shape.     The 
pons  and  medulla  were  normal. 

A  few  encapsuled  diplococci  were  found  in 
the  greenish  pus  of  the  cerebral  abscesses. 

We  have  recorded  this  case  mainly  because 
of  its  bearing  upon  the  relationship  between 
lung  disease  and  cerebral  abscess.  That  such 
relationship  frequently  exists  has  long  been 
recognized.  Only  last  year  one  of  us  (F.)  had 
a  case  under  observation,  presenting  many 
points  of  similarity  with  the  present,  and  while 
we  were  engaged  upon  studying  the  material 
obtained  from  this  case,  our  mutual  friend.  Dr. 
Williamson,  of  Manchester,  published  a  short 
article  in  the  Medical  Chronicle^  bringing 
together  the  observations  of  several  observers 
upon  this  very  subject.  Hence  it  is  not  inap- 
propriate to  call  attention  here  to  this  case. 

Williamson's  epitome  of  the  literature  of  the 
subject  shows  that  more  frequently  cerebral 
abscess  develops  as  an  accompaniment  ofchro 
nic  lung  trouble,  rather  than  as  a  sequela  of 
acute.  More  especially  it  is  incases  of  chronic 
bronchitis  and  bronchiectasis  that  the  relation- 
ship is  found.  There  are,  however,  several 
cases  in  which  the  abscess  formation  has  fol- 
lowed upon  acute  pneumonia.  In  the  case 
mentioned  by  us  the  exact  conditions  which 
had  led  to  the  abscess  formation  cannot  be 
stated  with  absolute  certainty,  although  it  is  safe 
to  infer  from  the  history  given  that  the  patient 
had  suffered  from  croupous  pneumonia,  and, 
from  the  condition  of  the  lung  both  macro- and 
microscopically,  that  this  disease  had  affected 
the  lower  lobes  on  either  side.  The  presence 
of  lanceolate  diplococci  in  the  characteristic 
greenish  pus  may  be  urged  with  some  force  in 
favor  of  this  contention.  On  admission  into 
hospital  the  condition  was  one  of  advanced 
resolution  of  the  disease,  the  only  activedistur- 
bance  found  at  the  autopsy  being  the  suppurat- 
ing gland  at  the  root  of  the  right  lung.  The  pre- 
sence of  this  condition  of  the  gland  is  in  itself 
suggestive  of  a  tendency  on  the  part  of  the 
inflammation  that  had  affected  the  lungs  to 
travel  beyond  those  organs. 

It  is  difficult  to  offer  a  satisfactory  explana- 
tion, or  one  that  will  embrace  all  cases,  why 
there  should  exist  this  liability  for  cerebral  ab- 
scesses to  be  associated  with  disease  of  the 
lungs  more  frequently  than,  for  instance,  renal 
abscesses  are  found  to  be  thus  associated.  In 
our  case,  it  is  true,  there  was  extensive  athe- 
roma of  the  cerebral  vessels,  and  the  diseased 
condition  of  the  arteiies  may  have  been  a  pre- 
disposing cause;  such  atheroma,  however,  is 
not  constantly  present. 

Remarks. — Dr.  James  Stewart  remarked 
that  although  there  were  plenty  of  opportunities 
for  examining  the  case,  a  diagnosis  during  life 
had  not  been  reached.  The  symptoms  were 
not  at  all  characterized,  being  simply  those  of  an 
acute    brain    lesion     causing    pressure.       He 


THE  CANADA  MEDICAL  RECORD. 


251 


thought  Dr.  Adami's  explanation  was  the  cor- 
rect one.  Articles  have  lately  appeared  in  the 
British  Journals  pointing  out  the  frequency 
with  which  acute  central  lesions  and  acute  pe- 
ritonitis were  brought  about  by  this  organism. 
At  the  present  time  in  the  Victoria  Hospital 
there  is  an  instance  of  a  suppurating  arthritis 
following  pneumonia,  and  in  which  the  pneu- 
mococcus  has  been  foimd  in  the  joint. 

Dr.  GuNN  had  first  seen  the  case  referred  to 
by  Dr.  Stewart  in  ihe  outdoor  department  of 
the  Victoria  Hospital,  and  found  an  area  of 
dullness  over  the  middle  of  the  right  lung  in 
front,  rather  small  in  proportion  to  the  atten- 
dant temperature,  which  remained  in  the  region 
of  104^^  for  first  3  days.  After  entry  to  hos- 
pital a  well  marked  crisis  had  occurred  and 
temperature  remained  normal  for  three  days, 
when  he  developed  a  violent  chill  and  showed 
all  the  signs  of  some  acute  infection  or  relapse. 
The  following  day  a  swelling  developed  in  the 
cellular  tissure  of  the  left  upper  arm  behind, 
showing  a  characteristic  erysipelatous  appear- 
ance, which  subsided  gradually,  and  4  days 
after  all  fever  had  gone,  there  was  another 
chill  and  rise  of  temperature.  This  time  the 
knee  joint  on  the  right  side  and  the  left  shoul- 
der became  very  painful,  tender  and  swollen, 
and  on  examining  the  contents  a  character- 
istic pus,  not  decidedly  green,  but  rather  of  a 
milky  nature,  was  found.  The  microscope 
showed  nothing  but  diplococci  with  the  cap- 
sules well  marked.  Bouillon  cultures,  however. 
did  not  show  characteristic  diplococciis  growth, 
but  rather  that  of  a  streptococcus.  The  exa- 
mination is  not  complete — no  inoculation 
having  been  made. 

Dr.  GuNN  asked  if  in  Dr.  Adami's  case  any 
other  micro-organisms  were  found  and  if  ino- 
culation had  been  made. 

Dr.  Mills  wished  to  know  whether  the 
arteries  of  the  brain  in  Dr.  Adami's  case  had 
been  examined,  and  whether  steps  were  taken 
to  exclude  emboli  or  ordinary  forms  of  brain 
softening  in  the  diagnosis. 

Dr.  Ad.\mi  stated  that  abscess  of  brain  with 
general  signs  of  inflammation  in  the  surrounding 
tissues  v/ere  not  caused  by  simple  emboli 
alone. 

Gall  Stone. — Dr.  Bell  exhibited  a  specimen 
which,  though  only  an  ordinary  gall  stone,  had 
a  clinical  history  of  especial  interest.  On 
Wednesday  last  he  had  been  called  iiilo  the 
country  to  operate  on  a  patient  supposed  to  be 
suffering  from  appendicitis.  She  was  an  un- 
married woman,  fifty  years  of  age,  and  although 
a  dyspeptic  for  many  years,  which  slie 
attributed  to  the  loss  of  her  teeth,  she 
never  had  a  day's  real  illness  in  her  life. 
On  the  previous  Friday  she  began  to 
suffer  from  pain  about  the  right  hypochon- 
drium ;  her  physician  saw  her  on  the  following 
Monday  and  found   her  suffering  from    great 


pain  on  the  right  side  of  ilic  abdomen.  Slight 
vomiting,  normal  temperature,  and  pulse  about 
one  hundred.  The  vomiting  persisted  all  that 
day  and  night.  Next  day  vomiting  had  ceased 
and  morphia  was  given  for  the  pain,  but 
towards  evening  of  the  following  day,  her  tem- 
perature rising  to  99-5'^,  her  pliysician  grew 
anxious,  and  upon  making  an  examination 
found  a  resisting  mass  to  the  right  of  the  um- 
bilicus and  extending  up  to  within  an  inch  of 
the  lower  ribs  on  the  right  side.  Dr.  Bell 
found  an  area  of  dullness  and  resistance  extend- 
ing along  the  right  linea  semilunaris  upwards 
to  a  finger's  breadth  below  the  lower  border  of 
the  ribs  and  down^vards  to  an  inch  and  a  half 
below  the  umbilicus.  Along  the  outer  border 
of  the  mass  at  the  so-called  McBurney's  point, 
there  was  special  tenderness,  although  tender- 
ness existed  more  or  less  all  over  the  area  of 
dullness.  While  concurring  in  the  diagnosis  of 
the  appendicitis.  Dr.  Bell  felt  that  the  symp- 
toms might  possibly  be  due  to  other  causes, 
such  as  suppurating  gall-bladder  or  some 
extiavasating  condition  about  the  stomach, 
and  hesitated  to  operate  in  the  country.  The 
]:)atient  came  to  Montreal  and  entered  the 
Royal  Victoria  Hospital,  when  on  further 
examination  he  had  almost  trade  up  his  mind 
that  the  case  was  one  of  appendicitis.  Upon 
opening  the  abdomen,  however,  he  found  a 
very  much  distended  gall-bladder,  very  red  and 
friable  walls.  Upon  making  a  puncture  an 
ounce  of  clear  fluid  escaped,  then  turbid  fluid 
and  lymph,  and  finally,  about  an  ounce  of  pus. 
The  sione  wai  found  to  be  impacted  in  the 
orifice  of  the  cystic  duct,  from  whence  it  was 
dislodged  with  great  difticulty. 

This  case,  though  one  of  ordinary  gall-stone, 
simulating  as  it  did  so  closely  an  appendicitis, 
is  of  more  than  passing  interest  to  the  surgeon 
who  is  now-adays  so  often  called  upon  to 
operate  for  appendicitis.  The  stone  was  an 
inch  in  length,  three-quarters  of  an  inch  in 
breadth,  and  half  an  inch  in  thickness,  being 
somewhat  oval  and  slightly  flattened,  and  has 
truncated  extremities,  one  of  which  was  direct- 
ed into  the  cystic  duct  and  the  other  into  the 
cavity  of  the  gall-bladder. 


Stated  Meeting  April  20///,  1894. 
James  Bell,  M.D.,  President,  in  the  chair. 

Dr.  Edward  J.  Kennedy  was  elected  an  or- 
dinary member. 

Angiosarcoma  of  the  lung. — Dr.  James  Stew- 
art brought  before  the  Society  a  young  man 
suffering  from  a  morbid  growth  of  the  lung. 

Cases  of  primary  sarcoma,  affecting  either 
the  lung  or  the  pleurae,  arc  far  from  common, 
and  the  case  which  we  are  here  about  to  record 
possesses,  for  us  at  least,  a  peculiar  interest, 
inasmuch  as  a  positive  diagnosis  of  the  con- 
dition was  made  during   life.     The   patient,  J. 


!52 


THE  CANADA  MEDICAL  RECORD. 


Vairder  Wee,  a  Belgian  by  birth,  aged  35,  had 
been  for  some  years  a  glass  blower.  He  first 
felt  unwell  in  the  beginning  of  February,  1894, 
experiencing  constant  pain  in  the  left  side  of 
the  chest.  Shortly  before  admission  into  the 
hospital  (upon  the  7th  of  April)  he  suffered 
from  frequent  vomiting.  Upon  admission  it 
was  noticed  that  the  upper  portion  of  the  left 
thorax  presented  very  definite  bulging,  and 
from  the  third  rib  upwards  upon  the  left  side 
there  was  absolute  dullness  upon  percussion, 
while  auscultation  over  this  area  only  gave  a 
distant  blowing  breathing.  Vocal  fiemitus  was 
absent.  The  dullness  and  the  auscultatory 
signs  were  the  same  both  above  the  clavicle 
and  above  and  around  the  upper  portion  of  the 
scapula  behind.  While  in  the  hospital  pres- 
sure symptoms  developed  in  the  left  arm,  the 
left  radial  pulse  was  distinctly  weaker  than 
the  right,  and  the  difference  was  well  shown  in 
sphygmographic  tracings  obtained  from  the 
two  radicals  ;  the  surface  temperature  of  the 
left  arm  was  liigher  than  that  of  the  right,  and 
there  was  pain  extending  down  the  inner  side 
of  the  left  arm. 

During  the  last  week  of  life  the  patient  suffer- 
ed from  excessive  vomiting,  and  was  unable  to 
retain  any  nourishment.  Three  days  before 
death,  which  occurred  on  May  the  5th,  the  pa- 
tient was  noticed  to  have  become  suddenly 
peculiarly  anemic,  within  24  hours  he  became 
delirious,  and  although  a  few  hours  before  death 
his  condition  seemed  to  be  improved,  there  was 
a  return  of  the  symptoms  and  he  died  with 
comparative  suddenness. 

The  absence  of  vocal  fremitus,  complete  dull- 
ness on  percussion  and  the  pressure  symptoms, 
together  with  the  absence  of  any  marked  ex- 
pectoration, and  again  the  absence  of  pulsation, 
led  one  of  us  (S.)  to  a  diagnosis  of  sarcoma. 
On  April  the  15th,  in  order  to  confirm  this 
diagnosis,  an  ordinary  Pravaz  syringe  was  care- 
fully sterilized,  the  skin  over  the  region  of  most 
considerable  bulging,  namely,  over  the  second 
interspace  on  the  left  side  in  front,  was  washed 
and  rendered  aseptic,  and  in  the  presence  of 
boih  of  us,  Dr.  Decks,  the  resident  physician, 
passed  the  needle  into  the  swelling  and  ob- 
tained without  great  difficulty  several  drops  of 
fluid.  This  fluid  was  in  the  main  composed 
of  blood.  In  it  could  be  seen  small  whitish  or 
creamy  masses  of  more  solid  material.  The 
needle  was  immediately  passed  through  the  side 
of  the  cotton-wool  plug  of  a  tube  of  sterilised 
Glycerine  Agar- Agar.  A  few  drops  of  what  re- 
mained in  the  syringe  were  immediately  exam- 
ined unstained  under  the  microscope,  but  be- 
yond plentiful  red  corpuscles  nothing  could  be 
clearly  distinguished  ;  later,  one  of  the  small 
whitish  masses  removed  from  the  surface  of 
the  Agar-Agar,  and  stained  under  the  cover 
slip  with  a  dilute  solution  of  methylene  blue, 
showed  the  presence  of  large  numbers  of  cells 


of  a  size  rather  larger  than  that  of  ordinary 
leucocytes,  and  with  nuclei  which,  instead  of 
being  rounded,  were  of  a  blunt  oval  shape. 
Together  wiih  these  cells  there  could  occasion- 
ally be  seen  definite  thin  spindle-shaped  cells 
with  nuclei  of  a  more  elongated  oval  or  spindle- 
shaped  appearance,  but  more  rarely  there 
were  to  be  recognized  larger  cells,  three  or 
four  times  the  diameter  of  the  cells  which 
formed  the  main  mass.  These  were  filled  with 
minute  oily  droplets,  and  had  also  a  more  pig- 
mented appearance.  It  may  be  added  here 
that  the  Agar  tube  placed  in  the  incubator  at 
37°  C.  remained  completely  sterile,  save  that 
after  several  days  there  developed  one  small 
whitish  growth  which  was  found  non-pathogenic, 
and  which  was  evidently  a  contamination  from 
the  air. 

These  cells  were  from  their  appearance 
neither  pus  cells  nor  the  products  nor  the  ac- 
companiments of  any  form  of  chronic  inflam- 
mation ;  their  appearance  entirely  tallied  with 
that  of  a  sarcomatous  nature,  and  it  was  held 
that  here  there  could  be  none  other  than  some 
rapidly-growing  oat-shaped  cell  or  oval  celled 
sarcoma  present,  and  in  fact  the  patient  was 
brought  before  the  Montreal  Medico-Chirurgi- 
cal  Society  upon  April  tlie  13th,  and  the  con- 
dition was  there  demonstrated  as  being  one  of 
sarcoma  of  the  lung,  or  pleura. 

At  the  autopsy  performed  upon  May  the  6th, 
the  body  was  found  to  be  that  of  a  well-develop- 
ed adult,  of  medium  size,  with  no  signs  of  ema- 
ciation or  oedema.  There  was  no  difference  to 
be  noticed  between  the  two  arms,  either  in  cir- 
cumference or  in  other  respect.  The  head  was 
not  examined.  Upon  opening  the  thorax  a 
large  soft  mass  was  discovered  extending  from 
the  very  upper  extremity  of  the  left  side  of  the 
thorax  down  to  the  level  of  the  sixth  rib  in  the 
left  mammary  line.  At  the  level  of  the  second 
rib  the  mass  extended  from  the  junction  of  the 
second  rib  with  its  cartilage  on  the  right  side 
across  the  whole  of  the  left  chest.  Below  this 
level  its  edge  slanted  obliquely  towards  the  left 
nipple  and  to  the  level  of  the  sixth  rib  as  above 
mentioned.  The  upper  portion  of  this  mass, 
down  to  the  level  of  the  third  rib,  was  apparent- 
ly firmly  adherent  to  the  costal  pleura,  so  that 
in  order  to  remove  the  growth  in  part  this  had 
to  be  dissected  off  from  the  ribs.  Below  the 
level  of  the  third  rib  the  wall  of  the  capsule 
appeared  to  be  thinner;  it  was  of  a  dark  bluish 
colour  and  resembled  a  cyst  containing  blood. 
The  heart  was  displaced  downwards,  and  to 
the  left  the  right  lung  showed  slight  adhesion 
along  the  fourth  rib,  behind  and  forward,  as 
far  as  the  anterior  axillary  line.  Upon  remov- 
ing several  inches  of  the  upper  ribs  upon  the 
left  side  in  order  to  dissect  out  the  tumor  in 
part  it  was  found  that  the  intercostal  humeral 
nerve  passed  down  from  the  pleura  wiihin  the 
(horacic  cavity,  that  is  to  say,  to  the  inner  side" 


THE   CANADA    MEDICAL   RECORD. 


253 


of  ihe  ribs,  and  that  it  appeared  lo  be  enmeshed 
or  implicated  in  the  capsule  of  the  growth, 
emerging  laterally  between  the  second  and 
third  ribs.  The  first  and  second  ribs  of  the 
left  side  were  slightly  eroded  as  far  as  their 
cartilages,  the  third  as  far  as  the  axillary  line, 
the  fourth  as  far  as   the  angle. 

Upon  removing  the  greatly  enlarged  left 
lung,  the  mass  upon  the  upper  and  anterior 
surface  was  found  to  be  peculiarly  soft,  and  so 
soon  as  the  capsule  formed  by  the  costal  pleura 
was  cut  in  two,  a  large  amount  of  soft  semi  tluid 
material  of  a  dark  purple  color  easily  passed  out 
through  the  openings  made.  As  much  as  700 
cubic  centimetres  of  this  material  was  taken  out 
at  the  autopsy,  and  a  quantity  almost  equal  in 
amount  was  still  left  within  the  sac  removed  at 
a  later  period.  Save  that  some  portions  of 
this  material  were  of  a  slightly  denser  consist- 
ency, the  whole  might  have  been  taken  for  soft 
breaking  dow^n  blood  clot. 

Upon  cutting  up  the  bronchi  of  the  left  lung, 
and  passing  a  probe  down  the  various  smaller- 
sized  bronchi  of  the  upper  portion  of  the  lung, 
no  communication  could  be  detected  between 
these  and  the  tumour  mass,  and  careful  exam- 
ination showed  that  this  mass  lay  in  the  pleural 
cavity  above  and  anterior  to  the  upper  lobe  of 
of  the  left  lung.  There  had  evidently  been  an 
old  chronic  pleurisy  of  some  standing,  causing 
adhesion  between  the  upper  lobe  or  the  lower 
boundary  of  this  lobe  and  the  costal  pleura, 
and  it  was  in  the  sac  formed  thus  between  the 
two  layers  of  the  pleura  over  the  upper  lobe 
that  a  tumour  had  developed  and  had  extended. 
The  upper  lobe  itself  was  greatly  compressed, 
the  lower  lobe  showed  compression  to  a  lesser 
extent;  the  right  lung  was  smaller  than  normal. 
It  presented  a  certain  amount  of  emphysema. 
At  its  apex  were  three  or  four  old  calcareous 
tubercular  nodules  well  encapsuled.  The  peri- 
cardium contained  an  ounce  of  slightly  blood 
stained  fluid,  the  heart  showed  no  signs  of  in- 
flammation, the  valves  of  the  heart  in  general 
were  normal,  the  abdominal  organs  presented 
nothing  calling  for  special  remark  in  this  con- 
nection. No  secondary  growths  could  be  re- 
cognized by  the  naked  eye  in  any  of  the  organs. 

Upon  examination  of  portions  of  the  soften- 
ed mass  of  the  tumour,  carefully  selected  from 
various  areas,  and  hardened  either  by  placing  in 
boiling  water  for  one  minute  or  by  Muller's 
fluid,  it  was  found  that  the  lower  edge  of  the 
tumour  mass  was  almost  entirely,  if  not  quite, 
pure  clotted  blood ;  portions  rather  denser  in 
their  consistency  originally,  but  still  equally 
blood-stained,  presented  a  very  interesting  con- 
dition. They  were  found  to  be  formed  of  lo- 
bules of  sarcomatous  tissue,  whose  cells  showed 
up  very  well  by  contrast  staining,  either  with 
methylene  blue  and  eosin,  or  with  hsematoxy- 
lon  and  eosin.  Running  in  various  directions 
through   these   lobules   of  sarcomatous   tissue 


were  greatly  dilated  vessc'.s  of  a  purely  em- 
bryonic type,  with  walls  so  delicate  that  the 
flattened  cells  forming  them  could  only  here 
and  tiiere  be  recognized.  Immediately  around 
these  vessels  the  sarcoma  cells  were  more  dense- 
ly arranged;  these  cells  were  identical  in  ap- 
pearance with  those  that  had  been  removed  by 
the  hypodermic  needle.  They  were  slightly 
oval,  their  nuclei  were  also  oval  and  stained 
well,  and  they  were  definitely  larger  than,  in  fact 
almost  twice  as  large  as,  the  leucocytes  which 
could  be  seen  here  and  there  lying  within  t!ie 
vessels.  Away  from  the  vessels  the  cells  be- 
came more  loosely  arranged,  and  here  and  there 
stained  badly,  inasmuch  as  lobules  were  sep- 
arated from  each  other  by  very  extensive 
effusion  of  blood,  and  this  extravasated  blood 
appeared  to  be  causing  the  destruction  of  these 
outer  layer  of  cells,  the  extravasation  extending 
in  between  them. 

Careful  study  of  sections  taken  from  various 
points  over  the  surface  of  the  upper  lobe  of  the 
left  lung  led  to  the  conclusion  that  the  tumour 
had  not  originated  from  the  visceral  pleura;  in 
general  the  tumour  mass  could  be  easily  re- 
moved from  the  surfaces  of  the  lung,  leaving 
this  relatively  smooth  and  glistening.  On  the 
other  hand,  sections  through  the  costal  pleura 
from  the  level  of  the  second  interspace  upwards 
showed  that  here  the  pleura  had  undergone 
great  fibroid  thickening,  and  that  it  was  infiltra- 
ted by  masses  of  sarcoma  cells.  It  would  seem 
evident,  therefore,  that  the  tumour  had  origin- 
ated, not  primarily  in  connection  with  the  lung. 
but  in  connection  with  the  costal  pleura. 

This  condition  presents  very  many  points  of 
interest ;  it  confirms  the  diagnosis  that  had 
been  made  intra  vitam.  The  rapid  growth  of 
the  tumour  and  the  erosion  of  the  upper  ribs, 
indicate  that  in  its  development  this  tumour 
had  pressed  upwards,  and  had  thus  affected 
both  brachial  and  nerve  supply.  The  fact  that 
the  tumour  was  extra  pulmonary  will  explain 
the  remarkable  absence  of  direct  pulmonary 
symptoms  observable  during  life  ;  while  the 
character  of  the  growth  is  fitted  to  throw  light 
upon  the  symptoms  which  immediately  preced- 
ed death.  As  we  have  mentioned,  the  tumour 
was  of  a  peculiarly  vascular  nature  ;  even  those 
parts  which  were  found  to  stain  so  well,  and 
which  showed  most  clearly  the  sarcomatous 
nature,  were,  when  removed  from  the  body  of  a 
consistence  scarcely  firmer  than  that  of  recent 
blood  clot,  tearing  apart  with  great  ease.  In 
i  addition  to  this  natural  softness  of  consistency 
on  the  part  of  the  tumour,  there  had  evidently 
been  a  very  great  amount  of  haemorrhage  into 
the  growth,  so  that  the  tumour  in  its  lower 
part  was  nothing  but  pure  blood  clot,  and  in  the 
rest  of  the  area  was  a  mixture  of  blood  and  sar- 
coma tissue. 

The  question  arises,  had  these  haemorrhages 
been     continually     occurring    during     several 


254 


THE   CANADA   MEDICAL   RECORD. 


weeks,  or  had  there  been  one  great  and  exten- 
sive hemorrhage,  which,  coupled  with  the  break- 
ing down  of  the  neopLasm,  may  be  looked  upon 
as  having  been  the  one  immediate  cause  of 
death.  Undoubtedly  there  had  been  a  certain 
amount  of  haemorrhage  and  breaking  down  of 
the  tumour  some  weeks  before  death.  This 
alone  is  capable  of  explaining  the  presence  of 
the  occasional  large  leucocytes,  or,  if  the  term 
may  be  employed,  "  Staubzellen,"  which  were 
found  at  the  time  of  the  exploratory  puncture 
in  April,  large  cells  containing  the  debris  of  the 
fatly  degeneration  of  the  sarcoma  tissue,  to- 
gether with  a  certain  amount  of  pigment  derived 
from  extravasated  blood.  But  we  are,  notwith- 
standing this  evidence,  inclined  to  believe  that 
shortly  before  death  a  most  extensive  haemorr- 
hage had  occurred,  for  this  alone  will  account 
for  the  sudden  onset  of  extreme  anaemia,  which 
was  noticed  three  days  before  death,  and  the 
almost  equally  sudden  low  delirium  which  en- 
sued. That  this  hgemorrhage  was  in  itself 
sufficient  to  account  for  death  we  will  not  say, 
but  it  had  led  to  extensive  breaking  down  of 
the  sarcoma  tissue,  and  this  haemorrhage, 
breaking  down  of  the  tissue  and  absorption  of 
the  products  formed  together,  in  our  opinion, 
a  sufficient  cause. 

Melanotic  Satxoina  of  the  I'oot. —  Dr.  Arm- 
strong exhibited  the  specimen  which  had  been 
removed  from  the  sole  of  the  foot  of  a  woman 
aged  67.  Five  years  ago  she  had  stepped  upon 
a  nail  which  had  pierced  the  sole.  After  it 
was  removed  the  wound  healed  ;  one  year  later 
it  re-opened  and  discharged  pus  for  some  time 
and  again  healed.  For  the  past  four  years  it 
has  periodically  opened,  discharged  and  again 
healed  up,  sometimes  remaining  closed  for  a 
month  or  two.  During  this  time  she  had  been 
doing  the  work  of  a  servant  and  never  had  any 
medical  attendance  until  a  month  ago  when 
she  called  upon  him.  Behind  the  middle  and 
fourth  toe  there  was  a  mass  about  one  inch 
square  which  resembled  an  exuberant  granula- 
tion. Under  ether  this  mass  was  shelled  out 
with  a  blunt  spoon,  it  being  connected  with 
neither  tendon  nor  periosteum.  On  examina- 
tion a  lymphatic  gland,  about  the  size  of  an  egg, 
was  found  below  Poupari's  ligament,  the  patient 
not  being  aware  of  its  presence.  The  haemor- 
rhage after  removal  was  considerable,  one  or 
two  little  vessels  spouting. 

Dr.  Armstrong  thought  at  the  time  that  the 
condition  was  malignant,  which  suspicion  was 
confirmed  by  Dr.  Adami's  report.  Such  cases 
are  instructive,  inasmuch  as  they  show  that 
irritation  may  sometimes  set  up  a  growth  in 
situations  where  otherwise  it  would  not  be  at 
all  likely  to  occur,  or  may  change  the  character 
of  a  growth  from  benign  to  a  malignant  type. 
This  principle  applies  to  the  breast  also,  and 
should  impress  us  with  the  miportance  of  pay- 
ing early  attention  to  any  lesion  which,  by  con- 


tinued irritation,  may  develop  into  a  malignant 
character  in  the  later  years  of  life. 

Dr.  Adami  stated  that  the  somewhat  alveolar 
arrangement  of  the  cells  in  portions  of  this 
tumour  brings  up  a  much  debated  question  as 
to  the  nature  of  these  melanotic  sarcomas.  Are 
they  ordinary  sarcomas,  or  a  mixture  of  sar- 
coma and  carcinoma,  or  a  very  malignant  form 
of  pure  sarcoma  ?  Here,  however,  the  evidence 
is  certainly  in  favour  of  a  pure  sarcomatous 
nature,  the  growth  originating  immediately  be- 
neath the  Malpighian  layer  of  the  epidermis. 
This  tumour  differs  from  many  other  melanotic 
tumours  by  being  very  well  defined,  and  there 
being  not  much  evidence  of  cell  growth  at  its 
borders,  a  condition  uncommon  in  primary 
melanotic  growths.  It  being  very  superficial 
may  account  for  it  not  being  attached  to  the 
deeper  structures.  It  will  be  interesting  to 
note  if  any  secondary  growth  appears  in  the 
gland  in  the  groin,  for  often  when  the  primary 
growth  is  of  small  size  there  is  rapid  increase 
in  the  secondary  form. 

A  case  of  Appendicitis. — Dr.  Armstrong  in 
exhibiting  this  specimen,  stated  that  the  clinical 
history  was  of  more  than  usual  interest.  The 
patient,  a  lady,  46  years  of  age,  a  morphino- 
maniac,  gave  a  history  of  eight  attacks  of  pain 
in  the  lower  part  of  the  abdomen.  In  one  of  her 
attacks  in  November,  1893,  she  was  five  or  six 
weeks  in  bed.  Dr.  Armstrong  saw  her  for  the 
first  time  two  months  ago,  when  on  examination 
he  found  in  the  right  side  of  the  pelvis  a  fairly 
large  mass,  hard,  painful  and  tender  on  pres- 
sure. On  considering  the  history  of  repeated 
attacks,  he  advised  early  removal  of  the  mass. 
While  the  patient  had  this  still  under  consider- 
ation, she  came  and  said  that  she  had  dis- 
charged about  a  pint  of  creamy  yellow  matter 
from  the  vagina,  then  on  examination  he  found 
that  the  mass  was  almost  all  gone,  and  there- 
fore came  to  the  conclusion  that  it  had  emptied 
itself  in  that  way.  Two  weeks  ago  she  com- 
plained of  abdominal  tenderness,  and  he  think- 
ing that  she  had  been  taking  morphine  by 
mouth  was  inclined  to  account  for  it  by  the  use 
of  that  drug.  Her  temperature,  however,  rose 
to  100*^,  and  next  day  she  began  to  go  into  a 
state  of  collapse.  Subsequently  the  tempera- 
ture dropped  to  95/-^°,  and  then  quite  suddenly 
returned  to  normal  with  an  accompanying  im- 
provement in  the  pulse.  This  latter  favourable 
condition  continued  for  some  days,  until  one 
morning,  when  on  going  to  the  hospital  he 
found  her  with  a  low  temperature,  small  weak 
pulse,  pain  and  extreme  tenderness  on  pressure. 
Operation  was  at  once  performed.  Thinking 
he  had  to  deal  with  a  tubo-ovarian  abscess,  he 
made  a  median  incision,  but  on  going  down 
into  the  pelvis  on  the  right  side  he  soon  reached 
pus.  After  working  at  what  he  thought  was 
a  tube  he  released  it  only  to  find  that  it  was 
the  plexure  of  the  colon  which  lay  to  the  right 


THE   CANADA.   MEDICAL   RECORD. 


of  the  uterus,  just  above  the  Faliopian  tube, 
wliich,  together  with  its  ovary,  was  perfectly 
normal.  The  colon  was  filled  with  water,  and 
found  not  to  be  i)erforated.  Then  examining 
the  region  of  the  caecum,  the  blunt  and  dis- 
eased appendix  was  found.  Such  a  condition  in 
a  woman  is  very  misleading,  pointing  as  it  did 
more  to  a  pus  tube  than  to  a  purulent  appen- 
dix, especially  as  her  husband  was  not  above 
suspicion. 

Acute  Lciikccmia. — Dr.  Stewart  gave  the 
clinical  history.  The  jjatient,  a  man,  60  years 
of  age,  was  admitted  into  the  Royal  Victoria 
Hospital  in  a  condition  of  high  fever  and  swell- 
ing of  all  the  lymphatic  glands.  These  were 
his  chief  symptoms  durmg  the  three  weeks 
prior  to  his  death.  There  was  enlargement  of 
liver  and  spleen,  marked  leucocytosis,  white  to 
red,  varying  1-30  to  1-50.  Diagnosis  was  acute 
leukaemia,  but  in  this  connection  it  was  difficult 
to  explain  the  high  pyrexia,  that  of  leuksemia 
being  very  moderate.  The  patient  died  from 
exhaustion,  his  condition  being  quite  unin- 
fluenced by  treatment. 

Dr.  Adami  gave  the  pathological  report. 
The  microscopical  examination  of  the  liver 
showed  increased  amount  of  fibrous  tissue  be- 
tween individual  cells  pointing  to  some  chronic 
disturbance.  Sections  of  the  pancreas  also 
showed  more  fibroid  tissue  than  normal.  Cul- 
tures from  the  spleen  upon  agar-agar  and  beef 
troth  showed  the  characteristic  development 
of  the  streptococcus  of  suppuration.  Dr. 
Adami  stated  that  at  the  time  cf  the  autopsy  he 
had  a  slight  scratch  upon  his  finger,  at  the  site 
of  which  small  pustules  subsequenty  developed  ; 
from  these  he  had  made  cultures  and  found 
very  characteristic  streptococcus  growth.  This 
led  to  a  more  thorough  examination  of  all  the 
organs,  and  enormous  numbers  of  streptococci 
were  found  throughout.  Emboli  formed  of  the 
streptococci  were  found  in  the  marrow  of  the 
sternum,  in  the  spleen  pulp,  filling  up  the  capil- 
laries between  the  liver  cells,  in  many  places 
in  the  kidney,  in  the  lymphatic  gland,  especially 
those  softened  glands  of  the  mesentary  about 
the  pancreas.  They  all  stained  by  Gramuis 
method  like  the  ordinary  streptococci,  and  the 
cultural  peculiarities  resembled  them  also. 
They,  however,  differed  slightly  from  the  or- 
dinary streptococcus  of  erysipelas  and  suppu- 
ration by  growing  more  freely,  the  broth  in 
which  they  grew  not  being  quite  so  clear  as 
usual,  and  the  size  of  the  chain  was  rather 
longer.  The  inoculation  experiments  are  as 
,  yet  incomplete. 

Dr.  Bell  asked  for  some  information  as  to 
the  man's  occupation  prior  to  his  illness,  for  it 
seemed  to  him  from  the  clinical  and  pathologi- 
cal report  that  the  case  was  one  of  septic  in- 
fection. 

Dr.  Geo.  Brown  wished  to  know  whether 
any  ear  symptoms  were  present.     The  case  re- 


called to  his  mind  one  reported  in  the  General 
Hospital  several  years  ago,  in  which  the  only 
symptom  was  a  septic  temperature,  and  in 
which  a  diagnosis  of  suppurative  endocarditis 
was  made.  The  autopsy,  however,  revealed 
suppuration  in  the  lateral  sinus. 

Dr.  GuNN  saw  the  patient  when  he  first 
came  to  the  hospital,  and  learned  from  him  that 
he  had  been  working  recently  cleaning  out  the 
sewers.  Another  important  feature  in  the  case 
was  the  rature  of  the  leucocytosis.  The  in- 
crease of  the  white  corpuscles  finally  reached 
the  proportion  of  i  in  37,  and  consisted  solely 
of  an  increase  of  the  polynuclear  leucocytes, 
the  mononuclear  variety  not  being  at  all  in- 
creased. This  condition  of  the  blood  corres- 
ponds with  septicaemia.  Another  very  interest- 
ing point  in  the  case  was  the  peculiarity  of  the 
splenic  enlargement,  which  instead  of  enlarging 
downwards  extended  upwards,  its  area  of  dull- 
ness reaching  behind  to  the  middle  of  the  sca- 
pula, and  being  continuous  in  front  with  the 
heart  dullness.  At  the  autopsy  this  condition 
was  explained  by  the  contraction  of  the  left 
lung,  which  accordingly  permitted  the  upward 
extension  of  the  spleen,  as  being  the  direction 
of  least  resistance. 

Tyt>Jioid  Ftvcr  with  Double  Pnewnotiia. — 
Dr.  Geo.  A.  Browx  reported  the  case.  D.  O., 
age  30,  complained  of  headaches,  pain  in  the 
back  and  bones,  dyspnoea  and  cough  with  ex- 
pectoration of  a  rusty  character.  Family  his- 
tory negative.  Patient  had  scarlet  fever  and 
measlt  s  in  childhood  and  la  grippe  four  years 
ago,  and  since  that  time  has  enjoyed  good 
health. 

Present  illness  began  about  ten  days  ago 
(Sept.  25),  with  chilliness, headache,  pain  in  the 
back  and  bones,  and  slight  pain  in  the  abdomen, 
followed  by  diarrhoea.  About  Oct.  ist,  he  had 
a  slight  hacking  cough,  with  expectoration  of 
a  frothy  character.  Thinking  that  it  was  only 
a  cold,  he  tried  to  battle  it  off  and  remained  at 
W(jrk  until  he  was  compelled  to  give  it  up. 
On  Oct.  4th,  I  saw  patient  for  the  first  time. 
He  was  in  a  semi-comatose  condition  and  there 
was  marked  signs  of  prostration.  Temp,  was 
105*^  ;  Pulse  120;  Resp.,  40;  pupils  were  con- 
tracted and  responded  to  light.  I  found  it  very 
difficult  to  wake  him,  and  when  awake  he  had 
difficulty  in  hearing,  and  did  not  understand 
questions  very  well. 

On  examination  of  the  lungs  I  found  sibilant 
rales  all  over  with  rapid  and  prolonged  respi- 
ration. At  the  back  in  the  right  inferior  scap- 
ular region  there  was  dullness,  blowing  breath- 
ing and  bronchophony,  also  some  physical 
signs  in  inferior  axillary  region,  showing  ex- 
tensive consolidation  of  the  right  lower  lobe. 
On  left  side  in  left  inferior  scapular  region  there 
was  another  patch  of  pneumonia  about  two 
inches  square. 

The  abdomen  was  covered  with  rose  spots. 


256 


THE  CANADA  MEDICAL  RECORD. 


On  palpation  it  was  tense,  tliere  was  tenderness 
and  gurgling  in  right  iliac  fossa,  spleen  was  en- 
larged;  dullness  extended  from  eighth  rib  al- 
most to    the  crest  of  the  ilium.     Urine  normal. 

For  first  seven  days  (Oct.  5th  to  i2lh)  of 
his  illness,  patient  remained  in  a  prostrated 
condition.  There  was  present  a  low  muttering 
delirium,  picking  of  the  bed  clothes  and  sub- 
sultus  tendinum.  On  eleventh  and  twelfth  of 
October  patient  was  in  a  semi-comatose  condi- 
tion all  1  he  time,  and  coul  1  not  be  aroused  when 
nourishment  was  given  him.  There  was  a 
cyanotic  condition  of  the  lips  and  finger  tips. 
Urine  was  examined  and  no  albumen  found. 
Oct.  13th,  the  delirium  ceased,  the  temperature 
and  pulse  dropped  and  there  was  profuse  sweat- 
ing. In  the  pneumonic  areas  there  was  a  few 
reflux  rales. 

From  Oct.  14th  to  21st  the  physical  signs  re- 
sembled acute  miliary  tuberculosis,  as  there 
were  numerous  moist  rales  all  over  the  lungs, 
more  especially  in  pneumonic  portions.  There 
was  a  hectic  flush  and  profuse  sweating  towards 
evening,  usually  lasting  about  two  hours.  There 
was  also  frequent  coughing,  at  times  followed 
by  muco-purulent  expectoration.  About  Oct. 
22nd,  physical  signs  in  lungs  cleared  up;  cough 
ceased,  and  tliere  were  also  a  few  mucous  rales 
in  the  bases. 

The  abdominal  symptoms  at  the  time  were 
more  marked,  there  was  distention  and  the 
stools  were  very  foetid. 

On  Oct.  28th,  temp  dropped  to  normal  and 
patient  made  a  good  convalesence.  Treatment 
was  milk  diet,  brandy  3  vi,  and  Trit.  Strychi- 
nince  Sulp.  gr.  1-30,  4  g.h.,  and  Trit.  Hydrarg 
Subchlor  gr.  i-io  2  g.h.,  while  the  stools  were 
fcetid. 

T/ie  causation  of  Inflafumation  0/ the  Brain. 
— A  comparison  of  authorities  07i  the  subject. — 
Dr.  Wesley  Mills  read  the  following  com- 
munication : 

Owing  to  some  remarks  made  at  a  recent 
meeting  of  the  Society  in  regard  to  the  relations 
between  the  blood  vessels  and  inflammation  of 
the  brain,  I  have  been  led  to  look  into  the 
literature  of  the  subject  and  now  submit  the 
following  brief  references  from  writers  in  Eng- 
lish. 

Fagge  in  his  Principles  and  Practice  of  Med- 
icine says :  •'  Now  it  is  well  known  that  an 
embolism  often  sets  up  inflammatory  processes 
in  the  parts  around  the  vessel  in  which  it 
becomes  lodged." 

Bristowe  observes  in  his  Iheory  and  Practice 
of  Medicine:  "  In  a  large  number  of  cases  en- 
cephalitis arises  from  the  influence  of  some 
irritating  mass  as  a  patch  of  softening." 

"Inflammatory  changes  occur  about  the 
softened  areas,  and  when  the  embolus  is  derived 
from  an  infected  focus,  as  in  ulcerative  endo- 
carditis, there  may  be  suppuration."  Accord- 
ing to  Flint :  "  If  the  embolus  is  infectious  it 
leads  to  the  formation  of  an  abscess." 


Ross  (Handbook  of  Diseases  of  the  Nervous 
System),  believes  that,  '•'  local  disease  of  the 
brain,  like  thrombosis,  embolism,  etc.,  often 
sets  up  surrounding  inflammation  of  the  brain." 

Bartholow  (Practice  of  Medicine)  remarks 
that,  "  more  frequently  encephalitis  has  oc- 
curred from  infective  thrombi." 

Osier  (Practice  of  Medicine)  writing  of 
thrombosis  and  embolism  hold.s  that  "  inflam- 
matory changes  are  common  in  and  about  the 
softened  [brain]  areas.  When  the  embolus  is 
derived  from  an  infected  focus,  as  in  ulcerative 
endocarditis,  suppuration  miy  follow." 

One  of  the  principles  I  learned  as  a  student 
from  that  great  teacher  of  Medicine  the  late  Dr. 
R.  P.  Howard,  was,  that  in  any  case  of  fatal 
brain  disease  it  was  a  wise  precaution  to  ex- 
amine the  blood  vessels  of  the  brain,  and,  in 
fact,  to  look  into  the  circulatory  system  gener- 
ally, especially  so  in  cases  of  softening,  inflam- 
mation, etc. 

From  such  an  examination  of  the  writings  of 
the  leading  teachers  of  Medicine  of  the  present 
and  the  immediate  past  as  I  have  been  able  to 
make,  it  appears  that  such  an  advice  is  still 
sound.  While  we  should  welcome  any  new 
light  that  microbic  or  other  processes  may 
throw  on  disease,  I  cannot  but  believe  that 
the  old  landmarks  have  not  yet  all  been  swept 
away. 


Iroitrtss    of    Science , 


INFORMATION     FOR    CONSU.MPTI\^ES 
AND  THOSE  LIVING  WITH  THEM. 

Health  Department, 
No.  301  Mott  Street, 
New  York,  February  13th,  1894. 

Consumption  is  a  disease  which  can  be  taken 
from  others,  and  is  not  simply  caused  by  colds. 
A  cold  may  make  it  easier  to  take  the  disease. 
It  is  usually  caused  by  germs  which  enter  the 
body  with  the  air  breathed.  The  matter  which 
consumptives  cough  or  spit  up  contains  these 
germs  in  great  numbers — frequently  millions 
are  discharged  in  a  single  day.  This  matter, 
spit  upon  the  floor,  wall  or  elsewhere,  is  apt  to 
dry,  become  pulverized  and  float  in  the  air  as 
dust.  The  dust  contains  the  germs,  and  thus 
they  enter  the  body  with  the  air  breathed. 
The  breath  of  a  consumptive  does  not  contain 
the  germs  and  will  not  produce  the  disease.  A 
well  person  catches  the  disease  from  a  con- 
sumptive only  by  in  some  way  taking  in  the 
matter  coughed  up  by  the  consumptive. 

Consumption  can  often  be  cured  if  its  nature 
is  recognized  early  and  proper  means  are  taken 
for  its  treatment.  In  a  majority  of  cases  it  is 
not  a  fata/  disease. 


THE  CANADA  MEDICAL  RECORD. 


257 


It  is  not  dangerous  for  other  persons  to  live 
with  a  consumptive  if  the  matter  coughed  up 
by  the  consumptive  is  at  once  destroyed. 
This  matter  should  not  be  spit  upon  the  floor, 
carpet,  stove,  wall,  or  street,  or  anywhere 
except  into  a  cup  kept  for  that  purpose.  The 
cup  should  contain  water,  so  tliat  the  matter 
may  not  dry,  and  should  be  emptied  at  least 
twice  a  day  and  carefully  washed  with  hot 
water.  Great  care  should  be  taken  by  a  con- 
sumptive that  his  hands,  face  and  clothing  do 
not  become  soiled  with  the  matter  coughed  up. 
If  they  do  become  soiled  they  should  be  at 
once  washed  with  hot  soap  and  water.  When 
consumptives  are  away  from  home,  the  matter 
coughed  up  may  be  received  on  cloths,  which 
should  be  at  once  burned  on  returning  home. 
If  handkerchiefs  are  used  (worthless  cloths 
which  can  be  burned  are  far  better)  they 
should  be  boiled  in  water  by  themselves  before 
being  washed 

It  is  better  for  a  consumptive  to  sleep  alone, 
and  his  bed-clothing  and  personal  clothing 
should  be  boiled  and  washed  separately  from 
the  clothing  belonging  to  other  people. 

Whenever  a  person  is  thought  to  be  suffering 
from  consumption,  the  name  and  address 
should  be  sent  at  once  to  the  Health  Depart- 
ment, on  a  postal  card,  with  a  statement  of  this 
fact.  A  medical  inspector  from  the  Health 
Department  will  then  call  and  examine  the 
person  to  see  if  he  has  consumption,  providing 
he  has  no  physician,  and,  if  necessary,  will  give 
proper  directions  to  prevent  others  from 
catching  the  disease. 

Frequently  a  person  suffering  from  consumption 
may  not  only  do  his  usual  work  Miihout  giving 
the  disease  to  others,  but  may  also  get  well,  if 
the    matter  coughed  up  is   properly  destroyed. 

Rooms  that  have  been  occupied  by  consump- 
tives should  be  thoroughly  cleaned,  scrubbed, 
whitewashed,  painted  or  papered  before  thejare 
again  occupied.  Carjiets,  rugs,  bedding,  etc., 
from  rooms  which  have  been  occupied  by 
consumptives,  should  be  disinfected.  The 
Health  Department  should  be  notified,  when 
they  will  be  sent  for,  disinfected  and  returned 
to  the  owner  free  of  charge,  or,  if  he  so  desires,  j 
they  will  be  destroyed. 

By  order  of  the  Board  of  Health, 

Charles  G.  Wilson,  President 
Emmons  Clark,  Secretary. 


CIRCULAR  OF  INFORMATION  TO  PHY- 
SICIANS REGARDING  THE  MEA- 
SURES ADOPTED  BY  THE  BOARD 
OF  HEALTH  FOR  THE  PREVEN- 
TION OF  TUBERCULOSIS  IN  THE 
CITY  OF  NEW  YORK. 

Health    Department, 
No.  301  Mott  Street, 
New  York,  February  13,  1894. 
The  communicability  of  pulmonary  tubercu- 


losis has  been  so  throiighly  established,  and  is 
now  so  generally  recognized  by  the  medical 
profession  throughout  the  world,  that  the 
Board  of  Health  of  New  York  City  has  deter- 
mined that  the  time  has  arrived  when  active 
steps  should  be  taken,  looking  towards  its 
prevention  in  this  city.  The  Board  has  there- 
fore resolved  to  adopt  the  following  preliminary 
measures : 

First — The  Department  will  hereafttr  register 
the  name,  oddress,  sex  and  age  of  every  person 
suffering  from  tuberculosis  in  this  city,  so  far 
as  such  information  can  be  obtained,  and 
respectfully  requests  that  hereafter  all  physi- 
cians forward  such  information  on  the  postal 
cards  ordinarily  employed  for  reporting  case!> 
of  contagious  diseases.  This  information  will 
be  solely  for  the  use  of  the  Department,  and  in 
no  case  will  visits  be  made  to  such  persons  by 
the  inspectors  of  the  Department,  nor  will  the 
Department  assume  any  sanitary  surveillance 
of  such  patients,  unless  the  person  resides  in  a 
tenement-house,  boarding-house  or  hotel,  or 
unless  the  attending  physician  requests  that 
an  inspection  of  the  premises  be  made  ; 
and  in  no  case  where  the  person  resides  in  a 
tenement-housCj  boarding  house  or  hotel,  will 
any  action  be  taken  if  the  physician  requests  that 
no  visits  be  made  by  inspectors,  and  is  willing 
himself  to  deliver  circulars  of  information,  or  fur- 
nish such  equivalent  information  as  is  required 
to  prevent  the  communication  of  the  disease  to 
others. 

Second — Where  the  Department  obtains 
kno.vledge  of  the  existence  of  cases  of  pulmon- 
ary consumption  residing  in  tenement-houses, 
bocirding-houses  or  hotels  (unless  the  case  has 
been  reported  by  a  physician,  and  he  requests 
that  no  visits  be  made),  inspectors  will  visit  the 
premises  and  family,  will  leave  circulars  of 
information,  and  instruct  the  person  suffering 
from  consumption  and  the  family  as  to  the 
measures  which  should  be  taken  to  guard 
against  the  spread  of  the  disease,  and,  if  it  is 
considered  necessary,  will  make  such  recom- 
mendations for  the  cleansing  or  renovation  of 
the  apartment  as  may  be  required  to  render  it 
free  from  infectious  matter. 

Third — In  all  cases  where  it  comes  to  the 
knowledge  of  the  Department  that  premises 
which  have  been  occupied  by  a  consumptive  have 
been  vacated  by  death  or  removal,  an  inspector 
will  visit  the  premises  and  direct  the  removal  of 
infected  articles,  such  as  carpets,  rugs,  bedding 
etc..  for  disinfection,  and  will  make  such  written, 
recommendations  to  the  Board  as  to  the 
cleansing  and  renovation  of  the  apartment  as 
may  be  required.  An  order  embodying  these 
recommendations  wiR  then  be  issued  to  the 
owner  of  the  premises,  and  compliance  with 
this  order  will  be  enforced.  No  other  persons 
than  those  there  residing  at  the  time  will  be 
allowed  to    occupy  such    apartments    until  the 


2sS 


THE  CANADA  MEDICAL  RECORD. 


order  of  the  Board  has  been  complied  with. 
Infected  articles,  such  as  carpels,  rugs,  etc.,  will 
be  removed  by  the  Department,  disinfected  and 
returned  without  charge  to  the    owner. 

Fourth — For  the  prevention  and  treatment  of 
pulmonary  tuberculosis,  it  becomes  of  vital  im- 
portance that  a  positive  diagnosis  shall  be 
made  at  the  earliest  possible  moment,  and  that 
the  value  of  bacteriological  examinations  of  the 
sputa  for  this  purpose  may  be  at  the  service  of 
physicians  in  ail  cases  not  under  treatment  in 
hospitals,  the  Department  is  prepared  to  make 
such  bacteriological  examinations  for  diagnosis, 
if  samples  of  the  sputa,  freshly  discharged,  are 
furnished  in  clean,  wide  necked,  stoppered 
bottles,  accompanied  by  the  name,  age,  sex  and 
address  of  the  patient,  duration  of  the  disease, 
and  the  name  and  address  of  the  attending 
physician.  Bottles  for  collecting  such  sputa, 
with  blank  forms  to  be  filled  in,  can  be  obtained 
at  any  of  the  drug-stores  now  nsed  as  stations 
for  the  distribution  and  collection  of  serum 
tubes  for  diphtheria  cultures.  After  the  spu- 
tum has  been  obtained,  if  the  bottle,  with  the 
accompanying  slip  filled  out,  is  left  at  any  one 
of  these  stations,  it  will  be  collected  by  the 
Department,  examined  microscopically,  and  a 
report  of  the  examination  forwarded  to  the 
attending  physician  free  of  charge. 

Fifth— The  authorities  of  all  public  institu- 
tions, such  as  hospitals,  dispensaries,  asylums, 
prisons,  homes,  etc.,  will  be  required  to  furnish 
to  the  Department  the  name,  sex,  age,  occupa- 
tion and  last  address  of  every  consumptive 
coming  under  observation  within  seven  days  of 
such  time. 

It  is  the  earnest  wish  of  the  Board  of  Health 
that  all  practicing  physicians  in  this  city  co- 
operate with  the  Board  in  an  earnest  and 
determined  effort  to  restrict  the  ravages  of  the 
most  prevalent  and  formidable  disease  with 
which  we  have  to  deal. 

By  order  of  the  Board  of  Health, 

Charles  G.  Wilson,  Preside^it . 
Emmons  Clark,  Secretary. 


WHEN  TO    OPERATE  FOR    SQUINT 

E-.  Jackson  (■Internatio?ial  Medical  Maga- 
zine, February,  1894),  in  a  careful  consideration 
of  the  question  of  operations  for  strabismus, 
makes  the  following  points  : 

No  operation  should  be  done  so  long  as  other 
methods  of  treatment  offer  any  probable  chance 
of  relief.  The  slow  development  of  co-ordinating 
power  in  some  children,  and  the  possibilities  of 
change  by  future  development,  should  prevent 
early  operative  interference  ;  and  as  a  rule, 
therefore,  operation  should  not  be  undertaken 
before  the  age  of  five  or  six  years,  and  at  that 
age  complete  correction  by  operation  should 
rarely  be  attempted.  At  puberty,  complete  cor- 
rection of  the    squint  by    operation  should  be 


undertaken  where  it  has  been  incompletely 
corrected  or  is  of  low  degree.  In  adult  life,  the 
existing  indications  govern  the  operation.  In 
cases  of  squint  due  to  ametropia,  the  latter 
should  be  corrected  before  operation  is  attempted. 

THE    TREATMENT    OF     PULMONARY 
TUBERCULOSIS  WITH  PROFESSOR 
KOCH'S    TUBERCULIN. 

Karl  Von  Ruck  {Internatio}ial  Medical 
Magazine,  February,  1894)  refers  to  his  earlier 
article,  in  which  he  reported  {Therapeutic 
Gazette,  June  15,  1891)  twenty-five  cases  of 
pulmonary  tuberculosis  treated  with  Koch's 
tuberculin .  He  then  gives  the  present  condition 
of  these   patients. 

Class  A,  of  five  cases  reported,  all  recovered, 
or  one  hundred  per  cent,  of  recoveries. 

Class  B,  of  seven  cases  reported,  six  made  a 
final  recovery,  and  one  improved,  making  eighty- 
six  per  cent,  of  recoveries. 

Class  C,  thirteen  cases  were  reported,  six  of 
which  have  improved,  while  seven  have  died. 

After  giving  some  precautions  in  regard  to  the 
selection  of  patients  and  making  observations 
while  they  are  under  treatment,  he  gives  his 
method  of  administration  of  tuberculin  as 
follows  : 

"  Beginning  with  one-twentieth  of  a  milli- 
gramme as  a  trial  dose,  to  which  I  have  never 
seen  a  response,  the  next  dose  is  one-tenth  of  a 
milligramme,  and  the  increase  is  thereafter  one- 
tenth  until  one  whole  milligramme  is  reached  ; 
then  I  increase  one-fifth  of  a  milligramme  until 
two  milligrammes  are  reached ;  next,  one-half 
milligramme  up  to  ten;  fiom  ten  to  twenty 
milligrammes  I  increase  two  and  one-half  milli- 
grammes, and  thereafter  five  milligrammes  at  a 
time." 

He  has  treated  one  hundred  patients  with 
between  six  and  seven  thousand  injections,  and 
he  therefore  concludes  that  tuberculin  is  no 
longer  on  trial  as  an  experiment,  but,  on  the 
contrary,  its  effects  are  as  reliable  and  as  uniform 
as  one  could  expect  them  to  be  under  the  large 
variety  of  individual  conditions,  such  as  con- 
stitution, stage  of  the  disease,  parts  involved, 
or  complications  present.' 


A 


CASE     OF    MULTIPLE    OSTEO- 
ECCHONDROMA. 


Whittaker,  of  Cincinnati  {^International 
Medical  Magazine,  February),  also  reports,  in 
detail,  an  interesting  case  of  multiple  osteo- 
ecchondroma. 

A  farmer,  aged  forty,  received  a  shock  and 
a  stroke  of  lightning  when  six  years  old.  Nine 
months  afterward,  the  middle  joint  of  the  right 
index  finger  began  to  enlarge,  and  gradually 
all  of  the  joints  of  both  hands,  except  the  thumb 
and  little  finger    of  the  left,    became  involved, 


THE  CANADA  MEDICAL  RECORD. 


259 


so  that  the  fingers  now  have  the  appearance  o 
medium-sized  nodulated  potatoes.  The  largest 
nodyle  is  on  the  index  finger  of  the  right  hand 
with  a  circumference  of  eleven  inches.  The 
right  upper  and  lower  extremities  are  much 
shortene  1,  owing  to  the  development  of  bony 
masses,  which  def>jrm  the  bones.  On  the  right 
external  malleolus  is  an  enlargement  about  the 
size  of  a  lemon.  The  iocs  of  the  right  foot  are 
involved  in  the  same  manner  as  the  hands,  the 
left  foot  being  nearly  normal.  The  article  is 
well  illustrated,  and  a  caieful  review  of  the 
literature  of  this  condition  follows. 


A  C.\SE  OF   ACROMEGALY. 

Mover  details  a  case  of  this  rare  disease, 
acromegaly,  in  a  man  twenly-four  years  of  age, 
which  began  at  the  age  of  seventeen  by  rapid 
growth  of  the  whole  body,  especially  of  the 
hands.  At  twenty  the  eyebrows  began  to  en- 
large. Subsequently  to  an  attack  of  influenza  he 
had  had  pain  in  the  head,  the  hands  and  fingers. 
The  present  condition  shows  enlargement  of  the 
frontal  sinuses  and  of  the  soft  tissues  covering 
them  ;  the  nose  is  large,  the  lower  jaw  wide, 
and  the  lijis  thick.  The  circumference  of  the 
head  is  24.5  inches.  The  spade-like,  symmetrical 
hands  measure  9  inches  in  length  and  4.5  inches 
across  the  palm,  and  are  covered  with  coarse, 
thick  skin.  The  mental  capacity  has  failed. 
Examination  of  eyes  showed  a  high  degree  of 
hyperopia  of  both  eyes,  squint  of  right  eye,  with 
some  optic  atrophy  and  amblyopia  of  the  left. — 
Internatiojial  Medical  Magazine,  February , 
1894. 


A  CASE  OF  RHINOPHYMA. 

A.  H.  Ohmann-Dumesnil  {International 
Medical  Magazine,  February,  1894)  reports  a 
case  of  rhinophyma  operated  upon  with  remark- 
able success. 

The  patient,  a  man  about  seventy-two  years 
of  age,  had  an  enormous  acne  rosacea.  The 
mass  consisted  of  a  central  and  two  lateral 
lobes,  and  weighed,  on  removal  nearly  two 
pounds.  The  tumor  covered  the  upper  lip  and 
encroached  upon  the  lower,  causing  stenosis 
of  the  nostrils  and  affecting  speech  and  respira- 
tion. The  skin  was  thickened  and  the  sebaceous 
ducts  patulous. 

Operation  for  removal  of  the  entire  mass 
was  perform.'d  in  the  following  manner  :  Each 
lobe  was  removed,  leaving  a  small  flap  of 
integument  on  each  lower  portion,  which  brought 
the  line  of  stitches  near  the  sulcus  of  the  ala  on 
each  lateral  portion,  and  directly  across  the  nose 
on  the  middle  lobe.  The  wound  heahd  by  first 
intention,  and  only  a  very  slight  deformity 
rem  lined. 

Microscopical  examination  of  sections  of  a 
lateral  lobe  showed   the    stratum  corneum  and 


stratum  niacosum  normal,  or  nearly  so,  the 
cellular  structure  marked,  the  pigmentary  layer 
very  prominent;  the  corium  was  lost  in  fibrous 
tissue ;  the  blood  vessels  large  with  hypertrophied 
walls.  The  sebaceous  glands  varied  greatly  in 
number  in  different  sections.  They  contained 
sebaceous  material,  and  the  ducts  opened  freely 
upon  the  surface  of  the  skin.  Cystic  bodies 
filled  with  fatty  material  were  found.  The  coil 
glands  were  normal,  their  ducts  penetrated  the 
entire  hypertrophied  mass.  The  subcutaneous' 
fat  was  about  normal.  Isolated  fatcells  and 
irregular  masses  were  found  in  the  fibrous  tissue, 
which  he  thinks  were  derived  from  sebum  or 
from  a  colunina  adiposa,  as  described  by 
Warren.  Two  half-tones  show  the  patient  both 
before  and  after  the  removal  of  the  tumor. 


AN  IMPROVED  CELL  OF  GLASS  AND 
CELLULOID  FOR  THE  PRESERVA- 
TION AND  EXHIBITION  OF  MACRO- 
SCOPIC EYE-SPECIMENS. 

C.  A.  Oliver  {International  Medical 
Magazine,  February,  1894)  describes  an  air- 
tight cell  for  the  [reservation  of  macroscopic 
eye-specimens.  It  is  made  of  two  parts,  the 
upper  one  being  of  glass  in  the  shape  of  a  Petry 
or  chemical  crystallizing  dish,  which  sets  into 
a  celluloid  base  by  means  of  a  deep  circular 
groove.  The  glass  is  filled  with  the  preservative 
fluid  (gelatine),  the  specimen  introduced,  and 
the  base  applied,  and  the  whole  inverted,  the 
raised  bottom  will  press  out  all  air-bubbles, 
and  the  glass  can  then  be  cemented  to  the  base. 
A  single  hand  magnifying-glass  of  any  amplifi- 
cation or  the  ordinary  dissecting  microscope  is 
then  used  for  examination  of  the  specimen. 


SURGERY    OF     THE 
NERVE. 


TRIFACIAL 


H.  Reineking,  M.D.  {International Medical 

Magazine,  February,  1894),  after  britfly  review- 
ing the  literature  of  this  subject,  and  consider- 
ing some  of  the  important  modifications  as 
made  by  Carnochen,  Thiersch,  Heuler,  Koenig, 
Leucke  and  Mussbaum,  refers  more  gspecially 
to  the  removal  of  the  Gasserian  ganglion  and  to 
intercranial  neurectomy  as  practised  in  the  last 
three  years  by  Horsley,  Andrews,  Rose,  Hart- 
ley, and  others. 

He  then  reports  a  case,  a  summary  of  which 
is  as  follows  : 

J.  B.  M.,  a  farmer  sixty-three  years  of  age, 
gives  a  history  of  pain  in  the  right  supra  orbital 
region  for  ten  years,  and  in  the  right  infra- 
orbital and  right  occipital  regions  for  five  or  six 
years.  Within  the  last  two  or  three  years  the 
pain  has  extended  to  the  upper  molar  teeth. 
It  generally  starts  in  the  frontal  region,  and  is 
never  first  in  the  occipital.  It  is  accompanied 
by  twitching  of  the  muscles  of  the  parts  affected. 
The  case  is  one  of  very  severe  chronic  intract- 


26o 


THE   CANADA    MEDICAL    RECORD. 


able  neuralgia  of  some  of  the  branches  of  the 
ophthalmic  and  superior  maxillary  divisions  of 
the  trifacial  nerve,  accompanied  by  less  severe 
but  equally  obstinate  neuralgia  in  the  region  of 
the  great  occipital  nerve. 

Neurectomy  of  the  frontal  and  infra-orbital 
nerves  was  decided  upon,  and  the  following 
operation  was  made :  the  supra-orbiial  nerve 
was  exposed  at  its  point  of  emergence  from  the 
supra-orbital  foramen,  liberated  by  chiselling 
away  a  small  portion  of  the  ridge,  and  separated 
as  far  back  in  the  orbit  as  possible.  By  traction, 
twisting  and  a  little  dissection  of  the  nerves, 
nearly  all  of  the  orbital  portion  and  its  branches 
were  removed.  The  infra-orbital  was  exposed 
by  removal  of  the  roof  of  the  infra-orbital  canal, 
and  grasped  and  twisted  off  in  the  same  manner 
as  before.  A  small  opening  into  the  antrum  of 
Highmore  was  accidentally  made,  and  was 
drained  for  three  or  four  days.  The  wound 
healed  by  first  intention,  and  all  pain  disap- 
peared in  about  three  days. 

The  points  in  the  treatment  oil  which  the 
writer  would  lay  special  stress  are:  r.  Thor- 
ough following  up,  extracting,  and  dissecting 
out  of  the  peripheral,  muscular  and  cutaneous 
branches  ;  2.  slow  torsion,  and  gentle  stretching 
of  the  central  slump  until  it  gives  way. 


CLASSROOM  NOTES. 

— Creasote,  Prof.  Hare  says,  will  often  prove 
valuable  in  Bronchitis  ofa  chronic  type. 

— Prof.  Hare  says  that  ergot  will  sometimes 
prove  a  valuable  drug  in  cases  of  Diabetes 
Insipidus. 

— Vomiting  is  a  common  symptom,  Prof. 
Wilson  says,  at  the  onset  of  pneumonia  in 
children. 

— Prof.  Wilson  says,  chills,  very  rarely  mark 
the  onset  of  an  attack  of  Bronchial  Pneumonia. 

— Prof  Hare  says  iodine  and  all  its  prepara- 
tions are  contra- indicated  in  cases  oi  Parenchy- 
matic  Nephritis. 

— Colocynth  is  the  best  drug,  according  to 
Prof.  Hare,  to  administer  in  cases  of  Consti- 
pation accompanying  gout. 

— Prof.  Hare  says  the  best  agent  that  can  be 
employed  in  cases  of  Rheumatoid  'A >t /iritis  is 
arsenic  in  large  doses. 

— As  a  rule,  the  first  symptom  that  presents 
itself  in  a  case  of  Laryngeal  Diphtheria,  Prof 
Wilson  says,  is  hoarseness. 

— In  Septicceniia  following  infec  ion  from  the 
uterus,  we  generally  have  a  greater  or  lesser 
tendency  to  diarrhoea. 

— Htiman  Vaccine  Lymph,  Prof  Wilson 
says,  produces  a  less  troublesome  sore  than 
that  caused  by  bovine  lymph. 

— Prof.  Wilson  does  not  think  that  ether 
children  or  aged  persons  should  be  bled  or 
leeched  in  cases  of  Pneumonia. 


— Ergot  in  combination  with  the  bromide  of 
potassium,  Prof.  Hare  says,  is  often  very 
serviceable  in  c3.?,e%oi  Retinitis. 

—  Ch/oroforjn,  Prof  Hare  says,  should  never 
be  given  a  patient  in  the  erect  posture;  ether 
may  be  so  administered. 

— Prof.  Parvin  says  that  chloral  injected  into 
the  rectum  has  been  found  useful  in  the  treat- 
ment of  cases  of  Vomiting   during  Pregnancy. 

— Rheumatism,  Prof.  Wilson  says,  is  of  very 
rare  occurrence  either  in  very  cold  or  hot 
climates.  It  is  most  frequent  in  temperate 
climates. 

— Amyl  Aitrite,  Prof.  Hare  says,  will  be 
found  to  be  useless  in  relieving  pain  unless  the 
latter  be  due  to  spasm  or  to  angina  pectoris. 

— Prof.  Keen  says  that  the  most  suitable 
time  to  operate  on  a  child  for  LLarelip  is 
between  the  sixth  week  and  the  third  month 
after  birth. 

— Prof.  Parvin  says  in  cases  of  Puerperal 
Infection,  alcohol  internally,  in  large  amounts, 
will  be  found  to  be  the  most  valuable  of  inter- 
nal remedies. 

— Prof.  Brinton  says  Ptieumonia  and  Pleu- 
risy may  be  produced,  in  fracture  of  the  ribs, 
by  rubbing  the  fragments  against  the  pleura 
and  lungs. 

— Prof.  Parvin  thinks  that  intermitting  con- 
tractions and  sensitiveness  of  the  uterus  are 
both  unreliable  signs  in  the  diagnosis  oi  Lnver- 
sion  0/ the  Ute7'us . 

— Prof.  Wilson  thinks  that  during  the  early 
part  of  an  attack  of  one  of  the  Infectious 
Diseases,  the  diet  of  the  patient  should  be  light, 
and  he  should  not  be  over  fed. 

— Prof.  Parvin  says  in  about  one-third  of  all 
cases  a  chill  occurs  during  labor  or  soon 
thereafter.  This  chillis  of  no  significance,  and 
is  not  attended  with  any  change  in  the  char- 
acter of  the  pulse  or  temperature. 

— Prof.  Brinton  says  Emphysema  may  de- 
velop in  a  case  of  fracture  of  the  ribs,  due  to 
the  fractured  rib  penetrating  the  pleura  and 
the  lungs.  As  a  rule,  nothing  need  be  done  for 
the  emphysema,  as  it  will  generally  disappear 
of  its  own  accord. 

— Prof.  Keen  says  in  operating  in  a  case  of 
Hemorrhage,  due  to  injury  of  the  head,  the 
question  on  which  side  to  begin  should  not  be 
decided  by  the  site  of  the  injury,  but  by  the 
localizing  nervous  symptoms  which  manifest 
themselves. 

— Prof.  Keen  says  in  Acute  Encephalitis 
alcohol  in  any  form  is  to  be  avoided  in  the  early 
stages;  but  during  the  latter  stages,  especially 
when  exhaustion  and  a  typhoid  condition 
develop,  it  may  often  be  administered  with 
advantage. 


THE   CANADA   MEDICAL   RECORD. 


261 


THE  CANADA  MEDICAL  RECORD 

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EDITORS : 

A.  LAPTHOflN  SMITH,  B  A., M.D.,  M.R.C.S.,  Eng.,  F.O-S. 

London 
F.  WAYLAND  CAMPBELL,  M.A  ,  M.D.,  L.RC.P  ,  London 

ASSISTANT  EDITOR 
EOLLO  CAMPBELL,  CM.,   M.D. 

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MONTEEAL,  AUGUST,  1894. 

POCKET   BOROUGFIS   IN   HOSPITALS. 

•  Medicine  has  ever  held  high  rank  amongst 
the  Hberal  professions,  and  none,  perhaps,  is 
better  entitled  to  it,  whether  we  base  its  claims 
on  the  devotion  to  duty  shown  by  its 
members,  or  the  broadness  and  liberality  which 
almost  invariably  characterize  their  views.  It 
is  even  one  of  the  unwritten  laws  of  the  body, 
that  all  discoveries,  even  those  which  may 
have  cost  long  years  of  investigation  and  toil, 
shall  be  placed,  without  delay,  at  the  disposal 
of  the  Faculty.  When  a  brother  errs,  it  is 
our  duly  to  counsel  him ;  when  he  is  traduced,  to 
defend  him,  and,  when  in  trouble,  to  help  him. 
In  these,  and  in  countless  other  ways,  have  the 
members  of  our  profession,  in  their  relation 
with  each  other  and  with  the  world  generally, 
shown  a  generosity  of  spirit  and  a  degree  of 
single-mindedness  which  challenge  unqualified 
admiration.  Nevertheless  there  are  not  wanting 
instances  to  prove  that  self-interest  is  beginning 
to  assert  itself  with  marked  prominence,  and 
would  appear,  at  times,  to  predominate  over 
all  other  considerations.  This  was  forcibly 
illustrated,  some  short  time  since,  when  certain 
physicians  connected  with  the  Protestant 
General  Hospital  in  Ottawa  passed  a  resolution 
that  those  who  were  attended  by  the  hospital 
staff,  and  those  alone,  should  receive  the  bene- 
fits of  the  nursing  and  diet  provided  by  the 
institution,  and  that  all  other  patients  should  be 
denied  these    comforts.     This  naturally  drew 


forth  an  indignant  protest  from  those  members 
of  the  profession  who  were  not  of  tlie  hospital 
staff,  and  so  fully  was  this  endorsed  by  the 
public  generally,  that  the  staff  rescinded  their 
resolution  ;  but,  rather  than  allow  patients  of 
outside  practitioners  to  engage  private  rooms, 
they  decided  to  close  the  privilege  against  all. 
A  similar  spirit  of  exclusion,  for  such  it  cer- 
tainly is,  manifests  itself  in  connection  with  the 
conduct  of  two  of  the  great  public  hospitals  of 
this  city — the  Montreal  General  and  the  Royal 
Victoria.  The  first  of  these  was  built  and  is 
supported  by  subscriptions  not  only  from  the 
rich,  but  from  the  poor,  and  is  regarded  as  par 
excellence  the  Public  Hospital  of  Montreal. 
It  seems  incredible,  yet  it  is  a  fact,  that  should 
even  one  of  those  subscribers  become  an  in- 
mate of  this  institution,  he  would  not  be  per 
mitted  to  have  his  family  physician  in  attend- 
ance unless  the  said  physician  should  happen 
to  be  a  member  of  the  staff — a  hardship,  it  must 
be  admitted,  which  affects  equally  patient  and 
physician.  Let  us  suppose  the  case  of  a 
gentleman  who  is  found  in  a  state  of  uncon- 
sciousness on  the  street.  He  is  transferred  to 
an  ambulance,  and  on  "  coming  to  "  finds  him- 
self in  a  private  ward  of  this  General  Hospital. 
He  asks  that  his  family  physician  may  be 
summoned,  but,  should  that  gentleman  not  be 
one  of  the  staff,  the  request  is  refused.  Should 
he  even  present  himself  at  the  bedside  of  his 
friend,  he  will  not  be  permitted  to  treat  or  even 
advise  one  who  is  now,  nolens  vohns,  the  patient 
of  th  is  particular  doctor  on  duly  for  the  time, 
who  will  studiously  excludes  every  possibility  of 
outside  interference.  Should  the  patient  ask  to 
be  removed,  his  family  or  friends  will  be  at  once 
warned  of  the  danger  attending  any  such  change, 
I  and  he  is  thus  persuaded,  forced  would  be  the 
better  term,  to  accept  the  services  of  one  who  is 
probably  a  stranger  to  him,  at  the  risk  of 
severing,  it  miy  be,  a  life-long  connection,  and 
with  it  all  the  moral  advantages  begotten  of 
years  of  mutual  confidence  and  esteem. 

That  the  Royal  Victoria,  the  pride  of  its 
founders,  should  lay  itself  open  to  charges  of  a 
similar  nature,  will  not  only  astoni.-h  but  pain 
great  numbers  of  our  citizens,  who  had  believed 
that  not  even  a  suspicion  of  illiberality  should 
be  allov/ed  to  creep  into  its  management.  Added 
to  the  fact  that  this  great  institution  is  as 
thoroughly  equipped  as  any  hospital  in  America 


362 


THE   CANADA   MEDICAL   RECORD. 


or  elsewhere,  it  has  also  a  large  number  of  private 
rooms,  yet,  following  the  selfish  and  ungenerous 
example  of  the  "Montreal,"  these  are  closed  to 
all  patients  other  than  those  of  the  favored 
half-dozen  who  constitute  its  staff,  and  in  so  far, 
therefore,  as  this  portion  of  the  Royal  Victoria 
is  concerned,  it  cannot  be  said  that  either  the 
general  public  or  the  members  of  the  medical 
profession  are  free  to  enjoy  what  it  has  believed, 
and  what  they  are  given  to  understand,  would  be 
open  to  all  on  equal  grounds.  Distinguished 
physicians  who  have  visited  this  city  h.tve  ex- 
pressed surprise  that  such  a  state  of  things  should 
be  permitted  to  continue  in  the  conduct  of  these 
t',vo  institutions,  more  especially  as  it  contrasts 
so  unfavorably  wiih  tiiat  which  obtains  in  the 
management  of  the  Hotel  Dieu,  the  Notre  Dame 
and  the  Western  Hospitals.  The  Hotel  Dieu, 
the  oldest  and  largest  hospital  in  Canada,  opens 
its  private  rcoms,  at  a  minimum  cost,  to  the 
patients  of  any  qualified  physician,  regardless 
of  creed  or  country,  although,  considering  the 
fact  that  it  receives  no  contributions  from  the 
public,  it  might  claim  and  exercise  the  rights 
of  a  ^^ pocket  borough  "  with  more  reason  and 
justice  than  those  which  exercise  them  with- 
out even  the  right  to  claim  them. 

Notre    Dame    acts    with     equal    generosity 
towards  the  profession,  and  any  one  of  its  mem- 
bers is  privileged   to  place  his  patient    in    the 
private  wards.     Some  narrow-minded    persons 
may  advance  the  argument  that  those  two  insti- 
tutions are  under  French  control,  and  that  the 
French  are  generally  more    polite  and  generous 
than  the  English.     While  we   should  repudiate 
this  proposition  on  general  grounds,  we  meet  it 
in  this  particular  case   by  the  well-known   fact 
that  the  Western  Hospital,  which  is  an  English 
institution,  lias  opened  its  private  wards  to  the 
profession  generally  from  the  earliest  days  of  its 
existence,  and  keeps  them  open  to  the  present 
day,  while  its  management  in  every  other  respect 
is  characterized  by  the  fullest  measure  of  liber- 
ality.    In  thus  drawing   attention  to    what   we 
consider   a   grievance    which    should    be  con- 
demned by    all   fair-minded   persons,    we   are 
influenced   solely   by  a  sense  of  what  we   owe 
not  only  to  those  whose  particular  interests  it  is 
our  especial  duty  to  protect  and   advance,  but 
to  our  fellow  citizens  generally,  and   to  all  who 
desire  to    see   the    public  institutions    of  the 
.country   honestly,  impartially  and  intelligently 


governed.  Let  us  hope  our  remarks  will  be 
accepted  in  the  spirit  in  which  they  are  offered, 
and  that  what  is  now  a  stain  on  the  escutcheon 
of  our  noble  profession  will  not  be  permitted  to 
remain. 


A   HOSPITAL  FOR  CONSUMPTIVES. 

We  are  pleased  to  learn  from  the  June  num- 
ber of  our  excellent  contemporary,  the  Domi- 
nion Medical  Monthly^  that  Toronto  is  about 
to  have  a  hospital  for  consumptives,  a  gener- 
ous citizen  of  that  town,  Mr.  W.  J.  Gage,  having 
offered  $25,000  for  that  purpose.  The  Canada 
Medical  Record  has  again  and  again  insisted 
upon  the  contagiousness  of  the  disease  as  well 
as  its  large  death  rate,  and  we  have  continually 
urged  the  necessity  for  special  hospitals  for 
sufferers  from  this  disease. 

It  is  probably  owmg  to  the  work  of  isolation 
carried  out  by  the  consumptive  hospitals  in 
England  that  the  death  rate  there  from  this 
disease  has  gradually  decreased  in  recent  years. 
In  the  meantime  Dr.  Trudeau  of  Saranac  Lake 
in  the  Adirondack  Mountains  is  doing  good 
service  by  establishing  a  Sanitarium  which 
should  be  more  heartily  encouraged  than  it  is. 
But  we  have  always  taken  the  stand  that,  as  the 
disease  is  a  national  scourge,  Canada  as  a 
nation  should  take  steps  to  stamp  it  out. 


PERSONALS. 


Dr.  N.  W.  Senn  is  engaged  on  a  new  work 
on  tumors,  and  in  order  to  obtain  quiet  and  in- 
spiration is  spending  July  and  August  among 
the  cool  breezes  in  the  Canadian  Maritime 
Provinces.  He  intends  visiting  Montreal  on 
his  way  home. 

Dr.  Hingston,  we  see  by  the  Toronto  Medical 
Journals,  has  been  a  very  welcome  visitor  at  the 
recent  successful  meeting  of  the  Ontario  Medi- 
cal Association,  where  he  was  invited  to  read  a 
paper.  Both  the  latter  and  also  his  speech  at 
the  entertainment  following  are  said  to  have 
been,  the  one  learned  and  the  other  particularly 
witty. 

Dr.  Major  is  spending  the  summer  in  Eng- 
land and  the  continent,  while  Dr.  Hamilton  is 
occupying  his  residence  and  office  iti  Union 
Avenue. 

Dr.  Proudfoot  was  so  fortunate  as  to  win  the 
election  at  the  Montreal  General  Hospital  to  the 
position  of  Oculist  andAurist,  rendered  vacant 
by  Dr.  Buller's  removal  to  the  Royal  Victoria. 
Dr.  Proudfoot  still  retains  his  position  as  Oculist 
and  Aurist  to  the  Montreal  Dispensary,  where 
he  has  served  so  faithfully  for  so  many  years. 


THE  CANADA  MEDICAL  RECORD. 


26^ 


Dr.  Hamilton  has  been  elected  Laryngologist 
to  the  Montreal  Dispensary,  where  he  attends 
on  Tuesdays  and  Thursdays  at  four  o'clock. 

Dr.  Lapthorn  Smith  has  returned  to  the  city 
after  a  five  weeks  vacation  to  the  Pacific  Coast, 
where  he  attended  the  Gynaecological  Section 
of  the  American  Medical  Association,  of  which 
he  has  been  elected  a  member.  He  was  one 
of  a  party  of  thirty  physicians  who  were  the 
guests  of  the  President  of  the  Associaiion,  Dr. 
Donald  McLean  of  Detroit. 

Dr.  F.  W.  Campbell  has  returned  from  his 
annual  vacation  at  the  salmon  fishing  in  New 
Brunswick,  the  doctor,  as  every  one  knows, 
being  a  past  master  of  the  art  of  landing  the 
king  of  fish.  Dr.  Campbell  is  building  one  of 
the  handsomest  residences  on  Sherbrooke  street 
at  the  corner  of  Crescent  street,  of  red  and 
white  sandstone,  which  will  be  ready  for  occu- 
pation this  winter.  He  will  be  missed  from  the 
classical  regions  about  Beaver  Hall  and  Phillips 
Square. 

Dr.  McPhail  has  been  combining  business 
with  pleasure  by  going  on  a  wedding  tour  to 
visit  the  principal  hospital  cities  in  Europe. 
He  has  recently  returned  after  an  absence  of 
several  months  with  increased  knowledge  and 
improved  health. 

Dr.  Wilson,  2436  St  Catherine  street,  Mon- 
treal, is  the  latest  and  most  welcome  addition 
to  the  corps  of  Montreal  specialists.  Afcer 
having  spent  several  years  in  New  York  under 
Dr.  Phelps,  the  leading  authority  on  this  branch 
in  America,  Dr.  Wilson  has  returned  to  Mon- 
treal, where  there  has  long  been  a  great  need  of 
an  Orthopedic  Surgeon.  Dr.  Wilson  is  working 
up  a  nicecUnic  at  the  Metropolitan  Dispensary. 


BOOK  NOTICES. 

Tumors,  Innocent  and   Malignant.     Their 
clinical  features  and  appropriate  treatment . 
By  J.    Bland  Sutton,  F.R.C.S.,  Assistant 
Surgeon  to  Middesex  Hospital,   London. 
In  one   octavo  volume    of  526  pages  with 
250  engravings  and  9  plates.     Cloth  $4.50. 
Lea  Bros.  &  Co.,  publishers,  Philadelphia. 
In  his  introductory  remarks  the  author  states 
that  having  been  convinced  eight  years  ago  of 
the  great  increase  in  diagnostic  power  that  re- 
sults from  the  combination    of  pathologic  and 
clinical  knowledge,  he  began  to  collect  materials 
from   man  and  the  animals  in  order  to    make 
himself  acquainted  with  the    histological  pecu- 
liarities of  tumors.     He  first  took  up  the  sub- 
ject of  cysts  ;  then  cancer,  which  he  employs  in 
a  sense  equivalent  to  malignant  adenoma,  the 
species  being  determined  by  the  gland  in  which 
the  cancer   arises.     He    thinks  that  the    terms 
scirrhus,  colloid  and  medullary  or  encephaloid 
have    dominated  the  minds    of    surgeons   and 
hindered   progress    long   enough.     As    in    his 


classical  work  on  diseases  of  the  ovaries  and 
tubes  he  makes  frequent  use  of  his  great  know- 
ledge of  comparative  pathology.  He  groups  all 
tumors  into  four  classes  .  7.  Connective  tissue 
tumors  ;  2.  Epithelial  tumors  ;  3.  Dermoids;  4. 
Cysts.  Each  group  contains  several  genera  ; 
each  genus  has  one  or  more  sp;.'cies  ;  of  each 
species  there  may  be  one  or  more  v.irieiies. 

Mr.  Sutton  then  i^roceeds  to  deal  with  ^ach 
variety  of  tumor,  introducing  such  a  knowledge 
of  the  pathology  not  only  of  man  but  also  of 
animals  as  is  very  rare.  He  draws  fr(rely  on  the 
wealth  of  specimens  in  the  Royal  College  of 
Surgeons,  l)ringing  before  our  notice  many 
strange  and  interesting  facts  which  have  hither- 
to been  buried  there.  Pathology  is  generally 
considered  rather  a  dry  subject,  but  this  cer- 
tainly cannot  be  said  of  Mr.  Sutton's  book,  for  he 
presents  even  the  driest  facts  in  such  a  dehght- 
fuUy  interesting  manner  that  one  is  loth  to  lay  it 
down  when  once  started  to  peruse  it.  It  is  if 
possible  made  still  more  interesting' by  the  very 
large  number  of  engravings  and  colored  plates. 
We  consider  that  Mr.  Sutton  has  conferred  a 
real  good  upon  the  profession  by  thus  render- 
ing a  knowledge  of  tumors,  innocent  and  malig- 
nant, more  general.  We  predict  for  it  a  large 
sale,  which  it  certainly  deserves. 


DesPeurs  Maladives  ou  Phobies.  Par  le  Dr. 
E.    Gelinas,    Paris.      Societe    d' Editions 
Scientifiques,  4rue  Antoine  Dubois,  1894. 
This    is    rather  a  remarkable   book,   dealing 
with  dreads  or  fears   of  every  kind.     Although 
we  do  not  remember  having  seen  this  subject 
before  in  print,  every  practitioner  will  recollect 
patients  who    liad   a   morbid   dread  of  beins 
alone;  of  passing  under   a  ladder;  of  dirt ;  of 
spermatorrhoea  and  so  on .     The  author  relates 
many  interesting  cases  of  this  kind.     The  treat- 
ment of  course  consists  of  moral  suasion. 


Transactions  of   the  American  Pediatric 
Society.    Fifth  session  held  at  West  Point, 
N.Y.,  24th,  25th  and  26th  May.  1893.   Edit- 
ed by   Floyd  M.  Crandall,  xM.D.  Volume 
V.  Printed  by  Bailey  &  Fairchild,  1893. 
This  volume  contains  a  number  of  interesting 
papers,  but  perhaps  the  most  so  are  the  Presi- 
dent's address  by  our  own  esteemed  Dr.  Black- 
ader  of  Montreal,  and  a  paper  on  the  Transmis- 
sion of  Tubeiculosis  to  1  he, Foetus  from  either 
parent,  by  the  late  Dr.  John  M.Keating  of  Colo 
rado  Springs.     Both  of  these  papers  are  of  the 
greatest  interest.       Dr.    Keating    thinks    that 
in   many   cases    tuberculosis   is   a    congenital 
disease,  and  cites  many    strong  arguments  in 
support  of  his  view.. 


264 


THE  CANADA  MEDICAL  RECORID. 


SAUNDfcRs'    Question     Compends,  No.     18. 
Essentials  of  Practice  of  Pharmacy  arrang- 
ed in  the  form  of  questions  and  answers, 
prepared  especially  for  Pharmaceutical  Stu- 
dents.      (Second    edition    revised.)      By 
Lucius  E.  Sayre,  Ph.G.,  Professor  of  Phar- 
macy and  Materia  Medica  of  the  School  of 
Pliarmacy  of  the    University  of   Kansas. 
Philadelphia  :  W.  B.  Saunders,  925  Walnut 
street,  1894.     Price  $1.00. 
The  author  has  shown  wonderful  aptitude  for 
condensing  the  whole  subject  of  Pharmacy  into 
a  very  small  space.     There  are  questions  and 
answers    on  every  conceivable   subject  within 
the    domain    of   Pharmacy.     It    is   especially 
suitable  for  students  while  reviewing  their  work. 


A  Manual  of  Therapeutics.     By  A.  A.  Ste- 
vens, A.M.,  M.D.,  Instructor  in    Physical 
Diagnosis    in  the  University  of  Pennsyl- 
vania, etc.    Philadelphia  :  W.  B.  Saunders, 
925  Walnut  St.,  1894.     Price  $2.25. 
This  is  a  neat  volume  of  435  pages  divided  into 
eight  chapters  as  follows  :   Physiological  Action 
of  Drugs;   Drugs;  Remedial    Measures    other 
than  Drugs  ;  Aj^plied  Therapeutics  ;  Incompati- 
bility in  Prescriptions  ;  Table  of  Doses  ;  Index 
of  Drugs ;  Index  of  Diseases.     The  chapter  on 
Applied  Therapeutics  is  especially  good.  While 
not  sufficiently  exhaustive  to  take  the  place  of 
the   larger   works,  students   and  practitioners 
will  find    this  little  work  very   convenient  for 
reference  and  thoroughly  up  to  date. 


PAMPHLETS. 

Three  Years'  Experience  with  the  Electri- 
cal Treatment  of  Fibroid  Tumors  of 
THE  Uterus,  with  a  report  of  forty-four 
cases.  By  W.  L.  Burrage,  A.M.,  M.D., 
Electro-therapeutist,  Free  Hospital  for 
Women.  Reprinted  from  The  American 
Journal  of  Obstetrics,  Vol,  xxix.  No.  3, 
1894.  New  York  :  William  Wood  &  Com- 
pany, publishers,  1894. 

Abstract  of  two  Articles  treating  of 
Progress  in  Midwifery.  By  Hunter 
Robb,  M.D.,  Associate  in  Gynecology, 
Johns  Hopkins  University,  Baltimore. 
Reprinted  from  the  Maryland  Medical 
Journal,  March  31,  1894. 

A  Case  OF  Double  Vagina,  with  Operation. 
By  Hunter  Robb,  M.D.,  Associate  in 
Gynaecology. 

Surgical  Shock.  By  Charles  P.  Noble,  M.D., 
Philadelphia,  Surgeon-in-Chief  of  the 
Kensington  Hospital  for  Women. 

NoN  NocERE.  By  A.  Jacobi,  M.D.,  New  York. 
Reprinted  from  the  Medical  Record, 
May  19,  1894.  New  York  Trow  Direc- 
tory, Printing  &  Bookbinding  Co.,  201- 
213  East  Twelfth  Street,  1894. 


Acute  Puerperal  Cellulitis  and  Prue 
Pelvic  Abscess.  By  Charles  P.  Noble, 
M.D.,  Philadelphia.  Reprinted  from  The 
American  Journal  of  Obstetrics,  Vol. 
xxix.,  No.  4,  1894.  New  York  :  William 
Wood  &  Company,  publishers,  1894. 

Teno-Suture  and  Tendon  Elongation  and 
Shortening  by  Open  Incision  ;  Advant- 
ages AND  Disadvantages  of  the  Various 
Methods.  Clinical  lecture  delivered  at 
the  Jefferson  Medical  College  Hospital. 
By  H.  Augustus  Wilson,  M.D.  Reprinted 
from  International  Clinics,  Vol.  I.,  fourth 
series. 

Habits  OF  Posiure  a  Cause  of  Deformity 
and  Displacement  of  the  Uterus.  By 
Eliza  M.  Mosher  ,  M  D.,  of  Brooklyn, 
N.Y.  Reprint  from  the  New  York  Journal 
of  Gynaecology  and  Obstetrics. 


PUBLISHERS  DEPARTMENT. 

SECURITY  AGAINST  IMPOSITION. 

Ihis  heading  is  suggested  by  and  is  particularly 
applicable  to  the  new  advertisement  of  the  Antikamnia 
Chemical  Company,  which  appears  in  this  issue.  Anti- 
kamnia, while  not  suffering  anything  like  other  standard 
preparations  from  substitution,  has  still  found  it  in  some 
few  instances.  To  the  end,  therefore,  that  there  may  not 
be  even  the  breath  of  suspicion  against  Antikamnia,  as 
well  as  to  give  every  doctor  the  fullest  confidence,  the 
company  has  gone  to  the  expense  of  withdrawing  all  the 
old  stock  from  the  market  and  leplacing  it  with  new. 
In  the  new  form  the  drug  is  identically  the  same  chemi- 
cally and  medicinally  as  it  always  has  been,  but  every 
tablet  bears  imprinted  upon  it  a  monogram.  (See 
advertisement.)  Every  package  of  Powder  or  Tablets  is 
so  wrapped  and  sealed  and  resealed  as  to  render  counter- 
feiting impossible.  The  entire  profession  should  insist 
upon  the  safeguards  provided,  and  there  can  be  no  ques- 
tion but  that  this  action  will  be  regarded  with  great 
favor  by  them. 

The  latest  edition"  Antikamnia  and  Codeine  "  tablets, 
can  be  obtained  direct,  or  from  your  druggist.  Each 
tablet  contains  43^  gr.  Antikanmia  and  X  g^'-  Codeine. 


"  SIC  TRANSIT." 

As  another  exemplification  of  the  old  adage  "  Many 
are  called  and  few  are  chosen,  "  it  is  reported  that  the 
"  Labordine  Chemical  Tie."  has  come  to  grief.  J.  H. 
Chambers  dr'  Co.,  publishers  of  the  Medical  Rrvieiv, 
secured  an  attachment  for  $75.00,  and  upon  the  Labor- 
dine  people  taking  an  appea',  the  appeal  bond,  filed  at 
the  time,  was  found  to  be  even  more  worthless  than  the 
account  it  sought  to  stave  off.  It  is  known  also  that 
they  are  behind  in  their  rent,  and  that  there  is  nothmg 
tangible  for  any  of  their  creditors.  Mercantile  agency 
reports  say  ''  there  is  said  to  be  little  if  anything  left  for 
other  creditors." 

This  company  originally  attempted  the  promotion  of 
their  specialty  under  the  name  of  Analgine-Laborde. 
But  more  recently,  however,  they  have  been  taking  the 
back  track  by  exlTibiting  the  words  Analgme  Laborde, 
cancelled  and  followed  by  the  announcement  that  here- 
after this  "  purely  vegetable  product  ''  would  be  known 
as  Labordine. 

This  is  an  illustration  of  the  result  that  frequently 
follows  efforts  at  pharmaceutical  promotion,  and  medical 
journal  publishers  will  find  in  many  cases  the  experience 
of  the  lilcdical  Review. 


Vol.  XXII. 


MONTREAL,  SEPTEMBER,  1894. 


No.  12, 


ORIGINAL  COMMUNICATIONS. 

Two  Herniotomies  in  a  cliild  iindfr 
Five  Years  of  Age— Bassini's  >re- 
tl'o.l 2C.J 

SOCIETY  PEOCEEDINGS. 

Keport  of  the  Canadian  Medical  As- 
sociation   266 

Montreal  Medico-Chirurgical  Soeielv  270 

The  late  Dr.  Josei.h  Workman '.  270 

Foreign  Body  in  the  Bronchus 270 

Six  Cases  of  Pyosalpinx 271 

Urinalysis  in  One  Hundred  Cases  of 

Ether  Aurt'Sthesia 271 

Exophthalmic  Goitre 273 

Morphcea 273 

Caries  of  the  Vertebra; . . . .' 273 

Osteo-Sarcoma  of  Femur 274 

Intra-Capsular  Fracture  of  the  Fe- 
mur   275 

Hyperostosis  following  Fracture 275 

Exostosis  Bursata  or  Exostosis  Car- 
tilagina 275 


GOISTTEITTS. 

Culture  of  Gonococci 075 

Pseudo-membranous  Enteritis  '^io 

Strangulated  Hernia 975 

Hiagnosis  of  I )ii>htheria ..'.'.'.  276 

Milk  Diet  in  Brighfs  Disease '^7 

Bronchitis 278 

PROGRESS  OF  SCIENCE- 

Treatment  of  Tabes  Dorsalis 279 

The  Severe  Forms  of  Scarlet  Fever 

and  their  Antipyretic  Treatment..  280 
Recent  Suggestions  in  rherapeutics.  281 
Therapeutic  Briefs  282 


EDITORIAL. 

The  Canada  Medical  Associati  .u 
The  T^niversity  0 .  Canada 

BOOK  NOTICES. 

Saunders'  Question  Compends,  No. 


285 


2S7 


A  Text-Book  of  the  Diseases  of  Wo- 
men    287 


PAMPHLETS  RECEIVED. 

Report  of  the  Rush  Ho.spital  for  Con- 
sumption and  Allied  Diseases 288 

Conservative  Treatment  of  Pyosal- 
Pinx 288 

Hysterectomy  Indications  and  Tech- 
nique  288 

Bloodless  Amputation  at  the  Hip 
Joint  by  a  New  Method 288 

A  New  Pathology  and  Treatment  of 
Xervous  Catarrh  288 

Report  of  Two  Years'  Work  in  Abdo- 
niinal  Surgery 288 

Surgical  Shock ......  2i?S 

A  Brief  Synopsis  of  the  Therapeu- 
tics of  Static  Electricity 288 


|ri$fnal    Communications. 


TWO  HERNIOTOMIES  IN  A  CHILD 
UNDER  FIVE  YEARS  OF  AGE— 

BASSINI'S  METHOD.=^ 
Dr.S.  E.  Milliken,  of  New  York,  reports 
in  the  Medical  Record  the  case  of  a  child 
under  five  years  of  age,  upon  whom  he  had 
done  a  herniotomy  in  June,  1893,  for  the 
cure  of  a  left  oblique  inguinal  congenital 
hernia,  after  the  method  of  Bassini,  or  bet- 
ter known  as  the  reconstruction  of  the 
canal,  by  bringing  together  the  shelving 
process  of  Poupart's  ligament  and  the 
conjoined  tendon,  postertor  to  the  cord 
structures,  with  interrupted  sutures  of 
kangaroo  tendon. 

The  obliquity  of  the  inguinal  canal  was 
re-established,  by  suturing  the  aponeurosis 
of  the  external  oblique,  which  had  been 
previously  divided,  by  a  continuous  suture 
of  the  same  material.  Theskin  wound  was 
closed  with  interrupted  catgut,  and  no 
drainage  was  employed.  The  wound  healed 
primarily  under  one   dressing,  which   was 

*  Abstract  furnished  by  author. 


changed   on  the  tenth  day.     The  patient 
was  kept  quiet  for  three  weeks,  so  as  to  en- 
sure union  of  the  deep  structures,  where  a 
specially  prepared  suture  material  was  used. 
One  year    later,    he  operated  upon  the 
hernia  of  the  right  side  which  was  acquired, 
and  the  only  difference  in  the  technique 
from    the  operation   on  the  left  side    was 
the  total  extirpation  of  sac.     The  second 
wound  healed    as  satisfactorily  as  did  the 
first,  and  the  same  instructions  were  given. 
The  author,  who  has  had  a  large  experi- 
ence   in    the    treatment    of  hernia    at  the 
Hospital  for  Ruptured  and  Crippled,  and 
at  the  New  York    Polyclinic,    particularly 
with  Bassini's  method,  concludes  as  follows: 
1st.  When  any  dii^culty  is  met  with  in 
the     mechanical     treatment,    the    radical 
operation  should    be   performed    even    in 
young  children, 

2nd.  If  after  six  months  or  a  year,  the 
truss  has  been  steadily  worn,  and  there  still 
exists  a  flabby  or  weakened  condition  of 
the  inguinal  region,  the  operation  is  iiidicat- 
ed. 

3rd.  The  risk  of  operating  on  children, 


266 


THE  CANADA  MEDICAL  RECORD. 


where  strict  asepsis  is  observed,  is  little,  if 
any,  more  than  in  adults. 

4th.  The  chances  for  a  radical  cure  in 
children  are  greater  than  in  adults,  because 
of  the  more  perfect  reparative  process  at 
that  age. 

•  5th.  The  reconstruction  of  the  canal  is, 
par  ex'ccllence,  the  operation,  and,  as  shown 
by  Bassini's  statistics,  has  stood  the  test  of 
time. 

6th.  To  obtain  the  best  results,  a  great 
deal  depends  upon  the  surgical  technique 
and  the  suture  material  employed. 

7th.  Drainage  should  not  be  employed^ 
if  the  surgeon  is  careful  to  observe  the 
modern  rules  of  cleanliness  ;  for  if  the  wound 
is  infected  during  the  operation,  it  must 
heal  by  granulation,  and  the  drainage  tube 
is  always  an  additional  source   of  danger. 

8th.  After  primary  and  complete  union 
of  the  whole  wound,  no  truss   is  necessar}-. 

36  West  59th  Street. 


gocidg     grocctbings. 

REPORT    OF  THE   CANADIAN    MEDI- 
CAL ASSOCIATION.* 

The  Canadian  Medical,  after  a  lapse  of 
twenty  years,  returned  to  the  old  city  of  St. 
John,  N.B.,  to  hold  its  annual  meeting.  The 
proceedings  were  presided  over  by  Dr.  i".  S. 
Harrison,  of  Selkirk,  Ont. 
•  After  the  routine  business  of  opening  and 
presenting  delegates^  Dr.  Hatlie,  of  Halifax, 
was  called  upon  to  read  the  first  paper,  in 
which  he  discussed  the  causation  of  Epilepsy. 
After  discussing  the  nature  of  convulsions  gen- 
erally as  occurring  in  different  brain  levels, 
he  advanced  the  theory,  that  instead  of  so  much 
importance  being  paid  to  the  question  of  here- 
dity, he  inclined  to  the  belief  that  it  occurred 
de  novo — that  what  is  ordinarily  signified  by 
epilepsy  was  a  group  of  symptoms  indicative  of 
systemic  disease.  This  was  the  result  of  mal- 
nourishment  consequent  on  insufficient  removal 
of  the  toxic  material,  which  as  an  irritant 
tended  to  instability  of  the  cerebral  cells. 

He  reported  his  results  of  an  interesting 
series  of  experiments  he  has  made  upon  the 
epileptics  in  Halifax  Hospital  for  the  Insane. 
This  consisted  in  the  record  of  the  number  of 
fits  occurring  using  KBr  with  an  intestinal  an- 
tiseptic, the  improvement  over  the  use  of  KBr 
alone  being  marked. 

*  Specially  reported  for  the  Canada  Medical  Record. 


After  the  discussion  of  this  paper  by  Drs. 
Cameron  of  Toronto,  and  Wright  of  Ottawa, 
Dr.  Muir  of  Truro,  N.S.,  reported  the  history 
of  a  case  of  local  tuberculosis  of  the  arm  which 
had  been  cured  after  the  accidental  inoculation 
of  erysipelas.  The  patient  was  a  female,  aged 
39,  who  had  been  suffering  from  the  disease  14 
years,  the  arm  between  the  elbow  and  the 
wrist  being  very  much  swollen,  brawny,  riddled 
with  sinuses  which  were  discharging  most 
offensive  pus.  Under  chloroform  these  sinuses 
were  scraped  out,  and  antiseptic  and  deodorant 
dressing  aj^plied.  There  was  little  improve- 
ment in  the  symptoms  until  the  wound  became 
infected  with  the  erysipelatous  germ.  The 
result  was  that  the  arm  became  completely 
better.  The  paper  was  discussed  by  Dr. 
Daniels,  Dr.  She]:)herd,  Dr.  Bulkley,  Dr.  Came- 
ron, Sir  Jas.  Grant,  Dr.  Muir  closing  the  dis- 
cussion. 

The  following  gentlemen  were  elected  as  the 
nominating  committee  : — Drs.  Hingston,  Shep- 
herd, of  Montreal ;  I.  H.  Cameron  and 
O'Reilly  of  Toronto  \  Christie,  Maclaren,Tobin. 
Dien?tadt,  Macleod  and  Johnson,  of  the  Mari- 
time Provinces. 

Dr.  Harrison  delivered  his  presidential  ad- 
dress, taking  as  his  subject  his  observations 
and  experience  in  medicine  during  the  past 
fifty  years.  He  compared  the  diseases  in  ex- 
istence then  with  those  we  have  now.  Since 
the  clearing  up  of  the  country  in  his  province 
of  Ontario  the  miasmatic  diseases,  had  become 
things  of  the  past.  He  referred  to  the  horrible 
concoction  of  domestic  medicine,  such  as  an  in- 
fusion of  sheep  excrement  for  measles,  and  that 
of  cat,  which  he  said  might  not  be  considered  a 
bad  substitute  for  assafoetida,  was  the'*sov- 
ereignest  "  thing  on  earth  for  fits.  The  old 
veteran  referred  to  many  pracljical  points  in 
his  practice.  He  pointed  out  the  danger  a  man 
was  in  of  becoming  egotistical  or  of  getting 
into  a  rut  when  he  was  so  far  removed  from 
other  medical  men.  The  corrective  of  this  he 
considered  to  be  the  attendance  of  medical 
associations.  A  considerable  portion  of  the 
address  was  taken  up  in  discussion  of  the  ques- 
tion of  inter-provincial  registration.  Every 
practitioner  in  Canada,  he  considered,  should 
have  the  right  of  practising  in  any  part  of  the 
Dominion,  without  having  to  submit  to  an  ex- 
amination. He  believed  in  a  high  standard 
both  as  to  matriculation  and  graduation . 

The  President  was  accorded  a  hearty  vote  of 
thanks  for  his  address,  and  a  committee  was 
appointed  to  consider  the  matter  of  reciprocity 
discussed  in  his  address. 

The  subject  of  appendicitis  was  discussed  by 
Dr.  Bell  of  Montreal.  He  reported  48  cases  : 
40  of  them  operated  on  with  recovery;  5 
not  operated  en ;  and  only  3  deaths  alto- 
gether. He  classified  his  cases  into  the  gan- 
grenous,   the    perfoi-ative,  the   non-perforative, 


trtE  CANADA    MEDICAL   RECORD. 


267 


and  those  bound  in  with  adhesions.  'I'hese 
cases  should  be  watched,  he  maintained,  by  a 
surgeon  from  the  first,  as  little  could  be  done 
for  its  relief  medicinally.  He  advocated  sur- 
gical interference  in  nearly  all  cases.  Dr. 
Kingston  thought  the  operation  was  performed 
unnecessarily  ;  no  young  man  should  attempt 
to  enter  the  abdominal  cavity  without  fir  .t  con- 
sulting one  or  two  others.  He  had  prevented 
the  operation  25  or  30  times,  and  only  regret- 
ted this  step  in  one  case.  He  was  strongly  in 
favor  of  conservatism. 

Sir  James  Grant  reported  two  cases  of  appen- 
dicitis,— one  the  gouty  form,  the  other,  rheuma- 
tic. He  found  it  difficult  to  know  when  to  oper- 
ate, and  he  knew  of  no  more  perplexing  point  in 
surgery.  It  required  great  observation,  dis- 
crimination and  judgment  to  know  how  to  deal 
with  them.  He  did  not  believe  the  trouble  was 
due  to  concretions  found  in  the  organ.  He 
attributed  its  causation  to  the  insufficient  time 
taken  to  masticate  food  and  allied  causes  com- 
mon to  the  rush  of  to-day. 

Dr.  Shepherd  pointed  out  that  the  surgeons 
gel  the  worst  cases  ;  so  it  was  difficult  to  say 
just  what  the  proportion  of  cases  was  which 
were  operated  on.  Someone  had  spoken  of 
unloading  the  caecum  at  the  beginning  of  the 
attack;  he  had  never  found  or  heard  of  any- 
thing being  found  in  it  at  the  p.m.  table.  He 
advocated  operating  in  the  interval  as  the 
safest  time.  In  regard  to  McBurney's  point,  he 
thought  the  tenderness  was  due  not  to  the  ap- 
pendix, but  to  the  inflamed  condition  of  the 
mesenteric  glands. 

Dr.  Strange  believed  in  non-interference  till 
there  was  evidence  of  pus  ;  and  then  to  open 
the  abscess,  as  one  would  any  other  abscess. 
He  leaned  to  the  conservative  treatment  from 
his  experience  with  the  disease. 

Dr.  Cameron  was  in  favor  of  the  conser- 
vative line  of  treatment.  In  the  majority  of 
his  cases  he  had  not  operated  at  first,  and  had 
found  his  results  to  be  as  good  as  those  in  which 
the  operation  was  performed  in  every  case  early. 
He  th.ought  it  unfortunate  that  the  experience 
of  a  hospital  surgeon  of  skill  should  determine 
the  matter  one  way  or  the  other.  With  regard 
to  the  gangrenous  form  due  to  embolism  of  the 
appendiceal  artery,  one  should  operate.  He 
agreed  with  Dr.  Shepherd  that  the  interval  was 
the  time  to  operate.  Tlie  difterence  was,  Dr. 
Shepherd  operated  before  pus  formed  and 
closed  the  cavity,  while  he  (the  speaker)  did 
not  operate  till  pus  formed,  and  he  did  not 
close  the  cavity. 

In  replying  to  the  discussion  on  his  paper, 
Dr.  Bell  made  a  strong  plea  in  favor  of  his 
statement — "  one  should  always  operate  ".  It 
was  generally  agreed  thai  no  one  knew  when  to 
operate.  If  the  patient  were  left  at  any  mo- 
ment, perforation  might  take  place.  However, 
in  the  40  cases  he  had  operated  on,    30  were 


perforated,  and  abscess  wasprcsv^nt  at  the  time 
of  operation.  In  three  the  appendix  was 
whol'y  gangrenous.  And,  here,  he  said  one 
could  not  wait  for  the  tumor  formation  or  the 
abscess,  because  there  was  none.  In  two  the 
appendix  was  bound  down  ;  in  three  the  appen- 
dix was  not  perforated,  but  gave  rise  to  urgent 
symptoms,  yet  there  was  no  abscess  found. 
He  used  to  follow  the  waiting  treatment,  but 
found  it  unsatisfactory.  The  mortality  was 
much  greater  than  that  of  his  eleven  months  of 
the  new  plan.  The  greatest  morialiiy  statistics 
for  the  operation  only  amounted  to  from  two  to 
three  p.c.  The  operation  as  a  rule  was  not  diffi- 
cult. He  considered  the  plan  of  waiting  for 
pus  not  the  best  surgery.  The  very  mild 
cases  where  the  symptoms  passed  off  in  say  12 
hours  he  would  not  interfere  with  ;  they  were 
probably  only  cases  of  cjecitis. 

"  Eye  Strain  Headaches  "  was  the  subject  of 
a  paper  read  by  Dr.  Morrison,  of  St.  John, 
N.B.  He  gave  an  extensive  list  of  such  cases 
where  the  true  cause  had  not  been  found,  and 
as  a  result  the  varied  forms  of  treatment  gave 
unsatisfactory  results,  only  in  so  far  as  they 
gave  rest,  unconsciously,  to  the  eyes  and  sup- 
ported the  general  bodily  health.  A  school-boy 
had  Wednesday  headaches.  Resting  Saturday 
and  Sunday  from  study, the  eyes  stood  the  strain 
till  Wednesday,  when  he  was  oliged  to  lie 
off.  Suitable  glasses  directed  the  correction  of 
the  astigmatism,  and  hypermetropia  effected  a 
cure.  Often  the  patient  was  treated  for  a  long 
time  for  some  other  disorder  altogether.  The 
eye  should,  in  the  headache  case,  be  taken  into 
consideration,  for  he  affirmed  that  90  p.c.  of  all 
cases  were  due  to  eye-strain.  Treatment  must  be 
directed  to  a  correction  of  the  mechanical 
defects  in  the  cornea,  to  strengthen  the  delicate 
muscle  of  accommodation  by  tonics  and  mas- 
sage ;  and  for  young  ladies  he  recommended 
gymnastic   exercises. 

Dr.  Lapthorn  Smith,  of  Montreal,  followed 
by  a  paper  on  the  treatment  of  diseases  of  tha 
ovaries  and  Fallopian  lubes.  The  subjects  of 
gonorrhceal  and  tubercular  salpingitis,  tumors 
of  the  ovaries,  ovarian  congestion  and  neural- 
gia vv-ere  elaborately  referred  to,  their  most 
prominent  symptoms  pointed  out  and  also  theii 
treatment.  The  paper  was  practical,  inasmuch 
as  numerous  histories  of  cases  were  recited  and 
pathological  specimens  shown. 

Thursday  morning. 
After  the  opening,  the  Nominating  Committee 
brought  in  the  following  report  : — President, 
Dr.  Bayard,  of  St.  John  ;  General  Secretary, 
F.  N.  G.  Starr,  of  Toronto  ;  Treasurer,  H.  B. 
Small,  of  Ottawa.  Provincial  officers  :— Ont- 
ario, Vice-President,  Dr.  Shaw,  of  Hamilton  ; 
Secretary,  Dr.  Fenwick,  of  Kingston.  Quebec, 
Drs.  Armstrong  and  Campbell  of  Montreal. 
New  Brunswick,  Drs.  McLaren    and  McNally. 


268 


THE  CANADA   MEDICAL   RECORD. 


Nova  Scotia,  Drs.  McKeen  and  Hattie.  Mani- 
toba, Drs.  Blanchard  and  Nelson.  North  West 
Territories,  Drs.  Haultain  and  Macdonald. 
Prince  Edward  Island,  Drs.  Maclaren  and 
McNeil.  British  Columbia,  Drs.  Edwards  and 
Richardson. 

The  use  and  abuse  of  the  various  cautery 
agents  in  the  treatment  of  nasal  affections  was 
treated  by  E.  A.  Kirkpatrick,  of  Halifax.  He 
referred  first  to  the  delicacy  and  importance  of 
the  nasal  mucous  membrane,  and  said  that  too 
often  it  was  the  subject  of  too  harsh  treatment. 
Caustics  were  used,  perhaps,  more  in  hyper- 
trophic rhinitis  than  for  anything  else,  and 
often  too  severely.  Of  the  caustics  he  used, 
chromic  acid,  tri-chlor-acetic  acid  and  the 
electro-cautery  were  the  principal.  The  chro- 
mic acid  he  used  in  anterior  applications,  the 
cautery  for  the  posterior  applications.  By  the 
injudicious  use  of  caustics  he  had  seen  the 
mucous  membrane  destroyed.  And  in  some 
cases  he  had  seen  very  serious  sequelae  follow 
in  connection  with  the  ear,  such  as  loss  of 
hearing,  and  mastoid  disease. 

The  Address  in  Medicine  was  delivered  by 
Dr.  Bayard  of  St.  John,  N.B. ;  subject— The 
Influence  of  the  Mind  on  the  Body.  This  was, 
he  claimed,  a  subject  of  growing  importance 
in  this  rushing  age.  Most  authorities  were 
agreed  that  surgery  and  medicine  were  rapidly 
advancing;  but  it  was  also  agreed  that  nervous 
diseases  were  on  the  increase,  particularly  in- 
sanity and  neurasthenia.  This  was  largely  due 
to  the  energy,  competition,  worry,  compulsory 
education,  sensational  novels,  newspapers,  spe- 
culation and  unrest  that  characterizes  the  last 
part  of  this  century.  Another  cause  was  the 
migration  from  the  country  into  the  town,  where 
the  strife  for  existence  was  greater  and  sanitary 
surroundings  bad.  Relief  from  this  condition 
of  affairs  was  largely  through  the  instrumentality 
of  educational  reform  and  the  employment  of 
preventive  measures  generally. 

As  an  outcome  of  one  of  the  points  referred 
to  in  the  Address,  at  the  suggestion  of  Dr. 
Kingston,  Dr.  Bayard  moved,  seconded  by 
Dr,  Hingston,  that  the  system  of  education 
generally  pursued  in  the  Dominion  of  Canada 
draws  too  largely  upcn  the  brain  tissue  of 
children,  and  materially  injures  the  mental  and 
bodily  health.  Drs.  Cameron  of  Toronto,  and 
Powell  of  Ottawa,  thought  the  terms  of  the 
resolution  were  too  sweeping,  that  there  was  no 
specific  statement  as  to  what  department  of  the 
school  system  was  at  fault,  nor  to  what  portion 
of  the  Dominion  it  more  especially  applied. 
Our  young  people.  Dr.  Cameron  thought,  were 
not  suffering,  the  older  people  neither,  from 
too  much  education.  The  educational  system 
had  been  the  subject  of  the  best  thought  of  our 
best  men,  and  he  considered  the  motion  too 
condemnatory.     A  resolution  was  then  passed 


that  the  matter  be  referred  to  a  committee  con- 
sisting of  Dr.  Powell,  Dr.  Hingston,  Dr.  Gra- 
ham and  Dr.  Bayard. 

The  committee  appointed  to  report  on  the 
President's  Address  reported  on  the  matter  of 
inter-provincial  registration.  It  was  adopted. 
Dr.  Daniel  moved,  seconded  by  Dr.  Powell, 
that  a  committee  be  appointed  in  which  each 
of  the  provinces  shall  be  represented  to  draw 
up  a  form  of  medical  act,  which,  after  being 
adopted  by  this  Association,  shall  be  presented 
to  each  provincial  legislature,  to  be  by  them 
passed  into  law  ;  and  that  the  committee  that 
brought  in  the  report  be  asked  to  name  such 
committee. 

Dr.  Buller  moved,  seconded  by  Dr.  Lapthorn 
Smith,  that  a  committee  be  appointed,  with 
power  to  add  to  their  number,  to  consider  the 
best  means  of  obtaining  a  uniform  standard  of 
medical  education  for  the  Dominion  of  Canada  ; 
and  that  said  committee  report  at  the  next 
meeting  of  the  Association.  This  was  carried. 
The  discussion  over  the  above  question  was 
long  and  animated,  and  taken  part  in  by 
several  of  the  men  from  the  different  provinces 
represented  at  the  Association. 

"  Functional  Derangements  of  the  Liver " 
was  the  title  of  a  paper  by  Dr.  J.  E.  Graham 
of  Toronto.  Little  was  known  of  the  liver  and 
its  functions  until  comparatively  recent  years  ; 
but  new  light  was  being  constantly  thrown  on 
its  pathology  since  the  discovery  of  its  glyco- 
genic functions,  the  peculiarity  of  its  circulation 
and  its  work  of  manufacturing  urea.  The  term 
"  ren^l  inadequacy,"  characterized  by  deficiency 
of  urea,  and  subjectively  by  susceptibility  to 
cold,  slowness  in  the  repair  of  wounds,  and 
inability  to  stand  ordinary  surgical  operations, 
with  no  apparent  structural  change  in  the  kid- 
neys, would,  he  considered,  be  more  properly 
designated  if  called  "  hepatic  inadequacy," 
as  all  the  symptoms  could  more  easily  and 
reasonably  be  shown  to  be  the  result  of  hepatic 
rather  than  renal  disorder.  When  the  hepaiic 
function  of  producing  glycogen  was  impaired, 
the  hepatic  cells  lost  their  power  of  arresting 
poisons  from  entering  the  general  circulation. 
The  poisons  wiiich  acted  deleteriously  upon  the 
hepatic  cells  might  be  classified:  —  i.  Those  in- 
troduced from  without,  as  arsenic  or  poison 
from  decomposing  meats,  etc.  2.  Poison,  the 
result  of  the  action  of  bacteria  as  found  in  fer- 
mentation of  the  stomach.  3.  Toxines  pro- 
duced in  infective  diseases.  4.  Poisons  Irom 
the  intestine. 

Dr.  Hingston  reported  four  cases  of  opera- 
tions on  the  brain.  The  first  two  were  for 
epilepsy.  The  first  without  the  results  hoped 
for.  The  second  was  operated  on  for  cephalgic 
pain  located  in  one  spot.  It  had  been  inces- 
sant and  severe  for  a  year.  The  Doctor  tre- 
phined, and  found  a  hydatid  pressing  on  the  brain, 


THE   CANADA   MEDICAL   RECORD. 


269 


pediculated,  which  he  removed.  The  patient 
made  a  good  recovery.  The  next  case  was 
that  of  a  young  man, whom  the  Doctor  presented, 
who  liad  suffered  for  twenty  years  as  the  result 
of  a  fall  and  injury  to  the  right  side  of  the  brain. 
He  was  the  subject  of  paralysis  of  the  left  arm 
which  was  drawn  up  and  flexed,  the  fingers 
also  being  flexed  in  their  terminal  jihalanges, 
and  extended  in  the  first.  The  orbicularian 
and  zygomatic  muscles  and  the  others  on  the 
left  side  were  spasmodic  and  over-developed, 
the  pupil  was  contracted,  the  vision  and  hear- 
ing on  that  side  impaired.  On  operating,  a 
thickened  portion  of  bone  was  found  impinging 
on  the  brain  tissue,  surrounded  by  a  cartilagin- 
ous material  which  nature  had  thrown  about  it. 
There  was  no  bleeding  upon  its  withdrawal. 
The  expression  of  the  face  at  once  became  re- 
laxed, and  the  patient  seemed  almost  complete  in 
facial  appearance.  The  arm  had  improved. 
Dr.  Kingston  recommended  the  use  of  a  large, 
trephine,  two  inches  in  diameter,  for  these  opera- 
tions. 

Dr.  Shepherd  of  Montreal  gave  the  history 
ofacaseof  removal  of  the  entire  upper  limb 
for  a  chondro-sarcoma  involving  the  shoulder- 
joint;  also  of  the  removal  of  a  large  enchon- 
droma  of  the  pelvis.  The  first  operation  had 
not  been  done  often,  his  being  the  first  that 
had  been  done  in  Canada.  Drs.  Kingston, 
Cameron    and  Steves  discussed  the  paper. 

Dr.  BuUer,  of  INIontreal,  read  a  paper  on 
"The  Present  Status  of  Asthenopia." 

Dr.  Inches  of  St.  John,  N.B.,  read  a  paper 
on  the  Prevention  of  Tuberculosis.  He  pointed 
out  the  danger  of  infection  from  diseased  ani- 
mals in  their  meat  and  milk,  stating  that  in 
herds  of  cattle  sometimes  as  high  as  98  per  cent, 
of  the  animals  were  affected.  Then  there  was 
the  great  danger  from  the  sputum  of  the  tuber- 
culous patient.  Of  course,  suitable  soil  was 
necessary  for  the  growth  of  the  bacillus.  He 
stated  that  in  the  perfectly  healthy  individual  it 
could  not  propagate  itself,  or  was  not  likely  to  ; 
but  in  very  many  the  general  health  was  low- 
ered either  by  hereditary  disposition  or  through 
unsanitary  surroundings.  For  its  prevention 
the  first  thing  to  be  attended  to  was  the  neces- 
sity of  perfect  cleanliness  as  regards  the  sputa 
on  the  part  of  the  infected  patient.  The  second 
was  the  establishment  of  special  hospitals  for 
this  class  of  patients.  These  patients  who  be- 
longed to  the  wealthy  classes  might  be  treated 
otherwise,  but  for  the  great  majority  of  the 
cases,  separate  hospitals  were  exceedingly  de- 
sirable. In  Italy  their  establishment  had  lessen- 
ed the  mortality  very  greatly. 

Dr.  L.  Duncan  Bulkley,  of  New  York,  gave 
a  paper  on  the  treatment  of  skin  diseases. 
More  success  would  come  to  the  general  practi- 
tioner in  the  treatment  of  the  skin  if  more  at- 
tention was  paid  to  each  individual  case.     He 


advised  careful  enquiry  into  every  detail  of  the 
patient's  system  and  habits.  The  history  of 
the  eruption ;  careful  enquiry  as  to  former 
eruptions  ;  family  tendencies  as  to  presence  of 
asthma,  rheumatism,  etc. — all  should  be  made 
a  note  of.  If  medical  men  knew  eczema,  acne, 
syphilis  well,  they  would  be  able  to  treat  the 
great  majority  of  their  cases  satisfactorily.  As 
to  Eczema,  too  much  was  often  done, — it  was 
over  treated  often.  More  and  more  he  had 
grown  to  know  that  much  depended  on  consti- 
tutional treatment  in  all  these  skin  affections. 
The  correction  of  some  fault  in  diet  or  habit  in 
life  was  sufficient  to  effect  relief.  The  Doctor 
pointed  out  some  of  the  principal  points  in  the 
management  of  acne,  syphilis,  psoriasis  and 
urticaria. 

Dr.  Lapthorn  Smith  gave  a  very  interesting 
exhibition  of  the  use  of  the  galvano  cautery  in 
which  the  street  lighting  current  is  used.  He 
showed  how  simple  it  was,  and  how  far  superior 
it  was  to  the  old  battery  arrangement.  The 
cost  was  trifling. 

'I'hursday  Evening. 

The  report  of  the  Committee  appointed  at 
the  last  Association  to  consider  the  matter  of 
the  establishment  of  a  pharmacopoeia  was  re- 
ceived and  adopted.  On  motion  of  Dr.  Starr, 
seconded  by  Dr.  Macdonald,  it  was  moved 
that  the  same  committee  be  requested  to  cor- 
respond with  the  different  medical  and  phar- 
maceutical associations  with  regard  to  the  ad- 
visabiUty  of  publishing  a  pharmacopoeia,  taking 
the  B.  P.  as  a  standard. — Carried. 

"The  Prevention  of  Consumption  "  was  the 
subject  of  a  paper  by  J.  F.  Macdonald,  N.S. 
He  advocated  bringing  the  matter  of  the 
contagiousness  of  this  disease  before  the  people 
by  means  of  the  secular  press,  by  the  estab- 
lishment of  philanthropic  societies  for  the  dis- 
cussion of  the  matter,  and  the  adoption  of 
practical  measures  for  the  treatment  of  the  cases. 
He  advised  the  system  of  registration  ;  a  care- 
ful system  of  disinfection ;  government  inspec- 
tion of  infected  places ;  the  establishment  of 
sanitaria  ;  and  the  enactment  of  laws  to  prevent 
the  infected  from  spreading  the  infection. 

Dr.  H.  D.  Hamilton  read  a  paper  on  "  The  Ad- 
hesions of  the  Soft  Palate  and  their  Treatment." 

"A  Medico-Legal  Romance  "  was  the  subject 
of  an  interesting  paper  by  Dr.  Steves,  of  St. 
John  Lunatic  Hospital. 

Dr.  K.  N.  Fenwick  then  read  a  paper  on 
Hysteropexy.  It  was  discussed  by  Dr.  Cam- 
eron, of  Toronto,  and  Dr.  L.  Smith,  of  Mon- 
treal. 

After  the   customary    votes    of  thanks,  the 
meeting  closed.     The  next  meeting  of  the  Asso- 
ciation will  be  held  in  Kingston,  Ont. 


270 


THE   CANADA   MEDICAL   RECORD. 


THE  MONTREAL   MEDICO-CHIRURGI- 
CAL  SOCIETY. 

Stated  Meeting,  April  zoth,  1894, 

James  Bell,  M.D.,  Prlsident  in  the  Chair. 

In  a  few  words  llu  iruih  in  regaid  to  iiiflam 
niation  and  sn])puration  of  the  brain  seems  to 
be  thus  :  Wliile  an  inflammation  of  the  biain 
nK:y  ari.se  and  go  on  to  sir  puration  without  the 
blood  vessels  being  especially  concerned  in  a 
.causative  way,  and  while  a  thrombus  or  an 
embolus  may  not  give  rise  to  inflammation,  yet 
on  the  other  hand  inflammation  and  suppuration 
may  follow  sooner  or  later,  ar.d  is  almost  sure 
to  do  so  if  the  thrombus  or  embolus  be  due  lo 
some  infective  process  near  or  remote.  It 
follows  therefore  that  the  examination  of  the 
blood  vessels  of  the  brain,  both  venous  and 
arterial,  is  a  sound  procedure  in  all  cases  of 
gross  brain  lesion. 

Dr.  Adami  remarked  that  he  presumed  the 
paper  was  intended,  by  Dr.  Mills,  as  an  answer 
to  his  (Dr.  Adami's)  statement  at  the  last  meet- 
ing, that  emboli  never  caused  suppuration.  He, 
at  the  time,  understood  Dr.  Mills  to  mean  that 
suppurative  inflammation  of  the  brain  miglit 
be  due  10  an  infarct  in  that  organ,  that  is  to 
say,  to  the  simple  blocking  of  a  vessel  by  some 
non-infective  mateiial.  Thi^^  he  regarded,  and 
still  regards  as  impossible.  To  have  suppura- 
tion 2nd  the  formation  of  an  abscess  ("as  there 
was  in  the  case  then  being  discussed)^  one 
must  have  the  presence  of  a  microorganism. 
Every  metastatic  abscess  is  the  result  of  the 
carrying  to  and  the  blocking  of  some  vessel  by 
micro-organisms,  which  cause  a  destruction  of 
tissue,  etc.,  at  that  point.  A  simple  infarct,  on 
the  other  hand,  causes  necrosis,  and  round 
about  the  necrosed  area  one  may  get  a  zone  of 
simple  inflammation,  but  never  the  formation  of 
pus.  The  authorities  quoted  by  Dr.  Mills,  in 
his  paper,  may  be  divided  into  two  classes  : 
(i)  Those  who  are  referring  to  simple  inflam 
mation  ;  (2)  those  who  are  referiing  to  sup- 
purative inflammation,  and  it  will  be  found  that 
they  both  agree  pretty  closely  with  the  foregoing 
views.  He  po'nted  out  that  in  giving  his 
description  of  the  brain,  he  had  referred  to  the 
atheromatous  condition  of  the  vessels. 

Dr.  Mills  admitted  that  his  paper  was  in- 
tended as  an  answer  to  Dr.  Adami's  treatment 
of  his  comments  on  a  case  discussed  at  the  last 
meeting.  In  asking  the  question  thu  night, 
he  simply  wished  to  know  wheih.r  the  blood 
vessels  of  the  brain  had  been  examinetl,  as 
while  he  did  not  wish  to  belittle  the  importance 
of  the  mote  recent  methods  of  bacteriological 
research,  yet  he  thought  it  inadvisable  to  desert 
entirely  the  good  old  landmarks  of  pathological 
investigation,  and  as  such  he  regaided  the 
condition  of  the  vessels  as  something  never  to 
be  overlooked, 


The  late  Dr.  Joseph  Workman. — Dr.  Gird- 
wood  called  the  attention  of  the  members  to 
the  death  of  Dr.  Joseph  Workman,  of  Toronto, 
who  was  an  Honorary  Member  of  the  Society, 
the  oldest  living  graduate  of  McGill  University, 
and  was  connected  by  marriage  with  one  of 
our  present  most  prominent  members.  He 
moved — "  Resolved,  that  the  members  of  this 
Society  have  heard  with  deep  regret  of  the 
death  of  Dr.  Joseph  Workman,  of  Toronto,  who 
was  an  Honorary  Member  of  the  Society,  and 
that  they  desire  to  express  their  high  esteem 
for  the  late  Dr.  Workman  and  theii  sympathy 
with  the  family  of  their  deceased  friend  and 
fellow-worker ;  and  that  a  copy  of  this  resolu- 
tion be  forwarded  to  the  representatives  of  the 
family." 

Dr.  Wesley  Mills,  although  regretting  the 
occasion,  had  great  pleasure  in  seconding  the 
resolution.  He  knew  Dr.  Workman,  he  had 
felt  the  influence  of  his  presence  for  good,  and 
knew  a  number  of  men  who  had  experienced 
the  same.  Dr.  Workman,  in  fact,  was  one  of 
those  men  who  influenced  profoundly  almost 
every  person  with  whom  they  come  in  contact. 
He  had  made  some  important  contributions  to 
our  Society,  and  was  for  many  years  a  trans- 
lator of  scientific  Italian  medical  work,  which,  if 
he  had  not  translated,  would  most  likely  have 
remained  entirely  unknown  to  the  majority  of 
the  profession  in  Canada.  In  this  respect  he 
even  wen*^  to  the  trouble  of  translating  an  im- 
portant .Lalian  work  on  the  brain,  for  which  he 
never  got  a  publisher.  He  was  in  many  ways 
an  extraordinary  man,  a  man  with  ti.e  courage 
of  his  convictions.  For  many  years  in  Ontario 
he  fought  the  battles  of  the  profession  through 
the  press,  and  we  to-day  are  reaping  the  fruit  of 
the  victories  won  by  this  great  Nestor  over  the 
iniquities  of  his  time.  Dr,  Mills  expressed  it 
as  his  conviction  that,  with  the  exception  of  the 
late  Dr.  Howard,  perhaps  there  was  no  man  in 
Canada  who  was  so  generally  respected  and 
admired  by  his  professional  brethren,  and,  in- 
deed, by  all  who  knew  him  intimately  enough 
to  appreciate  the  nobility  of  his  nature,  as  was 
Dr,  Workman. 

Stated  Meet iJig,  May  ^th,  1894. 
James  Bell,  M.D.,  President,  in  the  Chair. 

Foreign  Body  in  the  Bronchus. — Dr.  Bell 
exhibited  a  short  piece  of  lead-pencil,  with  a 
brass  top,  (<ut  of  which  the  rubber  had  fallen, 
that  he  had  recently  removed  from  the  lower 
division  of  the  left  bionchus  of  a  child.  A  week 
ago  last  Thursday,  a  little  girl  eight  years  of 
age,  while  nibbling  the  end  of  her  lead  pencil, 
was  struck  on  the  back  of  the  head  by  a  school- 
mate ;  the  pencil  slipped  from  her  fingers  into 
her  mouth,  and  being  a  nervous  child,  she 
jumped  up,  inspired,  and  drew  it  into  her 
larynx.     A  fit  of  strangulation  followed,  lasting 


THE   CANADA    MEDICAL   RECORD. 


271 


about  fifteen  minutes,  and  nearly  proved  fatal. 
A  doctor  was  immediately  called  in  ;  she  re- 
covered sufficiently  to  walk  home,  but  coughed 
violently  throughout  the  night.  Her  family 
doctor  saw  her  at  ten  o'clock  that  night,  but  as 
she  was  then  sleeping,  he  made  no  examination. 
The  ne.Kt  morning,  on  calling,  he  found  the  left 
side  of  her  chest  collapsed  and  dull,  with  no 
evidence  of  air  entering  the  lower  lobe,  and 
very  little  the  upper  lobe  of  that  lung.  The 
cough  then  had  almost  ceased,  but  she  com- 
plained of  great  pain,  which  she  vaguely  referred 
to  the  region  of  the  nipple.  Her  temperature 
rose  during  the  day,  and  in  the  afternoon  had 
reached  as  high  as  103.5'^.  She  was  brought 
to  Montreal  that  day,  and  when  Dr.  Bell  saw 
her  in  the  evening,  at  the  Royal  Victoria  Hos- 
pital, h.er  temperature  was  104",  respiration  50 
to  60  per  minute,  pulse  140  ;  she  was  very  rest- 
less, and  complained  of  great  pain  in  the  situa- 
tion already  mentioned.  The  collapse  of  the 
left  side  was  so  marked  as  to  be  visible  to  the 
naked  eye,  and  auscultation  revealed  that  ab- 
solutely no  air  was  entering  the  lower  lobe, 
while  in  the  upper  only  a  very  feeble  sound, 
without  any  vesicular  murmur,  could  be  heard. 
His  conclusions  were,  that  the  piece  of  pencil 
had  entered  the  left  bronchus,  into  the  lower 
division  of  which  it  had  become  impacted  so 
as  to  completely  occlude  it,  while  its  end,  lying 
across  the  orifice  of  the  upper  division,  partially 
blocked  its  lumen  as  well  ;  that  in  this  position 
it  acted  as  a  bullet  valve,  which,  when  she 
coughed,  permitted  the  residual  air  to  be  ex- 
pelled., but  which  upon  respiration  became 
firmly  impacted,  and  prevented  the  entrance  of 
air  to  the  lower  lobe,  and  allowed  very  liitle  to 
the  upper.  Recognizing  the  condition  as  a 
serious  one,  Dr.  Bell  thought  it  better  to  post- 
pone the  operation  until  the  morning,  by  which 
time  he  could  have  the  assistance  of  Drs.  Ste- 
wart and  Rddick  in  consultation.  With  thier 
concurrence,  the  next  day  (Saturday),  a  low 
tracheotomy  was  performed,  and  the  trachea 
opened  below  the  isthmus  of  the  thyroid. 
Before  attempting  the  extraction  of  the  foreign 
body,  the  child  was  placed  in  what  might  be 
described  as  an  exaggerated  Trendelenberg's 
position,  with  a  pillow  beneath  the  back  of 
the  neck,  to  throw  the  head  back;  so  that 
if  he  succeeded  in  dislodging  the  foreign 
body,  gravitation  would  cause  it  to  fall  down- 
ward towards  the  wound  in  the  trachea,  and 
thus  prevent  it  from  being  drawn  into  the  other 
bronchus.  To  reach  it,  an  angular  forceps, 
with  blades  3^^  inches  long,  and  the  angle 
nearly  ninety  degrees,  were  used,  the  angle  of 
which  went  completely  into  the  wound,  and 
thus  permitted  the  blades  to  be  manipulated 
with  great  ease.  Having  succeeded  in  grasp- 
ing it  with  the  forceps,  he  dislodged  it  from  its 
impacted  position  with  a  Httle  jerk  ;  but  then, 
fearing  he  might  have  been  mistaken,  and  have 


caught  hold  of  a  ring  of  the  bronchus  instead, 
he  let  go  the  object,  for  the  purpose  of  satisfy- 
ing himself  further.  Immediatfly,  however, 
there  was  a  gush  of  pus  up  through  the  tracheal 
wound,  which  threatened  the  patient  with  in- 
stant asphyxiation,  but,  fortunately,  not  having 
withdrawn  the  forceps,  he  passed  them  down 
again,  and  striking  the  brass  end  of  the  pencil, 
which  happened  to  be  uppermost,  he  imme- 
diately withdrew  it.  All  symptoms  of  urgency 
disappeared  at  once.  The  next  morning,  on 
examining  the  chest,  air  was  found  entering 
both  lungs  freely,  a  few  rales  were  found  in 
the  lower  lobe  of  the  left  lung  anteriorly;  but 
since  then  these  have  disappeared,  the  child 
appears  quite  normal,  and  is  only  waitingfor  the 
closing  of  the  tracheal  wound  to  return  to  her 
home. 

Dr.  James  Stewart  had  the  privilege  of 
seeing  the  child  before,  during  and  after  the 
operation,  and  felt  honored  that  he  belonged  to 
a  profession  capable  of  accomplishing  such 
beneficent  results.  It  was  quite  clear  to  any 
person  who  witnessed  the  great  distress  under 
which  the  little  patient  labored,  that  she  could 
have  lived  but  a  very  few  hours.  An  interest- 
ing feature  was  the  change  in  the  physical  signs 
which  the  plugging  gave  rise  to  ;  percussion 
over  the  lower  half  of  the  left  lung  gave  a  note 
quite  as  flat  as  that  met  with  in  pleural  effu- 
sion, while  over  the  upper  half,  though  not  so 
marked,  it  was  still  less  resonant  than  normal. 
On  listening  over  the  lower  half,  nothing  at  all 
was  heard,  while  in  the  upper  portion  one  had 
tubular  breathing.  These  phenomena  are 
worthy  of  consideration  as  illustrating  how 
respiratory  sounds  in  health  and  disease  are 
produced. 

Six  eases  of  Pyosalpynx. — Dr.  A.  Lapthorn 
Smith  read  the  reports  of  the  cases. 

Urinalysis  171  One  Hundred  Cases  of  Ether 
Aticesthesia. — Dr.  Gordon  Campbell  read  a 
paper  on  this  subject,  of  which  the  following  is 
a  synopsis  : — Specimens  were  examined  of  the 
urine  before,  during  the  actual  time  of,  and 
after  the  anaesthesia  and  the  occurrence  of 
albumin,  sugar  and  acetone  noted  and  the 
amount  of  urea  estimated  during  the  actual 
anaesthesia  as  compared  to  the  normal.  The 
amount  of  urine  secreted  while  under  ether 
an?esthesia  was  found  to  be  within  the  normal 
limits,  but  the  amount  of  urea  excreted  was 
largely  diminished,  averaging  only  (^s)  three- 
eighths  of  the  normal,  /.^.,  at  the  rate  of  177 
grains  per  diem.  Both  the  amounts  of  urine 
and  of  urea  varied  inversely  with  the  length  of 
anaesthesia.  Albumin  was  found  in  the  urine 
secreted  during  auEesthesia  in  6  per  cent,  of  the 
cases,  and  in  three  of  these  the  presence  of  a 
sound  in  the  bladder  during  part  of  the  time 
was  looked  on  as  a  possible  cause.  In  no 
case  did  the  amount  of  albumin  exceed  2 
grammes  per  Htre,  and   in  every  case  it  disap- 


272 


THE   CANADA   MEDICAL   RECORD. 


peared  the  following  day  and  was  considered 
to  be  of  vaso-motor  origin.  Sugar  was  not 
found  as  a  product  in  any  of  the  cases.  Ace- 
tone was  invariably  present  for  two  days  fol- 
lowing anaesthesia,  and  in  64  per  cent,  appeared 
during  the  administration.  It  lasted  from  3  to 
7  days  after. 

Dr.  BuLLER  reminded  Dr.  Campbell  of  a  case 
in  which  he  had  administered  ether  to  a  paiieni 
who  was  in  a  very  advanced  condition  of  sac- 
charine diabetes,  and  who  became  dangerously 
cyanosed  during  the  administration.  Noticing 
that  no  allusion  had  been  made  to  any  such 
case  in  the  paper,  the  speaker  wished  to  know 
if  Dr.  Campbell  had  ever  since  met  with  any 
similar  case. 

Dr.  Reed  wished  to  knov^^  wliat  test  had 
been  used  for  acetone,  also  whether  the  latter 
was  present  in  sufficient  quantity  to  be  recog- 
nizable without  distillation. 

Dr.  Laptiiorn  Smith  declared  himself  as  no 
friend  of  ether,  but  would  like  to  give  it  its  due. 
He  did  not  think  the  ether  was  responsible  for 
the  diminished  quantity  of  urine  secreted  after 
anffistheiization.      The  preparatory   treatment 
which  is  employed  in  cases  of  laparalomy  would 
alone  have  this  effect.     For  some  days  before  the 
o]  eration  a  patient   is  kept    on   dry  food,  and 
purged  freely  by  means  ofcathartics,  ihusgetting 
rid  of  a  large    quantity   of  water  from  the  sys- 
tem ;  the  day    previous  to  the   operation    the 
patient  is  not  allowed  any  water  to  drink;    and 
again  some  operators  prohibited  food  for  24  hours 
after  the  operation.     All  this  must  have  a  very 
considerable  effect  in   lessuiing  the  quantity  of 
urine.     Now,  as  to  the  diminution  in  tiie  quan- 
tity of  urea^  he    ventured  to  say  that  this  dimi- 
nution was  not  confined  to  the  patient,  but  that 
both  the   operator  and    the   anaesthetist  would 
find  themselves    similarly  afficted.     It  must  be 
remembered  that  urea  is  oxidized  nitrogen,  and 
that   during   every  hour  that    a  person  is   in  a 
room  without  much  air,  or  with  air  deficient  in 
oxygen,  the   oxidization    of  the  nitrogen    into 
urea   becomes    more   difficult,  and   it   is  often 
compelled  to  stop  at  the    urx  acid  stage.     For 
his  own  part,  he  has  frequently  found   himself, 
after  a  prolonged  operation,  in  a  crowded  room, 
to  be   suffeiing  from  soreness   or  aching  in  the 
joints,  which   he  attributed  to  an  excess  of  uric 
acid  in  his  blood.     Again,  as  to  the  safety  with 
which  Dr.  Campbell  has  administered  ether,  he 
thought  more  credit  was  due  to  the  anaesthetist 
than  the  anaesthetic.     A  great  deal  was  the  re- 
sult of  the  use  of  Clover's  Inhaler,  but  this  was 
an  apparatus   which  everyone  could  not  mani- 
pulate with  success;  very  few  have  been  as  suc- 
cessful with  it  as   Dr.  Campbell.     By  means  of 
it,  the   quantity  of  ether  administered    during 
a  given  time  is  much  less   than   would  be    re- 
quired to   keep  up  the  same  degree   of  insensi- 
bility were  the  ether  administered  by  any  other 
means  j  as  a  result,  therefore,  the  patient  con- 


sumes less  of  the  drug  per  minute  or  per  hour 
and  consequently  runs  less  risk. 

Dr.  Kingston  complimented  Dr.  Campbell 
on  the  spirit  of  thoroughness  with  which  he  had 
conducted  these  investigations  ;  and  expressed 
a  wish  that  Dr.  C.  might  undertake  a  similar 
series  of  experiments  with  chloroform.  To 
have  the  same  observer  study  the  properties  of 
the  two  drugs  would  be  much  more  satisfactory 
than  two  investigators  each  confining  himself 
to  one. 

Commenting  on  the  details  of  the  paper,  Dr. 
Hingston  took  exception  to  the  term  "post" 
being  used  to  designate  the  period  during  which 
the  patient  was  really  under  the  influence  of 
the  anesthetic,  and  suggested  that  a  better 
division  would  be  into  "ante,"  "per"  and 
"  post,"  or  before,  during  and  after  the  adminis- 
tration. 

Dr.  Wesley  Mills  praised  very  highly  Dr. 
Campbell's  paper.  He  concurred  in  Dr. 
Smith's  criticism  relative  to  the  changes  brought 
about  in  the  urine  from  excitement,  etc.,  as 
factors  which  should  be  taken  into  considera- 
tion when  estimating  the  effects  of  the  anaes- 
thetic on  that  secretion.  In  this  respect  he 
alluded  to  the  differences  which  he  had  fre- 
quently noticed  in  his  own  urine  after  lecturing, 
or  when  laboring  under  the  strains  of  exam- 
ination time,  differences  which  a  colleague  of 
his  had  also  observed. 

Dr.  James  Bell  expressed  himself  as  greatly 
interested  in  Dr.  Campbell's  observations.  As 
a  routine  practice  he  was  accustomed  to  use 
ether  as  an  anaesthetic,  reserving  chloroform 
for  certain  conditions  where  the  former  was 
said  to  be  contra-indicated.  One  of  these  was 
in  affections  of  the  kidney.  He  had  never 
been  able  to  see  any  good  reason  for  this  re- 
striction, and  a  study  of  Dr.  Campbell's  cases 
was  not  calculated  to  remove  the  doubt.  Only 
six  cases  of  albuminuria  appear  in  this  list ;  in 
three  of  which  a  sound  having  been  passed  into 
the  bladder  is  sufficient  in  itself  to  account  for 
albumen  in  the  urine.  Relative  to  the  undoubt- 
ed diminution  of  urine  and  urea  following  ether 
anaesthesia,  it  must  be  remembered  that  such 
phenomena  are  susceptible  of  more  than  one 
explanation.  The  length  of  time  during  which 
the  anaesthetic  had  been  administered,  and  the 
effects  of  the  shock  proper  to  the  operation  it- 
self, have  to  be  taken  into  account  in  this  re- 
G|:)ect.  At  the  same  time.  Dr.  Bell  thought  it 
well  to  remember  that  one  hundred  cases  were 
after  all  a  very  small  number  for  us  to  draw 
any  positive  conclusions  from ;  to  do  this,  the 
investigation  should  be  "continued  and  extended 
over  a  great  many  hundred  cases  if  possible. 

Dr.  Gordon  Campbell,  in  reply  to  Dr. 
Buller,  said  he  remembered  well  the  case  re- 
ferred to,  and  thought  that  the  cyanosis  in  that 
case  was  not  due  to  the  ether,  but  to  a  spasm 
of  the  glottis,  because  upon  introducing  a  finger 


THE   CANADA    MEDICAL    RECORD. 


273 


into  the  patient's  mouth,  and  raising  the  epi- 
glottis, the  spasm  was  relieved.  The  only  other 
case  he  had  seen  with  sugar  in  the  urine  took 
the  ether  normally,  although  it  must  be  said 
that  here  the  amount  of  sugar  was  very  small 
— a  mere  trace  only. 

In  answer  to  Dr.  Reed,  he  said  it  was  his 
practice  always  to  distil  the  urine  before  testing  ; 
he  tried  once  or  twice  testing  the  specimen 
direct,  but  did  not  meet  with  much  success, 
and  thought  it  would  not  be  easy  to  detect  in 
that  way. 

With  regard  to  Dr.  Bell's  remarks,  two  cases 
showed  pus  in  the  urine  before  the  operation,  I 
and  as  far  as  they  could  judge  by  the  eye,  and 
by    microscope,  the  condition  afterwards    re-   1 
mained  the  same.     He  did  not  mention  these,   ! 
as  two  cases  he  considered  proved  nothing.       1 
As  to  the  time  occupied  in  the  operations,  1 
Dr.  Campbell  explained  that  most  of  these  cases  I 
had    been  drawn  from  his  experience  in  Dr. 
Gaidner's  Private  Hospital,  where,  having  no 
fear  of  the  anaesthetic,  they  were  accustomed 
to  give  the  ether   in  the  patient's    room,  and 
keep  her  under  the  influence  of  it  until  she  re- 
turned there  ;  in    this  way  the  length  of  ti  ne 
occupied  by  anaesthesia  might  sometimes    ex- 
ceed by  an  hour  the  time  of  the  operation. 

Dr.  Wm.  Gardner,  in  reply  to  Dr.  Smith 
who  had  called  attention  to  the  importance  of 
the  preparatory  treatment  in  laparatomy  in  in- 
fluencing the  diminution  in  the  quantity  of  the 
urine,  said  that  his  patients  had  very  little  pre- 
liminary treatment.  His  operations  are  per- 
formed at  9  a.m. ;  a  dose  of  castor  oil  the  night 
before,  and  at  7  a.m.  they  have  a  cup  of  beef 
tea.  This  constitutes  all  their  preparatory  treat- 
ment. 

Exophthahnic  Goitre. — Dr.  A.  W.  Haldi- 
MAND  gave  the  clinical  history  of  a  case  which 
came  under  his  observation  in  the  Metropolitan 
Dispensary.  The  symptoms  were  exophthal- 
mos and  goitre  which  first  appeared  six  weeks 
ago.  There  was  no  tachycardia,  which  is  pecu- 
liar, since  authorities  seem  agreed  in  considering 
this  an  ever  present  symptom.  Neither  were 
there  other  circulatory  symptoms,  such  as  throb- 
bing of  the  carotids  or  flashing  of  the  face. 
There  was  nothing  in  the  family  or  personal 
history  of  the  patient  to  account  for  the  disease. 
The  patient  was  a  barber  by  trade,  27  years  of 
age,  and  with  the  exception  of  a  few  attacks  of 
gonorrhoea,  never  a  day  sick  in  his  life.  Auscul- 
tation revealed  a  slight  systolic  murmur,  and 
his  pulse  was  found  to  be  somewhat  irritable. 
The  treatment  employed  was  eight  minims  of 
the  Tinct.  Belladonna  three  times  daily,  under 
which  the  goitre  rapidly  diminished.  The  in- 
teresting features  in  the  case,  and  those  which 
he  thought  warranted  his  bringing  it  before  the 
Society,  were  the  acuteness  of  the  onset  and  the 
absence  of  tachycardia. 


Stated  Meeting,  May  iSt/i,  1894. 

James  Bell,  M.D.,  President,  in  the  Chair. 

Morpha'a. — Dr.  Gordon  Campbell  exhibit- 
ed a  case  of  this  rare  skin  disease.  The  patient, 
a  Russian  girl  about  25  years  of  age,  showed  in 
the  left  mammary  region  an  irregular  patch  of 
an  ivory  white    color,    having    a    smooth  and 
almost  polished  appearance  and  surrounded  by 
a  violet  zone.     The  skin  over  the  affected  area 
was  distinctly  thickened.     The  symptoms  were 
a  slight  tingling  and  itching  on  the  patch.     It 
had  been    present  for    the    past   nine   months, 
while  she  has  been  living    three  years  in    this 
country.     This   is  a  very   rare   affection,    only 
occurring  once  in  several  thousand  cases  of  skin 
diseases,  and,  as  far  as  he  (Dr.  Campbell)  could 
learn,  it  is  the  first  case  of  the  kind  ever  seen 
j  in   the    General    Hospital.      This  affection    is 
regarded  by    Radcliffe    Crocker  as    a  form  of 
diffuse  scleroderma. 
I        Dr.  Foley  had  only  seen  three  such  cases. 
I   Dr.  Crocker's    statistics    give  its   frequency  of 
occurrence  as  6  in  10  000  cases.    He  wished  to 
I  know  if  Dr.   Campbell   had   tried  the   massage 
treatment  in  this  case. 

Dr.  Lafleur  had  seen  one  case  of  diffuse 
scleroderma,  which,  although  spread  over  the 
whole  body,  bore  a  close  resemblance  to  this 
case.  The  infiltration  was  even  more  pro- 
nounced than  here,  giving  the  skin  a  peculiar 
brawny  feel,  and  although  the  blanching  of  the 
skin  was  well  marked,  there  was  yet  no  zone  of 
redness.  It  was  at  first  thought  to  be  an  oede- 
matous  condition  ;  but  as  there  was  no  pitting 
on  pressure,  this  view  had  to  be  given  up. 

Dr.  Gordon  Campbell,  in  reply  to  Dr.  Foley, 
said  he  had  purposely  refrained  from  active 
treatment,  as  hewishel  to  preserve  the  features 
of  the  case  in  all  their  distinctness  for  the  mem- 
bers of  the  Society.  An  interesting  point  about 
morphoea  is  that  it  occurs  on  the  breasts  of  wo- 
man, and  it  is  thought  that  the  irritation  of  the 
corsets  acts  as  a  causative  agency.  That  does 
not  seem  unlikely  to  be  the  case  here,  as  the 
patch  occurs  right  on  a  line  with  the  upper  mar- 
gin of  the  corsets. 

Caries  of  the  Vertebra. — Dr.  Williams  exhi- 
bited a  specimen  of  tubercular  spine  removed 
at  a  recent  autopsy  at  the  Royal  Victoria  Hos- 
pital. The  tenth  dorsal  vertebra  was  affected, 
the  changes  in  which  were  noticed  chiefly  in  the 
body.  The  latter  was  increased  in  size,  extend- 
ing slightly  forwards,  laterally,  and  backwards 
into  the  canal.  As  a  result  of  this  last  exten- 
sion, the  canal  was  diminished  in  size  by  five  or 
six  centimetres,  which  gave  rise  to  a  pressure 
on  the  spinal  cord.  The  intervertebral  sub- 
stance, however,  seemed  slightly  affected,  the 
bone  having  grown  over  it  in  the  canal. 

Dr.  Adami  called  attention  to  the  fact  that  in 
the  intervertebral  di.sc  immediately  above  the 
tenth  dorsal  vertebra  there  was  a  small  calcar' 


74 


THE   CANADA    MEDICAL   RECORD. 


eous  mass  evidently  tubercular  in  origin,  and 
indicating  apparently,  from  iis  relationship,  that 
the  disease  had  commenced  in  the  intervertebral 
disc  and  thence  had  extended  into  the  bone. 

Dr.  Jas.  Stewart  had  this  case  under  his  care, 
and  the  symptoms  pointed  clearly  to  a  com- 
pression myelitis.  For  a  time  there  were  marked 
symptoms  of  irritation  of  the  nerve  roots.  The 
extreme  tenderness  of  the  bom  s  was  an  interest- 
ing feature,  and  one  not  always  seen  in  such 
cases;  for  instance,  Dr.  Bell  has  at  the  present 
moment  two  c.ises  of  tuberculosis  of  the  spine 
under  his  care  in  the  Royal  Victoria  Hospital, 
and  in  neither  of  them  is  there  any  special  ten- 
derness. The  question  arose  whether  an  oper- 
ation in  this  case  would  have  been  followed  by 
any  beneficial  results  ;  but  as  the  patient  was  so 
far  reduced  when  admitted  to  the  hospital,  it 
was  doubtful  whether  he  could  stand  the  shock 
of  an  operation. 

Dr.  GuN.v  had  also  seen  this  case.  The  pa- 
tient came  to  tie  Hospital  complaining  of  lum- 
bago, lasting  uver  a  year.  He  fe't  pretty  well 
otherwise.  Examination  revealed  some  ten- 
derness over  one  or  two  vertebrae,  and  it  was  on 
this  account  that  he  was  admitted.  Consider- 
ing this  case,  Dr.  Gunn  thought  that  all  cases  of 
lumbago,  accompanied  by  tenderness  of  any 
of  the  vertebrae,  should  be  regarded  with  sus- 
picion. 

Dr.  Ja.s.  Bell  took  a  great  interest  in  cases 
of  this  kind.  It  seemed  to  him  that  in  a  case 
where  the  cord  is  pressed  against  the  unyielding 
vertebral  arch,  the  removal  of  that  arch  should 
relieve  the  symptoms,  provided  it  was  done  early 
enough.  But  as  this  is  seldom  the  case,  it  be- 
comes a  puzzling  question  to  decide  what  cases 
to  operate  upon  and  what  ones  to  leave  alone. 
The  opinion  held  by  many  in  the  profession, 
that  in  these  cases  of  paraplegia  the  condition 
was  apt  to  undergo  spontaneous  improvement, 
had  much  to  do  with  deterring  men  from  early 
operation, and  in  his  experience  this  opinion  had 
very  little  foundation.  He  could  recall  several 
cases  where  he  regretted  not  having  operated 
early,  when  the  paraplegia  first  appeared,  and 
where  he  would  have  operated  were  it  not  for 
this  prevailing  impression.  In  cases  of  this 
kind  he  thought  the  actions  of  surgeons  should 
be  prompt  and  fearless,  for  it  requires  only  a 
comparatively  short  time  for  degenerative 
changes  to  take  place  in  the  distal  portion  of  the 
cord.  He  had  already  operated  upon  two  cases, 
in  both  of  which  the  paraplegia  had  been  com- 
plete for  two  or  three  months.  Both  seemed  to 
improve  for  the  first  two  or  three  days  after  the 
operation,  but  in  neither  was  the  improvement 
permanent.  He  asked  how  long  after  the  para- 
plegia develops  can  one  reasonably  expect  reco- 
very to  take  place  on  removal  of  the  pressure  ? 

Dr.  James  Stewart,  in  reply  to  Dr.  Bell's 
question,  said  that  in  an  ordinary  case  of  de- 
scending degeneration  of  the  lateral    columns, 


recovery  may  take  place  many  months  after- 
wards, if  the  pressure  is  of  an  ordinary  kind. 
Of  course,  where  there  has  been  absolute  obli- 
teration of  all  the  functions  of  the  column,  one 
would  not  expect  restoration  to  take  place  after 
three  or  four  months. 

Osteo- Sarcoma  of  Feiniir. — Dr.  Williams 
showed  a  specimen  of  a  bone  tumor  occurring 
in  the  lower  portion  of  a  femur,  removed  by  Dr. 
Kirkpatrick,  which  measured  about  20  inches 
in  circumference.  The  tumor  was  lobulated  in 
outline,  and  quite  a  large  haemorrhage  had  oc- 
curred in  front  of  the  knee  joint,  and  numerous 
hemorrhages  were  noticed  in  various  parts  of 
the  growth.  The  inner  surface  of  the  patella  and 
the  head  of  the  tibia  were  somewhat  eroded. 

Dr.  Adami  said  that  microscopically  the  tu- 
mor presented  the  characters  of  a  periosteal 
sarcoma  of  the  large  mixed  cell  type.  A  little 
distance  from  the  surface  the  cells  were  to  be 
found  embedded  in  a  hyaline  stroma,  and  the 
section  suggested  the  possibility  that  we  were 
dealing  with  a  malignant  enchondroma.  In 
the  more  central  portions  hasmorrhagic  and  ne- 
crotic areas  existed.  Areas  also  were  seen 
which  had  almost  the  appearance  of  cylindroma. 
An  interesting  point  in  this  tumor  was  the  ten- 
dency which  apparently  existed  for  the  tumor 
substance  to  radiate  from  the  joint.  The  early 
history  also  received  in  this  case  was  the  history 
of  a  joint  trouble.  At  first  the  growth  was  the 
periosteal,  but  after  a  time  it  grew  inwards  also  ; 
yet  the  periosteal  growth  always  predominated, 
as  could  be  determined  by  observing  the  shaft, 
where  it  could  be  noticed  that  the  tumor  ex- 
tends to  a  higher  point  externally  than  inter- 
nally. 

Dr.  Kirkpatrick  showed  the  members  a  pho- 
tograph of  the  limb  taken  prior  to  the  operation. 
'J  he  history  extended  back  only  ten  months. 
The  ])atient  was  a  farmer,  22  years  of  age.  Sharp 
transient  pain  in  the  knee  joint  was  the  first 
symptom  noticed.  There  is  no  history  of  injury. 
At  the  end  of  four  months  he  could  not  bend 
the  knee  beyond  a  right  angle.  Until  the  6th 
month  it  was  regarded  as  an  ordinary  synovitis, 
and  treated  with  blisters,  etc.  At  the  seventh 
month  two  limips  noticed  at  the  knee  joint ;  fol- 
lowed, two  weeks  later,  by  similar  lumps  in  the 
popliteal  space.  In  the  middle  of  the  eighth 
month  these  lumps  had  grown  into  one  mass 
around  the  knee  joint ;  and  the  circumference 
of  this  mass  measured  eighteen  inches.  One 
month  later,  or  about  the  end  of  the  ninth 
month,  it  had  increased  to  a  circumference  of 
twenty-two  inches^  at  which  time  the  operation 
was  performed.  Ten  months  ago  the  patient 
weighed  over  200  pounds,  but  when  he  entered 
the  hospital  he  only  wei^^hed  146^.  Amputa- 
tion at  the  hip  joint  was  performed  on  April 
22nd  by  Wyeth's  method.  The  limb  was  trans- 
fixed by  two  iron  skewers,  which  were  pressed 
completely  through  the  limb,  and  proved  a  most 


THE   CANADA    MEDICAL    RKCOKD, 


275 


satisfactory  means  of  fixing  the  esmarch.  No 
blood  was  lost  when  tlie  circular  cot  was  mide, 
except  what  was  in  the  limb  below  the  point 
of  removal,  which,  however,  was  considerable, 
for,  owing  to  the  nature  of  the  tumor,  no  ban- 
dage was  employed  to  empty  the  limb  of  blood. 
Afrer  loosening  the  skewers  and  the  con- 
stricting bard  below  them,  much  blood  was  lost. 
To  counteract  the  effect  of  the  loss,  two  hypo- 
dermics of  strychnia,  and  two  enemata  of  saline 
solution  were  administered,  and  it  was  noticed 
that  each  of  the  latter  had  a  marked  and  almost 
immediate  good  effect  on  the  pulse.  The  patient 
is  now  doing  well  and  going  about  the  ward. 
The  wound  was  dressed  in  the  ordinary  way. 

Intra-Capsjilar  Fracture  of  the  Femur. — 
Dr.  Williams  showed  a  specimen  which  was 
obtained  by  Dr.  Adami  from  a  woman,  75  yea-s 
of  age.  She  lived  three  years  after  tiie  fracture 
occurred,  and  was  able  to  walk  about  with  the 
injured  limb.  The  specimen  shows  that  no 
bony  union  liad  taken  \)\  ce  ;  numerous  fibrous 
bands  pass  across  the  fractured  surfaces,  uniting 
them  with  fibrous  material  so  dense  that  it  re- 
sembled cartilage,  and  was  firm  to  the  feel.  In 
reference  to  a  discussion  which  took  place  at  a 
previous  meeting  as  to  how  often,  if  ever,  bony 
union  occurs  in  these  cases,  Dr.  Williams  re- 
marked that  he  had  looked  up  all  the  specimens 
of  this  kind  in  the  ISIcGill  Museum,  and  found 
that  out  of  ten  specimens  of  the  unimpacted 
intra  capsular  fractures,  not  one  showed  bony 
union  ;  while  of  two  of  the  impacted  variety, 
one  showed  union. 

Hyperostosis  Following  Fracture. — Dr.  Wil- 
liams exhibited  a  tibia  and  fibula,  illustrating 
this  condition.  The  tibia  showed  signs  of  two 
or  three  old  fractures  which  had  occurred  at 
different  times.  A  large  bony  growth  extended 
between,  and  united  the  tibia  and  fibula  in  their 
upper  portion.  Tliis  bridge,  as  it  may  be  called, 
of  bone  is  of  interest,  inasmuch  as  it  frequently 
takes  place  in  either  the  leg  or  forearm  when 
both  the  bones  are  broken.  Firmly  attached 
around  this  bony  growth  was  a  large  mass  of 
firm  fibrous  tissue  with  numerous  sinuses  from 
which  pus  was  oozing. 

Dr.  James  Bell  remembered  the  subject  of 
the  last  specimen  shown.  He  was  a  man 
about  40  years  of  age,  and  a  hard  drinker,  who 
had  a  compound  fracture  of  the  leg,  from  which 
he  recovered  with  difficulty,  but  was  ultimaie'y 
discharged  from  the  hospital  with  his  wounds 
all  healed  and  liis  bones  united.  He  soon  had 
another  spree,  in  which  he  again  fractured  his 
leg  (again  a  compound  fracture;  in  the  same 
place. 

Exostosis  Bursata  or  Exostosis  Cart ilagiuia. 
— Dr.  Bell  showed  a  specimen.  This  form  of 
exostosis  differs  from  the  ordinary  by  growing 
in  the  neighborhood  of  joints,  from  the  epiphy- 
sial Une,  and  the  growths  are  usually  directed 
away  from  the  joint  at  an  angle  of  45°    from 


the  shaft  of  the  bone.  They  are  covered  at  the 
free  extremity  with  cartilage,  and  enclosed  syn- 
ovial membrane  which  often  contains  a  large 
number  of  free  bodies.  The  first  case  of  this 
kind  which  came  under  Dr.  Bell's  care  was  in 
1 888,  at  which  time  only  two  cases  were  on 
record,  the  report  of  his  case  being  then  the 
third.  In  Prof.  Billroth's  case  25  free  cartilagi- 
nous bodies  were  found  within  the  synovial  sac, 
while  his  first  case  contained  155  similar  bodies. 
Bergmann  reports  a  case  in  which  500  were 
found.  The  exostosis  in  the  present  case  was 
situated  in  the  region  of  the  shoulder  joint,  and 
grew  f'om  the  bicipital  groove  at  an  angle  of 
45°  from  the  shaft.  As  to  the  pathology  of  these 
growths — they  are  generally  explained  by  Cohn- 
heim's  theory  of  embryonic  cells,  lying  dormant 
until  something  occurs  or  the  conditions  are 
favorable  for  them  to  take  on  active  growth. 

Cultures  of  Goiiococci. — Dr.  Adami  reported 
a  case  of  gonorrhoeal  synovitis,  the  clinical  his- 
tory of  which  is  rather  interesting  as  showing 
the  importance  of  bacteriology  as  aid  to  diag- 
nosis. The  credit  of  reporting  this  case  was 
due  to  Dr.  H.  S.  Shaw,  resident  surgeon  at  the 
Royal  Victoria  Hospital,  who.  Dr.  Adami 
stated,  had  done  all  the  work  connected  with  it. 
The  patient  was  a  man  with  a  swollen  knee  and 
a  slight  thin  discharge  from  the  urethra.  The 
question  arose  as  to  whether  or  not  it  was  a 
specific  synovitis.  The  knee  having  been  ren- 
dered carefully  antiseptic,  a  Pravaz  syringe  was 
used  to  withdraw  some  drops  of  clear  fluid 
which  were  immediately  spread  upon  the  sur- 
face of  two  tubes  of  glycerine  agar,  which  ten 
days  afterwards  showed  the  gonococci  culture. 
Subsequently  gonococci  were  discovered  in  the 
urethral  discharge.  Dr.  Adami  remarked  that 
it  is  of  importance  to  know  that  the  gonococci 
may  be  cultivated  on  glycerine  agar,  a  material 
which  is  easily  obtained,  where  hitherto  it  was 
thought  to  require  blood  serum  for  its  growth. 
He  pointed  out  that  the  growth  was  very  slight, 
and  that  it  might  be  not  so  much  a  growth 
upon  the  glycerine  agar  as  upon  the  fine  film 
of  synovial  fluid  which  covered  it. 

Pseudo-Membranous  Enteritis. — Dr.  Gunn 
read  a  paper  upon  this  subject. 

Dr.  Lafleur  remarked  that  he  had  seen  one 
of  the  cases  reported  by  Osier,  while  at  the 
Johns  Hopkins  Hospital.  The  ailment  did 
not  impress  him  as  being  very  distressing.  A 
slight  looseness  of  tiie  bowels,  with  the  occa- 
sional passage  of  very  perfect  intestinal  casts, 
which  microscopical  examination  showed  to  be 
composed  of  a  hyaline  laminated  material,  with 
here  and  there  desquamated  cells  from  the 
mucosa,  but  with  very  few  leucocytes  or  red 
blood  cells.  As  far  as  he  could  remember,  the 
treatment  was  local — washing  out  the  bowels, 
etc. 

Dr.  Allan  had  a  case  of  this  kind  which 
came  under  his  care   at  the    Montreal  Dispen- 


276 


THE   CANADA   MEDICAL   RECORD. 


sary.  She  passed  large  quantities  o£  these 
casts  daily. 

Dr.  Morrow  wished  to  know  if  this  condition 
was  analagous  to  the  somewhat  similar  condi- 
tion which  occuis  in  the  respiratory  tract. 

Dr.  Gordon  Campbell  had  seen  a  case  of 
tins  nature  in  which  the  chief  trouble  was  the 
involuntary  passage  of  the  casts.  They  were 
most  commonly  passed  during  sleep,  and  for 
a  time  it  was  not  settled  whether  they  were  of 
rectal  or  vaginal  origin. 

Dr.  GuNN,  in  reply  to  Dr.  Morrow,  said  it 
was  his  impression  that  the  pseudo  membranous 
condition  which  occurred  in  the  bronchi  was 
inflammatory  and  allied  to  the  diphtheritic  form. 
There  was  consequently  no  similarity  between 
them. 

SOCIETE  DE  CHIRURGIE. 

Strangulated  Hernia. — M.  Chaput  read 
the  history  of  two  cases  of  strangulated  hernia 
complicated  with  gangrene.  The  first  was  that 
of  a  woman,  aged  50,  who  suffered  for  five  days 
from  strangulation  of  a  voluminous  umbilical 
hernia  ;  fsecal  vomiting  and  collapse  had  already 
set  in  when  seen  by  one  of  his  confreres,  who 
immediately  practiced  a  long  median  incision 
and  opened  the  sac,  giving  issue  to  a  quantity 
of  fetid  liquid.  The  protruding  omentum  was 
resected  and  the  intestinal  folds  detached  from 
their  adherences,  on  one  of  which  a  long  ribbon 
of  gangrene  was  discovered.  Pinching  up  this 
portion  of  the  intestine  and  turning  the  diseased 
part  inside,  leaving  to  nature  the  care  of  dis- 
charging it,  the  operator  sutured  the  edges  of 
the  artificial  fold  together  and  completed  the 
operation  in  the  usual  manner.  The  second 
case,  reported  by  the  same  surgeon,  was  that 
of  a  strangulated  crural  hernia  in  a  woman 
aged  58.  At  first  taxis  was  tried,  but  it  was 
soon  evident  that  an  operation  was  necessary. 
The  strangulated  intestine  was  found  to  be 
sphacelated  to  an  extent  of  four  inches,  and 
beca'ne  detached  on  very  gentle  traction. 
]>oth  ends  were  sutured,  and  tlie  intestine  re- 
turned. A  stercoral  fistula  was  the  immediate 
result,  but  in  a  few  days  it  closed  spontaneous- 
ly, and  in  three  weeks  after  the  operation  the 
patient  was  quite  well. 

M.  Chaput  stated  that  taxis  in  such  cases 
was  bad  practice,  and  should  be  absolutely 
proscribed.  A  few  weeks  previously  he  was 
called  to  a  man,  aged  50,  who  had  a  riglit 
strangulated  inguinal  hernia.  Trying  taxis 
to  his  satisfaction  he  succeeded  in  reducing  the 
hernia,  but  the  following  day  his  colleague  was 
obliged  to  operate,  as  the  hernia  had  returned. 
The  intestine  being  sphacelated  to  a  certain 
extent,  an  artificial  anus  was  made,  but  the  pa- 
tient sank  in  a  few  days  from  exhaustion.  M. 
Chaput  said  that  if  he  had  not  tried  the  taxis, 
but  operated,   the  man  would  have  recovered. 


One  of  the  most  difficult  questions  in  surgical 
therapeutics  was  to  decide  between  suture  of 
the  intestine  and  artificial  anus.  The  crea- 
tion of  an  artificial  anus  is  extremely  simple, 
and  can  be  effected  without  the  aid  of  chlo- 
roform. It  presents  the  considerable  advan- 
tage of  emptying  rapidly  the  upper  end  ot  the 
intestine  of  products  which  contribute  to  poi- 
son the  organism,  but  it  presents,  on  the  other 
hand,  numerous  disadvantages  resulting  from 
the  flow  of  matter,  which  provokes  frequently 
the  development  of  phlegmon  of  the  walls, 
inoculating  the  peritoneum,  causing  septic 
thrombosis  of  the  femoral  vein,  with  pulmon- 
ary embolus  and  death,  as  has  happened  in 
some  cases  within  his  knowledge.  The 
mortality  of  this  operation  is  placed  by  a 
very  high  authority  at  76  per  cent.,  and  even 
if  the  patient  survives  all  complications  he  re- 
mains afflicted  with  a  disgusting  infirmity, 
which  cannot  be  cured  but  by  a  series  of  grave 
operations. 

Resection,  on  the  other  hand,  followed  by 
suture  of  the  intestine,  does  not  present  the 
same  drawbacks ;  the  mortality  is  less,  and 
the  operation  susceptible  of  being  rendered 
much  easier  to  perform.  It  is  true  that  with 
the  suture  secondary  gangrene  or  perforation 
of  the  upper  end  is  to  be  dreaded,  but  this 
accident  can  be  avoided  by  not  reducing  the 
intestine,  and  if  gangrene  supervene  an  artifi- 
cial anus  can  be  made. — Medical  Press  and 
Circular,  March  28,  1894. 

MEDICAL   SOCIETY  OF    LONDON. 

Diagnosis  of  Diphtheria. — Dr.  Weth- 
ered,  in  a  paper  on  this  subject,  stated  that 
he  had  examined  26  cases  of  diphtheria  and 
16  of  follicular  tonsilitis.  His  method  was 
to  obtain  particles  of  the  deposit  from  the 
throat  by  means  of  a  strong  piece  of  platinum 
wire  fixed  in  a  glass  handle  and  bent  into  a 
loop  at  the  end.  The  portion  thus  ob- 
tained was  drawn  over  the  surface  of  glycerin 
agar-agar  contained  in  large  test-tubes,  which 
were  then  placed  in  an  incubator  at  a  tempera- 
ture of  37°  C.  (98.6°  F.)  for  twenty-four 
hours,  and  the  cultures  examined  microscopi- 
cally. In  16  cases  of  follicular  tonsillitis  he 
found  staphylococci  only,  and  in  i  case  bacter- 
ium termo  also,  but  no  organisms  which  could 
in  any  way  be  mistaken  for  the  bacilli  of  diph- 
theria. In  26  cases  of  diphtheria  he  found  the 
Klebs  Loeffler  bacillus  fifteen  times,  strepto- 
cocci three  times,  and  staphylococci  eight  times. 
Baginski  had  stated  that  streptococci  might 
cause  mild  forms  of  diphtheria,  but  of  Dr. 
Wethered's  cases  2  recovered  and  1  died.  He 
offered  the  following  suggestions  :  i.  That  bac- 
teriological examination  of  material  obtained 
from  the  throat  in  doubtful  cases  of  diphtheria 
might  prove  of  great    service  in  diagnosis.     2. 


THE  CANADA  MEDICAL  RECORD. 


57; 


That  on  microscopical  examination  there  was 
no  great  danger  of  mistaking  organisms  found 
in  cases  of  follicular  tonsillitis  for  the  patho- 
genic organism  of  diphtheria,  although  the 
naked-eye  appearance  of  the  cultures  were  not 
characteristic.  3.  That  as  some  observers  had 
described  non-malignant  organisms  similar  to 
the  diphtheria  bacillus,  in  case  of  doubt  plate- 
cultures  on  gelatin  should  be  made  as  control 
experiments. 

Milk.  Diet  inBright's  Disease. — Dr.  Ralfe 
gave  the  result  of  observations  as  to  the  effect 
of  milk  diet  on  the  secretion  of  urine,  as 
regards  its  quantity,  amount  of  solids,  and 
excretion  of  urea  and  albumen,  in  patients 
suffering  from  nephritis  in  its  different  stages, 
such  as  ordinary  acute  nephritis,  chronic 
nephritis  with  active  hypertrophy  of  the 
left  ventricle,  with  strong  pulse-tension  ; 
chronic  nephritis  with  failing  cardiac  action 
and  degenerated  vessels  ;  chronic  renal  cirr- 
hosis from  venous  congestion,  the  result  of 
valvular  disease  of  the  heart,  and  nephritis 
complicated  with  lardaceous  disease.  The 
patients  at  first  for  one  week  were  placed  on 
an  ordinary  diet  (containing  4  ounces — 124 
grammes — of  meat),  and  afterward  for  two  or 
three  weeks  kept  on  milk,  and  then  again  for 
a  week  resumed  the  ordinary  diet.  The  re- 
sults were  given  on  charts  showing  the  weekly 
averages  of  the  quantity  of  urine  passed,  the 
solids,  the  urea,  and  albumen.  With  regard  to 
acute  nephritis,  it  was  found  that  the  effect  of 
a  milk  diet  was  to  increase  the  quantity  of 
urine,  the  amount  of  solids,  and  the  urea,  and 
to  diminish  the  albumen,  all  of  which  was  re- 
versed when  a  more  stimulating  diet  was  re" 
sumed.  In  the  chronic  cases  the  milk  diet  had 
not  such  a  marked  diuretic  effect  on  the  amount 
of  urine  secreted,  but  caused  a  decided  fall  in 
the  quantity  of  solids  and  of  urea.  The  effect  on 
the  amount  of  albumen  was  varied.  In  nephri- 
tis associated  with  high  pulse-tension  it  was 
certainly  lessened,  but  in  nephritis  with  failing 
cardiac  action  and  degenerated  vessels  very 
little  change  occurred.  As  a  rule,  the  milk 
diet  was  well  borne  by  the  acute  cases,  and 
they  certainly  improved  under  its  use.  On  the 
other  hand,  the  chronic  cases  generally  dis- 
liked milk  from  the  first ;  they  did  not  improve 
under  it,  and  it  certainly  increased  the  uremic 
symptoms.  It  had,  however,  considerable  in- 
fluence on  reducing  the  tension  of  the  pulse, 
which  rose  again  on  the  resumption  of  a  diet 
containing  meat.  This  raising  of  the  pulse- 
tension  was  an  important  objection  to  the  use 
of  a  too  stimulating  diet  in  cases  in  which  there 
was  a  strongly-acting  vascular  system,  for  fear 
of  its  inducing  cerebal  haemorrhage,  a  risk  as 
great,  in  Dr.  Ralfe's  opinion,  as  of  inducing 
uraemia  by  too  low  a  diet.  The  exclusive 
use  of  milk   should  be  confined  to  acute  cases 


alone,  and  for  a  time  perhaps  to  chronic  cases, 
wlien  it  might  be  necessary  to  reduce  the  ac- 
tion of  the  vascular  system.  In  cases  with  a 
failing  heart  and  degenerated  vessels  a  more 
stimulating  diet  was  called  for  ;  its  effect 
should,  however,  be  carefully  watciied,  and  it 
should  only  be  given  in  small  quantities  at  a 
time. 

Dr.  Hale  ^^'hite  referred  to  a  series  of  obser- 
vations made  by  him  on  the  effects  of  milk 
diet  in  patients  suffering  from  chronic  nephri- 
tis. His  conclusions,  on  the  whole,  agreed 
with  those  of  Dr.  Ralfe.  The  milk  diet  in- 
creased slightly  the  amount  of  urine  excreted 
j  and  lessened  its  specific  gravity,  but  the 
I  amount  of  albumen  increased.  He  insisted  on 
I  the  fact  that  the  loss  of  albumen  in  chronic 
nephritis  was  trifling /^r  se,  and  he  added  that 
too  much  importance  was  attributed  to  the 
amount  of  albumen  present  in  the  urine.  He 
agreed  that  the  milk  diet  tended  to  increase 
the  risk  of  uraemia  when  this  was  threatening. 
No  hard  and  fast  rule  could  be  laid  down  as  to 
the  milk  diet  in  chronic  cases  of  nephriiis, 
and  rather  than  give  it  in  all  cases  he  would 
prefer  not  to  give  it  at  all. 

Dr.  Solomon  Smith  suggested  that  the  failure 
sometimes  observed  with  milk  might  be  due  to 
its  not  being  digested,  which  would  make  a 
milk  diet  a  form  of  slow  starvation. 

Dr.  Shuttleworth  had  observed  that  boiled 
milk  was  seldom  tolerated  for  long,  and  he 
asked  whether  the  effects  of  the  milk  of  other 
animals   was  the  same  as  that  of  cows'  milk. 

Dr.  Kelson  mentioned  that  the  addition  of 
eggs  to  the  milk  diet  in  one  series  had  deter- 
mined disastrous  symptoms,  and  two  of  the 
patients  had  died,  apparently  in  consequence 
of  the  change   of  diet. 

Dr.  Wethered  pointed  out  that  the  effect  of 
a  milk  diet  must  vary  according  to  the  pre- 
vious habits  of  the  patients,  and  he  asked  wlie- 
ther  any  difference  in  this  respect  had  been 
noted   between  hospital  and  private   patients.  ■ 

Dr.  Ralfe  pointed  out  that  what  these  pa- 
tients required  was  a  more  solid  but  not  a  sti- 
mulating diet.  He  regretted  that  Dr.  Hale 
White  should  have  made  use  of  the  term  "  full 
diet,"  which  was  apt  to  mislead.  The  average 
quantity  of  milk  was  four  pints  dai^y,  but 
more  was  given  if  asked  for.  It  was  taken 
plain  or  boiled  or  with  effervescing  water,  as 
elected  by  the  patient.  He  explained  the  mode 
in  which  his  analyses  were  made,  in  order  to 
avoid  various  sources  of  error  and  to  insure  an 
accurate  estimate  of  the  quantity  of  albumen. 

Dr.  Hale  White  asked  permission  to  explain 
that  by  "  full  diet  "  he  meant  what  was  known 
as  full  diet  in  hospitals — a  technical  expression 
with  a  definite  meaning — British  Mcdicai 
Journal^  March  24,  1S94. 


27^ 


THE  CANADA  MEt3ICAL  RECORt). 


NEW  YORK  ACADEMY  OF  MEDICINE. 

Bronchitis. — Dr.  A.  Reich  gave  an  inter- 
esting summary  of  the  morbid  anatomy  and 
symptoms  of  bronchitis  in  children.  Among 
the  latter  were  mentioned  dry,  hot,  pale  skin  ; 
dilated  nostrils;  breathing  of  thoracic  type; 
bulging  of  supra  clavicular  regions  ;  rapid  pulse 
and  respiration;  short  inspiration,  followed 
by  a  pause  before  commencement  of  expira- 
tion ;  expiration  accompanied  by  a  moan, 
caused  by  pleuritic  pain ;  expectoration  of 
whitish  or  yellowish  muco-pus,  usually  swal- 
lowed, someiimes  tinged  wiih  blood.  There 
might  be  diarrhoea.  As  long  as  the  inflam- 
mation was  limited  to  the  bronchial  tubes 
the  fremitus  was  normal,  but  if  a  large  part 
of  the  lung  were  involved  it  increased,  sub- 
crepitant  and  crepitant  rales  changing  location. 
The  signs  varied  according  to  the  extent  of 
complicating  broncho-pneumonia  when  this 
was  present.  In  the  same  lobe,  healthy, 
partially  involved,  and  completely  involved 
tissues,  distinguished  by  their  respective  signs, 
were  sometimes  observed.  The  children 
might  feel  well  the  first  part  of  the  day,  and 
gradually  become  distressed  in  the  afternoon 
and  night.  The  termination  was  usually  by 
lysis.  The  .child  might  grow  weaker,  the 
blood  being  less  and  less  oxygenated,  and 
convulsions  and  death  follow  ;  or  it  might 
gradually  recover  after  several  intervals  of 
improvement,  with  involvement  of  fresh 
parts.  For  a  long  time  after  subsidence  of  the 
inflammation  there  was  diminished  respiratory 
murmur  and  a  few  subcrepitant  rales. 

Dr,  Charles  G.  Kerley  described  a  treatment 
based  on  an  experience  with  several  hundred 
cases  seen  at  the  clinic  and  hospital,  where  he 
had  lived  practically  under  the  same  roof  with 
the  patients,  in  many  instances  attending 
personally  to  the  details.  The  room  should 
be  of  a  uniform  temperature,  from  70°  to  72° 
F.  (20°  to  22.2°  C),  the  air  completely 
changed  in  twelve  or  sixteen  hours,  while  the 
patient  occupies  another  room.  Comfortable, 
loose  clothing  should  be  worn,  and  the  belly- 
band  be  dispensed  with,  as  it  interferes  with 
respiration.  Clothing  should  never  be  damp. 
The  infant  should  not  be  held  on  the  lap,  nor 
long  on  the  back.  Daily  bathing  or  sponging 
with  lukewarm  salt  water  is  beneficial,  prefer- 
ably in  the  evening.  Dr.  Kerley  has  not  yet 
seen  harm  come  from  the  bath.  If  there  were 
many  sonorous  and  sibilant  rales,  with  difficult 
breathing,  hot  water  would  be  beneficial,  as  a 
bath  or  pack,  but  it  would  be  rarely  advisable 
to  apply  it  oftener  than  twice  a  day.  Where 
there  is  a  short,  teasing  cough,  a  spray  of  steam, 
simple  or  medicated,  used  fifteen  minutes 
every  hour  or  continuously  for  several  hours, 
according  to  the  case,  will  be  found  of  value, 
if  tolerated.     In  light   forms  of  bronchitis  em- 


brocations of  almost  any  form  could  be  used, 
however  mild,  but  in  severer  cases  something 
more  irritating  is  called  for.  Mustard  might 
be  left  on  one  to  three  minutes  ;  it  will  make 
the  child  cry  quite  vigorously,  which  in  some 
cases  is  desirable.  As  a  rule,  it  should  not  be 
employed  more  than  twice  a  d-iy. 

Dr.  Kerley  regarded  drug  treatment  as  of 
least  value.  If  he  saw  the  case  early  he  or- 
dered castor-oil.  Ipecac  and  tartar  emetic 
might  assist,  the  most  convenient  form  being 
in  tablet  triturate.  An  emetic  was  seldom  ne- 
cessary. Carbonate  of  ammonia  might  be  in- 
dicated. If  there  were  a  tendency  for  the  dis- 
ease to  become  chronic  in  delicate  children, 
cod  liver  oil  was  indicated.  A  stimulant  might 
be  required,  as  whisky  or  strophanthus.  The 
habit  of  giving  cough-medicines  was  bad,  as 
they  nauseated  the  child  and  interfered  with 
nutrition. 

Dr.  Henry  Koplik  stated  that  treatment 
should  vary  according  to  whether  it  were  a 
simple  acute  bronchitis  in  a  child  previously 
healthy  or  in  one  in  bad  nutritive  condition, 
as  in  rickets,  or  whether  the  disease  was  a 
complication  of  the  exanthemata  or  heart  dis- 
ease, or  a  recurring  bronchitis  reseriibling  asth- 
ma in  the  adult.  In  uncomplicated  bronchitis 
a  little  camphorated  tincture  of  opium  (4  min- 
ims— 0.26  gramme — every  two  or  three  hours 
for  a  child  under  6  years)  might  be  used  to 
allay  cough  ;  if  a  malarial  district,  some  quin- 
ine. He  had  not  found  the  cold  pack  ne- 
cessary, and  had  even  interdicted  the  bath  for 
a  time,  lest  the  child  take  cold.  Nor  was  acon- 
ite indispensable  to  him,  as  it  seemed  to  be  to 
some  other  physicians.  In  many  cases  he  had 
found  the  syrup  of  ipecac  useful,  combined 
with  the  opiate.  In  the  subacute  stage  the 
opiate  should  be  prohibited.  Small  doses  of 
strychnia  would  then  improve  the  appetite  and 
aid  the  heart.  Where  relief  had  not  been  ob- 
tained by  the  means  suggested,  the  speaker  was 
inclined  to  resort  to  the  balsams,  such  as  tere- 
bene.  Terebene  should  not  be  given  in 
larger  doses  than  j4  io  2  minims  (0.03  to  0.13 
gramme)  ;  if  it  were,  it  would  disturb  diges- 
tion. 

In  rachitic  patients  there  was  a  tendency  to 
relapse  or  a  subacute  condition,  and  treatment 
should  be  directed  to  the  main  condition. 
Cod  liver  oil,  phosphorus,  and  tepid  bran  baths, 
followed  by  rubbing,  were  of  benefit.  If  sy- 
philis was  suspected,  iodide  of  potassium, 
either  alone  or  with  cod  liver  oil,  or  iodide  of 
iron,  should  be  given  in  the  subacute  stage. 
Iodide  of  potassium  combined  with  digitalis 
or  strophanthus  wis  of  most  value  in 
chronic  bronchitis  with   emphysema. 

Dr.  W.  H.  Thomson  believed  nothing  to  be 
a  better  prophylactic  against  bronchitis,  espe- 
cially against  repeated  attacks,  than  a  dry  towel 
to    protect  the    nai)e  of  the  neck  at  night.     If 


THE  CANADA  MEDICAL  RECORD. 


m 


children  perspired  much  about  ihe  head  and 
neck,  salt-water  sponging  before  bed-time  was 
of  service.  When  the  cough  was  irritant  and 
it  was  necessary  to  increase  the  secretion  and 
allay  the  pain,  Dr.  Thomson's  favorite  pres- 
cription was  an  emulsion  of  linseed  oil  to  ex- 
cite the  secretions  and  an  anodyne  of  about  a 
thirtieth  of  a  grain  (0.02  gramme)  of  niorpl-.ine 
and  three  or  four  grains  (0.2  or  026  gramme 
of  chloral.  Where  tiiere  was  threatened  mus- 
cular exhaustion  from  mucus  collecting  about 
the  glottis  an  emetic  was  needed,  as  ipecac  or, 
if  necessary,  sulphate  of  copper.  Tlie  mucus 
should  be  removed  with  the  finger  after  vomit- 
ing had  ceased. 

Dr.  Baruch  used  tepid  baths  in  children  up 
to  5  years,  beginnint:  with  95°  F.  (35°  C.) 
and  reducing  to  80°  F.  (26.8°  C).  At  the 
afternoon  bath  the  mother  should  slap  the  body 
of  the  baby  with  the  hand  dijiped  in  warm 
water,  the  temperature  being  reduced  from  day 
to  day  until  60°  F.  (15.6°  C.)  were  reached. 
Water  should  then  be  dashed  on  with  the  hand, 
beginning  with  80°  F.  (26.7°  C),  and  after 
some    days    graduallv     reducing     to    60°    F. 

(15-6°  C). 

Dr.  J.  W^  Brannan  used  mustard  combined 
with  flaxseed  as  a  poultice  for  the  chest.  He 
also  feared  the  exposure  of  baths.  Half  drop 
or  drop  doses  of  aconite  were  of  value  where 
there  was  fever. 

Dr.  J.  Lewis  Smith  staled  that  no  remedy 
was  better  than  carbonate  of  ammonium  to 
promote  cough,  small  doses  being  used  to 
avoid  gastritis.  The  position  of  the  child 
should  be  frequently  changed  to  avoid  pneu- 
monia or  atelectasis.  Under  the  fourth  month 
he  used  muriate  of  ammonium  witii  syrup  of 
Tolu.  Half  a  grain  {0.03  gramme)  of  phen- 
acetin  may  be  used  to  reduce  temperature. 
Mustard  should  not  be  used  under  the  tenth 
month.  Instead  of  water  he  preferred  a  lin- 
seed and  mustard  poultice  on  the  chest. — 
Archives  of  Pediatrics.,  April,  1894. 


li:o(trc8S    of    §cicitcc 


TREATMENT  OF    TABES    DORSALIS. 

Max  Weiss,  of  Vienna,  describes  a  case  of 
advanced  tabes,  in  which  the  connection  be- 
tween that  disease  and  syphilis  was  very  clear, 
thus  lending  additional  support  to  the  Erb- 
Fournier  theory.  This  case  is  especially  note- 
worthy from  the  fact  that  a  regular  and  steady 
specific  treatment  markedly  and  rapidly  dimin- 
ished pronounced  objective  and  subjective 
tabetic  symptoms,  a  few  of  tliese  even  disappear- 
ing eutirely.  The  treatment  consisted  solely  of 
rather  large  daily  doses  of  iodide  of  sodium, 
increasing    from     5     to    8    grammes     {\\^xo 


2  drachms)  for  several  months.  The  patient  was 
an  engineer,  35  years  old,  who  had  never 
suffered  from  illness  during  childhood  ;  in  1883 
he  acquired  an  indurated  specific  ulcer,  with 
secondary  symptoms.  He  was  given  twenty 
injections  of  corrosive  sublimate  and  small 
doses  of  iodide  of  potassium  ;  in  July,  1884,  a 
lingual  ulcer  developed,  which  tmderwent 
complete  resolution  after  twenty-four  injections 
of  corrosive  sublimate.  Since  that  time  there 
had  been  no  specific  eruption  either  on  the 
body  or  the  visible  mucous  membrane.  In  1886 
several  attacks  of  nausea  and  vomiting  oc- 
curred, each  lasting  about  fourteen  days,  ac- 
companied by  severe  pain  in  the  back.  In  the 
autumn  of  1887  renewed  attacks  of  vomiting 
occurred  early  in  the  morning  (gastric  crises). 
From  1S89  there  were  almost  daily  attacks  of 
vomiting.  Nutrition  was  much  impaired  and 
the  body-weight  decreased.  He  suffered  from 
lancinating  pains  over  the  entire  surface  of  the 
skin,  more  particularly  on  the  arms  and  legs, 
most  frequent  after  a  change  of  weather.  In 
1890  co-ordinate  disturbances  of  standing  and 
walking  were  first  noticed,  with  paraisthesia  of 
the  toes,  soles  of  the  feet,  and  the  two  small  fin 
gers  of  each  hand,  diminished  tactile  sensibility 
in  the  epigastric  region,  and  fatigue  after  the  least 
attempt  at  walking.  Constipation,  cramp-like 
pains  in  the  abdomen  (intestinal  crises),  some 
retention  of  urine,  and  severe  boring  pains  in  tl.e 
urethral  canal  were  added  to  the  other  symp- 
toms. In  the  spring  of  1893  the  sight  was  poor 
at  a  distance  of  from  twenty  to  thirty  steps,  but 
there  was  no  trouble  in  reading  and  writing 
In  August,  1893,  the  patient  was  submitted  to 
a  systematic  iodine  treatment.  For  the  first 
two  weeks  he  took  daily  5  grammes  (134^ 
drachms)  of  diluted  iodide  of  sodium,  no 
symptoms  of  iodism  being  observed.  The  daily 
dose  was  increased  2  grammes  (31  grains),  and 
for  some  time  3  grammes  (46  grains).  Within 
a  month  the  daily  gastric  crises  ceased  suddenly, 
and  have  never  since  reappeared  ;  in  September, 
disturbances  of  co-ordination  diminished  per- 
ceptibly, and  in  October,  when  the  patient  was 
•  taking  8  grammes  (2  drachm  )  of  iodide  of  so- 
dium daily,  and  had  already  consumed  the  enor- 
mous quantity  of  50c  grammes  (i  pound)  in  all, 
without  any  untoward  symptoms,  no  evidences 
of  ataxia  were  present.  The  cloudiness  of  vision 
had  also  disappeared,  the  lancinating  pains 
occurred  but  seldom,  and  were  much  less  severe 
than  formerly.  The  patient,  even  after  walking 
several  hours,  did  not  feel  any  fatigue.  His 
appetite  has  greatly  increased,  and  his  weight 
has  increased  6  kilos  (r2  pounds).  Treatment 
is  still  being  continued  in  daily  doses  of  from  6 
to  8  grammes  (134  to  2  drachms),  with  short 
intermissions.  The  parfesthetic  symptoms  have 
almost  entirely  disappeared.  The  urethral  crises 
and  the  weakness  of  the  detrusors  persisted 
longest,  and  .systematic  crosF-galvanization    of 


280 


THE  CANADA   MEDICAL   RECOkD. 


ihe  lumbar  portion  of  the  spinal  cord,  in  the 
region  of  the  perineum  and  of  the  bladder,  were 
resorted  to,  with  internal  administration  of 
ergot  and  strychnine,  tlie  result  being  that  for 
three  weeks  before  the  time  of  report  the  patient 
no  longer  complained  of  urinary  disturbance 
or  of  pain  in  the  urethra.  Dr.  Weiss  regards 
the  great  improvement  as  due  entirely  to  the 
treatment.  The  absence  of  any  symptoms  of 
iodism  is  remarkable,  and  in  his  opinion  may  be 
due  to  the  purity  of  the  iodide  of  sodium 
employed.  The  absence  of  iodic  acid  from 
preparations  of  iodine  causes  them  to  be  better 
supported,  even  in  larger  doses,  and  continued 
for  months.  Should  it  be  impossible  to  admin- 
ister the  drug  by  the  mouth,  it  may  be  given 
by  the  rectum. 

Weiss  refers  to  a  case  of  genuine  syphilitic 
tabes,  treated  by  Werner  Stark  (^Duodcciin,  v. 
viii,  p.  280),  in  which  a  Hke  rapid  and  marked 
improvement  followed  the  administration  of  the 
iodide  of  potassium  in  large  daily  dose?.  The 
patient  was  a  woman,  aged  43,  who  had  become 
infected  by  syphilis  thirteen  years  previously, 
and  recovered  without  relapse.  Five  years  ago 
the  first  indications  of  tabes  appeared,  the 
symptoms  increasing  in  intensity  until  the 
patient  was  unable  to  walk.  No  disturbances 
of  the  digestive  or  urinary  organs  occurred. 
When  the  patient  was  first  seen  by  Stark,  in 
1890,  she  was  pale  and  thin ;  there  was 
complete  ataxia  of  the  legs,  analgesia  and 
partial  anaesthesia  of  the  skin,  as  well  as  weak- 
ness and  atrophy  of  the  muscles  of  the  legs;  the 
patellar  reflex  was  absent.  Psychic  and  ocular  * 
disturbances  were  not  present.  The  patient 
had  been  discharged  from  hospital  as  incurable. 
Stark  first  gave  50 grammes  {i)^  ounces)  in  400 
grammes  (13  ounces)  of  water,  a  tablespoon- 
ful  being  taken  three  times  daily.  After  some 
time  the  pains  became  less  severe.  The  dose  was 
then  increased  to  60  to  400  grammes  (i3^to  13 
ounces)  ;  after  three  months  to  75  to  400  gram- 
mes (3^  to  13  ounces)  ;  and  again  after  three 
months  to  100  to  400  grammes  (3^  to  13 
ounces),  4  tablespoonfuls  daily,  this  strong 
solution  being  taken  for  four  months.  After 
the  first  increase  of  the  dose  improvement 
soon  occurred,  so  that  the  patient  was  able  to 
do  a  little  light  work  ;  after  the  second 
increase  the  pains  disappeared  and  the 
ataxia  and  anaesthesia  decreased.  After  the 
last  increase,  when  the  patient  was  taking 
12  grammes  (3X  drachms)  of  the  iodide  of 
potassium  daily,  there  was  perceptible  improve- 
ment; the  anaesthesia  and  ataxia  disappeared 
and  the  muscular  atrophy  diminished ;  the 
patient  could  walk  quite  well  with  the  aid  of  a 
cane  or  support.  During  the  entire  time  she 
did  not  suffer  from  any  disturbances  of  the 
digestive  or  other  organs.  Sometimes  the 
treatment  was  continued  steadily  for  weeks,  and 
again  it  was  interrupted   at  intervals  ;    during 


these,  liowcver,  Stark  observed  that  improve- 
ment was  not  progressive,  and  that  there  was 
occasionally  a  tendency  to  relapse.  At  the 
time  of  writing,  the  patient  had,  for  a  year  only, 
occasionally  been  taking  the  iodide  of  potas- 
sium, feeling  stronger  after  each  treatment. — 
Ccntralblatt  fi/r  die  ^esammte  T/ierapie,  Feb- 
ruary, 1894. 

THE  SEVERER    FORMS  OF    SCARLET 
FEVER  AND    THEIR    ANTIPYRETIC 
TREATMENT. 

Between  September,  1888,  and  July,  1890, 
Dr.  John  H.  Caeslaw  had  under  his  care  at 
the  Belvidere  Hospital,  Glasgow,  630  cases  of 
scarlatina.  The  majority  of  these  were  of  the 
type  "  scarlatina  simplex,"  the  others  varied 
greatly  as  to  severity.  There  were  50  deaths  ; 
from  renal  complications,  17;  pulmonary, 
complications,  5  ;  laryngitis,  4  ;  pyaemia,  2  ;  car- 
diac disease  with  embolism,  i  ;  rheumatism, 
chorea,  etc.,  i  ;  tubercular  meningitis,  i ;  pur- 
pura haemorrhagica,  t;  post-scarlatinaF  diph- 
theria, I,  In  17  cases,  complications  such  as 
the  above  were  absent,  11  of  them  being 
characterized  by  the  severity  of  the  attack  upon 
the  throat  and  neighboring  paits,  and  6  by  the 
prominence  of  severe  nervous  phenomena.  In 
the  II  cases  of  "  scarlatina  anginosa,"  with  very 
bad  throats,  there  was  generally  discharge  from 
the  nose  ;  the  neck  was  always  swollen,  in  some 
instances  distinctly"  brawny";  the  rash  was 
sometimes  delayed  and  "  irregular,"  and  the 
patients  were  usually  restless,  sometimes  delir- 
ious;  in  4  of  the  11  cases  convulsions  occurred 
just  before  death,  and  in  another  there  was 
inversion  of  the  thumbs,  this  and  Cheyne-Stokes 
breathing  being  noticed  just  at  the  close.  The 
6  cases  with  nervous  phenomena  were  rather 
such  as  would  be  called  "  scarlatina  maligna." 
The  throats  were  not  badly  affected,  but  in  all 
there  was  an  unsatisfactory  eruption,  while  the 
persistent  vomiting  and  collapse  described  as 
of  nervous  origin  were  among  the  symptoms. 
The  age  of  these  latter  patients  was,  as  a  rule, 
much  higher  than  that  of  the  patients  suffering 
from  severe  throat  symptoms,  but  in  spite  of 
this  fact  death  occurred  sooner.  In  both  "  scar- 
latina angina"  and  "  scarlatina  maligna"  very 
high  temperatures  were  met  with,  and  in  both 
some  albuminuria,  which  was  regai-ded  as 
"febrile."  In  some  of  them  there  was  diarrha'a^ 
an  important  symptom  as  regards  the  prognosis . 
In  many  of  the  fatal  cases  the  motions  were  par- 
ticularly observed,  and  are  noted  as  loose^  green 
and  offensive^  with  an  appearance  suggestive  of 
cabbage  and  spinach  cho|)ped  up  and  mixed 
with  water;  sometimes,  of  course,  particles  of 
undigested  milk  were  distinguishable.  As 
regards  the  condition  of  the  intestine,  it  seems 
to  be  determined  that  in  severe  cases  of  scarlet 
fever,  especially  such  as  come  early  to   post- 


THE  CANADA  MEDICAL  RECORD. 


28, 


mortem,  the  bowel  is  in  an  easily-irritated  condi- 
tion, and,  whether  for  iliat  reason  or  not,  severe 
cases  are  Hable,  during  the  febrile  attack,  to  the 
diarrhoea  described.  The  inference  as  regards 
treatment  is  obvious ;  purgatives  should  be 
avoided  and  an  enema  used,  if  recjuired,  in  any 
case  whose  severity  suggests  that  such  a 
diarrhoea   may  supervene. 

The  "  expectant  "  plan  was  followed  in  the 
great  majority  of  the  casesof  scarlatina  simplex; 
the  only  active  interference  was  by  some  appli- 
cation to  the  throat  when  it  was  at  all  sore  or 
even  slightly  ulcerated.  In  these  simple  cases 
antipyretics  were  not  employed  ;  when  restless- 
ness was  troublesome,  sponging  with  tepid 
water  was  used.  Mustard  spongings  are  par- 
ticularly useful  in  the  earlier  stages  of  an  attack 
with  nervous  phenomena. 

In  the  cases  in  which  the  laryngeal  and  ner- 
vous symptoms  predominate,  special  attention 
should  be  directed  to  the  conditions  in  and 
around  the  throat,  and  antiseptics  used  locally. 
Bits  of  the  ordinary  urethral  bougies  of 
eucalyptus  and  iodoform  were  found  very  useful 
by  the  author  for  introduction  into  the  anterior 
nares.  Quinine  may  be  given  internally,  but 
not  in  heroic  doses,  and  tepid  sponging  will 
allay  restlessness  to  some  extent. 

In  considering  the  applicability  of  antipyretics 
in  scarlet  fever,  certain  features  of  the  disease 
must  be  borne  in  mind,  the  most  important 
being  the  tendency  to  collapse,  the  rash,  and 
the  renal  condition.  These  being  kept  in  view, 
the  means  at  command  for  the  reduction  of 
temperature  are  diaphoretics,  antipyretic  drugs, 
and  cold  and  tepid  water.  Diaphoretics  may 
be  useful  in  moderately  severe  cases,  but 
when  nervous  complications  are  present  may 
increase  the  tendency  to  collapse.  Pilocarpine 
should  be  used  only  in  very  small  doses.  All 
antipyretic  drugs  are  open  to  the  objection  that 
they  tend  to  depress,  and  must  be  used  with 
caution.  The  external  use  of  cold  should  either 
be  postponed  altogether  till  the  rash  is  mature, 
or  must  be  used  in  such  a  modified  form  as  to 
minimize  the  danger  of  superficial  anaemia  ; 
even  supposing  the  rash  to  be  developed,  the 
application  of  cold  must  neither  be  so  prolonged 
nor  so  intense  as  to  lead  to  the  premature 
disappearance  of  the  rash,  to  the  danger  of 
collapse,  or  to  serious  internal  congestion.  The 
author  approves  of  the  cold  wet-pack,  at  from 
50°  to  60°  F.  (10°  to  15.6°  C),  in  the  hyper- 
pyrexia of  nervous  attacks.  In  his  cases  the 
rectal  temperature  and  pulse  were  lowered, 
and  there  was  a  marked  improvement  in  con- 
dition of  the  nervous  system,  the  most  restless 
patients  going  to  sleep  in  the  pack.  Even 
though  the  temperature  rises  soon  again  and 
the  symptoms  return  in  all  their  violence,  a 
repetition  of  the  pack  is  again  followed  by 
favorable  results,  the  tendency  to  hyperpyrexia 
is   overcome,  and  the  patient  makes  a   good 


recovery.  The  possibility  of  collapse  must 
never  be  overlooked,  especially  in  "  malignant '' 
cases  ;  and  the  nurse  should  always  be  instructed 
that  if  the  patient  bee  )me  livid,  sick,  shivery, 
or  faint,  he  must  be  at  once  removed  from  the 
pack,  and  warm'Ji  and  stimalants  employed. 
Great  care  must  be  taken  to  prevent  chills. — 
Glasgotu  Medical  Journal,  January  and  Feb- 
ruary, 1894. 


RECENT  SUGGESTIONS  IN 
PEUTICS. 


THFRA- 


Insomnia. — In  a  case  of  delirium  tre.nens, 
bro  nide  of  potaisinm  and  chloral  sulphoiial 
and  morphia  failed  to  produce  sleep.  Clilo- 
robrom  was  tried,  in  dose  of  i^  ounces  (4') 
grammes).  The  patient  fell  asleep  in  half  an 
hour  and  slept  two  hours,  when  i  tablespoon- 
ful  more  was  given,  causing  a  sleep  of  five 
hours.     (R.  B.  Lothian,  Lancet,  December  9, 

1893-)  .  ^       ^ 

Try  nature's  pUn,  instead  of  drugs  :  lower  the 
supply  of  oxyzen  to  the  blood  ;  produce  a  little 
asphyxia  ;  limit  the  quantity  of  air  to  the  lungs. 
The  heart  and  circulation  becoming  quicker, 
the  brain  will  lose  its  stimulant,  and  sleep  will 
follow.  Cover  your  head  with  the  bedclodies, 
and  breathe  and  rebreathe  only  the  respired 
air.  When  drowsiness  is  produced,  it  is  easy 
to  go  on  sleeping,  though  you  push  aside  the 
coverings  and  get  as  much  fresh  air  as  needed. 
The  cat  and  dog  bury  their  noses  in  some  soft 
hollow  in  taeir  hair  or  fur,  and  soon  drop  asleep. 
(J.  E.  Huxley,  Medical  Press  and  Circular, 
December  13,  1893.) 

Maligvaxt  Pustule. — Excision  of  entire 
pustule,  with  marginal  tissues.  Wound  dressed 
with  paste  made  of  ipecacuanha  and  water  and 
double  cyanide  gauze.  Internally,  5  grains 
(0.32  gramme)  of  ipecacuanha  with  1-6  grain 
(o.oi  gramme)  niorphia  every  four  hours  for 
five  days,  and  every  six  hours  on  sixth  day. 
Discontinued  internally  and  externally  on 
seventh  day.  Patient  dismissed  cured  on 
twenty-ninth  day.  (W.  H.  Moore,  Lancet, 
November  25,  1893.) 

Peritonitis. — Instead  of  opening  the  ab- 
domen in  tubercular  peritonitis  and  exposing 
the  peritoneum  to  the  atmosphere,  air  is  intro- 
duced into  the  cavity  by  means  of  an  insuffl  it- 
ing  apparatus,  which  first  sterilizes  the  air.  In 
three  cases  the  desired  result  of  preventing  re- 
currence of  ascites  was  obtained.  The  method 
is  regarded  as  safe  and  the  results  favorable. 
/NoLEN,  Berliner  klinische  Wochenschrift,  No. 
34.  1893.) 

Pertussis. — Bromofomi,  i  drop  for  eac 
year  of  age  of  patient,  four  times  daily,  for  first 
three  days,  increasing  dose  progressively  if  at- 
tacks do  not  diminish.  Vomiting  ceases,  ap- 
petite returns,  and  disease  lasts  but  three  weeks, 
sometimes  much  less.  (Pellicer,  Revista  ba- 
lear  de  cicncias  medic as^.  590,  1893.) 


282 


THE   CANADA   MEDICAL   RECORD. 


Phulixah. — An  oleaginous  substance  ob- 
tained from  a  wild  East  Indian  plant.  About 
the  size  of  an  areca-nut.  Melts  on  exposure  to 
heat ;  and  if  kept  for  some  time. in  liquid  form 
becomes  dirty-brown  in  color.  Largely  used 
by  the  hill-tribes  for  the  cure  of  frost-bite  and 
chilblains.  Topical  use  very  beneficial  in 
rheumatism,  sprains,  sciatica,  producing  an 
effect  when  other  remedies  were  useless.  (E. 
C.  Beddell,  Indian  Medical  Recoj'd,  Novem- 
ber i6,  1893.) 

POST-PARTUM       H.EMORRHAGE. — To       arrest 

haemorrhage,  pass  right  hand  boldly  up  to  pla- 
cental site,  readily  discovered  by  sense  of  feel- 
ing ;  make  a  few  sweeps  with  back  of  hand 
over  bleeding  sinuses,  at  the  same  time  induc- 
ing ^counter-pressure  with  left  hand.  Hold 
parts  with  double  grasp  until  right  hand  is  ex- 
pelled by  powerful  uterine  contraction.  (T. 
Shaw,  Medical A^^e,  December  11,  1893.) 

Rectal  Cancer. — Case  in  which,  two  in- 
ches above  anal  aperture,  upon  anterior  wall  of 
rectum,  there  was  irregular  oval  mass  of  infil- 
trated tissue,  one  inch  or  more  in  diameter 
when  first  seen,  but  invading  entire  circumfer- 
ence of  rectum  within  a  few  months.  Incision 
made  posteriorly,  one  inch  from  anal  outlet, 
carried  up  on  median  line  above  sacrum. 
Coccyx  andtwo-fifths  of  sacrum  removed,  allow- 
ing room  to  dissect  rectum  from  its  attachment, 
dividing  posteriorly  the  meso-rectum  and  enter- 
ing at  once  into  peritoneal  cavity.  Sufiicient 
length  of  bowel  was  thus  brought  down  for 
easy  manipulation.  Rectum  divided  two  in- 
ches above  anus,  constricting  diseased  portion 
split  open  upon  posterior  borders,  and  rectum 
divided  above  growth,  four  inches  being  re- 
moved. Murphy's  anastomosis  button,  larger 
size,  adjusted  in  divided  extremities  of  bowel, 
and  compressed  muscular  coat  being  hyper- 
trophied  in  upper  portion,  parts  re-inforced 
with  continuous  suture.  Opening  into  peri- 
tonemn  of  pelvic  floor  closed  with  same,  to 
prevent  prolapse  of  small  intestine,  and  possible 
subsequent  infection  of  peritoneal  cavity.  Pos- 
terior wall  of  bowel  re-attached  to  divided 
tissues,  and  large  portion  of  wound  closed  by 
several  lines  of  buried  sutures,  Iodoform  gauze 
drain.  Patient  discharged  from  hospital  on 
twentieth  day  after  operation,  button  having 
been  removed  on  twelfth  day.  (H.  O.  Marcy, 
Boston  Medical  and  Surgical  Journal,  De- 
cember 7,  1893.) 

THERAPEUTIC  BRIEFS.^^ 

— In  the  Berliner  klinische  Wochenschrift 
(cited  in  the  Centralblatt  fiir  Klinische  Medi- 
cin)  Dr.  P.  Furbinger  treats  of  the  peanut  as 
an  article  of  food  rich  iu  albumin,  of  which  it 
contains  forty-seven  per  cent.,  together  with 
nineteen  per  cent,  of  fat  and  non-nitrogenous 
extractive   matters.     He  recommends  the  use 

^  From  College  and  Clinical  Record, 


of  roasted  peanuts  in  the  form  of  soup  or 
mush.  On  account  of  their  cheapness,  pea- 
nuts are  recommended  as  a  popular  article  of 
food,  especially  in  poorhouses  and  the  like  ; 
moreover,  they  are  recommended  as  an  article 
of  food  for  the  corpulent,  for  diabetes,  and  for 
the  subjects  of  kidney  disease,  in  the  last  men- 
tioned of  whom  foods  rich  in  animal  albumin 
are  to  be  avoided. 

— Hemorrhage  is  a  very  common  accom- 
paniment of  malignant  disease  of  the  tonsils. 
A  solution  of  anlipyrine,  i  part  to  50,  may  be 
used  as  a  h?emostatic.  Should  such  treatment 
not  succeed,  then  ligation  of  the  base  of  the 
tumor,  either  by  one  ligature  or  by  several, 
may  be  resorted  to,  or  cauterization  by  the 
thermo  or  galvano-cauteiy.  In  the  event  of 
none  of  these  means  succeeding,  ligation  of  the 
lingual  and  facial  arteries  may  be  required,  or 
as  a  dernier  rcssort,  the  carotid  may  be  tied. — 
(Newman  in  New  York  Medical  Record?) 

— Casselberry,  N.  Y.  Med.  Journal,  recom- 
mends the  following  combination  as  a  soothing 
spray  in  Acute  Inflammation  of  the  Larynx 
AND  Trachea : 

R.     01.  pini  canadensis,  y^  v 

01.  gaullherise,  njj  ij 

01.  eucalypti,  »t^  ij 

Menthol,  gr.  j 

Benzoinol,  ^  ij 

Vaseline  oil  q.  s.  ad  5  j.      M. 

SiG. — To  be  used  with  a  double  bulb  atomizer. 
— Professor    Germain   See  recommends  the 
following    simple    but   satisfactory  Purgative 
Powder: — 

IJ.     Sulphur,  sublimat., 
Potassii  bitart., 
Magnesise  calcinat., 
Essent.  anisi, 
SiG. — A  teaspoon ful  in  a  little  water  before 
dinner  "and  supper. 

— The  following  treatment  is  recommended 
in  the  Revista  de  Ciencias  Mcdicas  de  Barce- 
lona {^Cinn.  lancet- Clinic')  for  Alopecia 
areata  of  parasitic  origin: — Wash  the  head 
with  a  solution  of  creolin  (3  :  looo),  and  apply 
to  the  affected  spots  once  01  twice  a  day  for 
five  minutes,  green  soap  and  then  a  salve  of 
lanolin  and  sublimate,  15  :  100.  When  it  is  of 
neurotic  origin  he  employs  pure  carbolic  acid, 
which,  after  the  consequent  inflammation  has 
passed  away,  may  be  repeated.  The  effect  is 
certain,  though  painful. 

— In  the  Med.  Neuigkeilcn  (^Cinn.  Lancet- 
Clinic)  the  following  treatment  of  Gonorrheal 
Vulvovaginitis  is  praised.  In  the  acute  stage 
a  bath  is  taken  daily,  every  four  hours  the  vulva 
is  washed  with  a  solution  of  sublimate  (5  :  1000), 
and  all  irritant  foods  and  beverages  are  to  be 
avoided.  In  the  subacute  and  chronic  stages 
two  injections  daily  of  a  solution  of  sublimate, 
four  grains,  and  one  gramme  (15  grs.)  of  tar- 
1  taric  acid  per  thousand,  using  two  quarts  of  this 


aa  grammes  xxx 
gramme  i.      M. 


THE  CANADA  MEDICAL  RECORD. 


283 


solution  al  each  injcclion.  At  the  same  time, 
two  or  three  times  a  week,  a  tampon  impreg- 
nated with  equal  parts  of  alum,  tannin  rnd 
salol  should  be  introduced,  and  every  evening 
a  vaghial  suppository  containing  four  grammes 
(,^j)  of  tannin  or  iodoform,  one-half  a  gramme 
{jJ4  grs.)  of  glycerine  and  cacao  butter. 

■ — The  writer  concludes,  after  two  operations 
of  Symphyseotomy  and  some  investigations  on 
the  cadaver,  that  not  more  than  two  centime- 
tres separation  of  the  pubic  joint  follows  sim- 
ple division  of  the  articulation,  while  by  section 
of  the  ligamentum  arcuatum  inferius  the  joint 
will  separate  to  the  extent  of  5  to  6  ctm. — 
(DoDERLEiN,  in  Afed.  Record.^ 

—  A  mixture  of  chloroform  Cten  parts),  ether 
(fifteen  parts)  and  menthol  (one  part),  used  as 
a  spray,  is  recommended  as  an  excellent  and 
prompt  means  for  obtaining  Local  Anaes- 
thesia lasting  about  five  minutes. — (^Boston 
Med.  and  Surg.  Journal.) 

— Hayem*  gives    the  following   prescription 
for  the  relief  of  Acute  Coryza  : 
]j.     Acid,  carbolic, 

Aquas  ammonias,  afi  3  ijss 

Alcohol,  5  V 

Aquce  destil,  5J.    M. 

*J?ev.  de  Laryitgol.^  d'Otol.  et  de  K/iiiioL,  in  Boston  Med. 
and  Surg.  Jourual. 

SiG. — Inhale  from  several  drops  upon  a  piece 
of  bibulous  paper. 

— Lotion  for  Pruritus  Vulva::  (^Practi- 
tioner) : 

Ij,     Hydrargyri  perchlorid.,         gf.  j. 
Aluminis,  gr.  xx 

Pulv.  amyli,  3  jss 

Aquee  menthai  pip.  q.  s.ad    3  vj. 
M.  et  fiat  lotio. 

SiG. — Apply  externally  to  the  affected  parts. 
— Dr.  Carasso  Micliele,  Director  of  tlie  Mili- 
tary Hospital  at  Genoa,  has  used  since  188S,  in 
the  treatment  of  pulmonary  tuberculosis,  con- 
stant Inhalations  of  Oil  of  Peppermint 
(^Boston  Med.  and  Surg.  Journal,  Jan.  nth, 
1894).  He  combines  the  inhalation  with  the 
internal  administration  of  an  alcoholic  solution 
of  creosote,  glycerine  and  chloroform,  to  which 
is  added  oleum  menthas  piperita,  i  :  100. 
His  results  are  reported  as  remarkable.  Not 
only  were  incipient  cases  cured,  but  advanced 
cases  also,  some  thirty-nine  in  all,  with  cavity- 
formation  and  abundant  bacilli  in  the  sputum. 
All  the  cases  treated  were  of  pulmonary  dis- 
eases only,  without  tubercular  affection  else- 
where. 

Epithelioma  of  superficial  variety  may  be 
treated  with  alternate  applications  of  ten  per 
cent,  methyl-blue  and  twenty  per  cent,  chromic 
acid. — (Darier,  m  Med.  Record.') 

— The  heart  cannot  be  weakened  under 
Chloroform  except  by  interference  with  the 
breathing.  It  is  useless  and  dangerous  to  take 
the    pulse  as  a  guide.     Watch  the  respiration. 


Safety  is  insured  only  by  regular  natural  breath 
ing. — (Lawrie,  in  Med.  Record.) 

— Indications  for  Cholecvstotemy  are 
frequently  recurring  biliary  colic  without  jaun- 
dice, where  medical  treatment  has  failed.  Per- 
sistent jaundice  where  the  onset  is  ushered  in 
with  pain,  and  where  recurring  pains,  with  or 
without  ague-like  attacks,  render  it  probable 
that  the  cause  is  gall  stones  in  the  common 
duct.  Distended  gall-bladder  from  impaction 
of  calculi  in  the  ducts.  Empyema  of  the  gall- 
bladder. Persistent  jaundice  with  enlargement 
of  the  gall-bladder  dependent  on  some  obstruc- 
tion in  the  common  duct,  even  where  the  cause 
cannot  be  clearly  made  out. — (Robson,  in  Med. 
Record.) 

— Supra-Sphincteric  Ulcers  of  the  Rec- 
tum require  the  galvano-cauterv  under  anaes- 
thesia and  with  the  aid  of  spsculum.  Boric 
acid  lotions  and  iodoform  tampons  may  be  used 
in  the  after-treatment,  and  antiseptics,  such  as 
naphthol,  administered  internally. — (Quenn  in 
Med.  Record.) 

— For  Rosacea,  Petrinio  in  Medical  Re- 
cord: 

B.     Ichthyol,  2  parts 

Resorcin,  i  part 

Collodii.  flexil,  30  parts. 

— Dr.  Liveing  {Milnchener  Med.  Wochtn- 
schri/t,  in  Cinn.  Lancet-Clinic,  Jan.  13,  1894) 
recommends  in  Itching  of  the  Anus  from 
Pin  Worms  the  following  salve,  to  be  rubbed  in 
every  evening : 

^.     Mercurial  oint.,  equal  parts. 

Vaseline, 
For  the  same  affection  the  following  formula 
is  also  of  service: 

Calomel,  gms.  3 

(grs.  xlv). 

A^aseline,  gms.  30 

(grs.    3J)- 
('ocaine,  i  part 

Bismuth  subnitrate,  2  parts 

Lanoline,  20  parts 

— In  Cancer  of  the  Uterus  total  extirpa- 
tion is  destined  to  be  the  operation  whether  the 
'  disease  is  cervical  or  corporeal,  and  if  done  in 
time  will  permanently  cure  a  certain  portion  of 
cases.  If  any  tissues  adjacent  to  the  uterus  are 
already  involved,  it  should  not  be  attempted. — 
(Lewis  in  Med.  Record). 

— Dr.  Y'xich  [Charlotte  Medical  Journal)  re- 
commends the  following  in  Summer  Com- 
plaint : 

B.     Acid,  hydrochloric,  dilut.,   »^xvj 
Pepsin,  pur.,  3s 

Bismuth,  subnitrat.,  3  ij 

Syrup.,  f^ij 

Aquce  destillat.,  fsij.         M. 

SiG. — Shake  the  bottle,  and  give  a  teaspoon- 
ful  before  each  feeding  or  nursing  to  an  infant 
one  year  old,  half  the  dose  to  an  infant  six 
months.      : 

This    mixture    must  be   made   fresh    every 


284 


THE  CANADA  MEDICAL  RECORD. 


second  day  and  kept  in  a  cool  place,  as  it  is 
prone  to  fermentation  and  would  therefore  be 
unfit  to  use. 

— To  Allay  Itching  in  Skin  Diseases 
(Dr.  A.  T.  Thompson,  Medical  and  Surgical 
Reporter')  : 

^.     Plumbi  acetatis,  gr.  xvj 

A-cid.  hydrocyanic.dilut.,  f  3jss 
Spirit,  rectificat.,  f^iv 

Aquce  destillat.,  fsvijss         M. 

SiG. — Use  as  a  wash. 

— In  Tubercular  Ostitis  of  the  Knee  in 
Children  (White  Swelling),  it  has  long  since 
been  established  that  the  growth  of  bone  is 
seriously  interfered  with  by  excision,  and  sur- 
geons, as  a  rule,  avoid  operating  on  the  knee- 
joint.  The  cases  that  I  have  presented  lend 
additional  weight  to  the  argument  against  the 
operation.  The  appearance  of  sinuses,  the 
infiltration  and  distortion  of  the  limb,  seem  to 
demoralize  the  surgeon  at  times,  and  he  feels 
that  only  an  incision  will  save  life. — (Gibney  in 
Med.  Record.) 

— We  quote  the  following  items  from  the 
Medical  Record 'l^.wwa.xy  13,  1894: 

Dr.  Bernheim  (Deutsch  Med.  JVochenschrift) 
recommends  in  the  Dyspncea  of  Acute  Phthi- 
sis the  following  formula  : 

9.     Caffein.  citrat.,  2  gms.  (grs.  xxx.) 

^ther.  sulphuric,       20  gms.  (  3  v.) 
Inject  two  grains  (3ogtt.)  morning  and  even- 
ing. 

In  Sciatica  and  other  Neuralgias  : 
5.     Tinct.  aconiti, 

Tinct.  colch.  seminis, 
Tinct.  belladonnae, 

Tinct.  acteee  racemosse.  aa  partes  sequales 
SiG. — Six  drops  every  six  hours. — (Metcalf.) 
Theobromin  (gr.  45  to    75    daily  for   three 
days)  gave  good  results  in  grave  cases  of  Car- 
diac Dropsy. — (Germain  See.) 

Strophanthus  is  much  more  rapid  in  its  ac- 
tion than  digitalis,  but  is  not  suitable  for  pro- 
longed use.  In  one  case,  in  which  during  three 
or  four  days  its  good  effect  was  conspicuous, 
the  heart,  under  its  prolonged  use,  became  ex- 
tremely frequent  and  the  sense  of  cardiac  dis- 
tress extreme;  and  yet,  when  its  employment 
was  entirely  given  up  for  a  week,  it  proved  as 
rapidly  and  as  distinctly  useful  as  before. — 
(Little.) 

In  Toothache  {Joiinial  de  Fharmacie)  : 
5.     Dry  alcoholic  extract  opium, 
Camphor,  aa     0.50 

Balsam  Peru, 

Mastic,  aa     i.o 

Chloroform,  lo.o 

Introduced  into  the  cavity,  it  calms  the  pain 
at  once. 

Acetate  of  Aluminium  is,  next  to  carbolic 
and  salicylic  acid,  the  disinfectant  which  pre- 
vents, for  the  longest  time,  tlie  development  of 
micrococci  and  produces  no  irritation. — (Frai- 
pont.) 


Caffein,  I  think,  deserves  to  rank  next  as  a 
cardiac  tonic.  I  have,  in  a  few  cases,  got  un- 
doubted help  from  it.  They  were  all  old  cases 
in  which  digitalis  and  strophanthus  had  ceased 
to  benefit;  they  were  all  aged  persons;  they 
were  all  short  of  breath  and  dropsical,  and  pre- 
sented the  signs  of  dilatation  with  degeneration 
of  the  ventricular  walls. — (Little.) 
Locally  for  Joint  Rheumatism  : 
5.     Acid,  salicylic,  ojss 

Alcohol,  absolut.,  fgj 

Olei  ricini,  f  3  ij. 

Apply  by  compress  covered  with  impermeable 
tissue. — (Ruel). 

Camphor  solution  for  Hypodermic  Injec- 
tion : 

5.     Camphor,  2.0 

Iviquid  paraffine,  8.0 

A  one-gramme  syringe  will  contain  twenty  cen- 
tigrammes of  camphor. — (Bosner.) 

Chloride  of  Gold  and  Sodium  in  pills  or 
granules,  given  in  doses  from  two  milligrammes 
to  three  centigrammes,  improved  the  general 
condition  of  paralytics  in  the  first  and  second 
periods. — (Boubila.) 

The  majority  of  so-called  recoveries  from 
Appendicitis  treated  medically  are  not  re- 
coveries in  the  full  sense  of  the  word,  but  sim- 
ply a  respite  which  enables  one  to  settle  worldly 
affairs  and  take  out  a  life-insurance  policy  in 
anticipation  of  a  fatal  termination. — (Sanborn.) 
Piperazine  is  perfectly  harmless.  In  birds, 
deposits  of  urates  can  almost  with  certainty  be 
produced  by  neutral  chromate  of  potash.  In 
the  majority  of  cases  piperazine  prevents  the 
deposition  of  urates  produced  by  the  chromate, 
while  lithium  carbonate,  borax,  and  sodium 
phosphate  are  powerless  to  prevent  it.  These 
experiments  confirm  the  results  of  treatment  of 
the  uric-acid  diathesis  by  piperazine. — (Birsen- 
thal.) 

Epilatory  Liquid  : — 
5.     Pure  iodine,  gr.  xij 

Essence  of  turpentine,      11K  xx 
Castor  oil.  f  5  ss 

Alcohol,  f  3  ijss 

Collodion,  f.^j.  M. 

SiG. — Apply  once  daily  for  three  or  four  days  ; 
when  the  collodion  comes  away,  a  clean  surface 
will  be  left. 

In  Asthma  a  capsule  containing  two  grains 
of  phenacetine,  one  of  quinine,  three  of  muriate 
of  ammonia,  one-eighth  of  capsicum,  and  one 
twenty  fourth  of  strychnine,   given  four    times 
daily,  will   often  relieve  an  attack  of   this  dis- 
tressing malady. — (Mays.) 
For  Emphysema  : — 
I?.     Essence  of  turpentine,     4-ij  gms. 
Peppermint  water,  120  gms. 

Sugar, 

Pulv.  gum  acacia,     aa     4  gms.      M. 
SiG. — Dessertspoonful   every   two    or    three 
hours. —  College  and   Clinical  Record. 


THE   CANADA   MEDICAL   RECORD. 


285 


THE  CANADA  MEDICAL  RECORD 

rL'BLIdllEU   MuMIII.V. 


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Copies,  20  cts. 

EDITORS : 

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London 
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ASSISTANT  EDITOR 
HOLLO  CAMPBELL.  CM.,   M.D. 

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MONTREAL,  SEPTEMBER,  1894. 

THE  CANADA  MEDICAL  ASSOCI- 
ATION. 

We  have  much  pleasure  in  calling  our 
readers'  attention  to  the  very  full  report  of 
the  meeting  just  held  at  St.  John,  New 
Brunswick,  which  will  be  found  in  another 
part  of  this  issue.  The  meeting  was  ad- 
mitted by  all  who  were  present  to  have  been 
the  most  successful  in  the  history  of  the 
Association.  On  one  occasion  only  was  the 
attendance  larger,  but  at  that  meeting 
there  was  not  the  enthusiasm  and  sustained 
interest  which  was  noticeable  at  St.  John. 

The  sessions  began  promptly  on  time,  the 
business  was  quickly  disposed  of,  and  one 
paper  after  the  other  was  rapidly  called 
for,  read  and  discussed.  The  hospitality 
ofthc  profession  of  St.  John  was  unbound- 
ed ;  besides  numerous  private  entertain- 
ments, there  was  a  large  public  ball  given, 
instead  of  a  banquet,  which  gave  an  oppor. 
tunity  to  the  younger  members  of  the 
Association  to  demonstrate  their  efficiency 
in  the  terpsichorean  art. 

Many  of  the  older  members  were  the 
guests  of  different  medical  men  in  the  city, 
while  the  hotels  took  good  care  of  the  others, 
although  the  city  at  the  time  was  unusually 
full  of  tourists.  The  sessions  were  especially 


well  attended,  the  hall  in  which  they  were 
held  being  nearly  all  the  time  crowded 
with  listeners.  It  was  not  until  nearly 
eleven  p.m.  of  the  second  day  that  the 
last  paper  was  read  and  discussed.  A  great 
deal  of  the  success  of  the  meeting  was  due 
to  the  untiring  efforts  of  the  Secretary,  Dr. 
Starr  of  Toronto,  who  not  only  secured  a 
good  programme  of  papers  and  addresses, 
but  also  a  good  attendance  of  listeners.  The 
President,  Dr.  Harrison  of  Selkirk,  commu- 
nicated with  the  Medical  Associations  of 
New  Brunswick,  Nova  Scotia  and  Prince 
Edward  Island,  as  well  as  Avith  the  Maritime 
Province  Medical  Association,  and  readily 
obtained  their  consent  to  amalgamate 
with  the  Canada  Medical  for  this  year, 
thus  ensuring  a  large  attendance  of  the 
local    members. 

The  Railway  Companies  gave  reduced 
fares,  for  which  they  received  a  vote  of 
thanks  ;  but  the  reduction  to  the  Medical 
delegates  was  nothing  like  so  great  as  that 
open  to  an}-one  or  every  one  a  ^e\v  weeks 
earlier  and  a  few  weeks  later,  when,  instead 
of  fifteen  dollars,  they  issued  excursion 
tickets  for  just  half  that  amount.  There  were 
many  who  thought  that  they  might  have 
extended  their  popular  excursion  rate  to 
the  Medical  delegates.  The  election  of 
Dr.  William  Bayard  of  St.  John  to  the 
presidency  gave  general  satisfaction  ;  al- 
though over  eighty-one  years  of  age,  he  is 
hale  and  hearty  and  attends  a  large  prac- 
tice— often  at  night  —  with  an  alacrity 
Mhich  would  put  many  a  younger  man  to 
shame.  Dr.  Bayard  has  been  the  leader 
of  the  profession  of  New  Brunswick  for  the 
last  forty  years,  and  it  will  be  no  small 
honor  for  the  Canadian  INIedical  Asso- 
ciation to  point  to  its  octogenarian  presi- 
dent next  year,  at  Kingston,  as  an  exam- 
ple of  what  the  air  and  food  and  habits  of 
New  Brunswick  will  do  in  prolonging  life. 
We  trust  that  every  member  of  the  profes- 
sion will  put  it  down  as  an  engagement  to 
attend  the  next  meeting  of  this  our 
national  Association. 


286 


THE  CANADA   MEDICAL   RECORD. 


THE  UNIVERSITY  OF  CANADA. 

During  the  recent  meeting  of  the  Canada 
Medical  Association  at  St.  John,  the  topic 
which  excited  the  most  interesting  discussion 
was  that  of  reciprocity  in  medical  practice. 
Not  that  the  subject  is  by  any  means  a  new 
one — on  the  contrary,  it  has  been  discussed  at 
every  meeting  for  several  years  past,  but  al- 
ways with  ihe  same  result ;  a  committee  has 
been  appointed,  which  has  practically  done 
nothing.  As  the  matter  stands  at  present,  the 
province  of  Ontario  has  a  Medical  examining 
board,  before  which  eveiy  one  must  pass  in 
order  to  obtain  a  licence  to  practise  ;  no  matter 
whether  he  be  the  gold  medallist  from  the  best 
University  or  the  last  man  in  the  pass-list  of  the 
weakest  medical  school,  he  must  pass  an  ex- 
amination before  examiners  who  are  not  pro- 
fessors of  that  subject  in  the  province.  This  is 
a  single  portal  for  all  who  wish  to  enter.  This 
system  has  its  hardships,  but,  on  the  whole,  it  is 
the  best  possible  one  under  the  circumstances. 
It  does  not,  however,  please  either  the  Medical 
Schools  of  that  province  nor  of  the  other  pro- 
vinces,who  would  prefer  to  see  no  barrier  thrown 
in  the  way  of  the  great  army  of  young  men  which 
they  annually  turn  out.  The  Medical  Council 
of  each  province  represents  the  general  profes- 
sion and  not  the  Medical  Schools,  the  interests 
of  each  not  exactly  coinciding,  for  the  ranks  of 
the  profession  are  comfortably  full,  having  al- 
ready reached  the  one  to  a  thousand  of  popu- 
lation limit,  and  any  great  increase  in  the  num- 
bers of  practitioners  over  and  above  those  neces- 
sary to  fill  vacancies  caused  by  death  or  to 
attend  the  increased  population  would  lead  to 
an  unnecessarily  hard  struggle  for  existence. 
The  province  of  Ontario  is  the  richest  province 
of  the  Dominion,  and  it  is  to  it  that  the  gradu 
ates  of  the  schools  of  the  other  provinces  natur- 
ally direct  their  footsteps  ;  and  were  it  not  for 
the  very  high  standards,  both  preliminary  and 
professional,  which  it  has  set  up  against  them, 
it  would  soon  be  over-run. 

It  is  therefore  useless  for  the  Canada  Medi. 
cal  Association  or  any  other  body  to  attempt 
to  arrange  reciprocity,  the  condition  of  which 
would  be  the  lowering  of  Ontarios  high  standard^ 
while  without  this  condition  reciprocity  prac- 
tically exists.  Even  the  little  province  of  Bri- 
tish Columbia  away  out  on  the  Pacific  Coast 


declines  to  be  flooded  with  the  overflow  from 
the  East,  and  it  too  has  a  Medical  Council  to 
protect  its  physicians  in  the  peaceful  practice  of 
their  profession.  Then  again  thel"e  is  the  ques- 
tion of  reciprocity  with  Great  Britain  which  is 
constantly  looming  up.  At  present  the  gradu- 
ates of  Canadian  Medical  Schools  cannot  ob- 
tain a  licence  to  practise  in  the  Mother  Country 
which  replies  to  their  demand  for  reciprocity 
by  saying :  We  cannot  recognize  your  diplomas 
when  you  do  not  recognize  them  among  your- 
selves. 

We  have  always  opposed  reciprocity  either 
between  the  provinces  or  between  this  country, 
and  Great  Britain,  for  the  reason  hat  it  is  not 
for  the  best  interests  of  the  prolession  of  Can- 
ada that  it  should  be  exposed  to  the  danger  of 
overcrowding,  which  would  almost  surely  fol- 
low the  throwing  down  of  the  barriers  which  at 
present  exist.  For  it  must  be  evident  to  any- 
one that  if  fifty  doctors  in  British  Columbia  for 
instance  are  at  present  barely  making  a  com- 
fortable living  by  hard  work,  those  same 
fifty  would  have  their  earnings  reduced  by  half 
if  another  fifty  doctors  were  admitted  without 
a  corresponding  increase  in  population.  In  our 
opinion,  it  is  more  just  and  reasonable  that 
each  country  and  each  province  should  decide 
for  itself  how  good  or  how  bad  a  doctor  it  will 
receive,  or,  in  other  words,  how  many  physicians 
the  population  can  support.  If  any  Canadian 
desires  to  practise  in  England  or  France,  let 
him  do  as  many  others  have  done,  pass  the  ex- 
aminations imposed  by  the  authorities  of  that 
country  for  its  own  citizens. 

As  all  are  not  of  our  way  of  thinking,  but  on 
the  contrary  maintain  that  one  who  is  fit  to 
practise  in  one  part  of  Canada  should  be  en- 
titled to  practise  in  any  part  of  Canada,  and 
that  those  who  are  fit  to  practise  in  one  part 
of  the  British  Empire  should  be  entitled  to 
practise  in  any  part  of  it,  we  beg  to  offer  a  sug- 
gestion for  the  only  practical  solution  of  the 
difficulty. 

This  solution  is  nothing  more  nor  less  than 
j  a  University  of  Canada,  n3t  a  teaching  body, 
but  an  examining  body  only,  founded  by  Royal 
Charter  on  exactly  the  same  lines  as  the  Univer. 
sity  of  London.  Its  examiners  could  be  chosen 
by  ihe  Universities  and  other  scientific  bodies, 
so  as  to  remove  them  from  the  blighting  influ- 
ence of  politics,  and  they  could  meet  at  Ottawa 


THE  CANADA  MEDICAL  RECORD. 


287 


once  a  year.  One  of  the  examiners  might  be 
a  delegate  from  the  University  of  London,  and 
the  examination  papers  might  be  duplicates  of 
those  used  at  that  institution.  In  tliis  way, 
the  University  of  Canada  being  aflfiliated  with 
the  University  of  London,  those  who  had  the 
M.D.  Canada  would  enjoy  all  the  privilege  of 
the  RLD.  London.  The  expense  of  the  degree 
would  be  two  hundred  and  :  fty  dollars,  which 
is  the  same  as  the  M.D.  Durham  and  the  M.D. 
Brussels.  This  fee  would  probably  be  ample 
to  pay  the  expenses  of  the  examiners.  It  has 
been  riised  as  an  objection  to  this  scheme  that 
the  British  North  America  Act  delegated  all 
matters  concerning  education  to  the  various 
provincial  legislatures,  and  that  therefore  a  Uni- 
versity of  Canada  could  not  be  established 
without  an  amendment  to  the  above  Act  being 
passed  by  the  British  Parliament.  In  reply  to 
this  objection  we  maintain  that  Great  Britain 
would  gladly  grant  any  legislation  which  might 
be  desired  unanimously  by  the  people  of  Canada. 
If  those  who  have  been  working  so  hard  for  so 
many  years,  in  order  to  bring  about  reciprocity, 
but  in  vain,  would  bring  their  energy  to  bear  in 
this  direction,  we  have  no  doubt  that  they 
would  not  only  obtain  their  wish  but  also  help 
thereby  to  raise  the  Dominion  of  Canada  to 
the  level  of  a  great  nation. 

AMENDE  HONORABLE. 

Owing  to  an  omission  of  the  printer,  the 
excellent  extracts  from  our  contemporary  the 
College  and  Clinical  Record  were  not  duly 
credited  to  that  journal  in  two  of  our  issues. 


BOOK  NOTICES. 

Saunders'  Question-Compends,  No.  14. 
Parti.  Essentials  of  Refraction  and 
THE  Diseases  of  the  Eye.  By  Edward 
Jackson,  A.M.,  M.D  ,  Professor  of  Dis- 
eases of  the  Eye  in  the  Philadelphia  Poly- 
clinic and  College  for  Graduates  in  Medi- 
cine ;  Part  II.  Essentials  of  Diseases  of 
THE  Nose  AND  Throat.  By  E.  B.  Gleason, 
S.B.,  M.D.,  Surgeon  in  charge  of  the 
Nose,  Throat  and  Ear  Department  of  the 
Northern  Dispensary  of  Philadelphia ; 
Second  edition,  revised  ;  124  illustrations. 
Philadelphia :  W.  B.  Saunders,  925  Wal- 
nut Street,  1894.  Price$r.oo. 
This  work  has  already  been  noticed  in  these 

columns.     We  are  pleased  to  see  that  a  second 

edition  has  been  called  for  so  soon. 


A  Text-Book  of  the  Diseases  of  WoiMen, 
By  Henry  J.  Garrigues,  A.M.,  M.D., 
Professor  of  Obstetrics  in  the  New  York 
Post-Graduate  Medical  School  and  Hospi- 
tal ;  Gynecologist  to  St.  Mark's  Hospital 
in  New   York  City  ;  Gynaecologist  to    the 


German    Dispensary  in  the  City    of  Ne.v 
York ;     Consulting    Obstetric  Surgeon  to 
the  New  York   Maternity  Hospital;  Con- 
sulting   Obstetrician    to    the    New    York 
Infant   Asylum   (resigned)  ;  Ex-President 
of  the  German  Medical  Society  of  the  City 
of  New    York  ;  Fellow   of  the  American 
Gynaecological    Society ;     Fellow    of    the 
New    York    Academy  of   Medicine,    etc. 
Conaining  three  hundred  and  ten  engrav- 
ings  and    colored    plates.     Philadelphia  : 
W.  B.  Saunders,  925  Walnut  Street,  1894. 
Price  :  cloth  $4.00  net  ;  sheep  $5.00  net. 
The  author  in  his  opening  pages  gives  such 
a  true  idea   of  the  scope   of  his  work  that   we 
cannot  review  it    better  than  to  give   his  own 
words  :     "  In  writing  this  book  I  have  first  had 
in  view  the  large  class  of  physicians   who  have 
not  had  the  advantage  of  hospital  training,  and 
who  go  to  a  post-graduate  school  in    order    to 
learn  gynaecology.     They  can  only  stay  a  short 
time,  and  they  want  a  full  but  concise  exposi- 
tion, up  to  date,  of  the  nature  and  treatment  of 
the  diseases  peculiar  to  women. 

"  Secondly,  I  have  tried  to  satisfy  the  require-, 
ments  of  that  much  larger  class  who  would  like 
to  go  to  such  an  establishment,  but  who  find  it 
impossible  to  leave  their  practice.  They  are 
busy  men,  who  have  to  keep  abreast  of  recent 
progress  as  best  they  can  in  all  branches  of  a 
general  practitioner's  work.  They  want  infor- 
mation about  the  present  state  of  Gynaecology, 
but  cannot  find  time  to  study  large  works. 

"  If  in  large  cities,  it  is  better  for  the  general 
practitioner,  as  well  as  for  his  patient,  to  leave 
the  treatment  of  most  gynaecological  cases  to 
those  who  have  special  experience  and  skill  in 
this  line  ;  the  same  does  not  always  hold  good 
in  country  practice.  'I'he  long  distances  in  this 
immense  country  make  it  very  difficult,  and 
often  imi  ossible,  to  send  patients  to  places 
where  they  can  be  treated  by  specialists. 
American  physicians  are  enterprising,  and 
some  men  practising  in  a  village  have  achieved 
world-wide  renown,  and  become  the  leaders  of 
their  city  confreres. 

"  Finally,  I  think  the  book  will  be  found  useful 
by  undergraduates  studying  in  medical  colleges. 
They  will  probably  at  that  stage  of  their 
development  skip  many  details  about  opera- 
tions which  they  will  be  glad  to  take  up  later, 
when  the  responsibility  of  a  medical  practitioner 
lies  heavy  on  their  shoulders.  The  division 
into  a  general  and  special  part  will  presumably 
be  useful  for  the  beginner,  and  he  wiU  hardly 
care  to  pay  much  attention  to  what  has  been 
placed  in  notes  under  the  text. 

"  This  being  a  book  for  General  Practitioners 
and  Students,  I  have  emitted  all  reference  to 
the  historical  development  by  which  gynae- 
cology has  attained  its  present  stage,  as  well  as 
all  reports  of  special  cases. 

"  The  limits  and  nature  of  the  work  have  not 


288 


THE  CANADA  MEDICAL  RECORD. 


allowed  me  to  speak  of  all  methcds  of  treating 
every  disease,  but  I  have  striven  to  give  a  clear 
and  succinct  desciiplion  of  the  best  modes  of 
treatment ;  and  the  reader  will  in  this  book 
find  many  details  which  he  would  look  for  in 
vain  in  larger  works. 

"  My  aim  has  been  to  write  a  practical  work. 
The  reader's  time  is  not  taken  up  by  theoreti- 
cal discussions^  and  the  pathology  has  been 
treated  very  briefly.  On  the  other  hand,  I 
have  tried  to  help  the  reader  to  make  a  diag- 
nosis, and  to  teach  him  how  to  treat  the 
different  diseases.  In  this  respect  I  have  gone 
into  minute  details  affording  manifold  informa- 
tion about  points  which  praciiiioners  who  live 
in  large  cities  learn  from  one  another,  or  by 
visits  to  the  shops    of  the  instrument-makers. 

''  1  have  treated  so  discursively  of  tlie  anatomy 
of  the  female  genitals  because  this  subject,  to 
a  great  extent,  has  been  worked  up  by  the 
gynsecologists  themselves,  and  is  not  as  yet  des- 
cribed satisfactorily,  in  the  textbooks  of 
anatomy,  but  only  in  large  works  of  an  ency- 
clopedic character  or  in  articles  in  journals  to 
which  many  have  not  access. 

I  txpect  to  be  criticized  for  having  devoted 
special  chapters  to  Hemorrhage  and  Leucor- 
rhoea.  I  know  well  that  they  are  not  diseases  ; 
but  they  are  symptoms  that  play  so  great  a  pan 
in  the  diseases  of  women,  and  so  often  require 
symptomatic  treatment,  that  I  take  it  to  be  in 
the  interest  of  the  general  practitioner  to  treat 
them  separately;  and,  besides,  by  so  doing 
infinite  repetitions  are  avoided. 

"  This  being  a  text-book  for  beginners  and  a 
manual  for  general  practitioners,  names  of 
authors  have  been  omitted  as  much  as  possible 
from  the  text,  except  when  it  was  necessary  in 
order  to  designate  different  methods  of  opera- 
tions. In  making  use  of  the  work  of  American 
authors,  I  have,  however,  given  them  credit  for 
it  in  foot-notes,  and  I  trust  that  it  will  be  found 
that  a  large  amount  of  information  of  this  kind 
has  been  embodied  in  the  text. 

"In  indicating  the  treatment  of  the  various 
affections,  I  mention  always  the  simpler  and 
innocuous  means  before  the  more  complicated 
and  dangerous,  medical  and  electrical  treatment 
being  accorded  precedence  over  surgical. 

"  Throughout  the  work  a  chief  object  has  been 
to  give  modes  of  treatment  as  they  are  prac- 
tised in  America,  by  which  I  hope  that  it  will 
be  found  more  useful  for  Ameiican  students 
and  practitioners  than  the  works  written  by  or 
translated  from  foreign  authors. 

"The  iWustraUonsfonii  a. co////'/eU at/as  of  tJie 
embryology  a?id  anatomy  of  the  female  geni- 
talia, and  represent  numerous  operations  and 
pathological  conditions.  Many  come  from  my 
own  operations,  dissections  and  microscopical 
examinations." 

A  careful  perusal  of  the  work  warrants  us  in 


saying  that  he  has  faithfully  accomplished  all 
that  he  has  undertaken.  One  cannot  read  it 
without  coming  to  the  decided  conclusion  that 
the  author  is  thoroughly  conversant  with  every 
detail  of  the  subject,  in  which  he  has  had  a 
large  and  ripe  experience. 


PAMPHLETS. 

I  Report  of  -iHE  Rush  Hospital  for  Consump- 
tion AND  Allied  Diseases,  from  February 
I,  1892,  to  February  i,  1894,  with  the 
second  report  of  the  Women's  Board  of 
the  Rush  Hospital.  Twenty -Second  and 
Pine  Streets,  Philadelphia. 

Conservative  Treatment  of  Pyosalpinx. 
By  Cornelius  KoUock,  A.M.,  M.D.,  Che- 
raw,  S.C.,  Fellow  of  American  Gynaeco- 
logical Society.  Read  before  the  Southern 
Surgical  and  Gynaecological  Association, 
1893. 

Hvsterfcto.my  Indications  and  Technique. 
By  J.  M.  Baldy,  M.D.,  Professor  of  Gyne- 
cology in  the  Philadelphia  Polyclinic. 
Reprinted  from  the  American  Journal  of 
Obstetrics,  Vol.  xxviii,  No.  5,  1893.  New 
York  :  Wilham  Wood  &  Company, 
publishers,  1893. 

Bloodless  Amputation  at  the  Hip  Joint  by  a 
New  Method.  By  Nicholas  Senn,  M.D., 
Ph.D.,  Professor  of  Practice  of  Surgery  and 
Clinical  Surgery,  Rush  Medical  College. 
Read  before  the  Surgical  Section  of  the 
Suffolk  District  Medical  Society,  Boston, 
February  ist,  1893.  Reprinted  from  the 
Chicago  Clinical  Review,  February,  1893, 
Chicago. 

A  New  Pathology  and  Treatment  op  Ner- 
vous Catarrh.  Read  in  the  Section  on 
Laryngology  and  Otology,  at  the  Forty- 
fourth  Annual  Meeting  of  the  American 
Medical  Association.  By  Seth  Scott 
Bishop,  M.D.,  Chicago.  Reprinted  from 
the  Journal  of  the  American  Medical 
Association,  November  25,  1893.  Chi- 
cago, published  at  the  office  of  the  Asso- 
ciation, 1893. 

Report  of  Two  Years'  Work  in  Abdominal 
Surgery  at  the  Kensington  Hospital 
for  Women,  Philadelphia.  By  Charles  P. 
Noble,  M.D.,  Surgeon-in-Chief.  Reprinted 
from  the  International  Medical  Magazine 
for  December,   1893. 

Surgical  Shock.  By  Charles  P.  Noble,  M.D., 
Philade]i)hia,  Surgeon  -  in  -  Chief  of  the 
Kensington  Hospital  for  Women. 

A  Brief  Synopsis  of  the  The.^^apeutics  of 
Static  Electricity.  By  S.  H.  Monell, 
M.D.  Reprinted  from  The  New  York 
Medical  Journal  for  January  20,  1894. 


r. 


R         Canada  medical  record 

11 

C358 

V.22 


GERSTS